Emer MacSweeney on why we are close to a turning point in treating Alzheimer’s
ADVANCES IN CANCER CARE ARE REAL
Dr. Alex Adjei on how the fight against cancer is progressing
GLP-1s AND THE IMPORTANCE OF BEHAVIOURAL CHANGE
How can an AI assistant help to ensure long-term weight loss.
Alzheimer’s is the seventh leading cause of death and one of the major causes of disability and dependency among older people globally.
However, Emer MacSweeney, a specialist in progressive neurodegenerative and neuro-developmental conditions and traumatic brain injury, believes that we are close to being able to treat the disease the same we currently do with diabetes.
She talks about why the new generation of drugs for Alzheimer’s is important, why caring for people earlier is key, and why we might even be not that far away from treating the disease in the same way that diabetes is.
Also in this issue, Alex Adjei, the head of Cleveland Clinic’s Cancer Institute, explains why the fight against cancer is a story of real, measurable progress; Andrew Chadwick-Jones, the chief executive officer of Welbeck Health Partners, talks about the boom in the private healthcare market since Covid; and much more.
We hope you enjoy!
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Contact: Adrian Murdoch, Editorial Lead adrian.murdoch@healthcaretoday.com +44 (0)7983 407607
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THE family of a young woman found fatally injured in an “unsafe” mental health hospital is campaigning to improve care for others.
In November 2018, a young woman was admitted to a ward in Cygnet Hospital Ealing. In July 2019, the young woman was able to take her own life while resident on the ward. Cygnet Ealing were aware of this young woman trying to harm herself in an almost identical way four months earlier, yet they failed to mitigate the known environmental risk to which she was exposed.
Cygnet Health Care was subsequently fined £1.53 million after pleading guilty in a criminal prosecution brought by the Care Quality Commission (CQC).
“People, especially those at such a frightening, vulnerable time in their life, should be able to expect safe care and treatment, so it’s unacceptable that this young woman’s safety wasn’t well managed by Cygnet Hospital Ealing when she needed them the most. This is why I welcome their guilty plea,” said Jane Ray, CQC deputy director of operations in London.
Cygnet acknowledged failings of providing a safe ward environment to reduce the risk of people being able to use a ligature; ensuring staff observed people intermittently in line with the company procedures; and not training staff to be able to resuscitate patients in an emergency.
Following the sentence on 21 September, 2023, the girl’s parents are now calling for improved mental health care among young people. It comes after an inquest jury concluded that the girl’s death was contributed to by neglect. It concluded that “the lack of documentation at Cygnet” was insufficient to provide a safe level of care and that a lack of staff in management roles contributed to instability and caused a lack of oversight.
The inquest was told that one mental health nurse and two healthcare assistants were on duty on the night she died. When the patient was found, one healthcare assistant was on a break and the other was carrying out one-to-one observations on another patient. No attempt was made to bring additional staff from another ward to cover the break. The
inquest was told that staffing levels on the night were “unsafe” and that a minimum of two nurses and two assistants were required to cover a ward.
“This isn’t an isolated incident. We continue to see too many cases of young people with mental health problems not receiving the level of care they deserve, often miles from home,” said human rights lawyer Camilla Burton at Irwin Mitchell, who is representing the family.
THE NHS has, for the first time, published league tables which rank every trust in England. The Department of Health and Social Care (DHSC) has said each trust will be ranked every three months against clear standards – from urgent and emergency care to elective operations and mental health services.
The government has said that topperforming trusts will be rewarded with greater autonomy, such as the ability to reinvest surplus budgets into frontline improvements like new diagnostic equipment and hospital upgrades. Those facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay. In an attempt to end the postcode lottery in care, the best NHS leaders will be offered higher pay to take on the toughest jobs, and they will be sent into challenged services to turn them around.
“These league tables will identify where urgent support is needed and allow highperforming areas to share best practices with others, taking the best of the NHS to the rest of the NHS,” said health and social care secretary Wes Streeting.
Trusts have been scored into four performance segments, with the first segment representing the best performing areas and the fourth segment showing the most challenged. The government has said that trusts in the middle segments of the tables will be encouraged to learn from top performers to help them improve
on their to benefit surpluses
“Letting more data even faster where from their in their on their Mackey,
“The data boards easily identify services deliver faster going
The data league ambulance scored Oversight the delivery performance waiting improving
The highest Moorfields Trust. “We in this first we have do so,” Ridley. College proud working and aspirations,
their rankings, so they too will be able benefit financially from their budget surpluses in the future.
“Letting patients and the public access data will help to drive improvement faster by supporting them to identify they should demand even better their NHS and by putting more power their hands to make informed decisions their choice of provider,” said Sir Jim Mackey, chief executive of NHS England.
data also supports local NHS trust boards and leadership teams to more identify the highest performing services in the NHS and adapt how they deliver care to drive improvement even going forward,” he continued.
data released has been split into three league tables for acute, non-acute and ambulance trusts. Each trust has been against metrics in the National Oversight Framework (NOF), which reflect delivery of NHS priorities, including performance against targets like reducing waiting times for electives and A&E, and improving ambulance response times.
highest rated acute trust was Moorfields Eye Hospital NHS Foundation “We are delighted to be recognised first table. Many of these are areas have focused on, and will continue to said interim chief executive Peter Also highly rated was Imperial College Healthcare NHS Trust. “I am very of how our staff are increasingly working as one team, with shared values aspirations, and to see that now
translating into improvements in all aspects of our work,” said chief executive Tim Orchard.
At the other end of the table is The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust. In a statement, the Trust admitted that it had “fallen short”. It continued: “Immediate steps are being taken to address the issues. We are working closely within our newly formed Norfolk and Waveney University Hospitals Group, as well as with NHS England and regulators to deliver urgent improvements”.
For non-acute hospital trusts, North Staffordshire Combined Healthcare NHS Trust was rated the highest. “Our ambition is to be Outstanding in everything we do and how we do it. We remain fully committed to improving the well-being of the people and families of our local communities – those we are privileged to serve,” said chief executive Buki Adeyemo. Birmingham Community Healthcare NHS Foundation Trust, which was rated the lowest.
For ambulance trusts, North West Ambulance Service NHS Trust was rated the highest, while the bottom place was taken by East of England Ambulance Service NHS Trust.
The publication of the data is significant and, as the government says, an effort “to raise standards and ensure better value for patients and taxpayers”.
“People want clarity on how their local NHS is doing, and so many will welcome
the aspiration to make this easier to understand,” said Chris McCann, deputy chief executive of Healthwatch England.
But there are questions about how useful the data will be in changing behaviour.
“If a service is struggling, transparency must come with accountability. Patients need to know what’s being done to fix the problem, and when it will improve,” McCann continued.
Hugh Alderwick, director of policy at the Health Foundation, has taken a similar line: “The new ratings need to be used as a way to support struggling organisations to improve, rather than another tool for top-down control and performance management,” he said, also warning that it could harm morale.
“Negative ratings can impact organisational culture, staff morale, and recruitment, which could – perversely –worsen performance further and impact patient care,” he said.
As for the patients, Nuffield Trust chief executive Thea Stein worries that it may harm rather than help patient safety.
Speaking specifically of small or remotely situated trusts whose ranking may be down to things outside their control, like the quality of their buildings or difficulty in attracting and retaining staff, she warned: “The scheme also risks discouraging people from getting treatment from poorly performing trusts, or staff from working for them”.
AN INVESTIGATION into corridor care in England has been announced, following sustained campaigning on the issue by the Royal College of Nursing.
It is an issue that Healthcare Today has long reported on.
The Health Services Safety Investigations Body (HSSIB) –which carries out independent patient safety investigations in England’s NHS and independent health care settings – will investigate “temporary care environments”. This is the first time official investigators will examine the impact of corridor care. HSSIB will provide a report directly to Westminster at the end of the year.
The HSSIB plans to speak to staff, patients and families, to understand how, where and when temporary care environments are being used; the needs of patients using temporary care environments, including those from vulnerable patient groups, and the associated patient safety issues; and the impact
of temporary care environments on patients and staff and how organisations are managing the associated patient safety issues.
“No patient should languish in a corridor, a chair or be forced to endure intimate examinations in public areas. This investigation must shed more light on the scale and impact of these shocking conditions and mark the beginning of the end for this unacceptable practice,” said RCN general secretary and chief executive Nicola Ranger.
For meaningful progress to be made to eradicate corridor care, demand within the acute sector must be carefully managed and reduced, the RCN said.
This will require patient capacity to be increased in the right places; challenges addressed in primary and social care; and the ambition to move care into the community – a key aspect of the NHS’s 10 Year Health Plan – must be prioritised and properly funded. Alongside this, additional nursing resources
in primary care and social care can help keep people healthier for longer, reducing the likelihood of complications leading to avoidable admissions.
“With the support of health leaders and ministers, this investigation could be a significant moment for patient safety. Alongside new investment to bolster the nursing workforce, there is hope that we can transform patient care,” Ranger said.
As Healthcare Today reported in August, corridor care has been blamed as a factor in the rise in violence against nurses.
Freedom of Information requests to 89 trusts in England found that incidences of physical violence against staff have almost doubled from 2,093 in 2019 to 4,054 last year.
Earlier this year, the Royal College of Nursing and the British Medical Association in Wales joined forces to call for an end to the practice, which threatens patient safety altogether in Welsh hospitals.
THE National Institute for Health and Care Excellence (NICE) is moving away from a one-size-fits-all approach, shifting from automatically starting everyone on one medicine to personalised treatment plans that aim to prevent heart failure, heart attacks and other serious medical problems.
NICE’s independent guideline committee has expanded access to newer diabetes medicines called SGLT-2 inhibitors from being secondchoice treatments to first-choice treatments. And some groups of patients will have access to GLP-1 receptor agonists rather than keeping them for later stages of treatment.
“This represents a significant evolution in how we approach Type 2 diabetes treatment. We’re moving beyond simply managing blood sugar to taking a holistic view of a person’s health, particularly their cardiovascular and kidney health,” said Jonathan Benger, deputy chief executive and chief medical officer at NICE.
“The evidence shows that certain medicines can provide important cardiovascular benefits, and by recommending them as part of initial treatment, we could help prevent heart attacks, strokes and other serious complications before they
occur. This is particularly important given that cardiovascular disease is the leading cause of death in people with type 2 diabetes.”
The guidelines also address concerns about under-prescribing of SGLT-2 inhibitors. Following an analysis of almost 590,000 people, NICE found that these medicines are not being offered equitably across the UK. SGLT2 inhibitors are under-prescribed, particularly to women, older people, and Black or Black British individuals.
The draft guidelines suggest that adults with cardiovascular disease should be offered triple therapy including a GLP-1 receptor agonist; adults with early onset Type 2 diabetes should be offered dual therapy before a GLP-1 receptor agonist is considered; people living
with obesity should receive specific treatment combinations; those with chronic kidney disease should have tailored recommendations based on their kidney function; and adults with frailty should be considered for metformin alone initially.
New evidence suggests that nearly 22,000 lives could be saved once uptake of the recommended changes for SGLT-2 inhibitors, as a joint first-line treatment option with metformin, reaches 90% of the patient population.
