Dr. Sandesh Gulhane on why healthcare managers should be registered professionals
POSTPARTUM PSYCHOSIS
What it is, what was missed, and what needs to be done THE POWER OF
MUSIC IN AGED CARE
How enagement with music can improve cognitive abilities
“I envision a healthcare system that is modern, efficient, locally delivered, and universally accessible. Achieving this vision requires fundamental change...”
As the only medical professional working in Holyrood, Dr. Sandesh Gulhane is uniquely positioned to talk about the needs of the NHS in Scotland.
In an exclusive interview with Healthcare Today’s Adrian Murdoch, the Scottish Conservative and Unionist Party’s spokesperson for health and social care talks about why funding for primary care should more than double to 15% of the NHS budget and why managers within the healthcare system should be enablers rather than gatekeepers.
Also in this issue, Richard Baish, development manager at Action on Postpartum Psychosis, talks about the most severe form of postnatal mental illness and how it should be treated; Emma Hewat, director of dementia care at care home company KYN, writes that regular engagement with music can help maintain and even improve cognitive abilities in older adults; and much more.
We hope you enjoy!
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SPENDING REVIEW SEES NHS TREADING WATER
THE GOVERNMENT
hopes that its spending review will enable the NHS to deliver on the government’s Plan for Change to cut waiting lists, improve patient care and modernise services.
“There’s no strong economy without a strong NHS,” said chancellor Rachel Reeves (pictured right) as she announced a record £29 billion funding boost along with a £2.3 billion rise in capital budgets to get the NHS back on its feet.
Up to £10 billion of that has been allocated towards technology and digital transformation, thousands more GPs will be trained and funding has been allocated to deliver an additional 700,000 urgent NHS dentist appointments a year. The funding is aimed at reducing waiting lists and reaching Labour’s milestone of ensuring the health service carries out 92% of routine operations within 18 weeks. The news was greeted with a sigh of relief by the industry,
Nick Lansman, chief executive and founder of the Health Tech Alliance, said that the review was “a clear indication that health remains front and centre of the government’s agenda”.
He went on to say that the funding boost provided “much-needed stability and ambition for the sector”.
The news was more cautiously welcomed by the insurers.
Not-for-profit medical defence organisation Medical Defence Union (MDU), for example, welcomed the announcement by the government, but emphasised that reform is still urgently needed to ensure this extra funding is spent effectively and has a direct impact on patient care. “This is an opportunity for the
government to be bold and embrace reforms which would allow for the most effective use of this additional budget,” said Tom Reynolds, director of policy and communications at MDU.
He highlighted the problem of spiralling medical negligence claims.
Last year, the NHS in England spent more than £2.8 billion on clinical negligence claims which was more than was spent on subsidies to farmers (£2.4 billion), on the combined cost of food and cleaning in hospitals (£2.3 billion) and the winter fuel payment (£2 billion).
The same issue was picked up by mutual protection organisation Medical Protection Society. Again referring to the rise in medical negligence claims, Sarah Townley, deputy medical director at Medical Protection Society, said: “At a time when NHS finances are in such a parlous state, sums like these are simply unsustainable and are being diverted away from patient care and improvements to services. A comprehensive, long-overdue strategy is urgently needed.”
Perhaps the largest concern is that the spending review has failed to convert nurses and doctors.
The British Medical Association said that it was not good enough for healthcare spending to keep treading water.
“The government is keen to highlight how much money is going into health and the NHS, but we need to be realistic about how far it will go for patients and for staff,” said BMA representative body chair Latifa Patel.
“It still falls short of average increases we’ve seen in health spending historically, and of the investment needed to fulfil the NHS workforce plan. The government’s own modelling reportedly concludes that today’s funding will still not be enough to meet its waiting list pledges within this parliament,” she continued.
The Royal College of Nursing similarly thought that the review did not go far enough: “Against a backdrop of other cuts, nursing staff will see the NHS being protected but not transformed by today’s spending plans,” said general secretary and chief executive Nicola Ranger.
If the review is being seen as a placeholder, all eyes will remain on what happens when the 10-Year Health Plan and the revised NHS Long-Term Workforce plan are announced.
20% JUMP IN A&E DEATHS
THE crisis caused by long waits in Britain’s emergency departments continues.
Analysis by the Royal College of Emergency Medicine (RCEM) shows that there were more than 16,600 deaths associated with long A&E waits before admission in England last year. That’s an increase of 20% (2,725) compared to 2023.
Last year, more than 1.7 million patients waited 12 hours or more to be admitted, discharged or transferred from A&E. That’s almost 14% more compared to 2023. Of these patients, 69.2% were waiting to be admitted to a ward for further care.
Using the Standard Mortality Ratio – a method which calculates that there will be one additional death for every 72 patients that experience an 8-12-hour wait before their admission – RCEM estimates that there were 16,644 associated excess deaths related to stays of 12 hours or longer before being admitted.
“I am at a loss as to how to describe the scale of this figure adequately.
To give it some context, it is the equivalent of two aeroplanes crashing every week,” said Adrian Boyle, president of the Royal College of Emergency Medicine.
The news shines a spotlight on the problems of long waits in Britain’s emergency departments again.
In February, Healthcare Today highlighted the jump in patients waiting more than 12 hours in Scottish A&E departments from 784 to 76,000 in only 13 years.
Earlier this month, we found that the average time that a person in a mental health crisis spent in A&E last year was an hour more than in 2023. That was based on data from 146 emergency departments across the UK which captured the experiences of almost 20,000 patients who needed urgent care due to selfharm.
Earlier this week, we reported that more than one million older people faced waits of 12 hours or more in A&Es in England last year and the older a person is, the more likely they are to experience a long stay which
has a significant impact on patient safety. And the issue of corridor care is a repeated theme. Most recently, the Royal College of Nursing (RCN) and the British Medical Association (BMA) in Wales joined forces to address the state of corridor care in Welsh hospitals and healthcare services.
The newly formed All-Party Parliamentary Group (APPG) on Emergency Care brings together parliamentarians who will engage with healthcare professionals and organisations outside government to advocate for improvements in Urgent and Emergency Care.
Launched last week, it is chaired by Rosena Allin-Khan, herself an emergency medicine doctor and member of Parliament for Tooting.
“These statistics make for sobering reading. Ever-increasing numbers of excess deaths and long wait times in our emergency departments are simply not sustainable. As an emergency doctor, I know exactly how stretched our A&Es across the country are, as I see it on a weekly basis on my shifts,” she said.
HOSPITALS FAIL TO SCREEN OLDER PATIENTS FOR FRAILTY
RESEARCH from the Royal College of Anaesthetists (RCoA) and the University of Nottingham has found that nearly three-quarters of UK hospitals do not routinely screen older surgical patients aged 60 and older for frailty – despite clear evidence that frailty significantly increases the risk of complications, including longer hospital stays, delirium, and even death.
As Healthcare Today reported at the end of May, more than one million older people faced waits of 12 hours or more in A&Es in England last year. The older a person is, the more likely they are to experience a long stay which has a significant impact on patient safety.
The research, published in the British Journal of Anaesthesia, is the most comprehensive study on frailty and multimorbidity in UK surgical patients to date and includes data from 7,134 patients across 263 NHS hospitals collected over five consecutive days in March 2022.
“This research provides evidence that patients living with frailty are more likely to experience complications from surgery such as longer hospital stays and delirium,,” said Claire Shannon, president of the Royal College of Anaesthetists.
“There is huge potential to improve patient outcomes by assessing all those over 60 for frailty as standard practice so that their care can be managed appropriately, with involvement from a geriatrician.”
People living with frailty are less likely to recover well from an operation and the risks increase the more frail someone is.
Compared to patients who are not frail, people living with frailty stay an average of three days longer in hospital after an operation, increasing to six days longer for those who are severely frail; are three times more likely to have complications from surgery; are four times more likely to have delirium following surgery, a condition that causes confusion;
and are three times more likely to die within one year of surgery.
Identifying patients living with frailty helps healthcare professionals discuss individualised treatment options.
This includes realistic discussions about the likelihood of survival and of remaining independent after the operation. It also helps hospitals to reduce risks, improve recovery, and provide the right support after surgery.
These discussions can only take place, however, if frailty has been identified. The research shows that in 71% of cases, UK hospitals are not routinely screening for frailty.
“Identifying frailty is straightforward and should lead to open and honest discussions with patients about what can be offered, what they want and what they can expect if they choose to have surgery,” said Iain Moppett, chief investigator of the third Sprint National Anaesthesia Project which carried out the research.
I’m a consultant and... I was under attack on social media
Should be struck off… Charlatan... Butcher!
Scanning down the comments on X left me breathless with shock.
I’d performed knee surgery on a young woman who was a local radio presenter. It was terrible to hear she’d died not long afterwards, as the result of a massive pulmonary embolism. Overnight, I was under attack on social media, targeted by uninformed people looking for someone to blame.
My medicolegal consultant at Medical Protection had already been a huge help in preparing my statement for the coroner. Now I needed help defending my reputation.
He reminded me that professional standards restrict how we can respond, and that our duty of confidentiality continues even after death. Pre-empting media interest at the inquest, he set up a call with Medical Protection’s specialist press team. They helped me prepare a statement for the media and talked me through requesting removal of the social media comments.
At the inquest, the coroner was not critical of the care I’d provided. Thankfully I wasn’t approached by the press, and the social media platforms removed the defamatory comments.
I now see my Medical Protection membership in a new light. The practical, reassuring support when you need it most, from experts who know what it is to be a doctor – that’s just priceless.
Always there for you
PRESCRIPTIONS OF ANTIDEPRESSANTS UP 40% SINCE 2020
PRESCRIPTIONS of antidepressants have risen by more than 40 per cent since 2020 and have cost the NHS £1.23 billion in that time. Between March 2020 and March 2025, more than 428 million antidepressants were issued in England.
In 2024 alone, more than 91 million prescriptions were dispensed, marking the highest annual total on record, according to group insurance company YuLife which has looked at The firm says that the findings reveal a mental health system under pressure, and a workforce increasingly caught in the middle.
“These numbers are a wake-up call, not because medication is wrong, but because it’s often the only support available. People don’t just need treatment, they need access to help earlier, and more of it,” said Sammy Rubin, chief executive of YuLife.
As Healthcare Today reported at the start of the month, the average time a person in a mental health crisis spent in A&E last year was an hour more than in 2023.
Mental health challenges are widespread, with mixed anxiety and depression affecting 7.8% of the UK population and between 4-10% experiencing depression in their lifetime, according to the Mental Health Foundation. Workplace stress plays a major role. According to Deloitte, UK employers lose an estimated £51 billion per year due to poor mental health, driven by absenteeism, presenteeism, and turnover. These costs are compounded by a system where many employees struggling with stress and burnout are prescribed medication before being offered preventative care.
While much attention is paid to rising prescription volumes, the financial
cost is just as significant. Over the past five years, the NHS has spent £1.23 billion on antidepressant medications. That equates to an average of £473 spent every minute. While spending has decreased almost by a third since 2020, it remains high, which reflects both the scale and frequency of prescribing.
The North West recorded the highest average annual prescriptions at over 1.13 million per year, while also being among the regions with the highest overall populations.
The South East followed closely behind in volume but recorded the highest annual cost, over £3.6 million, despite prescribing fewer items, which suggests higher per-item costs.
By contrast, the North East had the lowest volume and cost, with just over 550,000 prescriptions per year on average, and a total cost of £1.4 million annually.
DOCTORS MISSED HEART CONDITION
AT A FULL INQUEST, a coroner has concluded that doctors missed opportunities to identify a rare heart condition that caused the death of oneyear-old Archie Squire.
