OCTOBER 2026
REAL PROMISE IN RASE DISEASES Lifearc’s Sam Barrell on what we need to do to turn discovery science into patient benefit
HEALTH AND VACCINE EQUITY Özgür Tuncer discusses how thermostabilisation technology can redefine global health equity
THE NHS’s EYE-CARE SOLUTION IS ALREADY IN THE COMMUNITY Purvi Thomson on how community optometrists can deliver accessible front-line services
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OCTOBER 2026
Rare diseases affect approximately 3.5 million people in the UK, a patient cohort equivalent to the national cancer population, yet one where only 5% of conditions have approved treatments. Beyond the human impact, recent MHRA estimates place the combined healthcare and wider economic cost of rare diseases to the UK at nearly £19.6 billion a year.
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Combined with the rising global threat of antimicrobial resistance, the imperative for targeted healthcare delivery has never been higher. In this issue, LifeArc chief executive Sam Barrell breaks down why rare is not rare, how LifeArc is deploying £40 million into national rare disease trial acceleration centres, and what the UK must do to cement its position as a global life sciences hub. Also, Stablepharma chief executive Özgür Tuncer talks about vaccine wastage; OCL Vision’s head of optometry Purvi Thomson explains how community optometrists can deliver accessible front-line services; and much more...
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Tell us your news: Adrian Murdoch, Editor-in-Chief adrian.murdoch@healthcaretoday.com +44 (0)7983 407607 Katie Heslop, Senior Writer katie.heslop@healthcaretoday.com Glen Ferris, Managing Director glen.ferris@healthcaretoday.com +44 (0)7780 298825 To download a copy of our media pack, click here.
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PHSO AND NHS RESOLUTION TO WORK TOGETHER THE Parliamentary and Health Service Ombudsman (PHSO) and NHS Resolution have signed a memorandum of understanding to work more collaboratively together. In a statement, they said that more effective sharing of this information between the two organisations will enable them to provide robust evidence to the NHS about areas of safety concern; to help prevent future failings in care and support the safe delivery of services; and to plan more efficiently for demand on their services. “This agreement will strengthen the existing partnership between our two organisations,” said Helen Vernon, chief executive of NHS Resolution. “We have a clear shared focus: sharing the learning from complaints and disputes to improve patient safety across the NHS,” she added. Their work will also focus on making sure their own services are accessible and is designed, they say, around the needs of the people who use them. They have said that they will work together more closely to explain to service users the differences between PHSO and NHS Resolution functions, improve mutual understanding between staff in both organisations to support more effective collaboration, strengthen and standardise signposting between the two organisations, and improve communication in cases where both organisations are carrying out an investigation. “This agreement will strengthen the existing partnership between our two organisations. We have a clear shared focus: sharing the learning from complaints and disputes to improve patient safety across the NHS,” said PHSO’s chief executive Rebecca Hilsenrath. 4
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GUIDANCE TO IMPROV AND AUTISM
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AULA SUSSEX, the Parliamentary and Health Service Ombudsman, is calling on the government to publish clear national guidance to improve ADHD and autism services and to clarify patients’ right to choose a provider as complaints about care continue to rise. She is also calling for more support for Integrated Care Boards (ICBs) to make consistent decisions about ADHD and autism services that meet the needs of their local communities. The Ombudsman also recommends that NHSfunded providers delivering ADHD and/or autism assessments, but not ongoing care, should be registered with the Care Quality Commission. Currently, these providers are neither inspected nor monitored, creating a regulatory gap that must be
by Adrian Mu Editor-in-C
urgently addressed to make s consistent, safe, high-quality c
“ADHD and autism services a pressure, with demand outstr While commissioning cannot constraints, the way services commissioned and delivered pressure people experience a make the best use of available
“When these decisions work access high-quality care whe now, the system is too comple leaving too many patients fall she added.
NEEDED VE ADHD M CARE
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are under significant ripping capacity. t solve these supply are designed, d can compound the and make it harder to e resources,” she said.
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In its new report, Improving ADHD and autism services: commissioning with confidence, the Ombudsman shared its findings based on 3,000 complaints. It found recurring issues including uncertainty about patients’ right to choose a provider, inconsistent recognition of diagnoses across NHS and independent providers, and lengthy waits for assessment and treatment. In one case, a patient asked to be referred to Psychiatry UK for his ADHD treatment. Under Right to Choose legislation, patients in England can choose any NHS-funded provider offering a specialist service for their care. South East London ICB denied his request and wrongly insisted he be referred to a local ADHD service which was still being developed and had no opening date. The Ombudsman found his NHS treatment was delayed by five months and the patient felt he had no choice
but to pay for private care amounting to almost £4,000. In another investigation, South London and Maudsley NHS Foundation Trust removed a woman from the ADHD medication titration (the process of adjusting medication to find the right balance) waiting list without warning or valid reason, leaving her without specialist monitoring support for around six months. This delay may have affected her symptoms and her ability to carry out everyday activities, causing frustration and distress. “People should not have to fight their way through a confusing system to get ADHD and autism care. We have seen clear evidence that this has created a postcode lottery, with too many people’s access to care depending on where they live,” said Sussex. NEWS
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NEW DEGREE TO PREPARE NURSES FOR SHIFT TOWARDS COMMUNITY CARE A NEW nursing degree focused on community and social care is being launched by the University of Huddersfield. The course will begin this coming academic year, as the NHS moves towards providing more care in local communities. The programme has been developed in line with the NHS 10 Year Health Plan, which aims to shift care from hospitals into communities and put greater emphasis on preventing ill health. The plan envisages neighbourhood health centres bringing different care and health professionals together, with the aim of making services more accessible and reducing pressure on hospitals. It also aims to move the NHS towards earlier intervention and prevention, with more resources directed towards keeping people healthy and managing health conditions before they require hospital care. The new course will reflect these priorities, with students learning about prevention, personalised care, long-term condition management and health inequalities. Students will be based at the university’s national health innovation campus, where they will have opportunities to learn alongside healthcare and research organisations. The university is also planning a neighbourhood health centre at the campus, which it says will provide opportunities for practice-based learning and clinical placements. The proposed centre is expected to include out-of-hours GP services, urgent primary care, a pharmacy and wellbeing services. The facility could give students opportunities to gain experience of the different elements involved in delivering care within local communities. Mathew Blears, acting head of department for nursing at the University of Huddersfield, said that the course would prepare students for changing models of care. “Our graduates will be equipped to improve population health, address health inequalities and support people to live healthier lives within their own communities,” he said. Graduates will be eligible to register with the Nursing and Midwifery Council.
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MENTAL HEALTH CENTRES TO OPEN IN LIBRARIES AND FORMER BANKS
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ENTAL health services will be delivered from libraries, former banks and other community locations under a £343 million expansion of NHS support across England. The government is opening 159 new mental health facilities, with the first sites due to open this autumn. The plans include 100 community mental health centres offering walk-in support without a referral, alongside 59 mental health emergency departments for people in crisis, located in hospitals. The government said libraries, banks and other high-street locations could be converted into mental health centres, bringing services closer to where people live. They are intended to have a “nonclinical appearance”, and mental health teams will work alongside GPs, councils and voluntary organisations. They will also link patients to housing and employment services.
by Katie Heslop, Senior Writer
The first centres will open from autumn, with further sites opening from March next year. The mental health emergency departments will provide same-day specialist support. The aim is for the areas to provide a “calm, therapeutic environment”, where people can be connected to the right care. The expansion will more than triple the number of mental health emergency departments in England, from 23 to 82. The government said the investment would help people access support earlier, while reducing pressure on A&E, and described the plans as the “biggest redesign of mental health in a generation”. Demand for such services has risen sharply, particularly among children and the young, the government said, with around one in five people
experiencing a common mental health condition each year. Health and social care secretary Yvette Cooper said the centres would help people get support “earlier and closer to home”. Prime minister Andy Burnham added that, currently, thousands of people are waiting every day for help, with A&E the only option. The new hubs, he said, will be a “lifeline” for so many. Andy Bell, chief executive of the Centre for Mental Health, welcomed plans for the centres to be integrated into communities. However, he raised concerns about the government developing more mental health emergency departments before the model has been properly tested. He urged Burnham and Cooper to “proceed with caution”, to ensure the departments are “safe, inclusive and effective”. The investment must be backed by funding for the health and social care workforce needed to provide effective mental health care, Bell added. NEWS
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CATARACT SURGERY DRIVES SELF-PAY ADMISSIONS THERE were more self-pay admissions – using savings or a loan – at private hospitals in the first three months of the year than in any previous quarter, according to data from the Private Healthcare Information Network (PHIN), the independent, not-for-profit organisation that reports on the UK’s private clinics, hospitals and consultants.
“The overall self-pay increase was concentrated in specific procedures and should not be seen as uniform market-wide growth of self-pay. Blepharoplasty had the second highest number of admissions, suggesting ophthalmology procedures were responsible for much of the self-pay growth,” said Richard Wells, PHIN’s director of technology and insights.
There was also an increase for 20- 29-year-olds (3%), which PHIN suggests reflects growing acceptance and accessibility of private healthcare among younger people. There were several breastrelated procedures (implants, mastopexy and mastectomy) among the biggest admission increases, as well as diagnostic laparoscopy and laser eye surgery for this age group.
Cataract surgery made up 46% of the total increase in self-pay admissions in the UK, and virtually all of the net increase in cataract activity across self-pay and private medical insurance funding options.
“This growth in ophthalmic procedures was enough to push selfpay admissions to a record level, and the proportion of admissions versus those funded through insurance to the highest (31%) since Q3 2023, so it is definitely worth keeping an eye on,” he added.
The biggest decline in admissions (-990 or -22%) came for the 0-9 age category. Allergy testing admissions were down 89%, and there were fewer tonsillectomies and grommet insertions.
Cataract surgery has long been the most common reason for a private hospital admission, and in the first quarter of the year (Q1) 2026 admissions rose by 13% to reach a total of 22,805. For those opting to self-pay for the procedure, the increase was even greater at 21%. Patients aged 60 and over accounted for most of the additional self-pay episodes recorded by PHIN. There was a 13% increase in the 60-69 age group and 10% for the 70-79 and the 80-89 age groups. 8
NEWS
PHIN recorded 247,495 reported inpatient and day-case admissions in Q1 2026. The increased self-pay admissions offset lower insured admissions, leaving the total only fractionally higher than in the first quarter last year. There was a small decline in admissions for those aged 10-19 (-1%), 30-39 (-1%), 40-49 (-1%) and 50-59 (-3%), but an increase for 60-69 (3%), 70-79 (3%) and 80-89 (5%) year olds.
“Following a record year in 2025, the slight increase means that Q1 2026 sets another record level. There is not enough data to tell if the apparent slowdown in the growth rate of private admissions is the beginning of a trend. There were several significant worldwide events during this period which are likely to have impacted admissions, including the war in Iran,” said Wells. “We expect the next quarter to show a higher level of growth compared to Q2 2025, especially if self-pay admissions continue to increase.”
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POOR AND INACCESSIBLE COMMUNICATIONS BLOCK ACCESS
EOPLE with disabilities are being let down by public services due to poor or inaccessible communications, the Parliamentary and Health Service Ombudsman (PHSO) has warned. Disabled people are at risk of not getting the vital information they need to make informed decisions about their healthcare, finances or employment, because some services failed to provide accessible formats such as audio materials or British Sign Language (BSL) interpreters. The Ombudsman’s investigations, detailed in a new report, found instances where disabled people did not receive information in accessible formats such as audio materials or British Sign Language (BSL) interpreters, leaving them confused, distressed, and financially worse off as a result. This is an issue Healthcare Today has highlighted in the past. “When people feel they are not listened to and that their needs are
by Adrian Murdoch, Editor-in-Chief not met, they lose trust in the very services designed to support them,” said PHSO chief executive Rebecca Hilsenrath. “At worst, failures in communication can make services unsafe and cause serious harm if people are unable to understand information and advocate for themselves,” she added. A case in the report highlights how a deaf woman was given the wrong vaccination at a GP surgery because staff failed to provide a BSL interpreter. The woman, whose first language is BSL, attended the practice for a prebooked flu vaccination, but instead was given the COVID-19 vaccination without her consent. She said there was no interpreter present, and staff attempted to communicate with her through her grandmother, without knowing whether she knew sign language.
Staff also failed to show her the NHS COVID-19 vaccination video, which explains the vaccine and possible side effects in BSL. The woman later experienced side effects she had not been expecting. Had she been allergic to any component of the vaccine, the error could have had serious and potentially life-threatening consequences. Following an investigation by the Ombudsman, the practice outlined how it will improve its service for patients with different communication needs. “Public services have a duty to communicate clearly in a range of formats to meet the needs of people who use their services. “This must be consistently built into service delivery. Organisations must listen to people who use their services and make improvements so that services are inclusive, safe and effective for everyone,” said Hilsenrath. NEWS
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ASSISTED RETURNS T
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13/10/2016 11:08
HEAD of the second reading of the Terminally Ill Adults (End of Life) Bill on 11 September, a group of 11 senior Australian palliative care clinicians and VAD providers has written directly to Westminster MPs in the letter seen by Healthcare Today. Signatories to the letter include Chloe Furst, medical director of the Royal Adelaide Hospital Department of Acute and Urgent Care, Clare Fellingham, consultant anaesthetist and Western Australia clinical lead for voluntary assisted dying (VAD) at the East Metropolitan Health Service, and Peter Allcroft, chair of Palliative Care Australia and senior staff specialist in palliative care for South Australia.
by Adrian Murdoch Editor-in-Chief
“In the two years since we la contacted you, our view that palliative care and assisted d hand in hand has only streng as a direct result of our firsth professional experiences, an seeing more examples of the immense positive impact this can have on the dying peopl care for,” they write.
Concerned about misleading the media, they point out tha Care Australia’s 2024 Nation Workforce Survey found that the palliative care workforce believed the introduction of a dying legislation had decreas demand for palliative care.
DYING BILL TO COMMONS
h,
ast t dying go gthened, hand nd of e s choice le we
g claims in at Palliative nal t just 2% of e surveyed assisted sed the
“The overwhelming majority felt it had either no effect or had increased the demand for palliative care,” they continue. Voluntary assisted dying (VAD) has been available in the state of Victoria since 2019. Since then, every state and territory has chosen to legislate, and VAD has become an increasingly established part of endof-life care. To date, around 7,000 Australians have used these laws to choose an ending that suits them – accounting for approximately 2% of total deaths.
that the British press has chosen to pitch VAD and palliative care against each other. The signatories point out that data collated from every VAD oversight body in Australia shows that over 80% of people seeking VAD have also accessed palliative care. This figure will likely increase as palliative care providers become more comfortable with assisted dying and can discuss it with patients as another option.
More than 1,600 trained health professionals provide VAD services nationwide.
A third of people who are approved for the VAD substance do not end up taking it, but it is of immense comfort that the option is there, they add.
They take issue with the argument
“We believe that comprehensive
end-of-life care includes both palliative care and the option of VAD. Supporting individuals’ autonomy and discussing end-of-life options is consistent with being a good physician and what medicine is all about. “We consider it a privilege to play our part at a precious time in people’s lives – their ending,” they write. Following the failure of Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill at the end of April, the bill was reintroduced by Lauren Edwards, Labour MP for Rochester and Strood, and it returns to the Commons for a second reading. Prime Minister Andy Burnham has said he will not vote to avoid influencing the emotional debate. NEWS
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AI IS HELPING DOCTORS DOCTORS are increasingly using technology, including artificial intelligence (AI), to reduce their administrative burdens, improve efficiency and create more time for their patients, according to a report published by the General Medical Council (GMC).