Around 4.6 million people are diagnosed with diabetes in the UK, according to Diabetes UK, with about 90% of those having Type 2. Additionally, it is estimated that almost 1.3 million people in the UK are likely to have undiagnosed Type 2 diabetes.
AN NHS pilot incorporating blood pressure checks into routine eye tests has potentially saved 44 lives over the past eight months.
The NHS hypertension pilot delivered by eye care services provider Primary Eyecare Services in partnership with local NHS commissioners and local optical committees is active in four areas: Greater Manchester, Lancashire &
South Cumbria, Gloucestershire, and Cheshire & Merseyside.
During the first eight months of the pilot scheme, more than 4,000 blood pressure checks have taken place, with 22% of patients referred for further investigations after abnormal readings. Later, 44 individuals received medical assistance as a result of the blood pressure test.
“The data highlights the service’s effectiveness in identifying undiagnosed hypertension – an intervention that can significantly reduce long-term cardiovascular risk,” said Julia Maiden, clinical lead for the pilot in Greater Manchester.
The hypertension service has received high patient satisfaction, with 99.4% of patients recommending the service.
The Private Practice Committee ( PPC) is embarking on a campaign to specifically support doctors engaged in private practice; those doctors looking after self-pay patients/ patients with private medical insurance. If you are undertaking private practice work, it is crucial that this information is captured on our membership database so we can provide proper representation and lobby the relevant private hospital groups, private medical insurers, the Government and other key stakeholders. In particular, we would like to know where you are working.
Please update your details using the QR code or by emailing membership@bma.org.uk
AREPORT from the Health Services Safety Investigations Body (HSSIB) reiterates that challenges in maternity and neonatal safety are the result of systemic issues at a national level, rather than isolated issues within local areas.
Healthcare Today has consistently highlighted the issue of maternity safety such as maternity services at Swansea Bay University Health Board and those at Leeds Teaching Hospitals NHS Trust.
The HSSIB report emphasises the importance of taking a different approach to maternity safety. It has key themes, from the safety concern reports and 17 national stakeholder interviews, that indicate systemic issues need to be addressed to tackle the risks within maternity and neonatal care.
It highlights the fact that national and neonatal maternity systems are overly complex, national collaboration is inconsistent and variable, and that
too many recommendations are made at a national level, with limited implementation.
“The report evidences that serious safety concerns continue to exist across maternity services, despite past events. We need to ensure safety concerns are effectively and proactively understood and managed to ensure significant improvements are delivered,” said HSSIB’s director of investigations Philippa Styles.
The report suggests that there should be a focus on the systems that impact safety rather than a focus on individual actions. It reinforces this through the themes relating to risk and learning within maternity and neonatal services.
As Nina Vegad, director of Investigation Services at TMLEP, wrote last week: “When failures repeat across services for example, maternity, cardiology, orthopaedics, and over multiple years, we are no longer talking about individual lapses. We are confronting systemic weakness.”
This should be what the report calls “an urgent priority for stakeholders”. It highlights examples of where clinical risks relating to labour and birth were not anticipated or responded to. It also mentions the system has not been learning from past events, incidents, litigation or national inquiries in the way that would be expected.
Harm to women and families has been compounded by their treatment after maternity incidents. There is a huge variation in whether women and families feel listened to, the report says, and this variation reflects differences in organisational culture.
“There needs to be more positive support for staff working in maternity and neonatal services,” said Styles. “A culture focused on blame is impacting their wellbeing and their ability to work effectively, but will also stifle progress because they feel fearful to speak up about their concerns. Enabling staff to speak freely, without repercussions, is vital to supporting a positive and collaborative approach to improving maternity safety,” she concluded.
The most difficult period of my career began on a sunny Saturday morning. I’d just sat down with a coffee to catch up with the never-ending emails. One of them was from my employer. They were instigating formal disciplinary action against me. Having found gaps in my notes, they were alleging that my operating techniques were deficient. I was restricted to non-clinical duties pending investigation.
I just felt numb. I called Medical Protection and was assigned a very supportive medicolegal consultant. That support was a lifelineespecially when, not long afterwards, I was completely suspended.
Medical Protection instructed an independent expert surgeon, whose main criticism was around record-keeping. I did a lot of reflection on this and took an online course as part of my membership.
Eventually, the investigation found no grounds for ongoing suspension, and I returned to clinical practice. Medical Protection got me through those two long years of regulatory and legal process, and constantly kept the pressure on the hospital to move forward. More than that, their insight and understanding helped to make me a better doctor.
medicalprotection.org/case7
Always there for you
AFTER a strong start to the year, there was a small dip in insurerfunded healthcare during the second quarter, but the sector finished on a high, according to the latest invoice data from Healthcode.
The UK’s official clearing organisation for medical invoices validated more than 2.9 million invoices in the April to June period. This was a slight rise of 1.4% year-on-year but was 0.7% lower than the first quarter.
Nonetheless, a busy first three months of the year have meant that the total volume for the first six months of this year was still up 4% year-on-year at 5.9 million.
In addition, insured activity regained momentum by the end of the quarter: the volume for June (999,097) was up by 0.5% on May and by 9% yearon-year.
Healthcode’s managing director Peter Connor pointed out that the lull in the second quarter was only temporary. “We’ve seen volumes recover in recent weeks across all regions and settings while our current full-year projection anticipates another year of growth for insured healthcare,” he said.
That growth is likely to come from Millennials.
Private healthcare is increasingly being seen as “essential” for younger working-age people, with half of 35-44 year olds expecting to pay for treatment in the coming year.
The Independent Healthcare Providers Network’s (IHPN) latest Going Private 2025 report has found that while previously those under 30 have been most likely to consider using private healthcare, this openness to paying for treatment is now spreading to older groups. The 35-44 year old cohort is now
the most likely to say they will use private healthcare, with 49% of this group saying they are expecting to use private healthcare within the next 12 months – a jump of 10 percentage points over the last year.
IHPN sees this in the context of the normalisation of going private. The report says that 71% of the population would now consider using private healthcare, which is a jump of almost 10% over the past two years.
“Whilst a decade or two ago it may have been seen as the preserve of the rich, it’s now clear that private healthcare is becoming ever more relevant to people’s everyday lives, with the increasing numbers of employers who are providing private medical insurance to their staff proving a particular driver in encouraging more people to go private,” said David Hare, chief executive of the Independent Healthcare Providers Network.
THE Scottish government has said that general practice will receive an initial additional investment of £15 million this year to ease recruitment pressures and boost capacity, though the Royal College of General Practitioners (RCGP) has said that the sums are not transformative.
The new investment is to support workforce retention and recruitment, build service capacity and support the day-to-day running of GP services.
“We want to make it easier for people to see their GP and to achieve this, we are working towards ensuring a greater proportion of new NHS funding goes to primary and community care,” said Scottish health secretary Neil Gray.
He added that the government had already increased investment in general practice by more than £100 million in the past two years to meet recommended pay increases and to support practices with sustainability.
“This funding alone will not transform general practice or undo years of underinvestment. It must be seen as the beginning of a sustained commitment to properly resource general practice – stabilising services, supporting the recruitment of more GPs, and expanding capacity to improve patient access,” said RCGP Scotland chair Chris Provan.
He said that the funding should “mark the start” of a shift in the balance of care and funding towards primary and community care.
THE government has announced the development of an AI-assisted tool at Chelsea and Westminster NHS Trust to speed up the discharge process from hospital.
“This is exactly the kind of change we need – AI being used to give doctors, probation officers and other key workers more time to focus on delivering better outcomes and speeding up vital services,” said technology secretary Peter Kyle.
As part of the NHS Federated Data Platform (FDP) programme, the Trust is using AI and data tools to improve the way patients
move through our hospitals – from admission to discharge. This includes automatically identifying patients ready for discharge to free up beds, matching last-minute outpatient slots with patients who can attend at short notice, and reducing paperwork, freeing up staff time for direct patient care.
“This potentially transformational discharge tool is a prime example of how we’re shifting from analogue to digital as part of our 10 Year Health Plan,” said health and social care secretary Wes Streeting. “We’re using cutting-edge technology to build an NHS fit for the future and tackle the
hospital backlogs that have left too many people waiting too long. Doctors will spend less time on paperwork and more time with patients, getting people home to their families faster and freeing up beds for those who need them most,” he continued.
As Rob Hendry, medical director and chief member officer at Medical Protection Society, put it, “the UK government’s desire to turbocharge AI in healthcare has been clear from the outset”, and the greater use of AI was one of the government’s “three key shifts” announced in its 10 Year Health Plan in July.
AFTER the Care Quality Commission (CQC) rated Sue Ryder Wheatfields Hospice in Headingley, near Leeds, as inadequate, the hospice has fought back, calling the report “misleading and unnecessarily alarming”.
Sue Ryder Wheatfields Hospice, run by Sue Ryder, provides adult inpatient and community specialist palliative care services for people with life-limiting conditions where curative treatment is no longer an option and people are approaching the end of their life.
CQC undertook the inspection in March and May to follow up on concerns raised with them about the quality of care being provided to people.
Following this inspection, CQC has rated the areas of safe, effective and well-led as inadequate. Caring has been rated as requiring improvement. It has also placed the service into special measures, which involve close monitoring to ensure people are safe while they make improvements.
“When we inspected Wheatfields, it was disappointing to see how ineffective leadership had directly contributed to poor care. Staff were kind and worked hard to provide compassionate care but were let down by leaders who hadn’t investigated when things went wrong,” said Linda Hirst, CQC deputy director of operations in the north.
“Leaders didn’t respond effectively to concerns about understaffing and low morale, which impacted on people’s care. Staff also said they were frequently unable to take breaks as it placed people at risk due to there being no cover,” she continued.
Sue Ryder, however, has fought back against what it calls a “factually inaccurate” assessment of the Wheatfields Hospice.
It admitted that its own quality assurance and safety controls had identified areas that required improvement during a comprehensive internal review last year. These followed a proactive decision temporarily to close. They
included poor behaviours amongst some staff and concerns regarding their clinical practice, which resulted in a formal investigation and several employees at all levels of the service leaving the organisation. Following that, it said that a new leadership team was appointed and that there have been many improvements.
“At no point have we found evidence to suggest that any patients received unsafe care,” it said.
It also said that although the CQC mentioned understaffing of the inpatient unit, this only referred to four shifts out of 453, where there was one staff member down due to last-minute sickness.
In the note seen by Healthcare Today, it concluded: “Sue Ryder has had a strong working relationship with the CQC for many years and respects them as our regulator. However, despite attempts to work constructively with them during this inspection process, we have sadly been left with no choice but to seek legal advice in relation to this report.”
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THE Centre for Mental Health says that people in a mental health crisis are facing a postcode lottery of care, with children and young people sometimes unable to access care suited to their needs.
The report says that rising levels of need for emergency mental health care are placing current systems under major pressure. And too often, people’s experience of inpatient care can be coercive and re-traumatising.
The World Health Organization warned recently that Europe needs to spend more on mental health.
