NOVEMBER 2026

NOVEMBER 2026

REDEFINING OPTHALMOLOGY FOR A MODERN NHS SpaMedica’s chief medical officer on why the UK’s capacity crisis demands a long-term strategy for health equity

THE DECIMATION OF HEALTH VISITORS Institute of Health Visiting’s Eileen Perrins on postcode lotteries in care

WHY THE ASSISTED DYING DEBATE IS FAR FROM OVER University of Manchester’s Professor Alexandra Mullock on the resilience of the End Of Life Bill

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NOVEMBER 2026

When the Royal College of Ophthalmologists said that SpaMedica was delivering threequarters of all independent-sector cataract training placements in England, it marked a key moment in the evolution of NHS workforce delivery. What began as a temporary response to rising surgical backlogs has evolved into a vital pillar of clinical education, with SpaMedica now hosting trainees across every English NHS deanery. But as chief medical officer Alex Silvester argues expanding surgical capacity is only one part of a much larger equation. This issue, he talks about why training must follow patient choice, the myth of the independent sector’s over-reliance on cataract surgery, and how long-term NHS partnerships are key to safeguarding the future ophthalmic workforce. Also in this issue, Alexandra Mullock, professor in health law and policy at the University of Manchester, says that despite the defeat of the assisted dying bill, the debate is far from over; and much more...

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Tell us your news: Adrian Murdoch, Editor-in-Chief adrian.murdoch@healthcaretoday.com Katie Heslop, Senior Writer katie.heslop@healthcaretoday.com Julie Penfold, Senior Writer julie.penfold@healthcaretoday.com Glen Ferris, Managing Director glen.ferris@healthcaretoday.com To download a copy of our media pack, click here.

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DA VINCI 5 RECEIVES CE MARK FOR CARDIAC PROCEDURES GLOBAL technology leader in minimally invasive care, Intuitive, has revealed that its da Vinci 5 surgical system has received CE mark approval for adult cardiac surgery in Europe. This includes thoracoscopically-assisted cardiotomy procedures and minimally invasive coronary artery bypass procedures. Cardiovascular disease remains the leading cause of death worldwide, with around 18 million people losing their lives as a result of heart problems each year. In 2022, it accounted for one-in-three deaths in Europe. More than two million patients globally undergo open heart surgery annually, with most procedures requiring a sternotomy. This is an approach that involves splitting the breastbone to open the chest and access the heart. The design of da Vinci 5 can support minimally invasive cardiac procedures by enabling surgeons to operate through small incisions without opening the breastbone. The da Vinci 5 surgical system offers: 10,000x computing power, smart instrumentation that can capture 1,000+ data points per second, advanced imaging for enhanced visualisation of vessels and perfusion, and an integrated digital ecosystem to support the journey from pre-operative planning through to post-operative analytics. “CE mark for adult cardiac procedures with da Vinci 5 is an important step in a broader global effort to help transform cardiac care,” said Darla Hutton, Intuitive’s global vice president of cardiac. “By bringing together 30 years of innovation, team-based training, and a service model built on reliability and safety, we believe we can help cardiac teams adopt robotic-assisted surgery in a way that is consistent, scalable and sustainable.” Intuitive’s commercial president for Europe, Dirk Barten, added that “this clearance represents our firm commitment to bring back robotic-assisted minimally invasive cardiac procedures in Europe”. As Healthcare Today has previously reported, surgical robotics, including several models of the da Vinci systems, continue to transform the way surgeries are performed. 4

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HS ENGLAND has made efforts and has targeted funding towards improving A&E waiting times and patient flow through hospitals, but this growth in spending has not been matched with proportionate improvements for patients. A new report from the National Audit Office (NAO) has found that crowding in A&E has increased in the past 14 years, making it harder for patients to flow through hospitals as normal.

by Adri Edito

patients discharged, tr within that time. This t since 2013-14. The per 12 or more hours in A& the COVID-19 pandem suggesting that people in A&E are twice as lik leaving A&E, compare hours.

The annual numbers of A&E attendances have increased by 6.5 million since 2011-12, and in May this year, during any 24-hour period in England, there was an average of 2,241 patients waiting in corridors in A&E, and 669 patients waiting in corridors in hospital wards. Costs per A&E attendance have also increased by a third to £280 per patient in 2024-25, compared with 2018-19.

“Despite significant eff performance, patients long waits and delays and DHSC need to und improvements have be successful approaches consistently across the Gareth Davies.

The NHS constitution includes a maximum four-hour waiting time, aiming to have 95% of

Although there has be resources, including th

OVEMENTS IN A&E

ian Murdoch, or-in-Chief

ransferred or admitted target has not been met rcentage of people waiting &E has tripled since before mic, with ONS analysis e who wait 12 or more hours kely to die within 30 days of ed with those who wait two

fforts to improve A&E s continue to experience in care. NHS England derstand more fully why een slow and ensure s are adopted more e system,” said NAO head

een an increase in A&E he number of staff, this has

not correlated to a proportionate improvement in performance, suggesting that other factors such as bed occupancy may be limiting progress. Delayed discharge from hospital can also slow patient flow, with 14.2% of hospital stays involving a delayed discharge in 2025-26. These can be caused by delays from within the hospital, such as arranging take-home medicine or from outside the hospital, for example, capacity in care homes. Age UK has highlighted how delayed discharge disproportionately affects older people and patients living with frailty. NHS England estimates that delayed discharge has cost an estimated £2 billion between August last year and April this year. NHS England published a plan in 2023 to improve A&E care, with the main objective being to deal with reduced patient flow through hospitals resulting from increased bed occupancy rates, which NHS England saw as the

“key driver” of falling A&E performance. NHS England allocated £1.6 billion to ICBs and local authorities in 2023-24 and 2024-25 through the discharge fund to help reduce delayed discharge. Despite achieving many of the aims in this plan, however, NHS England has evaluated that many of the desired outcomes have not materialised. It is now aiming to speed up the rate of improvement by establishing a stronger system of accountability, financial incentives and placing more focus on local leadership. “While long waits for care are most visible inside hospitals, many of the solutions lie in the community. They include improved access to GPs and their teams, ambulance crews treating more patients on the scene, and better coordination with social care to speed up discharges,” said Ciarán Devane, chief executive of the NHS Alliance. “Steps like these can reduce the logjam in hospitals, or prevent the need for a visit to A&E in the first place.” NEWS

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FIRST UK PATIENT RECEIVES BREAKTHROUGH TREATMENT FOR LIFETHREATENING AVM ZEHAIR AYUB had been living with arteriovenous malformation (AVM), a condition that causes an abnormal tangle of blood vessels in the brain, since 2011. He had exhausted all viable treatment options and his health was declining fast. His AVM was located deep in his brain and he had developed a large aneurysm. This was pressing on his visual nerves, leaving him at high risk of potentially fatal or life-changing brain haemorrhage. He was also experiencing increasingly severe symptoms, including seizures, right-sided weakness and deteriorating vision. The patient was offered hope after meeting with Fathallah Islim, a consultant interventional neuroradiologist at Leeds Teaching Hospitals, and hearing about a breakthrough treatment that could help him. “For 15 years I lived with the AVM, but I was eventually told there were no treatment options left,” the patient said. “Everything was getting worse so quickly. My eyesight was failing, my coordination was going. I knew I needed help. [The consultant] came along exactly at the right time.” Islim had completed a fellowship at a centre in Germany that had been involved in the European trial of an innovative new therapy, called ihtObtura. The trial was not taking place in the UK, however, so Islim applied for special approval for use of ihtObtura on compassionate grounds. The therapy, ihtObtura, is a novel liquid embolic agent that is injected into the affected blood vessels close to them to prevent blood from flowing abnormally through the AVM. Islim and his team received support from international trial experts who travelled to Leeds General Infirmary to assist. The patient received four rounds of treatment from September last year to May this year. His AVM is now fully closed, the aneurysm is gone, and his physical symptoms have significantly improved. “Endovascular treatment of brain AVMs is often reserved for untreatable AVMs. The risks are high and daunting for both the clinician and patient,” Islim said. “Obtura is a new, innovative material that has helped cure Zehair’s AVM and help him get his life back, which made us very happy for him and his family. We are eager to get European and UK approval for use and help patients in the near future.”

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WHOLE-BODY MRI SCANS HELP MULTIPLE MYELOMA PATIENTS

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ESEARCHERS at The Royal Marsden NHS Trust have found that routine wholebody MRI scans can reveal far more about multiple myeloma patient health, including likely patient outcomes, than simply showing where their cancer is. Multiple myeloma is an incurable cancer of the plasma cells, and around 6,000 people are diagnosed with the condition every year in the UK. Patients often undergo prolonged treatment involving combinations of drugs over several years. While advances in treatment have significantly improved survival, these treatments can also affect muscle, body fat and overall physical health. Yet, until now, clinicians have had limited ways of objectively measuring these changes. Researchers at The Royal Marsden developed an AI tool that can automatically measure a multiple myeloma patient’s skeletal muscle, body fat and organ volumes based on routine whole-body MRI scans only. As part of the study, the MRI scans

by Julie Penfold, Senior Writer of 40 patients who had undergone imaging before treatment, after induction chemotherapy, and following a stem cell transplant, were analysed by the team’s AI tool. The Royal Marsden research team found that treatment was associated with measurable changes in body composition. For example, abdominal skeletal muscle decreased following induction chemotherapy, while both subcutaneous and visceral fat increased during treatment, before partially recovering after a stem cell transplant. “This research shows that we can learn more from the MRI scans that patients are already having as part of their care,” said Christina Messiou, chief investigator of the study, consultant radiologist at The Royal Marsden, and professor for personalised oncology at The Institute of Cancer Research. “By using AI to understand changes in body composition over the course of

treatment, we hope to build a more complete picture of a patient’s overall health, not just how their cancer is responding.” In the future, this approach could help to identify patients who would benefit from a more holistic approach to cancer care, including additional support such as physiotherapy, nutritional advice or exercise programmes. It could also help to detect treatment side effects earlier, and enable clinicians to compare the impact of different therapies on patient wellbeing, Messiou added. “While this technology is still at the research stage, our long-term vision is for every whole-body MRI scan to provide not only information about the disease itself, but also valuable insights into a patient’s overall physical health, helping us deliver more personalised care.” Larger, multicentre studies are now needed to confirm these findings before the technology can be introduced into routine clinical practice, the trust said. NEWS

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INADEQUATE MENTAL HEALTH EMERGENCY CARE PEOPLE experiencing a mental health crisis are too often being cared for in emergency departments that are not designed, equipped or resourced to meet their needs. A report from the Health Services Safety Investigations Body (HSSIB) has found that A&E departments have increasingly become the default location for people in mental health crisis due to gaps elsewhere in the urgent and emergency mental health care system. As a result, people can experience prolonged waits, overcrowded environments, a lack of privacy and unmet basic needs, which increase the distress and risk for patients, families and healthcare staff. The investigation found that many A&E departments are managing risks and needs beyond their intended role. Staff described increasing pressure, burnout, compassion fatigue and moral distress associated with caring for people who require specialist mental health support in environments unsuited to their needs. In some cases, delayed admission to mental health inpatient services, prolonged stays in A&E and lack of support following discharge were not consistently recognised as patient safety issues or monitored to drive improvement. “People who come to an emergency department in a mental health crisis 8

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may be at their most vulnerable. They need timely, compassionate and joined-up care that recognises their distress, protects their dignity and helps keep them safe,” said Nichola Crust, senior safety investigator at HSSIB. “Our investigation found that emergency departments are often caring for people in crisis in spaces that were not designed for prolonged mental health care. Long waits, limited privacy, unsuitable environments, gaps in information sharing and inconsistent approaches to care can increase distress and make it harder to understand and respond to a person’s changing risks and needs,” she added. The investigation concludes that improving care for people experiencing a mental health crisis requires action to support safe, therapeutic care in A&E departments alongside wider changes across the urgent and emergency care pathway. It made two safety recommendations. First, that the Department of Health and Social Care (DHSC)/NHS England works with relevant national stakeholders to set out and support national minimum operational service standards and built design expectations for emergency departments. This will help reduce unwarranted variation and meet the

therapeutic needs of individuals who attend emergency departments in a mental health crisis. Second, that there should be further support and guidance to address particular points raised in the report – that there are clear expectations for roles, responsibilities and accountability for clinically appropriate, co-ordinated Mental Health Act assessment pathways; effective shared care, governance and escalation arrangements and processes to identify, escalate and review delays related to assessment, bed availability and onward care; arrangements to assess, plan for and assure the capacity, capability and resilience of the workforce, including access to relevant specialist and statutory professionals; and agreed measures and reporting arrangements to monitor workforce and pathway pressures, evaluate improvement actions, identify variation in access, waiting, experience, use of restrictive interventions, and address inequalities between population groups. “We think developing clear standards of care would help everyone – clinicians, patients, families and the public and we welcome these recommendations,” said Dorit Braun, chief executive of Making Families Count, commenting on the recommendations.

CALL TO SAFEGUARD PALLIATIVE CARE SERVICES IN WALES

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OSPICE UK and Hospices Cymru are calling for urgent action from the Welsh government to secure fair and stable funding for hospice care, warning that essential services will become increasingly difficult to sustain without investment. Earlier this year, Healthcare Today highlighted that teams are caring for people with increasingly complex needs, while many hospices are struggling with the spiralling costs. They estimate that an additional £30 million is needed to ensure hospices can continue delivering vital services throughout the remainder of this Senedd term. The call follows a briefing at the Senedd, where Members heard directly from patients, families and hospice staff about the pressures facing palliative and end-oflife care. Across Wales, hospices support more than 20,000 children and adults every year, providing specialist care in people’s homes, communities and inpatient units. But demand for hospice care is rising fast as people live longer with more complex conditions. Many hospices are seeing more urgent referrals and growing pressure on community teams.

by Adrian Murdoch, Editor-in-Chief Despite the vital role they play, hospices still rely on charitable fundraising for around two-thirds of their income, alongside year-by-year Welsh government grants with no guarantee they will continue.

Most hospice care in Wales is delivered in the community, preventing unnecessary hospital admissions, supporting timely discharges, and reducing demand on GPs, district nursing and social care teams.

This lack of stability is placing services under strain and limiting the ability of hospices to plan for the future.

Without sustainable investment, hospices warn it will become increasingly challenging to meet the rising needs of their communities and to protect this vital role within the wider health and care system.

Public concern is growing too. More than 7,000 people across Wales have recently written to their Senedd members calling for stable funding to protect hospice care.

These issues will be on the agenda for the Senedd Cross‑Party Group on Palliative and Hospice Care, which is supported by Marie Curie Cymru, Hospices Cymru and Hospice UK.

“A recurring funding commitment for the remainder of this Senedd term is essential. Hospice teams are caring for people with increasingly urgent and complex needs, at a time when many services are under real strain from rising costs and demand,” said Liz Booyse, chair of Hospices Cymru and chief executive of City Hospice. “Securing stable funding will safeguard care today and give hospices, Welsh Government and the NHS the stability needed to plan a sustainable future for palliative and end of life services in Wales.”

“The Cross‑Party Group will support Members by providing evidence and insight from the frontline, helping us understand what needs to change to deliver the palliative and end-oflife care system Wales needs,” said Senedd member Sam Rowlands, chair of the Cross-Party Group. “That includes ensuring everyone in Wales can access the right care, in the right place, at the right time in their last phase of life. Our aim is to keep these issues firmly on the agenda and ensure government action matches the scale of need.” NEWS

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STAMINA PROGRAM HELPS PROSTAT CANCER

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EN receiving hormone therapy as part of treatment for prostate cancer who participated in the STAMINA lifestyle intervention programme had significantly better cancer-specific outcomes, a landmark 13/10/2016 11:08 NHS trial has found. The trial, delivered in partnership with Sheffield Hallam University, the NHS and Nuffield Health, is the largest study of its kind to date. It’s the first to integrate a lifestyle intervention programme offering supervised exercise, dietary advice and behavioural support into routine cancer care pathways at scale across the NHS. “STAMINA is a huge achievement, and it offers a step-change in how lifestyle programmes should be considered and integrated comprehensibly into routine prostate cancer care,” said Liam Bourke, professor of cancer research and STAMINA research team director at Sheffield Hallam University. “The trial is the first to be designed to work in the NHS from day one. This makes the study really unique and

by Julie Penfold, Senior Writer

ensures that the positive outc the research will be delivere where they need to be – to N patients during routine care.

As part of the STAMINA stud men who were receiving and deprivation therapy (ADT) tr were recruited to participate NHS hospitals in England.

ADT treatment lowers testos production to slow the growt prostate cancer and control disease. But it also causes ad effects including fatigue, incr central obesity, loss of muscl reduced bone density, cardio risk, and psychological distre significantly affects quality o

Study findings indicate the S lifestyle intervention approac can mitigate the debilitating effects of ADT therapy. Partic experienced less deterioratio prostate cancer-related qual life (26%), less fatigue (30%),

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improved overall cancer-related quality of life (37%), when compared to an optimised version of usual prostate cancer care. The men participating in the STAMINA lifestyle programme received supervised aerobic and resistance exercise sessions for 12 months, dietary advice, behavioural support, and complimentary gym membership. Adherence to the exercise programme was high, with 80% of men attending their scheduled sessions over the 12 months. Those participants had better cancer-specific outcomes, such as improved quality of life, and reported experiencing less fatigue, the trial found. Analysis of the cost-effectiveness of the STAMINA programme, designed to be prescribed alongside routine prostate cancer care, found it provided benefits at a cost significantly below the threshold for NHS cancer funding. Programme costs were £13,920 per QALY (qualityadjusted life year) and cost per participant per year was £1,000.

