Waiting for NHS hospital care: the role of the independent sector

Waiting for NHS hospital care: the role of the independent sector Waiting times for planned hospital care in England were worsening before the start of the pandemic, and things have now got considerably worse. The waiting list grew by almost 50% to 6.4 million by March 2022 and for the people waiting, the median wait had increased from 7.5 weeks to 12.0 weeks. The Health Foundation

Saving brains: save brains, save money, change lives

Saving brains: save brains, save money, change lives This report warns that, if the thrombectomy rate stays at 2020/21 levels, 47,112 stroke patients in England would miss out on the acute stroke treatment, mechanical thrombectomy, over the length of the newly revised NHS Long Term Plan. It finds that this year, NHS England missed its original target to make mechanical thrombectomy available to all patients for whom it would benefit – only delivering to 28 per cent of all suitable patients by December 2021. It calls for a 24/7 thrombectomy service, which could cost up to £400 million. However the report calculates that treating all suitable strokes with thrombectomy would save the NHS £73 million per year. Stroke Association

The impact of the pandemic on population health and health inequalities

The impact of the pandemic on population health and health inequalities This report looks at the impact of the pandemic on population health and health inequalities in the UK. It discusses how the pandemic has affected the nation’s physical and mental health, as well as social determinants of health such as education and employment. The report aims to pay particular attention to inequalities and how these pandemic effects were distributed. It also looks at the positive lessons that can be learned from the vaccine rollout and efforts to tackle homelessness. British Medical Association

See also:

• Obesity, deprivation and Covid-19 The King's Fund
• Government's slow COVID-19 response worsened health inequalities, warns BMA GPonline

The public health response by UK governments to Covid-19

The public health response by UK governments to Covid-19 This report examines the approaches and key decisions taken by UK governments during the pandemic and the public health measures they introduced. It assesses whether these choices were timely, appropriate, and proportionate to deal with the threat and impact of Covid-19. British Medical Association

NHS sets out long COVID action plan for thousands of people with persistent symptom

NHS sets out long COVID action plan for thousands of people with persistent symptom Patients with long-lasting symptoms from COVID will have access to more convenient tests and checks closer to home, under new NHS measures announced today.

Specialist clinics, dedicated to long COVID, will now be able to send people for tests at local one stop shops and mobile clinics, rather than people going back to their GP practice for multiple different tests.

Backed by an additional £90 million investment, the updated long COVID plan includes ambitions for all patients to have an initial assessment within six weeks to ensure they are diagnosed and treated quickly. NHS England

See also:

• Health leaders welcome Long Covid Action Plan but further detail needed NHS Confederation
• National flu and COVID-19 surveillance reports published UK Health Security Agency

Heart gene therapy to remove young sudden death risk

Heart gene therapy to remove young sudden death risk Scientists say they should soon be able to effectively cure inherited, life-threatening heart muscle conditions to save more young people from sudden cardiac death.

The British Heart Foundation has pledged £30m to the gene researchers who believe they can correct faulty DNA responsible for the damage.

Cardiomyopathies can kill without warning. BBC News

NHS to close Tavistock gender identity clinic for children

NHS to close Tavistock gender identity clinic for children The NHS is shutting down its gender identity clinic for children at the Tavistock and Portman NHS foundation trust after it was criticised in an independent review.

Regional centres would be set up to replace the service and “ensure the holistic needs” of patients are fully met, NHS England said, after being warned that only having one provider was “not a safe or viable long-term option”. The Guardian

See also:

• Regional model for gender care announced for children and young people The Tavistock and Portman NHS Foundation Trust
• NHS to close Tavistock child gender identity clinic BBC News
• NHS faces crackdown on giving puberty blockers to children as Tavistock clinic is shut down The Daily Telegraph
• Tavistock gender identity clinic is closing: what happens next? The Guardian
• Tavistock clinic: Failing gender service for children to be replaced by local hubs The Independent

Mystery over spike in Covid deaths on hottest day of the year: Virus fatalities doubled in 40C heat

Mystery over spike in Covid deaths on hottest day of the year: Virus fatalities doubled in 40C heat Covid deaths spiked on the hottest day ever in what experts say could be the first sign of a surge in heatwave fatalities.

Official figures show 258 people with the virus died on July 19 in England — the same day the mercury hit 40.2C (104.4F). The Daily Mail

See also:

• Covid in China: Million in lockdown in Wuhan after four cases BBC News
• Rise of Omicron subvariants sends UK staff absence soaring The Guardian
• When will Covid really be over? Three things that will mark the end of the pandemic The Guardian
• What is ‘Centaurus’? Fast-spreading Covid variant that has arrived in UK as cases soar The Independent
• NHS staff with 'disabling conditions' after COVID-19 should be able to claim benefits, say government advisers The Pharmaceutical Journal
• Serious self-harm in young people jumped during strict COVID-19 lockdowns - study Sky News

England's 'deadly' GP crisis deepens: Staff numbers fall to lowest level on record

England's 'deadly' GP crisis deepens: Staff numbers fall to lowest level on record The number of qualified GPs has dropped to its lowest level on record and just one in four family doctors work full time, according to official data that highlights the 'catastrophic' crisis in general practice.

There were around 27,500 fully-qualified, permanent family doctors working for NHS England last month, down from about 28,000 in June 2021 and 1,500 fewer than five years ago. The Daily Mail

See also:

• Patients per GP up 3% in a year as workforce slumps by over 440 GPonline
• General practice is 'chronically overstretched and haemorrhaging doctors' GPonline

Vitamin D supplements do NOT help elderly people avoid bone fractures

Vitamin D supplements do NOT help elderly people avoid bone fractures Taking vitamin D supplements every day does not help a person avoid bone fractures, a major study suggests — contradicting years of medical advice that said otherwise.

Researchers led by Harvard Medical School in Boston, Massachusetts, found that people who used the supplements were no less likely to suffer bone fractures than those who did not. The Daily Mail

See also: 

• Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults (abstract) New England Journal of Medicine

Northamptonshire health officials urge a return to mask wearing

Northamptonshire health officials urge a return to mask wearing Public health officials in an area with rising rates of Covid-19 have urged residents to "return to mask wearing" in public indoor spaces.

Councils in Northamptonshire warned increased mixing during the summer holidays could increase case numbers.