In Britain, Helen Morgan, Liberal Democrat MP for North Shropshire, and the party’s spokesperson for health and social care, told Healthcare Today earlier this year: A significant number of people are unable to work due to poor mental health, and accessing treatment is often frustratingly difficult. Ensuring proper support is available is not just a healthcare issue – it is a social and economic imperative.”
Despite the standard of care patients received improving, the average time a person in a mental health crisis spent in A&E last year was an hour more than in 2023. The Centre for Mental Health report argues that major investment in services, staffing and buildings is needed to move towards compassionate and timely care in a crisis. However, it also cautions that superficial changes or tokenistic attempts at reform will fail to achieve systemic change.
“Acute and crisis care are essential elements of our mental health care system. At their best, they save lives and are there for people when they most need urgent help. Too often, however, people struggle to get help in a crisis, and many report that their experiences of crisis care and hospitalisation create traumas of their own,” said Andy Bell, chief executive at Centre for Mental Health.
The report summarises research from the NIHR Policy Research Unit in Mental Health about ways of supporting people in a mental health crisis. It sets out the evidence about community-based alternatives to hospital care, such as crisis houses, day units, home treatment teams and crisis cafes, which enable people to get support closer to home. The provision of alternatives to hospital care is inconsistent, and what’s commissioned doesn’t correspond with the available evidence of what’s effective.
THE medical profession is more ableist than wider society, and hundreds of disabled and neurodivergent doctors are leaving the workforce as a result.
As James Henderson, a surgeon and neurodiversity lead at the Confederation of British Surgery, wrote in Healthcare Today earlier this year, 29% of autistic doctors conceal their diagnosis because of fear of discrimination.
Interim results from a BMA survey of more than 800 disabled and neurodivergent doctors and medical students suggest that a lack of support has driven over half of respondents (53%) either to leave the profession in the past two years or seriously consider doing so.
Over a third of respondents (34%) reported experiencing bullying or
harassment linked to their disability, neurodivergence, or long-term health condition, while 78% said they had felt worried about being treated unfairly or viewed negatively because of it.
There were 801 respondents to the survey across the UK: England (79%), Scotland (9%), Wales (5%), and Northern Ireland (3%) in May this year.
“Worryingly, the survey found that just 34% of respondents who disclosed their disability to their place of work or study experienced improved support,” said Amit Kochhar, chair of the BMA’s representative body.“When that support is lacking, we risk losing talented doctors from the profession altogether. This loss is detrimental to individuals, patients, and the NHS, compounding workforce retention challenges and increasing pressure on those who remain.”
The BMA says that it is currently working with stakeholders to address the issues highlighted in the survey, particularly those that affect doctors and medical students daily, such as the finding that 73% of respondents had not received all the reasonable adjustments they require.
“A lack of disability and neurodiversity awareness, coupled with discrimination and stigma, can significantly impact disabled doctors’ lives and careers.
“We also continue to see disparities, such as the later diagnosis of autism in women, and significant variation in access to services for international colleagues. Those who have already overcome personal hurdles should not face additional barriers, such as rigid exam policies or being unfairly penalised throughout their careers,” said Kochhar.
THE National Institute for Health and Care Excellence (NICE) has recommended a new first-line treatment for adults with advanced bladder cancer.
Enfortumab vedotin (also known as Padcev and made by Astellas) with pembrolizumab (also known as Keytruda and made by MSD) is recommended for treating unresectable or metastatic urothelial cancer for people who are eligible for platinum-containing chemotherapy.
The combination treatment is a step change in cancer care. Clinical trial evidence shows that it can significantly extend both progression-free survival and overall survival compared to current standard chemotherapy treatments.
“Advanced bladder cancer is a devastating condition which can have a substantial impact on people’s daily lives, often leading to them struggling to work, travel or maintain physical activity,” said Helen Knight, director of medicines evaluation at NICE.
“This is a highly promising and effective new drug, with clinical trial results highlighting the tremendous
difference it could make to the length and quality of people’s lives,” she continued.
It is estimated that more than 1,200 people per year could benefit from this targeted treatment, which is given as an infusion in a clinic or hospital. It is made up of a monoclonal antibody which recognises and kills certain cancer cells.
More than 10,000 people are diagnosed with bladder cancer each year in the UK, and only around 10% of people with Stage 4 bladder cancer will survive five years or more after they are diagnosed.
The recommendation is based on evidence from a clinical trial involving 886 adults with untreated unresectable locally advanced or metastatic urothelial cancer.
Progression-free survival almost doubled for people taking enfortumab vedotin and pembrolizumab to 12.5 months compared with 6.3 months for those on chemotherapy, and overall survival increased to a median of 33.8 months for those on the combination treatment compared with 15.9 months for those on chemotherapy.
Around 30% of people on the trial achieved a complete remission following treatment with enfortumab vedotin and pembrolizumab, meaning all detectable signs of the disease had disappeared. The news was welcomed by medical professionals.
“The NICE recommendation is a major leap forward for urothelial cancer care,” said Ian Pearce, president of the British Association of Urological Surgeons.
“For patients battling advanced bladder cancer, the prospect of having increased rates of progression-free survival and overall survival, combined with lesser sideeffects compared to traditional treatment methods, is nothing short of transformative,” he added.
“This new drug has the potential to increase how long people have before their cancer gets worse and how long they live compared with the current, limited, treatment choices available,” said Jeannie Rigby, chief executive of charity Action Bladder Cancer UK. “It’s also of importance that this treatment can mean these patients can experience a better quality of life with less hard-to-tolerate side effects,” she continued.
AN NHS pilot incorporating blood pressure checks into routine eye tests has potentially saved 44 lives over the past eight months.
The NHS hypertension pilot delivered by eye care services provider Primary Eyecare Services in partnership with local NHS commissioners and local optical committees is active in four areas: Greater Manchester, Lancashire &
South Cumbria, Gloucestershire, and Cheshire & Merseyside.
During the first eight months of the pilot, more than 4,000 blood pressure checks have taken place, with 22% of patients referred for further investigations after abnormal readings. Later, 44 individuals received medical assistance as a result of the blood pressure test.
“The data highlights the service’s effectiveness in identifying undiagnosed hypertension – an intervention that can significantly reduce long-term cardiovascular risk,” said Julia Maiden, clinical lead for the pilot in Greater Manchester.
The hypertension service has received high patient satisfaction, with 99.4% of patients recommending the service.
THE Association of Personal Injury Lawyers (APIL) has warned that plans to hike court fees in Northern Ireland will impact those wanting to make claims of medical negligence.
The Northern Ireland Courts and Tribunal Service (NICTS) wants to increase court fees in civil claims by a total of around nine per cent over three years, starting in 2026. And after these rises, it proposes annual inflationary increases.
“Access to the justice system should not depend on whether you can afford to issue court proceedings or not,” said APIL Northern Ireland representative Sabrina Lawlor.
“Anyone can become a victim of a negligent employer or a reckless driver. People who suffer needless injuries must have access to the civil justice system to get the redress they need to put their lives back on track,” she continued.
In its response to the consultation on the changes, APIL said: “The whole of society benefits from the functions of the court, not just the direct users, and as such should be largely funded by the taxpayer. Most people go to work safe in the knowledge that if they are negligently injured in the course of their employment, they are protected by the law and the impartiality of the court system, which enforces the law.”
APIL said it is also concerned that county court scale fees – the fixed amounts courts can order a losing party to pay the winning one for their legal expenses – have significantly lagged behind inflation.
“The failure to review scale costs has left many law firms chronically underfunded during a period of extraordinary inflationary pressure,” said Lawlor.
Firms representing victims of negligence often have to pay the initial costs of pursuing a case, such as the court fees and medical expert fees.
The combination of inadequate scale costs and rising court fees has a significant impact on a firm’s ability to do this. It’s a double hit on legal professionals and the vulnerable people they represent, she continued.
“The lack of efficiency in the court system also means that solicitors are paying costs upfront, and the time taken to resolve the case (and get those costs reimbursed) is too long. If there is no improvement in the efficiency, again, this may lead to some firms struggling to take on cases,” APIL warned in its statement.
THE Oxford University, through its strategic partnership with the Ellison Institute of Technology (EIT), has received £118 million research funding to launch a programme of vaccine research into infections.
The CoI-AI programme will study how the immune system responds to germs that cause serious infections and contribute to antibiotic resistance – including Streptococcus pneumoniae, Staphylococcus aureus and E. coli – which cause illness but have resisted traditional vaccine approaches. Researchers will use human challenge models, where volunteers are safely exposed to bacteria under controlled conditions, and apply modern immunology
and AI tools to pinpoint the immune responses that predict protection.
Andrew Pollard, director of the Oxford Vaccine Group, called it “a new frontier in vaccine science”.
In December 2024, Oxford University and EIT announced a long-term strategic alliance to develop the solutions and future leaders needed to tackle some of the most enduring challenges facing humanity.
EIT combines research and commercial capability to drive scientific breakthroughs and create sustainable, ethical companies, bringing together cross-cutting capabilities and talent spanning
generative biology, clinical medicine, plant science, sustainable energy and public policy. These efforts are underpinned by computing capability enabled by Oracle, an AI team, and a scholars programme.
The Oxford Vaccine Group is a vaccine research group within the Department of Paediatrics at the University of Oxford’s medical sciences division. “This programme will give us completely new tools to study how vaccines work at both a cellular and system-wide level, by studying infections in real time, in people, and using smart immunology tools and data to find the answers,” said Daniela Ferreira, deputy director of the Oxford Vaccine Group.
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FOLLOWING a spike in hospital admissions, the Medicines and Healthcare products Regulatory Agency (MHRA) is cracking down on the illicit trade in unlicensed botulinum toxin products, commonly referred to as Botox, used in cosmetic procedures.
Between the beginning of June and August, 41 confirmed cases of botulism – a rare but potentially life-threatening condition causing paralysis – were reported across several regions in England, including the North East, East Midlands, East of England, North West, and Yorkshire and Humber.
The Criminal Enforcement Unit says that it has seen evidence that some sellers and practitioners – often untrained – are obtaining unlicensed botulinum toxin products illegally and offering injections in unsafe, unregulated settings. The treatments are being delivered in domestic bedrooms and kitchens, hair salons, and through mobile beauty services.
“Anyone involved in the supply of unlicensed botulinum toxin is breaking the law and endangering lives,” said Andy Morling, the head of the MHRA’s criminal enforcement unit. “We are working across the country to identify those responsible, seize illegal products, and bring cases to court,” he added.
13/10/2016 11:08
Botulism caused by botulinum toxin in cosmetic procedures is rare but can be life-threatening. Symptoms can take up to four weeks to develop and may include difficulty swallowing, slurred speech and breathing difficulty. In severe cases, patients may require mechanical ventilation and intensive care treatment.
Since May 2023, the Criminal Enforcement Unit, working closely with its partners in Border Force, has seized more than 4,700 vials of unlicensed botulinum toxin both at the border and inland.
Almost all of the seized products originated in South Korea, including brands such as Botulax, reNTox, Innotox, and Toxpia, which are not authorised for sale in the UK.