MHRA SETS OUT POSITION ON REGULATION OF MICROBIOMEBASED MEDICINAL PRODUCTS THE Medicines and Healthcare products Regulatory Agency (MHRA) has published a position paper clarifying how microbiome-based medicines can be made available for patients in the UK. Microbiome-based medicinal products are medicines that work through modulating, restoring or replacing the human microbiome. They represent a promising new category of therapies with the potential to address areas of significant unmet clinical need such as antimicrobial resistance (AMR). The MHRA’s position is that MBMPs fall within the scope of the existing UK medicines regulatory framework. This provides developers with a clear route to licensing. Depending on their characteristics, microbiome-based medicines may be regulated as biological medicinal products, or in some cases may meet the criteria for advanced therapy medicinal products (ATMPs). “The UK’s existing, proportionate and evidence-based licensing frameworks are ready to support this field. Early engagement with us is the best way for developers to navigate it successfully,” said Julian Beach, executive director of healthcare quality and access at the MHRA. No MBMP currently holds a UK marketing authorisation. Some countries have authorised a small number of donor-derived microbiota products for Clostridioides difficile (C. difficile) infection. The position paper also clarifies existing arrangements for faecal microbiota transplantation. It is currently used for specific indications, most notably recurrent clostridioides difficile infection, and is supplied either through clinical trials or as an unlicensed medicine under MHRA “specials” manufacturing arrangements or extemporaneous preparation. These routes remain under the direct responsibility of the prescribing clinician and are unaffected by today’s publication. 12
NEWS
More than one in four doctors reported improvements they said helped them provide good patient care in the last year, with AI and better patient information systems among the most cited. Many of these doctors specifically cited the electronic patient record system, which became operational across all Northern Ireland Health and Social Care Trust areas in May last year. Doctors said the technology was helping reduce administrative workloads and enabling them to have more meaningful interactions with patients. Pressures remain, however. More than four in ten doctors (41%) said they found it difficult to provide the level of care they would like at least weekly. For GPs, the figure rose to six in ten (60%). Commonly reported barriers included inadequate staffing, heavy workloads and time spent on bureaucracy and admin, as well as delays for patients awaiting screening or treatment. Poor coordination between primary and secondary care was also a factor, with only one in five doctors agreeing that coordination was currently effective, with complex cases and systems often the cause. “Progress is being made, and some of the improvements are deceptively simple, but the challenge is turning those local gains into system-wide improvement,” said GMC chief executive Charlie Massie. “It won’t be straightforward, and it won’t solve all the problems of an under-pressure workforce, but harnessing technology can make a positive difference for doctors and their patients,” he added. The survey draws on more than 4,600 doctors, as well as interviews about their experience of working in the UK.
CANCER PATIENTS FACE UNNECESSARY BARRIERS MOVING BETWEEN NHS AND PRIVATE CARE
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ANCER patients moving between NHS and private care can face unnecessary delays and duplicated referrals, a new report argues. The Independent Healthcare Providers Network (IHPN) is calling for closer integration between the NHS and private sector as more patients use both during their cancer treatment. In a new report, the network highlights the growing role of independent providers in NHS cancer diagnostics, with the sector delivering one in five NHS MRI and CT scans and nearly half of all PET-CT scans. Around 320,000 private cancer admissions took place between 2022 and 2025. However, patients can encounter barriers when moving between providers. The IHPN said independent providers can face difficulties when making urgent suspected cancer referrals to the NHS, and patients may instead be required to return to their GP and begin the referral process again. The organisation points to a recent NHS Resolution review of delayed cancer
by Katie Heslop, Senior Writer diagnoses, which highlighted patients’ dependence on GPs for access to diagnostic testing and specialist referrals. The review also included cases in which patients sought private investigations or assessment after experiencing delays in primary care. Referral barriers could result in avoidable delays, duplication and additional administrative work for patients during an already stressful period, the IHPN said. It is calling for independent providers to be able to make more straightforward referrals into NHS urgent suspected cancer pathways, including when cancer is suspected following diagnostic tests carried out privately. The network also wants better sharing of patient records, scans and other diagnostic information between NHS and independent services to reduce duplication and improve continuity of care. The organisation has called for stronger links between NHS and
independent multidisciplinary teams, with clearer governance arrangements to allow clinicians from different providers to work together. Danielle Henry, director of policy at the IHPN, said cancer care needed to keep pace with the growing number of patients moving between the two sectors. “Cancer does not recognise organisational boundaries, and neither should cancer care,” she said. The calls come as the government’s national cancer plan, published in February, aims to ensure all three cancer waiting time standards are met by the end of this parliament. The standards require 80% of patients to receive a diagnosis or all-clear within 28 days of an urgent suspected cancer referral, 85% to start treatment within 62 days of referral, and 96% to start treatment within 31 days of a decision to treat. The IHPN is also calling for greater use of independent-sector capacity in cancer diagnostics, as well as more opportunities for independent providers to participate in cancer research and clinical trials. NEWS
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HSSIB LAUNCHES KNOWLEDGE EXCHANGE THE Health Services Safety Investigations Body (HSSIB) has launched an online Knowledge Exchange designed to improve access to practical guidance, learning and expertise for those involved in patient safety investigations. It is intended to support a wide audience, including patient safety specialists, healthcare professionals, commissioners and policymakers, as well as staff, patients, families and carers involved in investigations. The Knowledge Exchange will bring together learning resources and practical guidance aimed at helping those conducting and involved in investigations to ensure they are high-quality, professional, compassionate, and trauma-informed. Resources will include learning tools, guidance, webinars, blogs and practical materials, with more content being released over the coming weeks and months. It is intended to make investigation knowledge more accessible, with materials drawing on real-world experience rather than relying solely on theoretical approaches. The HSSIB sees the launch as a significant milestone in its Building Investigation Excellence Strategy, which was developed in response to changes in the patient safety landscape and the organisation’s role as a centre of excellence for healthcare safety investigations. “High-quality investigations are fundamental to understanding why patient safety events happen and to identify opportunities to make care safer. “The launch comes against a backdrop of increasing emphasis on the importance of learning from patient safety events and strengthening investigation practice across the NHS,” said Philippa Styles, director of investigations at the HSSIB. “The Knowledge Exchange will provide practical, accessible support and information for everyone involved in patient safety events, whether they are leading investigations, contributing to them, or seeking to understand the process,” she added. 14
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COST-OF-LIV MANY TO PUT
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ORE than one in five (22%) UK adults have needed urgent medical attention after ignoring early symptoms, as the continued cost-of-living crisis forces many to put their health on hold. Against a backdrop of sustained pressure on household finances and stretched public services, according to this year’s Bupa Wellbeing Index, an annual barometer of the nation’s physical and mental health, more than half (51%) of people say they find it harder to prioritise their health and wellbeing in the current economic climate. Many are making short-term tradeoffs that can carry longer-term health consequences, adding to their mental load and placing strain on personal wellbeing – with two in five people (41%1) admitting they are unable to put their wellbeing first because of the cost of living and almost a quarter (24%) saying delaying treatment due to the cost of living made their condition worse. “This year’s Bupa Wellbeing Index highlights a growing national challenge: financial pressures and competing demands are causing many people to put their health on hold, delaying diagnosis and treatment,” said Bupa Global, India & UK chief executive Chris Carroll, of the research, which polled 8,002 UK adults. “The consequences are felt not only by individuals, but also across workplaces and the wider economy, as health issues become more complex to treat, recovery takes longer, and people struggle to stay well and in work,” he added. What Bupa has dubbed “the cost of coping” is causing many people to put off getting the care they need.
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Adrian Murdoch, Editor-in-Chief
pressures and everyday are making it harder for ss healthcare when they han half (56%) of employed ave delayed seeking physical or mental health se they did not want to take
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people face in their daily it harder to prioritise their pport early and stay well,” xon, chief executive of the tion, commenting on the ntion and early intervention, thier working lives, must esponse, including from public services and
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REEVALUATION OF NHS ADVICE AND GUIDANCE SERVICES NEEDED
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HS advice and guidance services can benefit patients but must be better implemented and more rigorously evaluated to support safe expansion, a report by the Health Services Safety Investigations Body (HSSIB) found. In an interim report, it identifies patient safety risks linked to how advice and guidance (A&G) services have been implemented across England. These allow clinicians in general practice to seek specialist advice from secondary care, either before or instead of referring a patient to hospital. “A&G services are making a real difference for patients in many parts of the NHS, and we heard genuine enthusiasm for what they can achieve. But we also heard serious concerns, and found evidence of harm where implementation has not been adequately designed or monitored,” said senior safety investigator Nick Woodier. It found that poorly designed or inadequately monitored pathways have contributed to physical harm, delayed and missed diagnoses, and in some cases to delays in cancer care. “We need to be clear that the success of A&G should not be measured
by Adrian Murdoch, Editor-in-Chief simply by the number of referrals avoided or the volume of A&G requests processed. The important question is whether it is helping clinicians make better, safer and more appropriate decisions for individual patients. A reduction in referral numbers is not a success if it results in delays, repeated contacts, additional workload for clinicians, or risks to patient safety,” said Victoria Tzortziou Brown, president of the Royal College of GPs. There was evidence that A&G services had contributed to near misses and incidents of patient harm, both physical and psychological, where they had been poorly implemented or monitored. Harm included delayed or missed diagnoses and delays to care and treatment. There were significant gaps between how some local A&G and single point of access (SPoA) processes had been implemented and national expectations. This included local pathways that required GPs to use A&G rather than making direct referrals, and referrals for specialist assessment being declined despite persistent clinical concern.
And issues with the NHS electronic referral service (e-RS), including interoperability problems and delays to planned system upgrades, made it harder to track patients through pathways and share clinical information consistently. “Since its introduction, GPs have expressed deep concern with the advice and guidance system – we know our patients and know when a referral needs to be made,” said Clare Bannon, BMA GP committee chair. “So this report is tragic vindication for these concerns, now showing that patients have come to harm as a result of this rushed-out and inconsistentlyapplied process,” she added. The HSSIB has recommended that NHS England and the Department of Health and Social Care (DHSC) undertake a rapid evaluation of A&G services to address resource and capacity gaps, workforce training needs, e-RS digital risk management and weaknesses in patient safety incident reporting. It has also recommended that NHS England and DHSC, working with relevant Royal Colleges, commission the development of standardised A&G request and response templates for specialities where these do not currently exist, and support their effective use in practice. NEWS
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CONCERN OVER PLANS TO LIMIT PATIENT BLOOD PRESSURE TESTS NEW regulations, which limit potentially life-changing NHS blood pressure checks in pharmacies, are a “retrograde step” that will hinder the drive to cut heart disease and stroke, the National Pharmacy Association (NPA) has said. From next month, NHS England plans to impose a limit on NHS blood pressure tests in pharmacies, meaning that patients will only be permitted to have a test every five years. The NPA, which represents around 6,000 pharmacies across the UK, warned that the change could leave people with undiagnosed heart or cardiovascular problems and that the change flies in the face of efforts to improve prevention in the health service. It also called for a full impact assessment to be carried out before changes are implemented. “Imposing a five-year limit on pharmacies’ ability to check blood pressure will undermine the government’s ambition to promote health prevention and could leave health problems undiagnosed. It’s a clear retrograde step that flies in the face of efforts to prevent disease,” said Henry Gregg, chief executive of the National Pharmacy Association. “Pharmacies need the freedom to make public health interventions without constantly worrying about whether they will be reimbursed for their work. If some people are checked more frequently than every five years, that is a small price to pay. We need to focus on the real risk – which is people walking around not knowing that they are at an increased risk of an early heart attack or stroke,” he added.
MHRA REFORM AMENDMENTS TABLED
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by Adrian Murdoch, Editor-in-Chief
HE government has tabled three amendments to the Health Bill aimed at modernising the legislative framework for the regulation of medicines and medical devices in the UK. The measures form part of a wider package of reforms that impact the Medicines and Healthcare products Regulatory Agency (MHRA) and will now be subject to parliamentary scrutiny. The first amendment aims to give the MHRA clearer legal powers to share specific information about medicines and medical devices with relevant trusted UK government organisations and global regulatory partners, where this supports public health, patient safety, access to innovation and effective regulation. The second amendment intends to make medicines and medical device regulation more responsive to developments in science and technology. Proposals would allow for legislation to reflect future updates to documents including technical standards and international guidelines, enabling live changes and supporting smarter and faster regulation. In addition, the proposals aim to support a more proportionate approach to consultation, which would enable targeted engagement for minor changes, while maintaining full public consultation requirements for significant policy reforms. The third amendment would provide the MHRA with enabling powers for the development of a future medical device licensing regime. Under the approach being explored, medical devices placed on the Great Britain market through a domestic route could in future require a licence issued by the MHRA, rather than relying on third-party conformity assessments. In a statement, the government said: “These three amendments will form part of a broader programme of regulatory reform to ensure the MHRA remains flexible, balanced and capable of responding to scientific and technological change.” The amendments will be considered as part of the Bill’s remaining stages through Parliament. NEWS
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MHRA PARTNERS WITH MANCHESTER NHS ON HEALTH INNOVATION SANDBOX
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ATIENTS in Manchester could soon benefit from earlier diagnosis, increased personalised care, and faster access to proven new technologies under the trust’s new partnership with the Medicines and Healthcare products Regulatory Agency (MHRA). Healthcare solutions that can improve patient care and safety and reduce pressure on NHS services will be rapidly evaluated as part of the partnership’s first programme, Manchester Sandbox. Innovative technologies including AI-enabled medical tools will be deployed and tested in local NHS settings to gather evidence on how they perform with patients and clinicians in their day-today practice. “Patients should benefit from innovation as quickly as possible, but
by Julie Penfold, Senior Writer they should never have to choose between access and safety,” said Mark Cubbon, the trust’s chief executive. “By creating a clear route from innovation to safe adoption, we can help people gain faster access to developments that have the potential to improve care, while maintaining the high standards of safety that patients rightly expect.” One of the first technologies that is expected to be included is an AIenabled tool that can identify patients at higher risk of complications due to long-term health conditions. “AI and other emerging technologies have enormous potential to improve patient care,” said Lawrence Tallon, the MHRA’s chief executive. “The
challenge is understanding how they work in practice and where they can make the biggest difference.” New healthcare technologies often show potential in development, but proving they work in real NHS settings is critical. The Manchester Sandbox programme has been created to address this challenge and will bring together healthcare providers, regulators and innovators earlier in the process. Tallon added that learning from the programme could help to shape how safe and effective technologies are introduced across the country. Looking ahead, the MHRA has said it will invite expressions of interest from medical device developers interested in taking part in the next phase of the programme.
PATIENT HAS SIGHT SAVED IN AI-ASSISTED BRAIN SURGERY gland where blood vessels and nerves controlling vision are tightly packed together. The AI supported the surgical team to identify risky areas to avoid, while removing the tumour as safely as possible.
When waking from the surgery, he found his vision had dramatically improved as he could see everything in the operating theatre. Within a week, he was walking independently, without the need for vision aids.
The surgery took place at the National Hospital for Neurology and Neurosurgery (NHNN) at University College London Hospitals NHS Trust (UCLH), and was part of a clinical trial using AI technology that had been developed in-house at University College London (UCL).
Rhys Hibbert, 48, from Bedfordshire, volunteered to be the first patient to have a pituitary tumour removed in this way. Without surgery, his tumour would have continued to threaten his sight, and could have ultimately led to blindness.
During the operation, the UCLdeveloped AI analysed the live surgical video feed in real time, rather than using pre-surgery scans. This helped the surgical team to make more precise decisions by highlighting critical structures at the base of the patient’s brain. The tumour was located in the pituitary
His condition was discovered by chance when he collapsed during a walk and had a seizure. He was subsequently diagnosed with a tumour measuring around 11 millimetres in his pituitary gland. Over time, he began to experience increased problems with his sight and had lost his peripheral vision.
“Huge thanks to the trial participants and to the team committed to improving patient outcomes by taking this important first step globally and using UK homegrown AI to help reduce risk during these delicate surgeries,” said Hani Marcus, who performed this first AI-assisted surgery. He is professor of neurology at UCL Queen Square Institute of Technology and is a consultant neurosurgeon at NHNN.
THE first use of artificial intelligence to support a neurosurgeon during live surgery has successfully protected the sight of a patient having a brain tumour removed.
The UK’s health innovation minister, James Frith, said the innovation “is an example of AI at its best”. NEWS
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GOOD START CHALLENGE WINNERS OFFER INNOVATIVE WAYS TO IMPROVE PARENTAL WELLBEING The Good Start Challenge was launched in response to growing recognition that becoming a parent can be the catalyst for a period of increased vulnerability, uncertainty and isolation. For 2026, ideas were sought around innovative ways to improve parental wellbeing in underserved communities across Sub-Saharan Africa, Latin America and Southeast Asia. More than 1,000 entries were received from countries including Ethiopia, Kenya, Senegal, Uganda, Brazil, Colombia, Mexico, the Philippines and Indonesia. The winning solutions are derived from existing community efforts or have been inspired by reallife experiences. Each winner has been awarded €200,000 to further develop their initiatives. One of the winners, EKISIL CBO, developed community-owned, solar-powered spaces to provide 22
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integrated support for displaced mothers and young children in Ethiopia. Mothers can access parenting support, health screening for children, trauma counselling and digital learning all under one roof. The SafeHubs scheme helps parents to build knowledge, confidence and resilience, and strengthen their children’s wellbeing and development. “Our idea grew from our frontline work with displaced mothers on the Ethiopia-Turkana border, who were raising young children with little support, few opportunities and limited access to services,” said Damaris Mumbua Maundu, head of programmes and scale at EKISIL CBO. “Every mother deserves a safe place to heal, learn, connect and raise her child with hope,” she added. In Uganda, StrongMinds provides group therapy for refugees in the northern region, including for parents of young children, as part of its
work scaling depression treatment in sub-Saharan Africa. Winning the challenge will make an immediate difference to their work. “In East Africa, one in two refugee parents experiences untreated depression, and support is often fragmented and short-term,” said Charlotte Oloya, deputy country director at StrongMinds. “We know that when a parent recovers from depression, it impacts the whole family, especially when their children are young. Our solution was developed in direct response to this. “The Good Start Challenge has enabled us to reach 3,551 caregivers – far exceeding our goal of 2,400. Winning the €200,000 means that we can extend this care to the many more in need.” Other examples of the winning entries include a virtual wellbeing network for new mothers in Brazil and a WhatsApp-based mental health support tool for parents in Colombia.