The directors of public health in the county said they were concerned about rates in over-60s and pressure on health services. BBC Northampton

See also:

• Northamptonshire's health chiefs 'strongly recommend' return of face masks in shops, public transport and entertainment venues Northamptonshire Telegraph

A tale of two hospitals: the pandemic and its aftermath in Berlin and London

A tale of two hospitals: the pandemic and its aftermath in Berlin and London The pandemic challenged every health care system in the world. But what can we learn from one another in the way we responded, and how we might improve for future threats? 

In this episode we look up close at the experience of two large academic teaching hospitals embedded in two different health care systems – the Charité in Berlin, Germany’s largest teaching hospital, and Imperial College Healthcare NHS Trust in London, one of the UK’s largest. 

How do these two health care systems compare when dealing with the pandemic and its aftermath? And what can we learn? (podcast) The Health Foundation

Menopause and the workplace

Menopause and the workplace Employers' lack of support for menopausal symptoms is pushing 'highly skilled and experienced' women out of work, with knock-on effects on the gender pay gap, pension gap and the number of women in senior leadership positions. In a new report published today, the cross-party House of Commons Women and Equalities Committee calls on the Government to act, amending the Equality Act to introduce menopause as a protected characteristic, and to include a duty for employers to provide reasonable adjustments for menopausal employees.

See also:

• Working women need greater menopause rights - MPs BBC News
• 'Menopause leave' for women at work? Ministers told to step in as many receive 'little support' The Daily Mail
• Menopause should be ‘protected by law just like race and religion’ The Daily Telegraph
• MPs call for menopause to be protected characteristic in UK Equality Act The Guardian
• Lack of support for menopausal women driving them out of jobs, warn MPs The Independent

NHS leaders warn that social care workforce crisis risks patient safety

NHS leaders warn that social care workforce crisis risks patient safety NHS leaders across England say staffing gaps and a lack of capacity in social care are putting the care and safety of patients in the NHS at risk.

Almost 250 NHS leaders responding to an NHS Confederation survey say that patients are being delayed in hospital much longer than they should, with the knock-on impact resulting in higher demand on A&E departments and longer ambulance response times.

See also:

• System on a cliff edge: addressing challenges in social care capacity (report) NHS Confederation

Accelerating the pace and scale of action on health inequalities and population health

Accelerating the pace and scale of action on health inequalities and population health The NHS Confederation and Novartis UK have engaged a range of leaders from across integrated care systems (ICSs) in England, with a focus on accelerating the pace and scale of action on health inequalities and population health.

Guidance: Public health impact of drought: advice for the public

Guidance: Public health impact of drought: advice for the public Information on the potential health impacts of drought in England and the measures that people can take to stay healthy during these events. UK Health Security Agency

Fourth patient seemingly cured of HIV

Fourth patient seemingly cured of HIV A man who has lived with HIV since the 1980s seems to have been cured in only the fourth such case, say doctors.

He was given a bone marrow transplant to treat blood cancer leukaemia from a donor who was naturally resistant to the virus.

The 66-year-old, who does not want to be identified, has stopped taking HIV medication. BBC News

See also:

• 'City of Hope' patient, 66, is cured of HIV after receiving dangerous stem cell treatment The Daily Mail
• Oldest patient yet cured of HIV after stem cell transplant – researchers Reuters
• Fourth patient in history seemingly cured of HIV after stem cell transplant Sky News

Guy's and St Thomas': Hospital in meltdown over IT issues - whistleblower

Guy's and St Thomas': Hospital in meltdown over IT issues - whistleblower A whistleblower has warned a London hospital is "literally in meltdown" after its IT system was knocked out during last week's heatwave.

Operations at Guy's and St Thomas' Hospital in Lambeth were cancelled after its IT servers broke down in 40C (104F) temperatures on 19 July.

A doctor told the BBC "poor planning" and "chronic underfunding" meant issues remained a week later. BBC News

See also:

• Some systems back online but Guy’s and St Thomas’ IT issues continue Digital Health

Health Secretary Stephen Barclay issues plea for blood donors as supplies run low

Health Secretary Stephen Barclay issues plea for blood donors as supplies run low An urgent plea for blood donors to come forward has been issued by the health secretary as stocks required to carry out critical operations run low.

Steve Barclay said the NHS is running on three-and-half days' worth of blood reserves - whereas it normally aims to hold six days. Sky News

GPs to refer long Covid patients to 'one-stop-shops' under NHS England plan

GPs to refer long Covid patients to 'one-stop-shops' under NHS England plan An action plan to support patients with long Covid symptoms within six weeks – while reducing related GP workload – has been announced today by NHS England.

The plan, promised by a health minister for spring, will allow GPs as well as specialist long Covid clinics to refer patients for tests and checks at local one-stop-shops and mobile clinics, and is intended to prevent people having to go back to their GP practice for multiple different tests. Pulse

See also:

• UK scientists take ‘promising’ step towards single Covid and cold vaccine The Guardian
• Covid study finds millions have long-term smell or taste problems The Guardian
• Number of Covid-19 hospital patients in England shows signs of falling The Independent

Dental checkups to become less frequent in England and Wales

Dental checkups to become less frequent in England and Wales The decades-old routine of visiting an NHS dentist for a six-month checkup is being scrapped across England and Wales for most adults as part of changes designed to address the dire lack of access to dental care for many people.

Wales has announced that most adults now only need to see their dentist once a year, which the government in Cardiff says will free up NHS dentists’ time and allow them to take on more than 100,000 extra patients annually. The Guardian

How is YOUR hospital faring in NHS's busiest ever summer?

How is YOUR hospital faring in NHS's busiest ever summer? The ailing National Health Service's worst ever summer crisis was today laid bare by a forensic trust-by-trust breakdown of waiting lists, A&E pressure and bed occupancy by MailOnline.

It reveals that up to six in 10 patients in the queue for routine surgery at England's busiest trust have been waiting a shocking 18 weeks — and a fifth have been waiting over a year. The Daily Mail

Eating too much junk can give you dementia! Another study says ultra-processed foods harm the brain

Eating too much junk can give you dementia! Another study says ultra-processed foods harm the brain Gorging on too much junk food can also increase your risk of developing dementia, scientists say.

The study tracked more than 70,000 middle-aged for a decade to try and tease out the effects of a diet heavy in ultraprocessed snacks.

