The Bill & Melinda Gates Foundation on Tuesday said since 2016 progress in reducing global maternal mortality had stalled, partly because of disruption caused by the coronavirus pandemic. In some countries, including the US and Venezuela, maternal death rates had risen in recent years.

With nearly 800 women dying in childbirth every day, the foundation called for “immediate action” to meet the UN’s sustainable development goal of cutting the maternal mortality rate to less than 70 out of 100,000 births, and newborn mortality to at least as low as 12 deaths per 1,000 births, by 2030. The current projection is for 138 maternal deaths per 100,000 births by that date, or almost double the target, it said.

Foundation co-chairs Melinda French Gates and Bill Gates outlined seven “innovations” and practices — many low-cost and deliverable by midwives and birth attendants — that could prevent deaths from childbirth complications such as post-partum haemorrhages, sepsis and other infections. Measures such as increased use of antibiotics and anaemia treatments including micronutrient supplements could save 2mn additional lives by 2030, and 6.4mn lives by 2040, they added.

The report said “policy changes . . . and more investment in women’s health and healthcare workers, including midwives” would be needed to reduce maternal mortality.

Launching the report, Mark Suzman, the foundation’s chief executive, said “huge progress” had been made in reducing deaths during childbirth in low- and middle-income countries in sub-Saharan Africa, South Asia and other regions. Between 2000 and 2015, preventable child mortality had more than halved to fewer than 5mn deaths a year, he said.

Progress had first slowed then stalled “largely [as] a result of the Covid-19 crisis” that had “disrupted health systems and restricted funding”, he said.

The report noted 18 key indicators in the UN’s SDGs — from poverty to gender equality, education to food security, health to climate — may not be achieved by the 2030 target.

But if health authorities implemented the recommended innovations and increased use of vaccines or malaria bed nets, “then it’s absolutely possible to reverse the setbacks and to reach the SDGs”, Suzman added.

Professor Bosede Afolabi, head of obstetrics and gynaecology at Nigeria’s Lagos university, told the news conference that giving micronutrient supplements to anaemic women during pregnancy reduced the numbers of stillborn children by about 21 per cent and low birth weights by 19 per cent while also reducing “six-month infant mortality to a large extent”.

Anaemia affects as many as 37 per cent of pregnant women globally. In some places in South Asia, that rate jumped as high as 80 per cent, the report noted.

In a trial across sub-Saharan Africa, use of the antibiotic azithromycin reduced sepsis cases by a third. French Gates added it could also be a game-changer in the US, where sepsis causes 23 per cent of maternal deaths and which had some of the most “inequitable maternal mortality rates among high-income countries”.

Robert Yates, director of the global health programme at London-based think-tank Chatham House, said Covid-19 had exposed global under-investment in health. While he welcomed investment in the interventions recommended by the Gates Foundation, increased funding in infrastructure, workers, ambulances and commodities was also required.

“If we’re going to see improvements in maternal mortality, there’s a role for the international community to help,” he said, but added it would be “big increases in domestic public financing [that will] make the difference”.

This story originally appeared on: Financial Times - Author:Sarah Neville

Breast cancer accounted for the highest number of “early onset” cases in 2019. But cancers of the windpipe and prostate have risen the fastest since 1990, according to an analysis of the Global Burden of Disease 2019 Study, which covered 29 cancers in 204 countries and regions.

The findings in the journal BMJ Oncology, highlight the need for improvements in early detection and diagnosis, as well as greater research into the causes of early onset cancer in order to find more effective treatments.

Lung, bowel and stomach cancers were among the forms of the disease usually more common in older adults that were exacting the heaviest death toll in younger age groups. The researchers noted that the US Preventive Services Task Force, a group of independent experts, had recommended that colorectal cancer screening should now begin at 45.

The findings, published late on Tuesday, “upend received wisdom about the types of cancers typically affecting the under-50s”, the journal said.

New cancer diagnoses among the under-50s totalled 3.26mn, up 79 per cent on the 1990 figure, the BMJ’s research showed, although some experts cautioned that the size of the population had increased significantly over that period and that the rise may also be partly attributable to improvements in reporting.

The researchers estimated that the global number of new early onset cancer cases and associated deaths would rise by a further 31 per cent and 21 per cent respectively in 2030, with the 40-49 age bracket considered to be at the highest risk. 

The highest rates of early onset cancers in 2019 were in North America, Australasia and western Europe. But low- to middle-income countries were also affected, with the highest death rates among the under-50s in Oceania, eastern Europe and central Asia, the researchers reported.

In low- to middle-income countries, early onset cancer had a much greater impact on women than on men, in terms of both deaths and subsequent poor health.

Although medical researchers have not found a definitive explanation for the increase in cancer among younger people, in a linked editorial doctors from the Centre for Public Health, Queen’s University Belfast, said genetic factors were likely to play a role. However, they emphasised the probable significance of unhealthy lifestyles in driving the increases.

Areas of research now being explored included antibiotic usage, the gut microbiome — the vast population of microbes that play a vital role in human health — outdoor air pollution and early life exposures.

They concluded: “Prevention and early detection measures are urgently required, along with identifying optimal treatment strategies for early- onset cancers, which should include a holistic approach addressing the unique supportive care needs of younger patients.” 

Professor Stephen Duffy, of the Centre for Prevention, Detection and Diagnosis, Queen Mary University of London, said it was “interesting that there is a strong decreasing trend in liver cancer incidence, and an increasing trend in nasopharyngeal cancer incidence, since both have large numbers attributable to infectious causes”.

He pointed out that, for liver cancer, large numbers of cases are caused by the hepatitis B virus, for which there is an effective vaccine. This contrasts with nasopharyngeal (windpipe) cancer, where no vaccine has been developed for the Epstein-Barr virus — the leading driver of the disease.

This story originally appeared on: Financial Times - Author:Sarah Neville

Moving patients out of hospital and into the community to free up much-needed bed space has long been a key pillar of the NHS’s strategy, with Prime Minister Rishi Sunak pledging to cut waiting lists for routine care ahead of the election expected next year.

But while countries such as the Netherlands and Denmark have successfully shifted more care to community settings, the Nuffield Trust said on Tuesday that “progress and delivery on these ambitions has been minimal” in England.

“Insufficient capacity in community health and care services” had “beleaguered the system for years”, the think-tank added in its report, which drew on both international data sets covering the UK and detailed analysis of England’s health service.

