May 2026

THE IMPORTANCE OF CONTINUOUS PHYSIOLOGICAL MONITORING

Amanda Randles of the Duke Center for Computational and Digital Health Innovation explains why duration matters

TACKLING THE LACK OF BSL INTERPRETERS

How the NHS must overcome a shortage of trained British Sign Language interpreters

SCALING THE FUTURE OF INDEPENDENT LIVING

Evondos UK’s Nick Hucker on how technology can keep people out of hospital

“Our work represents a shift from population-level metrics to personalised health monitoring. Rather than asking if a patient has crossed an arbitrary universal threshold, we are looking at the specific change in their own trajectory...”

The director of the Duke Center for Computational and Digital Health Innovation, Amanda Randles, is working to change the current gold standard that is the CT scan.

Having spent her career at the intersection of high-performance computing and biophysics, she talks to Healthcare Today about the technical hurdles of noisy data, the shift from population-based averages to personalised baselines, and why she wants to replace invasive procedures with non-invasive tools.

Also in this issue, Clare Vale discusses the need to make British Sign Language interpreters more readily available in hospitals; Evondos UK’s new managing director Nick Hucker reveals how technology can fit into the discharge pathway; and much more...

We hope you enjoy!

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IMPLANT PROCEDURES SET FOR IMPROVEMENT

A RESEARCH partnership led by Birmingham Health Partners members, the University of Birmingham and the Royal Orthopaedic Hospital NHS Foundation Trust (ROH) is launching at the end of the month to improve understanding of the performance and failure of implants used in orthopaedic surgery.

The Birmingham Implant Retrievals Centre will analyse orthopaedic implants that have failed and associated tissue samples. Researchers will use these to analyse why devices fail, how implants behave inside the body, and how patient safety can be improved through earlier identification of risk.

“While joint replacement implants have improved significantly, and therefore patient outcomes, understanding why implants fail is critical,” said ROH’s Adrian Gardner, research and development director and consultant spinal surgeon.

The University of Birmingham is applying advanced engineering expertise to the study of implants that have been retrieved from patients following revision joint replacements, working closely with surgeons at ROH to understand how devices perform over time in patients.

By coordinating retrieval, consent, and transfer processes between ROH and the university, implants and tissue samples can be analysed quickly. This enables detailed insight into wear, corrosion, material degradation and failure mechanisms. The linkages with clinical data and close working relationships with clinicians will provide regulators and industry with the insight they need for future development of joint replacement implants.

The Birmingham Implant Retrievals Centre hopes this work will enhance patient safety by earlier detection of risk failure, improve understanding of the causes of revision joint replacements, and develop evidence to support better screening and testing of new and existing implant devices.

“Routine explant analysis, robustly linked to clinical records and National Joint Registry data, is a vital component of evidence-based life-cycle evaluation for both established and emerging orthopaedic devices. Explant analysis has long been, and continues to be, a key tool for detecting potential device-related safety signals and root cause failure mechanisms, strengthening postmarket surveillance, and ultimately enhancing patient safety,” said Michael Bryant, professor of tribology and corrosion engineering at the University of Birmingham.

CONSULTATION LAUNCHED REVIEW MEDICAL PROFESSIONALS

AN OVERHAUL of the General Medical Council (GMC) has been announced to modernise the regulation of doctors, making the system faster, less bureaucratic and better equipped to protect both patients and NHS staff.

What is the most significant overhaul of the regulation of medical professionals since 1983 will be set out in a consultation on the General Medical Council (GMC) Order, the legislation governing the regulation of doctors.

“It is clear that the current regulatory landscape is outdated and too bureaucratic, hampering the GMC’s ability to act decisively when doctors contravene their code of conduct,” the government has said.

A trigger has been the rapid review by John Mann, Baron Mann, into antisemitism and other forms of racism in the health service, which the government commissioned in November.

“The NHS is a universal health service, which means that everyone, regardless of race, religion, or belief, should feel safe seeking its care. It is unacceptable that this is not the current reality for many patients and staff, and I will not allow it to continue,” said heath and social care secretary Wes Streeting. “I am grateful to Lord John Mann for his rapid investigation into how we

can overhaul the look forward to recommendations patients and staff expect.”

The principal objectives Medical Council “modern and agile medical practitioners, and anaesthesia

The GMC will be rules more efficiently require Privy Council allow GMC to respond efficiently.

At the same time, more flexibility and training in teaching, digital settings or community-based

The new framework the GMC to hold multiple registers be divided into GMC regulates, public and patients registration information registrants.

Registration powers GMC can amend

CONSULTATION TO MEDICAL PROFESSIONALS

the current system, and I to setting his common-sense recommendations in motion to ensure NHS staff get the protection they objectives of the draft General Council Order are to introduce a agile regulatory framework” for practitioners, physician associates anaesthesia associates.

be able to consult and amend its efficiently as these will no longer Council approval. This should respond to external events more

time, GMC will be provided with flexibility to set standards for education different forms, like formal digital learning, as well as clinical community-based settings.

framework will provide a duty on hold a single register, rather than registers as it does currently. This will into parts for each profession the regulates, and will make it easier for the patients to find and understand information about the GMC’s

powers will be reformed so the amend requirements flexibly, which

means it will adapt more quickly to workforce needs and regulatory developments.

The fitness to practise process will also be overhauled to make it less adversarial, which will strengthen public protection and improve the experience for all parties involved. This should support the work GMC has already done to eliminate bias in its fitness to practice processes.

It will also establish a framework which may be used for future reforms to the other healthcare professional regulators, enabling faster and more consistent cross-regulator outcomes.

“Patients rightly expect assurance that doctors, PAs and AAs are safe to practise and can be held to account if serious concerns are raised. These proposed reforms will allow us to respond more quickly and flexibly when patient safety is at risk,” said GMC chief executive Charlie Massey.

“They will also allow us to further improve our efficiency and effectiveness, while at the same time enabling us to help patients navigate the complaints and concerns process more easily,” he continued.

The trade union British Medical Association (BMA) immediately said that the proposed changes are “a far cry” from what is needed to fix the regulator.

“The changes in today’s consultation are a far cry from what is needed to fix a broken regulator that is aggressively pursuing doctors and failing the public. Rather than restoring the medical profession’s confidence in the GMC or protecting the safety of the public, both will be further eroded,” said BMA council chair Tom Dolphin, saying that the BMA has been calling for complete reform of the GMC for years.

He has called the overhaul “a missed opportunity”.

One key change he has recommended is to remove the GMC’s right to appeal decisions made by the independent Medical Practitioner’s Tribunal Service (MPTS). Although this has been recommended several times since 2018, the recommended changes not only retain the right, they expand it.

“Anti-Semitism and racism are abhorrent and unacceptable in the NHS as they are in any workplace. Discrimination and abuse need tackling, but expanding and duplicating the powers of the regulator should not be used as a replacement for action by employers, where this responsibility should lie,” Dolphin continued.

The consultation on changes to the General Medical Council Order closes on 23 June.

NICE BACKS TREATMENT FOR MENOPAUSAL HOT FLUSHES

THE National Institute for Health and Care Excellence has recommended a new treatment option for menopausal hot flushes and night sweats that can be used in the NHS when hormone replacement therapy (HRT) is not suitable.

Fezolinetant (also called Veoza) is recommended to treat moderate to severe symptoms in final draft NICE guidance. It is taken once a day and is a non-hormonal treatment that works by blocking the nerve pathways in the brain that trigger hot flushes.

“We know that menopausal hot flushes and night sweats can have a profound impact on quality of life and significantly affect overall wellbeing,” said Helen Knight, director of medicines evaluation at NICE. “The evidence shows fezolinetant can meaningfully reduce symptoms, and was found to be cost-effective, offering value for the taxpayer. This decision will give much-needed relief to those for whom HRT is unsuitable.”

HRT remains the first-line treatment option and, given its established benefits and the range of formulations now available, it’s likely most people with moderate to severe vasomotor symptoms would continue to take it. Fezolinetant can be used when HRT is medically not recommended, for example in cases of deep vein thrombosis or pulmonary embolism. It can also be used following a clinical risk assessment in some cases of diabetes or heart disease.

“It’s another vital treatment option which could help hundreds of thousands of women experiencing menopause to better manage their symptoms and feel more in control of their health,” said Sue Mann, national clinical director in women’s health for NHS England.

DIGITAL TOOL HELPS WITH DEPRESSION

AN AI-DRIVEN tool that tailors antidepressant treatment to individual patients has been shown to improve outcomes for people with depression, compared to standard treatment. It is the first time that a mental health clinical prediction tool has been demonstrated as effective.

The PETRUSHKA tool, developed by the University of Oxford and funded by the National Institute for Health and Care Research (NIHR), supports clinicians and patients to choose the antidepressant that is better tailored to individuals. It uses AI to combine clinical and demographic information with patient preferences, particularly around side effects, to support treatment personalisation and shared decision-making in routine care.

The tool was tested in a large international randomised clinical trial across Brazil, Canada and the UK involving more than 500 adults with major depressive disorder (MDD) and launched in 2024. It found that people whose antidepressant was selected using PETRUSHKA were significantly more likely to continue their treatment and experienced better mental health outcomes compared with usual care up to six months.

“Mental health is lagging behind other fields of medicine, and for too long, antidepressant treatment has relied on trial and error. PETRUSHKA shows that by combining the best available evidence with patients’ own preferences, we can personalise antidepressant treatment from the outset and help more people in the NHS stay on the medication that is right for them,” said NIHR research professor Andrea Cipriani, the lead investigator of the study.

Choosing the right antidepressant remains a major challenge in everyday practice, with many people stopping treatment early because of side effects or a lack of perceived benefit. PETRUSHKA was designed to address this by using evidence from clinical trials and real-world data alongside what matters most to patients, helping to identify the most suitable options from the outset.

In the trial, participants using PETRUSHKA were around 40% less likely to discontinue their antidepressant within the first eight weeks of treatment. Fewer people stopped treatment because of adverse effects, and by 24 weeks, those in the PETRUSHKA group also reported greater improvements in depressive and anxiety symptoms. The tool was coproduced with people with lived experience of depression. It takes three minutes to be administered and is designed to be easy to use in everyday clinical settings, including primary care. Clinicians and patients use PETRUSHKA during a consultation ensuring that treatment decisions reflect both clinical evidence and individual priorities.

“This study shows the real power of combining digital technology and personalised treatment,” said Mike Lewis, NIHR’s scientific director for innovation. “By harnessing data and embracing cutting-edge digital tools, we can tailor care more precisely to each patient - improving outcomes for individuals. Forward-thinking research such as this shows the impact of using innovative technologies to ensure patients across the UK receive smarter, more effective care.”

CANCER DEATH RATES FALL

CANCER death rates in the UK are at their lowest level on record, 29% down from when they peaked in 1989, according to the latest figures from cancer charity Cancer Research UK.

“These figures represent decades of crucial scientific breakthroughs –from vaccines that prevent cancer to kinder, more targeted treatments,” said Sam Godfrey, the charity’s science engagement lead.

Cervical cancer has seen one of the biggest improvements across cancer types, with a 75% reduction in death rates over the past 50 years. That progress is set to continue thanks to innovations like the HPV vaccine, which was first introduced in 2008 and is expected to prevent 90% of all cervical cancer cases. At least 6.5 million people have now received the vaccine in the UK.

Research into new treatments such as Abiraterone, a drug that stops prostate cancer from creating testosterone to fuel its growth, has also played a role in pushing down cancer death rates.

Death rates for a number of other cancer types, including stomach cancer, testicular cancer and Hodgkin’s lymphoma, have also dropped considerably.

There’s also been progress against hard-to-treat cancers, including some of those that affect the brain and central nervous system, where death rates have fallen by 6% for men and 8% for women over the past ten years, thanks to advances like the drug temozolomide.

It was approved for use in the 2000s and helps people with fast-growing brain tumours called glioblastomas survive the disease for longer.

Less good news is that mortality rates for liver cancer, womb cancer and head and neck cancer have all increased in recent years. A growing and ageing population also means that overall cancer deaths continue to rise.

“The UK has been a global leader in cancer research, but we can’t take progress for granted,” said Godfrey.

“It’s essential that the Government makes it easier and faster to set up clinical trials, as well as providing NHS staff with the time and space to carry out life-saving research.”

The government’s National Cancer Plan was widely praised when it was published earlier this year.

In the Healthcare Today podcast, Fiona Hazell, the chief executive of Leukaemia UK, discussed the government’s new National Cancer Plan, the vital importance of early diagnosis and a hope for real change.

PLANS TO TACKLE CORRIDOR CARE

ALETTER from NHS England, which includes a new definition of corridor care and a duty on trusts in England to begin collecting data on incidences of corridor care, will be published in May.

“We all know that corridor care is unacceptable; it creates an exceptionally poor experience for patients – particularly older patients – and their loved ones, generates low morale for our staff, and undermines the public’s confidence in the ability of the NHS to provide safe care when they need it most,” wrote Sarah-Jane Marsh, national priority programme director of urgent and emergency care at NHS England.

At the beginning of March, the Care Quality Commission (CQC) updated its guidance for corridor care, the blight on emergency departments that is getting worse rather than getting better.

In summary, NHS England writes that a patient has experienced corridor care if they have spent at least 45 minutes in a clinically inappropriate area of an emergency department or general and acute ward.

Ambulance handover delays should continue to be reported separately

and monitored alongside corridor care to ensure efforts to reduce corridor care do not lead to longer waits in ambulances outside the hospital.

The 45-minute threshold for corridor care, Marsh writes, aligns with the W45 protocol for ambulances, and the aim is to revise both down to 30 minutes next year.

Data on corridor care will also be collected, and NHS England is committed to publishing it each month from May on NHS England’s website.

The move has been welcomed as a small step towards solving the issue, though the Colleges remain cautious about whether the problem will be solved.

“Corridor care is the reality faced by doctors working in hospitals and patients being admitted via emergency departments across the country every single day,” said BMA consultants committee emergency medicine chair Den Langhor.

“The largely symbolic move from NHS England to agree a definition of corridor care represents a minor step forward in recognising the issue,” he added, though conceded that forcing hospitals to collect and publish data on corridor care is welcome, and will

enable a more accurate picture of just how serious the problem has become nationwide to be built up.

Royal College of Nursing general secretary and chief executive Nicola Ranger called the new definition of corridor care “by no means perfect” and added that it had taken far too long to develop.

“Together, we need to start resetting the standards in our hospitals. These actions rightly place new expectations on trust leaders to own the corridor care crisis, put in place measures within their control to ease pressure, and recognise it as a risk to patients and staff by formally recording and reporting corridor care,” she said.

The Royal College of Emergency Medicine was similarly cautious.

“We absolutely welcome NHS England’s commitment to focus on this issue. We also welcome the intention behind today’s definition of corridor care. This has been promised since early last year,” said the College’s president Ian Higginson.

“However, we can already measure long waits and overcrowding. It remains to be seen whether trying to measure corridor care on top of this will prove more effective.

PUBLIC IS CAUTIOUS DOCTIFY TO PARTNER WITH THEMIS CLINICAL DEFENCE

DOCTIFY has inked a first-of-itskind partnership with THEMIS Clinical Defence that can reduce the cost of insurance for highly rated consultants.

Clinicians who meet the qualifying threshold of positive verified reviews will be able to benefit from premium savings, which reinforces the company’s commitment to building a portfolio defined by service excellence, transparency and professionalism.

“THEMIS is excited to announce this partnership and to work with Doctify to reward clinicians who truly deserve recognition for the quality of care and service they provide,” said George Maughan, director of insurance services at THEMIS. “By aligning patient feedback with our underwriting approach, we are continuing to champion consultants who place excellence at the heart of their practice.”

David Johnson, head of business development at Doctify, made the point that consultants who deliver exceptional care and are committed to transparency represent a lower risk and should benefit from reduced indemnity premiums as a result.

“THEMIS has demonstrated a truly forwardthinking and dynamic mindset in bringing this partnership to life,” he said.

In an interview with Healthcare Today in November last year, Doctify co-founder Stephanie Eltz talked about the importance of reviews. Trust, transparency and online reputation are universal concepts, she explained.

“By encouraging every patient to provide feedback, doctors can build a far more balanced and representative picture of their work,” she said.

WHILE the government has thrown £1.6 billion of funding at AI over the next four years, the public remains cautious and there are concerns too that the law hasn’t kept up.

In mid February, the government released its AI strategy for UK Research and Innovation to make AI deliver for the UK’s cutting-edge science and research efforts.

The UK’s largest public research funder UKRI committed £1.6 billion of funding directly targeted at the AI sector over the next four years, its biggest single investment area for 2026 to 2030. This includes funding for specific activities that UKRI will deliver on behalf of the Department for Science, Innovation and Technology (DSIT) – which is subject to change as delivery plans are finalised. It also sits alongside significant additional AI investment woven through the broader UKRI budget.

“From spotting cancers earlier to cutting backlogs in public services, new research into AI will be a gamechanger, bringing the promise of tomorrow’s technologies to the UK today,” said deputy prime minister David Lammy.

The strategy also commits to expanding doctoral and fellowship routes co-designed with businesses. It will also support recognised career frameworks for research software engineers, data scientists and ethics specialists – supporting the high-paying jobs of the future.