Although the study doesn't prove a bad diet causes dementia, it adds to the ever-growing pile of evidence linking the two together. The Daily Mail

See also:

• Association of Ultraprocessed Food Consumption With Risk of Dementia: A Prospective Cohort (abstract but available through OpenAthens to trust staff) Neurology
• Ultra-processed food ‘increases risk of developing dementia’ The Daily Telegraph

Appeal to find new governors for Kettering General Hospital NHS Foundation Trust

Appeal to find new governors for Kettering General Hospital NHS Foundation Trust Kettering General Hospital is calling for people to have their say in the future of the hospital by standing for election as a public governor.

Anyone from the Kettering, Corby, Wellingborough or Rushden areas can stand for election to become a public governor in their local area if they are over 16. Northamptonshire Telegraph

Man jailed after shocking attack on KGH security guards

Man jailed after shocking attack on KGH security guards An abusive patient who bit a Kettering General Hospital security guard before kicking another in the head has been locked up. Northamptonshire Telegraph

Air pollution: cognitive decline and dementia

Air pollution: cognitive decline and dementia The Committee on the Medical Effects of Air Pollutants reviewed nearly 70 studies in human populations (epidemiological studies) which looked at possible links between air pollution and a decline in mental ability and dementia in older people. They also considered studies which investigated how air pollution might affect the brain.

From this review, it can be concluded that it is likely that air pollution does contribute to these effects. The most likely way this occurs is through effects on the circulation. It is known that air pollutants, particularly small particles, can affect the heart and blood vessels, including to the brain. UK Health Security Agency

See also:

• Air pollution IS causing dementia: UK Government advisers acknowledge link for first time The Daily Mail
• Air pollution linked to rise in dementia in major Government study The Daily Telegraph
• Air pollution is ‘likely’ to raise dementia risk, find UK government experts The Guardian
• Air pollution likely to be causing dementia, say UK science advisers New Scientist

Poverty, economic inequality and mental health

Poverty, economic inequality and mental health This briefing explores evidence about the links between poverty, economic inequality and mental health, showing that living in poverty increases people’s risk of mental health difficulties, and that more unequal societies have higher overall levels of mental ill health. The briefing also demonstrates that poverty and economic inequality intersect with structural racism to undermine the mental health of racialised and marginalised groups in society. The briefing calls for concerted and concrete actions to improve mental health by increasing the incomes and reducing the costs of the poorest people in society. These include increasing benefits and paying the Living Wage, help with housing and childcare costs for the least well-off, and improving access to vital services in the most deprived areas. Centre for Mental Health

Enhancing Junior Doctors’ Working Lives: annual progress report 2022

Enhancing Junior Doctors’ Working Lives: annual progress report 2022 This is the sixth report that looks at the achievements over the past year of the Enhancing Junior Doctors’ Working Lives programme in providing improved support for doctors in training. The programme was established in March 2016, to address a range of issues that were having a significant negative impact on the quality of life of doctors in postgraduate training. Led by Health Education England (HEE), it is a cross-system collaboration to drive and deliver system improvements and meaningful change to postgraduate medical training. HEE worked collaboratively with system partners in the Academy of Medical Royal Colleges, the GMC, NHS Employers and the BMA as well as individual Medical Royal Colleges and the devolved nations to address those issues and provide trainees and stakeholders with yearly updates on progress. Health Education England

Managing cross-border travel during the COVID-19 pandemic

Managing cross-border travel during the COVID-19 pandemic In a report today the Public Accounts Committee says despite spending at least £486 million on implementing the international travel “traffic light system” during the pandemic, Government “does not know whether the system worked or whether the cost was worth the disruption caused”.

See also:

• Government’s contracts with Randox Laboratories Ltd Public Accounts Committee
• UK health department played ‘fast and loose’ when awarding Covid contracts to Randox The Guardian

Covid origin studies say evidence points to Wuhan market

Covid origin studies say evidence points to Wuhan market Scientists say there is "compelling evidence" that Wuhan's Huanan seafood and wildlife market was at the centre of the Covid-19 outbreak. 

Two peer-reviewed studies published on Tuesday re-examine information from the initial outbreak in the Chinese city. BBC News

See also:

• The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic (open access) Science
• The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2 (open access) Science
• Expert warns that Covid-caused smell-loss is returning with BA.5 variant The Daily Mail
• The most crushing thing about getting Covid so late? Knowing I’m not a medical marvel | Andy Welch The Guardian
• New studies find more evidence of Covid’s origin from Wuhan’s ‘wet market’ The Independent
• Two new Covid sub-variants are sparking global concern - what you need to know The Independent

Monkeypox: UK health officials identify new symptoms

Monkeypox: UK health officials identify new symptoms Health officials in the UK have updated the case definition of monkeypox to include new symptoms associated with the disease. The Independent

See also:

• Monkeypox case definition updated to include new symptoms UK Health Security Agency
• Statement: Vaccines alone won’t end the monkeypox outbreak – at-risk individuals will have to take action too World Health Organization
• The mystery virus that protects against monkeypox BBC Future
• Monkeypox: CDC says US leads globally in most known cases BBC News
• How worried should you be about monkeypox? The Independent
• Monkeypox emergency could last months, with window closing to stop spread, experts say Reuters

‘Without Find and Treat I wouldn’t be here’: the NHS service caring for London’s vulnerable

‘Without Find and Treat I wouldn’t be here’: the NHS service caring for London’s vulnerable On the streets of the capital with the doctors, nurses and outreach workers administering care to at-risk populations. 

“We take healthcare to people who need it most,” says Sive O’Regan, a health inclusion nurse with the NHS service Find and Treat, whose team in London cares for the city’s homeless, sex workers, drug addicts and asylum seekers. “We work with disadvantaged and marginalised groups who don’t get much healthcare normally.” The Guardian

Up to 300,000 people in Britain are unaware they may have potentially deadly heart condition

Up to 300,000 people in Britain are unaware they may have potentially deadly heart condition Now research suggests up to 300,000 people in Britain may have the potentially deadly condition without even knowing it.