While average lengths of hospital stay for UK patients compared well with other countries belonging to the Paris-based OECD, researchers found the country appeared to underperform when measured against other health systems with a similarly low number of acute beds.

The NHS seemed to be slower in sending patients home than countries including Sweden, Denmark and the Netherlands, which all have a similar bed base, they noted.

Difficulties in discharging patients deemed fit enough to leave has significantly inflated waiting lists for non-urgent treatment in England. Cutting the record backlog of 7.6mn took on fresh political urgency after Sunak made it a “people’s priority” in January, inviting voters to judge him on whether lists are falling when they next go to the polls.

Nigel Edwards, Nuffield Trust chief executive, said the study showed that the NHS focused disproportionate investment and attention on measures to stop hospital admissions and too little on “the ‘back door’ . . . sorting out the patients who shouldn’t be in hospital and could be cared for better, more effectively and more safely in other places”.

Data from NHS England shows that in the year to December 2022 the number of patients in hospital who were fit enough to leave but had yet to do so jumped by 27 per cent. Among those admitted for three weeks or more, 70 per cent were awaiting community health and social care services, such as rehabilitation, home care, or a nursing home place, the study noted.

Yet it found that the proportion of the NHS budget spent on primary care and community services fell in the three years to 2018-19.

The Netherlands, Sweden, Denmark and Norway respectively allot 62 per cent, 60 per cent, 58 per cent and 55 per cent of their total spend on health per head to outpatient, prevention and long-term healthcare compared with the UK’s 52 per cent, the researchers found.

Another key distinction is that in many other countries, local municipalities are responsible for community health and social care services, whereas in England accountability tends to be split between local councils and the NHS.

Edwards pointed to a “vicious cycle” in which patients were discharged from hospital without the necessary support to continue their recovery, meaning they were far more likely to be readmitted.

He acknowledged that the community-centric approach was not a panacea, however. Some countries’ experiences have highlighted that structural shake-ups may not deliver their intended effects unless supported by ample funding. 

In a 2007 shake-up, Denmark consolidated hospitals into larger, regionalised units, while smaller hospitals were converted into intermediate care or “step-down” facilities.

The report noted that over the past decade, the share of Denmark’s health expenditure invested in inpatient services fell by 15 per cent as more care has shifted to outpatient settings.

Karsten Vrangbæk, director of the Centre for Health Economics and Policy at the University of Copenhagen, said Danish politicians had employed “a sort of strong rhetoric” that centralising hospitals would allow more specialised services. “So it was really sold as raising the quality.”

However, he noted that giving municipal governments more powers had exposed differences in the levels of funding and staffing each was able to command, although a redistribution mechanism from richer to poorer municipalities and tighter regulation from the state had reduced the level of variation, he added.

In the Netherlands, Nuffield noted, “evaluations of long-term care reforms concluded that smaller municipalities had insufficient capacity to carry out their new responsibilities properly”.

Madelon Kroneman, senior researcher at the Netherlands Institute for Health Services Research, suggested the Dutch government had overestimated the savings that would come from decentralising care as it sought to control “unsustainable” growth in healthcare spending.

With costs still rising, ministers had attempted to limit the number leaving hospital for expensive long-term care homes, but doing so had meant families were increasingly expected to find, or provide, the support their loved ones needed, she warned.

Noting that the new approach had also put more pressure on GPs, Kroneman said there was consensus across the sector that there should be a focus on “the right care in the right place . . . [but] what that ‘right place’ is is not yet clear”.

The Department of Health and Social Care said it was “working to ensure patients leave hospital as soon as they are medically fit” and that “the number of patients each day who are ready to be discharged has reduced by approximately 2,800 in England since January”.

“We are investing a record £1.6bn to support this on top of £700mn to ease hospital pressures over last winter and buy thousands of extra care packages and beds,” it said.

NHS England said it had “rapidly expanded the use of out-of-hospital care” and was “increasing the number of patients treated at home or in the community”.

It added that treating patients at home via “virtual ward beds” could help them avoid “unnecessary hospital admissions . . . [and] recover faster where they are most comfortable”.

This story originally appeared on: Financial Times - Author:Sarah Neville

Dr Don Berwick was speaking after Letby, a former neonatal nurse, was sentenced to life imprisonment for killing seven babies and attempting to end the lives of six more. Doctors who worked with Letby said they tried to raise the alarm but were ignored by managers.

Berwick was among a number of leading healthcare figures interviewed by the Financial Times who suggested that NHS culture still needed to change to ensure staff felt safe reporting concerns over poor care.

Following Letby’s conviction this week, the government announced an independent inquiry into the circumstances that allowed her crimes at the Countess of Chester hospital to remain undetected for so long.

A decade ago, Berwick was commissioned to examine what lessons should be learned from a different tragedy — the deaths of 1,200 patients who died needlessly at Mid-Staffordshire NHS Foundation Trust between 2005 and 2009.

An inquiry found the victims had been failed “by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety”. 

In his report, Berwick concluded that “the most important single change . . . would be for [the NHS] to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end-to-end”.

Despite the commitment of many healthcare leaders, not enough progress had been made in the decade since, he suggested.

This had partly been because of the pressures of Covid, and austerity cutbacks which meant health trusts became “worried about their financial status and deficits”, he argued. Brexit “was another shock” and “attention to patient safety as a primary concern, [or] first duty, waned”.

Pointing to the challenges of changing NHS culture, Berwick told the FT that at Mid Staffs the leadership had “responded more with fear and justification than they did with openness and inquiry”.

Likewise, in the Letby case, staff who were suspicious about what was happening “were not responded to with the kind of openness and embrace and trust that is necessary for learning”, he added.

The NHS was not alone in falling short, he said. “Every large system is finding it difficult to achieve this culture change.”

Chris Ham, co-chair of the NHS Assembly which advises NHS England, and a former director of strategy at the Department of Health, said that while the Letby case was “an extreme example”, there had been other recent instances of concerns going unheeded.

He highlighted an inquiry into University Hospitals Birmingham NHS Foundation Trust, which found staff had not felt supported to express worries because of a culture described as “bullying” by Mike Bewick, a former NHS England deputy medical director, commissioned to lead the investigation. A junior doctor at the hospital died by suicide.

Ham lamented that Don Berwick’s recommendations had not been implemented, suggesting that if they had been, “it’s much less likely that we’d be in the position we are today”.