“Buying botulinum toxin in any other circumstances significantly increases the risk of getting a product which is either falsified or not licensed for use in the UK,” said MHRA chief safety officer Alison Cave. “If you are offered botulinum toxin without a medical consultation, in an informal setting, or at a price significantly below usual rates, this should be treated as a warning sign,” she added.
AREVIEW of joint inspections for services for children and young people at risk of harm in Scotland, undertaken by the national scrutiny body for care services, Care Inspectorate, has found overall improvements.
Inspectors acknowledged a high degree of relationship-based and trauma-informed practice across services and observed staff in a wide range of universal services working well together to support families.
They also noted strengths in multiagency responses to early indications of concern and the ways in which children and young people were involved in decision-making in relation to their own planning and support. In general, they also noted improvements across key processes of assessment, planning and reviewing.
“The Care Inspectorate and scrutiny partners will continue to reflect on,
and where appropriate, act upon the learning gained from the findings of this most recent joint inspection programme,” said Jackie Irvine, chief executive of the Care Inspectorate.
“We will also review feedback we have received on the most recent joint inspection processes and continue to develop our approach. There are many areas highlighted in this report which will support our focus,” she continued.
Inspectors also saw variability across partnerships in relation to some areas of practice. These included multiagency responses to situations of risk in relation to cumulative harm, poverty, deprivation, domestic abuse and mental health. Responses to risks for older young people in relation to community-based harms were, broadly speaking, not consistently effective.
The wider collation of children’s and young people’s views to help shape the development of services was not
taking place systematically in every partnership area. The extent to which partnerships were able to measure and demonstrate the difference they were making to children’s lives also varied due to differences in approaches to quality assurance.
“In these joint inspections, similar to the previous programme, we continued to note certain children and young people whose outcomes remained poorer than their peers,” said Irvine.
She highlighted the outcomes for children and young people subject to compulsory supervision orders and living at home with their parents, which remained an area in which partnerships could not easily demonstrate an improvement in outcomes.
“For this reason, we will focus our next joint inspection programme on these children and young people,” she concluded.
THE figures for burnout within the medical industry are depressingly high. In late August, Healthcare Today reported that 82% of doctors said that they were at risk of burnout.
The figures aren’t getting any better. New research from hiring platform Indeed which surveyed more than 1,000 healthcare professionals in the UK finds that 92% of healthcare workers have experienced burnout, with 96% reporting that they regularly work overtime.
The average amount of overtime worked is 14 hours, almost a third (28%) of which is unpaid. This rises among mental health workers, of whom 22% work 21 hours or more unpaid per week. Despite this, nearly half (44%) still feel undervalued, while 56% say understaffing is significantly making their job harder. Unsurprisingly, just over a third (34%) are actively considering leaving their current role, though there is a glimmer
of hope that 63% of respondents believe that better work exists within the industry, but struggle to find the right opportunity.
Despite the ongoing pressures, many healthcare workers remain committed to their profession and continue to find meaning in their roles. Helping patients (49%), working collaboratively (37%) and
building strong relationships (36%) are consistently cited as the most rewarding parts of the job.
Satisfaction is particularly high among midwives, all of whom say they’re happy in their role, followed closely by pharmacists (95%) and mental health professionals (94%).
For many, however, the challenge lies not in the work itself – but in finding the right environment. More than four in five (85%) workers say that belonging is important to them, but feel it is missing from their current role.
While almost two-thirds (63%) believe that better roles are out there in the industry, more than half (51%) say they’re too exhausted after their shifts to search for a new job.
Even if they did have the energy, the jobs are hard to find. More than half (55%) also describe the process of finding a suitable role as “like finding a needle in a haystack”.
FIGURES obtained by Personal Injury Claims UK show that over the past three years, ambulance services across the country have reported more than 20,000 staff injuries while on duty, as services have paid out over £4.5 million to injury claims since 2022.
This backs up Healthcare Today, which in April reported a 15% increase in reported incidents of violence, aggression and abuse.
Figures from the Association of Ambulance Chief Executives (AACE) revealed that more than 20,000 incidents of violence, aggression and abuse were directed at staff across the 14 UK ambulance services
last year. The number of incidents is the highest ever recorded in the sector and equates to at least 55 ambulance staff being abused or attacked every single day.
“No one should be attacked for simply doing their job. Ambulance workers who respond to emergencies, from heart attacks to car crashes, are trying to save lives,” said UNISON national ambulance officer Sharan Bandesha.
“Rising pressure on the health service has created a toxic environment where violence and abuse are becoming far too common. This is unacceptable. Staff are being left traumatised, injured
and even forced out of roles, which makes the workforce crisis worse,” she added.
The South Central Ambulance Service logged the greatest number of injuries at 7,386, followed by the London Ambulance Service, which recorded 4,927 of them.
Between 2021 and 2024, 486 claims were lodged against the services, with 268 of these claims being settled.
This has led to a total of £4.5 million being paid out to successful claimants, with the highest amount being paid in 2022/23 at £2.7 million.
EMER MACSWEENEY
co-founded Re:Cognition Health in 2011 to provide a specialist service for accurate diagnosis and access to the latest treatments for progressive neurodegenerative and neuro-developmental conditions and traumatic brain injury.
Here she talks to Healthcare Today about why the new generation of drugs for Alzheimer’s is important, why treating people earlier is key and why it might even be not that far away from treating the disease in the same way that diabetes is.
What do you think the public most misunderstands about new treatments for Alzheimer’s?
With the public, the issue starts even before treatment. The first problem is that people often don’t recognise the early signs of developing cognitive problems, particularly the gradual loss of short-term memory. People don’t always appreciate that these memory lapses could mark the beginning of a neurodegenerative disease process, rather than just “getting old”.
The second, related problem is a lack of understanding about treatment timing. With the new amyloidtargeting therapies, the earlier they are accessed, the more effective they are at clearing the amyloid protein and slowing the progression of the disease and its symptoms. Many members of the public – and indeed a significant proportion of the medical and healthcare professions – do not fully grasp that a diagnosis needs to be made long before
Emer MacSweeney, the co-founder of Re:Cognition Health, explains why the gradual loss of short-term memory in later life is not a normal part of ageing and why we are close to a turning point in treating Alzheimer’s.
Written by Adrian Murdoch.
dementia is obvious, and the only way to make that early diagnosis is through the use of accurate biomarkers.
If a patient comes to me saying they have memory problems, I cannot tell simply by carrying out a standard cognitive assessment whether they have toxic levels of amyloid protein in their brain, or whether tau proteins are beginning to form. The only way to know at that early stage is to carry out a biomarker test. Recognising that memory problems in later life are not a normal part of ageing, understanding that an accurate early diagnosis cannot be made through basic cognitive testing alone, and appreciating that amyloid-targeting therapies are most effective when given as early as possible – these are the foundations of the new approach to treatment.
For politicians, the argument is quite different. In the UK, as in every healthcare system, the Medicines and Healthcare products Regulatory
Agency (MHRA) is the body that decides whether a medication should be approved. Their decision is based entirely on the data from clinical trials – a straightforward assessment of whether the benefits of a treatment outweigh its risks.
Politicians, or more precisely, the National Institute for Health and Care Excellence (NICE) in the UK, have a different remit. Their role is to decide whether a treatment is costeffective in the context of the entire NHS budget. They have to weigh it against every other demand on resources.
Could you explain the key differences between the new generation of Alzheimer’s drugs –like lecanemab and donanemab –and previous treatments?
The new generation of Alzheimer’s drugs is disease-modifying treatments, meaning they address the underlying disease process. In contrast, the existing drugs –anticholinesterase inhibitors such as donepezil, rivastigmine and galantamine, along with memantine
only manage symptoms without altering the course of the disease. The difference is similar to cancer treatment: the new drugs are like chemotherapy, tackling the disease itself, while the older medications are like painkillers – helping a patient feel more comfortable but doing nothing to halt the cancer’s progression.
How do you recruit and retain participants for these trials, particularly those in the early stages of the disease?
When people enter clinical trials, the process begins with a conversation rather than an immediate medical procedure. At Recognition Health, advanced AI technology enables highly
sophisticated cognitive assessments. These tests don’t just measure the answers given, but also how quickly and in what manner they are delivered. For example, a simple clock-drawing task is analysed for around ninety different factors, such as the way it is drawn, not just the final image.
The first step in any trial is informed consent, after which participants undergo screening. After the cognitive stage, participants undergo a thorough medical work-up, testing thyroid function, vitamin B12 and folate levels, haemoglobin and other markers, to rule out other causes such as hypothyroidism, nutritional deficiencies or depression.
The final decision about whether someone enters the trial depends on confirmation of amyloid and tau biomarkers.
Surely, if we’re in the middle of a pandemic, shouldn’t we be putting more effort into precisely the drugs that treat the underlying problem?
Globally, there is huge research and development in this space – just as
there is for cancer treatments and other major diseases – because the world is wide awake to the need for Alzheimer’s drugs. The World Health Organization labelled Alzheimer’s Disease a pandemic in 2018, which means that in our lifetimes we’ve really only had two pandemics: Covid-19 and this.
One of the problems we face now is that people are living longer because they’re not dying as early from heart disease, stroke, or, to some extent, cancer. Alzheimer’s is different – it’s a progressive neurodegenerative disease that brings years of decline, with people no longer contributing economically as taxpayers but still requiring intensive support. From a purely socio-economic standpoint, it’s a very challenging condition.
That’s really the crux of it: Alzheimer’s is a pandemic. We saw what happened during Covid when all resources were redirected –people with heart disease had to wait for access to treatment, and hip replacements were delayed for years. It’s a dynamic problem, not just a question of whether a new therapy “works” in principle. The
challenge lies in how to scale up and deliver it safely without destabilising the rest of the health system.
How close are we to a world where Alzheimer’s is managed like diabetes?
It’s not unreasonable to be cautiously optimistic that we are moving to a turning point where prevention of Alzheimer’s will be possible. Right now, we’re running clinical trials involving people who are completely cognitively normal, generally aged between about 55 and 85.
The purpose of these trials is simple but powerful. We check that participants are cognitively normal, then measure their biomarkers. If we find high levels of amyloid protein – sometimes alongside other biomarkers, like inflammatory markers – we follow up with PET scans to confirm amyloid accumulation. That tells us these individuals may be only two or three years away from developing very mild symptoms. In other words, we’re identifying people years before they or their GP might notice the first cognitive changes.
These participants are then given medications – anti-amyloid drugs, anti-tau treatments – to reduce amyloid levels and, ideally, delay the onset of symptoms for years. The aim could be to push those symptoms into a person’s 90s – perhaps so far ahead that something else ends their life first. In that sense, it’s very much like managing diabetes based on HbA1c levels.
Alzheimer’s is actually an excellent disease to treat from this perspective: just as with diabetes or prostate cancer, we can detect
biomarkers decades before symptoms, and in the last five years or so before onset, we have a clear window for intervention.
The gap between what science and research can now achieve and what standard clinical practice offers is widening. Our mission at our clinics in the UK and US is to close that gap – giving people the best possible access to early, accurate diagnosis using biomarkers, whether through clinical trials or treatments already on the market. That is why I get up in the morning.