Under the new strategy, it will help to deliver up to £137 million as part of DSIT’s AI for Science Strategy to back AI-enabled scientific discovery, starting with drug discovery and new treatments.

All good news, but the public still remains cautious about AI.

New polling from the Health Foundation’s third annual health tech tracker survey shows that while the public backs most of the proposed new functions for the NHS App, many remain cautious around the use of artificial intelligence (AI) in health care.

With the government’s 10 Year Health Plan signalling major ambitions to expand the NHS App, the charity’s survey of 8,000 members of the public and more than 2,000 NHS staff reveals that around three-quarters of the public would be happy to use the NHS App for functions such as booking hospital appointments (76%), choosing a preferred hospital (73%) and accessing information about procedures (73%). But support drops significantly when AI-generated advice is involved. Only 49% of the public say they would be willing to use the proposed AI-powered Doctor in Your Pocket feature for nonurgent care, and nearly a third (32%) said they would not use it.

CAUTIOUS ABOUT AI

tech the many Health public reveals public App hospital accessing (73%). when Only be AI-powered non(32%)

the UK’s approach to overseeing and regulating AI in health care, it will be important to create an environment where the use of AI is trusted by patients and the public,” said Ahmed Binesmael, senior improvement analyst at the Health Foundation.

“While an effective regulatory framework may well be able to balance speed, safety and other principles, our findings suggest the public currently prioritises stronger diligence and safeguards over potential benefits such as speed or availability,” he continued.

It is a problem for which healthcare leaders are still striving to find an answer.

Matthew Taylor, interim chief executive of the NHS Confederation and NHS Providers, welcomed the great potential that AI and digital tools have to improve NHS productivity, solve organisationspecific problems and give people control and access to the information they need, but that there was still a need to “build trust” in their use. At the same time, concerns remain

that the law has not kept pace with advances specifically for patients who suffer injuries where faulty AI is used in their treatment.

“The law is lagging behind when people are injured and AI technology is involved. AI use in healthcare is set to be transformative in providing rapid, accurate diagnosis and personalised treatment, so it’s key that if patients are hurt due to negligence where AI plays a part that they have a clear and accessible route to redress through the courts in the UK,” said Pauline Roberts, vice president of the Association of Personal Injury Lawyers (APIL).

“People injured by medical products that utilise AI are forced to take on wellresourced manufacturers, sometimes based abroad, by pursuing product liability claims, which are notoriously complex, costly, and lengthy,” she continued.

APIL has responded to the Medicines and Healthcare products Regulatory Agency (MHRA)’s call for evidence to

inform the recommendations of the National Commission as it develops the new regulation framework for AI use in healthcare.

It is not alone, the Royal College of Radiologists (RCR), the Institute of Physics and Engineering in Medicine (IPEM), and the Society of Radiographers (SCoR) all called for a properly trained and funded workforce and clear, consistent regulation across AI developers, healthcare providers and professionals in their responses.

“AI must be regulated as a safetycritical technology. That requires clear standards across the AI lifecycle and a workforce with the capability and authority to assure these systems in clinical practice,” said IPEM’s president Mark Knight.

Although the consultation has closed, there is no timeline for when recommendations will be published. But whatever happens, it will be an uphill struggle to get people onside.

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RCS ENGLAND LAUNCHES MANIFESTO AHEAD OF SENEDD ELECTIONS

AHEAD of the Senedd Elections, the Royal College of Surgeons of England (RCS England) has warned that Wales is in danger of slipping further behind the rest of the UK unless progress on surgical hubs and workforce growth accelerates.

The latest figures show a decrease in the total number of patient pathways, falling from just under 741,000 in December last year to just over 713,000 in January. Since the waiting list reached its post-Covid peak of 802,268 in November 2024, only 89,220 pathways have been removed, it said.

Launching its Senedd Election manifesto, the College called on the next Welsh Government to expand longterm surgical capacity through new surgical hubs and to publish a comprehensive workforce strategy for health and social care. The College says both measures are essential to accelerating reductions in waits and supporting an overstretched workforce.

“Behind every statistic is someone living in pain. Without dedicated, protected space for planned operations, waiting lists in Wales will continue to be disrupted by winter pressures and spikes in emergency demand,” said RCS England’s director in Wales Jon Barry. “Without urgent action now, patients across Wales will continue to face long waits for surgery.”

Surgical hubs are used across the UK to separate planned operations from emergency pressures and protect elective capacity. Wales currently has just one operational hub for a population of 3.2 million. England has more than 120, and Northern Ireland has six for a population of 1.9 million. Findings from the UK Surgical Workforce Census last year reinforce the scale of the challenge. A higher proportion of surgeons in Wales than in any other UK nation reported difficulty accessing operating theatres, with six in ten (60.5%) citing it as a major barrier to delivering care.  Almost two-thirds (63.7%) reported burnout, highlighting the strain on the surgical workforce.

To accelerate progress, RCS England is calling for the Welsh Government to deliver a Surgical Hub Implementation Group, bringing together NHS Wales organisations, clinical leaders and the Royal Colleges, and a minimum of four surgical hubs, established on existing NHS sites within its first year. The manifesto also sets out further priorities, including cosmetic surgery regulation, improved reporting mechanisms and transparency for sexual misconduct and harassment, and child dental health to understand why progress on reducing childhood dental decay has stalled.

PUBLIC SATISFACTION WITH THE NHS ON THE RISE

PUBLIC satisfaction with how the NHS is run has increased for the first time since the COVID-19 pandemic, according to a report from The King’s Fund and the Nuffield Trust.

The think tanks looked at data from the British Social Attitudes (BSA) survey, which was carried out by the National Centre for Social Research (NatCen) between August and October last year.

In 2019, 60% of respondents said that they were satisfied with the NHS, and this figure had been spiralling downwards, reaching a record low of just one in five (21%) in 2024.

The authors of Public satisfaction with the NHS and social care in 2025 say the year-on-year falls in satisfaction seen since the pandemic appear to have eased, and while these results will be a welcome relief for the government, they do not offer a solid signal as to whether the bounce in NHS satisfaction marks a decisive turning point.

“The rise in public satisfaction will be welcome relief for an NHS that has seen satisfaction plummet in recent years. But whether this marks the start of a genuine recovery or is just brief respite remains an open question. Much will depend on how quickly the government can improve access to care,” said Dan Wellings, senior fellow at The King’s Fund.

Around half of respondents (51%) said they were ‘very’ or ‘quite’ dissatisfied, marking a drop of eight percentage points from 2024. Despite this, only half of respondents (50%) said they were satisfied with the quality of NHS care in 2025, and only 16% of respondents thought the standard of

NHS care would improve in the next five years.

Access to services is still the major issue for the public, and only around a fifth (22%) said they were satisfied with A&E services. When asked what the top three priorities for the NHS should be, nearly half (46%) of respondents selected both ‘making it easier to get a GP appointment’ and ‘improved A&E waiting times’ as their top priorities.

As in previous years, a strong majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply: 89% said that the NHS should be free of charge when you need to use it, almost four out of five (81%) said that the NHS should primarily be funded through taxes and nearly threequarters (74%) said the NHS should be available to everyone.

“It is true that there are some signs of clear progress that would have meant that a continued fall in satisfaction would have felt unfair: patient experience surveys show small signs of improvement; waiting lists have stabilised; productivity has begun to improve,” wrote Thea Stein, chief executive of the Nuffield Trust, and Sarah Woolnough, chief executive of The King’s Fund, in an article.

But, they warned, these changes are perhaps less the result of the government achieving some kind of sudden change in the NHS, and more the result of its presiding over a continued, slow, steady recovery.

Responding to the survey, Tim Mitchell, President of the Royal College of Surgeons of England, highlighted the 45% of respondents for whom improving waiting times for planned operations remains a top priority.

This is “a clear sign patients” are still waiting too long for the care they need, and “tackling these delays must start with expanding surgical capacity: increasing access to operating theatres and investing in the hospital infrastructure that is required to treat more patients,” he said.

David Hare, chief executive of the Independent Healthcare Providers Network, said that it was encouraging to see a small rise in public satisfaction with the NHS, but that these figures still reflect a system under significant strain.

“At a time of sustained pressure, making full use of all available resources across the system will be key to improving access, reducing waits and ensuring patients have real choice about where they receive their care,” he said.

Georgina Howe, chief executive of telemedicine and virtual healthcare company Teladoc Health UK, put the findings into a broader perspective.

“For employers, these findings highlight a growing challenge. Delays in accessing care don’t just affect individuals, they have a direct impact on productivity, absence and longterm health outcomes,” she said.

WRONG-SITE SURGERY CASES IN ENGLAND JUMP

BETWEEN 2020 and last year, 661 cases of surgery performed on the wrong patient or body part were reported in English hospitals, according to new data from Medical Negligence Assist.

The phenomenon, known as wrongsite surgery, is a medical error where an invasive procedure is performed on the wrong patient, the wrong body part or the wrong site on the body – such as operating on the left limb instead of the right. Many of these incidents are classified as “never events” by the NHS, meaning they are considered entirely preventable.

Obtained via Freedom of Information requests, 117 NHS Trusts were contacted. Of the 72 that responded, 661 cases were reported in total over the five-year period. While 69 incidents were recorded in 2020, that had jumped to 101 last year, marking a 46% increase in cases during that time.

The true figure is likely to be - some of the responding Trusts declined to specify exact figures due to smaller numbers, in order protect patient confidentiality.

“The increase in the numbers demonstrates that these Never Events are becoming common, is something that everyone should concerned about as the consequences can range from the catastrophic unnecessary scarring to avoidable pain and discomfort,” said Gareth Lloyd, head of medical negligence JF Law.

“These never events can be and more needs to be done to the issue, especially in those that have seen the highest numbers,” he added.

“For patients, wrong-site surgery be devastating, particularly when leads to avoidable harm or additional procedures,” said Matilda Blundell, trainee solicitor at Tomlin &

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“The fact that these incidents continue to occur, despite being classified as ‘never events’, suggests that more needs to be done to ensure safety systems are consistently applied. Learning from these cases is essential to prevent similar mistakes in the future.”

Of those 647 cases, 46 (7%) are reported to have involved the patient suffering serious harm, with incidents ranging from the wrong anatomy being removed to the excision of a pair of organs when only one was slated for removal. Meanwhile, 236 involved moderate harm to the patient, such as the wrong tooth being extracted, incorrect scars being removed, or Botox being injected into the neck instead of the mouth.

A total of 292 cases involved low harm, such as biopsies or anaesthesia being erroneously applied, while only 174 - just 26.89% of cases - resulted in no harm to the patient.

Inevitably, some Trusts reported higher numbers of incidents than others. The Newcastle-upon-Tyne Hospitals NHS Foundation Trust recorded 44 cases of wrong-site surgery over the past five years, with 10 of those having taken place in the first quarter of last year.

Manchester University NHS Foundation Trust also reported a notable figure with 20 cases, though it should be mentioned that neither of these two trusts reported cases involving serious harm to patients.

More seriously, University Hospitals of Morecambe Bay NHS Foundation Trust reported 23 cases, with two of those involving serious harm to patients, while there were 20 instances recorded by North West Anglia NHS Foundation Trust, 13 of which involved serious harm.

There are many reasons why wrongsite surgeries can take place. A common theme among causes listed

by the responding NHS Trusts was inevitably human error, as well as procedures not being followed, and non-adherence to safety checklists.

Issues with communication and organisation were also commonly cited, as well as environmental factors such as lighting and temperature. Some reports simply listed issues with documentation, suggesting handovers had not been clear enough or that information had been recorded incorrectly.

In other cases, the Trusts listed causes such as procedures being inadequate to deal with the circumstances, or issues with the information supplied on consent forms, often due to language barriers. Some just admitted that the wrong part of the anatomy had been identified.

Beyond that, investigations made reference to inadequate or faulty equipment, or even the inaccessibility of necessary equipment.

THE BRITISH COLLEGE OF COSMETIC SURGERY LAUNCHES

IT HAS long been recognised that aesthetic medicine has been outpacing regulation. To bring some standards to the industry, the British College of Cosmetic Surgery, an initiative dedicated to strengthening education, collaboration and professional standards within cosmetic surgery, has launched.

The College has been established to create an official, professionled standard for cosmetic surgery practice in the UK. Through a structured and rigorous fellowship pathway, it hopes to ensure surgeons demonstrate measurable competence, transparency and commitment to patient safety.

The founding board includes Ashish Dutta, founder of Aesthetic Beauty Centre; consultant plastic, aesthetic and reconstructive surgeon Ian Morgan; cosmetic surgeon and dermatologist Alexandra Chambers; cosmetic surgeon Mabroor Bhatty; and Sayani Sainudeen, chief executive and chairman of Y1 Capital. “Cosmetic surgery continues to evolve rapidly, and with that evolution must come clear, measurable standards. Our aim is to provide patients with confidence and surgeons with a framework that reflects true excellence,” said Sainudeen. “This fellowship is about accountability, transparency and raising the bar for our entire speciality across the UK.”

The fellowship is open to UK surgeons, including plastic surgeons, general surgeons, breast surgeons and doctors practising cosmetic surgery. It provides a structured pathway for surgeons who may not be on the GMC specialist register in plastic surgery to demonstrate competency through independent assessment.

While there is already a voluntary certification scheme run via the Royal Colleges, the British College of Cosmetic Surgery provides a dedicated body focused exclusively on cosmetic surgery standards across specialities.

As the College begins to accept fellowship applications, its founders hope it will become the defining accreditation for cosmetic surgery practice in the UK. By combining written examination, case scrutiny, observed surgery, oral assessment and peer review, the British College of Cosmetic Surgery introduces one of the most comprehensive cosmetic surgery accreditation processes currently available.

It is something that is needed. Research from UCL has found that aesthetic treatments are cheaper and more common in deprived areas where specialist medical care is less likely.

“The proliferation of botulinum toxin providers who do not have professional healthcare backgrounds raises questions regarding the adequacy of training standards and highlights challenges for the impending government reforms,”

said lead author and plastic surgery registrar Alexander Zargaran at Royal Free London NHS Foundation Trust.

The UK’s non-surgical aesthetics industry is worth more than £3 billion and is growing rapidly. Treatments such as Botox, dermal fillers, laser therapy and chemical peels are now commonplace, often promoted heavily through social media. Demand is increasingly driven by younger demographics, shaped in part by online beauty standards and algorithm-driven exposure.

At the beginning of March, Chris Dexter, partner at law firm Weightmans, noted that “in the absence of robust regulation, the sector has become a wild west in which procedures have reportedly taken place in Airbnbs, hotel rooms, garden sheds and even public toilets”.

The consequences of this regulatory vacuum, he continued, are not theoretical – they are reflected in legal claims and the rise in insurernotified cases involving people who have suffered serious, and sometimes life-changing, injuries as a result.

TRUSTS PAY OUT

£1.2 BILLION IN MISDIAGNOSIS CLAIMS

NHS TRUSTS in England have paid out more than £1.2 billion in misdiagnosis-related medical negligence claims over the past six years.

Figures obtained through a series of Freedom of Information requests by Medical Negligence Assist show that nearly 10,000 misdiagnosis claims – 9,989 in total – were lodged against NHS trusts between 2019/20 and 2024/25. Before the COVID-19 pandemic in 2019/20, lodged claims stood at a high of 1,824.

While numbers dipped during the height of the pandemic - falling to 1,516 in 2021/22 - they have now risen to a six-year high of 1,922 new claims in the 2024/25 financial year.

“The figures highlight a deeply concerning trend that leaves patients paying the ultimate price. We regularly see cases where a delay in diagnosis leads to devastating, lifealtering consequences - from delayed bowel cancer diagnoses resulting in tragic, premature deaths in patients in their early 50s, to missed ectopic

pregnancies causing permanent infertility,” said Sophie Cope, medical negligence solicitor for JF Law.

“We have also supported patients who have suffered severe brain injuries due to delayed diagnoses of subarachnoid haemorrhages, and even amputations following missed ischaemia.

Of the total claims lodged over the sixyear period, 7,500 were settled. Total damages of £1.2 billion were paid out, equating to an average payout of £160,200 per successful claimant.

A distinct North-South divide has emerged in the data, with Southern regions seeing significantly higher overall compensation bills.

Greater London trusts paid out £148.5 million over the six-year period. By comparison, the highestpaying northern region was Greater Manchester at £95.8 million, followed by South Yorkshire (£40.8 million) and West Yorkshire (£37.7 million).

When looking at individual cases, successful claimants at Birmingham

Women’s and Children’s NHS Foundation Trust came away with the highest average compensation, receiving £969,841 per claim. This was followed by Manchester University NHS Foundation Trust (£522,677) and Hillingdon Hospitals NHS Foundation Trust (£470,731).

In terms of the sheer volume of cases, Northern Care Alliance NHS Foundation Trust faced the highest number of misdiagnosis claims over the six years, with 278 lodged against it. Manchester University NHS Foundation Trust followed closely with 274 claims, and Mid and South Essex NHS Foundation Trust faced 221.

Some trusts saw almost all of their lodged claims result in a settlement. United Lincolnshire Hospitals NHS Trust had the highest settlement rate in the country, settling 152 of the 159 claims lodged against it - a staggering 95.6%. East Kent Hospitals University NHS Foundation Trust settled 100 out of 110 claims (90.9%), while County Durham and Darlington NHS Foundation Trust had a settlement rate of 90.8% (148 out of 163).

