BMJ - British Medical Journal

National PPE approach was focused on hospitalsDanny Mortimer, chief executive of NHS Employers and deputy chief executive of the NHS Confederation, told the inquiry that there was a lack of availability of personal protective equipment (PPE) in every part of the health service, but that it was particularly severe in general practices, community settings, and mental health services.1 He said members of the confederation believed that the national approach to PPE was focused on the acute sector. He cited a confederation survey of GPs in early 2020 in which 83% of respondents reported that they didn’t have proper access to masks with filters and 73% reported a lack of access to goggles and visors.Giving evidence on 18 March, Mortimer highlighted problems with the availability of specific equipment such as masks fitted with respirators. “There was particular concern about the availability of equipment that could fit different types of faces, whether...

In healthcare, prediction models or algorithms (hereafter referred to as prediction models) estimate the probability of a health outcome for individuals. In the diagnostic setting—including screening and monitoring—the model typically aims to predict or classify the presence of a particular outcome, such as a disease or disorder. In the prognostic setting the model aims to predict a future outcome—typically health related—in patients with a diagnosis of a particular disease or disorder, or in the general population. The primary use of a prediction model in healthcare is to support individual healthcare counselling and shared decision making on, for example, subsequent medical testing, referral to another healthcare professional or facility, treatment, discharge from hospital, or lifestyle changes. For example, the tool QR4 predicts the probability of developing a cardiovascular event within the next 10 years and informs whether individuals should undergo changes to their lifestyle or be prescribed drugs.1 Prediction models are...

bmj;388/mar21_10/r565/FAF1faAt the height of the Troubles in the early 1980s Ian Bownes, a young trainee psychiatrist in Northern Ireland, was sent into the notorious H blocks in Belfast’s Maze prison to assess if its paramilitary inmates were mentally fit to go on hunger strikes.It would have been an unsettling experience for anyone to go inside the Maze, which mainly housed republican prisoners. For a young Protestant like Bownes, however, it must have been even tougher. That Bownes did so for many years spoke to his “quiet heroism,” how much his professional opinion was valued, and how fully he was trusted to uphold the confidentiality on which his access depended, says friend and former colleague Harry Kennedy, a professor of forensic psychiatry at the University of Dublin.When Bownes first went into the Maze, republican prisoners were escalating a campaign of protest against the British government. This included demands to reinstate special...

Great British Energy, a new, publicly owned company created by the government, is to invest £200m to fit solar panels to the roofs of 200 NHS hospitals and 200 schools in England. The aim is to cut costs and carbon and make key areas of the public sector less dependent on the uncertain energy market. The programme is expected to save £400m over the lifetime of the panels (30 years), with savings reinvested in the NHS and education. The NHS spends an estimated £1.4bn a year on energy, a figure that has more than doubled since 2019.The programme is expected to last two years, and the first panels should be on NHS sites and schools by the end of summer 2025. The educational component of the programme will focus on schools in deprived areas, particularly in the north east, north west, and west Midlands.Mark Harber, special adviser on healthcare sustainability...

Weight management programmes for obese or overweight children may be effective, but their impact has been hampered by low uptake and completion rates, an evaluation of eight pilot projects across England has suggested.1A report from the Office for Health Improvement and Disparities evaluated eight projects funded through a £4.2m government grant in July 2021, which piloted extended brief interventions (EBIs) and expansion of behavioural weight management services for children aged 2 to 19 and their families.EBIs involve a practitioner discussing a child’s weight and growth with their parent or carer, and can include the use of behaviour change techniques, tailored support, and onward referral to services. Weight management services usually involve 12 week programmes and include diet and physical activity guidance. Their primary aim is weight maintenance and growing into a healthier weight, rather than weight loss.The pilots were funded for a year and took place across several areas in...