LEVEL 7 apprenticeships are postgraduate-level programmes, equivalent to master’s degrees. They’re designed to help professionals develop advanced skills, leadership capabilities and strategic insight.
Within the healthcare sector, these apprenticeships play a pivotal role in closing key competency gaps, particularly in leadership, healthcare management and digital transformation. They provide targeted training in areas such as digital technologies, clinical leadership and operational management – skills urgently needed to modernise healthcare services.
Level 7 programmes also support upward career mobility, helping to address issues like workforce retention and the lack of diversity in senior roles, by offering equitable opportunities for employees from underrepresented groups to gain the credentials needed to step into leadership roles.
They also allow for tailor-made learning, aligning directly with the unique challenges and goals of healthcare organisations. This also enables them to play a vital role in addressing both clinical and non-clinical skill gaps, so organisations can build resilient, future-ready teams.
But with levy changes – a tax on UK employers to fund apprenticeship training introduced in 2017 and revised last year – soon coming into play, alongside ever-tightening budgets in the industry, many healthcare organisations are understandably concerned about funding future leadership development.
Level 7 apprenticeships remain a vital and cost-effective way for healthcare organisations to
Steven Hurst, director of corporate partnerships at Arden University, looks at the benefits of 7 apprenticeships for the healthcare industry.
prepare for the future. They bridge critical skills gaps, foster diverse leadership and equip professionals with the tools they need to thrive in a rapidly evolving sector.
However, for many healthcare organisations, there may be limited scope to invest more in staff development.
This means that funding Level 7 apprenticeships post-levy changes may not be a viable option.
Yet the sector’s core challenges remain – it’s under tremendous pressure to adapt to growing patient demands, ageing populations and technological advances. And, unfortunately, many organisations face acute
shortages of leaders equipped to drive innovation and manage complex systems.
The good news is, there are other options for healthcare providers. Many apprenticeship programmes, such as the Level 6 Chartered Manager Degree Apprenticeship in Health and Care Management, are still covered under levy funding and can help healthcare practices to nurture a talent pipeline that’s designed to meet these challenges head on.
Future-ready healthcare leaders need to marry technical proficiency with strategic vision, and Level 6 apprenticeships, especially those that also offer a CMI qualification in leadership,
partnerships of Level industry.
give learners a robust blend of these capabilities.
According to workforce studies, ineffective management is one of the key drivers behind employee dissatisfaction in healthcare, with one in four believing senior leadership in their organisation is ineffective.
Both Level 6 and Level 7 apprenticeship programmes help to foster effective leaders who can inspire, motivate and retain their teams.
Finally, the integration of tools like AI, electronic health records and telemedicine requires leaders who understand both technology and its ethical application
in clinical settings. Level 6 apprenticeships focus heavily on equipping professionals with digital acumen.
The NHS workforce plan has set an ambitious target: to expand clinical-led training through apprenticeships from around 7% today to 22% by 2032. This makes apprenticeships a strategic and high-priority route for workforce development across the sector.
Continuous upskilling is critical for the healthcare industry to succeed. With levy changes fast approaching, it’s important that leaders assess their options while also maintaining a strong strategy to give employees the skills they need. To do this, we recommend:
• Conducting a workforce skills assessment – Identify gaps in the existing workforce. What leadership skills are lacking? Are there specific operational or digital challenges that teams are unprepared to tackle? Pinpointing the organisation’s needs will help to guide enrolment decisions.
• Partnering with education providers – Form partnerships with universities and training providers who specialise in healthcare apprenticeships. These providers can offer streamlined application processes, help candidates meet qualification requirements and ensure effective programme delivery. As mentioned, many Level 6 apprenticeships – which will still fall under the Levy funding – offer the skills and knowledge many employees need.
• Communicating internally –Raise awareness about the opportunities and benefits of apprenticeships among current staff. Highlight how upskilling can help them to progress and give them the skills they need to excel in their role.
• Develop succession plans –Use Level 6 apprenticeships to nurture future leaders. Strategic succession planning ensures organisations have well-trained staff ready to step into senior roles as and when needed.
Healthcare organisations that use apprenticeships will not only strengthen their workforce but also position themselves to deliver better outcomes in the years to come. Make sure to assess employee needs, communicate effectively with teams and partner with experienced education providers to make the most of these valuable programmes.
Alex Adjei, the head of Cleveland Clinic’s Cancer Institute, explains why the fight against cancer is a story of real, measurable progress.
Written by Adrian Murdoch.
THERE are few who know as much about cancers as Alex Adjei, head of the Cleveland Clinic’s Cancer Institute. A respected and experienced professor of oncology, after completing his doctorate at the University of Alberta in Edmonton, Canada, he was chief resident in the Department of Medicine at Howard University in Washington, DC, and completed a clinical fellowship at the Johns Hopkins University School of Medicine and Hospital in Baltimore. The winner of numerous awards, he is also editor-in-chief of the Journal of Thoracic Oncology and the JTO Clinical and Research Reports and has authored more than 300 peer-reviewed publications.
Here, he talks to Healthcare Today the progress made in cancer research, why oncologists have embraced AI and how we can diversify participation in clinical research.
Are we moving fast enough in cancer research, or rather, are we moving as quickly as we can?
It’s remarkable how much progress has been made. It hasn’t been fast enough, of course, but the advances are real.
When I began my career in the late 1990s, for example, a patient with metastatic lung cancer had only one chemotherapy option. It was poorly effective – tumours shrank in just 1720% of patients, and survival beyond a year was rare.
Today, it’s a completely different picture. We no longer think of lung cancer as a single disease. Instead, we look at a patient’s genetic profile
Which areas of oncology research are closest to delivering transformative changes for patients?
It’s important to recognise that advances have been made across all areas of cancer care.
Take imaging, for instance. Not long ago, detecting a brain metastasis required a tumour of around a centimetre, because we relied on CT scans. Now, with MRI, we can identify lesions as small as five millimetres. That change alone has transformed what’s possible. Treatment techniques have also evolved.
In the past, a patient with even one or two brain metastases would undergo wholebrain radiation.
Today, with gamma knife surgery, we can target and destroy individual tumours precisely – even multiple lesions – and repeat the procedure if necessary.
Surgical approaches have advanced as well. Now, minimally invasive techniques use small incisions and scopes, allowing patients to go home within two days.
Similarly, prostatectomy used to be a painful, debilitating operation. Today, robotic surgery means the surgeon controls the instruments from a console, and the patient can leave hospital the next day.
Systemic therapies themselves have also been transformed by immunotherapy and targeted treatments aimed at the genetic drivers of tumours. Progress has been made at every stage. The difficulty is that many cancers are still diagnosed late, and that’s where most deaths occur.
Precision oncology and genomic profiling are becoming more routine. Are we getting close to having personalised cancer treatment as standard?
We are getting closer, but human biology is far more complex than we once assumed. In the early days, the expectation was that by sequencing the genome, identifying mutations, and targeting them, we would be able to treat most cancers. The reality is that for the majority of cancers, there are still no actionable genetic mutations. In many cases, there isn’t a single driver mutation we can target – instead, there are multiple mutations working together.
Targeted, personalised therapies are very common in lung cancer but far less so in colorectal or prostate cancers, where there are only a handful of mutations we can exploit. This has led to a growing recognition that focusing solely on genes isn’t enough. We need to look at proteins as well, because it is the proteins that actually drive the biology.
The problem is that proteomics has proved enormously difficult. There are thousands of amino acids in the blood, producing extremely complex protein profiles. This is where artificial intelligence may represent the next frontier.
One particularly important application is in risk stratification. Today, when someone undergoes surgery for cancer, we often give them chemotherapy or immunotherapy afterwards for up to a year, just in case. With AI and proteomics, the first step in truly personalised therapy will be personalised risk. We will be able to say: this patient is cured, no further treatment needed, while that patient is at high risk of recurrence and should receive additional therapy. That would be a major breakthrough.
Enthusiasm for AI within the healthcare sector is mixed. Is it fair to say that oncologists are at the forefront of AI and are embracing it in a way that not everybody seems to be?
I think you are probably right, and it comes back to what I said earlier about the complexity of cancer and the limits of human perception and intellect in making sense of it. Take pathology, for example.
Traditionally, a pathologist studies slides under a microscope, deciding whether a sample shows cancer and, if so, which markers it has. It is remarkable how well this system has worked, given how subjective it is.
Now, with digital pathology and AI, we can train algorithms on thousands of samples. That gives us the potential not only to identify cancer more accurately, but also to distinguish between tumours that are likely to recur and those that are not. The same is true in radiology. In the US, for example, women begin screening mammograms from the age of 40, which creates a workload with which radiologists struggle to keep up AI could be trained to, at the very least, rule out normal scans.
AI is also transforming monitoring. One area we are working on involves wearable devices, which continuously record temperature, pulse, respiration and oxygen saturation and transmit the data to a central system.
The goal is to learn which combinations of readings predict that a patient is about to deteriorate. This is crucial because many of the novel cancer therapies we use, such as CAR T-cell therapy, can trigger severe complications. At present, we keep patients in hospital for observation, but with these biobuttons, we could instead allow them to go home while still being closely monitored.
And then there is the concept of the digital twin, which is still aspirational but could fundamentally change how we treat cancer. The idea is to build a detailed virtual model of each patient by integrating data from multiple sources. All of this information, combined with records of how other patients with similar profiles have responded to different treatments, would be fed into AI systems and the computer could then predict which treatment is most likely to work for them.
AI is what will allow us to integrate all these parameters and make
genuinely predictive models. That is why oncologists are so excited about its potential.
What needs to change in the way we run trials to speed up innovation and include more diverse patient populations?
This is a question that’s very close to my heart, because it’s an area I’ve been working on extensively: how do you diversify participation in clinical research? It’s not just about social justice or equity, though those are important. Scientifically, it also makes sense. People around the world have different diets, lifestyles and habits, and diseases can present differently across populations.
There are several challenges. One is human capital: do we have enough trained physicians and researchers to carry out the necessary studies?
Another challenge lies in the way we design trials. Traditionally, clinical research has relied on strict eligibility criteria. These rigid standards create
a kind of paradox: we only recruit the marathon runners of health, yet when the drug is approved, it will be used by people with realworld conditions. That mismatch is problematic. One promising approach is the pragmatic trial. Here, criteria are kept minimal, and oncologists treat patients as they normally would, with data collected as part of routine care.
Another key area is decentralisation. Participation in clinical trials is often hindered by the time commitment and travel required. We’re now reducing this burden through innovations such as remote consent. With secure platforms like DocuSign, patients can review information at home.
These kinds of changes – pragmatic trial design, simplified eligibility, and decentralisation through digital tools – are making it far easier for patients to take part. And that, in turn, is vital if we are to generate research that truly reflects the diversity of the populations we aim to serve.
How do you balance the speed of innovation with the cost pressures that exist in every healthcare system?