NHS ALLIANCE BRINGS NHS LEADERSHIP TOGETHER

The NHS Confederation and NHS Providers will merge from April, 2026. What will be called The NHS Alliance plans to bring NHS leadership together, represent their views to government jointly, and support them to improve their services at a time of what they call “significant pressure and transformation for the NHS”.

Plans were initially announced in January.

The NHS Alliance will launch with Ciarán Devane, currently chair of the Health Service Executive (HSE) in Ireland, as its inaugural chief executive. Devane has been executive director of the Centre for Peace and Security at Coventry University since 2021, chief executive of the British Council (2015-20) and chief executive at Macmillan Cancer Support (2007-14), for which he received a knighthood in 2015 for services to cancer patients. He was also on NHS England’s board as a non-executive director from 2012 to 2015.

“As the NHS Confederation and NHS Providers, we have not come together to be bigger: we have come together to be braver, more influential and to provide greater support to our members,” said Victor Adebowale, chair of the NHS Confederation and NHS Providers. He is the soon-to-be inaugural chair of The NHS Alliance.

“As the NHS Confederation and NHS Providers, we have not come together to be bigger: we have come together to be braver, more influential and to provide greater support to our members… The NHS needs collective leadership right now, and I am excited by what The NHS Alliance will deliver for all parts of the health and care system.”

AI TECHNOLOGY DOES NOT SPEED UP LUNG CANCER DIAGNOSIS

USING artificial intelligence tools to read thousands of chest X-rays and prioritise abnormal ones does not lead to faster lung cancer diagnoses, according to a new study from UCL, UCLH and the University of Nottingham.

The LungIMPACT trial, the largest randomised trial of its kind, ran across five NHS trusts in England and found no significant reduction in the time from X-ray to cancer diagnosis when AI flagged abnormal scans so that a radiologist could prioritise these for early review. AI prioritisation did speed up one part of the process: the median time for a radiologist to report on a chest X-ray fell from 47 hours to 34 hours. But this improvement did not cascade into faster progress through the rest of the diagnostic pathway. Referral rates, treatment start times, and cancer stage at diagnosis were all comparable across both groups.

“The hypothesis was that getting the X-ray reported faster would cascade into a faster diagnosis, but the NHS system simply could not respond at the same pace,” said UCLH consultant radiographer Nick Woznitza, principal investigator of the trial. “The bottleneck isn’t the reporting; it’s everything that happens next: telling the patient, the CT appointment, the clinic slot, the multidisciplinary meeting. We’ve shown that AI prioritisation, by itself, cannot fix that.”

Among the 558 patients diagnosed with lung cancer during the trial, the median time from chest X-ray to diagnosis was 44 days with AI prioritisation and 46 days without – a two-day difference that was deemed not statistically significant. The median time from X-ray to the more detailed CT scan was identical in both groups at 53 days. The median time from

chest X-ray to a fast-tracked CT scan (because cancer was suspected) was six days with AI prioritisation and seven days without, again not deemed statistically significant. A closer examination of patients ultimately diagnosed with cancer revealed a stark pattern. When both the AI and the radiologist judged an X-ray as abnormal, the median time to cancer diagnosis was 38 days. When both judged it as normal (X-rays detect only four out of five cancers), the median time stretched to 177 days, nearly five months.

There were 53 cases where the AI flagged the X-ray as abnormal, but the radiologist’s report did not identify an abnormality. These patients waited a median of 106 days for their cancer diagnosis, significantly longer than when both agreed. The researchers say this group warrants urgent further investigation, as some could have been diagnosed at an earlier stage.

“The cases where the AI spotted something the radiologist did not flag are the ones that interest us most,” said UCLH consultant radiologist and UCL honorary associate professor Arjun Nair. “These patients waited longer for a diagnosis. We need to understand whether there is a pattern, as this has implications not just for how we use the AI to spot these cases earlier, but also potentially how we train radiologists and radiographers of the future,” he added.

The authors argue that what is needed is not AI prioritisation alone, but a redesign of the whole pathway so that when AI flags a suspicious X-ray, a coordinated series of actions (CT booking, clinical review, specialist referral) is automatically triggered before the patient leaves the department. This will take investment in infrastructure and workforce, not just AI, the study concludes.

RISE IN CARE HOME ABUSE

THERE has been an 18% rise in reports of abuse in English care homes over the past three years, with 90,232 in 2023 soaring to 106,772 last year.

Figures, obtained through a Freedom of Information request to the Care Quality Commission (CQC) by Legal Expert, found that 292,356 reports of abuse were made in care homes across England between 2023 and 2025.

Various forms of abuse were reported to the CQC, and by far the most common of those proved to be ‘neglect or acts of omission’

– 52,868 incidents were reported during the timeframe, amounting to an astonishing 18.08% of all reports over the three years.

Reports of physical abuse were also significant, making up 16,264 accounts, or 5.56% of all reports in the past three years.

Meanwhile, reports of emotional abuse totalled 10,935, representing 3.74% of the three-year total.

Less numerous, but still giving cause for concern, were reports of financial abuse, of which 2,690 were logged (0.92%). Sexual abuse figures were also low by comparison, though still

perturbing, as 2,011 reports were made (0.69%).

“The figures paint a troubling picture of abuse on the rise in England’s care homes, which are supposed to provide support and living assistance to some of the most vulnerable members of our society,” said Patrick Mallon, senior personal injury solicitor at Legal Expert.

“Whether emotional, physical or even financial, the damage caused by abuse can have long-lasting, potentially life-changing impact, so victims should not feel troubled by seeking accountability when a carer lets them down in the worst possible way.”

JAAQ RAISES $17 MILLION SERIES A FUNDING

LONDON-based digital health platform JAAQ has raised $17 million (£12.8 million) to accelerate its entry into the US market and fast-track the development of its AI-native mental health content library. The financing round was led by Meridian Health Ventures, with participation from investors including Fuel Ventures, Bolt Angels, and Guinness Ventures.

JAAQ focuses on the access gap in mental health, where the demand for support far outstrips the availability of clinical professionals. While traditional tele-therapy models rely

on finite human capacity, JAAQ’s system uses artificial intelligence to deliver clinically governed, interactive video content that can be embedded directly into existing enterprise ecosystems.

“We have a structural problem in mental health: demand is infinite, but clinical capacity is finite,” said newly appointed chief executive Alex Packham in a statement. Packham, who previously founded and sold ContentCal to Adobe, noted that the new infusion of capital will allow the company to expand its strategic

partnerships and refine its Smart Content modality.

The company says that its technology has already demonstrated significant engagement and costsaving benefits for large-scale organisations. According to JAAQ, the platform currently covers over 1.5 million lives, providing instant access to more than 10,000 expertled videos covering more than 70 mental health topics. This model allows for safe, scalable support without the wait times associated with traditional care.

EARLY DIAGNOSTIC TEST FOR SEPSIS

DOCTORS in Liverpool working with researchers at the Centre for Trials Research at Cardiff University have identified promising evidence for the effectiveness of an early and rapid diagnostic test for sepsis.

Funded by the National Institute for Health and Care Research (NIHR), teams from the University of Liverpool and the NHS University Hospitals of Liverpool Group conducted the study. They were joined by colleagues at the Centre for Trials Research at Cardiff University, as well as investigators at 20 NHS acute care hospitals in England and Wales.

“The evidence supports the value of early and rapid diagnostics and indicates a need for further biomarker and algorithm development,” said co-chief investigator Stacy Todd, consultant in infectious diseases and general medicine at the University Hospitals of Liverpool Group

“Uptake of procalcitonin-guided care into health systems will now depend on greater understanding of the mechanism of effect, further health economic evaluations, and robust implementation frameworks,” he added.

Diagnosing sepsis in emergency departments remains difficult, as many non-infectious illnesses can mimic its symptoms, and there is currently no definitive diagnostic test. This uncertainty contributes to both over- and underdiagnosis. In both situations, delayed treatment can cost lives, while rapid antibiotics are required for those with confirmed sepsis, some patients may be treated for sepsis unnecessarily, contributing

to the urgent global issue of antimicrobial resistance (AMR). At the same time, misdiagnosis can lead to a failure to correctly identify and treat the actual underlying condition.

A procalcitonin-guided algorithm is a clinical decision-making tool that uses levels of the biomarker procalcitonin (PCT) to help guide antibiotic therapy in patients with suspected bacterial infections. However, it is not currently recommended for use in emergency settings because previous research has been inconsistent.

To address this gap, the research team conducted a large, controlled trial which randomised 7,667 patients who presented to emergency departments with suspected sepsis. The study tested whether adding the rapid procalcitonin-guided algorithm testing to current clinical practice could help clinicians recognise sepsis more accurately, reduce unnecessary antibiotic prescribing, and maintain at least the same level of patient safety, measured by overall mortality.

The study shows that there was a 17% relative reduction in mortality from 16.6% to 13.6%, which means for every

1,000 patients treated as suspected sepsis, 31 lives are potentially saved. Patients from the most deprived areas experienced the greatest mortality benefit. Existing research explores inequality in sepsis outcomes, and this latest research may help to overcome identified systemic biases.

Importantly, the trial found that regardless of whether patients were treated with the procalcitonin-guided algorithm or received standard care, there was no difference in how quickly intravenous antibiotics were started. Although the research team had anticipated that the algorithm might improve early antibiotic initiation, the trial showed it did not - a key finding, given that this was one of the coprimary outcomes.

“Each year, tens of thousands of people die from sepsis. Early detection and prompt management are crucial. These new findings demonstrate how better diagnostic tests can help clinicians care for patients with sepsis in the race to save lives, while also tackling the global threat of antimicrobial resistance,” said Anthony Gordon, director of NIHR’s Health Technology Assessment Programme.

WIDESPREAD SUPPORT FOR NHS’s ONLINE HOSPITAL

ALMOST two-thirds of NHS consultants have said that they are keen to work for the NHS’s online hospital when the service launches next year, a new poll has revealed. Six in ten consultants (60%) said they would be interested in working for NHS Online alongside their current NHS roles. This is many more than will be needed to run the service.

At the end of September last year, the government announced the fully digital hospital model as part of its 10 Year Health Plan to shift the NHS from analogue to digital. It will allow patients to access specialist care, book scans, manage prescriptions, and receive clinical advice from home via the NHS App. It plans to launch a fully digital hospital model, NHS Online.

The survey of nearly 300 consultants and specialist doctors also found that nearly half (48%) would be willing to offer at least four hours a week of their time, with the opportunity to care for

patients innovatively, work flexibly and improve patient experience among their top reasons for wanting to sign up.

“It’s fantastic to see that consultants and specialist doctors are hugely supportive of the NHS’s new online hospital, with nearly two-thirds willing to offer their time for this revolutionary service alongside their current roles,” said Stella Vig, national clinical director for elective care at NHS England.

The NHS Online service, which was announced by the Prime Minister in September 2025, won’t replace traditional care as patients will always have the choice of face-to-face appointments.

The idea is that patients referred by their GP will be able to book specialist appointments directly. If scans or procedures are needed, they can be scheduled at Community Diagnostic Centres closer to home. The hope is that this will offer greater convenience

and faster access. Clinicians will also be able to triage patients and review their notes remotely, potentially outside office hours, without the patient needing to be present.

The NHS has selected nine common conditions – glaucoma, macular degeneration, cataracts, inflammatory bowel disease, iron deficiency anaemia, prostate enlargement, raised PSA, menopause and menstrual problems, which may be a sign of endometriosis – as the first to be treated by the NHS Online service.

Prostate problems like prostate enlargement and a raised prostatespecific antigen (PSA) level will also be covered by the service, along with eye conditions including cataracts, glaucoma and macular degeneration.

NHS Online will also provide support for other painful and distressing conditions, such as iron deficiency anaemia and inflammatory bowel disease.

LIVING WITH LEUKAEMIA

AGLOBAl study of people living with chronic lymphocytic leukaemia (CLL) has identified gaps in patients’ understanding of their condition, with findings showing that knowledge about infection risk and disease monitoring is linked to quality of life.

The study, coordinated by international charity Picker and published in Frontiers in Hematology, analysed responses from 846 people with CLL who took part in the 2023 Global Leukaemia Experience Survey.

The study found that most respondents (69%) experienced symptoms before diagnosis, yet 89% did not recognise them as signs of leukaemia. Fatigue, swollen lymph nodes and fever/night sweats were the symptoms most often reported. Even after diagnosis, less than half (43%) said their diagnosis was explained in a way they fully understood.

“People with CLL often face uncertainty about symptoms, active monitoring, and their immunity status,” said lead authors Kathryn Huntley, director of the CLL Advocates Network in Bern, and Sam Salek, professor of pharmacoepidemiology in the School of Life and Medical Sciences at the University of Hertfordshire.

“When information and explanations are clear, people feel more confident and report better quality of life,” they continued.

The study found that people who did not know their immunity status or had not received complete information about infection prevention and immunisation strategies had worse quality of life scores.

CLL is often managed without immediate treatment, meaning patients must play an active role in monitoring their condition. However, the findings suggest that many people do not feel adequately informed or supported to do so.

Given the increased risk of infections in people with CLL due to disease-related and treatment-related immunosuppression, understanding immunity status and infection prevention is essential.

The study highlights the importance of ensuring that people with CLL receive clear, accessible information and feel supported to understand and manage their condition, particularly while on active monitoring.

The study was funded by the CLL Advocates Network

NHS ENGLAND SOUTH EAST INTRODUCES AUTOMATED

CATARACT

PATHWAY

NHS England South East has procured an automated cataract care pathway to modernise and standardise the cataract pathway. It has been jointly funded by the Department of Health and Social Care (DHSC) and NHS England South East region.

The AI-enabled solution replaces multiple pre- and postoperative outpatient appointments with clinically validated digital conversations. It supports referral triage, patient choice, reminders, waiting list validation and postoperative followup. It will also report on patient-reported outcome measures (PROMs).

The system is designed to flag and escalate any concerns to clinicians promptly. By standardising care pathways across the region, it is hoped that the service will ensure that capacity across the NHS and independent sector is used effectively to improve timely access to cataract care.

“By modernising and standardising the cataract pathway, we can reduce avoidable delays and improve the clarity and convenience of care for thousands of people each year,” said Anne Eden, South East regional director at NHS England.

For patients, it is hoped that the new system will mean fewer unnecessary appointments, with more checks completed remotely where it is safe to do so. It will also support patients to make informed choices about where to receive care, considering factors such as waiting times and travel distance.

Postoperative follow-up is supported by automated check-ups for routine cases, with rapid escalation to the clinical team if symptoms suggest any problems or concerns.

NHS England South East has said that early implementation has demonstrated reduced waiting times, fewer cancellations, and the release of tens of thousands of follow-up appointments each year.

The pathway is expected to free up substantial nursing and clinical capacity and refocus work on other eyecare subspecialties, improve patient experience, and support sustainable delivery of cataract care across the region.

KIDNEY CANCER GUIDELINES PUBLISHED

THE National Institute for Health and Care Excellence (NICE) has published its first kidney cancer guideline, which aims to double biopsy rates and prevent hundreds of unnecessary surgeries each year.

It introduces changes to how suspected renal cell carcinoma (RCC) is diagnosed and managed across the NHS, including a significant expansion in the use of renal biopsies to confirm diagnoses earlier, reduce unnecessary surgery, and improve outcomes for people with kidney cancer.

This guideline follows campaigning, evidence gathering and expert input from Kidney Cancer UK – whose Accord panel and clinical advisors worked closely with NHS England and NICE to demonstrate the need for clearer diagnostic standards, greater use of biopsy, and more consistent national care pathways.

“A few years ago, we approached NHS England to commission NICE to develop a clinical guideline for kidney cancer. When you see such significant

variation in care, it’s often because there isn’t a standard framework that everyone is working within. For whatever reason, there hadn’t previously been a NICE guideline for kidney cancer,” Andrew Greaves, general manager at Kidney Cancer UK, told Healthcare Today in October last year.

Key recommendations in the new guideline include that a biopsy be offered to people with suspected RCC who have a renal lesion 4 cm or smaller, where a tissue sample can be safely obtained and that one be considered for larger lesions when imaging suggests they may be benign, before non-surgical treatments such as ablation, or when a patient requests one.

All patients should have access to a clinical nurse specialist with kidney cancer expertise, providing personalised care plans, follow-up schedules and clear points of contact. There should also be guidance on diagnosing and managing heritable genetic conditions that increase kidney cancer risk, including Von Hippel–Lindau disease (VHL).

In general, the guidelines recommend greater patient information and support, ensuring people affected by kidney cancer receive consistent, high-quality care throughout their treatment pathway.

“These new recommendations will help transform the diagnostic pathway, reduce avoidable harm, and give patients a clearer, more consistent standard of care,” said Greaves after the announcement. “This is a vital step forward, and we are proud to have played a central role in driving this change,” he added.

Kidney cancer is now the sixth most common cancer in the UK, with around 13,800 new cases and 4,700 deaths each year. Until now, many patients have had part or all of their kidney removed without a biopsy beforehand, meaning the true nature of the lesion is only confirmed after surgery. Kidney removal can have long-term consequences for health and quality of life. The new guideline aims to ensure that more patients receive an accurate diagnosis before any surgical intervention is considered.