As Healthcare Today reported in midApril, Squire was born in November 2022 with an undiagnosed heart condition. He was reviewed in the A&E and Urgent Care Centre at Queen Elizabeth the Queen Mother (QEQM) hospital in Margate more than ten times over his life with symptoms including constipation, breathlessness and failure to thrive.
The day after his first birthday, Squire was admitted to the hospital from A&E due to constipation and vomiting. He died two days later after suffering two separate cardiac arrests.
Recording a narrative conclusion, Kent North East Area coroner
Sarah Clarke said that Squire died from heart failure and congenitally corrected transposition of the great arteries (ccTGA), a rare heart defect in which the heart’s ventricles and great arteries are reversed.
Records show that Squire was seen by frontline medical staff no fewer
than 16 times across his life, including nine trips to the QEQM accident and emergency department. He was never given an echocardiogram, an ultrasound scan which can diagnose ccTGA.
The coroner concluded that earlier recognition and diagnosis of Archie’s heart condition would almost certainly have meant he would not have died when he did. She is now considering whether to issue a prevention of future deaths report and has given East Kent Hospitals University NHS Foundation Trust two weeks to provide documents, including new standard operating procedures regarding ongoing referrals and triaging.
“In those months, he had been seen on many occasions by various clinicians, while exhibiting signs and symptoms of heart failure, and yet this was never diagnosed. Had it been diagnosed by an echocardiogram, he almost certainly would not have died when he did,” said Lily Hedgman, associate solicitor in the medical negligence department at Leigh Day,
Emily Raynor of Old Square Chambers was instructed as counsel for the family.
The inquest considered evidence from 27 witnesses across eight days at Oakwood House, Maidstone. It began on 19 May and concluded on 30 May.
TOPCON HEALTHCARE TAKES STAKE IN PANGAEA DATA
TOPCON HEALTHCARE has invested in London-based health AI company Pangaea Data.
The Tokyo-headquartered ophthalmic specialist wants to use Pangaea’s AI platform to address what it sees as critical care gaps in eye health and systemic disease.
Financial terms have not been disclosed.
Pangaea Data’s platform automatically analyses structured and unstructured patient records against clinical
guidelines, emulating a clinician’s manual review, to uncover patients who meet diagnostic or treatment criteria but are not currently in a treatment or management process. Integrated directly into existing electronic health records and downstream scheduling systems, the platform enables real-time clinical action without disrupting workflows.
Through this partnership, Pangaea Data’s platform will create an interface with Topcon Healthcare’s digital health platform so that optometry and
ophthalmology practices can identify patients who need follow-up or further evaluation.
This includes patients with conditions such as glaucoma and diabetic retinopathy many of who remain undiagnosed.
“Pangaea Data’s unique ability to find missed patients using AI, and to do so without burdening clinicians, has powerful implications for eye care and beyond,” said Ali Tafreshi, chief executive and president of Topcon Healthcare.
CALLS TO PRIORITISE OPTOMETRY IN NEW HEALTHCARE REFORMS
THE Optometric Fees Negotiating Committee (OFNC) and the College of Optometrists have written to Stephen Kinnock, minister of state for care, to emphasise that the 10-Year Health Plan must prioritise optometry in upcoming healthcare reforms.
They are calling for the government to make a long-term commitment to optometry, as part of its plans to move care from hospital to the community.
This includes the universal commissioning of community and urgent eye care services (MECS and CUES) to release capacity in hospitals to deliver consultantled care, alongside enhanced IT connectivity to ensure more fluid communication between primary eye care providers and hospital services.
The letter, from Gillian Ruddock,
president of the College of Optometrists, and Paul Carroll, chair of the OFNC, welcomes government recognition of the importance of improving IT connectivity and streamlining the interface between primary eye care and the hospital eye service.
It continues: “It is arguably even more important that there is recognition of the role of all parts of primary care as the critical first port of call for patients and gatekeepers to hospital services, doing so will help to realise the potential of providers to relieve pressure on secondary care.”
The economic benefit of universal commissioning of MECS and CUES is highlighted in a cocommissioned report from the Association of Optometrists, Fight for Sight, Primary Eyecare Services and Roche Products.
The report suggests that four
system-wide changes – national rollouts of CUES and integrated glaucoma and cataract pathways, as well as further use of optical coherence tomography in community settings – would save the NHS £98 million a year in England.
In the letter, the OFNC and the College of Optometrists emphasise the critical role optometry professionals play, as the first point of contact for patients and the gatekeepers to hospital services.
Primary eye care is already helping to reduce ophthalmology waiting times, but needs greater support to maximise its impact, the letter continues.
Ruddock and Carroll highlight the fact that 95% of the UK’s eye health needs are met within the primary eye care setting, and that because of this healthcare reforms are unlikely to succeed without long-term investment in the sector.
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MENTAL HEALTHCARE PROBLEMS REMAIN
THE mental health crisis is too often talked about but little acted on. As Healthcare Today reported on in May, the average time a person in a mental health crisis spent in A&E last year was an hour more than in 2023.
It is recognised as such an issue in Britain, that international healthcare group Bupa recently said that is to open 70 mental health centres across the UK in response to increasing demand for workplace mental health support.
A report from the Health Services Safety Investigations Body (HSSIB) has identified key risks across multiple areas that continue to affect the safety of mental health inpatient care.
These areas include safety, investigation and learning culture, system integration and accountability, the physical health of patients in mental health inpatient settings, caring for people in the community, staffing and resourcing, digital support for safe and therapeutic care, suicide risk and safety assessment.
“This report shines a light once again on the urgent and ongoing issues facing mental health inpatient care and the reoccurring harm that comes with those issues,” said Craig Hadley, senior safety investigator at HSSIB.
“Too often, we see well-intentioned recommendations fall through the cracks –not because people don’t care, but because systems don’t always support change in a meaningful or sustained way,” he continued.
A central concern running across all themes is that recommendations to support learning for improvement often does not lead to action. The report highlight several reasons for this, including a lack of impact assessments, no clearly identified body responsible for taking
forward recommendations, and duplication of similar recommendations across different organisations.
The report on mental health transitions from inpatient children and young people’s services to adult mental health services, highlighted several recommendations made to NHS England but where they could not provide evidence of action being taken in response. Within this report, there is also reference to longstanding recommendations to improve the physical health of people with severe mental illness being delayed, and premature deaths continuing to occur as a result.
“Ensuring patient safety in mental health services means understanding what can be realistically delivered within the pressures of day-to-day care, and aligning that with clear priorities, accountability, and follow-through,” said Hadley.
Another prominent issue highlighted in the report is the fragmentation between health and social care services. The report finds that delivery of mental health care is hindered by poor integration and misaligned objectives between systems. Currently the integration of health and social care relies on relationships, with an expectation and hope that they will work well.
In their absence, a lack of clear accountability can result in poor outcomes for people with mental illness and severe mental illness.
There remains a fear of blame in mental health settings when safety events happen. This contributes to a more defensive culture despite staff actively wanting to learn.
“Our findings call for a more joined-up approach to improvement to ensure that mental health services are safe, effective, and patientcentred,” said Hadley.
GENETIC TESTS CAN DIAGNOSE BRAIN TUMOURS IN TWO HOURS
RESEARCHERS at the University of Nottingham along with clinicians at Nottingham University Hospitals NHS Trust (NUH) have developed an ultra-rapid method of genetically diagnosing brain tumours that will cut the time it takes to classify them from up to eight weeks to as little as two hours.
The approach of the team at NUH has achieved a 100% success rate, providing diagnostic results in under two hours from surgery and detailed tumour classifications within minutes of sequencing. Moreover, the platform’s ability to continue sequencing enables a fully integrated diagnosis within 24 hours.
“Traditionally, the process of diagnosing brain tumours has been slow and expensive. Now, with this new technology we can do more for patients because we can get answers so much more quickly which will have a much bigger influence on clinical decision-making, in as
little as two hours,” said Stuart Smith, a neurosurgeon from the school of medicine at NUH.
The current treatment pathway starts with an MRI scan to ascertain the presence of a tumour; patients will speak to clinicians to discuss the possibilities of what type of tumour they may have.
For many tumour types, people would then undergo some form of surgery to obtain a sample of the tumour, which currently is sent away to centralised labs for testing to look for abnormalities in the DNA – which will determine what type of tumour it is.
Traditionally experts would then look at the specimens and the neuropathology view would be to try and identify the cells visually. But in the past few years, the process has changed and tumours are categorised on the DNA and genetic abnormalities – which traditionally is a slow process due to technological limitations.
The new method sequences specific parts of human DNA at higher depth using Oxford Nanopore Technologies’ portable sequencing devices. This method allows relevant parts of the human genome to be examined much more quickly and multiple regions of DNA sequenced at the same time.
“This new method now allows us to choose the bits of DNA that we need to look at in order to answer specific questions, such as what type of tumour and how can it be treated,” said Matt Loose, a biologist at NUH.
ESSILORLUXOTTICA ACQUIRES OPTEGRA
Franco-Italian eyewear company EssilorLuxottica has acquired ophthalmology platform Optegra from London-based private equity group MidEuropa to boost its med-tech portfolio. Financial terms have not been disclosed.
The Optegra group, under the Optegra, Lexum and Iris brands, operates a network of more than 70 eye hospitals and diagnostic facilities across Poland, Czech Republic, Slovakia, Holland and the UK and offers medically necessary ophthalmic treatments and elective vision correction procedures supported by AI in pre- and post-op stages. These include sight-saving cataract surgery, age-related macular degeneration and
glaucoma treatments, refractive lens replacement and laser eye surgery, serving both publicly reimbursed and private-pay patients.
“Optegra will bring new medical capabilities to our group, enabling us to address patients’ needs with the most advanced vision care technologies and treatments in one trusted system that will anchor our med-tech aspirations,” said Francesco Milleri, chairman and chief executive officer of EssilorLuxottica.
MidEuropa acquired a majority stake in Optegra in November 2022 from investment firm H2 Equity Partners. At the time the group had 29 facilities across four countries in Europe.
“We supported the opening of new clinics in the UK and completed eight strategic add-on acquisitions across five countries,” said Robert Knorr, managing partner at MidEuropa.
The group now has 19 locations across England and treats both private and NHS patients. In its last accounts for the financial year to December 2023, the company reported doubledigit revenue growth in the UK. Turnover rose 35% to £60.6 million predominantly on the back of NHS service offerings.
The sale to EssilorLuxottica is expected to close later this year pending regulatory approvals and other customary closing conditions.
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PROBLEMS INCREASE OF DEMENTIA
THOSE diagnosed with sleep disorders are more likely to develop a neurodegenerative disease within 15 years. The increased risk is independent of genetic risk for Alzheimer’s.
A new study, from scientists at the UK Dementia Research Institute (UK DRI) at Cardiff University and the US National Institutes of Health (NIH) Intramural Center for Alzheimer’s and Related Dementias, examined electronic health records from more than 1 million patients to look at the relationship between sleep and neurodegenerative diseases.
The meta-analysis found that people who had experienced certain sleep disorders were up to twice as likely to go on to develop a neurodegenerative disease in the 15 years that followed.
It also showed that sleep disorders increased the risk of Alzheimer’s and Parkinson’s, even in people with a low genetic risk of disease. This suggests that sleep disorders and genetics may influence risk separately, acting by independent mechanisms.
“Our results are compelling, indicating a clear increased risk of neurodegenerative disease following a sleep disorder, across three large biobank datasets,” said joint first author Emily Simmonds, bioinformatician at the UK DRI.
