Public satisfaction with the NHS has increased for the first time since 2019.

But although 26% of British adults questioned in the British Social Attitudes survey were satisfied with the health service – an increase of 6% from 2024 – the majority, some 51%, said they were dissatisfied with their experience. That “sounds more like a cause for concern than celebration”, said The Guardian in an editorial.

Puzzling findings

“The public appears inclined to accept the government’s narrative of a broken system being painstakingly put back together.” But hospital waiting lists are “still huge”, NHS dentistry has “probably never been in a weaker state” and there’s “justified impatience” on lagging social care provision. So “having pronounced the NHS ‘broken’”, Wes Streeting and his Department of Health and Social Care colleagues must “hurry up with their repairs”.

Still, the survey results, published by The King's Fund think tank, suggest the health service is “finally on the long road to recovery”, said The Mirror. The “gold standard assessment” found that the Labour government’s first full year in power “saw the greatest fall in dissatisfaction” in the NHS since “New Labour’s first full year in power in 1998”.

“Puzzlingly,” said Joseph Freer, from Queen Mary University of London, on The Conversation, “overall satisfaction rose”, but there was “no corresponding rise in satisfaction with each individual NHS service: GPs, A&E, dentistry and hospital care”.

This might be because services “did genuinely improve”, but the survey “simply did not poll enough people about each individual service to reliably detect small improvements”. Or perhaps the “political context” has “shifted”: a European study found that how people “feel about” the health system is now “influenced by things outside it”, such as “the political climate and what they see in the media”.

Skill shortage

While “debate” on the NHS “typically focuses on funding, waiting lists and plans for reform”, said Chris Day, chair of the Russell Group, in The Times, the system’s “most fundamental constraint” is that it “does not have enough skilled people”.

There are more than 100,000 vacancies across the wider “health ecosystem” and “demand for staff is rising faster than the system is able to meet”, thanks to “an ageing population, rising chronic illness and growing expectations”. So the “real solution” to improve the NHS experience is to increase “training capacity” and support a “range of alternative career paths into healthcare”.

Everyone should care, because the fate of the NHS is “a question that matters even to those who rarely use” it, said Chris Smyth in the Financial Times. Its budget of £200 billion “dwarfs any other public service” and will hugely “determine” whether Rachel Reeves imposes more tax rises.

The issue is also “central” to Labour’s “tenuous hopes of political recovery”; if Labour can’t convince voters it’s “fixing the NHS”, it “will have little else to offer”. But if it can “demonstrate tangible improvement” it will have a “powerful argument” against Nigel Farage, who has “repeatedly questioned whether the NHS funding model can survive”.

The UK was once a “world leader” in organ transplants, said the BBC’s “File on 4 Investigates”. But it has “fallen behind”.

In 2024, the number of heart transplants carried out per million people in the UK was lower than in most European countries, thanks to a lack of investment, resources and “outdated” technology. Waiting lists for organs are at a record high, while family consent rates for donation have fallen dramatically since the “opt-out” presumed consent system was implemented.

What’s going wrong?

“Organ donation is in crisis,” said Martha Gill in The Observer. Last year, the waiting list for an organ reached its highest on record, according to NHS Blood and Transplant: an 8% year-on-year increase. “As a consequence, many will die waiting for a phone call.”

There are only five heart and lung transplant centres in England, and one heart transplant centre in Glasgow. Anyone living in Wales or Northern Ireland must travel for a transplant, and there is significant regional variation in waiting times.

Half of the six main centres have also “lost their top surgeon in the past two years”, said the BBC. Others are leaving for jobs abroad: a “brain drain” of experts. Without experienced mentors, junior surgeons are increasingly “risk averse” and only using the healthiest donated organs, said Jorge Mascaro, Birmingham’s former director of cardiothoracic transplants (now based in the US). “It’s getting worse.”

The number of organs donated in the UK per head is equal to, or greater than, most of Europe. But the NHS transplants far fewer hearts and lungs than most countries, said the BBC. “Some countries make use of twice as many.” Surgeons say this is down to a lack of equipment and new technologies used abroad, such as machines that can scan organs to check if they are diseased. Ice boxes are often still used to transport organs between hospitals, which can harden them.