“The importance of optimising quality of life for men with prostate cancer cannot be overstated,” said Derek Rosario, chief investigator of STAMINA and consultant urological surgeon at Sheffield Teaching Hospitals NHS Trust. “As well as the direct individual benefit, we know that optimising quality of life and mitigating fatigue through exercise has potential beneficial effects on overall survival.” Describing STAMINA as the “first lifestyle intervention integrated into routine cancer care at scale across the NHS in England”, he said the trial findings are a “huge step forward” and will have an immediate impact for patients. The findings will also provide “compelling evidence for clinicians who have been crying out for an evidence-based intervention to recommend to their patients on ADT who present all the time with devastating treatment-related side effects,” he said. “The evidence from this trial also satisfies NICE recommendations and those of expert reference groups

across the world in mitigating devastating, but essential treatmentrelated side effects of those on ADT,” he said. Outcomes from the trial should serve as a template for integrating lifestyle interventions into cancer care in other complex health systems internationally, the trial’s investigators said. Following the success of the STAMINA trial, Nuffield Health has launched a cancer activity programme in partnership with eight NHS trusts to provide a version of the STAMINA intervention to eligible NHS prostate cancer patients. There are also plans to expand the programme to NHS breast and bowel cancer patients. The eight trusts are: Sheffield Teaching Hospitals, Nottingham University Hospitals, Royal Surrey, Surrey & Sussex Healthcare, The Christie, University Hospitals Plymouth, University Hospitals of Derby & Burton, and University Hospitals Bristol and Weston. NEWS

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CRODA OPEN NEW GLOBAL CENTRE FOR BIOTECHNOLOGY RESEARCH CRODA International has opened its new global centre for biotechnology research at Sci-Tech Daresbury, the UK’s leading science and innovation campus. The new laboratories will support the development of next-generation ingredients and technologies to help bring scientific breakthroughs from laboratory to commercial reality for some of the world’s leading consumer and lifestyle brands. An example of the work currently being developed at Sci-Tech Daresbury is KeraBio K31, a biotechnology-derived keratin ingredient designed to help repair damaged hair. This has been developed by Croda scientists at the facility and is now being commercialised with customers globally. KeraBio K31 demonstrates how UK science can be translated into innovative consumer products that address 12

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growing demand for premium haircare solutions, the company said. “Biotechnology will play an increasingly important role in how we deliver sustainable innovation for our customers and create long-term value,” said Steve Foots, Croda’s chief executive. “We had opportunities to locate this facility in several countries around the world but chose the UK because of the strength of its science base, talent and innovation ecosystem.” He added that much of the discussion around the European chemicals sector currently focuses on industrial challenges and lack of opportunities. “Croda’s investment highlights the continued opportunities for innovative companies to compete globally through intellectual property, advanced science and R&D-led growth,” Foots said.

Sci-Tech Daresbury is located in the Liverpool City Region, and Croda’s decision to establish its global research centre there speaks volumes, the local mayor said. “Our region is home to a world-class cluster of science-led companies that are driving growth, creating high-value jobs and developing solutions that can make a real difference to people’s lives,” said Mayor of the Liverpool City Region, Steve Rotherham. “Croda’s decision to establish its global biotechnology research centre in the Liverpool City Region is a powerful vote of confidence in our science base, our skilled workforce and our wider innovation ecosystem.” An ambitious target to invest 5% of GVA in research and development by 2030 has been set, he added, and attracting businesses like Croda “will be vital to achieving it”.

MHRA CREATES FOUR NEW CERSIS

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HE new programme has been developed through a partnership between the Medicines and Healthcare products Regulatory Agency (MHRA), the Medical Research Council (MRC), and the Office for Life Sciences (OLS). The four Centres of Excellence for Regulatory Science and Innovation (CERSIs) will bring together worldleading expertise from across academia, industry and healthcare and develop practical solutions to emerging regulatory challenges. They will also help to ensure new innovations can be safely adopted in practice. Previously, a CERSI pilot established seven centres working across areas including AI, digital health, in-vitro diagnostics, advanced therapies, chemistry, manufacturing and controls, and pharmacogenomics. The new partnership programme will build on the pilot and focus on strengthening UK capability in regulatory science and addressing emerging challenges across health and life sciences.

by Julie Penfold, Senior Writer Co-funding of the four new CERSIs is shared between the MRC and OLS, and the programme combines the MRC’s expertise in funding and supporting world-leading research with the MHRA’s regulatory science expertise. Following extensive engagement across the sector, the programme has identified four strategic areas where regulatory science capability is required to support the next generation of healthcare innovation. These are: data-driven approaches and artificial intelligence; prevention, early detection and novel evidence approaches; personalised healthcare and pharmacogenomics, and novel platform technologies. “The biggest challenges facing healthcare innovations can’t be solved by any one organisation alone,” said Jacob George, professor of cardiovascular medicine and chief medical and scientific officer at the MHRA. “These CERSIs will bring together the right expertise from

across the system to help us address emerging challenges in regulation, keep pace with advances in science and technology, and ultimately help patients benefit from new innovations more quickly and safely.” George added that the programme also supports the UK’s wider life sciences ambitions by helping to strengthen the expertise and partnerships needed to maintain the UK’s position as a leading destination for scientific research, innovation and investment. “Advances in areas such as artificial intelligence, personalised healthcare and novel technologies are creating exciting opportunities to improve people’s lives,” added Patrick Chinnery, professor of neurology and the MRC’s executive chair. “Through this partnership with the MHRA and OLS, we are inviting applications that bring together researchers, regulators and innovators to help ensure regulation keeps pace with innovation to deliver for patients, strengthen the health system and support the UK’s world-leading life sciences sector.” NEWS

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NEIGHBOURHOOD HEALTH PILOTS LAUNCHED TO TEST CARE CLOSER TO HOME PILOT schemes are being launched to test new approaches to neighbourhood health, as the government seeks to shift care towards prevention and earlier intervention. The six projects, backed by £1.5 million from the Office for the Impact Economy, will bring together NHS services, councils and community organisations to develop local models of care. Diana Johnson, minister of state for public health and patient safety, said the programme was a key part of the government’s 10 Year Health Plan, which aims to move treatment into the community, and focus on prevention. The six “trailblazer” sites will focus on areas including frailty, cancer, long-term conditions and end-of-life care. Bristol NHS Foundation Trust will develop a “1,000 days neighbourhood model” using population health data and community networks to support people with frailty and multiple conditions outside hospital. In North East Lincolnshire, a new service will link primary care, community services, mental health and social care to support people with complex needs before they reach crisis point. Other pilots will focus on cancer rehabilitation across 19 London boroughs, proactive care for people with severe frailty and multiple conditions in North Nottinghamshire and extending a neighbourhood frailty model into rural and coastal areas including Scarborough and Bridlington. Lewisham and Greenwich will develop an integrated model covering long-term conditions, cancer and end-of-life care. The government said the pilots would test whether neighbourhood models can support earlier intervention, reduce avoidable hospital admissions and help people remain independent for longer. The schemes are being delivered with Macmillan Cancer Support and Social Finance, a not-for-profit organisation and investment adviser, which works with the government and voluntary sector. Macmillan has committed £250 million to neighbourhood health across the UK over the next five years and intends to invest in the six pilot sites. 14

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NHS DOCTO BLUEPRINT USE IN HEA ISSUES SAF ADOPTION

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N INDEPENDENT expert commission led by doctors working in the NHS has published its blueprint for the regulation of AI in healthcare. The recommendations were made following extensive public, professional and industry engagement. The National Commission into the Regulation of AI in Healthcare found there is broad public support for AI when used to improve healthcare. But strong safety standards, human oversight and transparency whenever AI is used is also essential. “We innovate because we believe tomorrow’s healthcare can be better than today,” explained Alastair Denniston, chair of the National Commission, who is an NHS consultant ophthalmologist and professor of regulatory science and innovation at the University of Birmingham. “But any new innovation – including AI – needs to earn its place and earn our trust. These technologies need to show that they are safe, effective and bring benefits to patients, staff and the wider NHS, without leaving people behind.” Established by the Medicines and Healthcare products Regulatory Agency (MHRA) in September last year, the independent National Commission sought input from more than 12,000 people over the course of a year. This included patients,

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se those opportunities ern, dynamic regulatory ccelerates safe adoption, and commands public and dence.”

The National Commission has highlighted four key recommendations to strengthen the regulation of AI in healthcare to enable it to remain safe, keep pace with innovation, and continue to earn people’s trust. First, faster access to safe and effective AI. The introduction of staged authorisations for new AI models, similar to L-plates for learner drivers, would facilitate earlier patient access to promising new AI models. Next, continuous monitoring through AI device’s lifecycle – the independent commission recommends that AI-enabled medical devices should be subject to continuous, real-world monitoring throughout their working life. “We are particularly pleased to see specific support for monitoring of AI-enabled medical devices once they are in use,” said Stephen Harden, president of the Royal College of Radiologists, one of the organisations that contributed evidence to the Commission. “Getting this right will give doctors confidence to use AI tools, while protecting patient safety.” Third, public access to safety information. Members of the public should be able to easily search for information about the safety of specific AI-enabled medical devices. This would build on tools such as the MHRA’s interactive Drug Analysis Profiles, and would

give patients and the public clear, accessible information they can trust. And fourth, tougher powers to protect patients – the independent commission has recommended the introduction of stronger powers for the MHRA, including enhanced enforcement powers, to ensure that where AI systems fall short of the standards that patients expect, the regulator can act decisively. The Professional Standards Agency and 38 health and social care regulators have newly released a statement of intent in response to the National Commission’s recommendations. They will jointly develop a set of high-level principles to guide how they will regulate the use of AI by health and social care professionals across the UK. Bernie O’Reilly, registrar and chief executive of the Health and Care Professions Council said public trust will be “essential” if the benefits of AI are to be realised. “People should be able to understand when AI is being used in their care and have confidence that professionals can explain how it has informed decisions affecting them. Health and care professionals remain responsible for the decisions they make, regardless of whether AI has been used to support them,” she added. The government and the MHRA have said they will carefully consider the National Commission’s recommendations, and a formal response will follow in due course. NEWS

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RAPID GENOMIC TEST TO SPEED UP BRAIN TUMOUR DIAGNOSIS

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HOUSANDS of patients with suspected brain tumours could get a diagnosis and start treatment sooner as the NHS trials a rapid genomic test in five specialist centres before access is expanded further across England. The rapid genomic test was developed by scientists and medics at the University of Nottingham and Nottingham University Hospitals NHS Trust (NUH). It works by quickly analysing the DNA or genetic code of a small tumour sample taken during biopsy or surgery, to help doctors identify what type of brain tumour a patient has. NHS England’s pilot builds on a smaller trial that is already underway in Nottingham and Birmingham. In a recent operation at NUH, a tumour sample was taken in theatre and tested in the same hospital. The sequencing took around 20 minutes, with a result fed back to the surgical team less than two hours after the sample reached the laboratory – while the surgery was still under way. The rapid result gave the team an early classification of the tumour, with further analysis providing a fuller

by Julie Penfold, Senior Writer molecular diagnosis within days rather than the weeks patients can currently wait. “For people with suspected brain tumours, getting the right diagnosis quickly can feel like a race against time, while waiting for answers can be agonising for them and their families,” said Frankie Swords, national medical director for NHS England and the department of health and social care. “This remarkable rapid test has the potential to completely transform how we diagnose brain tumours, with results reaching patients in a matter of days rather than weeks,” she explained. “This is a huge leap forward for patients – a faster diagnosis means they can start the right treatment or access clinical trials sooner, while for some patients it could mean surgeons can make potentially life-changing decisions about their surgery while on the operating table.” Yvette Cooper, health and social care secretary, described the technology as an “incredible breakthrough” and said it provides “vital genetic information to surgeons within a matter of hours or days” to enable them to offer the

“most effective treatment to patients faster than ever”. She also gave recognition to the UK’s “world-leading” life sciences sector and its strength in genomics that enables NHS patients to be “routinely among the first in the world to benefit from these kinds of innovations”. The first phase of the pilot will introduce the testing across five NHS trusts: University Hospitals Birmingham, Nottingham University Hospitals, Great Ormond Street Hospital for Children, King’s College Hospital and Newcastle Hospitals. Additional genomic laboratory sites in Bristol, Oxford, Leeds and Manchester will introduce the testing in the second phase. Stuart Smith, consultant neurosurgeon at NUH and clinical associate professor at the University of Nottingham, was part of the team that developed the rapid genomic testing. He described the ability to have detailed information about the tumour at the point when decisions are being made in the operating theatre as “game-changing”. He added: “This gives us a glimpse of how brain tumour surgery could change in the future – with genomic information available during the operation itself, helping us make more informed decisions for each individual patient.” NEWS

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NEW INSTITUTE OF ROBOTIC SURGERY OPENS IN NORWICH TWO da Vinci surgical robots unveiled at the opening of the Norfolk and Norwich Institute of Robotic Surgery at Norfolk and Norwich University Hospitals NHS Trust will help to advance healthcare, train future surgeons and improve patient access to innovative, minimally invasive treatments. The names of the new robots were selected through a competition involving schools in Norfolk. The two names chosen were Renew, suggested by Norwich School, and Curiosity, suggested by Horsford Mill Lane Primary School. The new Institute brings together the Trust’s robotic surgery programme, providing a centre for innovation, training and enhanced patient care. The £2.8 million investment is already helping more patients to benefit from less invasive procedures, reduced pain and faster recovery times, the Trust said. Rachel Backshall is director at Norfolk and Norwich Hospitals Charity, and thanked supporters for their generosity, which has helped to make the Institute possible: “The opening of this Institute marks an exciting new chapter for healthcare in Norfolk,” she said. “Seeing the passion, expertise and innovation behind this programme has been truly inspiring, and it’s remarkable to see what has been achieved thanks to the support of the local community.” Backshall added that the opening of the Institute “is a proud moment”. The charity is now fundraising for a further £160,000 to help fund a fifth robot “and expand access to this lifechanging technology for even more patients”, she said.

HIGH SOY INTAKE IN CHILDHOOD AND ADOLESCENCE COULD REDUCE BREAST CANCER RISK

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by Julie Penfold, Senior Writer

HIGH intake of soy products in early life is associated with lower mammographic density in adulthood, a wellestablished predictor of breast cancer risk. The study, led by the Chinese University of Hong Kong and funded by the World Cancer Research Fund, assessed the lifetime soy intake of 815 healthy premenopausal women aged 35-45 across four life stages: current intake, young adulthood (20-34 years), adolescence (13-18 years) and childhood (6-12 years). All study residents were based in Hong Kong. Soy foods such as tofu, soy milk and other soy-based products are a common component of traditional Asian diets. Researchers found women consuming a high intake of soy products during early life had a 6% lower breast density than those with consistently reduced intake in childhood and adolescence. The proportion of dense breast tissue seen on a mammogram (mammographic density) is a well-established predictor of breast cancer risk. As well as taking mammograms, the researchers assessed soy consumption using a validated soy food frequency questionnaire covering 32 soy products. “Our findings suggest that lower soy consumption earlier in life, particularly during childhood and adolescence, is associated with lower breast density in adulthood,” said Suzanne Ho, emeritus professor of epidemiology and public health at the Chinese University of Hong Kong, who led the study. “As we did not see the same association for recent soy intake, it points to early-life exposure as a potentially important window for breast tissue development in later life.” She added: “This study adds to evidence suggesting that the timing of exposure to soy foods may matter. More research is needed to confirm these findings and understand whether modifying early-life soy intake could contribute to breast cancer prevention.” Dr Giota Mitrou, executive director of research and policy at the World Cancer Research Fund, said the study “adds to our understanding of how exposures across the life course may shape cancer risk”. The study also “raises the possibility that breast tissue may be particularly susceptible to dietary influences during specific developmental windows”, but added that further research is needed into dietary patterns in different population groups. NEWS

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HOSPITAL DISCHARGE CONTRIBUTED TO DEATH OF YOUNG MOTHER

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HOSPITAL’S decision not to admit a young mother who died from pneumonia less than 24 hours later contributed to her death, an inquest has found. The 25-year-old woman, from Chesterfield, died on 19 May 2023, after she was discharged from Chesterfield Royal Hospital. She had attended the hospital the previous day after becoming increasingly unwell with breathing difficulties, chest pain, a painful and swollen throat and a high temperature. Her GP had referred her to A&E for urgent assessment. The inquest heard that she was displaying signs that could indicate sepsis and should have remained in hospital for monitoring and intravenous antibiotics. However, rather than being admitted, she was given the option of returning home with oral antibiotics, which she accepted. The woman collected her car from her GP surgery and returned home but subsequently became acutely unwell. She was confused and had difficulty recognising her partner

by Katie Heslop, Senior Writer and 11-month-old son. She then stopped breathing while sitting on the sofa at home. Her partner called an ambulance and performed CPR before paramedics arrived, but she could not be saved. Slater Gordon, the law firm which represented the woman’s family, said the hospital’s initial internal investigation concluded the decision to discharge her had been appropriate, and an initial inquest was closed. Following a legal challenge by the family, however, the Chesterfield Royal Hospital NHS Foundation Trust admitted the decision had been inappropriate, and the woman should have been admitted for further observations. The inquest reopened in February. The assistant coroner for Derby and Derbyshire, Anita Davies, said the woman’s vital signs had been significantly outside normal ranges three hours before she was discharged and that she had a very high CRP result, alongside a high heart

rate, temperature and respiratory rate. She found that if the woman had been admitted and given appropriate intravenous antibiotics, it was more likely than not that she would have survived. “The decision not to admit [the woman] to hospital on the evening of May 18, but rather to offer her a choice between admission or return home, contributed to the death,” Davies said. Solicitor Rebecca Dowse represented the family. “They have had to endure not only the devastating loss of a much-loved daughter and mother, but also years of uncertainty while trying to understand how such a tragedy could occur,” she said. Following the inquest, medical director of the hospital trust Kevin Sargen said the trust accepted the coroner’s finding, and staff have since undertaken a “thorough review” of the circumstances surrounding the woman’s care. Improvements aimed at strengthening patient assessments, escalation and clinical decisionmaking have been put in place. Sargen again expressed his sincere condolences to the family. NEWS

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LEARNING FROM SUICIDE-RELATED COMPENSATION CLAIMS NHS Resolution has published a new thematic review examining suicide-related compensation claims made against mental health trusts in England. It identifies recurring themes associated with claims, with communication challenges emerging as a cross-cutting issue affecting patient care, family involvement and organisational learning. “Through this review, we have sought to understand what compensation claims can tell us about the challenges healthcare organisations face when caring for people at risk of suicide,” said lead author Louisa Bradley, safety and learning lead (North) at NHS Resolution. “While many of the contributory factors identified in our 2018 review remain evident, particularly around 22

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communication, family involvement and risk assessment, this updated analysis provides a deeper understanding of the organisational, leadership and system conditions that can undermine safe and effective care,” she continued. It analyses 960 suicide-related claims received by the Clinical Negligence Scheme for Trusts (CNST) between 2018 and 2025, alongside a detailed qualitative review of a representative sample of cases. The report finds that family engagement was absent in more than three-quarters (76%) of cases reviewed. Issues with risk assessment implementation were identified in 86% of cases, and delays in

assessment were identified in 32% of claims analysed, often linked to unclear referral pathways, poorly defined roles, capacity pressures and lack of local guidance. Poor communication between staff was also identified in 68% of claims, including issues related to handovers, record-keeping and escalation processes. “A collaborative approach involving patients, their families and significant others, and clinicians is essential for compassionate care and safety, enabling real learning and improvement when things have gone wrong,” said Dorit Braun, chief executive of non-profit Making Families Count, which aims to bridge the gap between healthcare services and traumatically bereaved or seriously harmed families.