Many will have no symptoms and will be diagnosed only when the condition is advanced — when half could die within five years without prompt treatment, according to the research by NHS England, UK universities and the University of Notre Dame in Fremantle, Australia. The Daily Mail

See also:

• Uncovering the treatable burden of severe aortic stenosis in the UK (open access) BMJ Open Heart
• 300,000 people suffering from potentially fatal heart disease ‘with third unaware of it’ The Independent

Tens of thousands of people in Northamptonshire estimated to have long Covid, according to NHS England figures

Tens of thousands of people in Northamptonshire estimated to have long Covid, according to NHS England figures NHS England estimates show tens of thousands of people in Northamptonshire are likely to be suffering with long Covid — and many won’t even know it. Northampton Chronicle and Echo

The parallel pandemic Covid-19 and mental health

The parallel pandemic Covid-19 and mental health This report, produced together with the northern National Institute for Health and Care Research Applied Research Collaborations (NIHR ARCs), shows that a parallel pandemic of mental ill health has hit the North of England with a £2bn cost to the country at the same time as the Covid-19 pandemic. Mental health in England was hit badly over the course of the Covid-19 pandemic. But people in the North performed significantly worse in their mental health outcomes compared to those in the rest of the country. Northern Health Science Alliance

How can NHS anchors support communities to create health: learning from the community response to Covid-19

How can NHS anchors support communities to create health: learning from the community response to Covid-19 This report provides real-world insight into how NHS anchor institutions are working in partnership communities, capitalising on both their strengths to address health inequalities. Health Creation Alliance

Likely cause of mystery child hepatitis outbreak found

Likely cause of mystery child hepatitis outbreak found UK experts believe they have identified the cause of the recent spate of mysterious liver problems affecting young children around the world.

Investigations suggest two common viruses made a comeback after pandemic lockdowns ended - and triggered the rare but very serious hepatitis cases.

More than 1,000 children - many under the age of five - in 35 countries are thought to have been affected. BBC News

See also:

• Adeno-associated virus 2 infection in children with non-A-E hepatitis (open access preprint) medRxiv
• Genomic investigations of acute hepatitis of unknown aetiology in children (open access preprint) UK Research and Innovation
• Scientists find culprit behind child hepatitis outbreak: Combination of two usually-harmless viruses The Daily Mail
• Hepatitis outbreak in children linked to surge in common cold cases after lockdowns The Daily Telegraph
• Childhood hepatitis surge ‘probably linked to two common viruses’ The Guardian
• Likely cause of hepatitis outbreak in children revealed by doctors The Independent
• Mystery child hepatitis cases linked to previously 'harmless' virus New Scientist 

Covid pandemic births: Mothers 'pitted against midwives'

Covid pandemic births: Mothers 'pitted against midwives' Women have spoken to the BBC about the "nightmare" of giving birth during the restrictions imposed because of Covid.

The London Assembly was told a de facto maternity ward ban on partners meant new mums often got very little support.

Campaign group Pregnant Then Screwed said elective Caesareans spiked, as women tried to find a way to have their partner by their side. BBC News

See also:

• Covid 19: 'Giving birth in 2020 was isolating and lonely' BBC News

Pandemic drinking could cause thousands of extra deaths and hospital admissions over next 20 years, NHS says

Pandemic drinking could cause thousands of extra deaths and hospital admissions over next 20 years, NHS says Excess drinking during the COVID-19 pandemic could end up leading to thousands of extra deaths and hospital admissions over the next 20 years, health experts have warned.

Research from NHS England and the University of Sheffield shows that while lighter drinkers reduced their intake during the pandemic, heavier drinkers ended up consuming more and may never return to the level they were at. Sky News

See also:

• The COVID Hangover: addressing long-term health impacts of changes in alcohol consumption during the pandemic (report) Institute of Alcohol Studies
• Modelling the impact of changes in alcohol consumption during the COVID-19 pandemic on future alcohol-related harm in England (report) University of Sheffield 
• Shifts in alcohol consumption during the pandemic could lead to thousands of extra deaths in England University of Sheffield 
• Alcohol deaths from pandemic drinking are predicted to rise BBC News
• Heavy drinking during the pandemic may add £5.2billion to our NHS tab and lead to 25,000 deaths The Daily Mail
• Lockdown drinking increase could cause 25,000 excess deaths in England The Guardian
• Increased pandemic drinking ‘will lead to 1000s of extra deaths’ The Independent

UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid

UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid Doctors are less likely to resuscitate the most seriously ill patients in the wake of the pandemic, a survey suggests.

Covid-19 may have changed doctors’ decision-making regarding end of life, making them more willing not to resuscitate very sick or frail patients and raising the threshold for referral to intensive care, according to the results of the research. The Guardian

See also:

• How is COVID-19 changing the ways doctors make end-of-life decisions? (open access) Journal of Medical Ethics

Time-lapse maps show how 'most contagious Covid variant yet' has taken off in the UK

Time-lapse maps show how 'most contagious Covid variant yet' has taken off in the UK Covid's most contagious variant yet now accounts for more than eight out of 10 cases in England, official figures suggest amid growing calls for the return of mask mandates and free tests. 

A total of 82.2 per cent of virus positive swabs examined in the week to July 16 were the BA.5 version of Omicron, according to figures from the Sanger Institute, one of the UK's largest surveillance sites. That figure is expected to have risen since. The Daily Mail

See also:

• Covid hospital admissions reach record high in Australia as country battles 'twindemic' with flu The Daily Mail
• Covid: Professor warns of two new ‘telltale’ symptoms as cases rise The Independent
• Long Covid causes erectile dysfunction and hair loss as symptoms list widens The Independent
• Hair loss and sexual dysfunction join list of long COVID symptoms Sky News

'Game-changer' blood test is even better at finding early breast cancers than a mammogram

'Game-changer' blood test is even better at finding early breast cancers than a mammogram A simple blood test that promises to be better at spotting early-stage breast cancer than a mammogram has been hailed as a ‘game-changer’ for women’s health.

The Trucheck test, which highlights cancer cells circulating in the blood, correctly identifies 92 per cent of breast cancers – around five percentage points higher than mammography. The Daily Mail

Patients to automatically access GP record in NHS app from November

Patients to automatically access GP record in NHS app from November 

NHS England will switch on automatic access to patient’s prospective GP record via the NHS App in November, following a delay due to ‘safeguarding’ concerns.

