The first two joint regional chief nurse appointments have been made by NHS England and NHS Improvement (NHSI).
In a move to provide “clear joint leadership” and greater collaboration across both organisations to deliver improved patient care.
Sue Doheny, a board-level director in the NHS for nine years, has been appointed to the South role, and Professor Oliver Shanley, OBE – who has most recently been deputy CEO and director of quality and safety (Chief Nurse) at Hertfordshire Partnership University NHS FT – has been named for London.
In their joint roles, Doheny and Prof Shanley will provide professional leadership to all members of the nursing and midwifery professions in their region, bringing greater clarity for frontline staff.
The roles will discharge the regulatory and statutory functions for which both NHS England and NHSI are accountable.
Both posts report to their respective regional directors who have described them as a significant development in the collaborative working arrangements now in place between NHS England and NHSI.
Doheny and Prof Shanley will report to:
- Steve Russell, NHS Improvement executive regional managing director for London
- Anne Eden, NHS Improvement executive regional managing director for the South
- Dr Anne Rainsberry, NHS England regional director for London
- Andrew Ridley, NHS England regional director for the South
Professor Jane Cummings, chief nursing officer for England, stated that she was very pleased about this new approach to joint chief nurse roles.
While Dr Ruth May, executive director of nursing for NHSI, was positive about the prospects of the new appointment.
“These joint appointments will strengthen our ability to provide great nursing leadership across London and the South. It will build on the support we provide to the nursing community and to the wider NHS on the important role that nursing care plays in the health service. I look forward to working with Sue and Oliver.”
The continuing argument over the government’s plans to scrap nursing bursaries means that this is an extremely critical period for the nursing profession.
A report by the Royal College of Nursing entitled “Overstretched. Under-resourced” back in 2012 reviewed the nursing labour market, and concluded that, as the title suggests, that the situation was already serious.
Data for the NHS in England at that time showed a reduction in nurse staffing of around 5,780 (headcount) and 3,700 (whole time equivalent) between May 2010 and June 2012.
Three of the leading nursing magazines in Britain have joined forces to condemn the plans of the government to scrap bursaries for nursing students.
Nursing in Practice, Nursing Times and Nursing Standard have collaborated in penning an open letter to Prime Minister Theresa May.
The three publications believe that the incumbent prime minister must reconsider the decision to force nursing students to take out loans in order to cover the cost of their study.
David Cameron’s government had previously floated the idea of removing the Health Education England bursary for pre-registration nursing students.
This was intended to ensure that the funding between nursing and medical students was equalised.
In urging May to address the issue, the letter notes that May had pledged in her very first speech as Prime Minister “to establish a fairer country that works for everyone and not just the ‘privileged few’”.
Of course, some may be sceptical about the legitimacy and sincerity of this particular claim.
Nursing students would be forced in many cases to accrue £50,000 of debt after leaving university, while being presented with an annual salary of £22,000 in the early years of nursing careers, should the scrapping of bursaries go ahead.
The letter comments that the scrapping of bursaries will be particularly disadvantageous to those from poorer backgrounds.
“Saddling graduate nurses with university debt will badly affect the number of students who wish to take up this vocation. Students with children will be disproportionately affected as will those from less privileged backgrounds.”
And concludes that the NHS “will no longer have a nursing profession that reflects the patients they serve.”
Angela Sharda, deputy editor of Nursing in Practice, outlined the reasons for writing the letter, suggesting that the decision will have a profound influence on the NHS, and not just the career plans of some nurses.
“In this letter, we have tried to explain why scrapping bursaries is a bad idea and what effect the decision will have on nurses. The nursing workforce is an important part of our NHS and it is a real shame that nursing bursaries have been cut – it will leave a negative impact on the industry. The decision to leave the EU has left uncertainty on the future of our NHS, but removing nurses’ bursaries will have a major impact on nurses financially.”
Sharda also pointed out that the three publications are usually in competition, thus underling the profundity of this action.
“Usually, we stand as three rival publications but in this instance we have decided to stand together and address the matter to the Prime Minister. We hope that we will get a chance to speak with Theresa May to revaluate the Government’s decision on cutting bursaries.”
Nursing remains a cornerstone of the NHS, and indeed always will be, and it is clear that the bursary plans of the government will have a massive impact on the publicly-funded healthcare system.
The Health Foundation has asserted that it is essential for any plan to abolish bursaries to be accompanied by a contingency plan to deal with a predicted fall in the number of applications for training places.