Alison Leary, professor of healthcare modelling at London South Bank University, said a key reason why the NHS often proved unable or unwilling to learn the lessons of past disasters lay in a “command and control culture from central government” that valued activity over quality.

This was manifested in ministers’ “promises to the population — ‘we will cut waiting lists, we will give people faster cancer treatment’ — when we don’t have the capacity to actually do that in the system,” she said.

Leary cited the saying that between “good, fast and cheap you can only pick two”.

She added that “50 years worth of inquiries” had vowed that lessons would be learned “and of course they never are because the environment isn’t created where the learning from those situations can be applied”.

Although the vast majority of treatment in the NHS turned out well, healthcare was “a high harm-potential environment”, she said. Yet in England, there was no single overarching regulator for safety and healthcare. Contrasting this with airline, rail and nuclear sectors, she said it was “the only high-risk, high-harm industry that doesn’t have a safety infrastructure”. 

Rob Behrens, the health service ombudsman whose role is to investigate complaints about poor care brought by patients and their families, echoed Leary’s concerns about the complexity of structures to scrutinise safety in the NHS.

In the wake of the Letby affair, he has written to the health department urging “an independent review of what an effective set of patient safety oversight bodies would look like”.

A public servant for 40 years, he said he had “never come across a more regulated sector than health but the problem is that it’s uncoordinated, it’s arcane, and people don’t understand how to use it”.

Official watchdogs such as the health and safety inspectorate division, the patient safety commissioner, separate ombudsmen for health and social care, and the Care Quality Commission were “not as effective as they need to be because they’re not integrated or joined up”.

Unlike most of his ombudsman counterparts around the world, he did not have the authority to investigate incidents unless a specific complaint had been made, he added.

In a letter to senior health managers after the Letby verdict, Amanda Pritchard, NHS chief executive, and other senior colleagues said the NHS was “committed to doing everything possible to prevent anything like this happening again, and we are already taking decisive steps towards strengthening patient safety monitoring”.

“We want everyone working in the health service to feel safe to speak up — and confident that it will be followed by a prompt response,” they added.

Berwick said despite the stresses facing the health service he was hopeful that “NHS leadership will find a way to restore quality improvement and patient safety to the centre of its strategic agenda. It really must do that,” he added.

The health department said: “Providing safe and compassionate care is the heart of what we do, and we’re committed to keep listening to the experiences of patients and their families and using what we hear to implement improvements for them.

“We’re improving the safety of care by increasing transparency and requiring Trusts to inform patients if their safety has been compromised, by the legal protections in place for whistleblowers, and by implementing the first NHS Patient Safety Strategy to create a safe learning culture across the NHS.”

This story originally appeared on: Financial Times - Author:Sarah Neville

Elsewhere, on Albert ward, one of five lavatories has been out of use for three months after a hole opened up in the floor, exposing it to the car park below, and rotted floor joists in patient bays, temporarily taped over, represent a constant trip hazard.

We “still provide the best care we can” but some patients are so horrified by their surroundings that they discharge themselves, said matron Marta Calvo Hernandez.

St Mary’s is one example of how a longstanding lack of capital spending is being felt across the NHS. The service is struggling with an accumulated maintenance backlog estimated to be worth more than £10bn, the highest since records began.

Stephen Rocks, an economist with the Health Foundation, a research organisation, said there had been “a very sustained under-investment in capital” over the austerity years of the 2010s, which had “left the NHS with insufficient capital investment to deliver the care patients need”. 

Rocks suggested this was part of the reason that a growth in staffing levels in the health service did not seem to have translated into a corresponding increase in activity.

“We’ve seen a ‘capital shallowing’, with less capital per worker, and that does have a very direct read across to productivity,” he said. 

Despite the evident dilapidation at St. Mary’s, where more than half the buildings are older than the NHS itself, it is not a priority in the government’s New Hospital Programme. The scheme, a legacy of Boris Johnson’s time in office, aims to construct or expand 40 hospitals by 2030, backed by about £20bn of capital funding.

The cost of St Mary’s rebuild is estimated to total £2.2bn — although this would be offset by selling land owned by the trust, reducing the contribution from the government to between £1.2-1.7bn.

The strategic case for the work was approved in 2021, but after five other hospitals were found to have deteriorating concrete roofs that posed a severe safety risk, St Mary’s was told it was no longer at the front of the queue.

Surveying his crumbling domain, chief executive Tim Orchard, who is also a consultant gastroenterologist, cannot hide his incredulity that so many other projects can be deemed more pressing than his own.

“I would find it very difficult to imagine worse estate than this,” he said.

Past disasters have included “a big problem with sewage coming out of the drains in our outpatient department” and “a very considerable electrical and flooding issue” in a relatively new part of the estate that meant “having to close down all elective work in one of the buildings for three weeks”, he added. 

Heath department insiders said St Mary’s remained part of the New Hospital Programme and suggested rebuilding would start before 2030, although they acknowledged that work would continue beyond that date.

The St Mary’s site includes historic buildings such as converted stables, once used by the nearby Great Western Railway. But the charm escapes staff who must provide outpatient and day treatment from premises dating back to the Victorian era. 

Deirdra Orteu, a former nurse who is one of the leaders of the trust’s redevelopment programme, pointed out a ward that has been permanently closed due to a structural problem with its ceiling that is considered simply too expensive to repair.

Orchard stressed that the care patients receive at his trust is still first-rate — its maternity unit has recently been rated outstanding by the Care Quality Commission, the health service’s inspectorate, despite operating from a building opened in 1863 — but all too often staff are delivering it despite their surroundings.

All of this has implications for Prime Minister Rishi Sunak’s pledge that waiting lists for non-urgent care, currently standing at 7.6mn, should be falling by the time of the general election expected next year.

Orchard said the hospital has still managed to achieve steep cuts in long waits for treatment and if not for the impact of NHS strikes, he believed waiting lists would this year have started to plateau and then fall. But he acknowledged that “there’s absolutely no doubt that is much harder if you’re doing it in a situation where you cannot rely on your estate”.

Some of the buildings have received attention in recent years. Backed by about £920,000 in investment, the hospital’s same-day emergency care department is a national pioneer where patients receive treatment such as transfusions and MRI scans, relieving pressure on the hospital’s endlessly overstretched A&E department.

St Mary’s is also at the centre of Paddington Life Sciences, a growing cluster that links clinicians with academic, community, pharmaceutical and technology organisations that have offices close to the hospital. The trust hopes to increase collaboration and attract funding via clinical trials and other healthcare innovations.