That’s a difficult challenge, and it requires everyone – clinicians, governments, pharmaceutical and device companies, NGOs, and patient advocates – to work together to find solutions. The costs are enormous. Some progress is being made: for instance, virtual care reduces the need for travel, which lowers costs for participants. As I just mentioned, pragmatic trials also help by avoiding frequent, expensive imaging requirements like MRIs.
AI and other technologies could simplify and shorten trials further, though that’s still in development.
This is crucial because the cost of developing a drug directly affects its price. Innovations in trial design and technology could reduce expenses for both companies and health systems.
Women’s health has historically been underfunded, with just 5% of healthcare research funding allocated to female-specific conditions. However, as Dr. Lara Zibners asserts, advances in femtech are now driving change.
WOMEN’S health has historically been underfunded and deprioritised, with a paltry 5% of healthcare research funding allocated to female-specific conditions.
Despite affecting millions, conditions like endometriosis and polycystic ovary syndrome receive significantly less investment than male-focused conditions such as erectile dysfunction.
Advances in technology, AI diagnostics, and femtech are now driving change, offering new solutions for early detection and treatment. However, funding remains a barrier, with women’s health receiving less than 2% of healthcare venture capital in 2023, despite a growing market demand.
Note: the term “woman” is used here to denote humans who were born female with all our superior biologic differences and fully intact XX chromosomes.
The investment gender gap
Did you know that between 2019 and 2023, there were eleven erectile dysfunction (ED) startups that were able to attract 28 times more capital
than eight endometriosis-related ventures?
Endometriosis affects at least one in ten women (probably more). About the same percentage of men suffer from ED. Endometriosis affects approximately 50% of women with fertility issues. Erectile dysfunction is certainly going to be an issue for a couple wishing to conceive, obviously. However, women with endometriosis can suffer crippling, whole body, complications and I suspect many of them would be deeply offended at the suggestion that a man with erection concerns warrants anywhere near as much sympathy as they do. I’m not here to argue whether one condition causes more suffering than the other. The point is that, historically, conditions that affect men have gathered more money, more attention, more innovation than conditions that affect only women.
But the times, as they say, they are a-changing.
And with good reason. As the much welcomed McKinsey report highlighted, women’s health represents a $1 trillion (£740M) economic opportunity. Whoa... I could buy a lot of shoes with that kind of cash. Of course, that number doesn’t reflect the pure profit for investors. McKinsey considered the
knock-on societal implications and economic growth that occurs when women have access to preventative healthcare, contraception and interventions that consider the ways in which people born female both present and respond to disease intervention.
For those of you who have been living under a rock blissfully unaware, women’s health is getting a lot of attention. That’s not just because the first generation of women who truly believed they could do anything, grow up to be anything, are hitting back at menopause with a vengeance.
Actually, that might be part of it. Gen X’ers (such as myself) represented a shift in thinking from traditional gender roles to a more gender-
neutral lens, at least when it came to the workplace. The little girls who were told they could be CEOs and Chairman of the board are not too thrilled when hot flashes and palpitations interfere so badly in their day-to-day lives that up to 10% of them leave the workforce earlier than planned. For whatever reason, the acknowledgement that the exclusion of women in healthcare research (another topic for another day) has failed women has fired up a movement demanding equal research and attention. What are just some of the discoveries that have lit these flames?
• Heart disease is the leading cause of death in women, but we are 50% more likely to be misdiagnosed. Why? Because women shouldn’t suffer from a “man’s disease” and our presentation is
labelled “atypical.” Think about that. “Atypical” is the typical presentation for 51% of the population.
• Women make up 75% of all autoimmune disease patients yet no one fully knows why.
• Across every single condition, it takes longer for women to be diagnosed than our male counterparts.
We’re mad, and we’re not going to take it anymore. For those of you in the investment world, let me translate that for you. Women’s health represents a legitimate market!
Back to pure economic profit, once we strip away all the “softer” benefits to society and the world at large, there is still a hefty profit to be found. What kind of money are we talking about? If we go back to erectile dysfunction, the first drug released, Viagra, generated $400M (£296M) in the first three months and after 14 years, had reigned in a whopping $2.1B (£1.6B). There is clearly a precedent set for gender-specific healthcare research and innovation.
Consider this:
• Women control 80% of the healthcare decision making in their households.
• Women spend nine years of their lives in poor health (compared to just 6.75 years for men).
• The femtech industry is already worth almost $61 billion and is projected to reach $130.8 billion by 2034
There is more than enough evidence that women’s health is a profitable investment. We are no longer satisfied with outliving our husbands if we aren’t well enough to go on a
cruise and finally enjoy some light reading without interruption.
Consider some of the innovation we are seeing. Hormones, immune markers, early signs of disease - it’s all there, offering a clearer picture of health than a one-time blood test ever could.
And the movement doesn’t stop there. AI-powered diagnostics to cut the time to treatment for conditions such as endometriosis from years to days. Wearable devices that provide real-time, personalised insights into hormonal health, protecting not only our fertility but our brains, bones and hearts.
The shift is underway, and women aren’t waiting for the system to catch up. They’re turning to private, techdriven solutions that prioritise their needs.
Investing in women’s health is not an act of charity. It’s a genuine market that is already massive and growing by the day. Innovation is everywhere.
It’s been nearly 20 years since Viagra appeared on the scene and made a lot of money for some very smart people who invested in the science to address a genuine health concern that affects millions of men. Yet, when that very same drug was studied for menstrual pain, the funding disappeared.
Without investment, innovation is dead in the water. A capitalistic society supports profitable businesses. Investment professionals have a duty to bring returns to their investors. What more evidence could those who control the reigns of the money we need in women’s health need? Men had their moment. Now it’s our turn.
AFTER many years at international management consulting firm Oliver Wyman, leading its international healthcare team, Andrew ChadwickJones is now chief executive officer of Welbeck Health Partners. Here, he talks to Healthcare Today about how the UK’s private healthcare market has grown, how he avoids medical risk, and why the British healthcare system is struggling with budgetary inertia.
The government’s plans to work with the private sector earlier this year was a distinct statement of intent. Where do you see the opportunities for the private and public sectors to work more closely together?
It’s a positive development for the private sector overall. In areas such as imaging and a range of straightforward procedures, the private sector performs very well, so having a strong role for it in a mixed healthcare economy makes sense. A balance between governmentprovided and privately-provided services brings investment and benefits the system as a whole.
For us, though, NHS work has never been a major focus. We’ve always kept things relatively simple by concentrating on the private market – serving mainly insured patients and those who self-pay. That has been a deliberate business choice over the years, allowing us to stay focused on a single customer segment.
That said, we recognise our place in the wider health economy. On
Andrew
Written by Adrian Murdoch.
the occasions when we’re asked to support the NHS – for example, if a local MRI or CT scanner goes down – we are always willing to step in and help. We’re not dogmatic about it. While our core business is private healthcare, we also acknowledge the importance of collaboration when it’s need
The UK private healthcare market has grown significantly in recent years. Where is the demand for the private sector coming from? Is it via self-funded patients, or is there an uptake in private medical insurance (PMI)?
Initially, there was a big surge in selffunded procedures just after Covid. People had accumulated ailments during lockdown, NHS waiting lists were very long, and many decided to pay privately to catch up on treatment. But that was largely a one-off phenomenon, and we’ve seen that market die down since.
In reality, there are two quite distinct self-pay markets. One is made up of people without private insurance who are worried about NHS waiting times – that tends to be more outside
London. The other, in London, has always been a high-net-worth market. For them, healthcare is often part of their lifestyle – for example, doing annual check-ups while they’re in London for the summer.
Where we’re now seeing the real growth is in the insurance-based market. It has been expanding at 5-10% a year, and one year after Covid it grew by as much as 30%.
A lot of that is employer-driven, but there’s also a growing consumer element: small business owners or individuals who decide to buy cover for themselves because they’re worried about NHS access.
To what extent is PMI being driven by employees rather than the companies themselves?
It’s a bit of both. We did some research in Cambridge and found that almost every major employer there offers private health insurance. Clearly, they’re competing for talent in a competitive market. But it’s not just about recruitment – employers also want staff to use it. If someone has a hip problem and ends up on
individual doctors carry their own cover, and the facility itself has its indemnity. Those operate in parallel, since patients might pursue claims in either direction. For us, though, the cornerstone is always clinical quality. We push responsibility and empowerment for safety as far to the front line as possible, because staff closest to patients need to have the knowledge and freedom to act. Creating a culture where people feel able to speak up is critical. That’s why we have a full-time Freedom to Speak Up Guardian, and I actively encourage people to use that route.
Governance has to be layered. At the front line, we invest heavily in training and clear policies. At an organisational level, we run dashboards across all clinics, compare performance between sites, and carry out regular audits and inspections. On top of that, we pay close attention to the scope of practice: doctors in the private sector should, as far as possible, mirror their NHS practice. Where there are exceptions, they need clear oversight. Because of this structured approach, our indemnity rates are surprisingly good. Each of our clinics is organised as a doctor group, which creates collective responsibility. In some cases, these groups even arrange group indemnity with providers, who value the governance that comes with it.
Finally, our risk profile is helped by the fact that we’re a day-case facility. We don’t take overnight patients, and we don’t do paediatrics – the kinds of work that generally carry higher indemnity risk.
How do you evaluate where to open new centres? You have Oxford and Cambridge opening next year. What does the pipeline look like?
Our aim is to build a network of around ten sites across the UK. We’re already focusing on places like Oxford and Cambridge, which are both high-growth regions with
world-class doctor groups and limited existing hospital provision. We’re also looking at Hampshire and other major hubs, with a view to opening one or two sites a year.
You recently signed a recruitment process outsourcing agreement with healthcare recruitment agency Compass Associates. Is that a reflection of challenges in recruiting and retaining healthcare professionals?
Generally speaking, recruitment hasn’t been a major challenge for us, even though we’re opening two centres next summer, side by side, and probably a third one in London. Of course, it means interviewing a number of people to find those who are aligned with our ethos, but beyond that, we don’t find it especially difficult. I think there are a few reasons for this.
First, the work–life balance we can offer in a day-case setting is a big
To make primary work, they need over local budgets.
draw. Everything closes at the end of the day, so staff can work to suit their lives. It’s very different from hospitals with night shifts, and it works well for people at every stage of life, particularly those with children.
Second, we are deeply committed to empowering frontline staff. Decision-making is quick, and if there are issues with patients or ways of improving the service, those things are addressed rapidly. That responsiveness translates into very high levels of staff satisfaction.
There is also a very strong bond between doctors and staff. Because the doctors are part-owners of the clinics, they value the contribution of their teams and recognise that it’s the staff who make things excellent. That relationship is something employees really appreciate. When we first opened in London, many people told us we’d never find staff, but in practice, it has never been an issue.
You have wide experience in the state sector and in policy. Do you have concerns about upcoming policy changes around private medical insurance, data sharing, or regulation of private providers? How will they affect you?
We feel good about where things are. When you look at the state system, there’s always talk about budgets, but the real strength lies in primary care at scale, especially when it’s preventative. That’s what helps manage patients locally. Policy recognises that, but you can never really have enough of it.