UCL AND BRISTOL START-UP PARTNER TO PREVENT CHILDHOOD SIGHT LOSS

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ESEARCHERS at the University College London (UCL) Great Ormond Street Institute of Child Health are joining forces with Bristol-based start-up Siloton on a project that will use groundbreaking new eye technology to help prevent sight loss in children. As part of the project, UCL’s child health team will have access to one of Siloton’s pioneering optical coherence tomography (OCT) systems, and this will be modified for children’s use. OCT is a safe imaging method that uses light to create detailed pictures of the inside of the eye, helping clinicians to identify a range of health conditions and monitor their progress. Currently, its use is limited because existing systems are large, expensive, and are typically only available in hospitals and optometry centres. Where Siloton’s Akepa device differs is that it compresses a tabletopworth of heavy, expensive and fragile components onto a single chip smaller than the size of a £1 coin. It’s been designed to work as part of an easyto-use binocular-style system that makes the diagnosis and monitoring

by Julie Penfold, Senior Writer of treatable eye conditions more affordable and accessible. A cohort of adult patients successfully trialled the technology last year. “The work we have done at the UCL Great Ormond Street Institute of Child Health and at Great Ormond Street Hospital (GOSH) has shown how transformational imaging can be, improving patient outcomes, and patient and family experience,” said Lola Solebo, professor of paediatric ophthalmology and epidemiology at UCL, and a consultant paediatric ophthalmologist at GOSH. “We want to bring this life-changing technology into children’s homes.” The OCT system will be adapted physically and interactively to make it suitable for young patients. Among the changes, the device’s lenses will be tuned to focus on the right place within children’s eyes, and the casing will be better shaped to their faces to prevent light from affecting the imaging process. Alasdair Price, the co-founder and chief executive of Siloton, said

the company’s patient focus had previously been adults, as age-related macular degeneration is the leading cause of sight loss in the UK. “But the fundamental principles of imaging the eye are the same, and with the right adaptions, Akepa can work just as effectively for children,” he explained. “Imaging children’s eyes presents different challenges, but the chip-based system we’ve developed could make it easier to capture high-quality images quickly and comfortably.” He added that making it possible to image outside of a hospital environment could reduce disruption for families and free up clinician time. “Children can experience a wide range of eye conditions – from diabetes-related issues to inherited diseases and even signs of brain tumours that first appear in the optic disc,” Price said. “By looking at ways to adapt Akepa to paediatric clinical practice now, UCL and GOSH is paving the way for a future where children can benefit from faster imaging, better monitoring and remote assessment.” NEWS

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HOSPITAL MATERNITY SERVICES COULD BE MOVED IN NORTHERN IRELAND by Katie Heslop, Senior Writer

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IRTHS and inpatient maternity care at Daisy Hill Hospital in Northern Ireland could be temporarily moved because of staff shortages. The Southern Health and Social Care Trust said it was facing significant workforce pressures following a number of consultant obstetrician retirements and resignations. Despite sustained recruitment efforts across the UK and internationally, the Trust has not yet been able to recruit enough consultants to fill the vacancies. It said its intention remained to maintain inpatient maternity services at Daisy Hill, with the safety of women and babies its “overriding priority”. However, it is now developing a contingency plan, which would involve moving the services to Craigavon Area Hospital, 21 miles away. As part of the plans, the trust would look at changes needed at both hospitals and the capacity required at Craigavon to accommodate additional births. It would also consider the provision of appropriate obstetric support for the emergency department at Daisy Hill. Trust chief executive Steve Spoerry said health minister Robbie Butler had asked the wider health and social care system to explore what support could be provided to help maintain services at Daisy Hill.

The trust is continuing recruitment while working with health service partners to explore other options. Spoerry said it was “responsible and necessary” to develop a contingency plan while those discussions continued. Speaking to BBC Radio Ulster, Spoerry said it was “more likely than not” that maternity services would move, but it was “not quite a done deal.” He said the trust was providing the update because it was committed to communicating “openly and transparently” with pregnant women, staff and the wider public. Beverley Adams, divisional medical director for maternity and women’s services, said staff had worked additional hours and made every effort to maintain services at both hospitals. However, she said recent staffing changes had placed the service under “significant pressure”. “Additional support is required if inpatient maternity care is to continue

safely across both sites,” Adams added. She said the trust recognised the announcement “may cause concern”, but its responsibility was to ensure every woman had access to safe and responsive maternity care. The Trust said it would continue to keep pregnant women and staff informed as the situation develops. In the last year, 1,713 babies were born at Daisy Hill Hospital and 2,768 at Craigavon Area Hospital. The situation at Daisy Hill is a result of inadequate long-term workforce planning and difficulties recruiting and retaining doctors in Northern Ireland, said Clodagh Corrigan, of the British Medical Association’s Northern Ireland Council. Corrigan called for greater transparency and meaningful consultation with doctors and staff before decisions are made about service changes. She added that the abrupt nature of the announcement causes “unacceptable staff anxiety and uncertainty”. NEWS

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REDEF TRAIN

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HEN the Roya Ophthalmolog SpaMedica w quarters of all sector catarac placements in England, it marke in the evolution of NHS workforc began as a temporary response backlogs has evolved into a vita education, with SpaMedica now across every English NHS deane

But as chief medical officer Alex that expanding surgical capacit part of a much larger equation. health inequalities in socioecon regions to upskilling high-street and establishing the first indepe undergraduate training framew England, eye care requires sy reform.

Here, he speaks to Hea about why training m patient choice, the independent secto on cataract surge term NHS partne safeguarding th workforce.

You’re now d 75% of indep cataract tra in England. W tell us abou ophthalm Britain?

While inde step SpaM 26

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EX SILVESTER:

FINING OPHTHALMOLOGY NING FOR A MODERN NHS

al College of gists said that was delivering threel independentct training ed a key moment ce delivery. What e to rising surgical al pillar of clinical w hosting trainees ery.

x Silvester argues ty is only one . From tackling nomically deprived t optometrists endent-sector work with NHS systemic, long-term

althcare Today must follow myth of the or’s over-reliance ery, and how longerships are key to he future ophthalmic

delivering around pendent-sector aining placements What does that ut the state of mology training in ?

e I hope to see other ependent providers pping up to do more, Medica has been

SpaMedica’s chief medical officer says that addressing the UK’s ophthalmic capacity crisis requires more than clearing cataract backlogs, it demands a long-term strategy for workforce development and health equity. Written by Adrian Murdoch.

pushing for years to bring trainees through our doors. We faced initial obstacles simply because it had never been done before, but we are now in a fantastic position, welcoming significant numbers of trainees with every new rotation. Rather than indicating a failure in NHS training itself, I view this shift as a direct reflection of patient choice. Over the past four to five years, patients have increasingly exercised their right to choose where they receive care, leading to a noticeable shift from traditional NHS trusts to independent providers. If that is where patients are choosing to go, it makes total sense for clinical training to follow. As healthcare providers, we have a clear duty to help train the next generation of ophthalmic surgeons. Trainee doctors should have ample learning opportunities across every environment where patient care is delivered, including the independent sector – especially if those are settings where they may ultimately choose to practice in the future.

independence – whether that means driving in their 70s, pursuing hobbies, or staying active in the workforce. There was a time when people accepted fading eyesight as an inevitable consequence of ageing, but today there is far greater awareness that cataracts can be safely and effectively treated. However, demographic growth is only part of the equation. We are still seeing patients present with highly complex, advanced cataracts, largely due to systemic bottlenecks in primary community care. In less affluent regions, there are fewer community optometrists available, making access to initial assessments significantly more difficult compared to wealthier areas where commercial optical practices thrive.

How much of the pressure on ophthalmology is just being driven by demographics?

Addressing that health disparity is a major priority for us. Many of our hospitals – such as those in Liverpool, Birmingham and Bolton – are deliberately located in areas that face high levels of socioeconomic deprivation. Historically, patients in these communities presented late with hypermature cataracts, often because they simply did not realise treatment was an option.

Demographics are certainly playing a major role. My sub-speciality interest is in public health, and the reality is that we are all living longer. Crucially, the conversation has now shifted toward living better. People today want to maintain their

Late presentations directly lead to poorer surgical outcomes. Operating on an advanced cataract requires significantly more energy inside the eye and takes longer to complete, which increases the risk of post-operative inflammation and INTERVIEW

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complications. Modern clinical evidence – and official NICE guidance – strongly supports intervening as soon as a cataract begins to impair a patient’s quality of life, whether that is difficulty driving or caring for grandchildren. The old clinical ethos of waiting for a cataract to ripen is completely outdated; early, proactive treatment leads to vastly superior patient outcomes.

Our focus is now shifting toward the devolved nations, where some of the most acute pressures exist.

Where is the shortage? Is it just that we need more ophthalmologists?

There is certainly a risk if you take a narrow view. A few years ago, there was a heavy spotlight on doctor training and surgical procedure numbers – a focus reflected in GMC reporting – and I am delighted to see progress on that front. But surgical capacity relies on far more than just doctors.

If you look at reports from the Royal College of Ophthalmologists, their clear message is that we need more ophthalmologists and a greater expansion of training places overall. I fully agree with that assessment. While cataract surgery is the most frequently performed elective procedure in Europe – and serves as a foundational skill for any eye surgeon – the doctor shortage impacts the entire field. Conditions like glaucoma, for example, carry a real risk of irreversible blindness if clinic capacity and specialist availability fall short. From a cataract training perspective, the primary hurdle was simply aligning training capacity with patient flow. Trainees need to be stationed wherever patients are receiving care, and the system is now catching up. The latest GMC national survey highlights that progress: three years ago, only 30% of year-three ophthalmic trainees were achieving their required cataract procedure targets, whereas today that figure stands at over 70%. There is still more to be done, but I am exceptionally proud that 160 trainees joined SpaMedica this August for six-month rotations. We now host trainees across every single NHS deanery in England, including London, which was the final region to integrate independent sector placements into its rotations. 28

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Is there a risk that we focus on producing more surgeons without addressing the other bottlenecks – theatres, nurses, equipment, consultants and follow-up capacity – that determine how many cataract operations can actually be delivered?

There is often an underlying fear that when an independent provider opens a facility, we simply poach staff from local NHS trusts, failing to create genuine net-new capacity. We actively avoid that model. A clear example of this is our hospital located down the road from Moorfields Eye Hospital, where not a single member of our nursing team was recruited from Moorfields. Instead, we hire clinicians from nonophthalmic specialities or recruit high-street optometrists and upskill them in-house to perform intravitreal injections, laser procedures and complex diagnostic clinics.

are uniquely positioned to detect broader systemic conditions like hypertension and diabetes through routine ocular exams. Upskilling and empowering community optometry is essential if we are to relieve pressure across the broader healthcare ecosystem. There is much criticism of independent providers that they have an over-focus on cataract surgery. Is that a myth?

That approach builds true, additive capacity rather than merely redistributing existing NHS staff.

It is a complete myth, and I think people simply aren’t fully aware of the breadth of services we deliver across the independent sector.

Beyond our own workforce, we invest heavily in upskilling community optometrists through regional training and outreach initiatives, even if they never work directly for SpaMedica. Primary care discussions in Parliament often focus on GPs and community pharmacies – such as the Pharmacy First scheme – while overlooking the vital role of optometrists. As the frontline of eye care, optometrists

At 25 of our hospitals, we deliver age-related macular degeneration (AMD) treatments within 48 hours of referral – well within the national guidelines. AMD is a condition where delay means permanent vision loss, yet official Royal College reports show that in many parts of the country, patients are still not being seen within the target two-week window. We are actively stepping in to fill those critical NHS

capacity gaps, stabilising patients’ sight and expanding provision wherever we can. Our work extends into specialised tertiary screening as well. A prime example is our hydroxychloroquine screening service. Hydroxychloroquine – a drug commonly prescribed in rheumatology and dermatology – requires specialised ocular monitoring to detect early retinal toxicity. High-street optometrists lack the specialised equipment to perform these checks, while NHS hospital trusts lack the capacity to screen otherwise healthy, asymptomatic patients. Is independent sector involvement in surgical training a permanent shift in NHS workforce delivery or is it a temporary relief for backlog? We are unequivocally a longterm solution, not a temporary fix. Independent sector partnership within the NHS is hardly unprecedented – high-street optometrists and GP surgeries

are private entities delivering NHS-funded care, and no one suggests dismantling those models. Independent providers add durable, high-quality capacity to the health service. We bring private capital to build state-of-the-art facilities in underserved communities that have lacked local access for years. Beyond official registrar rotations, we support under-recognised groups of clinicians, such as specialist, associate specialist, and speciality (SAS) doctors. Many of these overseas-trained doctors require high-volume surgical exposure to complete their portfolio pathway (formerly CESR) to attain full consultant status. Training is precisely what transforms a contractual relationship into a true, long-term partnership. If we were merely cherry-picking simple cases, critics might have a point. Instead, we manage complex cataracts through specialised pathways I have developed over the past five years, while actively training the next generation of surgeons.

If you could change one thing about the way ophthalmologists are trained in England, what would it be? If I could change one thing, it would be moving away from the transactional nature of current surgical placements. At present, trainees often attend our facilities one day a week solely to operate. While building up procedure numbers is vital for surgical confidence, becoming an exceptional surgeon requires far more than technical proficiency in the operating theatre. I would like to see training rotations evolve so that trainees manage the entire patient pathway, including pre-operative consultations and post-operative follow-ups. Although cataract complication rates are exceptionally low, learning how to assess patients beforehand and manage any post-operative issues is essential for holistic clinical development. INTERVIEW

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PROGRESS IN MYE

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N THE surface, progress in myeloma treatment is a huge success story. In the past 30 years, the treatment pathway has been completely transformed, moving from no bespoke treatments to a range of different drugs and combinations that can be given across multiple lines. More people are living longer, and many are living better than ever before. Yet, myeloma remains incurable, and life expectancy still lags behind many other cancers, with only a third of people living for ten years or more following diagnosis. Treatments have also become more intensive and continuous, meaning the burden of treatment is too high for too many people. The system that brings innovation to patients is also too slow and uneven. People with myeloma still face delays in access, restrictions on treatment choice, and unfair differences in care depending on where they live. There is so much more that needs to be done to make the hope for a cure a reality for people living with myeloma. Unfortunately, today’s health innovation and access system is not keeping pace with the changes we urgently need. Policy is too fragmented, and ambitions across research, regulation, and assessment are too often disconnected. As a result, the UK is falling behind other countries in adopting newer, more patient-led treatment approaches and in approving and using myeloma treatments. The UK needs to be an attractive place in which to research and launch new medicines to secure faster access to innovation. Recent health policy changes, including the increase in NICE thresholds and

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the government’s commitment to invest in medicines, should help with this. However, our processes for approving and implementing new treatments and taking innovations from clinical trials to clinical practice are fragmented, complex, and require a lot of time and resources. This can lead to delayed or cancelled launches. In myeloma, CAR-T cell treatments are a good example of this. These treatments could be transformative for patients, delivering deep, durable responses while giving them highly valued time off treatment. They are licensed in the UK and have been available in parts of Europe for nearly five years, yet they are not available on the NHS. We need a more joined-up approach and a clear access-to-medicines strategy to ensure that research and drug access systems work in harmony and deliver better access to treatment innovations. Getting innovative drugs approved for use on the NHS is only one step towards faster, fairer access. In myeloma, we have had several

Caroline Donoghue, acc cancer charity Myeloma that are needed for peop most effective drug treatments approved, but around half of these have come with restrictions that limit their use to specific groups and lines of treatment. These strict rules can block the option that best fits the patient and have resulted in a complex, inflexible pathway shaped by process and commercial pressures rather than by patient need or clinical judgement. Myeloma is a highly individual cancer, and treatment options depend on risk status, past treatment, the risk of side effects and overall health. The complex nature of myeloma means the restrictions on use can leave some groups of patients without options or having to settle for a harsher, less effective treatment. If we want to give all patients the best chance, treatment pathways must

ELOMA TREATMENT of life is often overlooked when new treatments are being developed.