Despite massive opposition, the Department of Health has already indicated that it will proceed with proposals to replace bursaries with student loans.
This is despite opposition from bodies including the Royal College of Nurses, Unite, the Patients Association and NHS Clinical Commissioners (NHSCC).
In a blog post, Toby Watt, a finance analyst at the Health Foundation, said that there is currently “an overwhelming demand” for nursing training, with UCAS data showing that 57,000 students applied for 21,450 places in 2015.
Watt believes that if reforms are unable to deliver an additional 3,300 health professional training places on an annual basis, as has been promised by the government, an average of 2,046 of these will be for nurses, leaving 2.4 applicants for every training place.
Yet many healthcare analysts believe that the new system will discourage applicants from entering the nursing profession, particularly those from economically disadvantaged areas.
London Economics and Unite have estimated that the scrapping of bursaries will cause a 71% increase in costs for students, possibly dissuading some individuals from training to qualify as a nurse.
Watt asserted that the situation is uncertain, and that the nursing stock of the NHS could be seriously damaged.
“We can’t be certain what the future holds. The removal of the bursaries must therefore be accompanied with a plan for what happens if the number of applicants does fall by 60% or more. Training more nurses is essential, and this reform will help liberalise the labour market so it can react more efficiently and help meet the growing demand for clinical staff. However, the long-term success of these reforms will depend on nursing becoming an attractive career option.”
Already some of the most authoritative bodies involved with the healthcare system have made predictions regarding the impact of the bursary scheme.
NHS Improvement has estimated that the shortfall of nurses needed as a result of the new policy could be as high as 189,000.
And some critics have suggested that the scrapping of bursaries will lead to 40% of potential candidates aged over 25 deciding against entering the profession.
NHSCC has also warned that an increase in student nurses is not necessarily a good thing because new applicants could be chosen “based upon the ability to pay rather than the key values and skills required in the nursing profession”.
Nonetheless, the government continues to insist that this policy will be followed through, despite the seemingly large impact on the nursing profession and ultimately the NHS.
An NHS whistleblower has revealed that a decision has already been taken regarding the closure of minor injuries units at Doddington, Wisbech and Ely.
The news was leaked to the the MP for North East Cambridgeshire, Steve Barclay.
Barclay has already spoken out on the subject, furious about the secretive nature of the NHS decision.
“They decided the only option is to close these and it’s all hush hush because they are going to have a consultation- but it is already decided. In one of the areas of highest health need they are going to take these facilities away. I am very alarmed since when I have made inquiries on behalf of this community about minor injuries units I have been told number of options being looked at.”
The MP also considered it duplicitous that the public have been given the impression that the process was still under consultation when a decision had in fact already been made.
“Yet this source has provided evidence that it was decided internally there is only one option; cynically they intend to have a public consultation when it appears the decision is already taken,” Barclay commented.
There have also been reports that the local clinical commissioning group has radical plans for outpatient services, effectively eliminating local appointments in some areas.
This is undermining the future viability of services at some of the key local sites in the area, according to healthcare professionals.
Despite attempts by interested parties to contact the local clinical commissioning group, the MP Barclay states that the CCG “is not only failing to address legitimate questions I have raised but treating the community with contempt by failing to be open and going against the chief executive of NHS England about re shaping services around local communities”.
The level of staffing and patient numbers at all three local sites are still not been submitted to the office of the local MP, despite Freedom of Information requests having been submitted.
“It is self-evident that following massive management failure of the CCG in respect of older peoples it now appears they are planning to take services from an area of clear health need to increase provision in major hospitals requiring this area to travel further and to pay in petrol and parking to do so,” Barclay asserted.
Council leader Steve Count is in agreement with his local MP on the subject, suggesting that the clinical commissioning group has fundamentally failed to communicate adequately with the public.
“We are disturbed by these reports and such closures are of real concern, but we really need to understand the facts and the options. The catchments include areas of deprivation and loss of these services could therefore be hitting our most vulnerable communities. It is vitally important that all our communities continue to have an equality of access to a high standard of health care wherever they are in Cambridgeshire. We will be seeking discussions with the CCG to establish the facts and to find out what are their plans. We will put forward our concerns and those of thousands of people who these clinics serve.”
Despite the assumption that these closures will indeed go ahead, there has been no official confirmation on the matter as of yet.
As gene-editing becomes a more feasible part of healthcare across the planet, a new technique is being trialled for the first time in China.