The research looked at data from three biobanks: the Secure Anonymised Information Linkage (SAIL) databank, UK Biobank and FinnGen. Across the three biobanks,
researchers were able to obtain accurate, timestamped records of when people were experiencing sleep disorders, as marked in their medical records.
The team looked at people who had been diagnosed with one or more sleep disorders, which were grouped for data analysis into organic sleep disorders thought to be caused by physiological factors like narcolepsy, sleep apnoea and circadian rhythm sleep disorders; and non-organic sleep disorders not linked to a known physiological condition, including generalised insomnia and nightmares.
Using large-scale statistical analysis methods, the scientists mapped out the relationships between the different neurodegenerative diseases and sleep disorders.
They found that for dementia, incidences of sleep apnoea and other organic and non-organic sleep disorders were associated with an increased risk of dementia in the 1015 years that followed. The risk was further increased for people recorded as experiencing multiple sleep disorders.
“This study adds to the growing body of evidence that sleep disorders, such as sleep apnoea, increase the risk for neurodegenerative disease. It is important that we develop scalable technologies to diagnose and treat these sleep conditions early and effectively,” said Derk-Jan Dijk, group leader at the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London and the University of Surrey.
The research comes on the back of a new report from the Care Quality Commission (CQC), which highlights the failings of treatment for the disease.
The CQC found that people do not always feel there is ongoing care for people living with dementia, that health and social care staff do not always understand their specific needs and there is a lack of understanding of how the care environment supports people’s wellbeing.
The CQC engaged with more than 50 stakeholders with interest and expertise in the care and treatment of people with dementia, and analysed feedback, surveys and other data to inform the report.
Inequality, the report says, is a root cause of issues facing people living with dementia.
Persistent misunderstandings and stigma associated with dementia can also lead to inequalities in how care is delivered and commissioned. Inequalities are present from prevention through to people’s experience of living with the condition.
“We will use the findings from this report to develop, alongside people with lived experience, providers and other stakeholders, a definition of what good, joined-up dementia care looks like so that we can apply it to all areas of our regulatory activity,” said James Bullion, interim chief inspector of adult social care at the CQC.
RECORD PRIVATE HEALTHCARE SPENDING REPORTED IN 2025
THIS year is on track to be another record year for private healthcare with a 6% rise in invoices to almost 3 million worth more than £1.3 billion in the first quarter of the year.
All private hospitals and more than 70% of practitioners, practices and clinics submit invoices to all the major insurers through the secure clearing service of healthcare IT developer Healthcode which makes the company’s volumes a measure of market activity.
“Our Q1 data shows that providers are on track to treat a record number of insured patients this year, many of whom will be choosing private healthcare for the first time.
“This is a great vote of confidence but it also presents a challenge to the sector to meet this growing demand and ensure patients have the best possible experience,” said Healthcode managing director Peter Connor.
Most private healthcare takes place in England but hospital invoice volumes were up across the country with year-on-year growth of 20% in Northern Ireland, 19% in Scotland, 5% in England and 3% in Wales.
Looking into the numbers, the firm said that most invoices are from nonhospital settings such as GP practices, but both hospital and non-hospital saw an average 6% year-on-year growth.
Within hospitals, there were 2.5 million invoices for outpatient care between January and March which is a rise of 7% year-on-year, and 282,000 invoices for admitted care which is up 1%. The total value of outpatient invoices exceeds those of admitted care for the first time.
In terms of hospital specialities, orthopaedics and trauma was the biggest hospital speciality in terms of invoice volume. They rose 9% to 188,000 while those for radiology saw 121,000 invoices. This is a 4% decline on the same period last year and reflects the sharp rise in volumes for this speciality.
Of the top ten hospital specialities, all except radiology saw a year-onyear increase in quarterly volumes. Hospital physiotherapy had the biggest year-on-year increase at 19% although the vast majority of physiotherapy happens in nonhospital settings.
VIFOR PHARMA AGREES £23 MILLION PAYMENT TO SETTLE ANTI-TRUST INVESTIGATION
THE investigation by the Competition and Markets Authority (CMA) into Australian global speciality pharmaceuticals company Vifor Pharma, best known for its intravenous iron deficiency treatment Ferinject, has concluded.
As Healthcare Today reported in January, the firm’s offer of £23 million to settle the anti-trust investigation has been accepted.
Following the decision, as well as the voluntary payment, the firm has agreed to correct any potentially misleading communications regarding the safety of Monofer and Ferinject, via a multi-channel
communications campaign to healthcare professionals. It will also introduce several compliance measures to prevent the future dissemination of potentially misleading communications.
The CMA launched an investigation in January to see whether the firm had restricted competition by spreading misinformation to healthcare professionals about the safety of a rival treatment, Monofer, supplied by Pharmacosmos. It is the first time a misleading claims case of this nature has been investigated by the CMA under its competition law enforcement powers.
The CMA’s investigation focused on intravenous iron treatments, typically prescribed where oral medicine is not suitable – such as treating patients with long-term health conditions or before undergoing major surgery.
Its concerns were based on the fact that Vifor may have abused what it calls “a suspected dominant position” by making potentially misleading claims about the relative safety of Monofer as compared to Ferinject.
Because Vifor Pharma has agreed to address the competition concerns, the CMA said that it would discontinue the investigation.
PATIENT SAFETY THREATENED AS NURSING COURSES CUT
THE crisis in higher education is a real threat to the supply of nurses in the workforce and poses a serious risk to patient safety, potentially derailing the government’s new NHS 10-Year Health Plan, says the Royal College of Nursing (RCN).
The professional body has found that nurse educator jobs in England decreased in 65% of institutions between August 2024 and February 2025.
In 2020/21, there were eight redundancies and severances in nursing departments. In 2024/25, however, this has risen to a new high of 103. In the past two academic years combined, there have been more than ten times the number of severances and redundancies than in the previous three years combined.
“This isn’t just about universities; it’s about patient safety. Without lecturers and those who run nursing
courses, there’ll be fewer nursing staff in our NHS and social care,” said Nicola Ranger, general secretary and chief executive of the RCN.
“Fewer staff and higher student ratios pose a risk to the quality of education that nurses of the future receive,” she continued.
Responses to a survey of RCN members working in higher education also revealed concerns about the impact of job cuts on already unsustainable workloads, student experiences and the ability of universities to accept people onto courses.
When asked how nursing programmes would be impacted by reducing staff costs, 91% of nurse educators who responded said job cuts would negatively affect their workload, while 88% said this would affect the experience of students. More than half (52%) said
reductions in staff would negatively affect the number of students who can be accepted onto courses.
Many lecturers are now responsible for teaching, assessing and providing pastoral care for increasing numbers of students as a result of the staffing and financial pressures on universities. Some educators (33%) said they were responsible for more than 80 students.
One in four educators said their workload is so overwhelming it’s affecting their personal life.
While the survey focused on courses in England, universities across the UK are facing similar staffing pressures. Earlier this year, the School of Nursing at Cardiff University was threatened with closure. Although an agreement with management has been reached that protects jobs this year, the risk of redundancies remains.
INTERNATIONAL CANCER TREATMENT PLANS LAUNCHES
ONLY three out of ten people in Europe and two out of ten people in the US with certain rare, advanced blood cancers receive access to CAR T-cell therapy.
An international coalition has launched CAR T Vision to unite stakeholders around the shared ambition that every eligible patient should have the opportunity for a cure with CAR T-cell therapy.
By 2030, the aim is to double the proportion of eligible patients treated with CAR T-cell therapy.
The coalition will work to address access challenges and drive meaningful change in the CAR T-cell therapy healthcare ecosystem with a focus on three priorities: increasing awareness and understanding of CAR T-cell therapy; expanding resources and capacity to deliver CAR T-cell therapy; and developing sustainable and innovative financing approaches
to manage the costs of treatment and care.
“Despite CAR T-cell therapy being available in the US for nearly seven years in large b-cell lymphoma, only approximately two out of ten eligible patients with some advanced blood cancers ever receive CAR T-cell therapy,” said Miguel Perales, CAR T Vision steering committee co-chair.
“When it comes to treating these potentially deadly cancers, every minute counts. That is why we established CAR T Vision with recommendations for interventions that, when adopted and scaled, will help many more eligible patients get the opportunity for cure within the next five years.”
The roadmap report has been developed by an independent steering committee made up of leaders from top North American and European patient advocacy groups, medical society organisations, academic and community treatment centres, health
technology assessment, policy, and other subject matter experts. Expert working groups will now be established to translate the vision into concrete, measurable actions, including specific recommendations and a measurement framework to track progress.
CAR T-cell therapy involves engineering a person’s own immune cells to target and treat cancer and is currently approved for certain types of aggressive blood cancers, enabling some patients to remain cancer-free for more than five years.
“Limited awareness of CAR T-cell therapy, low referrals, hospital capacity challenges and funding and reimbursement are among the barriers that either prevent people from accessing CAR T-cell therapy altogether or cause delays that advance a patient’s cancer beyond the point of treatment eligibility. In short, these barriers cost lives,” said Anna Sureda, CAR T Vision steering committee co-chair.
A NEW APPROACH TO OBESITY MANAGEMENT
HOW TO tackle obesity has been one of the themes of the year so far. The high costs of treatment mean that a third of NHS Trusts in England and many health boards in Wales have even gone so far as to block patient access based on their body mass index. At the same time, horror stories of unlicensed weight-loss jabs dominate the newspapers... But there is good news.
The Department of Health in Northern Ireland has announced the country’s first obesity management service with its first phase scheduled to start early next year. This phase will focus on the development of a communitybased service where patients will have access to lifestyle support as well as obesity medication, if clinically appropriate.
Currently, health service patients in Northern Ireland do not have access to specialist weight management provisions – including weight loss injections and medications.
This service will support access to weight loss medication in line with NICE guidance. Rollout will be carefully managed in a phased manner to ensure that treatment is provided in a safe and effective manner.
Further phases of the Regional Obesity Management Service (ROMS) will develop – subject to funding – other interventions such as weight loss surgery.
“This is a very significant step forward. I have many competing demands on a seriously overstretched budget but I was determined to prioritise this area,” said health minister Mike Nesbitt
Obesity is a significant public health issue in Northern Ireland, with 65% of adults and 26% of children living with obesity or overweight. A 2015 study which focused on estimating both the healthcare and productivity costs of overweight and obesity in Northern Ireland put this at around £414 million a year.
In November 2023, the Department of Health launched a consultation seeking views from the public on the introduction of an obesity management service. The outcome of the consultation, which received just under 19,000 responses, was overwhelming in favour of introducing this service.
News of the service was welcomed by the British Medical Association (BMA): “Targeted intervention is key to tackling obesity as it causes significant additional health issues for those who struggle with their weight. An obesity management service will have the potential to help make life-changing, long-term health gains for these patients and, most importantly, free up an enormous amount of resources for health services in the future,” said BMA’s Northern Ireland council chair, Alan Stout.
The phased and cautious approach of Northern Ireland rather than jumping straight to the solution of drugs like Wegovy, Mounjaro and Ozempic is the one preferred by healthcare professionals.
As Rachael Joy, chief clinical officer at SheMed, pointed out in Healthcare Today recently, GLP-1 treatment is a “welcome shortcut for overweight Brits, but it also increases the risk of health complications by allowing medications to be taken by the wrong cohort”.
This chimes with the recent report from the Tony Blair Institute for Global Change (TBI) which addressed the economic impact of obesity on Britain as a whole. “While the cost of treating obesity may be high, the cost of not treating it is higher,” it says.
Obesity, the report estimates, costs Britain around £98 billion a year and that treatment could boost economic growth by £52 billion. While the headlines have focused on sending weight-loss jabs through the post, the report encourages a more holistic approach to weight loss with weightmanagement services available through the NHS App, the expansion of the UK’s Health Check programme as well as the wider use of weightmanagement services as well as wider access to medication.