In a letter to all GP practices sent last week, NHS England primary care medical director Dr Nikki Kanani and primary care director Dr Ursula Montgomery confirmed the launch date, which will include practices using TPP and EMIS systems. Pulse 

GP satisfaction dropping in Northamptonshire as NHS battles to cope with ‘unprecedented demand’

GP satisfaction dropping in Northamptonshire as NHS battles to cope with ‘unprecedented demand’ Satisfaction with GP services in Northamptonshire has dropped, new figures show, as demand rises to “unprecedented levels”. Northamptonshire Telegraph

Persistent understaffing of NHS a serious risk to patient safety, warn MPs

Persistent understaffing of NHS a serious risk to patient safety, warn MPs The NHS and social care face the greatest workforce crisis in their history, compounded by the absence of a credible government strategy to tackle the situation, say MPs in a new report. In the NHS, persistent understaffing poses a serious risk to staff and patient safety in routine and emergency care.

See also:

• Health workforce report illustrates staffing emergency and dire consequences for staff and patients BMA
• Expert report exposes urgent need for government to sort NHS staff shortages NHS Providers
• Failure to adequately plan for workforce putting patient care at risk Nuffield Trust
• Government must act now and invest in England’s NHS maternity services and staff says the RCM as ‘crisis’ looms Royal College of Midwives
• RCN responds to Health and Social Care Committee's report on the health and care workforce Royal College of Nursing
• NHS in England facing worst staffing crisis, MPs warn BBC News
• Worst NHS staffing crisis in its history is putting patients at serious risk, MPs warn The Guardian
• ‘Persistent’ NHS understaffing ‘poses serious risk to staff and patient safety’ The Independent
• NHS faces 'greatest workforce crisis' in history - putting safety at 'serious risk', MPs say Sky News

Protecting human rights in care settings

Protecting human rights in care settings This report warns that gaps remain in how vulnerable people are protected in care settings, leaving their human rights at risk of being breached. It finds that mechanisms such as Do Not Attempt Cardio Pulmonary Resuscitation notices and Deprivation of Liberty Safeguards are often not applied correctly, meaning treatment can be wrongfully withheld or an individual’s liberty infringed. It calls on the Government to work with the Care Quality Commission to ensure there is stringent oversight of how care providers implement safeguards designed to protect the human rights of care users. Joint Committee on Human Rights

Palliative and end of life care: statutory guidance for integrated care boards (ICBs)

Palliative and end of life care: statutory guidance for integrated care boards (ICBs) This guidance has been developed by NHS England to support Integrated Care Systems (ICSs) with their duty to commission palliative care services. ICSs have a key role to play in ensuring that people with palliative and end of life care needs can access and receive high quality personalised care and support. It also contains links to resources and good practice for ICSs when planning locally and working collaboratively with local partners. NHS England

UK Covid cases continuing to rise

UK Covid cases continuing to rise Around 3.8m people - one in 17 of the UK population - has coronavirus, latest figures from the Office for National Statistics suggest.

That's up by a quarter of a million - 7% - on the week before when there were 3.5m Covid infections recorded.

The number of people testing positive across the UK has been rising since the start of June but the rate of rise is showing signs of slowing down. BBC News

See also:

• Covid cases rise by another 10% in England... but experts say it's proof outbreak really has peak The Daily Mail
• Why do the minority who haven’t had Covid account for most new infections? The Guardian
• This Covid wave may be cresting – now let’s prepare for the next one | Kit Yates The Guardian
• New top Covid symptom in patients revealed by latest data as infections surge across UK The Independent

WHO declares highest alert over monkeypox

WHO declares highest alert over monkeypox The monkeypox outbreak has been declared a global health emergency by the World Health Organization.

The classification is the highest alert that the WHO can issue and follows a worldwide upsurge in cases.

It came at the end of the second meeting of the WHO's emergency committee on the virus. BBC News

See also:

• Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox World Health Organization
• Accelerated monkeypox vaccination rollout in London as UKHSA secure more vaccines NHS England
• UK needs urgent vaccine drive to curb monkeypox, campaigners say The Guardian
• What is monkeypox and how worried should we be? The Guardian
• Monkeypox: Virus can be spread through ‘any close physical contact’ The Independent

Woman found decomposing at home after mental health services failed to check in on her

Woman found decomposing at home after mental health services failed to check in on her A 37-year-old woman from east London was found decomposing after mental health services failed to check in on her for weeks, an inquest has found.

Sophia Yurferev was found by police in her home in Hornchurch on 16 November 2021, more than a month after she had died. The Independent

'Exhaustion, sadness and stress': Midwives leaving the job as burnout takes its toll

'Exhaustion, sadness and stress': Midwives leaving the job as burnout takes its toll Exhausted midwives are walking away from the profession with burnout as growing staff shortages create a "toxic cycle" of resignations and further pressure on those who remain. Sky News

Maternity failings account for the majority of the NHS's £13bn spend on negligence

Maternity failings account for the majority of the NHS's £13bn spend on negligence Maternity failings continue to account for the majority of billions of pounds spent by the NHS on clinical negligence claims, as an NHS body warns of the “devastating” consequences of poor care.

Two-thirds of the £13bn spent by the NHS in 2021-21 in respect of negligence claims was related to maternity care, according to new data.

A report released by NHS Resolution said it was “a stark reminder that although the NHS remains one of the safest healthcare systems in the world within which to give birth, avoidable errors within maternity can have devastating consequences for the child, mother and wider family, as well as the NHS staff involved.” The Independent

NHS has 'broken' its promise to the public over the ambulance service

NHS has 'broken' its promise to the public over the ambulance service The NHS has broken its “fundamental promise” to the public that life-saving emergency care will be available when they need it, a top NHS doctor has said, as ambulances continue to lose tens of thousands of hours waiting outside hospitals. The Independent

Charge patients for hospital stays to help fund NHS, says report

Charge patients for hospital stays to help fund NHS, says report Patients would be charged £8 a day when in hospital under proposals from a former health service boss to raise more money for the NHS.

Prof Stephen Smith is also urging ministers to bring in charges of £4 to £8 to help cover the costs of medical equipment that patients need, such as hearing aids and walking devices. The Guardian

Potential fabrication in research images threatens key theory of Alzheimer's Disease

Potential fabrication in research images threatens key theory of Alzheimer's Disease A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease.