Generally speaking, around 5% of patients consume 50–70% of the healthcare budget. That group is mainly elderly people, those on a cancer journey, and a smaller group of children with very high needs. Take the elderly cohort: many of us have seen relatives go into hospital with several conditions, with poor communication between teams. Families keep calling ambulances, patients bounce back to A&E – it becomes a cycle. The UK has good primary care, so the opportunity is to scale it up into teams that improve the lives of these patients.
The challenge here is budgetary inertia. Hospitals don’t like money being reallocated away from them, even though their focus should really be on complex surgery and intensive care. To make primary care teams like this work, they need some control over local budgets – to hire health coaches, for example, and save on avoidable admissions. Data can help too. In the US, groups like Iora use predictive analytics: mobility data, pharmacy records, prescription refills. They can spot when something is going wrong and call patients directly. That kind of proactive, population-level management is where UK policy needs to head. The GPs here have the skills and the entrepreneurial mindset to do it. The question is why it hasn’t happened at scale yet.
HAVING supported more than 500,000 patients across areas including obesity, sexual health and hair loss, UK-based digital health firm Numan is leading the way in ensuring effective, longlasting change through medical knowledge and digital innovation.
Now, with the launch of its proprietary AI-driven health assistant, Nu, they’re able to deliver real-time, clinically guided health support, an advance they feel has the potential to have far-reaching results beyond their own customer base.
Here, Numan’s clinical director Danielle Brightman and head of clinical governance (and former NHS GP) Dr Luke Pratsides explore the challenges and opportunities surrounding the rollout of GLP-1 medications for weight management in the UK and the role of technology in supporting long-term success.
How does Numan’s approach differ from other models in helping to ensure long-term weight loss?
Luke Pratsides: GLP-1s are becoming more available, but the majority of ways that patients are accessing them are via the pharmacy model, where they’re being sent the drug and then left to their own devices. The key to healthy and sustainable weight loss is supporting someone
Danielle Brightman and Luke Pratsides from digital health company Numan talk about developing an effective AI assistant to help ensure long-term weight loss.
Written by Glen Ferris.
with the lifestyle and behaviour change aspects. The majority of services in the private sector are purely this magic bullet medication, while Numan is offering that additional lifestyle support.
Where does Numan’s AI health assistant, Nu, fit into providing that support?
Danielle Brightman: We have human health coaches in the loop, ensuring there is behavioural change alongside the medication. As we developed the AI tool, we wanted to replicate the advice and knowledge of health coaches to allow patients to have 24/7 support. We noticed that the people who were speaking to their health coach were staying on
the medication for longer and seeing more weight loss. By developing Nu, we wanted to augment the support from the human health coach and the clinician.
We specifically trained Nu on information around GLP-1s. We’ve made sure that we’ve put information into the system that it should only call on. We have also carried out a lot of prompt engineering work to make sure it’s really safe and always working within the guardrails. Finally, we built a whole monitoring system to review all of the patient interactions to feed back into Nu to make sure the information only got better and more accurate.
What’s the biggest risk to patients maintaining their weight loss after they stop taking a GLP-1?
Danielle Brightman: We’re keen to make sure patients realise that the medication itself is not going to be a magic bullet. You don’t take it, lose the weight, come off it, and then everything’s perfect. We treat obesity as a chronic condition. You need the medication alongside the behavioural change.
Luke Pratsides: It’s known that if you stop these medications, you gain weight. Somebody might feel a dip every afternoon around three o’clock and snack on something unhealthy.
When they’re on a GLP-1, they don’t need to do that. Supporting them helps them realise: “Actually, I don’t need that packet of chocolate buttons”. We want to support them to carry on that behaviour even after they stop treatment. Patients still have access to our coaching for a period of time after they stop treatment as well.
With so many platforms and apps, how can we better share patient data between private providers and the NHS to get a full picture of someone’s health?
Danielle Brightman: We would love to have better data sharing with the NHS to make it easier for patients. Once they’re in the healthcare ecosystem, they shouldn’t need to
worry about which provider has their information. That’s what we’re looking into right now.
Luke Pratsides: It’s no small task. How do you join up all the silos of data? We want to work with NHS systems that include being able to not only read from the Summary Care Record, but also write to them. I believe this will save unnecessary admin burden on the NHS from having to deal with letters sent from private sector to GPs informing them their patients are on GLP-1s. The NHS is not necessarily facilitating that..
Why are you confident that Nu works and is safe?
Danielle Brightman: We did a huge alpha and then beta testing. We tried
in many ways to break the system to make sure it would stay in the guardrails. We built a monitoring system and have health coaches review the AI’s interactions. We have a mechanism to escalate any unsafe messages to our human clinicians. The reason we think it’s doing really well is the engagement it gets. The people who use it are engaging a great deal, and they are the ones who we see are losing more weight.
Luke Pratsides: It’s increased access. This is the key. It gives people an answer whenever they want it, which traditional models of healthcare struggle to do. And at any time, if somebody wants to speak to a human clinician or coach, they can. It’s that increased access to reliable advice.
I’VE SPENT much of my career in oncology wrestling with a frustrating reality that while we’ve made remarkable strides in diagnosing cancer, our ability to treat it – especially in the survivorship phase – hasn’t kept pace.
We’ve become very good at finding the specific genetic cancer variations through advanced diagnostics, yet cancer treatment can only target 46 of the 750 known mutations which impact the disease’s progression and recurrence. This gap leaves patients in a vulnerable state post-treatment, often handed the outdated advice to watch and wait for the cancer to return. It’s a passive approach that fails both patients and clinicians, and I believe it’s time to rethink how we address cancer care, particularly for individuals who have survived cancer.
Artificial intelligence (AI) does not just have a role to play in new drug discovery and diagnostics. It has the potential to have a major impact on drug repurposing, which is better for patients. We need to challenge the conventional narrative that the future of cancer treatment lies solely in developing new drugs. Don’t get me wrong, new therapies are vital, but they often take over a decade and billions of pounds before they’re available. Meanwhile, cancer survivors are left without proactive options to prevent recurrence during a time when intervention could dramatically improve outcomes. This survivorship gap represents our greatest opportunity to change lives. The real breakthrough isn’t in chasing elusive new compounds but in leveraging AI to unlock the potential of existing, well-understood drugs to target patient-specific mutations and delay or prevent the cancer’s return.
Consider the scale of the problem. After surgery or chemotherapy, most
cancer survivors, across nearly all cancer types, have no standard maintenance treatment. They’re told to monitor for symptoms and hope for the best. This isn’t just a medical oversight; it’s an emotional burden, leaving patients feeling powerless when agency matters most.
Using AI, it’s possible to bridge the gap by analysing more than 100,000 peer-reviewed research papers to identify low-cost, low-toxicity drugs already on the market that can target the full spectrum of 750 cancer driver mutations. This approach isn’t about replacing active treatment but about extending remission through personalised care that empowers patients beyond watching and waiting.
In this context, the power of AI lies in its ability to process vast datasets, including biological, clinical and pharmacological, to uncover connections humans might miss. For instance, a study in the National
Shivan Sivakumar, associate oncology at the University explains why we need detection and novel
Institutes of Health (NIH) database suggests that anti-inflammatory drugs may reduce the risk of disease recurrence in breast cancer patients by 42%. What AI can do is identify combinations of existing drugs that can simultaneously target multiple cancer vulnerabilities, say four or five at once, maximising impact while minimising toxicity.
These aren’t speculative treatments; they’re based on existing evidence, repurposed for preventative care in ways that are safe, tolerable and affordable for long-term use. Unlike targeted therapies, which are often too toxic or costly for sustained application, the focus is on drugs that patients can integrate into their lives without the fear of debilitating side effects or financial ruin.
associate professor in University of Birmingham, to move beyond early novel therapies.
I’m often asked how this aligns with broader trends in oncology, including diagnostics. While initiatives like the UK’s funding of new blood tests for early cancer detection –capable of identifying 12 common cancers with over 99% accuracy –are transformative, they highlight the same diagnostic-treatment mismatch I’ve described. Early detection saves lives only if paired with effective interventions, yet many patients still face the survivorship gap post-treatment.
Work by companies like Astron Health complements such diagnostic advances by ensuring that once cancer is detected or treated, patients aren’t left without
options. Using AI to analyse existing knowledge and focus on therapeutic repurposing to reduce the risk of recurrence is a critical next step after diagnosis.
The patient perspective should drive everything we do. Survivorship isn’t just about surviving; it’s about thriving. Imagine a breast cancer survivor with a specific mutation profile receiving a tailored care plan of repurposed drugs, backed by peer-reviewed evidence, that targets her unique recurrence risks. She’s no longer passively waiting for bad news; she’s actively managing her health with affordable, tolerable medications. This shift could redefine survivorship, reducing not just recurrence rates but also the psychological toll of living in limbo.
Of course, challenges remain. Integrating AI-driven repurposing into clinical practice requires overcoming scepticism from healthcare providers. There’s also the hurdle of regulatory acceptance and payer reimbursement for off-
label drug use. Yet, the evidence is mounting – studies like those highlighted by the European Society for Medical Oncology (ESMO) emphasise the need for high-quality survivorship care that addresses recurrence risks.
I envision a future where every cancer survivor benefits from a personalised care plan, tailored by AI to their molecular profile and grounded in existing drugs. The survivorship phase could become the frontier of oncology innovation, as noted in discussions around rethinking cancer care models. If we can address all 750 cancer driver mutations through repurposing, rather than the current 46, we’ll offer a comprehensive shield against cancer, not just a partial one. To get there, we need a collective shift in mindset from patients and clinicians to policymakers and pharma. We must prioritise survivorship as much as early detection, recognising that the post-treatment phase offers an immediate chance to improve outcomes. As reports like the AACR’s forecasts suggest, AI and precision medicine are poised to advance cancer care in 2025 and beyond, including through innovative therapeutic strategies. Cancer care doesn’t need more waiting; it needs action and AI-driven drug repurposing how we deliver it.
I urge the oncology community to rethink where we invest our resources and focus. Money is poured into early detection and novel therapies, yet survivorship remains an afterthought. Let’s change that by harnessing AI to repurpose existing drugs, giving survivors not just hope but tangible, personalised tools to extend remission. The technology is here, the evidence is growing, and the need is undeniable. It’s time to stop watching and waiting and start acting.
LAST week, NHS England extended Martha’s Rule to all 210 acute hospitals in England, following a successful pilot across 143 sites. This interventional Rule enables patients, families, carers, and even hospital staff to request a rapid independent review by a different clinical team when concerns arise about deteriorating or inadequate care. Since its launch, the Rule has already delivered hundreds of critical, potentially life-saving interventions.
Martha Mills was a 13-year-old girl who, in 2021, suffered a pancreatic injury after a bicycle accident and was admitted to King’s College Hospital, London. She developed sepsis and tragically died, just days before her 14th birthday.
A coroner concluded that Martha would likely have survived had she been transferred to paediatric intensive care in time.
Martha’s parents - Merope Mills and Paul Laity - warned that their concerns about her deteriorating condition were repeatedly dismissed.