What needs to change? Innovators must focus on improving, as well as extending, people’s lives. STEP 3: What’s the problem? Myeloma affects each person differently, yet access pathways still rely too often on a one-size-fits-all model. If we want to find a cure for all patients, we cannot accept this lack of differentiation.

What needs to change? Treatments must be tailored to individual patients.

ccess manager at blood a UK, gives the five steps ple to have access to the gs and treatments. become more flexible and more patient-led. In recent years, we have also seen growing inequalities in access to newly approved treatments. Truly innovative treatments or treatment approaches often come with different side-effect profiles, new testing requirements and administration protocols that need to be rolled out in already stretched and sometimes underfunded clinics. We have already seen this with new bispecific antibody treatments. They can cause serious side effects when patients start them, so some hospitals need specialist training, additional resources and funding for setup before they can offer them. Myeloma UK launched the Closer to a Cure report to highlight these issues and remove the barriers preventing people from gaining

timely access to the most effective drugs and treatment approaches. Built on three decades of insight, the report sets out the five urgent steps needed by government, industry and policymakers to bring us closer to a cure and ensure everyone can access the treatments they need, when they need them.

STEP 4: What’s the problem? Strict eligibility rules and outdated restrictions often stop clinicians from using the treatment that best fits the patient’s needs. As a result, too many patients are excluded from or miss out on new treatments and have to settle for substandard treatments with reduced effectiveness and increased side effects.

Five steps

What needs to change? Treatment pathways must become more flexible and more patient-led.

STEP 1: What’s the problem? The system that approves medicines in the UK is fragmented, long and complex. As a result, the UK is falling behind other countries in approving and adopting new myeloma treatments.

STEP 5: What’s the problem? The approval of a drug by NICE means little if local barriers delay rollout of a treatment to a particular trust, hospital or region and lead to patients missing out on the most effective treatment.

What needs to change? We need research and drug access systems to work in harmony to deliver better access to treatment innovations.

What needs to change? Approved treatments must reach patients quickly and fairly.

STEP 2: What’s the problem? Many people with myeloma spend years on continuous treatment and live with serious side effects, repeated hospital visits and constant disruption to daily life. Yet, quality

These changes are achievable, but we need to act now. Progress will only come if everyone involved in getting drugs approved works together and prioritises what patients want: longer lives, a better quality of life and more personalised choices. FEATURE

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ORAL WEIGHT-LOS TREATMENTS COU CREATE A COUNTER CHALLENGE

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N JUNE, the Medicines and Healthcare products Regulatory Agency (MHRA) approved the UK’s first GLP-1 receptor agonist tablet for weight loss and management, marking a significant development for patients. Demand is expected to be high as the tablets are rolled out, with roughly 2.5 million adults already using weight-loss injections in the UK. But that demand is also raising concerns around counterfeiting. A huge number (97%) of pharmacies are worried that its introduction could lead to an increase in fake or unlicensed weight-loss pills being sold via unauthorised channels. There is good reason for that concern. Counterfeit Ozempic injectables have already demonstrated criminals’ willingness to exploit demand for weight-loss treatments, and tablets could make that opportunity easier to scale. Unlike injectable pens, which involve complex delivery mechanisms, coldchain requirements, and greater manufacturing precision, tablets are typically easier to manufacture, package, and distribute through conventional retail and delivery channels. As oral treatments become more widely available, particularly if they

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are cheaper and easier to access than injectables, criminal networks have a clear incentive to follow demand and take advantage of both online and physical distribution channels. Counterfeit medicines can pose an immediate risk for patient safety. A fake tablet offers no reliable assurance about what is inside it. It might contain the wrong dose, the wrong compound altogether, or harmful contaminants never intended for human consumption. The consequences can range from ineffective treatment to serious, long term health effects. There is also a wider societal impact. Organised crime groups that profit from fake products, including weight-loss pills, are often linked to other illicit activity such as money laundering and drug trafficking, meaning the harm extends beyond the individual who unknowingly consumes a counterfeit pill. Reducing the opportunity for counterfeit medicines to enter circulation therefore protects both patients and legitimate supply chains from criminal activity. Counterfeiting a medicine does not necessarily mean recreating an entire legitimate manufacturing process. Criminal networks have

Heather Clarke-Hit Authentication, says medicines is helped integrated into the supp several routes available to them. Falsified pharmaceuticals can be produced in unregulated laboratories using imported raw materials mixed with other substances, before being packaged and labelled to resemble the real product. Others may be genuine medicines stolen or diverted from legitimate distribution channels and then resold illegally. Packaging and documentation are part of the deception. Counterfeiters use fake labels, certifications, invoices, and customs declarations to disguise where products have come from, while falsified prescriptions can be used to obtain genuine medicines for illicit resale. In some cases, substandard or falsified medicines are simply relabelled under the name of a legitimate pharmaceutical brand. They then need routes to market. Online marketplaces and social media are already significant channels for counterfeit pharmaceuticals, alongside websites

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e, director at Crane s that verification for when measures are ly chain from the outset. designed to appear legitimate. Physical distribution can be equally difficult to detect, with tablets moved internationally and delivered through couriers and postal services. Counterfeiters can also break larger consignments into smaller parcels to make customs detection more difficult. For oral weight-loss treatments, that combination is significant. A product that can be packaged and transported as tablets potentially fits readily into many of the distribution methods criminal networks already use for illicit pharmaceuticals. As demand increases, the challenge is therefore not just identifying where obviously fake medicines are being sold, but preventing falsified, diverted, or illegally distributed products from appearing credible enough to reach patients. Because counterfeiters imitate genuine products with such sophistication, one of the difficulties is

that appearance alone is becoming a less reliable guide to authenticity. That places an unrealistic burden on consumers and pharmacists. Instead, pharmaceutical companies need ways for genuine products to demonstrate authenticity throughout the supply chain. Physical security features can form part of that approach by introducing elements that are more difficult to reproduce than conventional printing alone. For example, technologies such as micro-optics can create distinctive, visual 3D labels that are exceptionally difficult to replicate. It is equally important that any unique authentication feature on a product can’t be removed. Criminals may attempt to harvest a genuine security label from legitimate packaging and apply it to a counterfeit product. However, tamper-evident, heat-shrinking technology means a label can visibly contract and distort when exposed to the heat from an attempted harvest, rendering it useless when removed. Traceability measures add another layer of trust by helping manufacturers and pharmaceutical brands understand where a product has been and how it is travelling through the supply chain.

If brands are able to apply secure unique identifiers to each legitimate product, they can capture movements and events throughout the chain. A verifiable product history and centralised data can enable tracking from the production sites through every stage of distribution, stopping counterfeits from entering established legal distribution channels and flagging any incidents of diversion before the medication reaches a consumer. The growth of oral weight-loss treatments can significantly improve access for patients, but it also changes the counterfeit risk facing pharmaceutical brands and supply chains. Protection shouldn’t just happen after individual fake products appear. Combining physical authentication with product-level traceability can make genuine medicines easier to verify and give brands greater visibility over where products are moving and where risks are emerging. The key is to integrate measures into the supply chain from the outset. By doing so, organisations can help reduce opportunities for counterfeiters, protect legitimate distribution channels, and, most importantly, help ensure patients receive the treatments they expect. FEATURE

33

HEALTH VISITORS A PROFESSION HAS

E

ILEEN PERRINS, perinatal and infant mental health lead at the Institute of Health Visiting, has witnessed seismic changes to her profession in the past

decade.

Before joining the institute this year, Perrins was on the front line, first as a general health visitor, meeting new mothers and babies in their homes, and then going on to support those particularly struggling with their mental health. But the job is not what it once was. Here, she talks to Healthcare Today about her experiences. How has health visiting changed since you began your career? The profession has been decimated over the past ten years. In 2015, 11,192 health visitors worked in England. But as of last year, there were an estimated 6,649, which is a 41% decline. You can’t lose that number of health visitors without seeing a significant difference in what we can offer to families. Some health visitors are holding caseloads of up to 1,100 families, and that’s not safe. I’ve seen fantastic practitioners leave the profession due to burnout. They’re not able to offer the public health role they were trained to provide. Health visitors are skilled and competent and can make such an impact on families, but now it’s more like firefighting. We haven’t got the numbers to deliver the Healthy Child Programme, the national framework for improving the health and wellbeing of children and young people. The most recent State of Child Health report shows a stark landscape for the future. For example, the proportion of 34

INTERVIEW

As health visitor numbers drop by 41% in a decade, Institute of Health Visiting’s Eileen Perrins talks about unsafe caseloads and postcode lotteries in care. Written by Katie Heslop. eight to 16-year-olds with a probable mental health disorder is at 20%, up from 12.5% in 2019. And it’s entirely predictable. We’re not doing early intervention in the way that is needed, and the problem is being kicked down the road, leaving teachers, for example, to pick up problems they’re not trained to address. The idea that a family would see the same health visitor every time now seems like a myth, doesn’t it? That’s really sad to hear. When I started, you had a caseload, and you knew your families. You would see the child from ages zero to five. And then you might see the family again for their next baby, and you would already have a relationship with them. That meant it was easier to spot if the mother was struggling with her mental health after the birth. Health visitors can sit with people in their emotional distress and offer support, which can prevent the problem from escalating or the need for secondary care. But you need time and consistency to build that relationship. We act as the trusted health professionals, as others come and go. Your midwife is very important, but you are then discharged from their care days or weeks after giving birth. However,

the highest rate of perinatal suicide is between six weeks and 12 months, and that’s when your health visitor is still there. So that ongoing relationship is crucial. In some areas, that has been lost, and great health visitors are leaving because of it. We used to have people who would retire and then return part-time because they were so passionate about the job. Now they don come back.

Why is there a discrepancy between the services on offer in different areas

In 2015, responsibility for commissioning health visiting services was transferred from the NHS to local councils. This was done with good intentions, to allow for teams to respond to the different needs within their communities, for example, rural isolation may be a real issue in one place, but smoking might not be such a concern.

However, what we now see is insufficien funding and a postcode lottery for the service on offer. For example, in some areas, if a mother is experiencing postnatal depression she will be offered a package of care, with the same health visitor seeing her on six separate occasions. This can be very effective, bu in some areas, women are not offered it at all. There are pockets of hope. Some

ARE VITAL – BUT THE BEEN DECIMATED

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n’t

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teams that have enough funding are doing fantastic work and can deliver the kind of support I saw when I started. But the offering is different depending on where you live, and it shouldn’t be that way. There needs to be a core offer of care that every family can expect, wherever they live. There’s also a discrepancy in the number of caseloads. In some places, health visitors may be responsible for 205 families, whereas in other areas this soars to more than 1,100. Of course, that is going to impact the quality of care and the support available. What changes would you like to see? We have evidence from the floor to the ceiling about how important investment is in the first 1,001 days of a child’s life. Every month I read a new piece of research that backs this up, but where is the investment in health visiting? We need ring-fenced funding to recruit and train more people. Often, if someone leaves their role, the money for that post is absorbed elsewhere, which isn’t good enough.

s

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e ut t

Health visitors have a universal reach. We go down the dusty farm track. We go to the flats above the high street shops. We see the people who, for whatever reason, aren’t leaving their homes and help them enter the world again. But we need to be given the time and numbers to do the job we were trained for. INTERVIEW

35

A SMARTER ROUTE FROM

D

RUG development relies on thousands of clinical, scientific and operational decisions being made accurately and on time. Study protocols need to be drafted and reviewed, study sites prepared, data checked, safety information assessed and submissions assembled. When these activities become slow or fragmented, this delays the time taken for life-saving treatments to reach patients. AI agents are emerging as one way to reduce this friction. Unlike standalone tools, they can support defined activities across connected workflows, helping teams manage information, complete routine tasks, and respond to changing trial conditions. Their role is not to replace clinical, scientific, or regulatory expertise. It is to give that expertise more capacity by reducing the administrative and coordination burden around it. Current industry data indicates that 75% of clinical trial protocols require at least one substantial amendment. Each amendment can create a ripple effect across documentation, sites, systems and stakeholders, adding time and complexity to an already demanding process. As life sciences organisations look to make development more resilient and scalable, the question is no longer whether AI can support isolated tasks, but how it can be used safely across the wider R&D workflow.

The operational work behind every clinical milestone For healthcare professionals working in clinical development, the delays that matter most are often the ones that accumulate quietly in the background. Protocol development is a clear example. Before a study can begin, teams may work through multiple drafts, reviews and alignments across 36

FEATURE

clinical, regulatory, medical, safety and operational stakeholders. The same applies to study setup. Sites need to be configured, data needs to be prepared, and teams need to coordinate across multiple systems and geographies. Submission preparation adds another layer of complexity, with large volumes of information needing to be turned into precise, compliant artefacts. In each case, the challenge is not a lack of expertise. It is the amount of repetitive, document-heavy work required to keep everything moving. AI agents can help address this challenge by taking on repeatable tasks within clearly defined parameters. They can interpret documents, draw together relevant information and work across digital systems, while operating

Narayanan Rama advanced drug dev Consultancy Service agents are reshaping under controls designed for regulated environments. In practice, this could include supporting protocol drafting, clinical data processing, the creation of submission artefacts, monitoring activities and the identification of patterns across clinical and operational data. This reduces the manual effort required to prepare documents and helps teams surface relevant information faster. AI cannot simply be inserted into a clinical process and left to operate without direction. In drug development,

M TRIAL TO TREATMENT make the best use of highly trained expertise. By taking on repeatable work, AI agents can free people to focus more on judgement, insight and decisionmaking. That means more time can be spent on scientific discovery and identifying risk and opportunity, and less on moving data through the process. There is also a broader workforce implication. Life sciences organisations are under pressure from talent shortages, rising demand, and increasing regulatory complexity. A trusted AI workforce can help create more elastic capacity, especially in areas where expert time is limited, and demand can spike unexpectedly.

aswamy, head of evelopment at Tata ces, explains how AI g drug development every output must be reliable, traceable, and capable of standing up to scrutiny. Effective use therefore requires a clear context of use, defined quality standards, human supervision, and lifecycle controls. This is where an AI agent hub can play an important role. For example, our agentic AI platform is designed to support agentic AI across pharmaceutical R&D workflows, including clinical data management, study build and safety case processing. Its focus on role-based access, auditability, and a Human + AI

That does not reduce the importance of clinical teams. It makes their role more valuable. As AI takes on more routine execution, human expertise becomes even more central in setting direction, reviewing exceptions and making the decisions that shape trial quality and patient outcomes. operating model reflects the wider requirement for AI to operate within established governance frameworks, rather than outside them. For clinical teams, this means retaining responsibility for the decisions that require professional judgement. AI agents may support the execution of defined tasks, but people must continue to set direction, review exceptions and remain accountable for quality, compliance and patient safety.

Making more space for scientific judgement Today, many scientists and clinicians spend much of their time on preparatory and administrative work, such as analysing datasets, standardising them, reviewing reports and managing handoffs. These are essential tasks, but they do not always

Pharma has invested heavily in connected data and digitising clinical research. AI agents offer an opportunity to build on those foundations by linking operational activities more intelligently across the R&D environment. Their value will lie not in acting as an isolated technology layer, but in supporting a governed digital workforce with agents completing specific, repeatable tasks, while people provide the scientific, clinical and regulatory judgement that remains essential. If implemented with the right controls, this model could help life sciences organisations reduce avoidable operational delays and scale development activities with greater confidence, creating a more responsive and resilient route to delivering the essential treatments patients need. FEATURE

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THE LONG TAIL OF DELA Brett Hill, head of health and protection at Broadstone, expects continued innovation across occupational health, private healthcare and workplace health strategies to tackle MSK.

F

OR PEOPLE living with a musculoskeletal (MSK) condition, waiting for treatment can have a huge impact on their quality of life. Pain can worsen, mobility can deteriorate, and a condition that was once manageable can slowly start to make everyday living a challenge. Sadly, the NHS backlog is making this a painful reality for more and more people. In July, the number of people waiting for treatment in England rose to 7.33 million – its highest level in nine months – suggesting that hard-won progress on reducing the waiting list from its postpandemic peak has essentially stalled. MSK conditions are among those hardest hit by delays in treatment. Many issues, such as osteoarthritis, are chronic and progressive, while others, including back and neck pain, which often respond well to quick intervention, can deteriorate and lead to secondary pain in other parts of the body if left untreated. This matters even more against the backdrop of a worsening MSK landscape. The disruption to treatment during the pandemic, increasingly sedentary lifestyles, and rising obesity levels have all contributed to growing pressure on MSK health. The shift towards home working has brought major new challenges, with often poor workstation set-ups and less movement during the working day aggravating existing risk factors.