Operations are also regularly cancelled thanks to a lack of theatre space, hospital beds or staff. Post-transplant patient care is crucial to prevent complications, but the NHS “continues to struggle” to provide long-term support: the UK’s five-year survival rates “lag behind”.

Has the opt-out system failed?

When the “opt-out” system of presumed consent was implemented in England in 2020, “expectations were high”, said Gill. But the number of donors has been “crashing”. In the year to March 2025, there was a 7% decrease in the number of deceased organ donors, according to the Organ and Tissue Donation and Transplantation Activity Report. Life-saving transplants also decreased by 2%.

Most people support organ donation in theory, and nearly half the population have signed the Organ Donor Register, according to Organ Donation. But relatives have the final say; family consent rates have dropped from 69% to 61% over the past five years. Surveys suggest a “common reason: they didn’t know what their relative wanted”, said The Observer. The types of deaths that make donation possible – usually traumatic, sudden deaths of young healthy people – make it even harder for families to decide.

The presumed consent of the opt-out system acts as a “weaker signal of underlying preference” than the active consent of an opt-in system, said researchers at the Max Planck Institute for Human Development in a 2024 paper. This “uncertainty” means families are “more likely to refuse consent”. Evidence suggests an opt-out model alone doesn’t boost donations: it must be accompanied by a framework of logistics, psychological support and education.

What can be done?

The NHS and campaigners are calling for “better education in schools”, said The Mirror: for organ donation to be included in curriculums, and campaigns particularly targeted at ethnic minorities (among whom the family consent rate is significantly lower).

Evidence suggests an opt-out model alone doesn’t boost donations. Countries must invest in healthcare infrastructure, psychological support for families, and public awareness campaigns to encourage people to discuss their wishes. Family consent rates increase to almost 90% if the deceased has done so.

A government-commissioned review of heart and lung transplant services, published in 2024, made various recommendations, including better holistic care, a single-service model across the multiple centres, and “rapid-short term actions to improve organ acceptance decision-making”, said NHS England.

NHS England has since been abolished; responsibility for transplant services now lies with the Department of Health and Social Care. In a statement to the BBC, the department said the government had inherited a broken NHS, and that it recognised the “systemic issues” facing transplantation. The government said it would write to the NHS demanding that it “urgently implement” the recommendations, to make transplant services “fit for the future”.

The NHS has long been grappling with staff shortages and funding shortfalls but now another destabilising issue is coming to the fore: the vulnerability of its supply chain.

In today’s volatile world of tensions, tariffs and climate-related disasters, NHS stocks of vital medicines and equipment are increasingly under strain, and shortages are becoming more common.

Currently, a global shortage of bone cement has led to the postponement of scheduled knee and hip replacement operations across the country. For the people who have been waiting in pain to make it “to the front of orthopaedic surgery queue”, this is “a crushing blow”, Deborah Alsina of Arthritis UK, told The Guardian.

Painkillers, aspirin and hearing-aid batteries

There is also a UK-wide shortage of the highest prescription-strength form of the painkiller co-codamol. It’s most commonly manufactured in India but the Indian government is “delaying the authorisation to import ingredients required to make the drug there”, said the BBC.

With shortages expected until at least June, the Scottish government is limiting supplies, and warning patients who are prescribed the pills to gradually reduce the number they are taking because stopping abruptly can trigger withdrawal symptoms such as headaches and nausea. Alternative treatment options will be offered to those affected but some health boards have said the expected uplift in demand for these alternatives may not be sustainable.

Some deaf people are “being forced to turn off their hearing aids” because of a nationwide shortage of certain hearing-aid batteries, said The Times. The shortage, first highlighted in November, is expected to be resolved by 16 March but “it’s not a good situation from a personal safety point of view if people are turning off their hearing aids”, Kay Fairhurst of Salford Disability Forum told the paper.

Britain is also “grappling with widespread shortages of aspirin”, said PA Media’s health editor Jane Kirby. Most pharmacies are reporting “significant difficulties” in sourcing the vital drug, which is used to help prevent blood clots, strokes and heart attacks in high-risk patients. Pharmacists are being “forced to tightly ration” their aspirin stock, with many withdrawing it from over-the-counter sales.