GOVERNMENT SIGNS

PHARMA DEAL WITH THE US

AS PART of the USUK pharmaceutical partnership, UK pharmaceutical exports to the US will enter the US completely tariff-free, for at least three years. This makes the UK the first country in the world to secure 0% tariffs on pharmaceutical exports to the US.

The government claims that the partnership also accelerates NHS patients’ access to new medicines. Under the deal, it says that pharmaceutical companies have stronger incentives to launch innovative treatments in the UK, meaning patients can benefit from new cancer therapies, rare disease treatments, and other breakthrough medicines sooner. At the same time, the UK has also secured preferential terms for medical technology.

The Medicines and Healthcare products Regulatory Agency (MHRA) is finalising its collaboration with the US Food and Drug Administration (FDA) to support faster access to safe and innovative medical technologies in the future for patients in both countries.

The MHRA and FDA have said that they intend to work closely on options to improve and align regulations for medical devices. This includes exploring future mutual recognition mechanisms (ways to recognise parts of the individual approval processes), reducing duplication for manufacturers and streamlining approval processes to help patients access new medical technologies sooner.

Both regulators have emphasised that their work will remain independent and will ensure strict safety standards are maintained.

“This marks an exciting moment for UK innovation. By strengthening our working relationship with the FDA, we are allowing cutting-edge medical technologies to reach patients faster and more efficiently than ever before,” said MHRA chief executive Lawrence Tallon. “This is exactly the kind of partnership that enables the UK to stay at the forefront of global life sciences,” he added.

The news was welcomed by the industry. Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, called it a “landmark partnership”; Dave Ricks, chair and chief executive of Eli Lilly and Company, said it was an “encouraging move”; and Peter Ellingworth, chief executive of the Association of British HealthTech Industries, called it a “positive step towards reducing regulatory duplication”.

But there is no getting away from the cost to the British taxpayer of caving in to US president Donald Trump’s demands.

The Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) headline payment percentage – the rebate pharmaceutical companies pay on branded medicines sold to the NHS – will be capped at a maximum of 15% until the end of the current scheme, which expires at the very end of 2028.

As Healthcare Today has noted before, it is a move that will see the UK pay 25% more for new medicines and cost the NHS and British taxpayers an additional £3 billion a year. Campaigning organisation Global Justice Now is vocal about what a bad deal it is.

“This deal doesn’t guarantee patients will get access to many new medicines – but it does guarantee the NHS will pay more for the medicines we do get access to,” said policy and campaigns manager Tim Bierley.

“If the government truly cared about patient access to medicines, it would tackle the profiteering corporations that hold us to ransom. Not simply hand over more money to them.”

DUALITY HEALTHCARE PARTNERS TO TACKLE ADHD CARE

NORTHERN Irish private operator Duality Healthcare has partnered with specialist platform ADHD Now to tackle ADHD care in Northern Ireland.

There are currently no commissioned adult ADHD services anywhere in Northern Ireland, leaving many adults without access to structured diagnostic pathways or ongoing specialist care.

Through this exclusive partnership, patients will have access to specialist ADHD assessments, expert-led diagnostic evaluations, evidencebased treatment plans, medication initiation and management if clinically appropriate, and ongoing monitoring and follow-up care.

Untreated ADHD costs Northern Ireland more than £290 million a year in lost productivity, reduced employment participation, increased mental health pressures and wider societal impacts. Government figures

suggest that an estimated 150,000 people are living with ADHD in Northern Ireland and more than 9,500 adults remain on waiting lists for assessment, with some waiting more than eight years.

“The absence of commissioned adult ADHD services has created a significant gap in provision, and our exclusive partnership with ADHD Now enables us to offer a structured, specialist-led pathway for adults,” said John McEvoy, chief executive of Duality Healthcare.

ADHD is a recognised neurodevelopmental condition affecting attention, impulsivity and emotional regulation. When left untreated, it is frequently associated with anxiety, depression, reduced educational attainment and workplace challenges.

“ADHD does not disappear at 18, yet adults in Northern Ireland currently have no commissioned service to turn to,” said ADHD Now chief executive Matthew Gavin.

He lives with ADHD himself. For years, Gavin said that he felt like he was pushing forward but never quite understood why life seemed harder than it should be. It wasn’t until his late 20s, when he was finally diagnosed with ADHD, that the pieces started to fall into place.

“My own struggle to get a clear diagnosis inspired me to found ADHD Now, so others wouldn’t face the same challenges,” he said.

“Partnering with Duality Healthcare is an extremely important next step in supporting the many people in Northern Ireland waiting for an assessment, as well as those who have a diagnosis but cannot access ongoing management supports.”

The services are available through a combination of online and inperson assessment and treatment, with ongoing care supported by five Northern Ireland clinics in Belfast, Derry, Newry, Omagh and Ballymena, and further clinics expected to open this year.

THE IMPORTANCE OF CONTINUOUS PHYSIOLOGICAL MONITORING

IN THE world of modern medicine, the snapshot has long been the gold standard. Whether it is a single CT scan or a discrete blood pressure reading, clinicians have historically been forced to make life-altering decisions based on isolated moments in time. Amanda Randles, director of the Duke Center for Computational and Digital Health Innovation, is working to change that.

A physicist and computer scientist by training, Randles has spent her career at the intersection of high-performance computing and biophysics. Here, she talks to Healthcare Today about the technical hurdles of noisy data, the shift from population-based averages to personalised baselines, and why she wants to replace invasive procedures with non-invasive tools.

Let’s start at the beginning. As you have said, most digital twins today are essentially snapshots. What is the problem with that limitation?

Many of the digital twins we see today are focused on single heartbeats or isolated points in time. The fundamental issue with this approach is that disease is not static; it constantly evolves and changes. To understand a patient’s health, we must capture how the body responds to those changes over time. If we fail to do so, we risk missing the early warning signals and the underlying mechanisms that drive disease progression. A pertinent example is the identification of vulnerable states. If we only look at a certain snapshot, we are merely asking a binary question: was the patient in a vulnerable state at that specific moment, or were they not? In reality, what matters most is the duration of that vulnerability. Flipping into a vulnerable state for a single second may be medically insignificant; however, if a patient spends three

Amanda Randles, director of the Duke Center for Computational and Digital Health Innovation, explains why duration matters.

Written by Adrian Murdoch.

months, or perhaps 10% of their time over a half-year period, in that state, it becomes a serious concern. It is this cumulative exposure that often acts as the driving factor in the progression or localisation of a disease.

When building digital twins for cardiovascular disease, for instance, we often rely on representative heartbeats – such as a single resting beat or a single exercise beat – to understand physiological changes. Yet, a single representative exercise heartbeat fails to capture the different degrees of exertion. It misses how the body responds during the ramp-up to exercise and how it recovers afterwards. It is the data captured across these complete trajectories that is truly telling and, ultimately, predictive.

You have talked about continuous physiological modelling. What does that mean in practise?

There is currently a continuum on the path toward true digital twins. We have seen personalised models that provide a single snapshot, but I would argue that these do not necessarily constitute a digital twin. To reach that level, one needs constant, continuous feedback from sources such as wearables, sensors, or implantable devices – something that provides realtime data to update the digital model so it accurately reflects the physical entity. This shift towards continuous physiological monitoring is essential.

It allows us to connect wearable data with information from medical imaging, though there is a nuance there: depending on the type of imaging used, those records may also need periodic updates. For example, if a patient has a CT scan but then develops plaque build-up over the following six months, that original scan becomes outdated. We must understand what is happening longitudinally rather than viewing health as a series of discrete events. We need to know when to make those updates and how things are changing.

This approach also grants us the ability to map trajectories and identify shifts from a patient’s own baseline. It makes the process significantly more personalised; we are no longer relying solely on population-based thresholds or arbitrary cut-off points. Instead, we can identify a subtle shift in a specific individual’s average heart rate or recovery time. Even if that shift doesn’t cross a general clinical threshold, the fact that it is a departure from their norm is highly significant. This ability to monitor what is happening for you, as an individual, is where the real power lies.

How hard is this? What are the technical barriers to making that shift right now?

From a technical standpoint, the obstacles are numerous – starting primarily with the data itself. Depending on the clinical focus, we often require incredibly high-resolution, beat-to-

CONTINUOUS MONITORING

beat information. When we integrate physics-based modelling to understand blood flow, we can easily generate terabytes or even petabytes of data if we attempt to capture 3D flow volumes every second over several months. Managing that volume of information is a significant challenge in its own right.

Furthermore, we must contend with the reality of missing or noisy data. At the very least, a wearable device needs to be charged; there will inevitably be periods where a patient leaves their watch on the charger and forgets to put it back on for several days. Then there is the issue of data integrity – for instance, if one of my children picks up my watch and puts it on, how do we identify that the wearable is being worn by the wrong person? We cannot have a system that sends a crisis alert to a doctor simply because my six-yearold is wearing my device.

Beyond these practicalities, we currently lack standardised pipelines to aggregate and assess data across different manufacturers and devices. Conventionally, the simulations required for 3D blood flow are computationally expensive. While we are working extensively to train AI surrogates to create reduced-order models, progress varies depending on the specific disease area or biomarker. Integrating these disparate models –combining flow data with heart rate, sleep, gait and even dietary

information – presents a massive multimodal data challenge for computer science.

Finally, these technical hurdles do not even touch upon the essential concerns of privacy, security and fairness. Many of the clinical thresholds we use today are based on non-representative populations. Ultimately, we do not just need better models; we require an entire ecosystem to ensure that this technology is feasible, fair and safe as we move forward.

Where can it help? You’ve suggested simulations could complement or even replace invasive measurements. What procedures are most likely to be displaced first?

The most exciting aspect of this field is that we are already seeing these concepts in practice, particularly through what I would categorise as advanced personalised models. A prime example is the measurement of Fractional Flow Reserve (FFR), which is used to determine the burden of coronary ischaemia and whether a patient requires a stent. Conventionally, this involves an invasive procedure where a guide wire is inserted into the coronary arteries to measure pressure. Today, however, companies such as HeartFlow and CathWorks have FDA-approved technologies that are used globally. Instead of an invasive wire, they use a 3D simulation to measure FFR in a virtual replica of the patient. Large-scale clinical trials have already proven that these virtual replicas can match the accuracy and specificity of invasive measures.

Initially, the primary impact of this technology will be in diagnostics. We are starting with coronary arteries, but these methods will soon be applied to cerebral and peripheral vasculature. The goal is to replace invasive procedures with non-invasive tools wherever we have established biomarkers and thresholds. For instance, we are

conducting studies on heart failure, where we know that pulmonary artery pressure (PAP) changes before physical symptoms appear. While patients currently require implantable sensors to monitor these changes, our pilot studies have shown that computational models can capture this data non-invasively.

The next step is to monitor these changes over time. If PAP typically changes two weeks before a crisis, can we identify a shift in the trajectory three or four weeks ahead of time by monitoring other biomarkers? Access to this longitudinal data may even allow us to discover entirely new indicators of disease.

Once these computational tools are established, we can use them to project future outcomes. Before a patient enters the operating room, we could virtually try out different stents, bypass procedures, or even the effects of various drugs like statins. We can adjust the virtual patient’s geometry and activity levels to predict the physical forces and long-term effects of a specific

We are getting close to a reality high-level computational medicine is accessible, and integrated into

treatment. This represents the next wave of progress: using digital twins to inform treatment paths and monitor patients as they go about their daily lives.

Are current consumer devices (Apple Watch, Fitbit) clinically robust enough to feed into models like HARVEY?

an hour for the resting state. If our goal is to capture beat-to-beat variability, that level of averaging is inadequate.

Furthermore, a significant hurdle remains regarding the validation of these physiological signals. Much of the existing validation has been conducted on populations that are not universally representative.

We know, for example, that certain optical sensors may be less accurate depending on an individual’s skin tone. This is an issue that must be addressed with urgency to ensure that the data driving these digital twins is accurate for everyone. While there has been immense progress, the variability between devices and biomarkers means there is still considerable work to be done to ensure these systems are both precise and equitable.

Forgive the cynical question. Are we collecting the right data today – or the wrong data at scale?

getting remarkably reality where computational accessible, portable, into everyday life.

This depends entirely on the specific clinical question being asked. In many instances, if we are simply trying to determine whether a patient spent 20% versus 50% of their day in a high-risk state, the data is already sufficient. We do not necessarily require a measurement to the fifth decimal point to understand that a patient has crossed a significant threshold. In those cases, the existing data is more than good enough to inform a model.

However, the challenge lies in whether we are capturing the right data. While some methods provide high-resolution information during periods of exercise, they may only provide an average over

Our work currently involves a strategic mix; we are attempting to identify exactly when high-resolution data is essential and when a more streamlined approach will suffice. On one hand, we are pushing forward with projects that rely on standard commercial wearables. The goal here is to ensure the technology is as translatable and accessible to as many people as possible. On the other hand, for specific medical studies, we collaborate with research labs to develop custom wearables that provide the exact resolution required for our models.

A significant issue we encounter is that many metrics provided by consumer wearable devices are actually proxies for the specific physiological markers we need. These devices are often not directly measuring cardiac output or stroke volume; instead, they are estimating these figures – and even blood pressure – based on other available signals.

A major part of our research is understanding when these estimates are good enough and identifying the nuances of relying on such proxies. This is precisely where accuracy can falter, as the reliability of a proxy can vary significantly based on a patient’s body type or skin tone. We must determine exactly when we can trust these proxy measurements and, crucially, in which clinical scenarios we must remain cautious.

How do you validate a model that is unique to each patient?

Our work represents a shift from population-level metrics to personalised health monitoring. Rather than asking if a patient has crossed an arbitrary universal threshold, we are looking at the specific change in their own trajectory.

If a patient’s metrics drop by 15%, the starting point is less important than the drop itself; it is that deviation from their personal norm that flags a need for clinical review. This approach is powerful because it can account for consistent device bias –if a sensor has a slight inaccuracy, that bias remains constant from day one to day five, effectively washing out when we focus on the relative change for that specific individual.

For initial medical applications, we are focusing on patients who already require clinical intervention, such as those with heart failure. These individuals are already undergoing CT scans or right-heart catheterisations, providing us with invasive measurements like cardiac output. We use this high-fidelity data to calibrate the digital model specifically to that person, ensuring we are not merely estimating but truly tailoring the simulation to their unique physiology.

Validation becomes more complex when we move to longitudinal monitoring, as it is historically impossible to measure 3D blood flow continuously over long periods.

To address this, we compare our models against data from implantable sensors or discrete daily measurements across a wide range of patients. We also have patients undergo Doppler ultrasound of the carotid artery to obtain specific velocity waveforms, allowing us to verify that our fluid dynamic simulations match real-world observations during both rest and exercise.

Ultimately, a patient’s unique anatomy plays a massive role in how blood flows through their system. A specific heart rate will affect blood flow differently depending on the individual curves and turns of their coronary arteries. Therefore, we make a concerted effort to ensure our models are validated against a diverse range of 3D anatomies. We must ensure the model doesn’t just work for one specific arterial shape; we need to understand exactly how geometry affects the simulation to ensure the model remains robust for every patient.

If these models become widely used, what are the biggest ethical or clinical risks? Who is accountable if a digital twininformed decision leads to harm?

A crucial point to clarify is that we are not attempting to replace doctors; rather, we are creating clinical decision aids. Our goal is to provide clinicians with more comprehensive information and determine how to present that data in a way that is genuinely helpful.

A doctor does not want, nor could they quickly process, a petabyte of heart rate data spanning 20 years. We are focused on making that information actionable and useful. To that end, we conduct user studies with

clinicians to determine the most effective ways to visualise data to ensure they can assess the information accurately and at speed.

In practice, this system acts as a sophisticated monitoring tool that flags anomalies as a patient goes about their daily life. The objective

informed decision ahead of time. In many heart failure cases, for instance, a clinician might be able to intervene remotely by prescribing a statin or adjusting a medication dosage. This improves the quality of care while keeping the doctor firmly in the loop. Ultimately, we are drawing on the expertise and

simply providing them with a more complete picture of the patient’s health. That distinction is a critical component of our work.

Doctors are often cynical about innovation. What response are you getting so far?

tools will make their processes significantly faster. We are even refining the simplest details to maximise the accuracy and efficiency with which a doctor can identify a risk region.

The medical community has been remarkably supportive, particularly in cardiology. Groundbreaking work by companies such as HeartFlow and CathWorks has already laid the foundation; clinicians have seen the practical utility of these models and are fully on board. The consistent feedback we receive, however, is that they require actionable metrics rather than raw data. A cardiologist does not want a massive zip file of step counts or unfettered access to a patient’s Apple Watch data – they simply do not have the time to sift through it.

Instead, they are excited by tools that can autonomously monitor for specific events or threshold changes and then provide a concise summary.

We have been focusing heavily on how to visualise 3D blood flow in a way that is immediately useful. By using augmented reality (AR) and extended reality (XR), we allow clinicians to interact with a patient’s anatomy in an immersive way. This enables them to identify high-risk regions almost instantly.