DHSC ANNOUNCES £1.5 BILLION INVESTMENT TO IMPROVE NHS WEATHER RESILIENCE
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HE Department of Health and Social Care will invest £1.5 billion to help hospitals prepare for winter and extreme weather such as heatwaves to alleviate pressures on the health sector, it has announced. A total of 950 NHS projects will benefit including more than £200 million set aside for ten major hospital improvements, and £1.3 billion for maintenance, safety and resilience projects across the NHS estate. A further £32 million will fund specific projects to improve cooling and ventilation systems and to strengthen NHS hospital resilience to cope with extreme heat. Examples of this include Manchester Royal Infirmary and £154,000 to replace the PET scanner chiller to ensure reliable temperature control for highly sensitive imaging; Rampton Hospital, Nottinghamshire and £527,000 to replace air conditioning in a unit to maintain a stable, cool environment for patients, staff and visitors; and St Peter’s Hospital,
by Julie Penfold, Senior Writer Ashford, and £791,000 to restore reliable cooling capacity to support safe operating conditions within theatres “For decades, hospitals have focused on preparing for winter pressures, but the NHS is now facing new challenges, including periods of extreme heat and sustained pressure on services throughout the year,” said Yvette Cooper, health and social care secretary. The investment will help to “make our NHS hospitals safer and more resilient, helping them to remain open and able to care for patients when pressure on services is greatest.” “This includes investment in cooling and ventilation systems to help hospitals adapt to more frequent periods of extreme heat, and hundreds of projects to tackle urgent safety and infrastructure risks across the NHS estate,” Cooper said. The ten hospitals that will receive a share of the £200 million funding
for urgent improvements include Stepping Hill Hospital, Stockport with £26 million for a new pathology building; Bristol Royal Infirmary with £41 million for improvements to operating theatres and to make facilities safer; Queen Elizabeth Hospital, Gateshead with £12 million to redevelop maternity facilities; Wycombe Hospital, Buckinghamshire with £25 million for a new clinical building to move health services from an ageing tower to modern facilities; Crystal Centre/Linden Centre, Essex with £15 million to build 14 new bedrooms to provide additional space for mental health patients and enable existing wards to be improved; Lister Hospital, Hertfordshire with £11 million for a new children’s ward to provide a safe, modern space for children needing hospital care; St George’s Hospital, Stafford with £25 million to fund improvements to a mental health unit to replace ageing facilities and provide a safer environment for patients; and Royal Free Hospital, London with £32 million to fund two new operating theatres to offer patients access to safer, modern facilities for complex operations. NEWS
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GREEN SHOOTS FOR UK PHARMA INVESTMENT
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INCE September last year, the global pharmaceutical industry has committed an additional £2 billion of investment into the UK, spanning the value chain from AIenabled discovery science to largescale medicines manufacturing. These investments have been made possible through collaboration between industry and government, alongside a combination of shortand long-term policy commitments, including an increase to the baseline cost-benefit threshold used by NICE and a commitment to increase UK investment in innovative medicines to 0.6% of GDP.
As Healthcare Today reported at the end of last year, under pressure from the White House, the government cut the payment rate for newer medicines under the Voluntary Scheme for Branded Medicines Pricing and Access.
by Adrian Murdoch, Editor-in-Chief investment. Today, the picture is more hopeful,” said Association of the British Pharmaceutical Industry (ABPI) chief executive Richard Torbett. “Through a real partnership between government and industry, we have started to turn a trend of disinvestment into one of green shoots,” he added. High-profile recent deals include a £300 million backing from AstraZeneca to support operations in Cambridge and Macclesfield using artificial intelligence to discover new drugs, and Moderna opening an innovation centre in Oxfordshire with a £1 billion UK research and development investment commitment spanning the next decade.
The payment rate for newer medicines under the Voluntary Scheme for Branded Medicines Pricing and Access (VPAG) has been slashed to 14.5% from 22.9% last year.
In a new report, the ABPI has set out the UK’s attractiveness as a destination for global pharmaceutical investment against 12 leading markets, using more than 40 international metrics. The report finds that the UK has retained its core competitive strengths, but several are at risk of erosion.
“A year ago, the UK was losing ground in the global race for pharmaceutical
The UK’s science base, domestic talent, and intellectual property
policy framework remain globally competitive. Yet these structural capabilities take years to rebuild once lost, and international competitors are closing the gap. The UK has fallen behind in the quality of its research output as China extends its lead, and the proportion of UK students graduating in the natural sciences, mathematics, and statistics has declined. The UK is, however, making progress on the weaknesses that were deterring investment. Government commitments, the ABPI says, have begun to address the UK’s narrow access to, slow adoption of, and underinvestment in, innovative medicines, as well as high clawback rates on company revenues. “Investors make decisions that play out over decades, and they are watching closely to see whether the UK delivers on the commitments it has made. The task now is to provide and proceed along a clear, reliable roadmap to delivery so companies can invest with confidence. Get this right, and the UK can unlock tens of thousands of high-value jobs, billions of pounds of growth, and faster access to new medicines for NHS patients,” said Torbett. NEWS
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SAM REAL PR R
ARE diseases 3.5 million pe cohort equiva cancer popul only 5% of con treatments. Beyond the Medicines and Healthca Agency (MHRA) estimat healthcare and wider ec diseases to the UK at ne year. Combined with the of antimicrobial resistan targeted healthcare del higher.
Addressing these twin c shift in how translationa regulated and t officer of LifeA directing capit to-end clinica joining up pa pioneering a pathways d small, tailor
Here, she b not rare, ho £40 million disease tria and what t its position hub.
The UK is s science b translate Where is t down? Wh Where do
It is clear mechanis the mark. discovery world-lea available f 26
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M BARRELL: ROMISE IN RARE DISEASES
s affect approximately eople in the UK, a patient alent to the national lation, yet one where nditions have approved human impact, recent are products Regulatory tes place the combined conomic cost of rare early £19.6 billion a e rising global threat nce, the imperative for livery has never been
challenges requires a al science is funded, trialled. As chief executive Arc, Sam Barrell is tal into creating endal trial frameworks, aediatric datasets, and adaptive regulatory designed specifically for red patient populations.
breaks down why rare is ow LifeArc is deploying n into national rare al acceleration centres, the UK must do to cement n as a global life sciences
strong in early-stage but often struggles to that into patient benefit. the system breaking hich bits aren’t working? o we get it wrong?
that our investment sms are currently missing . As you rightly say, our y science in the UK is ading. Unfortunately, the funding mechanisms are
The chief executive officer of LifeArc explains what we need to do to turn discovery science into patient benefit and why the UK has the potential to position itself as a market leader for rare diseases. Written by Adrian Murdoch.
severely limited. This gap exists largely because the financial incentives are misaligned. Venture capital firms considering investments in earlystage biotechs or academic spin-outs require a clear prospect of future return. At this early stage of research, the risk of a project failing to reach the bedside remains exceptionally high. Because VC firms are navigating such high risk, intense competition for capital ensues. This means that only a small fraction of projects secure funding, even when the underlying science is immensely compelling. The second major issue lies in our regulatory pathways. Where rare diseases are concerned, regulatory frameworks have historically been built around common, high-prevalence conditions. Yet rare diseases follow an entirely different trajectory. We need a far more bespoke approach to regulation that accounts for the fact that many of these patients will ultimately require personalised medicine. The encouraging news is that the MHRA fully recognises this gap. It has recently launched a consultation on a specialised regulatory framework for rare diseases to make the approval process more adaptable, flexible and responsive to personalised therapies. The MHRA’s proposed Rare Disease Therapies Framework sounds promising, but what will it actually change for patients? Overall, this represents a hugely promising step forward and a significant improvement on where we were previously. We will see how the consultation unfolds. However, one key limitation
we see lies in the definition of rare disease itself. A rare disease is standardly defined as affecting one in 2,000 people or fewer. The MHRA’s current consultation framework, however, sets the threshold at an incidence of one in 50,000 – which pushes the scope firmly into the ultrarare category. We would certainly like to see that definition broadened. The other critical challenge is overall system integration. While a more tailored, expedited regulatory process is a vital improvement, it cannot exist in a vacuum. What we ultimately need is for NICE and other reimbursement bodies to align with those regulatory decisions. Without that join-up, we risk situations where a breakthrough therapy receives regulatory approval, but never actually reaches NHS patients. What does effective collaboration in rare diseases actually look like between academia, industry, charities and the NHS? It all comes down to money, doesn’t it? While funding is undoubtedly relevant and important, it is by no means the only barrier. Financial capital goes further in rare diseases than in standard drug development. Running a clinical trial for a rare disease does not require the £50 million to £100 million budgets typical of massive, multinational cardiovascular pharma trials. Because patient cohorts are significantly smaller, a targeted trial might cost us around £5 million. The primary bottlenecks are actually the regulatory and reimbursement pathways. INTERVIEW
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One might assume that scientific understanding is the principal bottleneck, but that is no longer the case. While gaps remain for certain conditions, there is a substantial subset of rare diseases where the underlying biology is fully understood, and where proven scientific modalities – such as gene editing or gene therapy – already exist to address them. When the science is clear and the initial funding is secured, developers hit a wall with regulatory processes and data collection. Trying to generate conventional clinical evidence across a small, highly fragmented patient population scattered across multiple international jurisdictions simply does not work. Instead, we need an entirely different approach. That means adopting adaptive trial designs, deploying real-world data, exploring digital twins and using post-market surveillance after treatment has started. The fundamental risk profile for these conditions is entirely different: patients facing life-threatening or severely disabling rare diseases often have a far higher risk tolerance for novel therapies than a patient taking long-term preventative medication for a common condition like high cholesterol. In rare diseases, small patient populations make traditional trials difficult. How do you manage those trials? What matters just as much is reforming regulation, modernising trial design and accepting alternative data gathering methods tailored to these conditions. This is not about compromising on safety; it is about gathering clinical evidence in a fundamentally different, more adaptive way than traditional pathways allow. Part of that challenge is locating the patients who could benefit from these 28
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trials and creating connected data networks. Right now, health datasets remain incredibly fragmented – not just in the UK, but globally. Fortunately, several brilliant initiatives are underway in the UK to address this. Health Data Research UK is working to establish a far more joined-up health data ecosystem. We have long-standing resources like UK Biobank, as well as Our Future Health – where LifeArc is a founding charitable partner – which is making fantastic progress in building datasets to identify rare disease cohorts. How do you ensure patients, particularly in rare diseases, are part of that collaboration, not just an afterthought? Our immediate priority must be connecting data within the UK. The government has signalled its commitment to this through Health Data Research UK, but our focus at LifeArc is ensuring rare disease datasets are specifically integrated. Currently, the National Rare Disease Registration Service is not linked
If the MHRA can new regulatory UK will quickly more attractive life sciences d
to NHS DigiTrials, meaning that researchers using DigiTrials cannot pull comprehensive rare disease data. Furthermore, paediatric rare disease records remain trapped in separate hospital silos. To break down these barriers, LifeArc has committed £40 million
If we modernise the UK’s rare disease infrastructure, we achieve a double benefit. We deliver immediate improvements for UK patients while establishing the country as a premier global hub for precision and personalised medicine. That, in turn, will encourage life sciences companies – many of which currently look elsewhere – to choose the UK as their primary destination for clinical development. We featured Basel as a research hub recently. What would make a company choose the UK over the US or EU for developing a new rare disease therapy today?
– spanning Newcastle, Belfast and Birmingham – is focused directly on rare disease trial acceleration.
n fully enact its framework, the y become a far e destination for development.
to build infrastructure across four specialised rare disease centres in the UK. We have established a dedicated centre focusing on rare respiratory conditions in Edinburgh, rare kidney diseases in Liverpool, and rare mitochondrial disorders in Cambridge. The fourth initiative
This fourth centre is building an end-to-end delivery framework to accelerate rare disease trials. This initiative is establishing a central national portal for rare disease patients across the UK. Patients can register voluntarily and indicate their willingness to travel for clinical studies. Specialist centres can then access this portal to match eligible patients with relevant trials. The team has already engaged with key NHS R&D hospitals to secure nationwide participation. Simultaneously, we are tackling administrative friction by establishing umbrella contracting agreements across NHS trusts. Currently, sponsors must negotiate separate contracts with every participating hospital. Developing a unified contract for participating trusts will streamline setup times significantly. Speed is essential here; patients facing life-altering conditions simply cannot afford to wait years for a diagnosis or trial placement.
The UK certainly has the potential to position itself as a market leader. Although LifeArc is rooted in the UK, our mission is global: we want to deliver real-world impact for patients with rare diseases wherever they are, and we will operate wherever necessary to achieve that. That global perspective forces us to evaluate different jurisdictions continually – we are constantly asking whether a project is best pursued in Europe, the US or the UK. Right now, every region presents its own set of advantages and drawbacks. However, if the UK moves quickly to resolve its current friction points, I believe it can take the lead. It is not just LifeArc driving this effort; partners like Genetic Alliance UK and many others across the sector are working to create an environment capable of accelerating patient impact. The next three years will be pivotal. If the MHRA can fully enact its new regulatory framework and begin applying it in real time, and if we can initiate a broader rethink of reimbursement pathways while embedding our end-to-end trial acceleration platform, the UK will quickly become a far more attractive destination for life sciences development than competing markets. INTERVIEW
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CLEARER IMPLEMENTAT PLANS NEEDED FOR NEIGHBOURHOOD HEAL
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HE ambition behind the government’s neighbourhood health model is difficult to argue with. Representing one of the biggest proposed changes to the way NHS services are delivered across the UK for many years, it aims to shift more care into community settings and encourages closer working between local healthcare providers. In doing so, patient access, satisfaction and improved clinical outcomes are expected, while reducing pressure on hospitals. In theory, the framework promotes unprecedented local flexibility and a broader, preventative focus for community care, yet in practice, it holds severe structural, financial and workforce challenges that could impact the future of local care. Increasingly, attention is turning to how these ambitions will be delivered across the UK amid tight budgets, system disruption and missing implementation and financial details. In speaking with local GPs, a recurring theme has emerged: national policy is advancing implementation. Practices want to engage, but they are being asked to redesign their futures while the fundamental blueprints are still being written.
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From ambition to implementation Outside the first 43 pilot neighbourhood health sites, the industry is still waiting for greater clarity on how the model will be implemented locally. Longer-term structures, funding arrangements and contractual frameworks are still evolving under national guidance. Yet, general practices can’t afford to wait for certainty. They must still decide whether to recruit additional staff, invest in expanding their premises, or commit to new technology - all without knowing exactly what the overarching model will ultimately require of them. These are commercial decisions that will affect their future and, of course, the patients they serve. After all, these are independent businesses, responsible for managing day-today operations, staff liabilities, and complex estate properties. Decisions on recruitment and succession cannot simply be paused or reversed as policy changes. They depend on having the confidence that choices made today will remain viable in at least two or three years’ time. And yet, that confidence is becoming increasingly difficult to find, as surgeries continue without clarity
Daniel Tremain, Xeinadi healthcare sector and Association of Independ Accountants (AISMA), sa health can’t work wh planning in over how the model will ultimately be funded and delivered. This concern is compounded by the broader financial reality: national policy dictates that resources must be shifted into the community out of existing envelopes, meaning local teams are expected to take on expanded preventative roles under already strained budgets.
The operational realities Most experienced GP partners have lived through numerous NHS restructures, with one partner telling me, “This isn’t my first NHS reorganisation”. The point is, most partners aren’t resistant to reform. They’ve adapted before, and they’ll adapt again. What’s more challenging this time is the lack of clarity surrounding implementation, paired with the fact that local frontline teams are currently stretched thin.
TION
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in’s lead partner for the d board member of the dent Specialist Medical ays that neighbourhood hile GP practices are n the dark. Another challenge is that true integration depends on organisations working together effectively. The proposed Integrated Neighbourhood Teams (INTs) will bring together professionals from across the NHS, local government and the voluntary sector, each operating under different governance, employment and regulatory frameworks. As well as this, in many areas, technology systems are also not yet fully interoperable, meaning clinicians can still face barriers when sharing patient information across organisations. And these challenges have real consequences. For one, investment decisions are delayed because practices are understandably cautious about committing resources without certainty. Secondly, workforce planning becomes more difficult when teams cannot
confidently predict future demand, manage distinct cross-sector working cultures, or understand how new responsibilities will be resourced. And lastly and most significantly, succession planning becomes more complicated during a period where many experienced GP partners are approaching retirement, and fewer younger GPs are opting for partnership due to the perceived risk of these unmapped structural reforms.