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FEATURE

The consequences of this are considerable, both for patients and the wider economy. Recent ONS research on MSK waiting times and labour market outcomes puts some stark numbers around the cost of delayed care. The median waiting time for elective inpatient treatment for MSK conditions – from decision to admit to admittance – was more than two months (69 days), rising to almost three months at 83 days for osteoarthritis, which saw the highest median waiting time across all the MSK conditions. More strikingly, longer waits were associated with reductions in gross employee pay that persisted for years after treatment. By the fourth year after first treatment, every additional four weeks of waiting was associated with annual earnings falling by up to £487 for people with joint disorders, £301 for osteoarthritis, £234 for back, neck and MSK pain, and £365 for other MSK conditions. That is a sobering reminder that the cost of delayed care isn’t just the clinical impact on patients, it’s often also the financial impact as they find themselves less able to work, and it can have a long tail. For the wider economy, MSK conditions are one of the main causes of workplace absence, and stand as one of the top drivers behind rising levels of sicknessrelated economic inactivity in recent years.

AYED MSK TREATMENT When someone is unable to access treatment quickly, there is a greater risk that their condition begins to affect their mobility, working hours, productivity and ability to remain in work altogether. For businesses already grappling with the productivity impact of long-term sickness, this is becoming increasingly difficult to ignore. There is some progress in recognising the scale of the challenge. The government’s investment in NHS England’s Musculoskeletal Community Delivery Programme is intended to improve access to MSK support and reduce waiting times, helping more people receive treatment before their conditions become more debilitating. But while efforts to tackle the NHS backlog continue, employers are also tackling the issue head-on to support people with MSK problems before they become long-term health issues. We are increasingly seeing businesses engage with workplace wellbeing providers, occupational health providers and group health and protection insurers on prevention, early intervention and vocational rehabilitation. This can include ergonomic assessments and home workstation visits, employee education programmes focused on movement and activity, and fast-track physiotherapy pathways – all designed to address problems

before they develop into more serious conditions. Once symptoms have developed, speed of access to MSK care is critical. Prompt and appropriate treatment can help prevent an acute problem developing into chronic pain, which is why employers are making greater use of private healthcare benefits in the workplace, such as private medical insurance and health cash plans. These provide fast routes into physiotherapy, diagnostics, pain management and specialist treatment, while early-intervention services through Group Income Protection can provide crucial rehabilitation support for employees whose conditions result in long-term sickness absence. The priority should be to keep people moving, working and well – intervening as early as possible rather than waiting for an MSK problem to become a debilitating, chronic issue. For employers, healthcare professionals and the wider health system, that means making preventative care and early intervention the cornerstones of an effective MSK risk reduction strategy. A combination of NHS care, occupational health expertise and employer-funded healthcare can help people access the right support at different points in their journey. Ultimately, with progress in reducing the waiting list backlog stalling, MSK looks set to remain one of the biggest health challenges facing the UK workforce. With the consequences of delayed treatment now increasingly clear, we can expect to see continued innovation across occupational health, private healthcare and workplace health strategies to tackle this problem, and meet the growing needs of an ageing workforce. FEATURE

39

CARE AT A CR

A

DULT social care is approaching a staffing cliff-edge. Care homes, home-care providers and supported-living services need a reliable supply of people willing to undertake demanding work around the clock. Yet vacancies and staff turnover have been stubbornly high. International recruitment became a crucial part of the answer, helping providers keep rotas covered, accept new residents and deliver care in people’s homes when domestic recruitment failed to keep pace.

That safety valve is now closing. International care worker hires have fallen from 105,000 in 2023-24 to just 30,000 in 2025-26 – a collapse of more than two-thirds. Trade union UNISON has warned that the consequences will be felt by staff, providers, families and the people who rely on care. The numbers mean fewer hands-on shifts, less flexibility and greater pressure on a workforce already operating close to its limits.

A series of immigration reforms This fall in numbers follows a series of immigration reforms. Care workers and senior care workers can no longer bring dependants to the UK, making relocation less attractive to people seeking to move with partners or children. Employers sponsoring overseas workers face tighter obligations and more intensive oversight, with greater responsibility for compliance, records and the eligibility and conduct of sponsored staff. Higher salary thresholds and restrictions on which roles qualify for visas have narrowed the pool even further. Individually, these measures may be framed as controls on migration or exploitation, but taken together they make sponsorship harder, more 40

INTERVIEW

expensive and less predictable for care providers. Nor has domestic recruitment filled the gap. The hoped-for bounce in UK recruitment has not materialised because the job itself has not changed. Care work is skilled, emotionally demanding and physically intensive, yet pay often remains close to the minimum wage. Unsocial hours, insecure schedules, travel between visits, limited staffing and the strain of supporting people with complex needs make the work difficult to sustain. The retail and hospitality sectors, for example, can offer comparable pay with less responsibility and more predictable hours High turnover compounds the

Lisa Uttley, immigra Gherson Solicitors, immigration curbs social care st problem. Providers lose people just as they become confident, while those who remain carry heavier workloads and face burnout. Too few employers offer funded qualifications, meaningful training or a clear route from care assistant to senior carer, manager or specialist practitioner. Recruitment campaigns cannot overcome the message that care is essential, but care workers are not being treated as professionals with a future.

ROSSROADS Introduce comparable pathways

One further option deserves serious discussion. Since 2012, when the domestic worker in a private household visa route was closed, international families have been unable to permanently relocate their domestic staff to the UK. If that route were reinstated, or a comparable pathway reintroduced with proper safeguards, it might somewhat ease the burden on other carers who otherwise need to be sourced from within the UK infrastructure. Experienced domestic workers could provide an additional channel of care staff, particularly for households managing demanding routines and broaden the pool of people with practical experience. This would not substitute for regulated social care employment, fair pay or robust protections, but it could be a carefully managed additional route when every responsible source of experienced care staff matters.

ation law partner at , writes about how are deepening the taffing crisis. The first response should be sustained investment in the domestic workforce: pay that reflects skill and responsibility, protected time for induction and continuing training, nationally recognised qualifications and career pathways that allow people to build expertise without leaving frontline care. Retention is not a side benefit – it is the quickest way to reduce vacancies and preserve continuity for the people receiving care.

The government should also reconsider immigration rules that are too blunt for social care. Strong safeguards against abusive sponsors are necessary, but responsible employers should not be treated as the problem.

Ultimately, the crisis cannot be solved by one visa amendment or a short-term recruitment drive. The government needs a long-term workforce strategy designed with providers, workers, trade unions and people who draw on care. It should set out projected demand, stable funding, national standards on pay and training and accountability for delivery.

A workable route must account for the sector’s pay structures, reduce unnecessary administration and give workers and providers certainty. Reexamining the ban on dependants, salary requirements and visa restrictions would not remove the need to recruit locally. It would just recognise that international workers remain part of a mixed workforce while domestic capacity is rebuilt.

The UK’s ageing population will only increase demand for home support, residential care and specialist services. If recruitment falls and retention remains weak, the human cost will be missed visits, delayed placements, exhausted families and less time for dignified care. Immigration reform should not deepen that pressure. Without action now, the staffing crisis will become a care crisis for everyone. INTERVIEW

41

THE COS

OBESITY AND

O

BESITY is one of the most prevalent and costly health conditions in the UK, affecting almost a third of adults in England. The consequences go beyond the health and wellbeing of individuals – there is a significant societal and economic impact, costing the UK economy £126 billion annually, including an £8.3 billion loss due to obesity-related sick days. Moreover, the burden the condition places on communities is not evenly distributed across the nation. Analysis of more than 113,000 patients from digital health provider Voy, in partnership with the Health Foundation, found people in the most deprived areas access 32% fewer GLP1 prescriptions, despite up to 70% more people suffering from obesity. All of this points to the significant inequalities in how obesity management is prioritised by local health systems, leaving many in the most pressing need of support without access to care – even as newer treatments, like the GLP-1 pill, emerge.

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Paul Mor pol have

The obe consider like Voy access t for peop Howeve framew have no the grou system’s nationw

The curr inaction populati estimate England of imple to treat 2 roll-out leaves th benefit w the disea health c and ope already

Slow pro underin prevalen last thre almost d 1990s), a to fundin Example £100 mi manage one yea contin in a

ST OF INACTION

D THE CASE FOR CHANGE

l Gately, chief executive of Obesity UK and relife, argues that current care pathways, licy frameworks and funding of resources e not kept up with how obesity is managed.

esity care landscape has advanced rably, and private organisations are instrumental in widening to impactful weight-loss treatment ple who have historically struggled. er, the current care pathways, policy works and funding of resources ot kept up in order to maximise undbreaking tools now at the s disposal, for fairer delivery of care wide.

rent system is failing through n. Under NICE guidance, the eligible ion for access to tirzepatide is ed at 3.4 million people. NHS d has mapped out the first three years ementing the new treatment, aiming 220,000 patients by 2028 – with full expected to take up to 12 years. This he majority of people who could waiting years for treatment, allowing ase to progress into other associated concerns and increasing the financial erational burden on a system that is under strain.

ogress is largely due to systemic nvestment in obesity care. Despite nce growing significantly over the ee decades (in 2024, cases had doubled compared to the earlya clear and intentional approach ng care has been severely lacking. es include the withdrawal of a illion government fund for weightement services in April 2022, just ar after it was announced, and the nued lack of investment identified an APPG report on access to Tier 3 services this year.

Further barriers to consistent and effective care result from a lack of clear frameworks or guidance for healthcare professionals. Current pathways suffer from a lack of training, time and confidence among clinicians – resulting in low rates of referral from primary care to specialist weight-management services. Access to support remains a postcode lottery, determined by a stark disparity in how obesity treatment is prioritised and funded on a local level. Particularly as new treatment options, such as oral GLP-1s, come into play, addressing these gaps will be critical to ensure equitable delivery of care.

As a first step, chronic recognition of obesity should be embedded in policy documents. NICE’s clinical guidance, recognising obesity as a disease that requires ongoing treatment and monitoring, has not been consistently reflected in DHSC policy. This gap between clinical guidance and government policy has real consequences, as care approaches do not reflect the ongoing, relapsing nature of the condition. What must follow is a national standardisation for equitable access to care, with clear eligibility criteria and service standards. These must apply across the full care pathway, and consistently across the UK, to remove the current biases and variation that exist in prescribing and referral practices.

There is an important role for private providers to expand access to advancing solutions, reducing the burden on public healthcare and reaching communities that otherwise have limited access. By drawing on modern digital and pharmacological capabilities, there is an opportunity to reduce prevalence on a population level, moving towards a comprehensive approach to treatment, grounded in early intervention and ongoing support.

Transparency will be key to ensuring providers deliver on commitments to equitable care and long-term support. We propose that NHS England should publish figures of programme uptake, completion and outcomes; monitor for variation across regions and incentivise positive outcomes. Crucially, the maintenance phase should be commissioned and funded as a core element, integrated into long-term treatment programmes – otherwise the benefits of investment elsewhere in the pathway could be lost.

Three organisations – registered charity Obesity UK, digital health provider Voy, and NHS community partner Morelife – collectively span the full obesity care pathway: through advocacy to delivery. Drawing on first-hand experience of the care barriers, we published a white paper as a call-to-action for MPs, with our recommendation for the DHSC to commission a ten-year obesity strategy aimed at improving access and equality in obesity care.

To deliver effectively for people suffering from obesity, the ten-year strategy we propose should set out explicit, funded commitments that address the full pathway, to reduce prevalence and burden of obesity, and improve access to treatment across England. Part of that strategy must prioritise the shift from analogue to digital management of care, and from hospital to community-led programmes – reflecting a wider shift that should cascade across a full NHS 10 Year Plan. FEATURE

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THE WAITING LIST THAT’S PUTTING CHILDHOOD ON HOLD

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HERE are childhood health problems that rightly command attention. Rising mental health referrals, delays in autism assessments, increasing obesity and deteriorating dental health access have become national debates. Bladder and bowel conditions rarely receive the same response.

dreading school trips because they do not know whether they will reach a toilet in time. Teenagers avoiding sleepovers rather than worrying about how they will explain an accident. Parents carrying spare clothes, planning outings around toilet access, if they feel able to leave home at all, while trying to bolster a child whose confidence and selfesteem are being eroded.

That might be understandable if they were rare, harmless, or difficult to treat. They are none of those things.

None of this is captured by waiting-list spreadsheets. Instead, it is measured in missed education, cancelled plans, family stress, and children avoiding normal social opportunities and extracurricular activities.

Recent Freedom of Information responses from more than 160 NHS trusts show children in some parts of England waiting up to two years for specialist bladder and bowel assessment and treatment, with waiting lists stretching into the hundreds. The picture is clear: access depends on local resourcing, with too many families left to cope alone for too long. The statistics are alarming but reveal little about the realities of life during the wait. For many, managing incontinence is a silent and secret struggle. Parents try everything to get their child clean and dry before reception. Children 44

FEATURE

Recent clinical guidance from the Royal College of Nursing highlights the profound and lasting effects. Children report embarrassment and shame, while older children and teenagers may withdraw socially because they fear bullying or being treated differently. Continence problems in adolescence have also been linked to depressive symptoms, peer victimisation, reduced self-image, and negative experiences of school. One young person described their condition as “not life-threatening, but life-ruining”.

Davina Richardson, nurse at Bladder & B children’s continence an awkward inconve serious he The unpredictability of symptoms places considerable pressure on daily life for the whole family, particularly as children reach school age. Parents describe anxiety, guilt, and a sense of failure when their efforts do not result in improved continence. Many are managing a health condition without the specialist knowledge and support their child needs. This is especially frustrating because most childhood bladder and bowel issues are treatable. With early assessment and intervention, symptoms can often be managed before they become more complex or enduring. Yet too many children are waiting months or years for that help. Access depends not only on awareness that these problems are not developmental or time-limited but also relies heavily on where a family lives. Only 45% of Trusts said they provide

specialist children’s Bowel UK, writes that e is often considered enience rather than a ealth issue. a dedicated children’s bladder and bowel service, while 40% said they do not. In some areas, services have been reduced or access restricted through tighter referral criteria. Some require additional steps before offering an appointment, others will not accept a child with bowel symptoms unless bladder problems are also present. This is not a coherent national service. It is a postcode lottery built around a health problem that many families are already too embarrassed or ashamed to discuss. When children’s services cannot provide support, the need does not disappear. It is pushed elsewhere. Adult continence teams are providing products and care to hundreds of children. These teams are working to fill gaps in paediatric provision while facing demands of their own.

The NHS then pays twice: first through the absence of timely community support, and again when untreated problems require more GP appointments, specialist referrals, hospital care, or emergency treatment, as well as product provision. What appears to be a low priority becomes more complicated and expensive, precisely because it was not addressed promptly. Wider society also pays when children and teenagers do not meet their potential. The issue struggles to attract attention. Part of the explanation is cultural. Bladder and bowel problems make adults uncomfortable, and stigma makes the affected children want to remain unnoticed. Their difficulties are dealt with privately – in bedrooms, bathrooms, school toilets, and in anxious conversations between parents and teachers. There is rarely a dramatic moment that forces the rest of us to pay attention. However, the absence of drama should not be mistaken for the absence of harm.

There are often conversations about early intervention, children’s and teenagers’ mental health and the barriers that keep pupils out of education. Continence care sits at the intersection of all three. The family unable to toilet train their child who has an undiagnosed bladder or bowel issue. The pupil fearful of wetting, soiling or needing the toilet during lesson time who avoids school. The teenager withdrawing from friends because of shame. All are dealing with far more than a physical symptom. A family waiting two years for help are not simply sitting on an NHS list. They are restricting and reorganising daily life around a condition that can and should be treated. For too long, children’s continence has been considered an awkward inconvenience rather than a serious health issue. An overstretched system is waiting for problems to deteriorate, become more complex and difficult to treat before acting. Children, teenagers and their families should not be left to reach crisis point before the system decides their condition matters. FEATURE

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ASSISTED DYING’S J PARLIAMENT CO

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N 11 SEPTEMBER, the latest attempt to legalise assisted dying in England and Wales ended in defeat, with the Terminally Ill Adults (End of Life) Bill failing at second reading in the House of Commons by just 16 votes. For supporters of assisted dying, the result raises the question of whether, after coming closer to changing the law than ever before, the opportunity for reform has now been lost for another generation. And if it hasn’t been entirely lost, the route back won’t be easy. One striking feature of the September vote was the absence of a number of Labour MPs who had previously supported the bill. Thirty-seven Labour MPs who voted for it at third reading in June last year didn’t vote for it this time, while opponents mobilised more effectively. While we can’t speculate why these MPs were absent, we do know that in the three months since the bill’s third reading, the political context has changed substantially.