The presence of the organisations “can demonstrate social value for our community”, argued Orchard, adding they can give an economic boost to a district with high health inequalities. He pointed out that there is a 13-year difference in life expectancy between the hospital’s immediate neighbourhood and the area around Hyde Park, a 10-minute walk away.

But visionary plans cannot obviate the desperate and immediate need to provide better facilities for patients and his workforce. 

Orchard fears the hospital may not receive substantive funding until 2030 and, given the scale of the work required, it could be another six or seven years before it is completed.

He said this would risk healthcare provision “in one of the most deprived parts of west London”, as well as a for patients from around the country who come to be treated for some rare infectious diseases and cancers. 

He added that after so many years, patients as well as staff have got used to the conditions in which they operate, but “the danger is that you start colluding in the idea that this is how it is, how it’s always been and how it always will be”.

This story originally appeared on: Financial Times - Author:Sarah Neville

The warning came ahead of the formal opening this week of the new laboratories, known as the Vaccine Development and Evaluation Centre, based at Porton Down in Wiltshire, which was established last year.

Dame Jenny Harries, chief executive of the UK Health Security Agency which runs the new centre, said much of its work would support the “100 Days Mission”. This was first outlined in 2021 under Britain’s G7 presidency, aimed at developing a vaccine against a potential killer pathogen within little more than three months of identifying it.

Speaking alongside Harries late last week, professor Isabel Oliver, the UKHSA’s chief scientific officer, said the goal of the 280 scientists at the centre was to “detect threats at source and control them before they spread”.

Covid-19 vaccines were developed at an unprecedented speed to counter the spread of coronavirus. But it was still close to a year after scientists realised the scale of the threat before the first jabs went into arms, which saved an estimated 14mn lives worldwide in the first 12 months, according to research published in the Lancet, and ultimately ended the need for damaging lockdowns.

“If those vaccines had been available just a bit earlier . . . or deployed more quickly we could have saved many more lives . . . and we could have obviously returned to greater normality much more quickly,” Oliver said.

She insisted the UK was “absolutely” in better shape to deal with the next pandemic but warned this progress should not be taken for granted. “These capabilities are expensive. It’s not just the resource issue, but actually [sustaining] the skills, the expertise, all that requires constant effort.”

The new laboratories stand amid a collection of nondescript buildings on a windswept site outside the city of Salisbury. About 200m away lies Britain’s top-secret defence research facility, with which the name Porton Down has become synonymous.

The latter hit the headlines five years ago when scientists there identified the poison, which was used to try to kill the former Russian double agent Sergei Skripal, as a nerve agent developed for use on the battlefield by Soviet scientists from the 1970s onwards.

The government has invested £65mn to build, equip and staff the two new vaccine laboratories, which are completely separate from the military facility. The UKHSA said it was seeking to build on Porton Down’s “heritage and reputation for working safely with a range of diseases”.

Its deputy director, Bassam Hallis, said the centre was “unique” in the world for co-locating all the functions needed to support the development of vaccines and therapeutics, from isolating the pathogen to late-stage clinical studies, on a single site.

Once inside the buildings — in which so-called “containment labs”, where live viruses are handled, are protected by airtight doors — the scale of the research being undertaken is immediately evident.

In a “high throughput” serology lab, thousands of blood samples a week are still being processed to monitor the spread of Covid-19, even though the pace has slackened somewhat from the 4,000 a day it handled at the height of the pandemic.

In other labs nearby a similar process is under way for a range of diseases, including tick-borne encephalitis, swine and bird flu.

In a separate “cell culture” lab, one scientist was examining blood samples from people vaccinated against Covid-19. These had been mixed with a live virus — a new variant of the disease — to see if existing antibodies were able to neutralise it.

Assays, or tests, for many conditions, have been developed on-site, including most recently for the virus that causes monkeypox.

The centre is collaborating with the Centre for Epidemic Preparedness Innovation based in Norway and harnesses expertise from academia and industry.

Harries acknowledges the 100-day goal will be easier to achieve for some pathogens than others. But she sees great promise in the relatively new mRNA vaccine technology, which produced some of the most successful Covid jabs.

“[They] give us a much more realistic opportunity, I think, of being able to say ‘actually we’ve got the main structure ready to go. We’re going to pop in the new pathogen’,” she added. It would not be as simple as that, she conceded, “but it does start to bring it into reality”.

But a significant milestone could be on the horizon with early trials under way on an inoculation to protect against Crimean-Congo haemorrhagic fever, a virus that is spread by the bite of an infected tick and is fatal in about 30 per cent of cases.

If the trials are successful it would be the first vaccine produced by the centre as well as the first of its kind in the world.

This story originally appeared on: Financial Times - Author:Sarah Neville

The government on Friday announced 13 new centres, to which patients will be referred by doctors for scans and other investigations, as it taps new sources of funding to tackle record waiting lists amid tight public-sector spending constraints.

Eight of the centres will be run by the private sector, as the Financial Times first reported on Wednesday, part of a plan backed by an elective recovery task force set up last year by prime minister Rishi Sunak.

Staff in the privately run CDCs will be employed by the independent sector, which will also own the buildings, keeping them off the Treasury balance sheet.

Five of them will be in the south-west and operated by InHealth, a specialist provider of diagnostic tests that has worked with the NHS for more than 30 years. They will be fully open in 2024. The other three — in Southend, Northampton and south Birmingham — will be operational by the end of this year.

Together with five more NHS-run centres across the country, backed by £2.3bn, the new centres will be able to deliver 742,000 more tests a year.

Sunak has made cutting waiting lists one of his five “people’s priorities” ahead of the general election expected next year. But he acknowledged on Wednesday that about 7.9mn people are awaiting non-urgent hospital treatment, the highest since records began.

More diagnostic equipment is badly needed in the NHS, which has fewer scanners and other facilities than many comparable OECD countries. At present, just four CDCs are being run fully by the independent sector.

David Hare, chief executive of the Independent Health Providers Network and a member of the task force, said the government’s announcement marked “a real, significant step forward to unlocking more of the capital, capacity and capability of the independent sector”.

Saffron Cordery, deputy chief executive of NHS Providers, said hospital trusts would welcome the extra support but insisted that the NHS be given the capital funding it needed “now and in the longer term to expand its own diagnostics capacity amid a backdrop of growing patient demand”.