The cost of uncertainty Surgeries are also spending valuable time trying to understand new funding arrangements and reimbursement mechanisms instead of focusing on implementing service improvements. As funding and contractual arrangements become more complex, many are increasingly relying on specialist advice to interpret policy changes, understand the financial implications, and make informed decisions. Time spent navigating uncertainty and bridging disconnected infrastructure is time taken away from planning improvements for patients. Neighbourhood healthcare can succeed if clinics are able to invest in their future. The practices I work with
want reform to succeed because they understand the pressures facing the wider NHS. They recognise the benefits of providing more integrated care closer to patients’ homes. But successful reform depends on recognising the realities of running a GP practice as well as the aspirations of healthcare policy. If policymakers want surgeries to invest in workforce, premises and new models of care, they must provide clear implementation plans, stable funding arrangements and realistic timescales. Policy can set the destination, but it can’t deliver the journey. That responsibility could rest with GP’s. Giving them the clarity, stability and support to do that is what will determine whether neighbourhood healthcare succeeds or fails. Alongside clearer implementation plans, practices should seek specialist financial and business advice as early as possible. Understanding the implications of policy changes, planning investment and workforce decisions, and developing a long-term strategy now will leave them in a far stronger position to adapt as the neighbourhood health model continues to evolve. FEATURE
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THE HIDDEN CRISIS
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T OFTEN starts with something small like a burning sensation. Maybe a sudden urgency or a feeling you can’t quite ignore. For many women, it’s a familiar discomfort that they learn to recognise, but not to trust.
Giovanna Forte, chief executive and co-founder of Forte Medical, says that if we want better outcomes for patients, improving UTI diagnosis is an important place to start.
Many of us have been told that it’s “probably just a urinary tract infection (UTI)”, handed antibiotics, and sent on our way. Maybe the treatment worked. Often it doesn’t.
cycle they repeatedly re-enter, one that costs us dearly, both as a society and as individuals.
What has stayed with me after talking to countless women about their experience with UTIs (as well as my own) is the uncertainty. Was the diagnosis right? Was the sample reliable? Was anyone really sure what was going on? This is as much a human issue as a clinical problem. UTIs deserve far more attention than they currently receive, with ten million presentations to GPs and nearly 190,000 hospital patients in England each year, predominantly adults and women. UTIs are often treated as routine, but new findings from the National UTI Patient Experience survey (NUPE) suggest that what’s often missing is confidence in the diagnostic process itself. And that gap has consequences. UTIs are among the most common infections affecting women and, for many, they are not an occasional inconvenience but a recurring disruption to daily life, because they were not treated right the first time. Recurrent UTIs place a significant burden on quality of life, work and wellbeing, affecting everything from sleep to social confidence. In the survey, nearly half of respondents experienced a UTI in the previous year, and 44% had two or more. So, for many women, a UTI is not a oneoff encounter with healthcare, but a 32
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Reliant on treatment Yet the conversation about UTIs often focuses almost entirely on treatment. Before treatment, however, comes diagnosis, and if that step is unreliable, everything that follows becomes more difficult. The survey data makes it even clearer than before that this foundational step is where the system is faltering. Perhaps the most surprising finding from the survey was not about symptoms or treatment, but about the urine sample itself. Only 49% of respondents received clear instructions about collecting a midstream sample, which is the basic requirement for an accurate test. Most received a simple screwtop container, a method that is supposedly easy to use but can be incredibly messy and far from ideal for avoiding contamination. Just 2% reported collecting what could be considered a fully reliable specimen. A diagnostic system is only as good as the sample it relies upon. If samples are contaminated or gathered inconsistently, clinicians may not have the information they need to make confident decisions. Women described embarrassment, confusion and practical difficulties, highlighting that this is not merely
a clinical issue but also a patient experience issue. When the very first step in diagnosis is compromised, the accuracy of the entire process is put at risk. Treating without diagnostic certainty can also carry risks. Some respondents reported serious complications, including kidney infection and sepsis – something which I have personally experienced due to lazy prescribing from an NHS GP who failed to follow guidelines, and it was pretty frightening. According to the survey, 92% of respondents had taken antibiotics for a previous UTI, yet only 65% had ever had a sample sent for laboratory culture. Many treatments appeared to be based primarily on dipstick testing, a useful tool but one that is far from definitive. While not every UTI becomes severe, every patient deserves to be confident that decisions are being based on the best available evidence. Diagnostic uncertainty can affect how people feel about their urogynaecological health and, more worryingly, the care they receive. That erosion of trust in the healthcare system can lead to real harm.
S IN UTI DIAGNOSIS Behind every statistic is a person navigating pain and, increasingly with UTIs, doubt. Survey comments reveal the human cost of diagnostic uncertainty, including delays in accessing care, long waits for results, ongoing symptoms despite negative or inconclusive tests, and the emotional toll of feeling dismissed or not believed.
can rely on. Greater emphasis on obtaining high-quality specimens, including wider use of tools such as the Peezy Midstream device that are specifically designed to reduce contamination levels, would significantly improve accuracy as well as reduce burden on GPs and labs with second and third tests for the same infection.
When women feel that their symptoms are not adequately recognised, trust in the healthcare system suffers.
Faster access to testing and laboratory results is essential, reducing delays that leave patients in pain and uncertainty.
Getting the diagnosis right with a clean midstream sample has two important benefits. First, it increases the likelihood that patients receive the most appropriate treatment, reducing the chance of prolonged, possibly painful, symptoms or complications. Second, it helps avoid unnecessary or ineffective antibiotic use. At a time when antimicrobial resistance is becoming one of the defining healthcare challenges of our era, accurate diagnosis is no longer a nice-to-have. It is a cornerstone of responsible prescribing and a safeguard for future generations. Improving UTI diagnosis requires system-level change, starting with clearer instructions and more consistent testing for urine collection. Patients should not be left guessing about how to provide a sample that clinicians
A routine inconvenience For too long, UTIs have been viewed as a routine inconvenience. Yet the experiences shared by hundreds of women in this survey tell a different story, one of repeated symptoms, uncertainty, frustration and the fear of the actual development of chronic conditions and sepsis. UTIs happen mainly to women – partners, wives, mothers and daughters, employees. With so many women disenfranchised by overlooked diagnosis and treatment, the day-to-day of business, home and the economy suffers unduly. This doesn’t have to happen. Increased use of innovative, proven and evidence-based diagnostic technologies, with more thorough communication with patients around sample collection and prevention, would help ensure that decisions by both care provider and patient are grounded in evidence rather than assumption. If we want better outcomes for patients and a stronger response to antimicrobial resistance, improving UTI diagnosis is one very important place to start. FEATURE
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WHY ARE WE STILL WAITING FOR PRO COSMETIC SURGE REGULATION?
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YEAR ago, the government promised action to tackle unsafe cosmetic procedures. The announcement was welcome. It recognised what those of us working in plastic surgery have been saying for years: the cosmetic sector needs stronger regulation, clearer standards and better protection for patients. But here is the uncomfortable truth. A promise is not protection. Patients considering cosmetic surgery still face a confusing landscape in which it can be difficult to understand exactly who is qualified to perform their operation, what specialist training they have received and how much experience they have with the procedure being offered. That needs to change. Cosmetic surgery is still surgery. Every operation carries risks. A facelift, breast augmentation, tummy tuck or liposuction is not simply an extension of the beauty industry. These are invasive surgical procedures involving anaesthesia, incisions, bleeding, infection, wound complications and other serious risks. Patients quite reasonably assume that if someone is offering cosmetic surgery, 34
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they must be appropriately trained and experienced in the type of surgery they are undertaking. That assumption cannot continue when it is not always the case.
Bryan Mayou, found Clinic and consulta writes that the cosm stronger regulation, c better protectio
We need greater transparency around qualifications and experience. Patients should be able to understand what speciality their surgeon trained in, what qualifications they hold, how experienced they are in the proposed procedure, and where they are authorised to practise.
Appropriate surgical expertise is not confined to plastic surgery. ENT and oral and maxillofacial surgeons, for example, may have specialist training relevant to particular cosmetic procedures.
This is not about restricting patient choice. It is about giving patients the information they need to make an informed choice.
What matters is that the surgeon has the appropriate training, qualifications, competence and experience for the procedure they undertake.
Specialist surgical training matters because surgery is about far more than learning how to perform a particular procedure. It is about understanding anatomy, assessing risk, making decisions when things do not go according to plan and knowing how to manage complications.
Another part of this conversation is often overlooked: what happens when surgery goes wrong?
Those skills are developed over years of training and clinical experience. They cannot simply be replicated through a short course or limited aesthetic training.
I have spent my career in plastic surgery and seen how transformative a well-performed operation can be. But I have also spent years treating patients who have come to me after cosmetic surgery has gone wrong elsewhere. Revision surgery can be considerably more complex than the original operation. Scar tissue can make
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der of the Cadogan ant plastic surgeon, metic sector needs clearer standards and on for patients.
choose a surgeon because they have the most followers on social media, the most persuasive advertising or the most impressive website. They should be able to make decisions based on transparent information about training, qualifications, experience and professional standing.
risks rather than waiting for the next scandal or serious patient harm. Most importantly, patient safety must come before commercial opportunity.
tissues difficult to dissect, anatomy may have been altered, and previous surgery can limit the options available. Behind every so-called “botched job” is a real person who may have been left with physical problems, as well as a severe loss of confidence and trust.
This is where regulation plays a crucial role.
The UK has some of the finest plastic surgeons in the world and a long tradition of excellent surgical training. We should set the standard for safe, responsible cosmetic surgery, not allow gaps in regulation to undermine public confidence.
These cases cannot always be fixed with a simple second operation. Correcting the result requires specialist knowledge, experience and careful judgement. Sometimes the first challenge is understanding what has been done in the first place. This is why a surgeon should be judged not only on their ability to perform an operation, but on their ability to recognise and manage complications and, where necessary, undertake complex revision surgery. A clinic’s reputation should mean something. Patients should not have to
The government’s proposed reforms are a step in the right direction, but regulation must not simply become another layer of administration or a box-ticking exercise. A licence alone does not make somebody a good surgeon. We need meaningful standards that reflect the intricacy, complexity and risks of cosmetic surgery. We need clearer definitions of who is appropriately qualified to perform particular procedures, greater transparency for patients and proper accountability for providers. We also need regulation that keeps pace with an industry that is constantly evolving. New procedures, techniques and technologies appear all the time. The rules must respond to emerging
We should not accept this as an inevitable consequence of cosmetic surgery.
One year after the government’s pledge, patients need more than promises. They need action. They need to know who is qualified to operate on them, what training that surgeon has undertaken, what experience they have and what safeguards are in place if something goes wrong. Cosmetic surgery is surgery. It is time our regulation, transparency and professional standards properly reflected that. FEATURE
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THE SINGLE PATIENT TRANSFORMATIO
T
HE ARGUMENT for a Single Patient Record is very simple. Patients should not have to retell their story at every point of care and clinicians should not have to make decisions with partial information. Bringing patient information together across organisational and supplier boundaries is therefore essential. But integrating the data is only the starting point. The real test is whether it changes how care is delivered. A shared record does not automatically create shared working. Making information visible in more places does not make it accurate, actionable or safe to rely on. Nor does it ensure that services are organised to act differently because of what that information tells them. The Single Patient Record will only deliver real value if the NHS treats it as a care transformation programme, not a data integration project.
Make adoption a frontline issue The NHS has already invested £1.9 billion through its Frontline Digitisation Programme to establish a baseline level of digital capability across NHS trusts. NHS England says the focus following the rollout of electronic patient records is increasingly on maximising their impact and usability, as well as laying the foundations for the Single Patient Record. A technically successful Single Patient Record could still fall short in practice. Connecting systems is only part of the task. The information also needs to be usable within the environments where care is actually being delivered. 36
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Frontline professionals already work with multiple systems and information that is technically available somewhere but not available quickly enough to support the decision being made now. Staff will not judge the Single Patient Record by its national ambition. They will judge it in the consultation, on the ward, during a home visit and at the point of discharge. If it becomes another portal, another login or another repository of unfiltered information, it will fail the frontline test. Staff need the right information, presented in the right way and at the right time, with enough provenance to know whether it can be trusted. Adoption will depend on whether the record makes safe care easier, rather
Ciaron Hoye, health at OneAdvanced, wr Patient Record is not s but part of a wider c progra than creating another obligation to search more, reconcile more and document more.
Turn visibility into action If a record shows that a patient is deteriorating, who acts? If a neighbourhood team can see unmet need, does it have the capacity and authority to intervene? If primary, community and social care can all see the same information, are they working to the same plan?
T RECORD AS A CARE ON PROGRAMME reasonably expected to review and act upon when a much larger patient record becomes available. Patients need equally clear answers about who can see their information, why and what happens when something is wrong. There also needs to be a distinction between information shared for direct care and data used for planning, research, innovation or other secondary purposes. These uses may have significant value, but they are not the same thing. Trust has to be built into how the record works: through clear purpose, meaningful access controls, provenance, routes for correction and transparency over how information is used.
h strategy director rites that the Single simply a data project, care transformation amme. The record can expose the issue. It cannot resolve it on its own. Integrated care requires more than shared visibility. It requires agreed pathways, clear escalation routes, clinical governance and clarity about who is responsible for what happens next. The bigger opportunity is therefore to connect the Single Patient Record to workflow, messaging, task management and decision support. It should not only tell the system what is known. It should help the system decide what needs to happen next.
DHSC’s early modelling estimates that, once the programme reaches maturity, the Single Patient Record could contribute to up to 20,000 fewer A&E attendances and around 6,000 fewer hospital admissions each year. These are illustrative estimates, but they underline the point: the value of a shared record comes from what the NHS can do differently with the information, not simply from making it available..
The Single Patient Record is the right direction for the NHS. But it should be judged by what it enables, not by what it contains. Success means fewer repeated histories, safer prescribing, less duplication, faster handovers and better care planning. It means staff spending less time searching for information and patients experiencing care as something joined up around them, rather than something they have to join up themselves.
None of this will translate into better care unless staff and patients trust the record.
The prize is not one national database. It is a trusted, usable and actionable view of the patient that helps care teams make better decisions and services respond earlier and more safely.
Staff need to know where information came from, how current it is and whether it has been verified. They also need clarity about what they are
That is why the Single Patient Record must be treated as a care transformation programme, not simply a data project.
Build trust into the model
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37
PRIVATE HEALTHCAR DOSE OF FINANC
T
diagnosti opticians, facilit
Fo acqu machin refurbishi treatment or upgrad managem can increa experience
External fi bridging th and the in but only if giving the
Healthcare with our re grow their say they a support th
The proble confidence providers affect real 38
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RE NEEDS A BOOSTER CIAL CONFIDENCE
T
HE UK’S private healthcare sector is a broad and vital part of the country’s health infrastructure, spanning not just hospitals and GP clinics, but also specialist ic centres, dental practices, , care providers and treatment ties. With pressure rising on the NHS, these businesses are growing to meet rising demand and plug the shortfall. It’s estimated that one in seven people now use private healthcare – double the proportion since 2023 – and providers are investing to meet that demand.
or one provider, that might mean uiring a new MRI or ultrasound ne. For another, it could involve ing a clinic, opening an additional t room, recruiting specialist staff ding patient booking and recordment systems. Each investment ase capacity and improve patient e.
finance can play a central role in he gap between growing demand nvestment required to meet it – businesses feel like the market is em the right support.
re businesses are highly ambitious, esearch showing that 88% want to r business. The same percentage are likely to use external finance to hat growth.
em is, however, a lack of e in the market. Healthcare are making decisions that l patients as well as balance
Alex Read, founder and chief executive of Portman Finance Group, explains why lenders and brokers must do more to support the sector. sheets. When a clinic invests in equipment, premises or staff, it needs total confidence that the funding arrangement will remain affordable and appropriate throughout the life of that investment. Our research found that a lack of trust in lenders is considered a major or very major barrier by more than 30% of healthcare businesses, while nearly half, 47%, say a lack of transparency in finance terms is a major or very major obstacle. Application complexity, cited by nearly three in ten as a major or very major barrier, adds further friction, as healthcare funding requirements are often highly specific. A dental practice financing treatment equipment has different needs from a diagnostics provider acquiring a scanner or a clinic refurbishing new premises. Put simply, the consequences of getting it wrong are even more pronounced in healthcare – especially when decisions are about extremely high value equipment or technology. Even a small degree of uncertainty can delay or postpone investment, with knock-on effects for patient care and the speed of diagnosis or treatment. Healthcare firms therefore need finance from a partner they can actually trust and structured in a way that aligns with clinical need. For healthcare providers seeking external finance, choosing the right partner is just as important as choosing the right equipment. First and foremost, they need to think about their business and clinical objectives. Are
you trying to reduce waiting times, recruit clinicians, improve digital systems or open a new site? Once that objective is clear, the next step is to start an open dialogue with your finance provider to give them a benchmark from which they can assess the best option. From there, a finance provider will be much better positioned to explain to you what is suitable, what is unlikely to work and what information will be needed before a full application begins. A good provider will also take the time to explain how different products work, what they are likely to cost and the associated risks to consider too. This is the best way to forge a trustworthy and sound relationship with a finance provider. Any provider that immediately and unquestioningly says yes to an application without properly understanding its customer’s business needs can be just as much of a red flag as the opposite end of the spectrum of being asked to go through a web of credit checks and assurances. After all, sometimes the right answer may be to delay an investment or seek a different product – which is why healthcare firms should work with a partner to choose the best course of action and feel more confident in the lending process. Private healthcare businesses are growing, and many expect finance to be part of that journey. The market now needs to give them the confidence and support to act. Clearer terms, simpler processes and advice grounded in the realities of healthcare can help providers invest and meet the changing needs of patients. FEATURE
39
H
EADLINE figures only ever tell part of the story, and that’s certainly the case when it comes to investment in femtech.