Under Keir Starmer, assisted dying had a prime minister personally sympathetic to reform. His experience as director of public prosecutions had placed him at the centre of difficult decisions about whether those who accompanied relatives abroad to die should face prosecution. New prime minister Andy Burnham brings a different perspective. Although he hasn’t rejected assisted dying in principle, his emphasis has been on improving social care and end-of-life provision. This matters because a central objection to assisted dying is that autonomy may be compromised when good alternatives are unavailable. If a dying person cannot reliably obtain high-quality palliative care, or fears becoming a burden because adequate social care is unavailable, can a request for an assisted death always represent a genuinely free choice? That concern may help explain the loss of parliamentary momentum. Some Labour MPs may have been influenced by the prime minister’s assertion that we need improvements to ensure that England and Wales have the health and care infrastructure necessary to introduce assisted dying safely. 46

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One of the shortfalls of the Leadbeater approach was the unanswered question of operationality and the impact on existing services and healthcare professionals. Questions about where assisted dying would take place, who would provide it, how professionals would participate and how the service would interact with the NHS and existing end-of-life care are not peripheral matters. They go to the heart of whether legislation can work safely in practice. Yet significant elements of implementation were to be determined through delegated powers after Parliament had approved the legislation. For critics, that asked MPs to take too much on trust. Whatever one’s position on assisted dying itself, some may argue that Parliament should have designed the architecture of such a profoundly new healthcare service before, rather than after, deciding whether to create it. This should be a lesson for any future bill – legislation establishing assisted dying needs to answer operational questions so that people understand where the service will fit into existing provision to ensure that Parliament is making a fully informed choice. Another Commons bill in the immediate future would face an obvious political obstacle. With a prime minister placing palliative provision and social care at the centre of his domestic agenda, supporters of assisted dying may struggle to rebuild a parliamentary majority unless they can demonstrate that concerns about palliative and end-of-life care have been addressed. That could take years. Social care is an especially difficult problem. Governments have spent decades trying to reconcile rising demand, workforce pressures, local-authority finances and the

Alexandra M in health law University of M despite the de dying bill, the de

JOURNEY THROUGH OMES TO A HALT

question of how care should ultimately Mullock, professor be funded. Palliative care may present a more tractable challenge, but achieving w and policy at the consistently good provision across England Manchester, says that and Wales would still require sustained efeat of the assisted investment and reform. ebate is far from over. And then there’s the House of Lords. The Leadbeater Bill’s experience there left considerable frustration among its supporters. After passing the Commons, it encountered hundreds of amendments in the Lords and ultimately ran out of parliamentary time when Parliament was prorogued in April.

That episode generated a constitutional argument alongside the ethical one: what should happen when an unelected chamber prevents a bill already approved by elected MPs from reaching a final decision? Assisted dying supporters in the Lords may therefore be tempted to begin again. But unless the underlying objections to the legislation have changed, another Lords bill could encounter many of the same difficulties. It is nevertheless important not to mistake this defeat for a return to the political landscape of the past. In September 2015, Rob Marris MP’s Assisted Dying (No 2) Bill was defeated at second reading by 330 votes to 118. Ten years later, the Leadbeater Bill secured a Commons majority at third reading in June last year. Support for reform has clearly grown, but not yet into a parliamentary coalition durable enough to carry assisted dying into law. For campaigners looking for a route forward, Jersey offers a useful example. Rather than treating assisted dying principally as a parliamentary contest, the island followed an extended process of public engagement, consultation and detailed consideration of how a service would work in practice.

Its Assisted Dying Law was approved by the States Assembly in February 2026 and received Royal Assent in July. The service is expected to begin in September 2027, allowing eligible terminally ill adults with decision-making capacity and a voluntary, settled and informed wish to die to seek an assisted death. There are important differences between Jersey’s model and the proposals debated at Westminster. But its significance lies as much in the process as in the legislation itself. Public opinion was considered alongside ethical and clinical concerns, while the practical arrangements for delivering assisted dying received detailed scrutiny before the law was finalised.

Jersey therefore provides a model worth watching. It demonstrates an alternative way of approaching an issue that combines medicine, ethics, law and deeply held personal values: establish what the public thinks; subject the proposals to sustained ethical and professional scrutiny; determine how the service will operate; and consider end-of-life care alongside assisted dying rather than treating the two as competing policy questions. The lesson from Jersey may be that assisted dying and good end-of-life care should not be treated as competing priorities. A future Parliament may be more receptive to reform if it can be confident that assisted dying represents a genuine choice, rather than an alternative to inadequate care. For supporters of reform, the immediate priority may therefore be to improve palliative and end-of-life care, learn from Jersey’s experience and develop the detailed clinical and regulatory framework for any future legislation. The Leadbeater Bill has been defeated, but the shift in parliamentary opinion since 2015 suggests that the debate is far from over. FEATURE

47

MAKING THE VALUE

WHAT TURNS MSK IDEAS INT

T

HE UK has no shortage of ideas in musculoskeletal health. Across our universities, hospitals and research centres, clinicians, engineers and scientists are working on technologies that could improve how MSK (musculoskeletal) conditions are prevented, treated and managed. The need is equally clear. More than 20 million people in the UK experience poor MSK health and, earlier this year, the government expanded an NHS programme designed to get people seen faster and help them remain in or return to work. As the population ages, that need will only grow. We need to help researchers recognise where their work could solve a real healthcare problem, encourage more of them to become entrepreneurs and then help founders translate technical promise into a credible case for patients, clinicians, partners and investors. A brilliant idea is important, but it will not reach people unless the wider story around it makes sense. Investors are attracted to founders who can tell a compelling story. I do not mean slick presentations or polished language. Experienced investors and clinicians can see through both. A strong story is evidence that a founder understands the whole business: the problem being solved, who benefits, the market opportunity, the regulatory hurdles, the team they need and how they plan to navigate the inevitable challenges. We see this at the end of the MSK Innovation Accelerator, when founders pitch to our research and investment committees. The most persuasive pitches are not necessarily attached to the most sophisticated technology. They are the ones that make the opportunity understandable and show how the clinical, regulatory and commercial pieces fit together. That matters even more when founders are talking to investors who are not specialists in the underlying science. A clinician may quickly recognise the technical significance of a new device or its potential patient benefit. A generalist investor may not. The founder has to make the connection between technical merit and commercial potential without overselling either.

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FEATURE

Martin Thomas, head of strategy at O Research UK and co-founder of the j MSK Innovation Network, says that Bri strengthen the route from research to r

Storytelling is not something to bolt on at the end when a business is ready to raise money. It is a useful test of the thinking throughout the commercialisation process. If a founder cannot explain clearly how the clinical need, evidence, regulation, market and business model connect, there may still be a gap that needs addressing. There is another side to this translation challenge. Some of the people capable of creating the next important MSK innovation may not currently think of themselves as working in healthcare at all. Someone working in sports science might be developing technology for elite athletes that could help a person in a physically demanding job avoid injury. An engineer may be working on a wearable with applications in rehabilitation. Materials scientists and computer scientists could be solving problems with applications to mobility, prosthetics or clinical decision-making without initially thinking of MSK as the market. This is one of the most exciting things about MSK innovation. It reaches well beyond surgery and orthopaedic devices into prevention, rehabilitation, workplace health, mobility and healthy ageing. Many of the founders and Accelerator participants we encounter come from non-clinical backgrounds, often bringing ideas and perspectives developed elsewhere. The challenge is making that potential visible. We have identified around 1,500 people working in MSK research and related disciplines such as materials science, sports science and biomechanical engineering. There will be others whose work could have an MSK application but who have never considered commercialising it, or even recognised the connection. Once that connection is made, technical expertise still needs to be supported by commercial

understanding, netwo where programmes su Accelerator can help. P the practical realities o business, from finance marketing and people their thinking with bus Five accelerator partic to receive investment f

The point is not that ev become an entreprene promising technology up. It is that people wit make a genuine differe realistic opportunity to market, build the right out whether there is a around their research.

The UK already has the talent and the clinical opportunity now is to g at making the value vi recognising promising wherever they originat helping founders artic why they matter and giving the strongest a credible route from research to real-world use. That is how more good ideas become investable businesses and, ultimately, reach the patients and clinicians they were created to help.

VISIBLE

TO IMPACT

Orthopaedic joint venture itain needs to real-world use.

orks and confidence. This is uch as the MSK Innovation Participants work through of launching and scaling a e, regulation and testing to e skills, while stress-testing siness and clinical experts. cipants have so far gone on from ORUK.

very researcher should eur, or that every should become a startth ideas that could ence should have a o understand the team and work viable business .

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49

PHYSICAL

THE NEXT FRONT IN HEALTHCAR

H

EALTHCARE is intrinsically human. Yet, with a global shortage of talent, there’s pressure to accelerate scientific discovery and do more with limited resources.

report at least limited use of physical AI. This early adoption is translating into practical applications across medicine to address repetitive, hazardous and high-risk tasks.

AI momentum is building across life sciences and healthcare (LSHC), with 28% of industry respondents in Deloitte’s State of AI in the Enterprise report saying their organisation has moved 40% or more AI experiments into production. Over half (57%) expect to reach that level in the next three to six months.

In drug discovery, which traditionally relies on slow, manual design-maketest-analyse (DMTA) cycles that can delay progress, AI-powered smart labs can automate important steps like sample transport and real-time data analysis with robotics. These labs can compress timelines, deliver capital efficiency and scalable infrastructure, increase discovery capacity and enhance reliability and reproducibility. By autonomously executing up to 70–80% of standardised tasks within the discovery cycle, physical AI can help organisations focus on the most promising drug candidates rather than those unlikely to succeed.

At the same time, physical AI is expanding the industry’s ability to help turn ambition into business value, and how organisations balance innovation with governance will determine success. Physical AI is a new source of operational capability where AI meets machine learning, sensors, controls and robotics. By bringing AI out of digital environments, organisations worldwide are helping to improve precision, consistency and performance in environments where persistent operational challenges and small errors can have significant consequences. Over half (57%) of LSHC companies 50

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In pharmacies, manual workflows can rely on recurring tasks that are difficult to scale, risking errors and slower operations. Physical AI can automate prescription processing, filling and dispensing systems with robotic assistants, enabling pharmacists more time to apply their clinical expertise. Similarly, in a lab environment,

As organisation models to machine Sebastien Burnett a from Deloitte expla can help improve pr innovation and stren performanc robots can eliminate monotonous strain and help enhance consistency in high-volume, cycle-time-driven tasks like sample handling, aseptic filling, packaging and quality-control inspection. In hospital operations, autonomous mobile robots (AMRs) can automate routine logistics, like transporting medications, meals, linens, laboratory samples and supplies. By taking on these tasks, AMRs help simplify workflows, so clinical staff can spend more time on patient care. They can also dynamically coordinate deliveries and balance workloads, helping hospitals maintain consistent service levels during high demand periods. Contamination control and safety are paramount in highly controlled

AI:

TIER RE

ns move AI from es, Costi Perricos, and Bogdan Mecu ain how physical AI recision, accelerate ngthen operational ce at scale. pharmaceutical manufacturing environments. Robotics can reduce the risks associated with human presence both by minimising contamination from movement, breathing and skin shedding with near-zero particulate level generation and by reducing workers’ direct exposure to hazardous drugs, active pharmaceutical ingredients and highly potent compounds. AI-enabled robotics can also strengthen quality monitoring, deliver more consistent execution, and support cleaning and decontamination procedures to prevent hazardous exposure in manufacturing. Together, these capabilities can help improve operational efficiency, support regulatory compliance and enhance productivity while maintaining quality and safety.

Precision is important in surgery. Microsurgery demands movements measured in fractions of a millimetre, where even natural hand tremors and fatigue can affect delicate procedures, like nerve repair and vascular reconstruction. Robotic-assisted microsurgery can help enhance surgeons’ instrument control, enabling greater precision and consistency during complex procedures. This can reduce tissue trauma, support better patient outcomes and potentially increase microsurgical procedure feasibility. Physical AI can be deployed for other high-risk scenarios like open-container aseptic processing, sterile-fill operations and facility inspection in restricted or ATEX (explosive atmosphere) zones. Where the proximity of a human operator is a dominant risk factor and human interaction requires extensive personal protective equipment (PPE), permits and exposure monitoring, robots can gather gas and particulate measurements, read gauges and detect leaks, while telemanipulation platforms allow operators to remotely adjust and maintain equipment. Taken together, the examples above can demonstrate how physical AI can

become a transformational enterprise capability rather than a collection of isolated technologies – and scaling it responsibly is top of mind. It may require organisations to build governance that helps enable clear human oversight by clinicians, pharmacists and researchers. Early deployments in well-governed environments can help organisations build confidence, demonstrate measurable value and establish the governance and operating models needed to scale. The future of healthcare should not be defined by machines replacing human knowledge, but by how they can enhance it. Physical AI can take on repetitive, precise and operationally demanding work so researchers, clinicians, pharmacists and care teams can spend more time applying judgement, empathy and scientific insight. As adoption grows, the organisations that succeed will be those that keep patients and people at the heart of their strategy.

Costi Perricos is Deloitte’s global GenAI business leader; Sebastien Burnett is partner in life sciences AI and data lead; and Bogdan Mecu is physical AI lead for life sciences and healthcare at Deloitte UK. INTERVIEW

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ALL YO

(AND A FIN

M

OST doctors will have complex financial arrangements. This stems from the myriad career opportunities and benefits the profession now has in both the NHS and the private health sector. Doctors may receive a mixture of NHS (including locum) and private patient salaries, hold NHS and private pensions, be a GP partner, own a private practice and have other medical business interests. Yet this financial picture, unique to the medical profession, can pose challenges for doctors going through the divorce process. It is not as straightforward as just dividing property and savings between the spouses. The value of these assets at face value won’t necessarily be clear and may not be easily splittable. Without proper scrutiny and understanding, a financial settlement reached with an ex-spouse could be disadvantageous to the doctor, or even both parties (especially when incorrect values are used to decide how much to offset against other assets belonging to the couple). An accurate evaluation of the income streams is especially important when spousal and child maintenance are being considered. Therefore, before agreeing on any financial settlement, it is important

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t t a d p d r m

M f

E a a c b e w

C m a i i w s m

W t t p c o a m m

U NEED IS LOVE

NANCIAL SETTLEMENT) Julian Ribet, partner and founder at Ribet Myles Family Law, urges doctors to understand the nature and value of their financial assets before agreeing divorce settlements.

to understand and seek advice on the true nature of these interests and assets, and how their value is to be properly determined and treated by the divorce process and the courts. This applies to all doctors, be they surgeons, consultants, resident doctors, GP partners or private medical practice owners.

Multiple salary streams and future earnings

transitioning to a consultant role, or if there is likely to be a large increase in income. This ever-changing and inconsistent picture means a doctor’s various salary streams should be understood and explained very carefully before putting them forward in settlement negotiations.

GP partnerships

Employment salaries from private, NHS and consultancy work will need to be assessed, as will potential future earning capacity. Levels of income will likely be different across these streams; for example, locum and consultancy work will be variable.

For GPs who are partners within the practice where they work, partnership shares, profit distributions, income from surgery premises, capital accounts as well as their salary may also need to be accounted for in the financial settlement process.

Career progression throughout the marriage, as well as beyond, should also be considered. This is particularly important in situations where the doctor is still undergoing medical training or where one spouse may have made sacrifices to support their spouse’s medical career.

Some of these assets may be less lucrative than others – for example, the partnership interest may be of less value than the premises. Hence why it is wise for the parties to jointly instruct an independent valuer who will be able to assess how much value the partnership and its constituent parts bring to the divorce. It is also important to revisit the terms of the GP partnership agreement.

While future earning capacity cannot be treated as an asset and split, the court - if the couple cannot agree between them - will consider the doctor’s career progression and likely future earning capacity in the wider context of deciding on the financial needs of each party, as well as levels of spousal and child maintenance. For example, the court might find it pertinent if the doctor is

margin. The NHS pension is also a defined benefit scheme which has its own complex rules, especially compared to private pensions. The NHS pension will need to be addressed in the financial settlement through a pension sharing order, or by considering its value offset against the value of other assets. Therefore, specialist actuarial advice from a Pension On Divorce Expert (known as a PODE) is likely to be necessary to determine its true value (as well as any other private pensions), so that the correct value is attributed to these assets within the settlement negotiations.

Private practice ownership and other business interests While a doctor may benefit from a large income from a private practice and is likely to in the future, its saleable value may be modest. This is due to the business’s goodwill being connected to the individual doctor running it, and therefore the small pool of potential buyers. Some doctors may also provide their clinical work under a limited company or consultancy business, which is bound by various financial regulations and responsibilities, which can impact their value.

NHS pension

An independent valuer can work with a lawyer to help doctors understand the true value of their commercial interests.

An NHS pension can be one of the most valuable assets for a doctor. However, doctors should not rely on the cash equivalent transfer value of their pension. This calculation usually undervalues the pension by a large

It really is worth seeking early legal advice to formulate a strategy and to understand how a court would be likely to divide the assets and income so as to be able to achieve the best possible outcome. FEATURE

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MAKING VOICES COUNT

T

hink about the last time you reached the end of an item in a team meeting, a case review or a handover, asked “Any thoughts?” and heard nothing back. You might have taken that silence as agreement and moved on, although the people in the room may have been unsure whether it was their place to speak. You had invited them to contribute, and the discussion needed a structure that let everyone respond. Amy Edmondson, professor of leadership at Harvard Business School, describes four interpersonal risks that make people hesitate before speaking at work: appearing ignorant when they ask a question, incompetent when they admit uncertainty, negative when they raise a concern and disruptive when they question direction. The review by Elizabeth Morrison, ITT Harold Geneen professor in creative management and the vice dean of executive programs at the NYU Stern School of Business, of research on employee voice and silence identifies fear and futility as the most consistent reasons people stay quiet about ideas and problems.

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This evidence suggests that silence in a meeting is a rational response to the conditions around it, and leaders can change those conditions.

Psychological safety The five foundations for psychological safety – mattering, clarity, voice, connection and learning – each ask their own question. Mattering asks “Do I matter here?”; clarity asks “Do I understand what is expected of me and how I contribute to decisions?”; voice asks “Can I speak up and will it be taken seriously?”; connection asks “Do we know what is expected in how we behave together?”; and learning asks “Do we use experience to improve how we work?” Each foundation has its own practices for teams, and each one depends on the others. Leaders can strengthen voice through inviting contribution, one of its four practices, by making it explicit that they expect to hear from everyone. A structured round gives leaders one of the simplest ways to do this. Everyone

Helen Sanderson, Sanderson Associ of Wellbeing Team Psychological Safety how health and soci bring more voices in responds to the same substantive question, in turn and without interruption, anyone may pass, and the team opens the discussion once everyone has had a turn. Rounds work because each person knows when their turn will come, so speaking up stops being a competition for airtime. Research by Anita Woolley, professor of organisational behaviour at Carnegie Mellon University’s Tepper School of Business, and colleagues found that groups perform better when their members share speaking turns more evenly. When people know their turn is coming, they also take on responsibility for contributing and stop assuming that someone else will raise the issue.