Health secretary Steve Barclay said it was important to “use every available resource to deliver life-saving checks to ease pressure on the NHS”. The task force had identified “additional diagnostic capacity that is available in the independent sector, which we will now use more widely to enable patients to access the care they need quicker,” he added.

Separately, the health department on Friday highlighted a new procurement system, the Provider Selection Regime. Its aim is to give bodies buying healthcare for the NHS more flexibility when selecting providers, in a push to cut unnecessary competitive tendering.

However, Labour sought to underline the government’s failure to make greater use of the private sector, saying that its spare capacity could have enabled treatment for a further 331,000 NHS patients since January 2022.

This story originally appeared on: Financial Times - Author:Sarah Neville

The department for health and social care said on Friday the sum included a £570mn workforce fund spread over two years and distributed to local authorities, and £30mn for areas with the most “challenged” health systems. 

Campaigners and health leaders welcomed the decision to announce the extra cash as early in the year as July, to guarantee it over two years and to give local authorities flexibility over spending.

However, they warned the sector, where around one in 10 posts currently stands vacant, remained under massive strain and urgently needed wider reform.

Alongside reforms announced earlier this year, intended to improve the status and training of social care staff, and an NHS workforce plan unveiled in June, they would “build a stronger overall foundation for the health and social care workforce”, DHSC said. 

The funding would also support the NHS by preventing hospital admissions and helping people to be discharged from hospital more quickly “cutting waiting times for A&E and ambulances”, the department added. 

A plan to boost urgent and emergency care published in January suggested that around one in four patients who were unable to be discharged despite being medically fit to leave hospital were awaiting home care.

Around 16 per cent were waiting for a care home place and 24 per cent intermediate care, the study showed. 

Minister for care Helen Whately said the government’s workforce reforms “will help more people pursue rewarding careers in social care with nationally recognised qualifications.

“Our investment in social care means more funding to go to the front line,” she added. 

Beverley Tarka, president of the association of directors of adult social services, said the government was “putting us in a much better place than last year, when funding came too late, while we were already in the middle of a winter crisis”.

Its latest survey found that three-quarters of directors were concerned they would not have enough in their budget to get people the right care at the right time.

While the additional funding would not solve all these problems, it would “help stabilise the situation and help us address the challenges this winter,” she acknowledged.

When the government announced its reforms earlier this year, campaigners and experts complained that only around £250mn had been earmarked for the social care workforce, compared with at least £500mn promised a year earlier. 

Welcoming the allocation of extra funding, Nuffield Trust fellow Camille Oung said social care was often raided to pay off other Whitehall budgets “so keeping this promised pot of money and prioritising care workers was the right decision”.

However, she warned that “we cannot be sure that this funding alone will meet the depth of the problem after years of neglect” and “a comprehensive programme of reform” was needed.

Matthew Taylor, chief executive of the NHS Confederation, which represents health leaders in England, Wales and Northern Ireland, said social care budgets had been “below what is needed for a very long time”.

While the promised funding was positive “there is still a desperate need for a long-term social care workforce plan, similar to the recently published NHS workforce plan”, he added.

This story originally appeared on: Financial Times - Author:Sarah Neville

About 5,000 radiographers — about one-quarter of the workforce in England, including staff delivering cancer support and treatment — will walk out for 48 hours from 8am on Tuesday, in the profession’s first-ever solo stoppage.

Their strike and the cancellation figures came as research group the Health Foundation forecast that a further 2.5mn people would be living with major illness by 2040, pointing to the long-term pressures that the NHS faces as the government seeks to cut waiting lists ahead of the general election next year.

Dean Rogers, executive director of the Society of Radiographers, defended the two-day action and said further walkouts could be prevented if ministers agreed to match the pay rise of 6 per cent offered to other public sector workers for 2023-24 and extend it to those on freelance contracts.

Radiographers received a pay rise of 5 per cent and two one-off payments totalling at least £1,655 as part of the deal in May that covered NHS staff in England.

Miriam Deakin, director of policy and strategy at NHS Providers, which represents health organisations across England, said 90 per cent of people saw a radiographer for acute diagnosis or treatment.

“The impact of this strike therefore cannot be underestimated — patients will be hit hard,” she warned. 

But health secretary Steve Barclay called on radiographers to call off “disruptive strikes” and accept the government’s “fair and reasonable” final offer.

The radiographers’ stoppage came as official data showed that at least 67,762 hospital appointments and procedures in England had to be cancelled across hospital, mental health and community services because of the walkout by consultants last week.

That brings to more than 820,000 the number of patients whose treatment has been delayed since industrial action first hit the NHS in December last year.

Health minister Will Quince described the cancellations as “disappointing” and said strike action was “hindering efforts to cut NHS waiting lists and impacting on patient care”.

Meanwhile, analysis by the Health Foundation pointed to forthcoming structural changes in demand for NHS care that would call for greater investment, particularly in general practice and community care to shift the service towards disease prevention and early intervention.

Research by the foundation and Liverpool university projected that more than 9mn people in England would be living with a major illness by 2040, a rise of 2.5mn from 2019, underlining the pressure that already squeezed public service budgets would face in the future.

Some 19 of the 20 health conditions studied were forecast to increase in prevalence, including a rise of more than 30 per cent in the number of people living with conditions such as cancer, diabetes and kidney disease. 

The rise partially reflects the ageing of the vast “baby boomer” generation: 80 per cent of the increase is expected to affect people aged at least 70.

Anita Charlesworth, director of the Foundation’s REAL Centre, which carried out the work, said that with one in five people projected to be living with major illness in less than two decades’ time, “the impact will extend well beyond the health service and has significant implications for other public services, the labour market and the public finances”.

This story originally appeared on: Financial Times - Author:Sarah Neville

Philip Banfield, chair of the BMA’s ruling council, said the percentage was an indicative figure and suggested that an acceptance by ministers that NHS salaries had been eroded over many years could pave the way for talks.

In an interview on the eve of the 75th anniversary of the founding of the NHS on Wednesday, Banfield suggested the backdrop to the strikes in England was an underfunded and understaffed health system in which demand outstripped resources by fourfold and rationing of care was increasingly evident.

Steve Barclay, health and social care secretary, has blamed the junior doctors — those below consultant grade — for refusing to budge from their pay demand, which they claim is needed to reverse 15 years of wage erosion, saying negotiations cannot begin until they reduce it.