The approach of the report has been welcomed. Richard Donnelly, emeritus professor of medicine at the University of Nottingham is strongly supportive of digital-first care models and the commissioning of accredited private sector providers to deliver weight management services.
“Requiring extensive in-person care is unsustainable for the NHS and worsens inequities in access. Digital solutions can help with rapid, equitable, and cost-effective rollout of weight loss medications, while also maintaining high standards of clinical and data governance,” he said.
Certainly, a broader approach to obesity is needed. As Kevin Joshua, superintendent pharmacist and clinical lead at Juniper, wrote in Healthcare Today: “Preventing obesityrelated diseases requires more than just identification and monitoring – it demands government action and a shift towards early intervention.”
BETTER MATERNITY CARE NEEDED
NHS PROVIDERS, the membership organisation for the NHS hospital, mental health, community and ambulance services, has called for bold action from the government to support them in their ongoing efforts to improve the quality and safety of maternity services in England.
Both the number and severity of cases of failures in maternity services have been significant this year.
Families have called for an inquiry into the standard of maternity services in Leeds after at least 56 cases of stillbirths or neonatal deaths as well as two maternity deaths between January 2019 and July 2024; Nottingham NHS Trust was fined £1.6 million for baby deaths in February; and both Oxford’s John Radcliffe Hospital maternity unit and Royal Lancaster Infirmary have faced criticism for gross failure of basic medical care.
Most recently, Llais, an independent body which represents patients in Wales, has highlighted the need for continued cultural, clinical and
leadership improvements in maternity care in Swansea Bay University Health Board.
“Too many women, babies and families are being let down,” said Lord Darzi in his report on the NHS in September last year.
Sands and Tommy’s Policy Unit points out that while everyone agrees that change is needed. “It is not clear that there is agreement on what that change looks like,” it said.
“For lasting progress, we first need to ensure there is a shared understanding of what a safe system looks like. This should be focussed on ensuring that everyone can benefit from best-practice care in line with national standards,” it said.
NHS Providers’ new report, sets out the worries of NHS Trusts about the quality and safety of care as demand rises amid reduced resources and the knock-on effect of deep-rooted problems in access and equality elsewhere in the health system.
“Improving maternity services is a vital step toward fixing our wider
health system and provides a litmus test for addressing system-wide inequalities,” said Isabel Lawicka, director of policy and strategy at NHS Provider.
Trust leaders are recommending that maternity services are sufficiently resourced to enable Trusts to implement long-term, strategic improvements and targeted interventions aimed at reducing inequalities and that funding should be targeted at areas with higher rates of inequalities in access to enable greater focus on interventions to overcome barriers to access.
There should be national prioritisation and support for Trusts in tackling structural racism and unconscious bias in services. To help this, all national, regional and local policies to improve maternity services should be co-produced with women and there should be more joined-up care.
“Getting it right for the most vulnerable mothers and babies will be a measure of how successful the plan has been in creating real change and improving our national health and wellbeing,” said Lawicka.
DR. SANDESH IT’S TIME TO REGULATE
The Scottish Conservative and Unionist Party spokesperson for health and social care explains why healthcare managers should be registered professionals.
Written by Adrian Murdoch.
THE ONLY medical professional in the Scottish parliament – he still works as a GP one day a week – Dr. Sandesh Gulhane is the Scottish Conservative and Unionist Party’s spokesperson for health and social care. Here, he talks to Healthcare Today about why funding for primary care should more than double from 6% to 15% of the NHS budget and why managers within the healthcare system should be enablers rather than gatekeepers.
You’re the only medical doctor in Holyrood and health spokesperson for the Scottish Conservatives. How do you characterise your party’s vision for the NHS in Scotland?
I envision a healthcare system that is modern, efficient, locally delivered, and universally accessible. Achieving this vision requires fundamental changes across several key areas.
Modernisation demands the full integration of technology into our services. We must extend digital healthcare across Scotland while shifting our focus from reactive treatment to proactive disease prevention.
Localisation is critical when we consider that 85-90% of patient interactions occur in primary care. Rather than concentrating on hospitals – which most people rarely need – we should
SANDESH GULHANE: REGULATE THE MANAGERS
partners, the NHS and, crucially, patients themselves. Only through this coordinated effort can we deliver the modern, efficient and locally responsive service Scotland deserves.
The SNP constantly blames Westminster austerity for pressure on the NHS, while your party argues it’s mismanagement. Where do you believe the primary responsibility lies?
Let’s consider the scandal at the Queen Elizabeth University Hospital in Glasgow. Who has been held accountable or dismissed? Not a single person.
We could look at virtually every scandal in the NHS, and the pattern is the same: not one manager has ever been held accountable.
We submitted a Freedom of Information request, which revealed that in the past five years, fewer than five
complaints have been made against NHS managers. As a doctor, I know that complaints are inevitable if you’re doing enough work. That is the unfortunate but undeniable reality of medicine.
Why is it that NHS managers are not receiving complaints? Doctors are left to carry the burden, while management is insulated.
This points to a deeper structural issue within the NHS. We have senior clinicians and we have management, but the two operate in separate silos. What we desperately need is a complete overhaul – a rethinking of how workflows are structured and where accountability lies.
The current culture suggests that if you’re an NHS manager, your position is essentially a job for life.
I’ve personally seen a manager perform so poorly that we were explicitly told not to cause any fuss – because they were being lined up for a promotion and would soon be leaving the trust. That’s the system: poor managers are promoted rather than disciplined.
The government has the authority to dismiss board members and managers but it doesn’t because of the cosy relationship between senior management and government. It’s a mutual protection pact: “I protect you; you protect me”.
We can’t get away from the fact that the NHS workforce remains under pressure. What would a Conservative-led strategy do differently to retain and recruit staff across primary and secondary care?
It’s about the culture. We need a complete cultural shift from the top down. Managers shouldn’t see themselves as being in charge. They should act as facilitators. We need enablers in management, not gatekeepers.
We should be making small, inexpensive changes that have a huge impact. Reintroduce common rooms so doctors can decompress. Hire one extra nurse per theatre to allow staff to take proper breaks –those breaks save hours each day in efficiency.
Give operating theatres an extra porter so patients arrive on time. These are simple changes, and they cost very little. But management thinks these are areas where savings can be made.
BMA Scotland has raised concerns about a £290 million shortfall in general practice funding. Do you accept that figure?
General practice is the cheapest form of healthcare in the world.
From a business perspective, if your most frequently accessed service is also the most cost-effective, what should you do? You invest in it. It’s basic logic – yet we’re doing the opposite.
Instead of investment, we’re piling pressure onto general practice. The rise in National Insurance contributions is crippling GP practices.
The baseline funding for GPs is under serious strain and general practice is in trouble. We have trained GPs who are unemployed, and at the same time, patients can’t get an appointment.
We need to invest properly in primary care. That’s why I would commit to allocating 12% of the NHS budget to primary care – rising
to 15% over the course of the next parliament.
That investment will lead to savings across the whole NHS system. But this isn’t just about primary care. Our hospitals also need to become more efficient. I don’t think it’s acceptable for a hospital to receive a set amount of funding for operations, without any accountability for how much they actually do. We need to move towards a model where funding follows the patient.
What role do you see for private providers within the NHS in Scotland? Is there space for expanding their role under Conservative policy?
There will always be a market for private healthcare. Even when there are no significant NHS waiting times, some people still choose to go
We need to establish where secrecy is disciplinary issue
private. That market will always exist. But what I want is a system where the average person never feels they have to consider going private. We’re British – we understand the concept of a queue. If you tell someone they need a hip replacement and that they’re on a waiting list, most people are fine with that. All they want to
establish a culture is treated as a issue
know is: how long is the wait? We need to move to a position where waiting times are fair and manageable.
That principle should apply across the board: for GP appointments, for out-of-hours services, for routine outpatient clinics. The standard must
be that the wait is tolerable, not endless.
The same applies to people in remote and island communities. No one living on an island expects to have a world-leading neurosurgeon on their doorstep. But they do expect to see a doctor when they need one.
In your recent comments to The Scotsman, you called medical negligence payouts in Scotland “eye-watering”. What policy change are you advocating in response?
Mistakes happen. If you do enough surgery, you will experience complications. It’s inevitable. I once had a patient die on the operating table while I was performing surgery.
It was devastating for me, for the family – and of course, for the
patient. But when complications occur, you must be honest. You must go and speak to the family, be open, and explain exactly what happened.
I didn’t receive a complaint about that case because we were honest. We explained how it had happened, what we did, and I offered my sincere regret and apology. Most complaints don’t stem from the incident itself – they come from the absence of an apology. It’s secrecy that breeds mistrust.
The second issue is the pressure we put our clinicians under. We have to ensure that the environment we ask our staff to work in is as safe as it can be. That means no 15-hour waits.
That means not bombarding staff with constant interruptions. We need a system that’s fit for purpose. We need our nurses to do the jobs they’re trained to do. And we need to give them the time and space to do those jobs properly.
When Healthcare Today talked to Jeremy Hunt earlier this year he was proud of bringing “duty of candour” into the NHS. Why is it taking so long to filter through?
If you start from a place of secrecy, it spreads throughout every level of your organisation.
We need to establish a culture where secrecy is treated as a disciplinary issue. I’m regulated by the General Medical Council (GMC); nurses are regulated by the NMC; but who regulates the managers?
Managers should be registered professionals. They should have a registration number, just like doctors and nurses. And that registration should come with responsibilities, just as mine does under the GMC.
Once you create that kind of framework, you give people the ability to raise legitimate concerns.
A CHALLENGE TO REDUCE
HOSPITAL-ACQUIRED INFECTIONS (HAIs) are a significant challenge across global healthcare systems, affecting patients, staff, and healthcare systems worldwide. Infections such as escherichia coli (E. coli) bloodstream infections and clostridioides difficile (C. diff) diarrhoea can lead to severe complications. They prolong hospital stays and increase treatment costs. Globally, between 7% and 8% of hospitalised patients develop a HAI, with the NHS alone facing an economic burden of approximately £2.7 billion per year. This financial cost is compounded by the growing threat of antibiotic resistance, which makes HAIs more difficult to treat and control.
Traditionally, antibiotics have been the primary method to combat these infections. However, the overuse of these medications have accelerated the rise of antimicrobial resistance (AMR), reducing the effectiveness of vital treatments. As a result, healthcare experts are urging UK hospitals to seek new solutions beyond antibiotics to reduce infection rates and protect both patients and staff.
With hospital-acquired infection rates currently increasing annually within UK hospitals, and the challenges of spreading antimicrobial resistance, new solutions are needed to cut infection risks in healthcare settings.
One of the key areas for improvement is hand hygiene. Healthcare professionals’ hands come into frequent contact with patients, medical devices and surfaces which makes them one of the main pathways for infection transmission. Despite longstanding policies designed to encourage proper hand hygiene, compliance rates remain worryingly low.
Mark microbiology that hospitals to infection
According to hand hygiene between 40% levels required pathogens
A major guideline World Health Moments of This policy to clean their patient, before exposure to patient, and surroundings.