The response to these tools has been incredible. Clinicians are notoriously time-poor, yet when we run user studies in the cardiology department, they are often so engrossed in the technology that it is difficult to move the study along to the next participant. They recognise that these

The key is to move away from the idea that doctors just want more data; what they truly need is a system that analyses that data for them.

How close are we to this being usable outside of research environments like universities? What kind of clinical evidence is needed to make that shift?

I believe we will see the first targeted digital twins for specific disease states within the next five years. We are already incredibly close. While we currently have single-time-point personalised models in clinical use, the shift toward true digital twins for specific conditions – such as heart failure – is imminent. Within a five-year window, I expect to see these tools rolling out for a set of defined disease areas, expanding to a much broader range over the next decade.

Furthermore, within the next five to ten years, we may see this technology transition into wellness guidance for the general public, powered by data from personal wearables. This acceleration is largely due to immense advances in computing. The trajectory of GPU (Graphics Processing Unit) computing, combined with breakthroughs in AI algorithms, means we no longer require a massive supercomputer for every single simulation.

These models can now be deployed at the edge. We are reaching a point where these sophisticated simulations can run on an iPhone or a standard mobile device. We are getting remarkably close to a reality where high-level computational medicine is accessible, portable, and integrated into everyday life.

WHY STATIC PRICING WORKS IN UK

Nick Boyer, senior director, strategic consulting EMEA at Conga PROS, argues

that those

who treat pricing as

an

isolated task risk watching their margins erode.

PRICING across the UK healthcare supply chain is under pressure. Energy costs are unpredictable. Labour is more expensive. This has been compounded by regulatory complexities that have increased as a result of Brexit. Supply chains have adapted, but disruptions have not disappeared. For manufacturers that rely on imported parts or raw materials, exchange rate shifts add further uncertainty. At the same time, healthcare cost inflation remains high. At 10.6% in 2025, the UK sits among the highest in Western Europe. Although there has been some easing in specific areas, the wider picture is still one of strain.

NHS budgets are stretched, and waiting lists remain long. Some services depend on local authorities that are facing their own funding gaps, adding to a system already under pressure. Suppliers, however, are still expected to hold prices steady even as their own costs increase. The issue is not just rising costs but the speed at which they move. Many pricing models were built for stability. Today’s market is not stable. When costs shift month by month, but contracts lock prices in for years, the risk sits largely with the supplier. Margins tighten. Forecasting becomes harder. Decisions become reactive.

When stability meets volatility

Much of NHS procurement is designed to create certainty. Framework agreements, multiyear contracts and fixed pricing structures are intended to protect public finances. That approach makes sense in principle. In practice, however, prices are often agreed long before a contract is signed. From bid submission to final signature, inflation, currency shifts and policy changes can alter the cost base significantly. By the time the agreement goes live, the original assumptions may already be out of date.

Suppliers usually try to price this risk into their bids. It is a delicate balance. Be too cautious, and the contract is lost. Be too aggressive, and margin is eroded for years.

Many frameworks link annual uplifts to a standard inflation index and require adherence to fixed rate cards. That offers limited flexibility if labour costs jump or compliance requirements increase. In areas such as advanced imaging or AIenabled diagnostics, where research investment is high and technology evolves quickly, the gap between fixed prices and real costs can widen quickly.

The quiet erosion of margin

Margin rarely disappears overnight. More often, it fades between renewals. In healthcare, that erosion can be tricky to spot. Profitability may differ by product, region or contract structure. Some organisations only see the impact when they carry out a detailed review, sometimes years into an agreement.

Where pricing, quoting, and contracting data sit in separate systems, visibility is often quite limited. Finance sees one set of numbers. Sales sees another. Legal holds the contract terms. By the time concerns surface, the organisation may already be tied to unfavourable conditions. NHS contracts can also include mandatory templates,

PRICING NO LONGER HEALTHCARE

specific clauses and detailed service obligations. If the final agreement contains commitments not fully reflected in the pricing model, those obligations remain fixed. In a low margin environment, that matters, because even small uncosted requirements can remove what little profit was built into the deal and cannot easily be recovered once the contract is signed.

When pricing, quoting and contracting operate in silos, inconsistencies follow. Sales teams may agree on terms that sit outside approved frameworks. Quotes may drift from agreed rate cards. Contracts may rely on outdated templates or be amended without a clear record. Multiple versions circulate, which can lead to delays.

In healthcare, governance can be heavily scrutinised. Procurement cycles are complex and involve many stakeholders. Disconnected processes slow progress and make compliance harder to demonstrate.

More importantly, they make it harder to take full control of margin. If pricing decisions are made without sight of contractual obligations, or if legal terms evolve without checking financial impact, coherence is lost. Over time, that can undermine both profitability and trust.

A more connected approach

A more resilient model treats pricing, quoting and contracting as one joined-up commercial process.

Products, pricing rules, margin targets and contractual commitments should sit within a clear framework. Pricing strategy needs to reflect realistic cost forecasts and competitive pressure - sales teams need defined guardrails that align with NHS frameworks and internal policy. Contracts must reflect what has been approved and quoted, supported by a transparent audit trail. The goal is clarity, and technology can help with this, particularly where data is fragmented. When a price is agreed, it should be consistent with strategy, compliant with procurement rules and sustainable over the life of the contract.

Responding to cost pressure does not mean pushing risk onto customers. Often it comes down to structure. Separating elements with volatile

costs, such as third-party services, allows for more targeted indexation. It means being upfront about what sits behind the price, instead of quietly building in extra margin just in case something goes wrong. For healthcare suppliers, that means tighter internal coordination, clearer commercial rules and greater discipline in how deals are approved and documented, creating a stronger foundation for sustainable performance.

Adapting to a new reality

UK healthcare will likely remain financially constrained. Innovative suppliers may struggle to demonstrate value within fixed payment rates and cost-effectiveness thresholds. Yet innovation is essential if outcomes and productivity are to improve.

Static pricing models are increasingly out of step with this environment. NHS procurement is unlikely to abandon stability. Suppliers, however, need greater agility in how they manage pricing and contracts.

Those that continue to treat pricing, quoting and contracting as isolated tasks risk watching margin erode quietly over time. Those that bring these processes together, supported by better data visibility and, where necessary, upgraded commercial systems, are better placed to make informed decisions, protect value and remain compliant and trusted partners to the health system. Volatility is not temporary, and commercial processes should reflect the conditions of today’s market, rather than those of the past.

WE NEED A NEW APPROACH TO TACKLE THE LACK BSL INTERPRETERS

FEW incidents could more powerfully underline the challenges faced by British Sign Language (BSL) users in the UK than a hearing teenager being forced to tell his deaf mother that her father might die.

Yet this was the experience of Alan Graham’s family after he was admitted to Queen Elizabeth Hospital in Birmingham in 2021. The shocking tale was revived last month when a Parliamentary and Health Service Ombudsman report was published on Graham’s care.

It noted that during the 11 weeks he was in hospital, the trust provided professional interpreters on only three occasions and that it regularly used two of his grandchildren to interpret medical information and details about his prognosis.

Unfortunately, this isn’t an isolated incident. In recent times, there have been many reports of other deaf people struggling to access NHS services, despite both the Accessible Information Standard and the Equality Act making clear that service providers should make reasonable adjustments to enable deaf people to access their services.

A study conducted last year by the Royal National Institute for Deaf People (RNID) and SignHealth found that more than half of those who are deaf or have hearing loss have had to rely on a partner, friend or family member to interpret during healthcare appointments.

While this is alarming, it is not altogether surprising. The RNID estimates there are about 1,500 qualified BSL interpreters to serve the

Clare Vale, managing director of Sign Solutions, says the NHS must better technology to overcome the shortage of interpreters available to help deaf people.

87,000 deaf BSL users across the country. Put simply, for every 60 deaf people, there is only one interpreter.

Automatic provision needed

Graham’s daughter, Jennifer, argued interpreters should automatically be provided for everyone who needs them, and she’s right. But this is far from simple when we have such a dire shortage.

A best-case scenario may be to train more BSL interpreters, but this wouldn’t provide a quick fix. It takes seven years to be fully trained, and those working in the medical field must have a number of years’ experience beyond this to ensure their skillset is of the standard expected.

For now, we need to make better use of our limited professional resources, and technology can go a long way towards making this happen. NHS providers should consider using video interpreting to fill the gaps between face-to-face provision, so deaf people can access health services as and when they need them.

An interpreter answering on-demand BSL video calls can cover five to ten times more interpretation sessions than attending in person, providing increased access and cover for emergencies. In addition, video addresses the problem of hard-to-reach areas and thus

helps reduce geographic inequality.

And while it’s understandable users would prefer a face-to-face a video interpreter is preferable being delayed or requiring friends to act as interpreters.

The issue with using family and extends far beyond the emotional might face when explaining a serious medical diagnosis to a There is also the fact that they to communicate specific medical accurately, and there are also neutrality and confidentiality.

So why is video not being used Many healthcare staff are unaware demand BSL video interpreting while technical issues can also

Sometimes BSL interpreting is alongside foreign language interpreting this has historically been delivered in-person or via telephone, and not a viable option for deaf people. demand is now widely available language interpreting, but NHS been slow to take it up for languages, has also impacted its implementation

There’s also the fact that for too people have had to complain services they receive to bring For example, in September last

APPROACH LACK OF

Video interpretation isn’t ideal for every scenario, and there will be sensitive appointments where a face-to-face interpreter is more appropriate. But if technology is used when it is suitable, there’s a greater chance of a face-to-face interpreter being available for those times when they are crucial, and this will benefit the entire BSL community. of better use

Lewisham A&E departments introduced 24/7 BSL video interpreting after one user argued the hospital provided 24/7 interpreters for foreign languages and ASL but only offered them between 0900 and 1800 for BSL.

Access for deaf people

inequality. And while many BSL users would interpreter, a video treatment being and family to act and friends emotional strain they a potentially a loved one. they may be unable medical terminology also risks around confidentiality.  used more widely? unaware that oninterpreting is available, also be a deterrent.  is procured interpretingdelivered mostly and telephone is people. Video on available for foreign NHS bodies have languages, and this implementation for BSL. too long, deaf complain about the about change. last year, two

But we shouldn’t wait until a BSL user demands changes, we must be proactive about increasing access for deaf people.

One great example of this comes from Contact Scotland BSL service launched by the Scottish government in 2016. It allows BSL users to contact any public, third or private sector organisation and communicate via an ondemand video interpreter 24 hours a day, seven days a week. If such a service were replicated in England and Wales, it could alleviate many of the barriers faced by BSL users, not just in terms of healthcare but in all areas of their lives.

FROM INTEROPERABILITY

THE digital transformation of the NHS has long been a shared ambition for healthcare professionals, policymakers and the public. So when the UK government set out its 10 Year Health Plan last July, the direction was welcomed. The plan acknowledged that the NHS had fallen behind technologically and called for a shift from analogue to digital, including stronger interoperability, improvements to the NHS App and more connected records and services.

That ambition is important.

Healthcare in the UK is a deeply fragmented system, and better data exchange is essential. But interoperability alone will not deliver meaningful transformation.

For years, healthcare organisations have invested in capturing more data across the care journey, from research and clinical trials to providers and payers. The problem is that this data does not exist in a single, shared context. The same information can be interpreted differently depending on the care provider across different points in a patient’s journey. That is why interoperability became such an

Mahesh Naphade, head of healthcare and life sciences at Star, explains why connected systems alone will not transform the NHS.

important priority in the first place: to reduce confusion, improve consistency and enable safer data exchange across a complex ecosystem.

Yet even as systems become more connected, a deeper issue remains unresolved. Interoperability helps data move, but it does not determine how that data should be understood, prioritised or acted on in a specific situation. Nor does it solve another major healthcare challenge: the people interacting with digital systems are not standard users.

Connectivity does not mean one-size-fits-all

Most digital systems are designed for generalisation. In many industries, that is manageable; in healthcare, it is often not.

Most digital health platforms today remain static. They present the same workflows to every user, regardless

of age, literacy, physical ability or clinical complexity. An 80-yearold recovering from surgery may navigate the same interface as a digitally confident 25-year-old. Even if chatbots are introduced, they often sit atop fixed pathways rather than reshaping the experience itself.

This is where many current digital health systems in most developed countries fall short. They may capture the right information, but they often rely on fixed interfaces and standardised workflows that assume everyone can engage in roughly the same way. In practice, that creates friction for patients and an extra burden for clinicians in high-pressure environments.

More importantly, it weakens engagement – in healthcare, that is not a minor design issue. It can directly affect whether patients follow treatment plans, report symptoms accurately and stay active in their care.

INTEROPERABILITY TO ADAPTIVE CARE

Adaptive care can improve outcomes and reduce cost

For the NHS, this matters because adaptive care is not just about improving patient experience. It is about lowering the cost of care by helping patients engage earlier, follow treatment plans more consistently and avoid preventable deterioration that drives demand on what are already stretched services.

When patients can engage with systems tailored to their individual circumstances, they are more likely to understand what is being asked of them, contribute meaningful information and remain engaged over time. That can support earlier intervention, even prevention, and better adherence to care plans. In a public health system under severe operational and financial pressure, those gains matter.

This is also why the conversation needs to move beyond seeing digital transformation as a connectivity challenge alone. The next phase is not just about connecting systems; it is about making them more responsive to the context they operate in.

Due to advancements in generative and agentic AI, this vision can become a reality. The healthcare industry can now design systems which adapt in real time to the person using them; the underlying clinical purpose may stay the same, but the interface and interaction model can change. A system might simplify navigation for someone with low digital confidence, use voice or multimodal interaction for someone who struggles with typing, adjust language for a patient with lower health literacy, or provide deeper analysis to someone who wants to understand their condition in more detail.

New principles for an adaptive healthcare sector

For a public healthcare system like the NHS, digital transformation creates an unprecedented opportunity to redesign how care is provided across a highly diverse society such as the UK. It can give local GPs and community teams the infrastructure to better understand and support patients, helping move the system from treating illness after it appears to enabling earlier intervention and more preventive care.

This matters especially because the NHS is scaling its digital infrastructure. If that infrastructure is built only around interoperability and standardised workflows, there is a risk of creating a system that is more connected yet ultimately ineffective, and compounding rigidity.

None of this removes the need for governance. In healthcare, adaptability cannot come at the expense of accountability.

Clinical oversight must remain with human professionals, with clear escalation pathways, defined decision rights and robust auditability built into the system.

The NHS has made real progress in connecting systems, and that work remains essential. But integration alone will not resolve the friction patients and clinicians still experience at the frontline.

The next phase of digital transformation must go further: from connected systems to adaptive care. The real opportunity is not just to build a more digital, AI-ready NHS. It is to build one that responds better to the people within it.

SCALING THE FUTURE INDEPENDENT LIVING

THE routine medication run has become one of the most significant, yet avoidable, pressures on the UK’s social care system. For Nick Hucker, newly appointed UK Managing Director of Evondos Group, the solution isn’t just about smarter hardware - it is about a fundamental shift in how we deliver care at the neighbourhood level.

With nearly two decades of proven success in the Nordic markets, Evondos enters the UK at a critical juncture. As the NHS pivots from analogue to digital and from hospital-based treatment to community-led prevention, Hucker is tasked with moving the conversation beyond the pilot phase. His vision for the UK is one of deep systemic integration, where automated medicine dispensing acts as a safety net and frees up human carers to focus on social and emotional support.

Here, Hucker talks to Healthcare Today about the elephant in the room regarding health and social care funding, the surprisingly personal relationship patients build with their devices, and how a 99.7% medication adherence rate can transform not only individual lives but the entire care system.

Evondos talks about supporting independence and keeping people out of hospital. What actually changes in a patient’s day-to-day care? How do you do it?

Evondos is not a flash-in-the-pan newcomer; the company has been established for 18 years and is currently the leading automated medicine dispensing firm across seven markets. To date, we have dispensed over 120 million doses, averaging approximately

Nick Hucker, the newly appointed UK managing director of Evondos Group, talks about keeping people out of hospital and how technology fits into a discharge pathway.

Written by Adrian Murdoch.

40 million doses per year. Fundamentally, our model involves collaborating with Integrated Care Boards (ICBs), local authorities, and technology-enabled care providers to integrate our products directly into patients’ homes.

Our primary focus is to enable individuals to live independently for the long term. This mission aligns perfectly with the government’s 10 Year Plan and the shift toward neighbourhood-based care. We work across various care pathways, generally supporting patients with complex polypharmacy needs - those taking three to five tablets, multiple times a day. We coordinate with pharmacies to package medication into pouches, which are then loaded into the device.

At the appropriate times, the device notifies the patient to take their dose. Crucially, the system includes a video capability, allowing us to ensure that medication is being taken exactly as required.

The scale of the challenge is significant; the World Health Organization notes that medication adherence typically sits at around 50%, yet many of the patients we encounter have adherence rates as low as 40%. Our pilot data demonstrates that we can increase this to an extraordinary 99.7%.

Currently, around 33% of a carer’s time is spent on routine medication runs, often during the high-demand early morning period. By automating this process, we remove the need for those routine visits, freeing up overstretched carers to provide more meaningful, high-quality support.

Can you quantify the impact? What does success look like?