This can be seen as indicative of the increasingly prominent role which China is playing on the world stage, as the world’s most populous nation becomes a major player in world affairs.
The groundbreaking gene-editing technique will be tested on humans for the first time, with Chinese oncologists trialling the innovation on lung cancer patients.
It is hoped that the new technique will enable a larger proportion of lung cancer sufferers to make a full recovery from the debilitating condition.
The team involved in the study hails from Sichuan University’s West China hospital in Chengdu, China, and intends to begin tests in August, according to the scientific journal Nature.
Lung cancer is a particularly big killer in China, with a two-pronged assault on public health having a massive impact.
Firstly, due to the rapid industrialisation of the Chinese nation, the levels of air pollution in some regions of the country are extremely dangerous.
Researchers estimate China endured 2.8 million cancer deaths during 2015 and 4.3 million new cancer cases, with lung cancer the most common of all.
“Cancer incidence and mortality have been increasing in China, making cancer the leading cause of death since 2010 and a major public health problem in the country,” researchers noted.
Secondly, China is the world’s largest consumer of tobacco, with 350 million people in China smoking regularly, and the country producing nearly half of all the world’s tobacco products.
It is this climate which has caused scientists and clinicians in China to seek new and innovative ways to treat lung cancer in particular.
Known as Crispr, the technique entails finding, removing and replacing specific parts of the DNA of individuals.
Those selected for the trial will already have received chemotherapy and radiotherapy, with these proving ineffective.
The Crispr technique adds a new genetic sequence, which is designed to help the patient’s immune system destroy the cancer.
Naturally this is a very technical undertaking, and the effectiveness of the approach and ultimate results are very much cloudy at the current time.
There are also moral concerns about gene-editing, despite the fact that Crispr could see the creation of pest-resistant crops and new cures for serious diseases such a signal-cell anaemia.
Supporters of gene-editing suggest that it differs significantly from genetic modification by not being hereditary.
Naturally everyone involved in the study will have volunteered, and also it must be said that their chances of survival otherwise are basically zero.
Healthcare campaigners and researchers in the UK will be observing the Chinese experiment particularly closely, as the Human Fertilisation & Embryology Authority in Britain approved an application from the Francis Crick Institute to use gene-editing on embryos earlier this year.
This research has yet to receive ethical approval, as the debate over gene-editing continues.
Medical gadgets have been a notable and increasingly prominent addition to the health landscape in the last few years.
Yet despite the benefits of such technology there is currently a distinct lack of legislation and regulation related to them.
In the United States, legislators are currently tackling this issue, with the Obama administration addressing the paucity of guidance for manufacturers of such devices.
It is well known among American government experts that the federal patient privacy law known as HIPAA (Health Insurance Portability and Accountability Act of 1996) has not kept pace with wearable fitness trackers, mobile health apps and online patient communities.
This was noted in a recent damning and delayed government report, which was actually supposed to have been compiled by the end of 2010.
Yet the US Department of Health and Human Services has frustrated many observers of both the technology and healthcare industries in the United States by failing to provide specific recommendations, despite being asked for them by the federal government.
The existing Health Insurance Portability and Accountability Act, the landmark 1996 patient-privacy law, only covers patient information kept by health providers, insurers and data clearinghouses, as well as their business partners.
Technology such as Fitbit falls outside of this legislation, yet enables users to store a huge amount of personal health information and data.
The new report has been compiled by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, in conjunction with other agencies, and notes that there is a legislative gap related to health devices.
“Health privacy and security law experts have a reasonably clear idea of where HIPAA protections end, but the layperson likely does not. Moreover, even entrepreneurs, particularly those outside the health care industry…may not have a clear understanding of where HIPAA oversight begins and ends,” the report observes.
But the authors of the report nonetheless suggest that it is an important milestone in the regulation of this industry, stating that readers can ultimately draw their own conclusions from the findings outlined in the text.
“At the end of the day, it’s a very complicated environment that we find ourselves in,” Lucia Savage, chief privacy officer at the Office of the National Coordinator for Health Information Technology, which took the lead on the report, suggested. “We believe we’re fulfilling our duties. If Congress has concerns about that, I’m sure that we will hear about them.”
A study conducted in 2014 assessed 600 of the most popular used health apps, and discovered that less than one-third have explicit privacy policies.
And policies on Apple and Google mobile phone platforms “may be inconsistent, not articulated to individuals, or simply ignored by web developers skirting the rules that operating system developers attempt to impose on them,” according to the recently published report.