, founder of Helen iates, co-founder ms, and author of y in Practice, explains ial care leaders can nto the conversation. In a round, the leader speaks last, because where hierarchy is strong, a leader who speaks early can set the direction of thinking and make other perspectives feel unnecessary, even during a structured round. By speaking last, the leader uses positional power deliberately, so the round widens the team’s thinking before authority shapes the decision. Some people think best before they speak, and Nancy Kline’s Thinking Pairs give them time to do that before a round begins. Two colleagues each have the same uninterrupted time, commonly two to five minutes, to think aloud about one question while the other listens with full attention and makes no comment. The pairs then return to the group and share their freshest thinking

in a round. Thinking Pairs especially help reflective thinkers, people lower in the hierarchy, and anyone still working through uncertainty. The question a leader asks in a round tells people what kind of contribution they want. Purposeframed questions, such as “What impact will this have on patients?”, link each contribution to its impact, and they often bring forward views from people who find positional debate harder and care deeply about purpose. Dissentinviting questions, such as “What are we missing?” or “If this went wrong, what would we wish we had questioned earlier?”, name disagreement as legitimate before anyone has to risk being the first to raise it. Both kinds of questions make challenge an expected part of the work.

Structured rounds The first few times I introduced structured rounds, people rolled their eyes and talked about “creeping death”. That reaction usually means the structure has felt mechanical, and it tends to change once people understand why the round exists and trust the leader to run it well.

Rounds work well with groups of up to around 12 to 15 people, and larger groups can run rounds in smaller breakout groups first and then bring the key themes back to everyone. An invitation opens the conversation, and people decide whether to speak again based on what followed the last time they did. Leaders can use making voice count, another practice in the Voice Foundation, to close the loop, so people can see how the team considered their contribution and why it made the decision, including when the outcome stayed the same. Morrison’s work on futility shows why this matters, because people who can see what happened to their views have a reason to offer them next time. At your next team meeting, handover review or case discussion, choose one agenda item and use a structured round with a single question, with the leader speaking last. Then notice what you hear that you might not have heard before. INTERVIEW

55

NIGHT-TIME BLOOD P SO WHY IS IT SO RA

B

LOOD pressure measured overnight and tracked over time can reveal patterns that a single clinic reading misses. The challenge is capturing that information practically, and over more than a single night. Hilo’s continuous, cuffless monitoring aims to help address that gap.

Out-of-office blood pressure monitoring is already an established part of hypertension care and the evidence for night-time pressure is strong. According to a Lancet cohort study of almost 60,000 patients, night-time systolic blood pressure was the most informative measure for assessing the risk of all-cause and cardiovascular death when compared with clinic blood pressure readings. The findings underline the value of understanding what happens to blood pressure beyond the clinic. But capturing night-time blood pressure presents practical challenges. Ambulatory blood pressure monitoring (ABPM) remains the reference standard for assessing blood pressure over 24 hours, but its cuff inflates at intervals through the night, potentially disturbing sleep. A recording also typically covers a single day and night. Home monitoring provides readings across multiple days, but routine home measurements generally do not capture blood pressure continuously during sleep. “If you really want to understand what is happening during the night, you need to see patterns over time,” says Dr Tomas Bothe, a physician scientist and Chief Medical Officer at Hilo. “Even a single night is only a snapshot.” 56

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How is it different from a fitness tracker?

“We now know that blood pressure during the night is far better at predicting risk than daytime blood pressure,” says Dr Bothe. “An elevation in nocturnal blood pressure is a much stronger predictor of stroke and heart attack risk.”

Wearables promising health insights are everywhere, so the distinction matters. Hilo is a CEmarked Class IIa medical device built specifically to measure blood pressure, rather than a wellness feature added to a fitness tracker. Its accuracy was assessed in a pivotal trial following the ISO 810602 protocol for validating blood pressure monitors, under different body positions, passing all the clinical criteria. Additionally, in a 2025 study comparing its 24-hour, daytime and night-time readings with ABPM, Hilo recorded a smaller overnight drop than ABPM, but once that difference was accounted for, the two showed 79% agreement in identifying nocturnal dipping patterns.

Sleep also makes for a cleaner measurement, he adds. “People are generally doing the same thing: sleeping. There are fewer of the daily factors that can affect a reading.”

It is not designed to diagnose or to replace clinical judgement. The data is there for clinicians to weigh alongside the patient’s history, symptoms and other findings.

What does continuous monitoring add? The Hilo Band is designed to fill that gap. It is a wrist-worn medical device that measures blood pressure without an inflatable cuff, using photoplethysmography (PPG) to detect changes in blood volume with each heartbeat. Hilo’s algorithms analyse the shape of each pulse wave to estimate systolic and diastolic pressure, and the band is periodically calibrated against a validated cuff. Readings are taken automatically, generating 35 measurements a day, including while the patient sleeps. Monitoring continues overnight and across the day, helping build a picture of blood pressure patterns over time. Patients can easily download their blood pressure reports and bring them to appointments.

PRESSURE MATTERS, ARELY MEASURED? that regular visibility of blood pressure encourages people to change their behaviour or stick more closely to treatment plans. It draws on the wider evidence for selfmonitoring, and on the way people tend to behave differently when they know they are being observed. Hilo’s analysis of data from 30,092 users between 2022 and 2025 found that systolic blood pressure fell by 5.8 mmHg on average over six months. The analysis was observational, so it shows an association rather than proving that monitoring caused the fall. The researchers pointed to behaviour change, the effect of being monitored, and more active treatment prompted by the extra data.

Could seeing the data change behaviour? There is another question worth asking: What happens when patients can see their own blood pressure over time? Hilo calls this the “Hilo effect”: the idea

For clinicians, that last explanation may be the most interesting: better information leading to better decisions. “Success is not just telling someone their blood pressure,” says Dr Bothe. “Success is helping prevent strokes and heart attacks.”

Where could it fit? Continuous monitoring will not suit every patient, and it does not replace home monitoring or ABPM where these are clinically appropriate. But it could help where those tools struggle: patients starting or changing treatment, those whose clinic and home readings don’t add up, and those for whom a night in a cuff is impractical. It could also help identify which patients most need a full 24-hour ABPM recording. And for patients, seeing their own trends can turn an abstract number into something they can act on. As hypertension care moves towards earlier detection and more personalised treatment, the case for seeing what happens between appointments, and overnight, is only getting stronger.

Try Hilo for yourself Healthcare professionals can request a complimentary Hilo Band, including a 12-month subscription, to evaluate for themselves, and explore the evidence behind it at https://professional.hilo.com/ About Hilo: Hilo is the brand of Aktiia, founded in 2018 and headquartered in Neuchâtel, Switzerland. Aktiia develops continuous, cuffless blood pressure monitoring and operates in 13 markets worldwide. Hilo’s technology is supported by 30+ published studies and more than 30 clinical studies. The Hilo system is not intended to make diagnoses. Data should always be used in consultation with a healthcare provider. SPONSORED CONTENT

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WHY CLINICAL RISK BE BAKED INTO SO

U

K PRIVATE hospitals and clinics recorded 953,000 inpatient and day-case admissions across insured and self-pay patients in 2025, the fourth consecutive record year, according to the Private Healthcare Information Network. Behind every admission are decisions that depend on accurate records, medication information and test results reaching the right clinician. Software increasingly supports those decisions, but its design can also introduce risks, from warnings that are easily overlooked to information that fails to reach the right person. For private healthcare providers, the question is no longer simply whether a digital system works. It is whether that system has been designed, tested and maintained with patient safety in mind.

Where clinical safety assurance falls short A 2025 study published in the Journal of Medical Internet Research examined 14,747 digital health technology deployments across NHS organisations in England. Among the 9,292 deployments with comparable assurance data, just 17.3% had documented assessments against both national clinical risk standards, DCB0129 and DCB0160. This does not prove that systems lacking documentation were unsafe, nor does it measure private sector performance. It does, however, raise questions about how consistently software risks are assessed. 58

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The consequences can be serious. In a review of 50 patient safety investigations, the Health Services Safety Investigations Body (HSSIB) identified recurring problems with electronic patient records, including poor usability, difficulties sharing information and risks introduced through local configurations. One investigation found hospital staff copying medication details onto paper because the computer used for electronic prescribing could not fit inside the medication room. The technology was available, but the clinical environment forced staff to work around it. Although these investigations concern NHS settings, the underlying challenges are not unique to the NHS. Private providers also rely on software configured around local teams, facilities and clinical workflows. That makes understanding how technology performs in everyday practice just as important as assessing its technical capabilities.

Building safety into software from the start DCB0129 governs clinical risk management in health IT development, while DCB0160 covers deployment and use. Developers must identify hazards, assess their consequences and document safeguards. Providers must consider how those systems will operate in their own clinical environments.

Although their precise applicability varies, NHS England strongly recommends adopting both standards, including for entirely privately funded healthcare technology. In practice, this means considering more than whether individual features function correctly. Safety assessments must account for how clinicians encounter alerts, how information moves between teams and what happens when established processes fail. These questions need to inform design decisions before software reaches clinical settings. For Dr Patrick Lester, Healthcode’s Clinical Safety Officer, effective risk management means understanding both the technology and the clinical decisions it supports. “Ultimately, a lot comes down to a risk-benefit analysis of new

K STANDARDS MUST OFTWARE DESIGN Putting clinical safety into practice Healthcode aims to empower every healthcare professional to be the best they can be. Central to that ambition is technology that supports clinicians in their everyday work, with safety built in from the outset. Healthcode has formalised this approach through a clinical advisory board that brings healthcare professionals into product development, alongside Lester’s appointment as its first Clinical Safety Officer in September 2025.

functionality,” he explained in an April 2026 interview. Software directly influencing patient care, he argues, needs greater safeguards than systems designed primarily to reduce administrative work. His experience as a radiographer has shaped that approach. Understanding who requests investigations, who interprets results and who is responsible for acting on them helps identify risks that may not be apparent from technical specifications alone.

Why oversight cannot stop at launch Even software that has undergone a thorough safety assessment can develop new risks as it changes. A HSSIB investigation documented a hospital relying on the manufacturer’s original safety case for adult prescribing without

a local safety case covering subsequent modifications or its introduction into paediatric care. The example illustrates why clinical oversight must continue throughout a product’s life. New features, system integrations and changes to clinical workflows can all introduce hazards that earlier assessments did not consider. This requires clear communication between developers, healthcare providers and the clinicians using the technology. Risks identified during everyday use need to be reported, assessed and addressed, while software updates must be reviewed for their potential impact on existing safety measures. Lester advocates a continuous process in which new risks are identified, prioritised and fed back into software development, ensuring that clinical concerns lead to practical improvements.

Working through clinical safety consultancy ETHOS Ltd, Lester is helping embed risk management into the development of Healthcode’s ePractice platform as it expands into clinical functions, including prescribing. In February 2026, Healthcode reported progress on baseline safety checks, a clinical safety plan and a hazard log for ePractice Prescribing. These provide a framework for assessing potential hazards and responding as the software evolves. For private healthcare providers, this points to a broader responsibility: asking not only what digital systems can do, but how their suppliers assess and manage the risks those systems introduce. As healthcare becomes more digital, clinical expertise must shape the technology supporting patient care. The most important safeguards are those built into software from the outset and maintained as that technology changes. SPONSORED CONTENT

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AI: WHY THE SO THE ANSWE

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HERE’S a medical textbook that sits in my practice today. It taught me at the time much of what I needed to learn the art of medicine. That, and a lot of experiential learning on the job. It now occupies the role of raising my second screen. NHS IT. Don’t ask. As I worked through my 80th online consultation of the day, I was struck by a question I had no idea of the answer to. “Can you prescribe me Itulazax?” Instinctively, I thought, let me just search it online. That experience will be recreated across the country in every GP practice, outpatient room, and ward. Medical knowledge is increasing at a pace previously unseen. New technology, medicines, pathways - it is a constant source of change. And yet all of this was previously confined to a search bar. We’ve seen an explosion of tools that sit there in our consulting room. The days of paper forms, the days of handout leaflets - almost all of that now lives in a digital space. And whilst this helps democratise the availability of information, it presents the risk of the quality that sits behind it. For example, all of us will have had the experience of searching in a browser bar and asking a simple question, whether that’s searching for a new microwave, a place for dinner, or actually a new treatment class. The challenge here is that when we use generalist search tools, we receive generalist knowledge back. And by that, I mean it pulls from the entire internet that sits out there, regardless of the quality of the

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From apple cider vinegar to unfamiliar prescriptions, Dr Tim Cooper, GP and Clinical Director for UK & I at Heidi, explains why clinicians need AI that draws on trusted evidence rather than the whole internet.

source. For example, many of you will have worked across healthcare over the past few years, and I’m sure many of you will have had the experience of apple cider vinegar and its link to acute gastritis. There was a time where apple cider vinegar, perhaps rightly, perhaps wrongly, was seen as a cure-all for many of the challenges we saw. This was more so prevalent at a height of understandable health anxiety during the pandemic. What I saw in my clinic was more and more people coming to me with acute epigastric pain. Again, the skill of the history taking, particularly when you’re asking, “Has anything else changed?” revealed the fact that for many of these patients, they had read online that a shot of apple cider vinegar could help do everything from boost immunity, improve sleep, to even preventing COVID. And this is the heart of the challenge of generalist knowledge today. How do we know that the quality of the information that both us and our patients are finding in front of us

actually lends itself to the future of high quality care? As we increasingly use tools like this, we will need to have safeguards. We will need to have boundaries. We need to know that if we ask the question, we’ll get an appropriate, realistic, and importantly, true source. As I’ve commented previously, when we’re learning to train, we weight evidence differently. We know there’s a difference as to why a randomised controlled trial occupies a higher status in the hierarchy of evidence than a simple observational one. Observations and an “n=1” could be hugely helpful, but ultimately, we need to be able to compare evidence with a true evidence bank in order to make sure we make the right decisions. We need to weight the RCT more than the Reddit thread. The future of AI in healthcare increasingly looks exciting and optimistic. Clinical decision support,

OURCE BEHIND ER MATTERS

where actually we’re supporting clinicians of any type at the time that they’re making their decisions, is increasingly likely. I, for one, am not afraid that this suddenly means my role as a GP is redundant. Rather, I think it enhances my role and actually ensures that I maintain my medical knowledge and depth and breadth across everything that will present to my clinic room. Indeed, one of the joys of being a GP has been precisely because you’re never quite sure what’s coming through the door. Although this has been helped a little bit by triage, which gives us a bit of a heads up before the patient walks through. Ultimately, that’s one of the joys of medicine - you never quite know what someone’s going to ask, what they’re going to say, or what they’re going to present with.

and frantically checking to see what this could possibly be, I’ll have decisions in real time, augmenting my ability to both manage patients but also navigate the system. I feel this is more important than ever, not least because of the pressures and challenges that we face across the entire system. We know that healthcare’s capacity is struggling. We know that the demographic challenges suggest that we’re going to be dealing with more patients who are more ill and who live longer. We know as well that there cannot be a traditional response to this of if only we could just train more people. The macroeconomic picture, evident to the majority of people who watch health policy, is that that is not plausible, so we must find alternative routes.

Where I see these tools being hugely valuable is acting as a support for me. Rather than having to reach for the book that sits under my monitor

I also think that by making every consultation count in a way that matters both for the patient but also for the clinician, we can drastically

reduce the need for recurrent followups or even ending up in the wrong part of the system. For example, the ability to host knowledge and pathways in a system could be hugely transformative. All of us who’ve been through training will understand that feeling on the first day, when you’re being asked to look at a process or move a patient through a pathway. Where do I look? Who do I ask? How does it work? Do they need this test before they go? What do I tell the patient? Again, that’s not even medical knowledge - this is system knowledge, which again usually is held tightly, in the minds of those who work in it and is not often as visible as perhaps it should be. The future of clinical tools here looks like a repository that will not only host this information, but be able to present it back to you almost immediately. No longer should there be a day where it’s unclear about what pathway to use or how to refer. No longer should there be a question of having to use a generic chat bar to ask a clinical or pathway question. No longer should there be a day where I feel uncomfortable because my training didn’t quite cover what I’m being asked in front of me, or I’m too new to the organisation to know what I should. Googles’ strapline has always been “to organise the world’s information and make it universally accessible and useful”. The future of clinical AI should be to organise the world’s clinical and system information and make it universally accessible and useful to all in healthcare. It won’t be Dr AI, but it may well be Dr and AI. SPONSORED CONTENT

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IMPROVE THE FIN OF YOUR PRIVA

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OR independent healthcare providers, medical billing is much more than an administrative task, it is a critical part of the patient journey and the financial resilience of your practice. Yet it is also becoming increasingly challenging. Medical billing is complex as each private medical insurance (PMI) company has its own coding rules and fee schedules. Self-pay patients require modern payment pathways and chasing payment can quickly absorb valuable clinical and administrative time. Good billing practice should aim to achieve the following objectives: • • • •

Make payment straightforward for patients and payors Optimise revenue Improve cashflow and minimise bad debts Provide transparency and control over practice finances

The following principles provide a practical framework for doing both.