One of the most important shifts I have introduced to the business and the team is the move away from simply selling technology. We are not interested in merely selling a product to our partners. Instead, our focus is now entirely on demonstrating a clear tripartite benefit: a tangible improvement for the patient, a practical advantage for the care provider, and a demonstrable financial saving for the commissioner.

To achieve this, we analyse each distinct care pathway to identify the metrics that matter most to that specific stakeholder.

For some, the priority is often getting people out of hospital beds and back into their homes as quickly as possible. In other settings, the primary concern might be medication adherence or the reduction of avoidable readmissions. By identifying these key performance

FUTURE OF LIVING

What happens if there’s a problem with the patient and the patient deteriorates?

A critical differentiator for our platform is that we do not simply offer medication dispensing; we provide a robust means of monitoring and interacting with the patient.

Our video technology allows for a high degree of proactive engagement. For example, if there is a concern, we have the capability to initiate a call to a patient - let’s call her Mrs Smith - to check on her well-being and confirm that her medication has been taken.

There are rigorous protocols in place to manage these interactions. If a patient does not respond to these video calls or if the medication remains untaken, the system escalates the situation until a carer is dispatched to the home for a physical welfare check. This ensures that no lapse in adherence or health goes unnoticed.

What happens if something goes wrong? Wifi/power etc? How do you deal with that?

The reliability of our technology is underpinned by a high rate of remote fixes. In the rare event of a technical issue, we can resolve the vast majority of problems without a physical site visit, which is a significant differentiator for us.

However, we also maintain incredibly stringent protocols to account for real-world variables such as Wi-Fi outages or power failures. These contingencies are built into every care package we develop with our partners.

We have had instances where our teams were deployed on Christmas Eve following a power-cut anomaly to ensure a patient received their medication within the required clinical window. We leave nothing to chance because the stakes are

undeniably high. Medication nonadherence is linked to an estimated 200,000 deaths annually and costs the NHS approximately £500 million in avoidable hospital readmissions.

Our mission is to ensure that medication is administered safely and at the correct time, and every care provider we work with is covered by these exacting safety standards.

To what extent is your model about addressing workforce shortages in community care? Are you just replacing elements of human care or augmenting them?

When we engage with care providers, we demonstrate that our goal is never to reduce headcount. While the sector faces significant budget and staffing challenges, the

The most profound comes from themselves, a newfound independence.

need for care is constant. Our role is to free up time, not eliminate roles.

profound feedback the patients

The ripple effects of this efficiency are remarkable. In one recent case in Sweden, a single provider was able to reduce their travel by 70,000 kilometres per year. By removing those routine medication journeys, they not only saved vast amounts of time but also met their Net Zero targets.

Ultimately, the most profound feedback comes from the patients themselves, who report a newfound sense of independence. Consider the traditional morning routine: a carer might have 14 visits to complete between 0800 and 0900, meaning many patients are left waiting.

Our technology grants them the freedom to manage their own

schedule. When the care provider does arrive, the visit is no longer a rushed, functional medication run; it becomes an opportunity to focus on the vital social and emotional aspects of care.

What’s the biggest barrier to adoption at the moment?

It is no secret that the most significant hurdle for any new technology in this space is determining the funding mechanism. This is our primary area of development.

We are focusing on the intersection of healthcare and social care, asking the critical question: how do we work with our partners to move a project from the pilot stage to a state of scale and sustainability?

My team and our various partners are dedicated to ensuring that our solution is not viewed as an optional add-on, but as a core component embedded within clinical pathways.

Our goal is to become a fundamental part of the existing healthcare infrastructure, providing a long-term, sustainable answer to the challenges of medication adherence and independent living.

What does success look like for Evondos in the UK over the next three years? What were your goals?

Our strategy is inextricably linked to the three major pillars of the current government health policy: the transition from analogue to digital, the shift from treatment to prevention, and the move from hospital-based care to independent living.

These national goals are entirely consistent with our own mission to enable patients to live safely and independently in their own homes for as long as possible.

HOW TO REBUILD PATIENT IN JOINT PAIN

MORE than 12% of the population currently suffers from joint pain, which remains one

of the most common reasons that patients seek advice from healthcare professionals. Whether associated with osteoarthritis, inflammatory conditions, injury, overuse or simply the physiological effects of ageing, joint pain places a substantial burden not only on individuals but also on the wider healthcare system.

As our population ages and expectations around mobility and independence increase, consumers are increasingly adopting an active living lifestyle, devoting more of their time to physical and indeed mental activity to improve their overall wellbeing.

As a result, they can consider how their own pain management strategies can, through greater self-care, better support this positive lifestyle, enabling them to maintain mobility and remain socially engaged.

For many patients, joint pain is not simply a symptom but a barrier to participation in work, exercise, daily living and even restorative sleep. Poorly managed pain contributes to reduced physical activity, deconditioning, low mood and, in some cases, increased reliance on secondary care services. While some of this demand is unavoidable, a proportion relates to patients seeking reassurance or incremental adjustments to pain control that might be better managed through informed self-care.

Supporting informed self-care

This is where healthcare professionals play a pivotal role. Empowering patients to make appropriate over-the-counter (OTC) choices for mild to moderate joint pain can reduce avoidable appointments while maintaining safety and efficacy.

However, empowerment must be underpinned by education. Patients are often influenced by marketing messages or anecdote rather than clear evidence. Guiding them towards evidence-based selection – including reviewing the Summary of Product Characteristics (SmPC) where appropriate –ensures decisions are made on a clear understanding of dosing and formulation characteristics.

Not all ibuprofen formulations, for example, are manufactured in the same way. Advances in measurement may yield additional data on their differing characteristics as treatments despite delivering the same active ingredient. For example, lipid-based formulations of ibuprofen are designed to dissolve the active ingredient in lipids. Lipids are absorbed in the small intestine and are used in other medicines to aid absorption.

For patients, efficacy matters, but so does how well a treatment is tolerated. These factors together shape not just the relief that patients experience but also their confidence in managing joint pain day to day. Gastrointestinal concerns remain one of the principal limitations of

Philip Lindsell, managing discusses the challenges an era of active

non-steroidal anti-inflammatory drug (NSAID) use, particularly in older adults who may already have comorbidities or be taking concomitant medications. While no NSAID is without risk, understanding formulation differences enables more nuanced patient conversations.

Encouraging patients to read and understand product information – and guiding them through it where necessary – can support safer self-management and reduce inappropriate switching between products without clinical rationale.

PATIENT CONFIDENCE

PAIN RELIEF

managing director of Flarin, challenges of joint pain relief in active living.

Access and responsibility

The commercial availability of pain relief products has expanded significantly in recent years. Retail outlets such as supermarkets and pharmacies, together with online stores such as Amazon, now provide extensive availability, and patients frequently make their own choice of products rather than seeking advice. In the UK alone, pain relief products are widely accessible across high-street retailers as well as pharmacies. This accessibility has clear benefits in enabling consumers

to manage their symptoms themselves and reduce pressure on GPs and the NHS. However, where consumers do seek advice from a GP or at a pharmacy, it also places greater responsibility on healthcare professionals to ensure patients understand what they are selecting and why.

Joint and muscular pain relief products account for a substantial proportion of OTC analgesics sales. Poorly managed musculoskeletal pain has broader repercussions, contributing to lost productivity, increased sickness absence and secondary complications associated with inactivity.

At a time when healthcare systems are under intense financial and operational pressure, optimising management through self-care is not simply a clinical issue, it is a public health and economic imperative.

Safe and active living

Active living should be a shared goal across healthcare. Supporting patients to remain mobile and independent requires effective, accessible pain management strategies. This includes encouraging lifestyle interventions, which for some patients may include physiotherapy or even weight management, alongside pharmacological options where appropriate. OTC analgesics, when selected thoughtfully and used correctly, can form part of that toolkit.

For healthcare professionals, the challenge is balancing safety with

accessibility. The challenge is to avoid both under-treatment, which drives repeated consultations and patient dissatisfaction, and overreliance on systemic therapies where risks outweigh benefits. Clear guidance on duration of use, appropriate dosing and red-flag symptoms remains essential.

Structured, informed conversations about joint pain can make a real difference. When patients leave with clear, evidence-based guidance backed by reliable product information, the result is fewer unnecessary/trivial re-attendances and they become more confident in self-management.

Looking ahead

Looking ahead, the evidence around formulation science will continue to evolve, potentially offering a clearer basis of choice around such factors as improved tolerability and targeted effect. Evidence can then support education, transparency and professional guidance in responsible pain management.

Joint pain will continue to be one of the defining clinical challenges of an ageing population. Informed self-care, leveraging advances in the evidence around formulation science and maintaining a patient-centred approach, can reduce system burden while helping individuals remain active for longer.

In doing so, consumers can move closer to a sustainable healthcare model that supports active living and quality of life.

TAX-EFFICIENT PLANNING

AMONTH ago, the Spring Statement came and went without fanfare. No new announcements, no emergency measures, no unexpected twists.

For doctors scanning the headlines, it might have looked like good news - a moment of stability. But April has arrived, and with it, the consequences of that silence. The changes announced in last year’s Autumn Budget are now in effect, and for doctors - particularly those in mid-career or considering partnership - the financial pressure just intensified significantly.

The trap has closed

The income tax threshold extended in the Autumn Budget is now active. Those thresholds will remain frozen until 2031 - a full decade without adjustment for inflation or wage growth. For doctors, whose pay progression is predictable and earnings often cross critical thresholds early, the impact is immediate and brutal.

A doctor earning just over £50,000 will start to lose child benefit. For many hospital doctors, this happens around age 27. By £60,000, the benefit has disappeared entirely - over £2,000 a year gone for a family with two children. But the real sting comes at £100,000. Cross that threshold and your personal allowance starts to disappear, creating an effective 60% marginal tax rate on every pound between £100,000 and £125,140. You also lose access to tax-free childcare.

For doctors working additional sessions to cover rota gaps or taking on extra responsibility, this creates a flawed system where more work genuinely means less reward. And these thresholds aren’t moving.

As pay rises with inflation or doctors progress through pay scales, more will be pulled into these bands through fiscal drag. The trap is tightening without any new legislation required. For doctors approaching or crossing these thresholds now, proactive planning matters.

Maximising pension contributions, using salary sacrifice arrangements, or timing discretionary income can help manage exposure to the 60% trap. For those with partners earning less, rebalancing household finances through pension contributions may help preserve child benefit. These aren’t loopholes, they’re legitimate ways to structure your finances more efficiently.

Added complexities for GPs

The threshold freeze affects all doctors, but for GPs, the picture is particularly complex. Partnership income structures mean many are

Alec Collie, head of medical Financial Services, explains no fresh start for doctors’

affected by the 2% dividend tax rise that took effect this month. For those drawing income through a mix of salary and dividends, the calculation just became even more complicated.

Meanwhile, practices are adapting to new contract arrangements that took effect this month - and the uncertainty is taking its toll.

Our recent research into GP views on the new contract and NHS reforms found that 37% of GPs say the contract will make them consider early retirement within the next year.

Among those aged 45-54, that figure rises to 45%. The concern cuts across all roles: partners, salaried GPs and locums are equally worried.

PLANNING IS A NECESSITY

medical at Wesleyan explains why spring brings doctors’ finances.

The contract itself brings immediate pressures, but it’s the broader NHS 10 Year Health Plan reforms where uncertainty still looms.

Talk of neighbourhood health centres and technology investment lacks concrete detail on implementation, timelines, or funding.

What GPs do know is worrying, with 70% believing the reforms will intensify workload pressures, while 61% are concerned about increased financial risk and liability for practices.

Meanwhile, costs continue to rise, putting pressure on partner drawings, while the tax system simultaneously takes a bigger bite.

For doctors considering partnership, this creates genuine uncertainty. The financial rewards that once made partnership attractive are being eroded from multiple directions. The question many are asking is simply, is it worth it’? This is where specialist planning becomes essential.

Reviewing your salary-dividend split in light of the new rates, considering employer pension contributions as a more tax-efficient extraction method, and investing retained profits within the company rather than drawing them immediately can all help manage both current and future tax exposure.

For those holding profits longerterm, commercial investments may help grow company value, though these need careful structuring to avoid increasing capital gains tax liabilities at exit.

The calculations are complex, but the potential savings are significant.

Time to act

One month into these changes, the impact is already visible. When taking on an extra shift means facing a 60% marginal rate and losing childcare support, doctors make different choices. Some reduce hours. Others turn down leadership roles. A few leave the NHS entirely.

And there’s more to come. Next year, Cash ISA limits will be reduced, and pensions enter the inheritance tax net, adding another layer of complexity.

The Spring Statement’s silence was clear - relief isn’t coming. No adjustment for inflation. No recognition of the specific pressures facing doctors who lose benefits early, hit high marginal rates young, and navigate complex income structures.

So doctors need to understand exactly where they sit relative to these thresholds.

Knowing whether additional work pushes you into the 60% trap or costs childcare support changes how you think about rotas and opportunities.

For those with private work through limited companies, reviewing your salary and dividend split is now essential. For GPs considering partnership, understanding how practice income, tax thresholds and contract changes interact is no longer optional.

Tax-efficient planning is now a necessity when working harder can genuinely mean keeping less. Given the complexity of how these changes interact, specialist advice is essential for protecting what you’ve earned effectively. One month on from the Spring Statement’s silence, the question remains what doctors can do in response.

HOW TO DEPLOY AI SAFELY

HEALTHCARE has become one of the most discussed frontiers for artificial intelligence. From diagnostic models to medical imaging systems, the conversation often centres on whether machines might eventually replace clinicians. But this framing misses the more immediate reality.

The real question in healthcare AI is not whether machines can perform certain tasks. In many cases, they already can. The harder challenge is deploying these systems safely in environments where the cost of error is high.

Modern AI systems are capable of interpreting unstructured information, summarising complex inputs, identifying patterns across large datasets and generating structured outputs at speed. These capabilities make them particularly useful in areas where healthcare systems struggle most: navigating fragmented information and coordinating operational workflows.

AI can assist with tasks such as patient intake, information triage, documentation, and interpreting unstructured patient queries. By structuring large volumes of information quickly, these systems can reduce much of the operational

Healthcare tech founder Shirin Krall argues that AI is already more capable in healthcare than we admit. The real challenge is deploying it safely.

friction that surrounds care delivery. The technical capability is advancing rapidly. The harder question is not whether these systems can work, but how they should be integrated into healthcare environments where reliability, accountability, and safety matter more than speed alone. In other words, the bottleneck in healthcare AI is no longer capability. It is safe system design.

Healthcare operates under fundamentally different constraints from most industries. In many digital products, occasional errors are inconvenient. In healthcare, they can affect patient outcomes, which means the acceptable margin for error is far smaller.

Modern AI models remain probabilistic systems. Even when they perform well overall, they can still produce inconsistent outputs or confidently generate incorrect information, a phenomenon commonly referred to as hallucination. The challenge in healthcare AI is therefore not simply improving models. It is designing

systems that allow those models to operate safely within environments built around verification, accountability, and professional responsibility. Any AI deployed in this context must include mechanisms for review, escalation, and validation.

One of the most effective ways to deploy AI safely in healthcare today is through human-in-the-loop system design. In these systems, AI performs tasks where it has clear advantages: interpreting unstructured information, summarising inputs, structuring data, and surfacing relevant insights. Clinicians then review those outputs and make the final judgement.

Human oversight should not be treated as a fallback when systems fail. It should be designed into the architecture of the system itself.

Both clinicians and AI systems have error rates. Human decision-making can be affected by fatigue, workload, or incomplete information. AI systems, while increasingly capable, can still produce unreliable outputs.

DEPLOY

Combining the two can therefore produce more robust outcomes than relying entirely on either. AI processes information at scale, while clinicians apply contextual judgement where decisions carry real consequences. Much of the public discussion around healthcare AI focuses on clinical decisionmaking. In practice, some of the most immediate improvements may come from addressing operational inefficiencies.

Healthcare systems remain highly fragmented. Patient enquiries arrive as unstructured text, clinical services are described inconsistently across providers, and administrative workflows often rely on manual coordination. Much of this complexity comes from organising and navigating fragmented information across patients, providers, and systems – exactly the type of problem modern AI systems are well suited to address.

In aesthetic medicine, these challenges appear early in the patient journey. Patients rarely arrive requesting a specific treatment. Instead, they describe a concern, such as improving skin quality or addressing lines, leaving clinics to interpret intent and determine the appropriate next step. In systems we built at MARBL for aesthetic

clinics, where we structured and normalised more than 100,000 individual services across providers, models were generally capable of interpreting these unstructured patient requests and narrowing down appropriate treatment options.

Rather than replacing the consultation, the system acted as a form of prequalification. It could interpret the patient’s concern, capture relevant context, explain appropriate treatment options, and narrow the range of suitable paths before the patient reached the clinic.

Clinicians still made the final decision on treatment, but the intake, fact gathering and patient education that often consume much of the consultation process could already be completed.

Interestingly, when workflows failed, the cause was rarely AI misunderstanding. In many cases, the system reached the correct decision point, such as initiating a booking, but the process broke down during execution.

Completing the action required interacting with the clinic’s practice management software. While the AI could determine what should happen next, implementing that action reliably through existing clinic

software proved far less predictable. In other words, the system often knew what should happen next. The difficulty was making it happen within the constraints of existing healthcare infrastructure. As models improve, the balance between automation and human oversight will likely evolve.