The government has blamed “manufacturing delays” for the shortage but pharmacy associations are also blaming the NHS payment model. “The prices paid for many medicines by the NHS are so low that manufacturers often prioritise supplying other countries instead, leaving the UK pushed to the back of the queue,” Leyla Hannbeck of the Independent Pharmacies Association told PA Media. And, even if they can order stock, pharmacies are left out of pocket: the aspirin shortage has pushed its price up to £3.90 a packet but the NHS will only reimburse pharmacies £2.18 a packet. These are “signs of a fundamentally broken pharmacy contract”, said Olivier Picard of the National Pharmacy Association.

‘Critical pinch points’

The UK depends on supply chains for antibiotics, vaccines and diagnostic tests that are “highly brittle and vulnerable”, The Centre for Long-Term Resilience think tank reported last year. These supply chains have “critical pinch points overseas”, and NHS reliance on a small number of manufacturers, often in China, “has never looked more fragile” in this time of “turning geopolitical tides”.

All of NHS England’s supply of gentamicin, an antibiotic used to treat serious bacterial infections, comes from two supplier factories in the same Chinese city. Any disruption to that city, or any geopolitical issue that causes an export ban between China and other countries, would “wipe out UK access to gentamicin”, the report warned.

The NHS supply chain is “exposed to vulnerabilities of unprecedented scale and complexity”, said global risk consultancy Marsh. Geopolitical tensions, the aftermath of the pandemic and disruptions to crucial shipping routes have “exposed the fragility of international supply chains, causing costly delays and supply shortages that reverberated across healthcare systems worldwide”.

Global tariffs, including on medical equipment and pharmaceuticals, have “introduced significant cost pressures on international trade flows”. The NHS has “felt these disruptions acutely”. There is an “urgent need to build a more resilient, agile and secure NHS supply chain”.

US tech giant Palantir has wrapped its tentacles around the British state, securing major contracts with the Ministry of Defence and the NHS in the last three years. However, many are questioning the transparency and procurement process of such deals, and asking whether the company’s ties to Peter Mandelson, Israel and Ice could derail the UK.

The company was criticised this week by hedge fund manager Michael Burry, played by Christian Bale in the film “The Big Short”. He claimed that the tech firm had “systematically unreliable” third-party language models.

In a 10,000-word essay on Substack, he said that the company’s $300 billion valuation will fall by more than two thirds once others realise that “Emperor Palantir has no clothes”.

What is Palantir?

Founded in 2003, Palantir is a technology company that sells software that “processes large sets of data” to help clients, including governments, “find patterns and make operational decisions”, said The Times.

Since it launched its “artificial intelligence platform” in 2023, it has recorded a “surge in sales growth”. The platform has allowed the integration of large language models created by the likes of OpenAI and Anthropic into customers’ datasets.

Since this pivot three years ago, it has become a “stock market darling”, rising to a valuation of around $300 billion. Last year it “reported annual sales of $4.5 billion, up 56% year-on-year”.

What is its relationship with the UK?

In December, Palantir signed a contract with the MoD worth £240 million to continue its data analytics relationship. The contract is believed to be worth “three times more” than a previous MoD agreement signed in 2022, said the Financial Times. In 2023, Palantir, as leader of a consortium, also won a seven-year £330 million contract to help manage patient data across the NHS.

In briefings to Health Secretary Wes Streeting in June 2025, Department of Health and Social Care officials feared that Palantir’s associations with the Israeli military and Ice’s operations in the US would hinder the roll-out of the company’s Federated Data Platform in the NHS, according to documents seen by The Guardian. This would mean the contract would not offer value for money for the UK government.

This has arguably materialised. According to NHS data, the number of organisations within the health service using Palantir’s technology has increased from 118 to 151 since June last year. However, this is “well short of the target of 240 by the end of this year”.

Doctors are now being actively told “how to limit engagement with the NHS Federated Data Platform (FDP)” because of the “controversial” ties with Palantir, said the British Medical Journal. Given the US company’s “track record” with immigration enforcement and “risks to patient trust” and “data security”, there must be a “complete break” between Palantir technologies and the NHS, British Medical Association chair of council Tom Dolphin told the BMJ.