Recent research that we conducted has revealed that investment in the UK femtech sector has increased substantially over the past decade, with deal activity rising by more than 194%. Not only has volume increased – from 18 to 53 deals – so too has value. Total funding has grown sharply, rising from £9.4 million in 2015 to more than £100 million 10 years later. The average deal size has also gone up, more than doubling since 2015 from £527,000 to £1.9 million. Companies such as SheMed, Gaia, Emm and Hertility have all completed sizeable funding rounds in the last 12 months, with the majority of investors being UK-based. While the wider women’s health market has also hit a funding milestone, with investment reaching a record $1.55 billion (£1.1 billion) last year, according to the 1st Global Women’s Health Investment Report, the standout figures need to be treated with a word of caution. Yes, we are on an upward trajectory, and this positive trend demonstrates growing investor confidence and increasing institutional interest in the sector. However, when it comes to UK femtech, these figures are still relatively low compared to other segments of the health and care market. As such, more work needs to be done to create the right funding environment that is balanced and evenly spread across the UK. Currently, the majority of deals have been conducted in London, with the capital strengthening its position as the main hub for femtech startups in the UK. Elsewhere, other regional clusters have been slow to emerge, with areas such as the North East, North West and Yorkshire & the Humber significantly underrepresented in the national figures.
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THE GROWTH DEAL AC So what do the figures really say about the investment landscape in femtech? A decade after the term ‘femtech’ was first coined by Ida Tin, co-founder and chief executive of Clue – one of the first period-tracking apps for women – the market has clearly grown in maturity; however, a large proportion of deals are still seed investments.
Vicky Protano, corpor Reeve, argues that alt are on the rise, mor done to create market continues to face significant funding barriers, which are hindering strategic ambitions.
The early-stage nature of the sector creates an understandable funding ceiling when it comes to investment values, with companies traditionally relying on angel investors and angel networks to help scale and grow.
A key challenge faced by female founders, in particular, is that their businesses are often driven by purpose, emerging from lived experience rather than commercial ambition.
While dynamics are shifting, with more venture capital and PE investors appearing in funding rounds, the
In fact, research shows that the most damaging thing a female founder can do in funding pitches or company
creating a better environment where digital innovation can thrive, with a renewed focus on prevention through market-leading consumer-driven products. The UK has a real opportunity to transform women’s healthcare into a model of fairness, accessibility and excellence, and femtech businesses have a crucial part to play in achieving this transformation. But there is clearly room for improvement.
OF FEMTECH CTIVITY
rate partner at Mills & though femtech deals re work needs to be e a sector shift.
There’s also a wider societal issue that is holding back the femtech market. For decades, women’s health has been under-funded, under-researched and misunderstood, creating an undeniable gender health gap.
publicity is to suggest they champion their product’s cause. It’s hardly surprising that innovators led by allmale teams are four times more likely to receive funding than those that have a female leader.
Businesses focused on women’s health may be at the cutting edge of healthcare innovation, transforming women’s health and wellness, but while barriers such as a lack of funding, gender bias, and societal disparities still exist, those businesses will struggle to close that funding gap.
Investors clearly remain sceptical, with the sector in need of more strategic exits and improved early-stage conversion to achieve a more mature, equitable landscape beyond the headline figures.
There’s no doubt the investor landscape is evolving. The data around the femtech sector is valuable and growing. It demonstrates progress is being made from an investment point of view,
Encouraging more women-led funds, as well as increasing representation of female investors who prioritise women’s health, are essential steps to ensuring that femtech receives the funding it deserves. Expanding dedicated funds which prioritise founders addressing female health issues will also help to promote investment in women’s health. These approaches not only advance the cause but also mainstream it within the investment landscape. What’s more, we need to better educate. VC infrastructure in the UK lacks a deep understanding of women’s health solutions. The sector needs greater support to take something that is unfamiliar and translate it – not just from a healthcare perspective, but from an investment perspective as well. The good news is the landscape is beginning to shift in a more positive direction, with several initiatives in place that are designed to address the funding gap to drive greater innovation and economic growth, particularly for female founders. With government-backed initiatives, such as Investing in Women Code, the investment community is making a concerted effort to break down barriers that prevent female entrepreneurs from accessing capital. The seeds have been sown, and the growth of femtech deal activity over the past ten years demonstrates a desire and ambition to build on that momentum. INTERVIEW
41
HOW T
A
ROUND 16 people wo health car is overwh
million peo
mental health services more than doubled sinc wait years to be seen. digital support is desp services reach more p the care they need.
Yet in the UK, despite a rigorously tested digita an impact, many fail to need them most. Rout health and care servic complicated and hard littered with barriers th inhibit effective implem tools from being made
With a new administra national health priorit for change. Smoother, to adoption are neede health solutions where ensure the innovation mental health crisis do hurdle. Barriers to effe of digital mental healt stages of the procurem tools are commission how they are integra
The commissioning mental health in En fragmented. In the a groundhog day applications and t Care Boards (ICB own priorities, pro challenges, comm The same regionexists for partneri authorities, such a slow, sporadic ad postcode lottery fo Meanwhile, chang commissioning cycl 42
FEATURE
W TO FIX THE BARRIERS TO MENTAL HEALTH
60,000 brilliant, dedicated
ork to deliver mental re in the UK. But demand helming. More than four ople are in contact with s, CAMHS caseloads have ce 2020, and many people . Accessible, scalable perately needed to help people, sooner, and deliver
a wealth of approved, al tools ready to make to reach the patients who tes to adoption across ces are fundamentally d to navigate. They are hat stall procurement, mentation, and prevent e available long-term.
ation currently setting its ties, now is the moment r, more streamlined routes ed to get digital mental e they are needed and poised to ease the UK’s oes not fall at the last ective implementation th tools occur at multiple ment process. From how ned and get funded, to ated into existing systems.
g processes for digital ngland are deeply e NHS, providers face of repeated regional tenders: 36 Integrated Bs), each with their ocurement cycles, and mission for different areas. -by-region approach ing with other local as councils. The result is doption of solutions, and a or those seeking support. ging priorities across les can mean that
Manjul Rathee, chief executive and co-founder of BFB Labs, argues that digital mental health is falling at the last hurdle.
promising new tools are continually piloted, trialled with patients, and then phased out. This phenomenon, known as ‘pilotitis,’ means even the best solutions often fail to achieve longterm adoption, and service users lose access to digital tools they have come to rely on. It can also cause frustration for practitioners, who are left unsure which tools will be available and for how long, while services waste an inordinate amount of time and resources picking up pilot after pilot. The services commissioning digital mental health tools operate with limited resources. A finite pool of funds has to be carefully allocated across a vast number of competing priorities and targets. Digital mental health faces fierce competition for its share. Even when a digital tool is approved and commissioned, funding is often tied to shortterm cycles. Re-commissioning can be an annual process, requiring providers to prove year after year, region after region, their value from scratch. In turn, this uncertainty can discourage third-party investment in the tech itself as revenue is hard to forecast and growth can be inhibited by the risk of contract nonrenewal. The final hurdle is integration. New digital tools face lengthy regulatory processes that often have to be repeated for every region: from completing DPIAs to ensuring Information Governance and DTAC standards are met. While regulation is crucial, this repetitive process can complicate implementation and stall the scaling of effective treatments. On the ground, clinicians face their own challenges with implementation. The innovation fatigue created by a cycle of short-term rollouts can mean there’s a lack of trust or motivation to engage with new tools. Poorly managed
rollouts have been shown to directly increase staff stress and workload. While there is no quick fix to any of these barriers, a more joined-up approach to commissioning and funding could help significantly unblock progress and create real economies of scale for digital mental health. One step would be to end pilotitis by standardising success criteria, establishing a more consistent framework for measuring pilots’ effectiveness, and restructuring contracts so a successful pilot can transition straight into a longer-term agreement. This could significantly streamline recommissioning, remove the need for repeated proof of impact, and enable successful rollouts to be replicated across different regions. All of which would provide a clearer, more stable path to long-term adoption, while ensuring the best-fit solutions are implemented, based on real impact data. National certification and regulatory approval could also help to end the fragmented cycle of regional adoption, increasing treatments’ reach and removing the postcode lottery for care. The technology to ease the UK’s mental health crisis is ready, and backed by evidence. Numerous solutions have been approved by the National Institute for Health and Care Excellence (NICE) for use in mental health support. What
we need now is a system that enables more consistent, widespread adoption and unlocks access for those who need it most. As it stands, countless people are waiting years for a face-to-face appointment while the digital tools that could deliver the mental health support they need sit idle. Fixing the barriers to digital implementation is crucial to help increase access to care, while freeing up vital capacity for existing services. FEATURE
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ÖZGÜR TUNC
HEALTH AND VACCINE
A
T THE beginning of August, StablePharma announced Phase 1 clinical trial results for SPVX02, a room-temperature-stable reformulation of a licensed tetanusdiphtheria (Td) vaccine. It is hard to underestimate what a breakthrough this is. Keeping vaccines cold from the factory to the patient is one of the biggest challenges facing immunisation programmes worldwide. If, as expected, the Phase 2b trials confirm these results early next year, then this technology could help transform the way vaccines are stored and delivered around the world. Here, Stablepharma chief executive Özgür Tuncer talks to Healthcare Today about vaccine wastage, why fridge-free vaccines are a game changer and how the technology will help health equity. Let’s start with the obvious question: how big is the vaccine-wastage problem actually caused by the cold chain? Up to 50% of all vaccines produced globally are wasted, which is a staggering figure. Put simply, we are manufacturing two vaccine doses just to get one into a patient’s arm – a massive inefficiency given the billions of doses produced worldwide every year. While precise localised data can be difficult to pinpoint, our own studies across developed markets – including surveys of GPs and clinicians in the UK, Germany and Spain – reveal telling results. While wastage in the Western world may not reach the 50% mark seen globally, it still reaches up to 30%. Around a third of the doctors we surveyed reported frequently having to discard 44
INTERVIEW
Cold-chain dependence is not just a logistical burden, it is a primary driver of global health inequality. Following promising Phase 1 results for SPVX02, StablePharma’s chief executive discusses how thermostabilisation technology can redefine global health equity. Written by Adrian Murdoch. vaccines due to cold chain breaches or related logistics failures. Gavi, the vaccine alliance, recently published a paper underlining that cold
chain management remains one of the single greatest logistical hurdles in global healthcare. Whether in emerging markets or developed nations, temperaturesensitive vaccine wastage remains a critical, pervasive problem. Stablepharma currently quotes WHO estimates that more than half of vaccines are wasted every year, “primarily due to failures in the logistical cold chain”. 50% of what, across which vaccines and countries, and how much is actually cold-chain failure? To grasp the scale of the issue, one first has to understand what cold chain failure actually entails. This is not like a household fridge where you can take out a bottle of milk and put it back later without issue. Most conventional vaccines must be kept continuously within a strict two-to-eight degree Celsius range – with
some requiring deep-freeze storage at minus 20 or even minus 80 degrees, as we all saw during the pandemic.
Cold chain failure occurs whenever ther is a temperature deviation. Over a typic vaccine shelf life of two to three years, the probability of a temperature spike occurring somewhere along the supply chain is extremely high; maintaining an unbroken temperature window for year is a monumental logistical challenge.
Expirations create another major source of wastage, as many vaccines have relatively short shelf lives. Our technolog directly addresses both hurdles.
By thermostabilising – essentially fortifying – the vaccine, we eliminate the need for temperature-controlled refrigeration while simultaneously extending product shelf life beyond that of standard cold-chain products. We tackle wastage from both ends: extending viability and removing cold chain dependencies entirely.
CER:
re cal
n rs
e
gy
EQUITY Using dehydration for preservation is an ancient concept. For thousands of years, our ancestors knew that removing moisture preserved food, for the simple reason that where there is water, biological activity thrives. Powdered milk is a modern parallel: convert fresh milk to powder, and its shelf life expands dramatically. That is essentially what we are achieving with vaccines – converting them into a stable powder format that remains viable for extended periods without any need for refrigeration. What does a fridge-free vaccine make possible that simply improving today’s cold chain can’t? What does it mean in human terms? There are parts of the world where, no matter how much you invest in cold chain infrastructure, reaching remote populations remains nearly impossible. Health workers are still forced to rely on insulated boxes packed with ice. That dynamic introduces another frequently overlooked issue: freezing damage. Standard vaccines must be maintained between two and eight degrees Celsius; if they drop below
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45
Millions of people continue to suffer from illnesses that are entirely preventable simply because of where they live.
freezing, the biological active ingredients degrade, and the batch is ruined. Placing vaccines directly against ice packs carries a significant risk of accidental freezing, resulting in immediate waste. Enormous sums have been poured into improving cold chain technology – refrigeration manufacturers have built entire business models around pharma logistics. Yet equipment upgrades alone cannot make the supply chain bulletproof. Maintaining an unbroken temperature window relies heavily on human behaviour, not just hardware. Even here in the UK, we routinely hear anecdotes of clinic fridges being accidentally unplugged over a weekend. Across a multi-year shelf life, human error is almost inevitable. Our technology provides genuine peace of mind by ensuring vaccine potency regardless of external conditions. That reliability touches on an uncomfortable question that many in the industry avoid, but as a sector disruptor, I believe needs addressing: vaccine scepticism in developing regions across Africa, Asia and Latin America. 46
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When communities express doubt because they have seen vaccines fail to protect patients, the core issue is often not the vaccine’s design, but how it was stored. In remote settings, there is currently no way to verify whether a dose has retained its potency by the time it reaches a patient’s arm. At StablePharma, our goal is to guarantee that a vaccine administered anywhere in the world remains fully potent. That guarantee represents a fundamental shift for global immunisation. Your Phase 1 results were impressive. What does that result tell you about the underlying technology – and what don’t we yet know? The earlier trials demonstrated a great deal; the results were fantastic and confirmed that both our science and the underlying product are working as intended. The vaccine was stored at 30 degrees Celsius for up to 12 months before administration, and it performed exceptionally well in human trials. We have now initiated our Phase 2b trial, which serves as our pivotal study. While the Phase 1
trial directionally proved that the technology functions brilliantly, it was not statistically powered to hit every endpoint required to declare full non-inferiority against the standard reference vaccine. Certain endpoints achieved statistical significance, but not all of them. Our Phase 2b trial addresses that limitation by expanding the sample size. The trial design itself remains virtually identical to Phase 1: a twoarm study directly comparing our reformulated, thermo-stable vaccine against the original refrigerated version to prove non-inferiority, backed by fully powered statistical data. We expect to report the top-line results from this pivotal Phase 2b study in the first quarter of next year. How much could removing refrigeration actually reduce the cost of delivering a vaccine? There is compelling published pharmacoeconomic research showing that even if a thermostable vaccine were priced at three times the cost of a conventional vaccine,
health systems in developing nations would still save money. That is because a massive portion of immunisation budgets is swallowed up by cold-chain logistics and product wastage. To explore whether this issue applies to high-income regions, we partnered with IQVIA to publish a joint white paper titled The Tip of the Iceberg. There is a common assumption that thermostabilisation technology is only relevant for developing countries, but our findings in Europe prove otherwise. Out of €31 billion spent on vaccines across Europe, €21 billion goes directly toward cold chain maintenance and absorbing wastage. The actual cost of the vaccines themselves represents just €10 billion of that total sum. The potential savings – even in advanced healthcare systems – are vast. This brings me to a fundamental question for the broader industry: given that we now possess proven technology to create shelf-stable vaccines that eliminate waste and reach every patient, why is there not
greater political and commercial determination to deploy it? Opting for lower-cost, traditional vaccine formulations is a false economy. In the long run, “cheap” proves vastly more expensive – both in financial terms and in environmental footprint. If we were having this conversation five or ten years from now and fridge-free vaccines had become mainstream, what would have changed about the way we vaccinate people? Ultimately, this comes down to health and vaccine equity. Millions of people continue to suffer from illnesses that are entirely preventable simply because of where they live. As the pandemic demonstrated, no population is truly safe until everyone is safe. The political impulse to close borders and isolate within national boundaries has rarely proven effective in human history, yet we saw a return to that instinct during COVID-19. Protecting global public health requires eradicating preventable diseases everywhere – and given that effective vaccines already exist, achieving that goal should be entirely within our reach.