Today, the safest way to deploy AI in healthcare is through systems that combine machine capability with human review. AI can interpret information, structure complex inputs, and surface insights at speed, while clinicians apply judgement and accountability where decisions affect patient outcomes. This reflects the realities of healthcare environments, where the cost of error is high, and current AI systems remain probabilistic.

As models become more reliable and evaluation methods improve, AI systems may take on greater levels of autonomy in certain parts of care. For now, the most effective healthcare AI systems are those designed as structured collaborations between machine capability and human expertise.

The real constraint in healthcare AI is no longer model capability. It is the systems that those models must operate within.

FROM TIKTOK TO POLARISED

MILLIONS of people in the UK are now encountering health advice first on their telephones, not from clinicians. Viral clips rack up views in which influencers insist, for example, that women “retain” the DNA of previous sexual partners and later bear children who resemble their exes, an idea recently spotlighted in Louis Theroux’s Manosphere documentary. These claims are biologically baseless, yet they travel fast, often reaching teenagers and vulnerable groups long before a GP, the NHS or a trusted public body appears in their feed.

This is just one example in a wider pattern. From “gut-health hacks” and miracle anxiety cures to conspiratorial takes on new treatments, an always-on stream of content is reshaping how people understand their own bodies and risks. Much of it is confident, emotive and wrong, and it lives in the same feeds as legitimate medical voices, often indistinguishable at first glance.

Taken together, these threads tell a single story. We have allowed a vacuum to open up between scientific evidence and what people actually see, share and act on. In that gap, politicised commentary, commercial incentives

Louise Clarity must

and algorithmic reshaping health.

Trust in UK high, but it has become identity politics, as questions evidence. The on the frontline. anxiety and who arrive podcasts and rather than teams are at once: confused presentations, treatments

When misinformation areas of treatment organisations and even market clarity, speed communication they are central whether the matters most.

To make progress, about why the attention TikTok about a sinister pharma absorb than NICE guideline. identity-based to be shared; conditional

Social platforms, engagement,

TIKTOK PSEUDOSCIENCE POLARISED POLITICS

Louise Kitchingham, senior vice-president at Clarity Global, explains why UK healthcare must treat misinformation as an emergency.

algorithmic amplification are quietly how the UK public understands

clinicians remains comparatively is no longer unshakeable. Health become entangled in culture wars and politics, as many areas are framed questions of allegiance rather than The consequences are visible frontline. Clinicians describe rising and confrontation from patients armed with half-remembered and TikToks, seeking validation than explanation. Public health forced to fight on several fronts confused expectations, delayed presentations, and suspicion around new or technologies.

misinformation touches sensitive treatment and care, healthcare organisations face serious reputational market risk. In this climate, speed and consistency of communication are not “nice to have”; central to clinical safety and to the public trusts guidance when it most.

progress, we have to be honest misinformation keeps winning attention battle. A confident, emotive about a “natural” cure for anxiety or pharma plot is far easier to than a carefully worded guideline. Stories, outrage and based narratives are designed shared; probability ranges and conditional language are not.

platforms, built to maximise engagement, naturally reward content

that shocks, simplifies or polarises. Health misinformation is particularly “sticky” because it appeals to fear and hope at precisely the life stages when people feel most uncertain. Younger generations increasingly treat social media as their main source of news and advice, navigating an endless stream of confident claims without the tools to weigh evidence or spot red flags.

Regulation, meanwhile, remains fragmented and slow. The Online Safety Act and Ofcom’s codes are meaningful steps, but they focus largely on illegal content. Much of what does real damage in health sits in a lawful-but-harmful grey zone: monetised “wellness” products with exaggerated claims or ideologically slanted takes on complex science. Enforcement is patchy, and the result is an information ecosystem in which bad actors enjoy structural advantages and reliable information is often late, bland or invisible.

If false information can alter behaviour in ways that cost lives, then strategic communication is a patient safety intervention. That requires a mindset shift. This is not about spin or glossy campaigns. It is about designing communication ecosystems that are as robust, proactive and evidence-based as the clinical care they support.

First, healthcare organisations need to move from reactive firefighting to genuine surveillance of the information environment. Social listening, media monitoring and horizon-scanning should be embedded disciplines, not occasional crisis tools, with clear triggers for when and how to respond.

Second, there must be a shift from institutional broadcasting to human, platform-native voices. Official channels still matter, but they are not enough in a world where trust is relational and highly visual. People want to hear from real clinicians and credible experts, in plain language, on TikTok, Instagram, YouTube and in community WhatsApp groups. That means training and protecting those voices, providing guidance and clear guardrails so that participation online feels safe rather than professionally risky.

Third, we need to move from a narrow focus on “myth-busting” towards building long-term literacy and resilience. Releasing a statement that bluntly declares “X is false” can inadvertently amplify the very idea it is trying to knock down. A more sustainable approach equips the public, especially young people, to interrogate claims themselves: to ask who is speaking, what evidence is cited, whether there is a plausible mechanism, and whether trusted independent bodies agree.

The defining challenge of the next crisis is likely to be whether our information infrastructure works as well as our clinical one. We can’t afford a repeat of the pattern in which conspiracies, half-truths and politicised narratives outrun well-evidenced advice at every turn. We also can’t assume exhausted clinicians and under-resourced comms teams can win that race without new tools, mandates and support.

If we recognise misinformation as the systemic risk it is, and respond with the seriousness usually reserved for clinical safety, there is a real opportunity. The UK could be better informed, more confident in evidence, and less easily manipulated when the next crisis hits. That will demand coordinated action from government, regulators, platforms, healthcare leaders and communicators.

HEALTHCARE organisations are balancing workforce shortages, rising operational costs and growing levels of staff burnout, while also responding to increasing patient demand driven by ageing populations, making the need for effective communication between individuals and departments crucial for managing intense workloads.

New research has revealed that 62% of healthcare organisations experience downtime due to connectivity issues. With 215 NHS trusts in England alone, and the NHS planning to build smart connected healthcare environments, IT issues no longer solely affect IT. The reality is that any interruption to a healthcare organisation’s network is no longer solely an operational inconvenience. In fact, any communication failure can now halt diagnostics and monitoring, or treatment and, consequently, pose a significant risk to vulnerable patients.

Supporting employees with the rollout of complex communication tools remains a persistent issue in the healthcare sector. Nearly two-thirds (62%) of healthcare professionals report that they receive insufficient training when new technology is introduced. As a result, many lack the confidence needed to effectively use new systems in their daily work, which can create siloes and delays when teams have trouble getting access to patient records or coordinating across departments.

Too many tools

Alongside a lack of resources, healthcare employees struggle with or are even reluctant to adopt new technologies and systems. In fact, the same survey found 63% of healthcare employees are hesitant to embrace new tools, often due to the growing number of communication platforms that are being used across healthcare organisations. Two-thirds (66%) of healthcare professionals

WHEN COMMUNICATION FAILS, PATIENTS

admitted to feeling burdened by too many tools, yet 64% say they lack access to communication technologies that are tailored to their specific roles. This creates a disconnect between the number of platforms available and the practical needs of frontline employees.

The consequences of this fragmentation extend further than just internal workflows. In fact, when healthcare professionals have to navigate multiple systems or rely on outdated communication tools, the effects can and will be felt directly in patient care. This is especially exacerbated in

Steven Wishart, head of writes that disconnected patient care

time-sensitive situations such as emergency admissions or when clinicians need quick access to patient records or test results. When communication systems are outdated or poorly integrated, critical information may not reach the right teams in time. As a result, treatment decisions could be delayed, even leading to missing or misinterpreted information.

COMMUNICATION PATIENTS PAY

healthcare,

UK at Mitel, disconnected communication puts care at risk.

Fortunately, this new research already highlights a shift in priorities among healthcare leaders, who are now increasingly looking to invest in technologies and workflows that directly support frontline staff and patient care. As a matter of fact, on average, 60% of healthcare IT decision makers say they now prioritise workflows designed to empower healthcare professionals,

reflecting a broader recognition that digital tools must simplify day-to-day clinical work, rather than complicate it. That being said, investment in new technologies alone isn’t always enough.

In order to truly improve care delivery, organisations should be thinking about modernising and integrating communication tools within clinical workflows from the outset. Without this, fragmented systems can create operational gaps that significantly impact coordination and limit overall visibility, which will, ultimately, harm the patient experience.

The right information at the right time

This is particularly obvious in emergency and critical care environments, where 68% of healthcare leaders are prioritising improvements to workflows. In high-pressure settings such as these, it’s vital that communication within and across different departments is seamless, to ensure that clinicians have access to the right information at the right time.

More importantly, though, the need for seamless collaboration and increased efficiency has to extend beyond the emergency settings. Already, healthcare leaders are increasingly focused on improving everyday operational workflows, with 59% of decision makers now targeting nursing and inpatient care processes to better support daily clinical operations while also investing in public health and preventative care workflows. By improving coordination across different care pathways and departments, healthcare providers can reduce inefficiencies and avoidable trips to A&E, close operational gaps and move toward a proactive, patient-centred model of care, which will better support long-term outcomes.

Ultimately, modernising healthcare systems will require more than simply introducing new digital tools and replacing legacy ones. Organisations must ensure that their communication technologies are not only reliable, secure and fully integrated into clinical workflows, but also that their teams are fully trained and confident in using them, otherwise collaboration across departments may remain fragmented and inefficient. When implemented thoughtfully, however, modern communication systems can streamline collaboration and reduce operational friction, but most of all, ensure that patient safety remains central through every stage of digital transformation.

LESS BURDEN, MORE

FROM at-home diagnostics to AI-powered health tracking tools, digitally powered prevention is changing healthcare for the better - but adoption remains patchy. Why? Recent research suggests that one in six healthcare leaders is concerned about the added burden on frontline staff. This belief holds back the benefits.

From simple sensors to AI-powered tools, digitally powered prevention saves time, costs, and capacity. Athome diagnostics are empowering people to self-manage their conditions at home, reducing system demand.

Early detection tools are catching conditions early, enabling swift intervention. And pathwayintegrated digital solutions are transforming care pathways from reactive to proactive. These new technologies give healthcare professionals the ability to focus on what matters: people, not processes.

Healthcare leaders see the potential of digitally powered prevention, but have reservations. While 83% believe digitally powered prevention will drive better health outcomes, they’re concerned about unintended consequences.

Their biggest worry? Added pressure on frontline staff. This isn’t a technology problem - it’s a change management problem. Adopting digitally powered prevention means changing ways of working and using technology to transform care pathways rather than digitising existing pathways.

The answer is to make it easy for frontline workers through simple selection, high-value use cases, and attitudinal shifts.

Take the guesswork out of selection

From screening to clinical notetaking, there are many proven examples of technology reducing the burden on staff and performing tasks as well as, or better than, a human. However, badly designed or poorly implemented technology increase the burden. The challenge is differentiating between the good and the bad - especially when there are so many options to choose from.

The sheer volume of unregulated suppliers of ambient voice technology (AVT) - which combines speech recognition and natural language processing to capture

James Davis, healthcare explains how healthcare digitally powered prevention

patient-clinician conversations in real-time for notes and letters - has been likened to a ‘wild west’. In response, NHS England has created a pre-approved AVT framework to take the guesswork out of selection. Importantly, a national, digital Health Store will help ICBs and practices choose from medically-approved diagnostic devices. The Health Store will be available on the NHS App, supporting smooth selection.

The action for healthcare leaders is to engage with these frameworks.

MORE BENEFIT

expert at PA Consulting, healthcare leaders can make prevention strategies work.

But they can also look to promising pilots for specific solutions, identifying pilots with strong outcomes to justify expansion into other use cases. Crucial to this is an overarching evaluation framework that supports comparisons and scalability across the system.

Start with big-ticket items

The question isn’t whether technology is mature or accessible enough. It’s about which solutions will achieve the highest value in the

shortest timeframes. The action for ICBs and practices is to pinpoint high-demand areas where digitally powered prevention will deliver the strongest results. This is likely to differ by location, underscoring the need for local flexibility when applying new solutions. Existing local health data from EPR and GP systems can be used to identify and launch two or three ‘quick win’ initiatives with measurable ROI.

Crucially, successes need to be shared and replicated. There’s a role for NHS England and the Department for Health and Social Care to find and encourage promising pilots, combating pilot purgatory by supporting scalability. National bodies are the connective

tissue, linking ICBs so that impactful pilots can be replicated elsewhere. Each major technological shift takes confidence. Take technologyenabled care (TEC). What was once a novel concept is now a core part of social care, supporting people to live more independent, safer lives. Local authorities such as Kent County Council are demonstrating the advantages - one project alone delivered a financial benefit of more than £350,000 over a 12-month period. Councils like Gateshead bring the numbers to life by communicating the tangible, positive impact on individuals, sharing stories with social workers and other organisations involved in people’s care. The same approach needs to be taken with newer digitally powered prevention tools.

Workforce confidence

Leadership confidence leads to workforce confidence. If leaders worry about the added burden on teams, frontline staff will pick up on and internalise this sentiment. This doesn’t mean leaders should pretend things will be easy. It’s about shifting mindsets from risk to reward - and seeing digitally powered prevention as capacity saving, not draining. A combination of financial metrics and human storytelling, communicated widely, will build confidence.

While there might be teething problems, digitally powered prevention is worth the bite. Healthcare leaders - the decisionmakers and strategists who set the direction - can make it easier for frontline teams through defined procurement frameworks, identifying and supporting successful use cases, and sharing human stories that speak to hearts and minds. It will take time and energy, but the investment will be worth it.

OUTSOURCE YOUR MEDICAL REFOCUS ON WHAT

WHEN we need specialist help, we go to experts. The same should apply to your medical billing. Running a private practice is hugely rewarding but it’s also demanding.

Between seeing patients, managing their clinical pathways and keeping everything moving it is often the medical billing that can quickly become the part of the job that drains the most time and energy.

That’s where outsourcing to professionals can make a real difference.

At Civica Medical Billing and Collection (MBC), we’ve been supporting private consultants, groups and hospitals for more than 35 years. Today, we work with over 2,500 partners across the UK, covering every speciality. And the feedback we hear time and again is simple: “I wish I’d done this sooner.”

More time for patients

The biggest benefit of outsourcing isn’t financial, it’s time.

When you remove the burden of invoicing, chasing payments and dealing with insurer queries, you free up valuable time to focus on your patients. Free from the burden of financial admin and those awkward conversations about money you and your team can focus on the patient’s clinical journey and growing the practice.

Your secretary can respond more quickly to new enquiries. Patients experience a smoother, more

When you remove the burden of invoicing, chasing payments and dealing with insurer queries, you free up valuable time to focus on your patients, says Civica’s Simon Brignall

professional service alongside excellent care.

Many of our clients tell us that once they step back from having to manage the billing, their practice revenue increases. This is often as result of being able to redirect their energy back into the key areas of patient care and service.

Billing is a business function, and it’s complex

As a consultant, you’re highly trained in your clinical field. But managing your own private practice also means running a business, and billing is one of the most technical parts of it.

There are more than 2,000 CCSD procedure codes and the schedule is updated monthly. Every insurer has its own pricing as well as coding rules for invoicing multiple procedures. Small errors can lead to delays, underpayments or rejected claims and in some cases derecognition.

This is a lot to stay on top of, especially when it’s not your core expertise.

As this is one of the primary roles of

a medical billing company it is their responsibility to ensure that you stay up to date with coding changes, insurer rules and fees, helping to ensure you optimise your revenue and your billing remains compliant.

Improving cashflow and reducing bad debt

Cashflow is the lifeblood of any practice. But we regularly speak to consultants experiencing:

• Delays in sending invoices

• Difficulties reconciling payments

• Inconsistent chasing processes

• Limited visibility of what’s outstanding

• Restricted payment options for patients

MEDICAL BILLING AND WHAT MATTERS MOST

Over time, these issues impact income, affect cashflow and create unnecessary stress. At Civica MBC our approach is straightforward as our fees are based on the income received which means we share the same objectives. Through timely invoicing, proactive chasing and by offering a range of simple secure payment options we achieve an average bad debt rate of less than 0.5%. In some instances, this can even be as low as 0.18% [based on Civica MBC client data].

Meeting the needs of the modern private patient

Private patients expect convenience. They want to pay quickly and securely, often outside traditional

working hours which means offering a range of payment solutions.

Outsourcing can be the easiest way to deliver these. At Civica MBC we offer:

• E-billing to insurers and patients

• 24/7 online and phone payments

• Text message reminders (with a 75% success rate within 14 days)

• Advanced self-pay collection tools

• Simple payment of multiple invoices

• Website payment links

These aren’t just “nice to have” features. They genuinely improve the patient experience and when it’s easier to pay, payments arrive sooner.

Removing staffing pressures

Recruiting and retaining experienced staff isn’t easy. Absence, staff turnover or increases in patient footfall can prove challenging and can often disrupt your finances.

Outsourcing gives you access to experiences staff when you need them.

At Civica MBC our service is built on a solid foundation of UK-based Dedicated Account Management which means that you have MBC’s capacity on tap to support your growth.

As your practice grows, we scale with you. There’s no need to make difficult hiring decisions or worry about bottle necks and delays.

It’s expertise on tap, when you need it.