However, Banfield said: “The fundamental issue here is that the government refuses to acknowledge that there has been a fall in the value of pay.” 

If that admission was made, “then the juniors would be able to say, ‘right OK, so now . . . let’s discuss how to get back to restoring that value over whatever period of time you want to negotiate about”, he added.

The percentage was “not set in stone at all. It’s an indicative amount that when we do our calculations back to 2008 and apply RPI to it, that’s the figure you get to,” he said. 

Record numbers are waiting to start non-urgent treatment for conditions such as knee and hip replacements, a situation worsened by walkouts from staff across the NHS, including nurses and ambulance workers, which has contributed to more than 650,000 cancellations of operations or appointments.

Banfield said the unprecedented scale of the action “reflects the frustration and anger of the frontline staff of not being valued in getting on with the job”. 

But he played down the impact on waiting lists, pointing to a hollowing out of NHS workforce and infrastructure over many years. “I would argue that operations are cancelled every day because of lack of capacity, not enough staff, not enough beds.

“The industrial action that takes place for a few days doesn’t materially add to the overall picture,” he claimed. 

He also defended the decision by consultants to strike for two days in pursuit of their own pay demand, insisting patients would not come to harm as a result. Emergency cover would be unaffected as senior doctors would provide a “Christmas Day” service. “We will keep patients safe . . . no ifs or buts,” he said.

Banfield suggested that “recalibrating the value of doctors and what they do in the workplace” was in some ways even more important than a pay rise for his members.

Referring to physician associates, he said: “You’ve now got people in the workplace who can do less than doctors, being paid £10,000 more and that’s the quickest way of driving doctors out of the NHS and out of the UK.”

Junior doctors have been painted as militants and criticised for their hardline stance in a battle fought partly through social media. Defending the approach, Banfield said: “This government has ignored anyone who has tried to talk to them nicely. It just gets blanked.”

Banfield, who began medical school in 1979, said he was “not going to criticise the juniors for organising themselves, motivating themselves, getting their spirits together . . . I admire their get up and go. I wish my generation had [had] such determination.” 

He added: “It is the bloody mindedness of this government that is really getting in the way of resolving these disputes.” 

Banfield, comprehensive-school educated and trained at St George’s hospital in south-west London, was the first in his family to attend university.

He recalled being told that he should not aspire to gain a place at a distinguished London teaching hospital because no one from his school had ever done so. “That exposed my characteristic of ‘when someone tells me it can’t be done, do it’,” he added. 

Working as a consultant in obstetrics and gynaecology in Rhyl, a deprived area of North Wales, he said the social mix he encountered at school “kept my feet on the floor . . . and I feel at home with these patients because you’re standing up for them and with them as part of the advocacy against the system.”

Separately, the heads of three leading health and care research institutes, the King’s Fund, Nuffield Trust and Health Foundation, have written to the leaders of the three largest political parties in England, calling on them to commit to long-term investment and reform of the NHS.

“Persisting with the current addiction to short-termism and eye-catching initiatives will risk the health service being unable to adapt to the huge challenges ahead and reach its centenary,” they wrote.

Banfield said that, while there was “absolutely no fundamental reason” why the current, taxpayer-funded model of the NHS could not survive, amid an enormous strain on its resources Banfield suggested the public needed to be involved in a discussion about what it could deliver in future.

He pointed to an initiative by BMA Scotland, which was calling for “a big conversation with the Scottish government to say ‘actually if there is a mismatch between resource and provision, then you’ve got to talk to the public about what is going to be provided and not provided’.”

The health department said the government had presented an opening offer — a 5 per cent increase and one-off payment for 2023-24 — “and there were active discussions ongoing about a range of pay and non-pay measures to improve the working lives of junior doctors.

“However, the junior doctors committee turned their back on negotiations by announcing further strikes,” it added.

The government had been “clear that strikes must be paused while talks take place, and we remain ready to continue talking at any point if strikes are called off and the junior doctors committee show willingness to move significantly from their unreasonable pay demands”, it added.

This story originally appeared on: Financial Times - Author:Sarah Neville

It is rare, unique even, for a modern democracy to celebrate the anniversary of one of its public services with state-orchestrated rejoicing.

Yet many Britons are being made aware of the approaching 75th “birthday” of their health service. This anthropomorphising of a healthcare system speaks volumes about the grip the taxpayer-funded NHS has on the nation’s hearts and minds.

Although a belief in its exceptionalism is hard-wired into those who benefit from its cradle-to-grave care, the truth is that most western European countries enjoy a form of universal health provision even if some are funded through employer-based social insurance, for example, rather than taxes.

While the NHS continues to stand out, it is increasingly for the wrong reasons. People are flocking to use the private sector to escape record waiting lists for hospital treatment. Doctors, lionised just three short years ago for their heroism during the Covid pandemic, will walk out on strike next month, furious at what they say is 15 years of pay erosion. The backdrop to these travails is the soaring demands of an ageing population — a problem that scarcely troubled the NHS at its foundation when men on average died at 66 and women at 71.

That Britons’ fealty to their health service nevertheless endures is testament to the way it embodies the most visceral form of security — eliminating money worries in time of serious illness — but also the values of fairness and inclusion that the UK sees as the best of itself. Yet as two new histories of the health service demonstrate, there was nothing inevitable or preordained about its foundation, or its subsequent survival.

The need for better access to healthcare for those who lacked means had begun to loom larger in the years before and during the second world war. But as both Isabel Hardman, in Fighting for Life, and Andrew Seaton in Our NHS explain, the precise form this took — and the postwar Labour government’s ability to bring it to fruition at all — reflected the political canniness and pragmatism of its progenitor, health minister Aneurin Bevan.

It was Bevan who managed to circumvent medical opposition to the plan by allowing GPs to remain independent contractors, and consultants to treat private patients in so-called “pay beds” in the newly nationalised hospitals.

In the US an equivalent attempt to introduce a system of free healthcare, backed by then-president Harry Truman, failed due to the astonishingly relentless and well-funded opposition of the American Medical Association. The British Medical Association ultimately proved less obdurate than its US counterpart, for which generations of Britons must be grateful. 

The two books inevitably cover similar terrain but take different approaches to their subject matter. Hardman’s writing is breezily accessible, and her deeply researched book is full of colourful vignettes and an enjoyable spice of gossip as befits a political journalist.