Beyond equity, there is another industry-wide trend that deeply concerns me: the relentless pressure to drive down vaccine prices. While lowering costs is often framed as a positive move to expand access, it has rendered vaccine development commercially unattractive. Over the past five years, numerous vaccines have been withdrawn from the market simply because they were no longer financially viable for manufacturers. By removing the massive logistical overhead of the cold chain, technologies like StablePharma’s offer a different path forward. Eliminating supply chain waste enables manufacturers to capture fair value and reinvest in research and development, restoring commercial incentives for new vaccines. As part of my work with the UK Health Security Agency (UKHSA) working group, I frequently emphasise that private industry must be given viable commercial incentives. If manufacturing remains unprofitable, companies will continue to exit the sector – leaving us with a dangerously depleted vaccine development pipeline. INTERVIEW
47
THE NHS’S EYE CARE S IS ALREADY IN THE COM
W
HEN discussing the growing crisis in eye health, the conversation often starts in hospital corridors. Long waiting lists. Increasing demand. Overstretched clinics. Yet, focusing solely on hospitals risks overlooking that one of our greatest opportunities to expand eye care capacity is already sitting in communities across the country. The challenge facing eye health services is undeniable. Ophthalmology is the NHS’s largest outpatient speciality, accounting for almost nine million appointments in England each year. Around 600,000 people are currently waiting to begin ophthalmology treatment in England, and this number is only set to grow with an ageing population where the prevalence of glaucoma, cataracts and other age-related eye conditions is expected to rise. Hospitals will remain essential for surgery, specialist intervention and the management of complex diseases. But if we’re serious about creating a sustainable eye care system, we must recognise a simple reality - the NHS already has a highly trained eye care workforce outside of hospitals equipped with advanced diagnostics operating in communities nationwide. The real question is: why are we not making greater use of it? Many people still think of their local optician primarily as somewhere to have their eyes tested or to update a glasses prescription. The reality is very different. Today’s community optometrists are highly skilled healthcare professionals who play a central role in detecting, monitoring and managing eye diseases. Many optometrists have further specialist qualifications such as advanced glaucoma or retina care, and many practices are equipped with sophisticated technologies,
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FEATURE
Purvi Thomson, head of optometry at OCL Vision, writes that while hospitals will continue to provide specialised care community optometrists can deliver accessible front-line services.
such as optical coherence tomography (OCT), digital retinal photography and visual field testing, providing hospitalgrade capabilities. However, this clinical capacity is not being fully utilised. Evidence increasingly shows what can happen when community optometry is integrated more effectively into the wider eye care pathway. Peer-reviewed research, for example, found that minor eye conditions services (MECS) reduced GP referrals to hospital ophthalmology by 30.2% in one London borough and 75.2% in another, demonstrating the potential for community optometry to absorb significant demand safely and cost-effectively. An analysis also suggested that up to 78% of A&E attendances for eye problems, amounting to hundreds of thousands of visits each year, could be safely managed through community optometry services. At a time when emergency departments are operating under extraordinary strain, enabling patients to access appropriate care through local optometry practices represents an important opportunity to improve both efficiency and patient outcomes. Patients benefit too. Receiving care closer to home is often quicker and more convenient than attending a hospital appointment. In fact, cataracts are generally first picked up in routine eye exams in community practices. Earlier assessment is also particularly important
for conditions such as glaucoma, whe irreversible sight loss can occur befor symptoms emerge.
Despite this evidence, across England access to enhanced eye care service remains highly variable. This postcod lottery means some patients benefit f established community pathways wh others have no access to equivalent services. In some cases, successful se have even been decommissioned de positive outcomes for patients and commissioners alike.
Unlocking community capacity there requires more than good intentions. I requires stronger integration betwee primary and secondary care, more consistent commissioning and better digital connectivity across the system
Eye care is particularly well placed to benefit from innovation because it is around imaging and data.
Artificial intelligence is likely to accele these gains further. Research conduc by Moorfields Eye Hospital and Deep demonstrated that AI systems can an OCT scans and identify retinal diseas with accuracy comparable to experie specialists.
We are also seeing innovation transfo treatment itself. For example, in catar surgery – the most frequently perform operation in the UK – a new surgical has been created using AI technolog the Galaxy Spiral Lens, which provide
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glasses-free vision at all distances without the bothersome side effects of many other lenses. Groundbreaking innovations such as these have the potential to improve pre- and post op times, whilst helping patients to achieve stronger visual outcomes. The aim of all this emerging technology is not to replace clinicians, but to help them support more patients safely and efficiently closer to home. Ultimately, the future of eye care should not be framed as a choice between hospitals and the community. The strongest systems will be those that bring both together. Hospitals will continue to provide highly specialised care. Community optometrists can deliver accessible front-line services, monitor chronic conditions, refine referrals and identify problems earlier. And technology can connect these settings more effectively while helping clinicians work smarter. No single intervention will resolve the pressures facing NHS eye care. But the solution is also not starting from scratch. Much of the workforce, expertise and technology needed already exists. The opportunity is to unlock it. Community optometry should be at the heart of the strategy, not on the sidelines. FEATURE
49
M
EDICINE has spent years documenting gender bias among physicians. Pay gaps, patient trust, career penalties tied to motherhood – all of it has been measured, published and argued over in journals for a decade or more. Dentistry never got the same treatment.
surrounding structures – and she was the owner, the one signing the check.
So we ran them! We surveyed 500 women working in dentistry across the US, UK and Canada. The findings put figures behind a set of experiences a lot of women in this field have had for years without ever seeing them written down.
As many as 43% of surveyed women reported being treated differently by a vendor or sales rep because of their gender. More than one in ten (14%) were quoted different financing terms than a male colleague, to their knowledge. Another 12% suspected it happened without being able to prove it.
I watched this happen to a colleague a few years back. A rep came in to pitch a CBCT unit – a type of X-ray scanner which can create detailed 3D images of the teeth, jawbone, nerves and 50
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He spent most of the meeting addressing me instead. I wasn’t even on the payment side of the conversation. She corrected him twice. He kept drifting back to me anyway. At the time, it read as clumsy. Reading the survey results, it reads as a habit.
The open responses kept circling one specific sequence. A woman asks for the same terms a male colleague received. She’s told the offer expired. Weeks later,
Darius Kucinas, gene and co-founder of highlights the prob in den the identical offer reappears for him. That exact pattern showed up again and again, across practices with no connection to one another. Patients bring their own assumptions Bias doesn’t stop at the supply closet. Getting on for half (46%) of respondents said patients question their competence at least occasionally. One in four has had a patient ask to be switched to a different dentist, specifically because that dentist is a woman.
WOMEN IN DENTISTRY ARE STILL PAYING A BIAS TAX
eral practice dentist f Dental Reviewed, blem of gender bias ntistry. Associates take the worst of it. A third report a reassignment request, compared with 16% of practice owners. Then there’s parenthood, which is where the survey’s numbers get harder to sit with. Of the 283 respondents who are parents, 73% report a career setback tied to having children. Reduced hours that never went back to full-time, delayed partnership, or patients lost to colleagues during leave. Only 10% received fully paid leave while 30% received none. Geography changes the shape of the problem but doesn’t solve it. UK
respondents reported the highest rate of unpaid leave, at 40%, largely because self-employed associates there don’t qualify for statutory maternity pay. US respondents reported 28%. Canadian respondents reported 22%, the lowest of the three, still nowhere close to fixed. Women now make up close to 40% of the dentist workforce across all three countries. Practice ownership hasn’t kept pace with that shift. Female dentists remain less likely to own a practice at every career stage, and separate research out of Canada found they earn 21% less than male dentists after adjusting for hours and region. Respondents named specific changes, not vague hopes. Real part-time partnership tracks, rather than parttime roles with no path forward. Reduced hours read as reduced hours, not as reduced commitment. More
women involved in setting leave policy, since the people deciding it are often the people who never took any. Clear protections for self-employed associates and practice owners. A guaranteed patient panel on return from leave, so nobody comes back to an empty schedule. A written leave policy costs almost nothing to put on paper. A protected patient panel costs even less. Training vendors to treat every dentist in the room as a decision-maker costs a single conversation. Most dentists I know like to think the job comes down to steady hands and good clinical judgment, nothing else. Our survey at Dental Reviewed says otherwise. It’s been going on for a long time. Now there’s data to back it up. What practices do with that is up to them. INTERVIEW
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DIGITAL FR TIME THAT AFFO
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EALTHCARE workers have never had access to more technology. Prescribing platforms, scheduling tools, patient records and internal messaging are all designed to make everyday tasks easier. But when healthcare employees spend more time switching between systems than using them, it is a sign that something has gone wrong with their integration and adoption. With work spread across so many platforms, staff are too often left with the extra burden of choosing the right tool, searching for information quickly, re-entering context and trying to remember where they were before the last interruption. More than half (53%) of healthcare workers spend at least 11% of their working week dealing with problems caused by fragmented workplace systems, research shows. In a typical full-time week, that is more than four hours spent navigating problems rather than doing the work itself. Over an entire year, this equates to five and a half weeks’ worth of time lost to tool management.
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This is digital friction, and the healthcare industry is paying for it in what it can least afford to waste – people’s time and attention.
A c u c w m s t a s
As technology and AI adoption increases, it can be easy to think that more tools make work more efficient.
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RICTION IS STEALING HEALTHCARE CAN’T ORD TO LOSE Hannah Soye, chief people and culture officer at employee experience platform Haiilo, says that we should be asking how we can streamline tools so healthcare workers do less.
While we have become very good at measuring technology adoption, knowing how many people logged in and their usage rates tells us very little about what it feels like to use it.
But in the real world, now nearly twothirds (64%) of healthcare workers often or always need to switch between multiple workplace tools to complete a single task.
The reality is that 59% use four or more workplace platforms during a typical working week.
Every time they switch between them, it introduces another opportunity to lose context, interrupt concentration or simply forget where you were.
Searching for information is one of the clearest examples of hidden friction. Half (50%) of healthcare workers spend at least two hours every week looking for information across workplace systems, and 15% spend more than five hours doing it. Searching may not feel like ‘lost productivity’ in the same way as a cancelled appointment or an empty shift. But it is still precious time that healthcare workers could be spending with patients. This challenge has caused healthcare workers to find their own, longer fixes. Over half (58%) of healthcare workers say they often or sometimes duplicate work because information is difficult to find.
A high level of software adoption can create a blind spot around the people using them. Without consultation, it can be difficult to see that healthcare workers are quietly losing time trying to make them work. And when alreadystretched workers have to spend their time working around the systems that are supposed to support them, the sector risks losing valuable staff.
Almost half (48%) say colleagues regularly ask questions that could have been answered if information were easier to access.
Measuring tools should go hand in hand with measuring the experience of using them.
If we want to reduce digital friction, we need to look at technology from the employee’s perspective.
While this can look like individual habits or resistance to change, they are really employees adapting intelligently to systems that do not fit the way that work actually happens.
Take a common task and ask how many systems someone has to open, how often they have to switch, where they have to re-enter information, and when they ask a colleague for help. This exercise can reveal more than an adoption report ever will. The starting point should be about getting a comprehensive understanding of how employees work and what they need from their technology to create efficiencies and streamline processes. To get a full picture of the impact that digital friction is having, the first step is to make the problem visible. Healthcare organisations already know how to measure performance in incredible detail. Some of that discipline should be applied to the digital environments in which staff work every day. That means measuring more than logins and adoption, and most importantly, listening to the people doing the work. Reducing digital friction requires leaders to recognise that technology should reduce the effort required to do good work, not create another layer of admin around it. In healthcare, every hour recovered from unnecessary digital friction is capacity returned to give back to patients. We have spent years asking what technology can do for healthcare, but now we need to be asking how we can streamline tools so healthcare workers do less. FEATURE
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CL PH
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OR PHARMACEUTICAL companies, climate change is moving from the sustainability agenda to become a defining business resilience challenge. For years, sustainability was viewed as a long-term corporate ambition. But as climate-related disruption grows, the industry’s ability to manufacture, transport and deliver medicines increasingly depends on how effectively it prepares for a changing world. Leaders increasingly recognise that building resilience is essential to maintaining access to medicines. Almost nine in ten (87%) pharmaceutical organisations surveyed in BSI’s 2026 G7 Temperature Check expect climaterelated disruption to their supply chains to increase in the years ahead. For an industry built on reliability, quality and patient safety, this should serve as a warning. Pharmaceutical supply chains are among the most complex and tightly regulated in the world, making them particularly exposed to disruption. From sourcing raw materials and active ingredients to manufacturing,
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storage and distribution, every stage of the value chain depends on stability, predictability and efficiency. Climate change threatens all three. Extreme weather events can disrupt manufacturing facilities and critical transport infrastructure, creating significant challenges for supply chains. Access to high-quality water is essential for many manufacturing processes, yet water availability is already under pressure in a growing number of highrisk water basins. Rising temperatures also present new risks to the efficacy and stability of temperature-sensitive medicines during storage and transportation, particularly in low- and middle-income countries experiencing more frequent and severe heat events. Despite these emerging challenges, the impact of climate change on medicine stability has yet to be fully reflected in the eco-design and development of new treatments. Flooding, drought and other severe weather events can further exacerbate existing vulnerabilities, leading to supply delays, disruptions in access to medicines and increased uncertainty for healthcare systems and
Courtney Soulsby, hea director at BSI, writes becoming a business for pharma population health outcomes worldwide. It is hardly surprising, therefore, that nearly nine in ten pharmaceutical leaders surveyed are concerned about the resilience and cost implications of failing to prepare for climate change. More than three-quarters (78%) say their net zero programmes are critical to future business resilience, while eight in ten (82%) believe the risks of failing to transition outweigh the costs of taking action. The business case for climate action is increasingly inseparable from the case for resilience. Encouragingly, the industry is responding; ninety-six per cent of leaders remain committed to achieving net zero in line with national targets, and more than a third (37%) expect to increase investment in net zero initiatives over the next year. Perhaps most tellingly, 71% say they will continue their net zero efforts
LIMATE CHANGE THREATENS ARMACEUTICAL COMPANIES
althcare development that climate action is resilience imperative aceuticals regardless of political conditions because they see sustainable practices as fundamentally good for business. Customers are already a powerful driver of change. More than four in five respondents (83%) cite customer expectations as a key factor influencing their sustainability strategies, while 82% point to a broader commitment to building a more sustainable future. Other drivers for action include healthcare systems’ procurement requirements, investor expectations and emerging regulation, including environmental risk assessment that is directly connected to market approval. However, ambition alone is not enough. Organisations need a clear understanding of their environmental impacts and opportunities for improvement. This is where standards play an important role in turning
ambition into action. One of the challenges facing the pharmaceutical sector has been the lack of consistency in how environmental impacts are measured, and hotspots are identified. Organisations increasingly want to assess the footprint of medicines across their entire lifecycle, from raw material extraction and manufacturing through to distribution and disposal. Yet different methodologies can make meaningful comparisons difficult and limit organisations’ ability to make informed decisions. The specification for pharmaceutical products, product category rules for environmental lifecycle assessments (PAS 2090), aims to address this challenge by providing a consistent methodology. Without a common approach to measurement, it becomes harder to identify the greatest opportunities for improvement, benchmark performance or make informed procurement decisions. Importantly, a common framework enables organisations to identify environmental hotspots, benchmark performance and prioritise interventions
that can deliver both sustainability and resilience benefits. Yet measurement is only the first step. Insights from a recent BSI roundtable suggest that many pharmaceutical leaders are now moving beyond identifying climate-related risks and are beginning to focus on how resilience can be embedded operationally. While organisations increasingly understand their climate exposure, adaptation has not yet been consistently integrated into governance structures, investment decisions, supplier management strategies and day-to-day operations. As a result, a significant gap remains between understanding climate risks and translating that understanding into measurable resilience outcomes. Net zero plan are far overshadowing their relatively immature efforts towards adaptation. Closing that gap will be critical. As climate-related disruption becomes more frequent and severe, organisations that successfully embed adaptation will maintain continuity, protect patient access to medicines and respond to future risks. INTERVIEW
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BRIDGING THE GAP DEMAND AND FRA
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K PRIVATE hospitals recorded 1.1 million admitted episodes in 2025, with Healthcode’s Clearing Service processing 11.8 million invoices during the year, generating £5.5 billion in sector revenue. Demand for private care has rarely been stronger. Increasingly, though, patients are not only judging the treatment they receive. They are judging the experience around it.
right specialism and real availability, book at a convenient time, complete forms before they arrive, receive digital updates and manage parts of their care without having to phone multiple practices, clinics and hospitals.