The entrenched culture of medical deference, dismissing parental insights, contributed to the systemic failure that cost Martha her life.
Motivated by grief and a fierce determination for systemic change, Martha’s parents embarked on a campaign to establish a formal right to request a second clinical opinion when concerns go unaddressed. Widely published, Merope’s
account catalysed rapid momentum. Within days, the initiative gained cross-party support in Parliament, and by February 2024, NHS England publicly committed to implementing Martha’s Rule.
By April 2024, the rule’s phased rollout had begun: initially targeting 100 acute hospitals with mature critical-care outreach structures. Regulators—GMC, NMC, and CQC—joined in endorsing the principle of listening to patient and family concerns and safeguarding the right to a second opinion.
The policy rests on three core components:
• Daily structured inquiry into patients’ well-being, inviting them or their family/carers to voice any sense of deterioration.
• 24/7 access for staff to request peer review from a different team if concerns escalate.
• 24/7 access for patients, families, and carers to trigger a rapid review via clearly advertised helplines or escalation processes.
While the Rule originated within and has been implemented in the NHS, the principles upon which it is based are equally applicable to the independent sector and so it is expected that the Rule should apply also in private hospitals.
Data from the pilot phase (September 2024 through June 2025) show nearly 4,906 calls were logged across 143 pilot hospitals. About 72% of these originated from families.
These escalations triggered:
• 241 potentially life-saving interventions, including 93 urgent ICU or HDU admissions and 49 transfers to enhanced care or tertiary centres.
• 720 care changes, such as starting antibiotics or arranging specialist imaging.
• 794 interventions addressing delays in clinical actions like investigations or medication.
• 1,030 cases resolved around communication or discharge planning.
On 4 September 2025, on what would have been Martha’s 18th birthday, NHS England officially rolled out Martha’s Rule to all 210 acute hospitals in England. The decision was grounded in the clear success of the pilot.
Parents Merope and Paul called it “a landmark moment” and emphasised the hope that every patient in the UK will know of and access the Rule. The policy is now also being trialled in maternity, neonatal, emergency, community, and mental health settings. NHS England’s National Medical Director, Professor Meghana Pandit, described the Rule’s “transformative impact” on how hospitals collaborate with patients and families to respond to deterioration.
For lawyers, risk managers, and indemnifiers, Martha’s Rule carries significant implications in clinical negligence. By embedding a formal escalation process grounded in real-time awareness of patient risk, hospitals can better defend against allegations of failure to act. Key impacts include:
• Stronger documentation of care decisions, showing that concerns were surfaced and addressed promptly.
• Potential for faster resolution of near-miss events, reducing litigation exposure.
• Greater shared responsibility culture, where staff and families engage proactively, minimizing omissions or late escalation.
• Mitigation of reputational risk, as patient safety becomes demonstrably stakeholderinclusive.
Certainly, the positive statistics seen to date suggest that the Rule should reduce overall the number of complaints and claims that might arise in situations where the Rule applies.
To fully embed and sustain Martha’s Rule, the following actions are recommended:
• Visibility & Awareness
1. Display posters and leaflets across all departments, wards, and waiting areas.
2. Incorporate information into admission materials and discharge summaries.
• Staff Training & Culture Change
1. Train all levels of staff on how to respond to escalations.
2. Promote a culture that values family/carer insight, flattens hierarchy, and fosters psychological safety.
• Clear Escalation Procedures
1. Define clear steps: whom to call, response time expectations, and documentation standards.
2. Ensure seamless coordination between outreach, ICU, and ward teams.
• Governance & Monitoring
1. Include Martha’s Rule in existing patient safety metrics.
2. Log calls, categorize responses, and audit impact quarterly.
3. Escalations should be followed by debriefs and learning reviews.
• Extension Beyond Acute Settings
1. Pilot and assess adaptation of the rule for maternity, neonatal, and emergency care.
2. Implementation across the independent sector.
• Regular Stakeholder Feedback
1. Survey patients, families, and staff on awareness, satisfaction, and experience with the Rule.
2. Involve patient safety charities to audit fairness and equity across vulnerable populations.
While Martha’s Rule has been hugely successful, there is room to strengthen its future:
• Timeliness of data transparency: Monthly data began from September 2025; more frequent insights (even real-time dashboards) could enhance responsiveness.
• Wider geographic rollout: NHS Scotland, Wales, and Northern Ireland would benefit from adopting similar approaches.
• Extension beyond Acute Hospitals: Into mental health,
community, primary care and General Practice.
• Digital innovation: Integrate escalation triggers into electronic health records, mobile apps, or patient portals to reduce dependence on physical signage or staff recall.
• Equity in access: Ensure materials are accessible in multiple languages and formats (e.g., visual/audio), and mindful of those with disabilities or cognitive impairment.
• Staff workload management: Recognising concerns about workforce capacity, ensure that outreach teams are adequately resourced to handle surge calling volume.
The extension of Martha’s Rule marks a defining moment in patient safety in the NHS. What began as a tragic injustice for one family has evolved into a system-wide safeguard, realigning dynamics for staff to better listen, respond, and act when a patient’s condition worsens.
By formalising the right to an independent clinical review, hospitals are not just averting preventable deaths, they are building a culture of responsiveness, shared accountability, and compassion.
Martha’s Rule offers an opportunity to strengthen care quality, reduce avoidable harm, decrease the number of complaints and claims, and foster trust in an increasingly pressured healthcare environment.
With continued refinement, transparent monitoring, and equitable access, Martha’s Rule promises to be more than a legacy, it is a catalyst for more humane, safer, and inclusive healthcare.
HEALTHCARE is a field where trust, timely action, and accountability is critical.
In recent years, patient safety has taken centre stage in the UK, with systemic reforms designed to prevent avoidable harm and empower patients, families, and healthcare staff to act when concerns arise.
Among the most significant developments is Martha’s Rule, a patient safety initiative now fully implemented in all 210 acute hospitals across England.
Martha’s Rule was introduced following the tragic death of 13-year-old Martha Mills from sepsis in 2021.
The rule allows patients, carers, families, or NHS staff to request an independent review when there are concerns that a patient’s condition is deteriorating or that care has not met expected safety standards.
Its aim is to ensure that concerns are escalated promptly and acted upon before serious harm occurs.
Since its nationwide rollout, Martha’s Rule has led
TMLEP’s lead healthcare investigator Nina Vegad delves into the complex and evolving field of patient safety.
to 241 confirmed life-saving interventions from nearly 5,000 calls received. These figures highlight the critical importance of giving every voice the power to trigger independent oversight in patient care.
Alongside Martha’s Rule, the NHS has transitioned from the Serious Incident Framework (SIF) to the Patient Safety Incident Response Framework (PSIRF). This change reflects a shift towards:
• System-wide learning: Investigations now focus on understanding how incidents occur rather than attributing blame solely to individuals.
• Inclusive engagement: Patients and families are now active participants in investigations, ensuring their perspectives inform safety improvements.
• Continuous improvement: Lessons learned are embedded across care systems to prevent future harm.
While PSIRF represents a step forward in promoting a learning culture, it also introduces challenges. Families and staff may feel their concerns are not fully addressed if investigations are perceived as procedural rather than meaningful. It is crucial that implementation balances learning, accountability, and compassion.
At TMLEP, we provide guidance, support, and oversight to healthcare organisations navigating patient safety investigations. Our work ensures that:
• Investigations are thorough and transparent: Every incident is examined with attention to both systemic factors and individual responsibilities.
• Patient and family engagement is meaningful: We prioritise inclusive communication so that those affected feel heard and supported.
• Learning drives action: Insights from investigations are translated into policy updates, staff training, and improvements in care delivery.
Our goal is to foster a culture where patient safety is everyone’s responsibility, and where the lessons learned from each incident prevent harm in the future.
While Martha’s Rule and the PSIRF are promising, patient safety remains a complex and evolving field. Some ongoing concerns include:
• Ensuring timely and consistent reporting across hospitals.
• Addressing potential resistance from staff accustomed to traditional investigative models.
• Integrating electronic health records and digital systems safely to prevent technical errors.
TMLEP is committed to addressing these challenges by supporting best practices, offering investigative expertise, and promoting transparency. We believe that a strong, responsive patient safety framework not only prevents harm but also reinforces public trust in the healthcare system.
The implementation of Martha’s Rule is a landmark moment for patient
safety in the NHS. It demonstrates a commitment to listening to patients and families, acting decisively to prevent harm, and fostering a culture of accountability.
At TMLEP, we remain dedicated to enhancing investigative practices, supporting healthcare professionals, and advocating for systems that place patient safety at the heart of every decision.
Together, with continued vigilance and collaboration, we can make the NHS safer for everyone.
For more information on TMLEP’s services, click here.
AS THE final quarter of the year approaches, many consultants in private practice find themselves under mounting pressure, not from the clinic, but from their admin.
Unpaid invoices, disputed claims, and inconsistent billing practices can create financial headaches that not only impact cashflow but also distract from patient care.
If you’ve noticed that billing tasks are creeping onto your to-do list, or worse, that income gaps are starting to build, it’s time to act before these issues roll into Quarter 4.
At Medserv, we’ve helped hundreds of consultants across all specialties regain control of their billing and end the year on strong financial footing. Here’s how you can prevent common pitfalls and set your practice up for a smoother, more profitable year-end.
Outstanding invoices rarely resolve themselves. The longer they go unaddressed, the harder they are to recover. Insurers may reject claims past a certain time limit, and selfpaying patients often need a clear, structured follow-up to settle their accounts.
Medserv solution: Our billing team follows up on unpaid invoices promptly and diplomatically, ensuring you don’t lose hard-earned income to administrative delays.
As the year rolls on, billing can pile up. Let Medserv’s Derek Kelly help you end 2025 on a strong footing.
not paperwork
Quarter 4 is often one of the busiest times in private practice. As patient volumes increase, so too does the administrative burden. Every hour spent chasing invoices is an hour not spent with patients or family.
Errors in coding or mismatched insurer schedules are a leading cause of delayed payments. Even small mistakes can create weeks, or months, of disruption to your cashflow.
Medserv solution: We handle accurate, insurer-compliant invoicing within 24–48 hours of consultation or surgery, dramatically reducing errors and ensuring faster reimbursement.
Many consultants discover too late that they have a cashflow gap. Without clear reporting, it’s easy to miss underpayments, aged debt, or income trends until they become problematic.
Medserv solution: Our online portal gives consultants real-time access to payment data, aged debt reports, and income forecasts, offering transparency and peace of mind.
Medserv solution: By outsourcing your billing to Medserv, you reclaim valuable time while knowing your practice’s financial health is in expert hands.
Private practice is rewarding, but only when the business side runs as smoothly as your clinical work.
Don’t let unpaid invoices and financial uncertainty drag into the final quarter of the year.
At Medserv, we specialise in helping consultants:
• Optimise billing and reduce errors
• Improve payment turnaround
• Recover aged debt
• Maintain financial visibility
With strong systems in place, you can finish the year with confidence and step into 2026 on the best possible footing.
Contact Medserv today for a no-obligation chat and take control of your billing before Quarter 4 begins.
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