While the framework compliance challenging. environment, pressure to which makes their hands
Additionally, based soaps leading some their hand
Given these approach hand hygiene needs to be. on strict hand difficult to should explore integrate seamlessly and maintain
One promising control is the spectrum,
TO UK HOSPITALS INFECTION RATES
Wilcox, professor of medical microbiology at the University of Leeds, says hospitals need to rethink their approach infection prevention.
to NHS England, adherence hygiene protocols is often only 40% and 60%, far from the required to prevent the spread of pathogens within hospitals.
guideline for hand hygiene is the Health Organization’s (WHO) “5 of Hand Hygiene” framework. policy instructs healthcare workers their hands before touching a before aseptic procedures, after to bodily fluids, after touching a and after touching the patient’s surroundings.
framework is well-intended, compliance in the real world is often challenging. In the fast-paced hospital environment, staff are under constant to move quickly between tasks makes it challenging to sanitise hands as frequently as required. Additionally, frequent use of alcoholsoaps can cause skin irritation, some healthcare workers to limit hygiene practices.
these challenges, the current to infection prevention via hygiene is not as effective as it be. Rather than relying solely hand hygiene protocols that are follow consistently, hospitals explore innovative solutions that seamlessly into daily workflows maintain patient and staff safety.
promising advancement in infection the development of broadresidual antimicrobial
protection for hands. These technologies offer prolonged protection against pathogens, reducing the need for constant handwashing and hand sanitisation. Unlike traditional alcoholbased hand rubs, which provide only temporary cleanliness, antimicrobial coatings can remain effective for hours and offer a practical solution for busy healthcare environments.
Technology is also introducing opportunities to improve hand hygiene compliance. Simple and straightforward systems make hand hygiene regimens easier to follow, offering hospitals a way to improve compliance and reinforce optimal infection prevention behaviours among staff. These new systems provide a safety net that helps to maintain protection even when some compliance moments are missed.
Beyond technological advancements, hand hygiene policy should evolve to reflect the realities of modern healthcare environments. Infection prevention should be prioritised at both policy and operational levels. Hospital leadership can support the creation of an environment in which hand hygiene is intuitive, achievable and ingrained in hospital workflows rather than being an added challenge.
One of the most significant barriers to progress in infection control is the balance between efficiency and thoroughness. Healthcare workers operate in high-pressure environments, often caring for multiple patients
simultaneously. While hand hygiene and surface sanitisation are essential, expecting staff to maintain rigorous compliance with complex systems adds additional pressure to their responsibilities. Hospitals can find ways to implement solutions that enhance, rather than hinder, workflow throughout their facilities. Innovations in new hand hygiene formulations that prevent skin irritation accompanied by a simple hand hygiene regimen, are an opportunity to make a measurable difference.
Now, healthcare experts are calling on hospital administrators, policymakers, and healthcare workers to elevate infection control strategies. The goal is not just to react to infections but to prevent them from occurring in the first place. This includes taking measures to support better hand hygiene and compliance through modern infrastructure, improved protocols, and innovative technologies.
Traditional methods of infection control have been shown to include significant challenges when fully addressing the issue, making it crucial for hospitals to embrace new, evidence-based solutions. Whether through innovative antimicrobial technologies, enhanced environmental hygiene measures, or more effective hand hygiene regimens, the UK healthcare sector has an opportunity to adapt and innovate.
The challenge is upon us to take decisive action and commit to reducing infection rates. By rethinking their approach to infection prevention, hospitals can protect patients and staff whilst easing the economic burden of HAIs on the NHS. The future of infection control lies in proactive, forward-thinking strategies that go beyond traditional methods. The time for change is now.
THE LONGEVITY OF Alex
AS DIGITAL HEALTH platforms reshape medical care, their sustainability is under scrutiny. These platforms promise efficiency, accessibility and innovation, but their long-term viability depends on navigating unique challenges in healthcare’s complex environment, supported by long-term sustainable funding.
Successful examples in digital health
Digital health platforms use technologies like artificial intelligence, telemedicine, and data analytics to transform healthcare delivery. By adopting platformbased business models, they connect patients, physicians, and service providers through unified interfaces. Notable examples include Teladoc in the US, Kry/Livi in Europe, and JD Health in China. These platforms go beyond simple video consultations and offer services such as chronic disease monitoring and AI-driven patient-provider matching. This enables more precise diagnostics, triage, and treatment planning, improving interactions and outcomes for patients and clinicians. However, transitioning traditional healthcare to digital platforms – known as platformisation – is particularly slow and complex in this sector. Unlike other industries, healthcare’s shift involves replacing established public or private providers with digital intermediaries, fundamentally altering how care is delivered.
What’s special about the digital healthcare context
Implementing platform strategies in healthcare is uniquely challenging due to the sector’s characteristics. While healthcare systems differ globally, several factors consistently complicate digital transformation.
At the company level, organisations must manage sensitive patient data and adhere to strict ethical standards. The diversity of medical conditions means that no single platform can offer the full range of services provided by a hospital. Risk aversion is high, especially given the need for continuous care for chronic patients, which can conflict with the transactional focus of many digital platforms. Additionally, healthcare cannot be fully digitised – physical examinations and in-person consultations remain essential, requiring seamless integration between online and offline services.
At the ecosystem level, healthcare involves a complex network of public and private hospitals, clinics, insurers, technology firms, and regulators. Integration and collaboration among these actors are challenging. The sector is also highly regulated, with strict entry requirements and a limited supply of highly trained professionals.
Notable failures of digital health providers and platforms
Despite early successes, several digital health platforms have faced high-profile failures.
Apricity Fertility, launched in 2018 as a virtual fertility clinic in the UK, offered online consultations and athome testing. After securing €17 million (£14.3 million) in Series B funding in 2022 and
Fairweather explains health leaders need safety and funding
reporting rapid growth, Apricity encountered unexpected financial troubles in late 2024 when a planned investment fell through, exposing its fragile financial position.
Similarly, 23andMe filed for bankruptcy in March 2025, with its valuation plummeting from $6 billion (£4.4 billion) to under $50 million. The company’s reliance on one-time genetic testing sales proved unsustainable, and efforts to diversify into subscriptions and therapeutics failed to deliver
OF DIGITAL HEALTH
explains why digital need to keep patient funding in their minds.
profitability. In hindsight, the business model itself could have been more heavily scrutinised before such a large-scale investment.
Other notable failures include Forward, which shut down in 2024 despite $100 million in funding for its AI-driven clinic model, and Babylon Health, which declared bankruptcy in 2023 after overestimating AI revenue and facing an unsustainable cost structure.
Ex-Babylon executives also cite high-level pressure to diversify
services and geographical reach without first perfecting their technology and core proposition.
Challenges
Healthcare regulations, designed for traditional providers, often do not align with digital models, creating regulatory grey areas and unclear accountability. Jennifer Reynolds, a healthcare policy researcher, notes that digital health companies frequently operate without clear standards for patient protection.
Governance issues that precipitate failure
Several governance problems commonly undermine digital health startups:
• Poor board oversight and lack of accountability, leading to ineffective management and strategic missteps.
• Executive leadership failures, including weak planning, mismanagement, and ethical lapses, undermine long-term goals.
• Misalignment between corporate culture and healthcare values, as the tech industry’s “move fast and break things” ethos clashes with health-care’s “first, do no harm” principle.
• Business models that prioritise user growth over profitability, leaving companies vulnerable when investment slows.
Effective strategy for digital healthcare
With myriad potential for applciation, digital health platforms hold significant promise for improving cost, productivity and access to healthcare.
They can complement traditional services, especially in specialised areas like chronic disease management.
To succeed, digital health leaders must focus on organisational learning, systematic integration with existing healthcare systems, and distributed ecosystem management.
Financial strategies should emphasise sustainability over rapid expansion, with realistic milestones that account for healthcare’s slow adoption cycles.
Above all, patient care and safety must remain central. No matter how advanced the technology or how strong the financial backing, platforms that neglect this core value risk failure.
As the sector matures, learning from recent setbacks can strengthen future innovations, ensuring digital health fulfils its potential to deliver high-quality, sustainable care.
Is it enough to solely connect patients with providers?
Or enough to provide digital alternatives to traditional care pathways?
Pertinent questions need to be asked by digital health startups that keep patient care at their core, even if at the expense of a founder’s ideal vision.
POSTPARTUM PSYCHOSIS
WHAT IT IS, WHAT WAS MISSED, AND WHAT NEEDS TO BE DONE...
Richard Baish, development manager at Action on Postpartum Psychosis,
talks about the most severe form of postnatal mental illness and how it should be treated.
UNTIL 24 October 2022, I was living a very normal, fulfilled life. As a husband, dad of two and assistant headteacher, I had everything I’d ever wanted. Now, I’m known by many people in my home town of Witney as: “That guy whose wife took her own life”.
My wife, Alex, succumbed to what we now know to be postpartum psychosis (PP), a rare but lifethreatening mental illness which can affect mums in the days and weeks after giving birth.
There is the obvious tragedy of losing my wife, which is a scar that my family and I will wear forever. But there’s also another tragedy in the sense that because PP is a treatable illness. I now know that if signs were spotted and acted on quickly, she would still be with us today.
I liken it to climate change: no matter how many news stories you see about floods or forest fires which devastate lives across the world, there’s largely a feeling among people that it won’t affect me. Until your house burns down, you probably won’t take the risk all that seriously. This was my house burning down. And I knew nothing about the cause until after the fact.
So today I share my story to raise awareness and to serve as a warning to others about the seriousness of PP.
Postpartum Psychosis is the most severe form of postnatal mental illness, which can occur in the days or weeks following childbirth. The mother might feel extreme mood swings and confusion, and experience hallucinations, mania, delusions or suicidal thoughts.
PP is a psychiatric emergency which should be treated with the same urgency that a heart attack would require. Immediate admission to a specialist Mother and Baby Unit (MBU) is the most appropriate course of action – but, sadly, due to misdiagnosis and a lack of MBU beds in some parts of the country, this doesn’t always happen. PP affects one or two in every 1,000 mothers worldwide – approximately
psychiatric emergency should be treated same urgency that attack would require
Richard Baish and his children
Psychosis is a emergency which treated with the that a
heart require
1,200 per year in the UK, or three mums every day. The numbers it affects are similar to those born with Down’s Syndrome, and yet PP has far less coverage or awareness.
Many people who develop PP have no previous history of mental illness, which was the case with my wife.
People shouldn’t feel guilty of having never heard of it. I hadn’t until it was too late.
Most people have, however, heard about the baby blues, but this is a far cry from serious perinatal mental health conditions like PP and postnatal depression, which are, tragically, sometimes misdiagnosed as the baby blues.
For many women suffering from psychosis, there will be more obvious signs that something is wrong: they may be animated, hyper or manic, and very different to how they usually appear.
For others, however, it won’t be as obvious. They may have a low mood, appear catatonic, feel confused, or become very quiet with it. They might be seeing, hearing or believing things that others don’t but feel unable or too afraid to articulate it.
This can make it a lot harder to spot and was certainly true of my wife. She wasn’t in a frame of mind where she could reach out and describe the full extent of the turmoil she was feeling, and the onus therefore
Action on Postpartum Psychosis’ national awareness campaign
needed to be on those around her to spot the signs.
I try my hardest not to apportion blame to any individual when I think about losing Alex.
However, there are definitely gaps which should be filled in order to make the birthing process, and the postnatal period, a bit smoother, and to take away any extra pressures put on mothers.
In our ante-natal group, there was no mention of postnatal mental health problems. I know the aim is to make mums and partners feel empowered and more confident, but the shock and trauma of suffering
from psychosis when they have no awareness of it is surely far worse and risks lives.
Research has shown that antenatal classes usually focus on the physical health problems one might experience during and after pregnancy – but they don’t always discuss postnatal mental health.
In fact, according to a YouGov survey for Action on Postpartum Psychosis (APP), the UK’s only charity dedicated to supporting mums and families affected by PP, only 6% of pregnant people are given any information about postpartum psychosis at their antenatal classes.