The sector has the clinical capacity to respond. But growth on that scale puts pressure on everything around the consultation: finding the right clinician, booking an appointment, sharing records, receiving prescriptions and settling invoices without unnecessary friction.
The same shift is visible inside the NHS. The 2026 GP Patient Survey found that 30.8% of patients contacted their practice online or through the NHS App, up from 22.4% a year earlier. Almost eight in ten had used online services in the previous 12 months.
Each one of those touchpoints shapes how patients feel about their care.
For providers, the message is clear. The experience around care now matters almost as much as the care itself. In a market where clinical quality is often assumed, operational efficiency and patient experience have become important ways to stand apart.
Patient expectations have changed dramatically Patients no longer compare healthcare only with other healthcare providers. They compare it with the digital services they use every day: banking apps, supermarkets, airlines, retailers and delivery platforms. Research conducted by 451 Research for Verato found that 95% of consumers expect healthcare experiences to match the standards set by other sectors. And those sectors have raised expectations around convenience, speed, accuracy and control. In practice, patients increasingly expect to find a clinician with the 56
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Healthcare has been disjointed for too long Healthcare delivery has traditionally been divided across different organisations and systems. A single private episode can involve a referring GP, a consultant, a hospital or clinic, a diagnostic provider, an insurer and a pharmacy. Each may hold a different part of the patient’s record. Information, prescribing and administration are often managed through separate systems built
independently and not designed to work together. As a result, the patient is frequently the only person carrying the full story of their care, and is asked to repeat the same details at each handover. The Verato research found that 81% of people provide the same information repeatedly across healthcare interactions, while 48% encounter incorrect or inconsistent information about themselves. Among 18 to 34 year olds, that second figure rises to 69%. This is also the age group moving towards becoming a core self-pay market for private healthcare. For patients, repeated forms, missing details and inconsistent records do not feel like minor administrative issues. They make the service feel disconnected, and they reduce confidence at moments when trust matters most.
P BETWEEN DIGITAL AGMENTED CARE and correspondence are among the details clinicians need to make safe, informed decisions. Every manual reentry of information creates another opportunity for delay, duplication or error.
The shift towards connected patient pathways One of the most important changes now taking place in private healthcare is the move towards better connected patient journeys.
The gaps are widest where NHS and private care meet Around six million people in England are currently waiting for treatment, and the 18-week referral-totreatment standard has not been met since 2015. Nearly one in eight people in the UK now hold some form of private medical cover. In practice, few patients use one system exclusively. A pathway might begin with an NHS GP, move to a private consultant for diagnosis or surgery, involve prescriptions on both sides, and then return to NHS follow-up. The patient moves between systems, but too often, the information does not move with them. That has clinical consequences as well as operational ones. Medication history, allergies, diagnostic results
The aim is simple: information should move securely and reliably between the organisations involved in a patient’s care, regardless of where that care is delivered. This reduces friction, supports continuity of care, improves clinical decision-making and gives patients a smoother experience. Policy is moving in the same direction. The Single Patient Record, legislated for under the Health Bill 2026 and due to be available through the NHS App by 2028, will require NHS trusts, general practices, social care providers and contracted private healthcare organisations to share patient data securely and in real time. Dr Alec Price-Forbes, National Chief Clinical Information officer at NHS England, has defined the problem as information being held in silos, leading to duplication and gaps in clinicians’ understanding. For private providers, the direction of travel is irrefutable. Interoperability is becoming a basic requirement of modern healthcare.
How Healthcode approaches the problem
Healthcode has spent more than two decades building infrastructure for the private healthcare sector. Today, more than 58,000 practitioners are registered on its Private Practice Register. Healthcode’s practice management platform, ePractice, brings appointments, patient records, prescribing, invoicing and secure communication into one joinedup system, while interfacing with a wide variety of external systems and databases. This reduces the need to re-key information between tools and helps practice teams spend less time on administration Its real-time booking exchange, ICE, allows practitioners to publish their live availability once and make it bookable wherever patients are searching. Free digital prescribing is built into the same workflow. Prescriptions are coded to the NHS Dictionary of Medicines and Devices, digitally signed and fulfilled through Healthcode’s partnership with Pharmacy2U, with medicines delivered to the patient’s door and tracked by email. Private healthcare in the UK is growing. The next question is whether the journey around treatment can meet the standards patients now expect from every other part of their lives. The providers best placed to answer it will be those that treat operational infrastructure as part of the clinical offer. See how Healthcode can make healthcare easier for you. SPONSORED CONTENT
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LOGGING THE HAZARD
TRAINING IS THE MISSING MITIGATION IN CLINICAL A
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CCORDING to the recent BMJ review around 40% of GPs in the UK now use an ambient scribe. In July, the MHRA clarified that ambient scribes intended solely for transcription, summarising clinical conversations and drafting clinical documentation are not regulated as medical devices under the current framework. Clinician review remains a critical safety control before that output reaches the patient record. The National Commission into the Regulation of AI in Healthcare has now published its recommendations, and the direction is away from a single approval at launch towards staged authorisation, real-world evidence and continuous monitoring across a product’s life. It is the right direction. It also enlarges the clinician’s job. The safety control for a technology already in daily use across clinical practice is a clinician reading carefully, and almost nobody has been trained to do it. I should declare an interest. I am a GP and I work for a company that 58
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As ambient AI scribes become routine in general practice, GP, Clinical Safety Officer and Clinical Director for UK & I at Heidi, Dr Tim Cooper says the missing safeguard isn’t regulation – it’s training clinicians to read the output critically.
voice is on the same curve but even faster.
sells this technology, so I have every commercial reason to talk about benefit rather than risk.
NHS England’s guidance names an overlapping set of hazards, including transcription inaccuracy, hallucination and uneven recognition of accents and dialects. Patients in Rotherham found the last of these this summer, unable to make themselves understood to their surgery’s AI phone line, and some gave up and walked in instead. None of these are reasons to stop, but every one is a reason to train those wielding the tool.
I am writing about the risk because it is the half of this that suppliers alone cannot fix, and because the opportunity is too good to lose to a failure of preparation. Digital change in healthcare arrives at pace. Video consultations and virtual wards became normal faster than preparation allowed, and we caught up afterwards on the goodwill of clinical teams and the sympathy of our patients. Ambient
A review this month in BMJ Digital Health & AI, led by researchers at the University of Edinburgh across 27 studies, reflects that ambient scribes capture what is said but can miss what is meant. Facial expression and emotional state, what my psychiatry colleagues would call “affect”, do not always reach the transcript unless vocalised. Summaries risk privileging clinical fact and in primary care it is often the ideas, concerns and expectations that shape the plan.
The system’s own safety infrastructure is sparser than most people assume. A national study
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in JMIR found that 70% of digital health technologies in NHS trusts and integrated care boards had no documented clinical safety assurance. Organisations reported roughly one full time equivalent Clinical Safety Officer, 1.3 in trusts and 0.4 in integrated care boards, almost always alongside a substantive job. These are not people failing at safety oversight, they are at capacity and doing it in the gaps of a week that was already full. Our own survey of NHS healthworkers this year found 90% using AI in practice, and 65% doing so before anyone had told them how. I read that as a workforce under pressure reaching for something that helps them get the job done, and on time for once. I remember learning the hierarchy of evidence as a student. It was drilled into us because a plausible claim and a well founded one look identical on the page. There’s a reason we weight RCTs over observational studies. We have no equivalent taught for the output of a language model. Fluency is not correctness, and nothing in current training teaches a clinician to tell them apart.
So what should training cover? Not the tools, as they will have changed before the module is built. What lasts are the principles of use. Knowing the difference between a general chatbot, a clinical tool built on constrained sources and a regulated device. Reading the note before signing, in a fixed order rather than with a general intention to be careful: the history in the right time frame, the medications right, the plan the one you agreed. Finally, consent, a conversation to be had and recorded rather than a line delivered on the way through the door. The Commission names workforce training as part of the answer. Three things would make it real, and none requires slowing adoption down. 1.
2.
Make appraisal of AI output an assessable competency in Royal College curricula, and name it in GMC standards, so the skill is taught rather than absorbed. Fund Clinical Safety Officer capacity as a role in its own right rather than a line in an existing overstretched job plan.
3.
Make ongoing training and competency support a procurement requirement, so suppliers compete on how well their tools are used in year three, not on how well they pitch a year-one price.
Suppliers carry real obligations and we should quite rightly be held to them, including for how our tools behave in use long after procurement rather than only at the point of sale. The Commission’s emphasis on responsibility shared between manufacturers, providers and clinicians is welcome, and suppliers should be the first to say so. But a hazard log cannot mitigate a risk that only appears in the room, at the moment a clinician signs a note they have not read. That mitigation is training, and it sits with the system. I remain optimistic about these tools. Adoption at this speed is a vote of confidence from a profession not easily impressed. The Commission has set a direction and a government response will follow but closing that training gap is the most useful thing policymakers, systems and professional bodies could do this year. SPONSORED CONTENT
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BEFORE THE NHS CAN IT NEEDS TO BECO
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I IS rarely out of the healthcare headlines. It is being used to support diagnostics, reduce administration, improve productivity and help organisations make faster, better informed decisions. The NHS has placed it at the heart of its plans for the future. Its 10 Year Health Plan includes a major shift towards the digital approach and sets an ambition for every hospital to become AI enabled over the lifetime of the plan. But the conversation about AI should start one step earlier: AI can only produce meaningful insights if the data it relies on is accurate, complete and reliable.
The NHS wants every hospital to be AI-enabled but algorithms are only as good as the data behind them. h-trak explains why the AI conversation needs to start with better data capture at the point of care.
It only takes one missed product or incorrect entry to create a gap: •
While this sounds obvious, as NHS and private healthcare organisations invest in increasingly advanced technology, it is worth asking a much simpler question:
Do you have the right data to support it? Healthcare organisations generate vast amounts of data every day, but not all of it is captured in a useful format. Picture a typical procedure. Consumables, implants and medical devices may be used, each with its own product details, cost and traceability information. In some clinical areas, those items are still written down by hand. The record might be completed during the procedure, or afterwards from packaging and memory. The same information may then need to be entered again into multiple systems. 60
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• •
•
The stock system may show an item that is no longer on the shelf. The cost of the procedure may be incomplete. An implant may not be digitally linked to the patient who received it. If that product is later recalled, finding the affected patient can become a time-consuming task.
These are not future problems created by AI. They affect stock visibility, traceability, purchasing, costing and staff time today. Adding AI further down the line will not make those gaps disappear. No algorithm can analyse information that never made it into the system.
as it minimises the risk of incorrect data entry. Point of care barcode scanning is one way of making that happen, and it is where h-trak can make a difference. h-trak allows clinicians to scan consumables, implants and medical devices as the procedure takes place. Adopting data capture as part of the clinical workflow and reduces the reliance on staff remembering and recording information afterwards.
Better AI starts with better data capture
Each scan creates a digital link between the product, patient and procedure. It can also capture details including the product code, lot or serial number, location, time and cost.
The most reliable data is captured at the moment the activity takes place
The aim is not to collect information simply because it might be useful to
N BECOME AI READY, OME DATA READY around 30 minutes, enabling faster responses with greater confidence in the findings.
From what happened to what happens next Once information is captured consistently, healthcare organisations can start asking more useful questions. Why does one surgeons’ procedures cost more than another? Why is a particular product used more frequently in one area? Where is stock sitting unused? Which items are at risk of expiring? What is likely to be needed next month?
AI one day. It is to create an accurate record of what has happened, providing clinical, procurement and finance teams with information they can use today. At the same time, every completed record contributes to something increasingly valuable: a structured and dependable source of data for future analysis. The value of this becomes particularly clear during highrisk events such as a product recall. At University Hospitals of Derby and Burton, a potential CJD contamination incident could previously require at least 50 hours of manual patient note reviews for each patient, without complete confidence that everyone exposed had been identified. Using the electronic records captured through h-trak, all affected trays, patients and staff can now be identified in
Over time, AI could make it easier to analyse activity at scale, identify unexpected variation and forecast future demand. But those insights will only be meaningful if they are based on a complete picture of what is actually happening. By capturing products at procedure level, h-trak helps build that picture. It turns individual scans into a detailed history of product usage, costs and clinical activity, providing a stronger starting point for both everyday reporting and more advanced analysis. Before organisations can confidently predict what will happen tomorrow, they need to understand what is happening today.
One scan, several answers The value of accurate data capture extends beyond AI. When a product is scanned through
h-trak, that one action can support several teams. For clinical teams, it creates a traceability record and makes it easier to identify affected patients during a product recall. For procurement, it provides a more accurate view of consumption, stock levels and replenishment requirements. For finance, it contributes to a clearer understanding of procedure costs and helps identify products that may otherwise have been missed from billing or reimbursement. Through integration and interoperability, a single scan creates a shared record that can be used across systems and teams, reducing duplicate data entry and improving visibility across the organisation.
The work behind the headline
AI may be the most visible part of digital transformation, but its success depends on accurate, structured data that reflects what happens at the point of care. h-trak helps create this foundation through everyday clinical activity, improving traceability, inventory management and procedure costing while preparing organisations for future technology. The NHS’s AI ambitions will not begin with an algorithm, but with capturing the right information, at the right time, at the point of care. To find out more about how h-trak is being used in practice, you can get in touch with the team. +44 (0)330 127 6240 info@htrak.com SPONSORED CONTENT
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GIVE YOUR PRIVAT VISIBILITY IT NE
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HILE many consultants find private practice hugely rewarding because of the freedom it offers to deliver care to patients in a manner of their choosing, they can also find it extremely challenging. Consultants need to deliver excellent clinical care while the practice team needs to manage new enquiries, patient communications, diaries, and treatment plans, while at the same time ensuring that the business side of the practice runs smoothly.
Civica Medical Billing and Collection’s Simon Brignall discusses how access to up to data financial information about your private practice, can optimise cashflow, increase revenue and ensure that you make better informed decisions to grow your practice.
• Unfortunately, many private practices suffer from lack of visibility on their billing activity and finances that often rely on outdated or incomplete information leading to problems with cash flow, lost revenue and a poor patient experience. In this article, we will demonstrate how access to up-to-date reporting can revolutionise your practice finances and ensure you make better strategic decisions to drive success.
24/7 access to your practice data One of the most common challenges we see when speaking to consultants is a lack of transparency around billing and financial performance. In many cases, there either is a lack of visibility around these key metrics, or the data is not current resulting in problems in the key revenue cycle management process such as delays in: 62
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• •
Invoicing insurance shortfalls and excesses Chasing of outstanding payments Dispute resolution
These delays not only deliver a less than ideal patient experience but also lead to poor cashflow and in some instances loss of revenue. At Civica Medical Billing and Collection, we partner with 2,500+ consultants, groups, clinics and hospitals across the UK. Our clients have access to our market leading ‘Dashboard’ reporting tool ensuring they have 24/7 visibility to an array of reports to analyse their practice data; which delivers all the reporting benefits of a practice management system for free.
practice or clinic. Some practices want to review aged debt, revenue composition, payment reporting or cashflow by provider, patient payee type or specific location. That is why the ability to generate customisable reporting is so important. Civica Medical Billing and Collection‘s Dashboard helps practices review performance and activity at both a summary and granular level. Our Dashboard not only shows a range of Key Performance Indicators (KPIs) for the practice in an easy to digest format but also the ability to run a range of reports offering a full range of custom fields to analyse • • • •
Invoices raised Payments received Patient activity Aged Debt
It supports practical questions, such as how much revenue is currently outstanding, which patients or insurers are slow to pay, what patient payee types or locations are driving revenue and your practice revenue composition. Accurate data turns medical billing from a reactive admin task into a practical management tool.