This can be considered of particular concern to the UK healthcare system, considering the recent public-private partnership between Google and the NHS.
The new US report can be seen as a stepping stone to the safeguarding of this crucial area of technology.
Over 50 hospitals in England have been granted permission to ignore key waiting time targets owing to their extreme financial difficulties.
The decision is part of an overall package of measures which have been taken by NHS bosses following the £2.5 billion deficit accumulated by NHS trusts during the previous financial year.
Fines for missing targets in A&E, cancer and routine operations have been scrapped altogether as part of the initiative.
The decision to relax targets has already been strongly criticised by the Patients Association.
The chief executive of the organisation, Katherine Murphy, suggested that the initiative would ultimately have a negative impact on the efficacy of NHS operations.
“This is the slippery slope back to the bad old days of never-ending waiting times and uncertainty – with patients left endlessly on A&E trolleys and waiting for life-changing operations. Where is it all going to end?”
But regulators have set up what is described as a ‘failure regime’, with the most incompetent trusts in the country entered into this programme.
The government will place senior managers in hospitals struggling to deliver adequate service, in order to help produce plans to improve the situation.
Five trusts – Barts Health in London, Croydon Health Services, Maidstone and Tunbridge Wells, Norfolk and Norwich Hospitals and North Bristol – have already been informed that they will be parachuted into this system.
And another 13 trusts across the country are threatened with the same prospect if they fail to demonstrate significant and rapid improvement.
Commenting on the issue, NHS England chief executive Simon Stevens indicated his belief that the current period is a critical one for the future of the NHS, and one at that will effectively make or break the health service.
“Precisely because the pressures across the NHS are real and growing, we need to use this year both to stabilise finances and kickstart the wider changes everyone can see are needed.”
But Nigel Edwards, of the Nuffield Trust think tank, believes that the measures taken will be rather trivial in and of themselves, and that more must be done in order to ensure that the health service is placed back on the appropriate footing.
“My big worry is what happens next. I fear that in order for hospitals to virtually eradicate their deficits the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.”
Many trusts and hospitals have been struggling to meet targets related to some of the most critical aspects of the healthcare process, and will welcome this decision.
Although it will inevitably draw some criticism, equally many healthcare experts have suggested that government targets have been too stringent.
Two studies presented at the UK Breast Cancer Research Symposium suggest that research into oestrogen receptors may be critical in treating breast cancer.
It is believed that understanding this may be key to explaining why some forms of breast cancer do not respond adequately to treatment.
The research has already been praised by healthcare experts as groundbreaking, and it is hoped that it will significantly inform the scientific response to the disease going forward.
In the first study, scientists at the University of Pittsburgh analysed non-inherited mutations in the ESRI gene across 122 samples of breast cancer tumours.
Researchers discovered that there are significantly more mutations in secondary samples when this process is conducted.
While it is early to draw firm conclusions on the subject, this nonetheless suggests that primary breast cancers containing ESRI mutations could be an early indication that tumours are resistant to common cancer treatments.
Although scientists are still working to understand the issue, it is hoped eventually that this breakthrough could help doctors understand whether patients will be resistant to certain treatments before cancers become unresponsive to medication.
Further trials are planned to develop this technique still further.
Dr Steffi Oesterreich, who led the research, was enthusiastic about the potential of the study, and explained the results and their significance.
“The ESR1 gene has a very important role in the process by which cancers spread from the breast to elsewhere in the body. Research on the way this gene mutates will help us to identify the cancers which will relapse, and also those which will not respond to our current treatment. It shows how, in the future, new extremely sensitive technologies could give us an ever more detailed picture of what is going on inside a patient’s breast cancer and how the cancer is responding to treatment.”
A second study analysed genetic changes in more than 120,000 women.
Researchers were able to identify five distinctive genetic alterations which could influence the risk of women developing particular forms of breast cancer.
Commenting on the research, Dr Alison Dunning, who led the study, was positive about the potential for treatment that the results indicated.
“All five of the genetic variants we have found near the ESR1 gene affect the levels of oestrogen receptors in breast cells. This seems to indicate that if there are too few or too many oestrogen receptors then the breast cells are more likely to become cancerous.”
The University of Cambridge study discovered that genetic changes in oestrogen receptors can help inform clinicians of the risk of developing breast cancer, and even potentially aid prevention and treatment.
The charity Breast Cancer Now was effusive in its praise for the research, considering the results to be groundbreaking in the understanding and treatment of the debilitating condition.