Listening to mums are struggling, adapting to what is absolutely crucial
who
they need,
I would strongly advocate for a dedicated session or briefing, even if it’s just for a few minutes, either in ante-natal groups or meetings with a perinatal professional, where postnatal fatigue, depression and psychosis, are all referred to. APP offers a tool for antenatal educators
Friends and family members also need to be vigilant around a new mother. APP launched a national awareness campaign last year: New mum seems strange? Seek help.
People need to know that should PP be suspected, urgent medical help is needed. Loved ones can call 999 or take their partner straight to hospital,
where they should be assessed by a specialist in perinatal mental health within four hours, and, if a PP diagnosis is confirmed, they should receive same-day admission to a specialist Mother & Baby Unit.
There are a number of other factors which don’t help. A friend of mine studying to be a doctor told me that the amount of study time dedicated to PP in his cohort was minimal; the systematic pressures put on new mothers to breastfeed can lead to a decline in their mental health; social media even plays a part by making mums feel inadequate or inferior.
Listening to mums who are struggling, and then adapting to what they need, is absolutely crucial.
Thankfully, word is getting out there about PP. But I won’t stop, and nor will APP, until every expectant mum, new mum, partner, family, friend and colleague of a new mum knows what postpartum psychosis is, and what they should do when they spot the signs of it.
PP is completely treatable and the vast majority of patients will recover from it with the correct intervention.
I’ve tried to turn this devastating moment in my life into as much of a positive as possible.
I want Alex to be remembered for all the right reasons: not just as the incredible teacher, daughter, wife and mum that she was, but as the reason why mothers in the future are treated for and saved from postpartum psychosis.
You can read more of my story, and the impact it had on me and my family, here, and if you think you, or anyone you know, may be suffering from PP, you can access free support by visiting Action on Postpartum Psychosis’ website here.
ONE person’s experience of dementia is as individual and unique as they are. While a diagnosis of dementia can mean a greater need for care, the focus has to be on supporting the emotional well-being of residents; helping them to maintain their identity and dignity; and enabling a continued engagement with their family.
We do this by offering choice, respect, minimising medicinal intervention, and placing an emphasis on research-led care. We provide our residents living with dementia with calm, enriching environments, in areas designed specifically for their needs with dedicated social spaces, outside terraces, and sensory gardens.
While there are many ways that caregivers can help to enrich the quality of life of those living with dementia, music especially has long been celebrated as a powerful tool for transforming lives, for those affected by the condition as well as those enjoying a regular, everyday life – we all know what it’s like when you’re having a bad day, and your favourite song comes on the radio. The power to change your mood with music is without a doubt transformative.
The benefits of music for older adults are wide-ranging and wellresearched, with studies showing that listening to familiar music and participating in group singing lessons can lift spirits and alleviate feelings of depression. Regular engagement with music can help maintain and even improve cognitive abilities in older adults, including those with only mild cognitive impairment.
Music has also been shown to decrease anxiety and stress levels (in older adults particularly), helping them to feel more at
THE TRANSFORMATIVE OF MUSIC IN
ease in their environment. This could probably be said for many children, too!
On top of this, group music sessions provide wonderful social opportunities for meaningful connections and engagement, helping to combat feelings of loneliness and isolation, as well as offering an alternative means of communication, creativity, and connection, for those with speech difficulties or impairments. Rhythmic music can also inspire movement and improve coordination, potentially reducing the risk of falls and allowing for some physical activity and freedom.
From an emotional point of view, music can also reinforce a sense of self for those living with dementia, with familiar songs triggering
Emma Hewat, director of care home company KYN, engagement with music even improve cognitive abilities
memories and emotions. This can assist individuals with reconnecting to their past, strengthening their sense of self, identity and place in the new world in which they find themselves.
Whether through listening, singing, playing instruments, or composing, musical activities can be tailored to meet the individual needs and preferences of each person. In the context of older adult care, music can take various forms, including but not limited to music therapy sessions led by qualified professionals, group singing or instrumental activities,
TRANSFORMATIVE POWER IN AGED CARE
of dementia care at KYN, writes that regular can help maintain and abilities in older adults.
live concerts and performances, one-to-one music enjoyment with carers or musical practitioners and the creation of tailored playlists.
For people living with dementia, music has the power to reach parts of the brain that remain relatively unaffected by the disease, allowing them to connect with memories and emotions that may otherwise be difficult to access. This is why it is such an important part of dementia care, helping to soothe, calm, stimulate, and preserve, and potentially reduce behavioural and psychological symptoms.
Our teams work with organisations such as Songhaven and Live Music Now to integrate music into the daily lives of our residents, creating personalised programmes that honour each individual’s unique musical preferences and needs. This includes musician residencies, live music concerts, interactive music sessions, and one-to-one music enjoyment.
In April, we recruited a musical care practitioner for our KYN Bickley home. This professional musician joined the team to bring music to residents in both planned and spontaneous ways throughout the week. Musical care is an approach to integrating music into the day-to-day living and caring experience.
Moving from the starting point of being fun and enjoyable into the
opportunity for a range of music activities (listening, participation, making, expression) that support and impact positively on the well-being and health of the residents and advance the quality of care. Greater access to music positively impacts residents’ ability to communicate their personality, express their preferences and take agency.
We all have an individual relationship with music, whether or not we are trained musicians. It is used as a means by which we formulate and express our individual identities and present ourselves to others in the way we prefer. It is shaped through exposure to lifelong musical experiences and encounters, relationships, memories and heritage. Our musical tastes and preferences can form an important statement of our values and attitudes. A key element of the musical care practitioner’s role is ensuring that music activities are personalised, person-centred, meaningful, inclusive and accessible and respond to, reflect and value the identities and contributions of all taking part
The starting point for any musical interaction is looking for what people can still do. The musical care practitioner builds on this by looking for ways people can achieve, progress and be creative despite the realities of living with a condition which leads to a decline in function. This role focuses on the progressive and creative expressive experience during the dementia journey reinforcing the idea that dementia is not just an experience of decline. Already we are noticing small changes in our residents.
The transformative power of music can create more joyful, engaging, and fulfilling experiences for older adults in care.
TTHE PROBLEM WITH Paul Gordon, medical financial planner at paying potentially on Scheme Pays allowance
HE McCloud Remedy corrected a historic injustice for younger doctors. It restored their rights to the same pension terms as older doctors, finding that the 2015 transfer into a new scheme was unlawful under age discrimination rules. However, it exposed a second injustice for doctors who had used Scheme Pays to clear tax liabilities associated with annual allowances. This remains unresolved.
The history will be familiar to many doctors. In 2015, public sector pensions including the NHS Pension were reformed, primarily involving a move to career average schemes (rather than final salary). The reforms allowed older people to remain in their existing schemes while forcing younger public sector workers into an alternative option –usually one that involved retiring far later. The McCloud Judgment was a Court of Appeal ruling in 2018 that said these reforms discriminated against younger members with more than ten years until their normal retirement age in April 2012 by allowing older members to remain in the original, arguably more generous, schemes.
The McCloud Remedy sought to ensure that all active members are in the reformed career average scheme, providing equal treatment for all. While this seems like an equable settlement, the rollback created some complexities. As members were put back into their legacy schemes, it required a significant recalculation of the annual
allowances for the years from 1 April 2015 to 31 March 2022 when they were in the old scheme. These needed to be recalculated as though the member had always been a member of that scheme. Members who saw their growth increase from 2019/2020 onwards may well be left with a liability and would need to make additional payments or use a Scheme Pay option, where the pension scheme would step in, pay the tax and recoup it, with interest, from the final pension pot.
At the time, this appeared a neat, and possibly the only, solution to the problem. Younger doctors may have had mortgages, tax charges, family commitments and faced the prospect of paying tax on benefits they hadn’t received. However, many doctors would likely have made a different choice in light of the McCloud Remedy, and we believe they should not now be penalised for a choice made in response to a wholly different set of information available to them at the time.
Doctors may now find themselves with 30+ years where they will be accruing interest on a loan against their pension pot. This is 30 years of unknown inflation-linked interest added to a charge on benefits now due from state retirement age. This may impact their retirement planning. The government lost its case in the Court of Appeal on the grounds of age discrimination. We
believe that could reasonably be argued here too.
Many of these tax charges were triggered by having two sets of pension growth. One that they volunteered to be in when they started out, and one they were forcibly moved into as part of the change in scheme. In short, they are paying additional interest/taxes because they were forcibly moved from pension scheme A to B. Then, after the Court of Appeal ruling on age discrimination, they were moved back from scheme B to A. As it stands, doctors have no option to unwind historic scheme pays. They can be reduced but not rescinded.
What is the scale of the problem?
If our client base is anything to go by, it is significant. Perhaps even more importantly, the burden is highest on some of the most productive members of the NHS –those taking on managerial roles, clinical or medical director roles, or simply working within the NHS and receiving private practice income We have a number of clients in
WITH NHS PENSIONS
medical specialist at atomos, sees GPs significant interest used for annual
charges.
their 40s and early on in their NHS careers, who didn’t want to retire at 68 in line with the 2015 pension arrangements. They decided to opt out of the pension and overpay using the savings to overpay
mortgages, assist with education costs, or just cover some of the increased costs of living.
During the seven-year McCloud Period, they incurred annual allowance charges and didn’t have sufficient capital to pay the charges. They opted to use Scheme Pays and now have a 20-plus-year liability against their pensions. Our view is that this creates an incentive problem with many choosing to work fewer NHS programmed activities or decline pensionable pay increases over concerns around potential
tax charges. The delays in issuing Remedial Pension Savings Statements (and corrections) is another frustrating aspect resulting from the McCloud Judgement. In a number of cases, they haven’t been received, or they have received at least two as the first was incorrect.
We are trying to get NHS Pensions to engage on the issue and reconsider its stance on unwinding these Scheme Pays arrangements. To date, NHS Pensions insist Scheme Pays are irrevocable. However, so was the wholesale move to the 2015 scheme which landed many in this situation, which was subsequently reversed when the Government lost in the Court of Appeal. In a number of cases, it is possible to amend the Scheme Pays election downwards with the tax payment required (along with interest) paid to HMRC directly from savings.
In the meantime, we suggest all clinical staff review their positions carefully, request up-to-date information from NHS Business Services Authority (NHSBSA), and check it against their records. It is staggeringly complicated, so you might want to see if there are financial planners in your area who specialise in the medical sector and your pensions.
IN THE often-quiet corridors of private healthcare, a patient’s voice can sometimes be drowned out by polished brochures, glowing testimonials, and promises of a personalised service. Yet it is precisely in this space – where care is commodified and expectations are high – that complaints must be treated not as nuisances, but as vital instruments of accountability, growth, incremental improvement and ethical practice.
Private care providers operate in a competitive marketplace where reputation is everything. However, the pursuit of excellence cannot be limited to glossy surface-level impressions. While positive reviews might attract new clients, it is the unresolved complaints that tell the story of service gaps, systemic issues, and ethical oversights. On occasions, these are swept under the rug or dismissed as rare anomalies or disgruntled voices. But ignoring these signals does more than damage individual trust – it erodes public confidence in the very notion of private care.
Unlike public healthcare systems, private providers are not always bound by the same governmental planning and rules. This autonomy brings both opportunity and risk. It allows for innovation and personalised service but also creates a grey area where profit motives may be perceived as quietly overshadowing patient welfare.
In this environment, complaints should not be viewed defensively but embraced as a corrective compass. They offer direct insight into patient experience, organisational weaknesses, and the human cost of business decisions.
