In a letter to senior managers and board members across the health service on Tuesday, chief commercial officer Jacqui Rock and director for emergency planning Mike Prentice said senior staff must “assure yourselves as far as possible that Raac is identified and appropriately mitigated, to keep patients, staff and visitors safe”.

The letter follows days of controversy over the safety risk posed by reinforced aerated autoclaved concrete, or Raac, in schools and fears that other public buildings could contain the material.

In particular, boards of NHS Trusts must check that inspections were “sufficiently thorough and covered all buildings and areas on your estate” including non-clinical areas and buildings, Rock and Prentice added.

The letter came after Prime Minister Rishi Sunak held a meeting with representatives of government departments on Monday to try to determine the extent to which the public estate contains Raac and may need remedial work.

Surveyors are currently investigating whether Raac could be present in the House of Commons, while more than 150 schools are already known to contain the porous material. Two-thirds of these have been ordered to close sites while repair work is carried out. The government is currently trying to establish how many more schools were built with the concrete, but has conceded it could run into the hundreds.

Education secretary Gillian Keegan said on Tuesday that school leaders should “get off their backsides” and complete surveys in an effort to identify sites that may contain Raac, with around one in 20 schools failing to respond so far.

NHS England said that since 2019 it had worked closely with 27 sites containing Raac and had secured funding for “investigative, safety/remedial and replacement work”. It added that three of the sites had eradicated the material.

It also disclosed that other potential problem areas had been identified in May after all trusts had carried out checks. The service added that work to confirm or rule out the presence of Raac was expected to be completed by the end of the week. 

Rock and Prentice warned that while effective management of Raac “significantly reduces associated risks . . .[it] does not completely eliminate them”.

They added that a regional evacuation plan had been created and tested in the East of England and that it was “essential” all organisations known to have Raac incorporate it into their own planning “as a matter of priority if it has not already been completed”.

The government announced in May that it was adding five Raac-affected sites to its hospital building programme, promising they would be rebuilt by 2030. Two other hospitals containing the materials were already part of the programme.

One of those added to the roster in May, Hinchingbrooke Hospital in Cambridgeshire, confirmed that since 2020 it had had to confine treatment of some heavier people to the ground floor owing to concerns about the state of the building.

“Conditions for managing patients over 19 stones continue to remain in place at Hinchingbrooke Hospital. This is due to the cumulative weight of patients, staff and equipment being more of a risk in some of our first floor clinical areas,” the trust said.

Simon Corben, director of estates and facilities at NHS England, said the health service had put “in place a national programme to support Trusts with their mitigation, monitoring and eradication programmes, in line with expert guidance from the Institution of Structural Engineers”.

The health department has said the NHS had “a mitigation plan in place for hospital buildings with confirmed Raac, backed with significant additional funding of £698mn from 2021 to 2025 “.

It added: “The technical advice received from the NHS is that the current approach to monitoring and mitigation remains appropriate.”

This story originally appeared on: Financial Times - Author:Anna Gross

Professor Matt Brown, chief scientific officer at Genomics England, a government-owned company, told the Financial Times the price of sequencing a whole genome was “plummeting”, having fallen from $1,000 just 12 months ago to $100 today. 

He said that genomic sequencing — where computers are used to transcribe the genetic code of an organism — could be rapidly expanded to tackle a range of health problems.

The technology could, for example, be used for early diagnosis of certain types of heritable illnesses, or to screen for risk of cancer and other diseases, helping to shift the focus of healthcare from reactive to preventive. But Brown suggested the opportunities yielded by the lower cost of sequencing had not been adequately recognised by the government.

In some respects the health service had done “incredibly well”, he said, noting that NHS England’s genomic sequencing programme for people with rare diseases was “the most comprehensive and best in the world”. 

Establishing the 100,000 Genomes Project — a British initiative launched in 2012 to study the role genes play in health and disease — was “one of David Cameron’s great legacies” and the support of politicians “from both sides” for the project had ensured Britain’s “leadership position”. He did not see this “changing any time soon”.

However, progress on applying genetic coding to practical problems on a wider scale would require more capital, Brown said.

Genomically sequencing all newborn babies and everyone over the age of 70 would involve more than half a million people a year and “at the moment there’s no plan [or] pipeline for getting us to that”.

Brown said the government should invest more in rolling out the technology more widely and hiring personnel to analyse the data. This could potentially save the NHS money in the long run while improving public health and increasing lifespan.

The NHS employs clinical scientists to interpret genomes and report on the data. But he said there were “not nearly enough” of them. The hope was that AI would ultimately make a big difference in boosting capabilities “and I think that’s very likely”. However, it had yet to make much of an impact, he said.

“This is one of the few big data areas where analysis is still pretty much a manual cottage industry and there aren’t widely used AI-enabled decision support software tools to interpret genomes either for rare diseases or for cancers,” Brown added. 

The government last week sought to streamline cancer diagnosis and treatment targets to ensure doctors were not overloaded with multiple goals that sometimes slow the pace at which patients receive care.

The move, which Brown welcomed, came after successive years in which the NHS had struggled to efficiently diagnose and treat life-threatening cancers, amid a swelling backlog caused by the Covid-19 pandemic.

From October 2022 to June 2023, 623,000 patients were still waiting for a diagnosis or to have cancer ruled out 28 days after an urgent referral, equating to three in every ten patients.

About 95 per cent of genomic sequencing taking place today is to detect and understand rare diseases and viruses.

Brown said the NHS would need to increase sequencing from about 4,000 people a month today to 40,000. That would enable it to sequence the genome of all newborns and ascertain which diseases they were liable to develop, and to track predisposition to adverse drug reactions in all people over 70.