“Both discoveries relating to the ESR1 gene show great potential to tailor treatment for patients and reveal more about the genetics of breast cancer risk. It is work such as this that will lead to steady improvement in the prevention, diagnosis and treatment of breast cancer in coming years,” chief executive of Breast Cancer Now, Delyth Morgan, commented.
London’s Great Ormond Street Hospital has suggested that the exit of Britain from the European Union could reduce medical research funding and ultimately cost lives of vulnerable children.
The infamous organisation claims that leaving the European Union permanently will pose a serious risk to research funding going forward.
Great Ormond Street also believes that it will lose staff from the Eurozone and that established partnerships with healthcare institutions in Europe will be diluted.
But not all experts agree with the verdict of great Ormond Street, with one leading cancer specialist describing the claims of the hospital as hysterical.
Angus Dalgleish, professor of oncology at St George’s, University of London, who also represents Brexit movement Scientists for Britain, asserted that the claims made by great Ormond Street were a “gross overreaction and rather hysterical”.
Dalgleish went on to discuss what he deems to be a climate of fear.
“There are a lot of scare stories about people not wanting to come because we’re leaving the EU. I don’t think that will happen. There are a lot of us trying to make sure that when Brexit comes, that all the good bits will be left in place. It’s not going to be a break.”
Supporting the statements of Dalgleish, the universities and science minister, Jo Johnson, indicated the commitment of the government to scientific pursuits, stating that the Conservative party wants the UK to remain “a science powerhouse”.
Johnson stated that the government is fully committed to maintaining that position and “limiting some of the risks which the sector has identified.”
“We are more open and outward looking than ever before. We want to forge international collaborations with European partners and countries beyond the EU,” Johnson added.
The Department for Business Innovation and Skills has also indicated that there will be no immediate change to the funding of the Department of Science in the UK, and that this eventuality is not likely to materialise in the remainder of the decade.
Nonetheless, there will be a discussion about the access of Britain to European research and innovation funding.
In what could be described as an uncertain climate, Great Ormond Street Hospital has urged the government to secure a deal with Europe which protects research as soon as possible.
The hospital is also concerned about a potential brain drain as an ultimate result of Brexit.
Great Ormond Street has received £25 million in research funding from European Union sources since 2010, which the hospital divulges is equal to approximately 10% of its overall research budgets.
The chief executive of Great Ormond Street Hospital, Dr Peter Steet, suggested that the current situation with funding is critical, commenting that “for the vulnerable, very ill children we care for, every day counts.”
The hierarchy of the NHS in England has been accused by MPs of failing to be strict enough on an important area affecting mental health.
NHS bosses have been slack in tackling delays regarding medically fit patients being discharged from hospital, according to the Public Accounts Committee.
Commenting on the subject, the committee indicated that NHS England must make more effort to support hospitals in this critical area of patient well-being.
MPs suggested that officials are too ready to rely on excuses regarding care services run by councils, and indicated that there is considerable room for improvement in the way that this system operates.
And the politicians overseeing the issue also promised extra funding in order to address the issue.
Reporting from the committee comes hot on the heels of delays in discharges reaching record levels according to official figures.
It is often the case that community support services such as district nursing, carers or care home places, cannot be found for vulnerable patients.
The elderly have been particularly badly affected by this issue.
A recent report released by the National Audit Office estimated that delays are costing the NHS over £800 million annually, following a rise in the number of delays by over one-third in the past two years.
To put the figure into perspective, it is estimated that care in the community for such patients would cost under £200 million.
This is particularly detrimental for patients, the risk of infection escalates in older people affected by such delays during extended stays.
And the National Audit Office has even suggested that the worrying figures should be considered an underestimate, owing to the fact that the NHS measures delays only from the point patients are deemed ready for discharge.
The report instead indicates that delays waiting for this figure to be recorded, or in other procedures during stays in hospital, could extend delays further still.
This cross-party report urges NHS England is to do more to address the situation, suggesting that the organisation has shown what the MPs described as a “striking poverty of ambition”.
Meg Hillier, who chairs the committee, asserted that “blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out.”
In response to the report, a spokesman for the Department of Health outlined some of the investments in these services which have already been agreed and set aside.
“Local authorities will have more money – up to £3.5bn extra – for adult social care by 2019-20 and by 2020 we will be investing an extra £10bn a year so the NHS can introduce its own plan for the future and help fewer people go to hospital in the first place.”