Elevating standards in private care begins with a cultural shift: seeing complaints not as threats, but as catalysts for change and improvement. Transparent, responsive complaints mechanisms
ELEVATING STANDARDS IN PRIVATE CARE
must become non-negotiable elements of any private care operation. This includes not only proper documentation and timely responses but also meaningful analysis that leads to real change. Moreover, staff must be trained to see feedback – especially the negative kind – as part of a continuous improvement cycle, not as a personal failure, PR or financial risk.
The industry must also be willing to go beyond minimum regulatory compliance. Voluntary audits, patient advisory boards, and independent complaint adjudication services are just some of the measures that can ensure accountability. Shared learning and nationwide
benchmarking practices support quality improvement. If private care truly seeks to position itself as a premium alternative, it must rise above the minimum and hold itself to higher, not lower, standards of scrutiny.
Ultimately, the measure of any care system – public or private – is how well it listens when things go wrong. Elevating standards in private care is not simply about better facilities or shorter wait times. It is about building trust, practising humility,
2023–2024). While it does not offer compensation, it plays a critical role in early resolution and service learning.
She goes on to say that ISCAS has a memorandum of understanding with, and is signposted by, the Care Quality Commission, Healthcare Inspectorate Wales, Healthcare Improvement Scotland, the Regulation and Quality Improvement Authority, the Human Fertilisation and Embryology Authority, and the Private Healthcare Information Network, and helps providers demonstrate their quality credentials.
“Nevertheless, a gap remains: while nearly all independent providers in acute secondary care are ISCAS subscribers, only 17% of NHS Private Patient Units (PPUs) participate – despite the Paterson Inquiry recommendations for sector parity,” she said.
For providers, subscription to a recognised and reputable external adjudication service signals a commitment to accountability, transparency, and continuous improvement.
and creating a system where every voice – especially the critical one of the patient – is heard, respected, and used to do better. For an industry built on the promise of care, there can be no greater calling.
As scrutiny of patient safety and transparency intensifies across UK healthcare, not least in the recent public inquiries, independent external complaint adjudication is a vital force in maintaining public trust and professional standards in the private sector.
Sally Taber, director at the Independent Sector Complaint Adjudication Service (ISCAS), said that healthcare is increasingly coming under scrutiny from commissioners, regulators and not least the patients.
“Taking complaints seriously and acting on them to improve standards and demonstrate commitment to high-quality care, is a must for the private healthcare sector,” she said, adding that ISCAS provides an independent, structured complaints process for unresolved disputes.
Its Stage 3 adjudication process includes mediation options and allows for goodwill payments up to £5,000 (average award: £815 in
The external adjudication service should help strengthen governance and quality assurance frameworks and reassure regulators and patients alike, that concerns are taken seriously. It should offer access to expert adjudication and mediation from a number of industry experts with different specialist backgrounds who can offer wide-ranging experience to support all types of healthcare complaints and disputes.
In a landscape where reputation, regulation, and responsibility intersect, healthcare organisations need a proven framework for managing complaints competently and fairly without involving the legal sector and its associated expense – and learning from them to improve quality.
consultant Vivienne Heckford complaints about private care industry attention.
REDUCING HIGH-VALUE
HIGH-VALUE obstetric claims – often arising from catastrophic brain injuries to babies – constitute a disproportionately large share of the cost of clinical negligence. Tackling this challenge demands collective effort from clinicians, patient safety teams, indemnifiers, and legal professionals. By understanding how these claims arise, learning from past events, mitigating costs, and preparing for future reforms, we can collectively reduce their incidence and financial impact.
The scale and sources of the problem
In England, maternity claims represent around 10% of the total number of clinical negligence claims received by NHS Resolution – in recent years approximately 1,200 out of 12,000 claims annually. However, based on the 2023/24 provision, maternity accounted for nearly twothirds of the total of £58.5 billion.
The cost of a single high-value obstetric claim can exceed £30 million, where lifelong care is needed for a child with cerebral palsy or hypoxic brain injury. Fortunately, in the private sector, such claims are exceedingly rare and unlikely to exceed the limits of indemnity. Common incident types include antenatal screening failures, delays in recognising foetal distress, poor management of labour, failure to escalate care, and misinterpretation of cardiotocography (CTG) traces. These are often compounded by systemic issues such as inadequate staffing, inconsistent training, or suboptimal communication.
Learning lessons and enhancing patient safety
Improving maternity safety starts with delivering quality care
Neil Rowe, head of practice at Maulin Law, considers how to reduce the incidence and financial impact of obstetric claims.
consistently. Staff education and training are foundational. Simulation training for obstetric emergencies, CTG interpretation workshops, and multidisciplinary team exercises help build clinical confidence and cohesion. Understanding patient expectations and being proactive in addressing concerns is key.
Additionally, attention must be paid to health inequalities and perinatal mental health. Evidence shows that women from minority ethnic backgrounds and deprived areas face worse outcomes; whilst perinatal mental health increasingly relates to catastrophic outcomes. Maternity services must be inclusive, culturally competent, and resourced to meet diverse needs.
Should something go wrong, it is crucial that the statutory Duty of Candour is fully implemented alongside the Patient Safety Incident Response Framework (PSIRF). Transparency, accompanied by timely apologies and clear explanations of the steps being taken to prevent recurrence, can help preserve trust and even reduce the likelihood of litigation. Proactive and inclusive complaints handling should reduce claims. Support for staff involved in adverse outcomes is equally vital, continuing to address any remaining cultural issues and protecting staff wellbeing will help reduce complaints and claims.
Mitigating the financial impact
The specialist lawyers who practice in this area play a pivotal role in determining the number of highvalue maternity claims made and their outcomes. Claimant lawyers familiar with these types of claims will filter out those which have insufficient grounds to proceed. If a claim does eventuate, lawyers on both sides will engage highly respected independent liability experts and counsel to analyse whether the claim is likely to succeed or fail at trial. The objective of the defence lawyer is to defend the defensible and promptly settle the meritorious. When it comes to quantum, such claims typically involve young children with profound neurological injuries requiring lifelong care, adapted accommodation, equipment, assistive technology, and a range of therapies. Again, claimant and defence lawyers will engage quality experts and counsel to assess what is a reasonable need and cost, analyse what a court is likely to award, and hopefully negotiate a reasonable settlement. Schemes like the Early Notification Scheme (ENS) introduced by NHS Resolution offer an opportunity to intervene early to investigate and provide interim support, including rehabilitation services. Early financial help can transform family circumstances, reduce adversarial tensions, and reduce overall costs.
The future of maternity care
The spotlight has been shone on maternity care in recent years due to the number of scandals reported. Ambitious change is therefore underway in several areas. Lord Darzi’s recommendations
MATERNITY CLAIMS
for the 10-year NHS plan include re-engaging staff, empowering patients, simplifying care delivery, leveraging technology, and reforming structures to enhance efficiency. Implementing these recommendations in maternity care will improve patient experience and reduce adverse incidents. The government’s review of the duty of candour, whose call for evidence closed last year, is expected to provide greater clarity, potentially decreasing complaints and claims. The NHS Resolution’s Maternity Incentive Scheme has produced enhanced performance, linking compliance with safety actions to financial rewards. It is hoped full compliance will be achieved as such incentives can drive accountability and promote shared learning, thereby reducing adverse incidents.
Looking ahead, the Avoiding Brain Injury in Childbirth (ABC) programme has moved to national rollout in September this year after a successful pilot involving 12 maternity units alongside the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and The Healthcare Improvement Studies Institute. It is designed to close the safety gap by equipping multidisciplinary teams with enhanced skills to rapidly identify foetal distress, act decisively in obstetric emergencies (including complex C-section scenarios), and reduce variation in outcomes across trusts. With a dual focus on evidence-based training and teamwork, ABC aims to ensure that even lower-performing units can achieve results comparable to the top 20% nationally. Its implications extend beyond clinical practice – this is a strategic, system-wide quality improvement programme with the potential to reshape incident investigation, family involvement and reduce future litigation.
Technological advances – such as electronic health records (EHRs) and artificial intelligence – offer the potential for improved decision support, real-time monitoring, and data-driven risk prediction in maternity as well as other areas of medicine. The extra £10 billion earmarked by the chancellor in the Spending Review will hopefully accelerate implementation; however, whilst it is hoped that these tools will reduce adverse incidents and therefore claims, they do not come without their own risks.
Sustainable change will also depend on workforce investment. It is hoped that the 3% NHS budget increase for the next three years just announced by the chancellor will assist with the recruitment and retention of ultra-sonographers, midwives, obstetricians, and neonatal specialists.
The future of maternity claims
Given the scale of the problem, wide-ranging legal reform is being debated. The National Audit Office (NAO) investigation this autumn into clinical negligence costs will review the increase in long-term liabilities and annuities and so will be particularly relevant to maternity litigation costs and may spur policy shifts.
There are calls to repeal section 2(4) of the Law Reform (Personal Injuries) Act 1948, which permits the recovery of private care costs, the most expensive aspect of these high-value claims, often worth up to £300,000 a year for life. Repeal would mean that the claimant would have to fall back on statutory funding to provide such care, which would be controversial given the NHS caused the need in the first place and social care is drastically underfunded.
Renewed debate around limitation periods for bringing claims might arise. Limitation is often disapplied in these cases and historically it can take many years for a claim to be notified. Whilst the legal system must strike a balance between justice and finality it would be a significant change to prevent the most vulnerable from bringing a claim. No-fault schemes (as in Sweden or New Zealand) are under discussion. While politically complex, these models offer the potential to balance fairness with fiscal responsibility. However, the UK economy is very different to those adopters and while maternity claims as a discrete type of claim might be more suitable than the remainder, a no-fault scheme appears unlikely to be introduced.
Less far-reaching changes might lead to incremental savings. Changes to the discount rate (used to calculate future losses) if rates of return improve, will trim the contingent liability, but they fluctuate. Control of legal costs in these higher-value claims through mandatory budgeting would help, and it would not be impossible to introduce fixed recoverable costs for some aspects, for example preaction, but cost reform appears to have stalled recently.
Reducing high-value maternity claims is not simply a legal or financial objective – it is a moral and professional imperative. Every claim represents a tragic story of profound loss, affecting families, clinicians, and entire organisations. Progress depends on open learning, targeted investment, and legal evolution. With shared vision and commitment, we can make maternity care safer; only time will tell if there can ever be claims reform.
For more information on Maulin Law, click here.
IMPROVING GOVERNANCE AND TRAINING FOLLOWING INVESTIGATIONS
IN HEALTHCARE, clinical incidents are an unfortunate but inevitable part of delivering complex, highpressure care. When something goes wrong, organisations have a duty to understand what happened and why.
However, identifying what went wrong is only part of the story. To make healthcare safer, we must ask a deeper question; are we truly learning from what we find?
At TMLEP, our work centres on independent clinical investigations. These investigations aim to deliver objective insights into the root causes of patient harm, exploring potential breaches of duty, causation, and systemic failings. But over the years, we’ve noticed a pattern: organisations often commission investigations with the best of intentions, yet the resulting insights are not always fully integrated into their wider learning culture.
This article explores how healthcare providers can move from investigation to transformation - embedding findings into training, clinical governance, and organisational development.
The limits of a “boxticking” approach
All too often, healthcare organisations treat investigations as an end in themselves: an action taken to meet regulatory
TMLEP’s lead healthcare investigator Nina Vegad asks if we’re learning from clinical incidents and if fitfor-purpose safeguards are being put in place to ensure history doesn’t repeat itself.
requirements, satisfy duty of candour obligations, or respond to a complaint. The investigation is completed, the findings are logged, and perhaps a few changes are recommended. But without strategic follow-through, the deeper value of the investigation is lost.