Capture accurate information at the outset Many payment delays begin before treatment takes place. Incomplete patient details, inaccurate insurer information, missing authorisation numbers can all lead to delays, rejected claims and avoidable follow-up work. Best practice is to verify the patient’s demographic, contact and funding information at the earliest opportunity. For insured patients, practices should record the insurer, membership and authorisation 62

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Simon Brignall, Head of Sales and Accounts at Civica Medical Billing and Collection, discusses how following medical billing best practice will increase practice revenue, optimise cash flow and improve the patient experience.

point to identify missing or incorrect information before an invoice is submitted. This “right first time” approach reduces unnecessary adjustments and protects both income and the patient relationship. We also routinely update our records to reflect any changes to the CCSD schedule or updates to the PMI tariffs.

Offer convenient, secure ways to pay

details, and for self-pay patients, the expected charges, payment terms and options should be clearly outlined. A patient registration form combined with a pre-treatment checklist helps prevent errors and identifies missing information that can be then obtained from the patient.

Bill promptly and correctly It stands to reason that the longer a practice waits to raise an invoice, the longer it will wait to be paid. Invoicing should take place in a timely fashion with a focus on accuracy as well as speed. Procedures must be coded correctly and charges aligned with applicable tariffs, contractual arrangements and insurer rules. Regularly reviewing insurer fee schedules and keeping pace with monthly changes to the CCSD (Clinical Coding and Schedule Development) code schedule can help practices avoid underbilling, rejected claims and unnecessary disputes. At Civica Medical Billing and Collection (MBC), our checking process provides a valuable audit

Private patients increasingly expect the same convenience when paying their medical bill that they receive in other parts of their lives. Practices should offer a range of simple, secure payment options that are available at all times of the day. Civica MBC’s service provides patients with a range of 24/7 payment options either online or over the phone. These include digital solutions such as Google Wallet, Apple Pay or Open Banking. This includes pathways for collecting money ahead of treatment, on the day via our Client Self-pay module or post treatment depending on your needs.

Manage outstanding debt consistently It is important to have a robust chase process that is routinely followed. Practices need a structured credit control process with clear stages, timescales and ownership. Early, polite reminders are more effective than allowing balances to age, and unresolved insurer claims should be investigated promptly to seek resolution. Insurance shortfalls and excesses should be identified and invoiced promptly to patients

NANCIAL HEALTH ATE PRACTICE alongside a clear explanation. Many patients are surprised to discover they have an unfunded liability because they may not be familiar with all the terms of their policy. Communication should therefore be informative, respectful and sensitive and you should keep accurate records of each interaction and any agreed next steps.

Practices should have access to reporting to monitor aged debt by patient, insurer and invoice type. This will ensure that any issues around recurring delays can be identified and steps taken to address the issue.

Reconciliation and access to meaningful reporting Reliable and regular invoice reconciliation is essential. Every payment needs to be matched to the correct invoice with discrepancies investigated quickly. As well as being a key stage in identifying insurance excess or shortfalls, it will also aid the management of group practices where often payments may need to be allocated across different consultants or have been paid into different bank accounts. Private healthcare, like any other business, benefits from data transparency. Civica MBC’s Dashboard ensures our clients have 24/7 access to timely financial management information. Including an array of reporting such as: • • • • •

Invoices raised Payments received Aged Debt/Bad debt Location/patient type Patient activity

Reporting is available at both summary and detailed levels to allow for better informed decision making.

Protect data and maintain strong governance Billing records contain sensitive personal data including clinical and financial information and as such any systems should use appropriate security controls, and staff should understand how to handle data safely. Practices should also maintain clear audit trails and documented procedures for corrections, refunds, complaints and disputed invoices. Governance includes business continuity. A resilient billing operation should not depend on one person’s knowledge or availability. Documented workflows, appropriate oversight and sufficient capacity help ensure that invoicing and collection continue during absence, periods of growth or sudden increases in activity. Civica MBC is ISO27001 and Cyber Essentials certified and our service is built on a strong foundation of UK based Dedicated Account Management.

Consider the value of specialist support For many healthcare providers, maintaining all these capabilities internally can be challenging. Outsourcing to a specialist medical billing company can add experience, capacity, purpose-built technology alongside modern payment solutions all while improving the financial health of the practice. Civica Medical Billing and Collection service has more than 35 years

of experience of partnering with more than 2500+ consultants, groups, clinics and hospitals. Each practice receives its own UK based Dedicated Account Manager which combined with our ‘intensive care’ onboarding process ensures we better understand the nuances of your practice.

Civica MBC’s billing expertise has seen increases of revenue of up to 25% and the combination of our credit control processes and simple to use payment options ensures that we optimise your practice cashflow. Civica MBC has an average baddebt rate of less than 0.5%, and as low as 0.18% for many practices. By partnering with experts, you are free to focus on delivering amazing care to your patients and growing the practice.

Put your practice on a healthy foundation for growth Medical billing works best when it is incorporated fully into the practice rather than seen as an administrative headache. Accurate data capture, prompt invoicing, convenient payment routes, consistent debt management, reconciliation and access to reporting all contribute to a more professional private practice and an improved patient journey. To see how your practice could benefit from partnering with experts, contact a professional medical billing company such as Civica Medical Billing and Collection and transform your private practice. SPONSORED CONTENT

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HARM GRADING IN PATIENT SAFETY INVESTIGATIONS: BENEFITS AND LIMITATIONS

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ARM grading is a key part of NHS England’s Learn from Patient Safety Events (LFPSE) service and a mandatory part of incident recording where a person has been involved. It is important that providers have an awareness of the principles of harm grading and its benefits and limitations within the wider patient safety investigation landscape.

Harm grading is a mandatory part of NHS incident recording, but it has limits. Rebecca Beaumont, Technical Director – Clinical Investigations at Maulin Group, explains what providers need to know.

What are the benefits and limitations of harm grading in patient safety investigations? The benefits of harm grading in patient safety investigations are: •

What is harm grading? The aim of harm grading is to record the actual impact of an incident in healthcare on the patient. NHS England’s policy guidance as part of the LFPSE service is widely used, and built on the principles and standards of the National Reporting and Learning System (NRLS), which LFPSE replaced in 2024. The harm grades in the LFPSE separate out physical harm from psychological harm, which allows the physical and psychological effects of patient safety incidents to be acknowledged separately. Harm ranges from no harm to severe harm - severe physical harm 64

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involving, for example, “permanent harm” or “needing immediate lifesaving clinical intervention” and severe psychological harm “distress that did or is likely to result in a new mental health diagnosis, or a significant deterioration in an existing mental health condition, and recovery is not expected within six months.” The policy guidance outlines that harm grading should be applied based on the best information available at the time of incident recording, and that harm grading can be reviewed and updated as more information becomes available.

•

•

Harm grading incidents allows for the impact on the patient to be recorded. This is strengthened if patients are involved in the investigation process and their views are sought, giving a higher level of confidence that the selected harm grade is reflective of their actual experience. Use of a single harm grading matrix, like the LFPSE service’s matrix, ensures that data collected in the aftermath of patient safety incidents and during investigations is consistent. Consistency in data means that comparison is more possible and helps to broaden the conclusions that can be drawn through identification of patterns. Harm grading can inform the prioritisation of investigation and patient support and redress. The approach to investigation may need to be different for a patient

•

who has suffered severe harm, as will the support that patient will need. Grading harm can help organisations to use resources effectively and target and tailor support measures for patients. Certain levels of harm can constitute notifiable incidents under statutory schemes, such as the Care Quality Commission’s Regulation 20 Duty of Candour. Harm grading allows for other policy, regulatory, and statutory requirements to be enacted promptly and appropriately.

•

•

• As with any system of categorisation, there are limitations to harm grading such as: •

Variability and inter-rater disagreement can be present. Raters can be presented with exactly the same scenario and assign different harm grades based on their individual interpretation of the categories in the harm scale, personal experience, and background. This was looked at in a 2018 article in Med Care by Walsh et al. They found that reliability improved where 2 reviewers were used as opposed to 1.

A harm grading can cause anxiety and distress amongst patients if not delivered alongside proper support during a patient safety investigation. Harm grading is applied based on the best information known at the time of the incident reporting or patient safety investigation. The patient’s pathway can evolve over time, however, and what started as an incident involving no harm can progress to severe harm if the patient’s condition deteriorates. As harm grading can trigger regulatory and statutory duties such as the Duty of Candour, clinicians must feel psychologically safe in assessing incidents and supported to learn from them. Organisational culture can encourage retrospective minimisation of incidents if it is not open, just, and supportive.

What do providers need to be aware of? Harm grading is a useful tool within the patient safety incident investigation framework, and allows for harm to be categorised,

compared, and analysed to allow for providers to systemically learn from incidents. Providers using harm grading in their incident reporting and requiring the same in independent investigations should ensure: •

•

•

•

Use of multiple reviewers is considered to assist in reducing variability. Patients are given a voice during the incident investigation process and supported in understanding and coming to terms with harm. Harm grades are revisited to make sure that data is accurate and updated if the patient’s situation changes. Staff are regularly trained and supported on the processes surrounding incident reporting and harm grading.

Maulin Investigations have experience of harm grading within patient safety incident investigations and can give robust, independent reviews and advise where policy and procedure can be improved. For more information on our services, please contact info@maulingroup. SPONSORED CONTENT

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WHY THEMIS I RETHINK CLINIC

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OR YEARS, many clinicians have viewed indemnity as a paper exercise rather than something that supports their practice. You fill in some information, buy a policy, file it away and hope you never need it. But healthcare has changed dramatically. Today’s clinicians often work across multiple settings, offer a wider range of treatments and face increasing regulatory and legal expectations. The question is no longer simply “Am I covered?” but “Has my indemnity actually adapted, and does it reflect the way I practise?” That’s the thinking behind THEMIS.

Indemnity that evolves with clinicians

Indemnity has too often been treated Northeast, Principal Associate at THE evolve with the way clinicians actual claims and pricing

One of the biggest differences with THEMIS is that its policies are never designed to stand still. As healthcare evolves, so do the risks clinicians face. Rather than relying on outdated policy structures, THEMIS continually reviews its cover to ensure it remains relevant to modern clinical practice. In many cases, new areas of cover are introduced because clinicians have asked for them. As practice changes, the policy changes too. This means the cover is designed to stay fit for purpose, not just today, but for the future of healthcare. 66

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Built by specialists, not general insurers Clinical indemnity isn’t just another insurance product. The wording of a policy matters. The exclusions matter. The definitions matter. That’s why every THEMIS policy is supported by specialist insurance professionals who understand healthcare, clinical risk

and the complexities of medical practice. Instead of navigating generic insurance language, clinicians have access to experts who understand exactly what their policy is designed to do.

What happens when you actually need to claim? Most insurance products are judged when a claim happens, not when a policy is purchased. This is what

IS MAKING US CAL INDEMNITY Its underwriting combines artificial intelligence with specialist clinical insight to assess risk more accurately. Rather than treating every clinician in a specialty the same, pricing can take into account factors such as recent claims trends within that specialty, evolving clinical risk data and the individual clinician’s experience. THEMIS says this approach helps identify lower-risk practitioners and offer more competitive, sustainable premiums where appropriate. The aim isn’t simply to make premiums cheaper. It’s to make them fairer.

The future of indemnity

d as a box-ticking exercise. Margot EMIS, explains why cover should lly practise, from policy wording to

is behind the premium, behind the language, behind the sales piece. When a claim is notified to THEMIS, it remains under the control of its own specialist claims team. Rather than passing the case between multiple third parties, claims are managed by professionals who deal exclusively with clinical negligence matters, within the Maulin Group.

Clinical practice will continue to evolve. This creates a more joined-up approach from notification through to resolution. For clinicians, that means one less thing to worry about during what is often one of the most stressful moments of their career.

New procedures, new technologies and new ways of delivering care will create new risks that yesterday’s policies weren’t built to address. Indemnity shouldn’t be something clinicians have to adapt to.

Smarter premiums through better data

Indemnity should adapt to clinicians.

Pricing clinical indemnity has traditionally relied on broad assumptions. Discipline perception, raw income data, etc.

That’s what THEMIS is trying to achieve: contractual cover that evolves with healthcare, specialist people who understand the profession and a claims process designed around supporting clinicians when they need it most.

THEMIS has taken a different approach.

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RESPONDING TO PAT

WHY THE WAY CLINICIA

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ECEIVING a patient complaint can be stressful for clinicians. Even when they are confident in the care provided, a clinician may feel tempted to defend their position immediately. From a legal perspective, however, the initial response can be crucial. A well-handled complaint may resolve a patient’s concerns before the matter even escalates, avoiding implications for indemnity cover and future litigation. That is why early notification to a clinicians’ insurer matters. It allows the insurer to consider the clinician’s position and provide key support at an earlier stage before the complaint escalates.

Start by listening, not defending Once a complaint has been received, clinicians should be aware of the complaints process as the immediate priority is typically to acknowledge it rather than attempt to answer every allegation on the spot. In that acknowledgment, it is important to make the patient aware of this process, how the complaint will be investigated, what evidence will be considered, how communications will take place and when a response is expected. Its purpose is to set expectations, and demonstrate that the complaint has been taken seriously. The tone matters; clinicians should always look to be polite, sensitive and empathetic. 68

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Handling a patient complaint well can make the difference between resolution and litigation. Owen Stacey, trainee solicitor at Maulin Law, sets out how clinicians should respond - from the first acknowledgement through to the final letter - without inadvertently admitting fault.

As part of this acknowledgement phase of the response, it may be useful to request a meeting with them to clarify and explore their complaint. This allows the clinician the opportunity to get an understanding of what the patient’s concerns and expectations are, even if that is just an apology for what happened. Where allegations appear unfair or inaccurate there may be a natural instinct to correct the patient immediately. However, it is usually better to understand their concerns first and establish the facts before reaching conclusions.

raised the complaint. Appropriate consent should be obtained, with particular care where the patient lacks capacity or is deceased.

Investigate before reaching a conclusion A robust response depends on a proper investigation. Medical records should be reviewed carefully, including consultation notes, consent records, follow-up documentation, treatment history and information given to the patient. The purpose is to establish what actually happened before deciding how to respond. If it is found that something had gone wrong negatively impacting the patient, then it is important to disclose this to them. This is part of your professional obligations, having a duty of candour. This disclosure does not automatically require an admission of legal liability.

Where there will be a delay, the complainant should be kept informed.

When any issue or complication occurred during the patient’s care journey, it is likely that there would already have been an open and honest discussion with them pursuant to the duty of candour prior to the complaint. Therefore, anything that has been discussed as part of this needs to be borne in mind during any subsequent complaint investigation and response.

Confidentiality should not be overlooked. Complaints can be made by family members, friends or other representatives, but clinicians should not assume that they can disclose confidential clinical information simply because somebody else has

It is also important to consider that in many complaint situations, all a patient may want is for the clinician to apologise, even if there was no blame or fault involved. Apologising here would not be a legally binding admission of liability.

TIENT COMPLAINTS:

ANS RESPOND MATTERS It is, however, important not to go beyond this. The distinction matters because an early admission of fault can potentially make a claim more difficult to defend and may also raise issues with the clinician’s insurance. The lesson is not that clinicians should be defensive or evasive. It is that honesty needs to be combined with care over the legal wording of the response.

What should the final response contain? A final complaint response should be structured so that the patient can see that their concerns have actually been fully addressed. It should acknowledge the concerns raised, identify each part of the complaint, explain how the investigation was carried out, including the evidence considered, who was involved, and the outcome. Including a brief chronology can provide useful context to address in turn each part of the complaint. Where the clinician agrees with the complaint, that should be made clear. The response should explain any changes made, or being made, to clinical practice or systems to reduce the risk of the same problem recurring. A patient will often simply want a reassurance that the adverse event they suffered can’t happen to someone else, so evidencing any changes made where appropriate will be crucial.

Where they disagree, the response should explain why. It is also necessary for the clinician to know if their response is being provided as part of a wider private hospital complaint response. It is important for that clinician to have the opportunity to review the final complaint response letter before the hospital sends this out, to ensure that it does not prejudice their position.

Be careful when money is involved

clinicians should understand exactly what they are being asked to pay and what the payment represents.

Three common pitfalls Late reporting: Delaying notification to the insurer may create coverage issues and may make the position more difficult. Admitting fault too early: Clinicians should respond honestly, including acknowledging where something went wrong, but should take care not to make premature admissions of legal fault or negligence.

A refund is not the same as compensation. A refund cannot exceed the amount paid by the patient for the care provided; anything above that is compensation.

Poor record keeping: When a complaint arises, the medical record is often central to understanding and defending what happened. It should show what the clinician knew, what they did, why they did it and what they told the patient. Incomplete records can make it much harder to demonstrate that the appropriate standard of care was met.

If a clinician goes beyond a refund or free revision surgery, and provides a goodwill payment to the patient, it is possible that this payment could be considered compensation. This can have wider consequences for the clinician.

Ultimately, the best complaint response is not necessarily the most defensive one. It is one that shows the patient has been heard, the facts have been made clear, and their concerns have been addressed.

Giving compensation would trigger a statutory duty to register the compensation with the DWP. This would then mean that the clinician becomes liable for any recoverable benefits that the patient has received as a result of the care concerned.

Treat a complaint seriously from the outset, notify promptly where required, think carefully before making admissions or agreeing payments, and make sure the records tell the story. It can provide an opportunity to learn, improve practice and, in some cases, prevent a complaint from becoming a claim.

One area where a seemingly straightforward attempt to resolve a complaint can create unexpected consequences is payment.

The broader point is straightforward: before agreeing to make a payment,

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