The World Health Organization (WHO) has called for an urgent international public health response as tuberculosis (TB) funding cuts threaten to reverse two decades of progress in containing the world’s deadliest infectious disease.The UN health agency said that it was particularly concerned about services in the world’s worst affected nations collapsing, allowing the respiratory disease to spread almost unabated.More than a million people died from TB last year, but that number is expected to rise sharply as public health systems, particularly in Africa, are no longer able to diagnose, treat, and monitor the disease. WHO warned that the situation could quickly deteriorate, as 27 countries faced “crippling breakdowns” in their TB response as funding cuts hit every stage of detection, treatment, and prevention.“The huge gains the world has made against TB over the past 20 years are now at risk as cuts to funding start to disrupt access to services...

A US judge has blocked drastic job cuts to the US Agency for International Development (USAID).On 18 March Judge Theodore Chuang of the US District Court for Maryland ruled that the moves—which effectively shut the agency—had probably violated the US constitution. The case was brought by more than 20 current and former USAID employees and contractors.The fired employees are not back at work but have been placed on paid administrative leave. The judge said the fast shutdown of the agency “deprived the public’s elected representatives in Congress of their constitutional authority to decide whether, when, and how to close down an agency” authorised by Congress.1The cuts were initiated by the Department of Government Efficiency (DOGE) which is headed by billionaire Elon Musk, adviser to President Donald Trump. Around 1600 of USAID’s US employees were fired and most of the rest were placed on administrative leave. USAID had about 13 000...

Liz Calhoun was halfway through her three year emergency physician training when she learnt from a text message that her hospital was closing in three months. She and the other 571 resident physicians at Hahnemann University Hospital in Philadelphia did not know how or where they would finish their training. In the end they didn’t have three months to figure it out: the training programme closed 30 days later.Hahnemann, located in the heart of the city, was a “safety net” hospital, meaning that its staff provided care to patients regardless of their insurance status or ability to pay. At the time of its closure in 2019, Hahnemann made headlines as the model for what can go wrong when a profit driven private equity firm takes over a hospital. In the years since, several other hospitals bought by private equity firms have abruptly closed, leaving their communities’ health, economies, and resident...

Over the past year, a firestorm of debate has been swirling around the role of physician associates (PAs) in the NHS. Many commentators have used the lack of regulation of PAs and oversight of their education as evidence that PAs are trying to hide their practice or escape the consequences of their actions. Nothing could be further from the truth.PAs, like doctors, nurses, physiotherapists, pharmacists, and all NHS professionals, want to ensure that only highly qualified people are admitted to their profession and that there is a mechanism to manage those who are not performing to standard. Just as all doctors do not bear responsibility for the mistakes of other doctors, nor do all PAs bear responsibility for every mistake made by another PA. Yet the government has been slow to respond to the need for regulation.The lack of statutory regulation has meant that the PA profession took the initiative...

The BMA has announced plans to take legal action over an exam error that left some doctors facing the risk of unemployment.The error affected nearly 300 candidates who sat part 2 of the membership of the Royal College of Physicians (MRCP) exam in September 2023.1 A total of 61 doctors who were originally told they failed were informed 18 months later that they had passed, while 222 doctors who had been told they passed were belatedly informed that they had failed.Some doctors who thought they had passed were in the process of applying for higher specialty training when the error was announced in February. They have now had their applications withdrawn from the process, as they no longer meet the eligibility criteria for the roles.2 Doctors who have been affected told The BMJ they were concerned about becoming unemployed when their current training programmes end in August.The decision to withdraw...

Nottingham University Hospitals NHS trust is investigating allegations that healthcare staff illegally accessed medical records of the victims of a stabbing attack that left three people dead.Barnaby Webber and Grace O’Malley-Kumar, both 19 year old university students, and Ian Coates, a 65 year old school caretaker, were stabbed to death by Valdo Calocane in June 2023.The claims that their medical records had been accessed illegally were first reported by the Daily Mirror.1 In a joint statement the families of the three victims described the news as “distressing and traumatic.”The statement said, “These are not just alleged data breaches but gross invasions of privacy and civil liberty. For individuals to choose to access information regarding the vicious attack and murder of Barney, Grace, and Ian with no reason to do so is sickening. It’s gross and inexcusable voyeurism at the most repugnant level.”The families found out about the potential breach in...