In August 2021, Matthew Schrag, a neuroscientist and physician at Vanderbilt University, got a call that would plunge him into a maelstrom of possible scientific misconduct. Science

See also:

• Seminal Alzheimer's study may have been manipulated The Daily Mail

Organ donation from five KGH patients leads to 12 transplants

Organ donation from five KGH patients leads to 12 transplants Five Kettering General Hospital patients who donated their organs after death have helped to save or transform 12 lives following transplant surgery.

NHS Blood and Transplant and Kettering General Hospital have released the figures to mark the publication of the annual Organ Donation and Transplantation Activity Report covering the period April 2021-March 2022. Northamptonshire Telegraph

The contribution of newborn health to child mortality across England

The contribution of newborn health to child mortality across England This report draws on data from the NCMD to investigate how illness around the time of birth affects the health of children up to the age of 10, and to draw out learning and recommendations for service providers and policymakers. National Child Mortality Database

RCGP joins other medical royal colleges and the Academy of Medical Royal Colleges in calling for the next PM and leader of the Conservative Party to make health and care a priority

RCGP joins other medical royal colleges and the Academy of Medical Royal Colleges in calling for the next PM and leader of the Conservative Party to make health and care a priority With the election of the leader of the Conservative Party coming down to two candidates, the RCGP has signed a joint statement calling on them both to commit to make health and care a priority.

There is a crisis in general practice and the RCGP will continue to work with politicians from across Parliament to call on them to deliver a bold new plan to help GPs and their patients. Royal College of General Practitioners

Management of PPE contracts

Management of PPE contracts This report identifies ‘significant failings’ in the management of PPE contracts that have led to a stockpile of almost four billion items that are not needed. It finds little evidence of action being taken against potentially fraudulent suppliers despite the Department of Health and Social Care's estimate that as much as five per cent of PPE expenditure may have involved fraud. The report urges that more robust and transparent practices should be put in place to prevent such losses in the future. House of Commons Public Accounts Committee

National flu and COVID-19 surveillance reports published

National flu and COVID-19 surveillance reports published Surveillance indicators suggest that, at a national level, COVID-19 activity has increased slightly in several indicators in week 28 of 2022.

The number of acute respiratory infection incidents (suspected outbreaks) decreased in England to 528 in week 28, compared to 537 in the previous week. UK Health Security Agency

Covid inquiry: Lessons will be learned before next pandemic

Covid inquiry: Lessons will be learned before next pandemic Lessons will be learned about the UK's handling of Covid, before another pandemic strikes, Baroness Hallett, chairing the public inquiry, has said.

Opening the inquiry, she promised to be "fair and robust".

The former High Court judge said she would conduct the inquiry as quickly as possible, without giving a timeframe for its completion. BBC News

See also:

• US President Joe Biden tests positive for Covid BBC News
• Covid hospitalisations have now peaked in EVERY region The Daily Mail
• Public inquiry into UK Covid-19 response opens The Guardian
• How Covid keeps surprising us and confounding the experts (podcast) The Guardian
• Rise in Covid-19 hospital patients in England levels off The Independent
• Is Omicron sub-variant BA.2.75 more transmissible and could it bring another Covid wave to the UK? ITV News
• Doctors are concerned about the risk of hospital-acquired Covid-19 New Scientist
• COVID: Is the virus getting smarter? Sky News

Patients paying for private ops to avoid NHS waits

Patients paying for private ops to avoid NHS waits Long NHS waiting times appear to be pushing people into paying thousands of pounds for private treatment.

There were 69,000 self-funded treatments in the UK in the final three months of last year - a 39% rise on the same period before the pandemic.

Experts said it was a sign of how desperate people had become.

The BBC has seen evidence of people taking out loans and resorting to crowdfunding to pay for private treatment. BBC News

Doctors reveal ‘severe’ new symptoms of monkeypox similar to STIs

Doctors reveal ‘severe’ new symptoms of monkeypox similar to STIs Scientists have discovered a new set of signs of monkeypox that resemble sexually transmitted infections (STIs).

The symptoms, which include genital lesions and sores on the mouth or anus, may be severe and have led some sufferers to be admitted to hospital for pain management and difficulties swallowing, researchers say.

But the lesions or sores can easily be misdiagnosed, the scientists warn. The Independent

See also:

• Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 (open access) The New England Journal of Medicine
• Clinical features and management of human monkeypox: a retrospective observational study in the UK (open access) The Lancet Infectious Diseases
• Monkeypox vaccine rollout ramped up in London as virus continues to spread The Independent
• NHS scaling up monkeypox vaccination programme in London as more than 2,000 cases confirmed across UK Sky News

This is how we should rebuild the NHS

This is how we should rebuild the NHS The government loves a good driving analogy, doesn’t it? Roads and maps are particular favourites – the last two years have been full of them. We’ve had road maps for just about everything from recovering London’s economy to “coming out of” Covid; and the latest has been a “road to recovery” plan for the NHS as it moves forward and “out” of the pandemic. The Independent

See also:

• How can the NHS weather its summer storm? The Independent
• Children’s health waiting lists rising double the rate of adults, top doctor warns The Independent

London NHS trust cancels operations as IT system fails in heatwave

London NHS trust cancels operations as IT system fails in heatwave One of the NHS’s biggest hospital trusts is facing major problems after its IT system failed because of the extreme temperatures earlier this week.

Guy’s and St Thomas’ trust (GSTT) in London has had to cancel operations, postpone appointments and divert seriously ill patients to other hospitals in the capital as a result of its IT meltdown. The Guardian

Watchdog fines Pfizer and Flynn £70m for overcharging NHS for epilepsy drug

Watchdog fines Pfizer and Flynn £70m for overcharging NHS for epilepsy drug The drug makers Pfizer and Flynn Pharma have been fined a total of £70m for overcharging the NHS for a life-saving epilepsy drug.

The UK’s competition watchdog fined New York-based Pfizer £63m and imposed a £6.7m penalty on Flynn, a smaller UK pharmaceutical firm based in Stevenage. Both companies said they would appeal. The Guardian

‘A giant step’: charities welcome plan to widen access to IVF on NHS

‘A giant step’: charities welcome plan to widen access to IVF on NHS The government’s decision to remove additional barriers some LGBTQ couples face in accessing NHS-funded fertility treatments has been welcomed by charities and equalities organisations.