Seaton, an Oxford research fellow, has a less rollicking style and his book is clearly aimed in part at an academic audience. However, his analysis is sharp and compelling and makes a considerable contribution to the scholarship surrounding what he terms “Britain’s best-loved institution”.

This is scarcely a happy birthday for the NHS, which is paying the price for a decade of funding attrition after the financial crisis, followed by the coronavirus pandemic. So while both books are histories, readers pondering the health service’s current state and its future will reflect on whether the past serves as prologue.

Hardman’s division of her book into 12 “battles that made our NHS” feels a little contrived as a device: could the introduction of heart transplants and IVF really be so described, even though both innovations certainly created controversy? But it is wholly apt for the difficult birth of the health service that she describes in her opening chapter. She debunks the popular myth that the Conservative party — which was leading the wartime coalition government when the social reformer William Beveridge produced his 1942 report sowing the seeds of the NHS — opposed the idea. Although it voted against the second and third reading of the bill that introduced the NHS, they put down a reasoned amendment making clear they welcomed the principle of a comprehensive health service.

However, she makes the astute point that Conservative opposition to the particular blueprint that Bevan chose, involving the nationalisation of even voluntary-run hospitals, fostered an indelible narrative that the Tories cannot be trusted with the health service. “It has meant that for the rest of the lifetime of the NHS, however long or short, the Conservative party will never have the full political permission to do as it pleases with the health service in the way that it would like.”

Perhaps a case in point is that more than 30 years later, Margaret Thatcher — a political realist despite her “conviction politician” reputation — considered but did not pursue a proposal to ditch the NHS model for a private insurance system. To this day, says Hardman, some believe the Tories have a secret plan to dismantle the NHS, given the chance. However, since it did not happen when the prime minister had such large majorities and was already pushing back the frontiers of the state, “it is unclear what that chance would be”, she notes drily.

One of the biggest puzzles about the NHS is how it has survived with its form essentially unchanged since its foundation

Hardman is particularly good at locating the NHS within the wider social movements that have changed British life over the 75 years of its existence. Her chapter featuring the discovery of the contraceptive pill, which sparked a concerned senior civil servant to muse about a woman having the same rights under the NHS “whether she is married or living in sin”, speaks to its need to adapt and respond to societal change.

She also traces the roots of one of the most regrettable aspects of NHS culture: an often harsh command and control approach to leadership. The introduction of more professional management in the 1980s was the legacy of Thatcher’s flirtation with a wholesale overhaul of the system. In 1992, Duncan Nichol, the then-chief executive of the NHS, protested against the “macho” management style that had developed. Hardman writes: “It is now very hard to find anyone who doesn’t think there is widespread bullying — whether of staff in underperforming hospitals and units or of whistleblowers to safety threats — in the service.”

One of the biggest puzzles about the NHS is how it has survived with its form essentially unchanged since its foundation. Other examples of welfare, such as mass council housing and state-owned industries, did not outlast the turbulent 1980s.

In his book, Seaton points to the very strong popular support that the service garnered as the years went by, and its willingness to adapt, accommodating increasingly individualistic patients’ desires for more privacy and autonomy. This, he argues, has enabled it to endure as a bastion of social democratic politics, even as neoliberalism has become the dominant political credo and free market policies have reshaped other areas of British life.

He counters the preconception that Britons embraced their NHS with gushing gratitude from the start, however. “Rather than a natural or inevitable process, the growth of the public’s affection towards the NHS was a historical process that required work. In short, ‘Our NHS’ had to be made, both as an institutional reality and as a cultural icon.”

Some of this sense of ownership, Seaton suggests, developed amid a growing realisation that other countries did not necessarily share Britons’ respect for their health service. Bevan’s hope that the NHS would be embraced as a template for the world gradually faded in the face of opposition from US doctors, who presented the UK service’s failings as an awful warning of what the embrace of “socialised medicine” would mean.

Instead, he says, “welfare nationalism” increasingly took root among Britons. Seaton defines this as “a belief that welfare services express something essential about the nation”, a view that can encourage feelings of superiority over other countries and even marginalised groups such as immigrants.

In the 1980s, a number of documentaries on the iniquities of the US healthcare system from left-leaning film-makers encouraged viewers to equate private medicine with the worst of the US system, helping to end the “neoliberal dream” of Britain becoming a nation of private health insurance subscribers, Seaton suggests.

Indeed the NHS went on to reach its zenith of funding and public support during the New Labour years, long after the election of the Thatcher government was supposed to have swept away the last vestiges of social democracy. 

As the government and health leaders prepare to commemorate the service’s “big birthday”, it is easy to conclude that the NHS has precious little to celebrate. Neither Hardman nor Seaton reach a definitive judgment on whether it can survive in its current form, given the glaring mismatch between demand and resources.

Hardman suggests politicians need to better define what “protect the NHS” — the slogan that took on an ominous tinge during Covid when it led patients to delay seeking treatment in unexpectedly large numbers — really means. Politicians thus far have been too “fearful or lazy” to confront the state of the NHS and create a vision to address it, she writes.

Seaton is marginally more hopeful. The history of the NHS, he says, “shows the importance of asking who is stoking the sense of crisis, and to what ends. It also demonstrates that the service has recovered from serious challenges in the past, and might do so again.”

As the metaphorical bunting goes up in hospitals and GP surgeries across the land, both books should be prescribed reading for a nation that has long embraced “our NHS” but may now be wondering precisely what that relationship will look like a decade hence.

Our NHS: A History of Britain’s Best-Loved Institution by Andrew Seaton, Yale £20, 320 pages

Fighting For Life: The Twelve Battles that Made Our NHS, and the Struggle for Its Future by Isabel Hardman, Viking £20, 384 pages

Sarah Neville is the FT’s global health editor

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This story originally appeared on: Financial Times - Author:Sarah Neville

The British Medical Association, the doctors’ union, said on Tuesday that consultants would walk out on July 20 and July 21 after 86 per cent voted for strikes on a 71 per cent turnout.

Strikes by nurses, ambulance workers and junior doctors, which began with the first RCN walkout in December last year, have led to the cancellation of more than 650,000 operations and procedures by the NHS in England, jeopardising Prime Minister Rishi Sunak’s pledge to ensure waiting lists for treatment are falling by the general election.

In April, the government offered nurses and other NHS workers covered by the NHS’s so-called Agenda for Change framework a wage rise of about 9 per cent over two years, plus two one-off payments worth up to £3,789.