Several recent cancer studies have shown that genomic mutations leading to cancer can occur several years before a patient is diagnosed with the disease, so if sequencing is used to detect those early, patients could be treated pre-emptively. 

The government said that last year it had announced more than £175mn in new genomics funding, including £26mn for cancer diagnosis. “Taken together, this funding will ensure we can continue to offer NHS patients the most advanced and effective treatments — ultimately saving and changing lives,” it added.

This story originally appeared on: Financial Times - Author:Anna Gross

The prime minister, giving evidence to the public inquiry into what has been dubbed the worst treatment disaster in the NHS’s history, resisted a request from Jenni Richards, counsel to the inquiry, that he rethink a decision to await publication of Sir Brian Langstaff’s final report before launching a payout scheme.

The review by Langstaff is expected in the autumn, but Richards noted that an interim report published in April “constitutes the [inquiry] chair’s complete recommendation on compensation”.

She suggested that this timetable “inevitably means further delay. And depending on how long the government then takes to consider the report, may then lead into a period . . . of [general] election purdah with all the policymaking constraints that imposes”.

In response, Sunak said Langstaff had at one point described his determination “to proceed as quickly as thoroughness allows. I think that is a good guide to how government should behave as well.”

“As a matter of general principle, good policymaking and legal advice would suggest it’s important for a government to have the full findings of an independent inquiry before making final decisions,” Sunak said later.

He added that everyone wanted to see as “swift [a] resolution to this tragedy as possible”, and that the Cabinet Office was “conducting an extensive amount of cross-government work to analyse all the various questions and recommendations” so ministers could act after receiving Langstaff’s final report.

“That work continues at pace,” he added, sparking ironic laughter among attendees at the hearing.

In May, the Financial Times reported that the compensation bill for those affected by the scandal could reach £10bn, in a further blow to the UK’s stretched public finances. 

In the 1970s and 1980s, tens of thousands of Britons were infected with HIV and hepatitis C after receiving tainted blood transfusions from the NHS.

About 2,900 of those who received contaminated blood products mostly originating in the US at the height of the Aids epidemic are believed to have died between 1970 and 2019, according to figures released by the inquiry this week, although it acknowledged that there was “considerable uncertainty” around the estimate. 

Pressed repeatedly on whether the government should have acted with more speed to address the scandal, Sunak said he could not comment on what previous administrations had done.

But he added: “The reassurance I hope people would take is . . . since I’ve been prime minister, which is just eight and a bit months, we’ve seen interim compensation payments made to 4,500 people, a significant sum of £100,000 [each].

“We have seen the moral case for compensation accepted for the first time in those 30 or 40 years, and we have seen a level of intensity of work on all the questions surrounding compensation that has not happened before.”

The compensation scheme is expected to require primary legislation. Asked whether it would be included in the King’s Speech scheduled for November 7, which will lay out the legislative agenda for the coming parliamentary session, Sunak said the issue of compensation was a personal priority but added: “I can’t speak to the composition of the [speech] for obvious reasons.”

This story originally appeared on: Financial Times - Author:Anna Gross

NHS Test and Trace inventory, such as test kits and other medical equipment, worth £3.3bn and transferred to the UK Health Security Agency could not be properly accounted for, according to a report published on Wednesday by the House of Commons public accounts committee. 

The findings come as the government faces recriminations over its response to the pandemic, with a public inquiry under way into the effectiveness of its preparedness and response strategy.

Dame Meg Hillier MP, committee chair, said it was “completely staggering” that an “organisation envisaged as a foundation stone of our collective security was established with a leadership hamstrung by a lack of formal governance and financial controls so poor that billions of pounds in NHS Test and Trace inventory can no longer be properly accounted for”.

The report noted a lack of adequate governance from the outset and referred to the appointment as the agency’s chief executive of Dr Jenny Harries, who at the time had limited technical experience of running a complex organisation.

The committee called on the UKHSA urgently to apply robust financial controls, develop a plan to deliver complete accounts and create a stockpile of equipment and medicine in the event of another health crisis.

“For the government not to make serious preparations for any future pandemic would be utterly inexcusable,” Hillier said.

The UKHSA was established in April 2021 to replace Public Health England, the agency blamed by ministers for its muddled response in the first year of the pandemic.

The new organisation, which was originally called the National Institute for Health Protection, was intended to focus on health security and use scientific and health evidence to respond to future disease threats.

The department came under criticism from the National Audit Office, the independent public spending watchdog, earlier this year for failing to complete an “effective programme of year-end stock counts” and for a “lack of adequate governance, oversight and control”.

The public accounts committee also pointed to an absence of effective control over the agency’s cash management processes, including a failure to perform bank reconciliations, a process used to verify bookkeeping, or to conduct stock takes on emergency stockpiles. 

The committee also found that three years after the pandemic started the agency still lacked adequate controls over its stocks of personal protective equipment (PPE), and continued to incur high costs for storage and disposal of unusable items.

In the past two years the agency has written off £14.9bn of spending, the report found, including £9.9bn worth of PPE and £2.6bn of Covid-19 medicines, in part because the government overpaid for items and over-ordered.

Harries said the UKHSA was “created in unprecedented circumstances when tackling Covid was our first priority, and we inherited significant pre-existing accounts challenges without full governance autonomy”.

“We have already instituted strong governance arrangements in a hugely complex organisation at the earliest opportunity within the controls available to us,” the agency’s chief executive added. “Despite these inherited financial challenges, the UKHSA continues to fulfil its priority remit — to protect lives.”

“In the face of an unprecedented pandemic, we had to compete in an overheated global market to procure items to protect the public, frontline health and care workers and our NHS,” a government spokesperson said. “We will consider the committee’s recommendations and formally respond in due course.”

This story originally appeared on: Financial Times - Author:Anna Gross