Clear visibility and better decision-making

One of the most common weaknesses we see in private practice is a lack of up-to-date financial insight. If you can’t clearly see what’s been billed, paid or chased, it’s difficult to plan confidently.

Our client dashboard provides transparent reporting across activity, payments and income, giving you the visibility you need to make informed decisions about your practice.

A partnership built properly

Outsourcing your billing is a big decision. It’s important to know who will be handling your accounts, where they’re based and how the service is delivered.

At Civica MBC, we place real emphasis on partnership. Our structured onboarding process supports you through the transition and beyond, ensuring continuity and confidence from day one.

After more than three decades in this sector, we understand that trust matters. Our role is to remove the burden of billing, so you spend less time on paperwork and more time with patients.

If you’re considering your next step, it might be worth asking: what could you do with that time back?

Discover more about Civica Medical Billing and Collection here.

WHY THE FUTURE OF MEDICAL LIES IN UNDERSTANDING

The limitations of income-led underwriting

For decades, the dominant model of medical malpractice underwriting has been built around a single axis: how much does this clinician earn? Income has served as a convenient proxy for exposuremore procedures, greater income, greater risk. But this approach flattens a richly complex picture into a single number, and in doing so, it fails both clinicians and the patients they serve.

A consultant performing a high volume of complex orthopaedic procedures carries an entirely different risk profile to a colleague in cardiology practice at a similar income level. A clinician who actively seeks patient feedback, maintains transparency in their outcomes, and commits to continuous professional development is demonstrably different from one who does notyet traditional underwriting treats them identically.

This is not merely an abstract concern. Inaccurate risk pricing has real consequences: it crosssubsidises high-risk practice at the expense of clinicians who have invested in doing things right, and it removes any financial incentive for consultants to improve the patient experience. The result is a market that inadvertently rewards mediocrity and penalises excellence.

THEMIS and the pursuit of intelligent underwriting

When THEMIS set out to build a different kind of medical indemnity provider, we started with a fundamental question: what actually predicts risk? The answer, we found, is not income alone. It is a

Medical indemnity has long been priced on a blunt instrument: income. It is time for the profession - and for underwriters - to ask whether that is good enough. George Maughan, director of insurance services at THEMIS Clinical Defence, believes it is not.

constellation of factors: the speciality and scope of practice, the flexibility with which a clinician works across different settings and procedures, the quality of communication with patients, their engagement with clinical governance, andcrucially - what patients themselves say about their care. This belief sits at the heart of how we have built our underwriting engine. THEMIS uses real claims data and specialist medical malpractice underwriters to develop premiums that are meaningfully tailored to the individual clinician - not to a generic income band. Our bespoke, contractual indemnity policies are designed to reflect who a clinician actually is, not simply what they earn.

Our AI-assisted underwriting engine is built to do exactly this: to hold multiple dimensions of a clinician’s practice in view simultaneously, and to translate that nuanced picture into a premium that genuinely reflects their risk. This is not just a technical achievement - it is an ethical one. Pricing risk accurately means pricing it fairly, and that matters enormously to the clinicians we serve.

Three pillars: Risk, flexibility, and patient safety

Our underwriting philosophy rests on three interconnected commitments.

1. A thorough understanding of clinical risk

Risk in medicine is not static. A consultant’s scope of practice may evolve; they may expand into new procedures or reduce their caseload as their career matures. Our underwriting engine is designed to engage with this dynamismassessing not just what a clinician does today, but how the texture of their practice is likely to develop. This requires access to rich data and the analytical capability to interpret it, and it is precisely what artificial intelligence enables us to do at scale.

2. Flexibility of practice

Modern consultants in private practice do not fit neatly into boxes. Many work across NHS and private settings, across multiple specialties or sub-specialties, and in a variety of clinical environments. Traditional

MEDICAL INDEMNITY UNDERWRITING

THE WHOLE CLINICIAN

-insurance products frequently struggle to accommodate this complexity, leaving clinicians either underinsured or paying for coverage that does not reflect the reality of how they work. THEMIS’s approach is different: we build policies around the individual, not the other way around. Our AI engine allows us to assess portfolios of activity with a precision that human underwriting alone could not achieve.

3. A commitment to patient safety

Patient safety is not merely a regulatory requirement or a marketing phrase - it is the purpose around which all sound clinical practice should be organised. We believe that insurers have a role to play in reinforcing that culture, not just responding to it after the fact. When we reward clinicians whose patients consistently report outstanding experiences, we are making a statement about what good practice looks like. We are saying, in concrete financial terms, that transparency and excellence are not just morally admirable - they are measurably lower risk.

The Doctify partnership: Turning patient voice into underwriting signal

Our new partnership with Doctify is, I believe, a natural and important expression of this philosophy. Doctify is one of the UK’s leading platforms for clinician reviews and patient booking in private practice. Consultants who consistently earn outstanding patient reviews through Doctify will now be rewarded with meaningful savings on their THEMIS indemnity premiums.

This is not a marketing exercise. It is an underwriting decisionone grounded in the genuine belief that patient experience data is a meaningful predictor of clinical risk. Clinicians who attract consistently positive reviews are, as a population, doing things right: they are communicating well, managing expectations, maintaining good outcomes, and creating the conditions in which complaints and claims are less likely to arise.

By integrating Doctify review data into our underwriting approach, we are adding a new and powerful dimension to our AI engine. We are enabling our underwriters to see not just the clinical and procedural profile of a consultant, but the lived experience of their patients. That, to my mind, is a genuine step forward for the profession.

What this means for the future of medical indemnity

The medical indemnity market is at an inflection point. Litigation risks facing clinicians and hospitals are higher than ever, as Miss Lorna Phelan, Consultant Obstetrician at Imperial College Healthcare

NHS Trust, has noted - and the consequences for the advancement of medicine and provision of patient care are real. Against this backdrop, indemnity providers who continue to rely on crude proxies for risk are not just being imprecise. They are failing the clinicians and patients who depend on them.

At THEMIS, we are committed to a different path. Our underwriting engine will continue to evolveincorporating new data sources, refining its analytical models, and deepening its understanding of what good clinical practice looks like. The Doctify partnership is one significant step along that road, but it is not the last. We believe that the consultants who invest in their patients - who seek feedback, who embrace transparency, who strive to improve - deserve to be recognised for it. Not just with a certificate on a wall, but with a premium that reflects the lower risk they genuinely represent. And we believe that underwriters who cannot see that difference are not doing their jobs properly.

A call to the profession

If you are a consultant in private practice who takes patient experience seriously, I would encourage you to explore what THEMIS and this partnership with Doctify can offer you. The era of one-size-fits-all medical indemnity is drawing to a close. The future belongs to providers who are willing to look further, think harder, and build insurance products that are genuinely worthy of the professionals they serve.

At THEMIS, that is the standard we hold ourselves to. And with partnerships like this one, we are just getting started.

WEIGHT-LOSS INJECTIONS: LEGAL RISK AND EMERGING

THE rapid rise in the use of weight-loss injections in the UK has created a convergence of clinical innovation and legal risk. Originally developed for the management of type 2 diabetes, these medications are now widely prescribed - and in some cases obtained outside traditional care pathways - for obesity management.

It is estimated that last year 1.6 million adults - 3% of the population - used them. For healthcare providers, insurers, and medical malpractice practitioners, this evolving landscape raises important questions around patient safety, standard of care, and liability exposure.

What Are weight-loss injections and what are they intended for?

Weight-loss injections primarily refer to glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide and liraglutide. In the UK, these are marketed under brand names such as Wegovy (semaglutide for obesity), Ozempic (semaglutide for diabetes), and Saxenda (liraglutide). These drugs work by mimicking hormones that regulate appetite and insulin secretion, leading to reduced food intake and improved glycaemic control.

They are licensed in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) and in practice, access is through specialist NHS weight management services or private providers. However, increasing numbers of patients are sourcing these medications via online pharmacies and prescribing platforms. There is also a growing pipeline of similar agents, including

Neil Rowe, head of practice at Maulin Law takes a look at the medico-legal impact of “skinny jabs”.

dual and triple agonists such as tirzepatide (marketed as Mounjaro).

It is widely anticipated that further drugs in this class will receive UK licensing soon, expanding both therapeutic options and the potential medico-legal risk profile.

Growing popularity and media reports

Media coverage has significantly amplified public awareness. Reports highlighting rapid weight loss, celebrity use, and social media promotion have contributed to surging demand. At the same time, investigative journalism and professional commentary have raised concerns about:

• Ease of access through online prescribing platforms

• Inadequate patient screening

• Supply shortages affecting diabetic patients

There is increasing evidenceboth anecdotal and reflected in regulatory commentary - that some online providers have prescribed these medications without adequate clinical interaction. In certain cases, prescribing decisions appear to rely heavily on online questionnaires, without face-to-face or even video consultation. Such practices have been criticised by professional bodies as potentially falling below expected standards of care.

Known side effects and clinical risks

While generally considered effective, GLP-1 receptor agonists are not without risk. Common side effects include:

• Nausea, vomiting, and diarrhoea

• Gastrointestinal discomfort

• Fatigue

A key issue emerging in recent clinical and medico-legal commentary is gastroparesis (delayed gastric emptying). Although these medications intentionally slow gastric emptying, there are increasing reports of more severe or prolonged symptoms consistent with gastroparesis, including persistent vomiting, abdominal pain, and inability to tolerate oral intake. This complication has become central to litigation in other jurisdictions.

More serious risks include:

• Pancreatitis

• Gallbladder disease

• Hypoglycaemia (particularly when combined with other therapies)

• Potential psychiatric effects, including mood changes

Uncertainty also remains regarding long-term safety as further data is gathered.

Minimising risk: Practical steps for pharmacists and doctors

To mitigate the risk of complaints or claims, healthcare professionals should adopt a cautious, structured, and well-documented approach:

Robust patient assessment

• Verify BMI, comorbidities, and obtain a full medical history

INJECTIONS: CLINICAL PROMISE, EMERGING LIABILITY TRENDS

• Independently corroborate patient-provided information where possible

• Exercise heightened caution in remote or online consultations

Informed consent

• Provide clear, balanced information on benefits, material risks, and reasonable alternatives

• Specifically address gastrointestinal risks, including the possibility of gastroparesis

• Document discussions thoroughly

Appropriate prescribing

• Adhere to licensed indications wherever possible

• Avoid prescribing where adequate assessment cannot be achieved

Monitoring and follow-up

• Establish mechanisms for ongoing clinical review

• Provide clear advice on escalation of adverse symptoms

Supply chain vigilance

• Ensure medications are sourced from legitimate suppliers and not “counterfeit”

Clear communication

• Manage expectations heightened by social media and avoid overstating benefits

Scope for clinical negligence and product liability claims

The expansion of use beyond traditional clinical pathways increases exposure to both clinical negligence and product liability claims.

Clinical Negligence Claims may arise where:

• Prescribing occurs without adequate assessment, particularly in online settings

• Risks -including gastroparesisare not properly explained

• Patients are not appropriately monitored

• Adverse effects are not recognised or managed promptly

Courts are likely to scrutinise whether remote prescribing models meet the Bolam/Bolitho standards. Informed consent arguments may centre around factual causation and whether the patient even if fully informed of the risks would still have proceeded.

Product Liability

The most significant recent development is the emergence of large-scale litigation in the United States concerning GLP-1 drugs, including Ozempic, Wegovy, and Mounjaro. Thousands of claims have been brought and consolidated into multidistrict litigation, with allegations that manufacturers such as Novo Nordisk and Eli Lilly failed to adequately warn patients and clinicians about serious risks, particularly gastrointestinal injury and gastroparesis, over and above the anticipated nausea and discomfort. There have also been reports of visual stroke.  A central issue will be intended versus offlabel use (e.g Ozempic for diabetes, Wegovy for obesity).  Given the typical lag between widespread use, adverse event reporting, and litigation, it is likely that it will take some time before individual or group claims emerge in the UK. Should those claims arise it will be interesting to see if the focus will fall on the manufacturers rather than providers.

Implications for insurers and brokers

Insurers and brokers should anticipate increased claims activity and consider proactive risk management strategies:

Policy Review: Ensure coverage reflects risks associated with remote prescribing and weight management services; exclusions might be indicated, reserving rights may be appropriate for off-label use

Underwriting scrutiny: Assess clinical governance frameworks, particularly for online providers

Risk management support: Promote strong consent and documentation practices

Education and training: Highlight emerging risks such as gastroparesis and lessons from US litigation

Claims preparedness: Develop expertise in handling claims involving novel therapies and potential group actions

Conclusion

Weight-loss injections represent a significant advance in the treatment of obesity with its associated benefits. However, their rapid adoption - particularly in private and online settings - has exposed gaps in prescribing, consent, and monitoring practices. The emergence of gastroparesis as a reported complication, alongside large-scale litigation in the United States, highlights the evolving risk landscape.

UK Healthcare providers, insurers, and legal practitioners should prepare now for this developing area of clinical negligence and product liability risk.

HOW SILENCE IN MEDICAL PATIENTS AND

Rebecca Beaumont, Director of Investigation Services at TMLEP, considers the impact of poor documentation in the context of the recent case of Shaheen and Ahmed (As Executors of the Estate of Mr Ajaz Ahmed) v Dr Joanna Daish [2025] EWHC 3056 (KB).

MEDICAL records are the key reminder of clinical interactions with patients. Professional standards are set for record keeping by all regulatory bodies, emphasising their importance in clinical practice. An example is the standard set in the General Medical Council’s Good medical practice guidance from 2024, which states at paragraph 69: “You must make sure that formal records of your work (including patients’ records) are clear, accurate, contemporaneous and legible.”

The guidance goes on at paragraph 70 to indicate what patient records should include. Relevant clinical findings and treatments provided feature as one would expect, but the guidance also indicates that patient concerns and preferences relevant to their ongoing care should usually be documented, as well as any decisions made and when those decisions are to be reviewed.

This illustrates that medical records are not only a contemporaneous documentation of the clinical interaction had with a patient, but also a key piece of the puzzle in

PRACTITIONERS

ensuring continuity of care for them moving forward.

Medical records are also key evidence in investigations into healthcare and clinical negligence claims. Whilst lack of documentation does not necessarily mean that the care delivered to a patient was substandard, it does introduce risk to practitioners if they are subject to investigatory, regulatory, or clinical negligence proceedings. Investigators, solicitors, and Courts all place weight on the medical records when making findings, and silence in the medical records regarding aspects of care delivered can result in an adverse finding against a practitioner.

The recent trial of preliminary issues by the High Court in the case of Shaheen and Ahmed (As Executors of the Estate of Mr Ajaz Ahmed) v Dr Joanna Daish [2025] EWHC 3056 (KB) highlights the risk that can arise for practitioners where medical records are silent.

The claim in Shaheen and Ahmed was brought by the wife and son of Mr Ahmed, who died of lung cancer at the early age of 49.

The claimants allege that there was an opportunity to intervene and treat the cancer earlier and this was missed due to the negligence of Mr Ahmed’s general practitioner, Dr Daish.

MEDICAL RECORDS PUTS PRACTITIONERS AT RISK

Mr Ahmed had seen Dr Daish on 11 February 2019, and she requested a chest x-ray using the Integrated Clinical Environment (ICE) system. A request made through the ICE system is not followed up or acted upon unless the patient attends a walk-in radiology department.

Crucially, the record for the appointment in Mr Ahmed’s GP record noted that an x-ray had been requested but was silent on the exchange between Mr Ahmed and Dr Daish at the appointment. The Court was therefore asked to decide whether Dr Daish communicated the need for a chest x-ray to Mr Ahmed and advised him that he needed to attend a walk-in

radiology department for this to be undertaken.

As no note was made in the GP record of the discussion and Dr Daish had, understandably, no recollection of the appointment, she relied on her usual practice. Dr Daish asserted that she would have told Mr Ahmed about the x-ray and its purpose, namely, to rule out serious pathology including cancer. The time pressure of busy general practice was noted but Dr Daish advised that 10 minutes would have been sufficient time for the examination and to explain the need for the x-ray to Mr Ahmed.

In weighing the evidence, the Court found in favour of the claimants and

that, on the balance of probabilities, Mr Ahmed was not told about the x-ray. Several factors were determined as carrying greater evidential weight than Dr Daish’s statement including that there was no record in the appointment of any discussion about the chest x-ray. The judge particularly highlighted an “obvious contrast” (paragraph 36 (v)) between Dr Daish’s record on 11 February 2019 and the notes of other doctors in Mr Ahmed’s GP records, who had specifically noted the need for further investigations.

The case of Shaheen and Ahmed highlights the vital nature of medical records for patient safety and risk management by practitioners. Whilst silence in contemporaneous documentation will not always lead to an adverse finding against a practitioner, it can do so, particularly where there is contrasting evidence in other entries in medical records that show that such documentation is usually made.

At TMLEP, lack of documentation is a frequent feature of matters where we are instructed to provide independent expert evidence and investigation services. Our reports quickly assess such situations and provide unbiased recommendations for learning and improvement.

The case of Shaheed and Ahmed shows that silence in documentation is a risk that healthcare providers should not overlook. Engaging with recommendations made in TMLEP’s reporting can aid in systemic improvements which will mitigate such risk.

For more information on TMLEP’s services, click here.

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