The pay deal was subsequently approved by the NHS Staff Council, representing 14 health unions.

But the offer was rejected by just over half of the RCN members who voted, and the nursing union sought a fresh mandate for industrial action.

Sir Julian Hartley, chief executive of NHS Providers, which represents health organisations across England, said the “double whammy” of strikes by consultants and junior doctors “means disruption for many thousands of patients and yet more pressure on overstretched services”. He added that there was still time for the two sides to settle their differences and avert strikes.

The health department welcomed the end to “hugely disruptive” industrial action by nurses, but said it was “disappointing” that consultants had voted to strike and urged the BMA to “carefully consider the likely impact of any action on patients”.

It added that consultants had received a 4.5 per cent pay uplift in the last financial year, increasing average earnings to about £128,000, “and they will benefit from generous changes to pension taxation announced at the Budget”.

This story originally appeared on: Financial Times - Author:Sarah Neville

Swan, who turned 87 last month, walked on to the thump of a techno track, whoops and applause. “Wow. I have to say” — she chuckled gamely — “I’ve never had an introduction like that. And it’s wonderful.” As the hall quietened, she began to speak, calmly and without notes, about the animating purpose of her professional life. “I’m going to tell you a mystery story,” she said. “And hopefully, you’ll help me to solve it along the way.”

Swan rebuts this, pointing out that her most recent work, published last November, suggests sperm counts are falling worldwide. Climate change scientists faced similar scepticism, she noted. “People said, ‘Oh, well, it’s warm right now. But [temperatures will] go down. And that’s the way climate is.’ Well, in fact, that’s not the case.” While she accepts that a lower-than-average sperm count does not necessarily doom a man to childlessness, there is a consensus that once sperm counts hit a particular level — below about 40 million sperm cells per millilitre of semen — fertility can be impaired.

The chemicals she has been able to link most directly to reproductive health are phthalates and pesticides, where she and others have found convincing evidence of a causal link between reproductive disorders and the “triazine” category of herbicides. Other researchers, she says, have found equally incontrovertible evidence of harm to reproductive health from other classes of EDCs such as the bisphenols. “When we began this work, we were in the medical and scientific wilderness because no one believed us,” Myers, who wrote the 1996 best-seller, told me. “And then gradually we built up the science.” But the regulatory climate remains heavily weighted towards industry. Some companies have proudly declared their plastic bottles and baby products “BPA free”, referring to Bisphenol-A, a chemical that can seep into food and beverages and, some researchers believe, harm human health — only for it later to emerge that the substituted product amounted to “slightly tweaked molecules”, Swan said.

Some nights Swan lies awake worrying. “The alarm I feel is a global alarm,” she said. “I feel it equally for human and non-human species.” She and her fellow campaigners have notched some successes. In 2008, for example, children’s toys and childcare items containing more than 0.1 per cent of three types of phthalates were permanently banned in the US. This year, the European Food Safety Authority recommended lowering the “tolerable daily intake” for BPA by a factor of about 20,000. (The European Medicines Agency is opposing the change.)

In April, G7 climate, energy and environment ministers issued a communiqué committing to “actively preventing chemical pollution, or . . . minimising its associated risks, including when caused by releases of endocrine disrupting chemicals”. Swan characterised this as a “very, very big” moment in her long-running battle to wake up governments and regulators to the dangers from EDCs.

As I spent time with her, I sensed that what keeps her going, above all else, is a lifetime habit of curiosity. Now based in San Francisco, she continues to pursue research breakthroughs in her field. While studying maths in her youth, she won an award after conceiving the notion that logic need not be binary, with true or false the only options, and developing a system of “three value” logic. She resists the security of the status quo, and while she revels in collaboration, she has also stayed true to the independent little girl, determined to navigate the world on her own terms, that found sanctuary in Juxey’s House.

Her overriding preoccupation remains how to alert a still largely oblivious world to the threat from EDCs. “You and I, and everyone on this planet, are really serving as guinea pigs,” she says. “And nobody asked us.”

Sarah Neville is the FT’s global health editor

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This story originally appeared on: Financial Times - Author:Sarah Neville

But his discovery, tenaciously pursued over decades, is now viewed as one of the most remarkable medical advances of modern times. It paved the way for a preventive vaccine expected to save millions of lives. In 2008 it netted him the ultimate accolade: the Nobel Prize in medicine.

This story originally appeared on: Financial Times - Author:Sarah Neville

Starmer warned that the NHS would not survive “five more years of Tory government”, arguing that a Labour administration would get the health service “back on its feet” by meeting within five years long-missed targets for the time people waited for ambulances and hospital treatment, and halving the gap in healthy life expectancy between different regions.

Matthew Taylor, chief executive of the NHS Confederation, which represents health organisations, praised Labour’s “constructive” vision but added: “[W]e need to see specifics on what a boost to funding would look like.”

He welcomed Starmer’s commitment to shift more care out of hospital and into the community but added that “we need to understand how Labour would achieve — and fund — such a move”, with more details needed on the party’s plans for social care.

This story originally appeared on: Financial Times - Author:Sarah Neville

RCN members in England last month rejected an offer that would have given nurses two one-off payments covering the 2022-23 financial year, worth up to £3,789 — on top of a previously promised rise of about 4 per cent — as well as a 5 per cent consolidated pay increase for 2023-24.

This story originally appeared on: Financial Times - Author:Sarah Neville

The extent of the problem was revealed in data published on Thursday for the first time as part of a government initiative aimed at trying to improve accident and emergency care.

This story originally appeared on: Financial Times - Author:Sarah Neville

Sir Brian Langstaff, a former judge, said he believed action was “necessary to alleviate immediate suffering” of those affected, noting that many were now “on borrowed time”.

This story originally appeared on: Financial Times - Author:Sarah Neville

The government-commissioned report, published on Tuesday, examined the role of “integrated care systems”, statutory bodies that bring together health authorities, local government and the voluntary sector to plan and fund healthcare.

This story originally appeared on: Financial Times - Author:Sarah Neville

The state of the NHS will be a pivotal issue at next year’s general election with Prime Minister Rishi Sunak aware he must show improvements if he is to reassure voters the service is safe in Conservative hands.

She is also thought to be keen to reduce the amount of detailed information that ICSs are required to submit to NHS England, reflecting the wide range of performance metrics.

This story originally appeared on: Financial Times - Author:Sarah Neville