Under current rules, heterosexual couples can access NHS-funded fertility treatments once they demonstrate that they have been trying to conceive naturally for a period of time. The Guardian

Surgeons do multiple operations at same time under policy to combat record-length NHS waiting lists

Surgeons do multiple operations at same time under policy to combat record-length NHS waiting lists Surgeons are helping to perform multiple operations at the same time under a controversial policy aimed at combating record NHS waiting lists.

So-called ‘overlapping surgery’ sees a single senior surgeon split their time across two theatres, with juniors starting and completing the operation.

It allows them to focus on the critical parts of the procedure and reduces the time they waste waiting for anaesthetists and other staff to prepare and sedate patients. The Daily Mail

See also:

• The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review (open access) Anaesthesia
• NHS staff find innovative way to tackle surgery waiting lists Guys and St Thomas NHS Trust

Ambulance trust asks staff to work for FREE: Anger erupts over volunteer scheme

Ambulance trust asks staff to work for FREE: Anger erupts over volunteer scheme Paramedics have been asked to treat patients for free in their spare time amid the NHS ambulance crisis. 

The controversial scheme, unveiled by the East of England Ambulance Service, is entirely voluntary.

It will see medics rush to the scene of the most seriously ill 999 calls in their local area. The Daily Mail 

KGH on black alert as pressure forces them to open more beds

KGH on black alert as pressure forces them to open more beds Kettering General Hospital was forced to find more beds yesterday after a significant rise in A&E patients left them on black alert.

The trust declared an internal incident and was at escalation level Opel 4 – the highest level of operational pressure – where the strain leaves organisations unable to deliver comprehensive care. Northamptonshire Telegraph

Knife-crime campaigners gift more bleed cabinets to Northampton, Corby, Kettering and Wellingborough

Knife-crime campaigners gift more bleed cabinets to Northampton, Corby, Kettering and Wellingborough More bleed control cabinets containing lifesaving equipment are coming to Northampton, Corby, Kettering and Wellingborough thanks to a group set up to tackle knife crime in Northamptonshire.

The 17 new cabinets contain medical items to stop catastrophic bleeding and keep someone alive until emergency services arrive. Northamptonshire Telegraph

NHS leaders facing real-terms cut in funding and ‘impossible choices’ over which areas of patient care to cut back

NHS leaders facing real-terms cut in funding and ‘impossible choices’ over which areas of patient care to cut back The health service is facing a real-terms cut in funding of between £4 billion and £9.4 billion this year, new NHS Confederation analysis has found.

NHS leaders face impossible choices over whether to cut patient care or reduce investment in much needed diagnostic capacity and new technology after a series of unexpected cost pressures, including a new pay award for staff, left the NHS facing its first real terms cut in funding.

See also:

• NHS services may have to be cut to fund pay award BBC News
• Average GP practice faces £40,000 loss after unfunded pay award GPonline
• NHSE: ICSs must cut agency spend by 10pc or more (log in required) Health Service Journal
• Bosses face 'impossible choices' over cost pressures, says NHS Confederation The Independent
• Cancer backlog ‘vulnerable’ to pay deal cuts at ‘worst possible time’ The Independent

Ill-equipped prisons and lack of health care access leave pregnant prisoners and their children at significant risk

Ill-equipped prisons and lack of health care access leave pregnant prisoners and their children at significant risk A lack of appropriate maternity facilities and staffing is putting women in prison at significant risk of pre-term labour, missed midwifery appointments, and without appropriate support for mothers and young children dealing with the severe impact of separation. Nuffield Trust

See also:

• Inequality on the inside: Using hospital data to understand the key health care issues for women in prison Nuffield Trust

Coping with Covid in Prison: the impact of prisoner lockdown

Coping with Covid in Prison: the impact of prisoner lockdown 1 in 3 prisoners show symptoms of “severe anxiety disorder” indicating high levels of post-traumatic stress

‘Coping with Covid in Prisons’ research has found Covid-response measures led to periods of prolonged solitary confinement across the prison population, resulting in dramatically increased levels of anxiety and depression.

The study, funded by the Economic and Social Research Council, was a partnership between the ex-offender led charity User Voice and social scientists at the Queen’s University Belfast. User Voice

See also:

• UK prisoners ‘traumatised’ by Covid solitary confinement, study says The Guardian

Monkeypox cases confirmed in England – latest updates

Monkeypox cases confirmed in England – latest updates UKHSA procures more than 100,000 additional vaccine doses and updates close contact guidance as monkeypox cases rise to 2,137

UKHSA has published the latest epidemiological overview for the ongoing monkeypox outbreak.

It shows that as of 18 July 2022, there were 2,137 confirmed cases in the UK. Of these, 2,050 are in England. UK Health Security Agency

See also: 

• Guidance: Monkeypox: people who are isolating at home UK Health Security Agency
• Guidance: Principles for monkeypox control in the UK: 4 nations consensus statement UK Health Security Agency

Better Care Fund policy framework: 2022 to 2023

Better Care Fund policy framework: 2022 to 2023 This document sets out the agreed way in which the Better Care Fund (BCF) will be implemented in the financial year 2022 to 2023. 

BCF plans are jointly developed by health and social care partners in every area in England and support integrated, person-centred care in communities.

The policy framework is intended for use by those responsible for delivering the Better Care Fund at a local level (such as integrated care boards, local authorities, health and wellbeing boards) and NHS England. Department of Health and Social Care

Parents urged to help their kids get active over the summer holidays with the 10 Minute Shake Up

Parents urged to help their kids get active over the summer holidays with the 10 Minute Shake Up Parents of primary school children across England are being encouraged to get their kids active over the summer holidays, as the government relaunches its 10 Minute Shake Up campaign. Department of Health and Social Care

Transformational therapy cures haemophilia B

Transformational therapy cures haemophilia B A "transformational" therapy has effectively cured people with the bleeding disorder haemophilia B, say British doctors.

The treatment corrects a genetic defect that leaves people's blood struggling to clot and stop bleeding.

Elliott Mason, who was part of the trial which tested the therapy, says his life now feels "completely normal". BBC News

See also:

• Phase 1–2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B (abstract) The New England Journal of Medicine
• Haemophiliacs’ faulty gene could be cured with single injection The Daily Telegraph
• Gene therapy trial markedly cuts bleeding risk in haemophilia B patients The Guardian

UK government refuses public review before launch of NHS data platform

UK government refuses public review before launch of NHS data platform The UK government is refusing to run a public consultation on the expanded use of centralized data analytics on personal health information – under a £360 million ($432 million) contract that spy-tech business Palantir is tipped to win.