This approach can lead to recurring incidents, staff disengagement, and missed opportunities for improvement.
Creating a learning culture means refusing to see investigations as isolated events. Instead, they must become part of a dynamic, ongoing process of organisational learning.
From insight to action: Five ways to embed learning
1. Translate findings into training priorities
If a clinical investigation highlights knowledge gaps or repeated errors in judgement, those findings should directly inform workforce education.
For example:
• A case involving delayed escalation should lead to refresher training on early warning scores and sepsis protocols.
• A medication error linked to distraction should trigger scenario-based training on cognitive load and interruption management.
Staff training must be reactive to actual patterns of harm, not generic or tick-box driven.
2. Incorporate themes into governance frameworks
Clinical governance should not operate in a vacuum. Investigation findings should feed into:
• Quality dashboards tracking not just incident volumes, but recurring themes such as documentation errors or missed handovers.
• Board reports that reflect not only what went wrong, but how learning has been actioned.
• Policy reviews, where investigation insights highlight the need for clearer protocols or process redesign.
Governance must be a bridge between insight and implementation.
3. Create cross-departmental learning mechanisms
The same issues often occur in different departments. An
investigation in A&E may reveal a communication flaw that is also relevant in maternity, surgery, or mental health. Consider:
• Hosting regular “learning huddles” across departments to share investigation themes.
• Using case-based discussions to bring investigation insights into clinical team meetings.
• Encouraging departments to audit their own risk areas in light of wider organisational findings.
This helps foster a collective responsibility for safety, rather than leaving learning separate within specific services.
4. Use investigations to strengthen culture, not just correct process
Often, underlying cultural factors, fear of speaking up, blame culture, lack of psychological safety, play a role in patient harm.
Investigations that identify cultural issues should lead to:
• Leadership development around inclusive and transparent decision-making.
• Initiatives to improve multidisciplinary collaboration and flatten hierarchies.
• Forums where staff feel safe to discuss near misses and learning moments.
Creating a learning culture means building emotional and professional safety alongside technical competence.
5. Establish feedback loops with frontline staff
Staff involved in investigations often never hear what happened next. This can fuel disengagement or the perception that investigations are punitive or performative.
Leaders should commit to:
• Closing the loop with clear, accessible communications: “You said, we did.”
• Sharing positive outcomes from learning - reduced incidents, improved processes, team reflections.
• Involving clinical teams in codesigning changes based on investigation outcomes.
Empowering staff with outcomes strengthens the safety culture and reaffirms the value of learning from harm.
The role of independent investigation in driving change
At TMLEP, we see our independent clinical investigations not as end points, but as launchpads for learning.
We work with organisations not just to deliver factual, legally robust analysis, but to help them use those insights to strengthen their systems, people, and governance.
By bridging the gap between investigation and improvement, healthcare organisations can:
• Reduce the likelihood of repeat harm
• Build trust with patients and regulators
• Develop more reflective, resilient clinical teams
• Shift from a reactive model of safety to a proactive one
• Final thoughts: Learning is a practice, not a policy
Creating a culture of learning is not about having the right buzzwords in board papers. It is about what actually happens after harm has occurred, who learns, what changes, and whether those lessons stick.
Clinical investigations are rich with insight. But without integration into governance, training, and team culture, even the best reports gather dust.
Learning must be continuous, visible, and shared. That is when real safety transformation begins.
For more information on TMLEP’s services, click here.
THE KEY TO KEEPING
POOR health among working-age people costs the UK economy £150 billion a year, equivalent to 7% of gross domestic product (GDP). That’s why the government has undertaken an independent review into what employers can do to help tackle poor health in their workforces.
The Keep Britain Working Review is being led by former John Lewis chair Charlie Mayfield and is due to report in the autumn. Its purpose is to explore how employers and government can help more people from falling out of work due to poor health, as well as re-entering the workforce. It follows on from the government’s recent white paper on the same subject in which it expressed a long-term aim of achieving an 80% employment rate. Workplace health is key to economic growth, holding significant value in helping to prevent ill health in the workplace, driving productivity and attracting and retaining talent. As the leading provider of healthcare services to businesses across the UK, from FTSE100 organisations to small to medium-sized enterprises (SMEs), at Bupa we know that keeping workforces healthy and in work is a primary concern for employers.
For many employers, health insurance is the simplest and most effective way to put in place a broad package of health and wellbeing support for their people. It is easy to set up and provides a flexible funding mechanism for employers to deliver the mix of services that their people need.
Association of British Insurers’ figures show that 1.8 million people accessed healthcare through either health or protection insurance in
There are many tools at the government’s disposal to reduce ill health in the workplace, writes Dr Robin Clark, medical director for Bupa Global, India and UK Insurance. The private healthcare sector is already harnessing many of them.
2022, and of those, three-quarters (1.3 million) relied on workplaceprovided schemes to do so.
Health insurance delivers an immediate impact – providing faster access to diagnosis and treatment, reducing absenteeism and improving productivity. In a typical year, in a company of 1,000 people, Bupa insurance will cover treatment for 236 people, including 27 for mental health, 118 for musculoskeletal issues, and 28 for cancer and heart disease.
Mental health support is an area where we’ve seen increasing demand from our health insurance
customers. There has been a 20% increase in those claiming for mental health each year since 2020, and an analysis of 58,000 Bupa health assessments showed that 44% of people were at risk of poor mental health. The cost of poor mental health is calculated to be £300 billion a year in England alone, and £51 billion of this is the cost to employers for employees struggling with their mental health.
Women’s health is another area that is important to our corporate clients. Women can grapple with a diverse range of health concerns which can impact their health
KEEPING BRITAIN WORKING
at home and in the workplace, including period and menopause symptoms.
Research carried out by the Chartered Institute of Personnel and Development (CIPD) in 2021 found that six in ten working women experiencing menopause said it negatively impacted them at work. Bupa research from 2019 found that almost a million women had left the workplace due to menopause symptoms.
Menopausal women are the fastest-growing demographic in the workplace, but the reality is that many are struggling to manage the psychological and physiological changes their bodies are going through. We developed our Menopause Plan which offers women personalised care to manage their symptoms. We also offer a menopause-specific helpline for our customers, and a women’s health hub, providing
nearly 83,000 people with free information about areas such as the menopause.
Around 1,800 women have used the Menopause Plan and they report over a 60% reduction in the majority of severe or very severe symptoms between initial and follow-up appointments.
Other ways in which menopause can be tackled in the workplace include training for managers so they are up to speed on how people going through it can be affected, menopause champions in the workplace and publicising any menopause support offered.
Research we carried out earlier this year highlighted a concerning rise in addiction in the workplace with just over one in three employees surveyed admitting to substance use or addictive behaviour or witnessing it during work hours. It also revealed that more than half
of UK employees surveyed (57%) have struggled with some form of addiction.
For those who have battled addiction, stress is reported to be a major driver, as almost half of employees surveyed (48%) say they’ve turned to addictive behaviours as a way to cope with professional stress, while 46% cite work-related pressure as a contributing factor.
Help is at hand though, employerprovided health benefits including Bupa’s mental health cover which offers direct access to specialists without the need for a GP referral. This ensures quicker intervention and ongoing support, crucial for managing long-term conditions like addiction.
Health assessments are also important in providing early detection of potential health problems and are a key measure in preventive healthcare. By identifying risk factors and health concerns, people can take proactive measures to prevent the onset of diseases.
Regular assessments can lead to healthier lifestyles and improved health outcomes. Bupa research in 2022 showed that 85% of people changed their habits for the better after their health assessment.
Our experience shows that by working with employers, we can make a real impact on the health of the nation. Key to achieving this is making sure that all workplaces take steps to improve the health of their workforce. The government needs to find a way to incentivise employers to treat the health and wellbeing of their employees as a duty of care, in the same way as health and safety.
BETTER FINANCIAL PLANNING FOR PRIVATE PRACTICES
THIS article explores the key pillars of financial planning like budgeting, forecasting, and longterm strategy and how structured support can make all the difference.
Create a realistic, responsive budget
A well-built budget gives you a clear picture of your practice’s financial health and sets the stage for informed decision-making. It should be detailed, dynamic, and responsive to change.
Smart budgeting tips:
• Review historical data: Use previous financial reports to forecast income and flag recurring costs.
• Differentiate fixed vs. variable expenses: Understanding your overheads including staff, technology, and premises is key to managing cash flow.
• Account for fluctuations: Many practices see seasonal trends in patient volume. Build these into your budget to avoid surprises.
• Use digital tools: Reporting platforms like those offered by Medserv allow you to monitor financial performance in realtime and make evidence-based adjustments.
Forecast beyond the month-end
Budgeting tells you where you are. Forecasting tells you where you’re
Running a private practice in today’s healthcare environment requires a dual focus of clinical excellence and financial resilience. From navigating rising costs to ensuring prompt reimbursement, practitioners must treat their practice like a business. Sound financial planning isn’t just an option; it’s essential for long-term success, says Medserv’s Derek Kelly.
At Medserv, every client receives access to our expert team members who can help you interpret financial trends and plan proactively.
Keep cash flow steady and strong
Even a profitable practice can struggle without consistent cash flow. Delays in billing, administrative bottlenecks, or uncollected fees can quickly cause instability.
Tips to improve cash flow:
• Streamline billing: Timely, accurate billing is essential. Medserv’s specialist billing team manages this end-to-end, ensuring prompt invoicing and reducing delays.
going. Accurate forecasting helps you prepare for growth, investment, or even temporary downturns.
Effective forecasting includes:
• Revenue projections: Based on patient volumes, average invoice values, and expected reimbursements.
• Scenario planning: What happens if a consultant leaves? Or if you open a second location? Forecasting these scenarios empowers smart decision-making.
• Resource investment: If you’re expanding services or hiring, forecasting future financial impact is crucial.
• Transparent payment terms: Ensure patients understand their financial obligations up front. Offering card payments, instalments or online options can reduce friction.
• Chase aged debt smartly: Automating reminders and flagging overdue payments early can prevent small balances from becoming big problems
Build a supportive infrastructure
Many clinicians attempt to manage admin and billing themselves until inefficiencies begin to erode time and revenue.
The right infrastructure can transform your operations.
What should you consider?
• Practice management software: Solutions like Medserv’s integrated platform bring billing, appointment scheduling, and reporting under one roof.
• Remote admin support: A growing number of consultants now use virtual secretarial teams, like Medserv’s, to manage bookings, patient comms, and document handling remotely.
• Registration support: Setting up in private practice can be daunting. Medserv assists with clinician registrations via the Private Practice Register (PPR), an often overlooked but critical task.
Plan for long-term success
Financial planning isn’t just about surviving it’s about building a resilient, future-ready practice.
Consider these forward-thinking strategies:
• Track KPIs regularly: Monitor average revenue per consultation, outstanding debt, or cost-per-appointment. Medserv clients receive custom reports that highlight these insights monthly.
• Set business goals: Whether you’re aiming to increase patient numbers or reduce reliance on a single hospital, align financial decisions with your vision.
• Prepare for succession: Whether retiring, selling, or scaling, your exit strategy should be built into your financial planning from early on.
Private practice offers the freedom to shape your clinical career but with independence comes responsibility.
Strong financial planning, supported by the right systems and people, can
be the difference between stability and struggle.
Medserv supports consultants across the UK by combining expert billing, remote admin support, practice management software all within one flexible service.
Whether you’re just getting started or ready to optimise an established practice, remember robust financial planning isn’t just smart business. It’s good medicine for you, your patients, and your future.
Medserv has been supporting doctors in private practice for more than 25 years.
From billing and admin to practice technology and financial insight, we help consultants spend less time on paperwork and more time with patients.
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