Customisable reporting to support better decisions
Built around the way your practice works
Every practice is different. A single consultant will not always need the same information as a large group
Civica Medical Billing and Collection’s Dashboard can replicate your practice/group/clinic structure
ATE PRACTICE THE EEDS TO THRIVE within our software, allowing tiered access to be provided where required. This means individual consultants, secretaries, practice and finance managers can each access the right information for their role, whether the organisation is a singleconsultant practice, a group, a clinic or a multi-site operation. This flexibility becomes increasingly important as practices grow. Consultants may want to see only their own activity, while a practice manager or finance lead may need visibility across a wider group. A system that mirrors the structure of your practice helps improve control, protect sensitive information and support more efficient working across the whole organisation.
A better patient experience Billing conversations can be difficult, particularly when a patient is unsure what has been paid by their insurer, what remains outstanding or why they have received an invoice for a shortfall or excess. These conversations become much easier when they are carried out in a timely fashion supported by a range of simple to use payment options that meet the needs of the modern private patient. As Civica Medical Billing and Collection service manages the entire medical billing revenue cycle on behalf of the practice we
ensure that each link in the billing and credit control chain is manged effectively increasingly the likelihood of payment. Civica MBC has an average bad debt level of less than 0.5%, and in some instances, it as low as 0.18%, which is often a 90% improvement on when this role is managed inhouse.
Security that protects patient and financial data Medical billing involves highly sensitive patient, clinical and financial information. It is therefore essential that any system used to manage this data is secure, controlled and compliant. Civica MBC’s secure platform has ISO 27001 and Cyber Essentials accreditation, helping ensure that patient and financial data remains protected and GDPR-compliant.
Simpler tax and accountant reporting Financial reporting is another area where accurate billing information is vital. At key points in the year, accountants need clear, reliable information about income, payments received and outstanding balances. If this information is incomplete, out of date or held across multiple spreadsheets and systems, preparing reports can become unnecessarily stressful and timeconsuming. Civica Medical Billing and Collection makes this easier by giving practices
access to accurate, up-to-date tax reports for their accountant, supporting compliance and reporting requirements with less disruption. This is particularly important with the introduction of Making Tax Digital this year for sole traders requiring quarterly submissions and an annual confirmation statement. Our UK based Dedicated Account Managers will also happily liaise with the accountant directly to provide this data.
Free to focus on patient care By partnering with a medical billing company, the practice can prioritise what they do best the patients clinical journey. At Civica Medical Billing and Collection, we have been supporting consultants, groups, clinics and hospitals with their medical billing for more than 35 years. Our service combines billing expertise, modern payment solutions, secure technology, 24/7 reporting capability and most importantly UK based Dedicated Account Management to help private practices deliver an exceptional service to their patients. Accurate, up-to-date information is at the heart of this. With Civica Medical Billing and Collection, practices can use this data to make well informed strategic decisions to grow the practice safe in the knowledge that the finances are being looked after by experts. SPONSORED CONTENT
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GREATER THAN T
THE ANATOMY OF EP
Electronic Patient Records promise safer, faster care - but when systems fail, fragmented governance can put patients at serious risk. Simon Bowgen from Maulin Group’s investigations team, examines what recent NHS incidents reveal about EPR safety, and why fixing it requires more than blaming the individual.
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LECTRONIC Patient Records has fundamentally created opportunities to improve patient safety and reduce clinical risk. They provide instant access to up-todate records, reduced test result wait times, clearer communication between healthcare departments and whole access to a patient’s medical history. However, centralisation of patient records consequently encompasses multiple clinicians, software and processing. Digitising complex care plans requires interoperable systems. If a system fails, it risks patient harm, even when no deliberate wrongdoing has occurred. This article will examine the anatomy of EPR workflow disruption alongside human-centred mitigation. System design, usability, governance and interoperability will be assessed to demonstrate EPR safety cannot be singularly focused as an individual’s responsibility, but rather it is dependent on cooperation between
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the system users, system function and the organisation in which it operates.
EPR workflow disruption EPRs which enable departmental customisation risks workflow disruption, without established clinical governance and policy implementation. Health Services Safety Investigations Body (HSSIB) reported a paediatric ward incident in an unnamed Trust, where an unconfigured electronic prescribing system (ePMA) quick list still included adult dosages, with no guardrails in place to catch this unusual dosage. The patient subsequently received over ten-times the recommended dosage on multiple occasions, causing intercranial bleeding. The clinical leadership team failed to appropriately audit the system prior implementation into paediatric care. The HSSIB investigation further discovered that the clinical staff had concerns about the implementation of the ePMA system to paediatrics before integration, with some clinicians failing to recall any training on this system.
The failure of clinical governance allowed a flawed tool system for frontline use. To better understand EPR workflow risk, we must look beyond clinical management and towards the usability of software interface. Clinicians work in a high-demanding, time-pressured environment. Convoluted systems contradict the environment they are required to operate in, as seen in the case of Darnell Smith. Royal Hallamshire Hospital staff were not aware that Darnell’s vitals required monitoring hourly due to the digital system not making his care plan easily visible. Darnell sadly passed two weeks later. This has not been an isolated incident. In 2017, an investigation at Nottingham University Hospitals revealed more than 400,000 digital letters to patients and GPs had failed to send as they required signingoff and were placed in an unknown folder. A clear association can be seen between cognitive overload and alert fatigue with inefficient EPR use and patient harm.
THE INDIVIDUAL:
PR WORKFLOW RISK
and clinical users helped shape the intervention. The University Hospitals of Leicester faced an interoperability EPR workflow risk when a significant prescribing error rate in discharge medication was identified. This was caused by manual transcription of medication between their two systems, ePMA and Integrated Care Environment (ICE). To mitigate this, an interface between the two systems was developed which included the safeguard that medication imported from the prescribing system could not be amended on the discharge letter. Poor interface design makes patient information difficult to locate. Poor interoperability makes information and clinical responsibility difficult to transfer within a hospital. Patient data needs to be able to be interpreted correctly by the varying systems. Failure to act upon these can risk severe delays in patient referrals, medicine requests or tests. This was demonstrated at the launch of Cambridge University Hospitals EPR, where the system became unstable, resulting in pathology test results not correlating to the correct patient. This required manual checking and for blood tests to be re-ordered, dropping A&E performance by 20% and losing staff confidence. Inaccurate and delayed patient data from poor system interoperability greatly increased the risk of patient harm.
Human-centred solutions We have assessed the impact of poor clinical management on patient risk. However, in a system with a clear chain of command and responsibilities outlined, governance is fundamental in EPR safety. When
NHS England issued the National Patient Safety Alert for the Euroking maternity system due to data overwriting, rapid clinical oversight and escalation took place before patient harm could occur. Trusts audited their Euroking systems to identify where data corruption could occur, and many Trusts replaced the system to ensure long-term patient safety. Resultantly, there were no records of direct patient harm from this incident. When Colchester General Hospital’s electronic communication system for patient handovers was not sufficient, a development team which grouped staff from varying hospital departments formed Watchpoint. This supported the identification and escalation of clinical tasks and was continuously developed from clinician feedback. Following its introduction in 2015, a study into the impact of Watchpoint showed an 87% reduction in cardiac arrests from failure to escalate, and wait times reduced from 158 to 102 minutes. The solution was developed by people experiencing the workflow problem in varying departments,
Changes had to be made on the former to transfer across to the discharge letter. Making the two systems compatible eliminated transcription errors, reduced prescribing errors and fastened the discharge medication process for staff.
How we help support safer digital healthcare At Maulin Group, we provide clinical and investigative insight to support healthcare systems, recognise and alleviate EPR patient risks. Our approach strongly recognises that electronic patient safety is a shared responsibility between system users, healthcare organisations as well as IT departments. Despite the transition to digital records, we have identified longstanding issues remain. Inconsistencies within patient data and the continued absence of key clinical information continue to risk patient safety. At Maulin Group, our understanding of clinical governance, system usability and interoperability enables us to assist organisations in investigating how electronic workflows can be made safer. SPONSORED CONTENT
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WHY CHOOSING YO MALPRACTICE IN
S
TARTING private practice brings plenty of decisions: Where to work, how to attract patients and how to manage the costs of getting established. Arranging medical malpractice insurance can understandably feel like another administrative task before the first clinic. Yet that first arrangement has implications beyond the opening premium and the certificate required to begin working. For me, the distinction is between having insurance and understanding what it provides.
The practice behind the policy
Getting malpractice insurance sorted private practitioner’s mind - but Geo Services at THEMIS Clinical Defence choose can shape your cover for yea
A clinician purchasing their first policy may already have considerable clinical experience. What is new is the responsibility for understanding their own insurance arrangements. The GMC requires doctors to have adequate and appropriate insurance or indemnity covering the full scope of their practice. NHS indemnity does not automatically extend to separate private work (Choose and Book can have separate arrangements), and most private facilities operating a privileges-based arrangement require clinicians to have access to £10million indemnity limit. Consider two consultants with similar projected earnings: one intends to offer consultations only; the other will also undertake procedures across several locations. One has been practicing as a consultant for five years; the other has been 66
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a consultant for six months. Their income may look alike, but their activities and profile differ. A meaningful opening conversation therefore extends beyond specialty and anticipated revenue.
How today’s arrangements relate to tomorrow’s claims There are two separate indemnity distinctions worth understanding. Contractual insurance creates enforceable obligations within the policy’s terms; discretionary indemnity provides assistance at the provider’s discretion. Separately, occurrence-based arrangements generally relate to incidents during
the covered period, whereas claimsmade protection depends on when claims are made and reported, subject to the wording. These labels describe different aspects of an arrangement which are not routinely explained well enough, and at this point in your career, I have been told from consultants that they were told “not to worry” about these terms so early in their career by indemnity providers. Because claims can emerge years after treatment, the first year’s work may remain relevant long afterwards. Under a claims-made policy, a retroactive date generally identifies the earliest date of work eligible for cover. When changing
OUR FIRST MEDICAL NSURER MATTERS what sits behind the premium is just as important as knowing the figure.
A relationship that develops with the practice The work planned at inception may change. A consultation-only practice might introduce procedures, expand into another location or add medico-legal work. The GMC identifies changes in scope, income and employment or contractual arrangements as reasons to review indemnity, while policy terms may also require particular developments to be disclosed.
d is rarely the first thing on a new orge Maughan, Director of Insurance e, argues that the first policy you ars to come.
providers, continuity depends on you ensuring that you have informed a new provider that you were on a claims made basis, and what your retroactive date is. Run-off or extended reporting arrangements can provide protection for earlier work after active cover ends. Their duration and qualifying conditions vary, making them relevant even when retirement feels distant. None of this means someone must remain with their first provider. It does however mean that you must understand the run off, or extended reporting period, available to you under any product a clinician considers.
More than a headline limit
That makes an accessible relationship with the provider valuable beyond the initial application.
Clinical negligence cover is only part of the picture. Depending on the product, additional protections may include regulatory representation, inquest support, medico-legal assistance or reputational support.
At THEMIS, our emphasis is on understanding the clinician’s practice and making insurance discussions approachable. Explaining what is covered, where the boundaries sit and what responsibilities accompany the policy is central to that approach.
These are not automatically included, nor does access to a helpline necessarily mean legal representation is covered. Their scope, limits and conditions matter alongside the main indemnity limit.
The first choice matters not because it must be permanent, but because it establishes a foundation for future decisions.
More benefits do not automatically make a product appropriate for every clinician. Equally, a comparison that overlooks them is incomplete. Cost remains a legitimate consideration, particularly when establishing a practice. My observation is that understanding
The aim is not simply to be insured from day one. It is to understand what that insurance means from day one.
For general information only. This article is not advice or a recommendation to purchase a particular insurance product. Cover depends on the applicable policy wording, schedule, endorsements, limits, conditions and exclusions. SPONSORED CONTENT
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SUBJECT ACCE
WHAT CLINICIANS
S
UBJECT Access Requests (SARs) submitted by patients, or by solicitors acting on their behalf, are frequently one of the earliest formal steps in a potential clinical negligence claim. How a request of this kind is handled, from the moment it is received through to disclosure, can materially affect your position if a claim is subsequently pursued. You do not need detailed data protection expertise to manage this correctly, but you do need to understand what is expected of you and where the boundaries of your responsibilities lie.
Recognising the signs before a SAR is received A SAR is not always an isolated event. In practice, it is most commonly preceded by one of two things: a formal complaint about the care provided, or a direct request for compensation, whether made informally or through a solicitor. Where either of these has occurred, it is reasonable to anticipate that a SAR may follow, and to treat the eventual request accordingly. This does not mean every complaint results in a claim; most do not. It does mean that complaints and compensation requests should be reported promptly and consistently to your private practice’s complaints lead or to your indemnity provider if you hold a claims made policy, so that if a SAR is subsequently received, it is not dealt with in isolation from the wider context. 68
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Ellie O’Brien, paralegal at Maulin Law, offers up some practical guidance for private providers, whether corporate entities or individual practitioners, on the steps required upon receipt of a Subject Access Request from a patient or their solicitor.
The request should be actioned, not assessed Where a SAR is known or suspected to relate to a potential claim, it should still be processed through the practice’s standard SAR procedure without delay or additional scrutiny. The law does not permit a SAR to be refused, restricted, or delayed on the basis that it may be intended to support a claim; the requester’s underlying motive is legally irrelevant to the obligation to respond. You should refer the request to whoever is responsible for SAR compliance at your private practice and should not attempt to manage or filter it personally.
The statutory time limit is unaffected A SAR must be responded to within one calendar month of receipt, extendable by up to two further months only where the request is
genuinely complex or the volume of records is substantial, and only where the requester is informed of the extension, and the reason for it, within the first month.
The consequences of non-compliance Failing to comply with a SAR, particularly once the deadline has passed and reminders have been given, carries real consequences. The Information Commissioner’s Office (ICO) can take regulatory action for the underlying failure, ranging from a reprimand to an enforcement notice requiring compliance within a set period, continued non-compliance can lead to a monetary penalty. Separately, a patient can apply directly to the court for a compliance order, with costs awarded against a provider found to have failed in its obligations without good reason, and can claim compensation for any damage the delay or refusal has caused. Beyond the direct regulatory and legal exposure, a delayed or incomplete response is likely to be noted by any solicitor already acting for the patient and can become a further point of complaint in its own right, regardless of the underlying clinical position.
Records must be preserved, not amended Once a SAR is received, the clinical record must be preserved exactly as
ESS REQUESTS:
S NEED TO KNOW it stands. No entry should be added to, edited, or clarified retrospectively, regardless of the intention behind the change. Where a genuine correction is required, this should take the form of a new, separately dated entry explaining the correction, rather than an amendment to the original text. Retrospective changes to a record are generally identifiable on examination and, where identified, are liable to undermine the credibility of the record as a whole, irrespective of the clinical merits of the underlying care.
What must be disclosed, and what may not need to be The clinical record itself, including consultation notes, results, imaging, and related clinical correspondence, must be disclosed in response to a SAR and cannot be withheld on the basis that a claim is anticipated. A narrower category of material may fall outside this obligation: communications with lawyers, or documents prepared specifically because litigation was already in contemplation, may be protected by legal professional privilege. Incident reports and complaint investigations prepared as part of routine clinical governance will not usually attract this protection, even where they discuss the same events. Decisions of this kind should not be made by clinical or administrative staff in isolation; they should be
referred to the practice’s indemnity provider or legal advisers.
Where clinical judgement is required Clinical input is genuinely required in two circumstances. The first is where disclosure of specific information is likely to cause serious harm to the physical or mental health of the patient or another individual; this is a high threshold and is not met simply because the information is distressing or would ordinarily be communicated in person. The second is where the record contains identifiable information about a third party, such as a family member, another patient, or a colleague, which may need to be redacted. In both cases, your assessment and the reasoning behind it should be documented at the time.
Notify the indemnity provider promptly In many cases, an adverse incident, a complaint, or a request for compensation will already trigger a notification obligation under the terms and conditions of your indemnity or insurance policy, and should have been reported to your indemnity provider or insurer at that earlier stage. In any event, receipt of a SAR connected to such circumstances should be notified to your indemnity provider or insurer immediately,
regardless of whether they have already been made aware of the underlying incident or complaint. Early notification allows the indemnity provider to advise on any privilege or disclosure questions before they become time critical and is consistent with the reporting obligations most clinicians hold under their indemnity arrangements in any event.
A SAR is a data protection right, not a step in litigation It is worth noting that a SAR is a right of access under data protection law and exists independently of any litigation process. Formal pre-action disclosure in a clinical negligence claim follows a separate protocol; a SAR is often used first because it is faster and involves no cost to the requester. Responding properly and within time to a SAR is not an admission regarding the standard of care provided, and should not be treated as such. Handled correctly, a SAR request, requires nothing more than the practice’s standard process, applied without alteration to the underlying records. Your role is limited but important: report the relevant background promptly, leave the record untouched, provide clinical input only where it is genuinely required, and ensure the appropriate people are informed early. For more information on Maulin Law, click here. SPONSORED CONTENT
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