Minister of State for Care and Mental Health Gillian Keegan told Parliament that NHS England, a non-departmental body which runs the NHS, is not proposing to conduct an open debate on the nature or remit of the forthcoming Federated Data Platform. The Register

25% of BAME non-executive directors in NHS ‘have seen discrimination’ at work

25% of BAME non-executive directors in NHS ‘have seen discrimination’ at work A quarter of Black, Asian and minority ethnic (BAME) non-executive directors of NHS trusts have seen or experienced discrimination in the course of their work, a report reveals.

While almost four out of five (79%) of these BAME non-executives said they challenged such behaviour when they encountered it, only half (50%) said that led to a change of policy or behaviour. The Guardian

Yes, women’s healthcare is poor – but gender bias is not to blame for that

Yes, women’s healthcare is poor – but gender bias is not to blame for that | Zoe Williams Female GPs have outnumbered male ones for a decade – but after years of cuts, they are all under extreme pressure

The health secretary, Steve Barclay, this morning unveiled his plan to tackle gender health inequality. A “landmark moment”, he called it, “in improving the health and wellbeing of women across the country”.

The proposition was unarguable. That the healthcare system was historically designed for men, by men, is evidenced everywhere, from the comparatively lower life expectancy among women in poor areas to the fact that women, while they live longer, spend a quarter of their lives in poor health, compared with a fifth for men. The report was the result of a 100,000-strong consultation, in which 84% of respondents said they had felt “ignored or not listened to” when seeking help from the NHS. The Guardian

HRT will be sold over the counter so menopausal women can beat hot flushes without a prescription

HRT will be sold over the counter so menopausal women can beat hot flushes without a prescription Hormone replacement therapy will soon be available over the counter in the UK for the first time.

Today's move, which kicks in from September, only applies to one brand of vaginal tablets. 

Women needing other menopause-busting treatments, such as patches, gels and implants, still need a prescription. The Daily Mail

Top doctor 'really concerned' general practice will go the same way as dentistry

Top doctor 'really concerned' general practice will go the same way as dentistry General practice could go the same way as dentistry — with millions having to pay for appointments, the country's top doctor warned today.

Professor Martin Marshall, chair of the Royal College of GPs, admitted he is 'really concerned' about the sector, which is plagued by a staffing crisis. The Daily Mail

Government’s nursing target could still leave NHS short of nearly 40,000 nurses by next election

Government’s nursing target could still leave NHS short of nearly 40,000 nurses by next election Analysis published today by the Health Foundation’s REAL Centre shows that the NHS in England could face a shortfall of around 38,000 full time equivalent (FTE) registered nurses by 2023/24 relative to the numbers needed to deliver pre-pandemic levels of care. This is despite the expectation that the government could meet its own target of recruiting an additional 50,000 FTE registered NHS nurses by the end of the parliament.

See also:

• NHS workforce projections 2022 The Health Foundation
• Next Prime Minister must face up to chronic staff shortages compromising patient care NHS Confederation
• NHS urgently needs a fully costed and funded long term workforce plan NHS Providers
• NMC responds to NHS workforce projections report Nursing and  Midwifery Council
• NHS in England 'could face shortfall of almost 40000 nurses by 2024'  The Independent
• NHS in England could face 'apocalyptic shortage of 140,000 NHS nurses by 2030' ITV News

NHS staff to receive pay rise

NHS staff to receive pay rise The government has today accepted the recommendations from the independent NHS pay review bodies in full.

The pay review bodies considered a range of evidence from various organisations including government, the NHS and trade unions.

All NHS staff under the remit of this year’s pay review will receive a pay rise. Over one million staff under the Agenda for Change contract, including nurses, paramedics and midwives, will benefit from a pay rise of at least £1,400 this year backdated to April 2022. Department of Health and Social Care

See also:

• Independent report: NHS Pay Review Body Thirty-Fifth Report: 2022 Department of Health and Social Care
• Independent report: Review Body on Doctors’ and Dentists’ Remuneration 50th Report: 2022 Department of Health and Social Care
• Independent report: Senior Salaries Review Body Report: 2022 Department of Health and Social Care
• ‘Brutal pay cut will come as a bitter blow to doctors’ BMA
• Unfunded NHS staff pay increase could leave big hole in severely stretched NHS budget The Health Foundation
• NHS Confederation responds to NHS staff pay award for 2022/23 NHS Confederation
• Funding failure for NHS pay award would hit services for patients NHS Providers
• Unfunded pay increases risks blowing NHS budget further Nuffield Trust
• Below inflation pay award ‘unacceptable’ Royal College of Midwives
• Royal College of Nursing responds to NHS pay award Royal College of Nursing
• NHS pay deal for England: RCN to ballot members on industrial action Royal College of Nursing
• Public sector pay: Police and most NHS staff get below-inflation rises BBC News
• Should public sector workers get bigger pay rises? BBC News
• NHS could face bill of more than £1bn to fund upcoming pay rise The Guardian
• NHS workers handed 71p pay rise despite cost of living crisis Nursing Notes
• NHS staff get 4.5% pay rise, teachers 5% and police £1,900 - but unions say it is 'kick in the teeth' Sky News

First Women's Health Strategy for England to tackle gender health gap

First Women's Health Strategy for England to tackle gender health gap Women and girls across England will benefit from improved healthcare following the publication of the first ever government-led Women’s Health Strategy for England today (Wednesday 20 July).

Following a call for evidence which generated almost 100,000 responses from individuals across England, and building on Our Vision for Women’s Health, the strategy sets bold ambitions to tackle deep-rooted, systemic issues within the health and care system to improve the health and wellbeing of women and reset how the health and care system listens to women. Department of Health and Social Care

See also:

• Funding and staffing must underpin Government’s women’s health strategy Royal College of Midwives
• Women's health: Mandatory training for all new doctors BBC News
• What are the key areas of England’s women’s health strategy? The Guardian
• New women’s health strategy for England aims to end decades of inequality The Guardian
• Are there enough concrete commitments in the women’s health strategy to truly ‘reset the dial’? The Guardian