A spokesperson for Palantir said that its software is “helping to deliver better public services in the UK”, including “delivering 99,000 more NHS operations and reducing hospital discharge delays by 15%”.

What are the concerns?

This week, the government came under pressure to review the MoD contract, due to Peter Mandelson’s links to the company, said The Times.

Mandelson co-founded and held shares in the lobbying firm Global Counsel, which worked with Palantir. Mandelson, as the UK’s ambassador to the US at the time, helped arrange a visit by Keir Starmer to Palantir’s showroom while he was in Washington in February last year and accompanied the PM on the visit.

During the visit, Starmer met Palantir CEO Alex Karp and the company’s UK chief Louis Mosley. Conservative leader Kemi Badenoch told the FT that this should be “looked at very, very closely”, as the meetings “were not minuted” and she said that the MoD deal last year was a “direct grant of £240 milllion – not a tender, not a bid”.

Palantir has shown an interest in the British state in other ways, too. Last year it hired four ex-MoD officials, said openDemocracy, as part of its “revolving door” recruitment, where firms “appoint outgoing ministers, senior civil servants and special advisers to lobbying or advisory posts”. Mosley also joined the MoD’s Industrial Joint Council, which the government describes as its “main strategic mechanism for defence sector engagement”.

More broadly, the £240 million MoD contract has “renewed a debate about Britain’s dependence on American technology”, said Politico. Despite promises from the MoD that Palantir’s AI technology would accelerate decision-making and protection, the recent contracts raise “potential risks of technical dependence”, or “lock-in” with the US, especially at a time of “heightened trade and wider geopolitical tensions between the US and its traditional European allies”.

Why does Russia send so many ships through the Channel? What does a ‘feminist’ approach to cancer involve? And who is Mickey’s new boss?

Olly Mann and The Week delve behind the headlines and debate what really matters from the past seven days.

A podcast for curious, open-minded people, The Week Unwrapped delivers fresh perspectives on politics, culture, technology and business. It makes for a lively, enlightening discussion, ranging from the serious to the offbeat. Previous topics have included whether solar engineering could refreeze the Arctic, why funerals are going out of fashion, and what kind of art you can use to pay your tax bill.

You can subscribe to The Week Unwrapped wherever you get your podcasts:

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Three-quarters of people diagnosed with cancer will survive for five years or more by 2035, if a new national cancer plan for NHS England meets its target.

A person is diagnosed with cancer in the UK at least every 75 seconds, according to cancer charity Macmillan, so the plan announced by the government this week will impact millions.

What is the plan?

England’s first national cancer plan was published in 2000. It introduced targets for waiting times, but those have been missed for more than a decade. Ahead of unveiling the new scheme, ministers have been studying the situation and progress in Denmark. In 2000, both countries had similar survival rates, but Denmark has since “leapfrogged ahead, outperforming the UK in survival rates for all but one major cancers”, said The Times.

The result is a 10-year strategy for the UK covering cancer prevention, diagnosis, treatment, care and research. Some 11,000 people responded to the call for evidence, offering “stories of resilience against the odds” and “personal battles against a healthcare system buckling under the cancer burden”, said health correspondent Ashish Joshi on Sky News.

How will it improve outcomes?

If the plan hits its targets, by 2035, three out of four people diagnosed with the disease will be “living well” with their cancer under control or cancer-free within five years of diagnosis. The Department of Health said this would represent the fastest rate of improvement in cancer outcomes this century, and would translate to 320,000 more lives saved over the lifetime of the plan.

It also pledges that NHS England will meet all its cancer waiting-time targets by 2029. There will be a major expansion in robot-assisted surgery, with the number of such procedures increasing from 70,000 currently to half a million by 2035, and faster diagnostic tests to shorten delays in diagnosis and treatment, with community-based diagnostic centres operating 12 hours a day, seven days a week where possible.

The plan also aims to cover travel costs for people seeking treatment across the country, so families do not have to face the financial burden of transportation to access the most appropriate treatment.

What has the reaction been?

Outcomes in England have “lagged behind comparable countries for decades”, said Cancer Research UK, so it’s positive to see improving survival rates at “the centre of the plan”. However, meeting such ambitious targets will require “much faster progress” alongside additional detail on the implementation of the commitments made, where responsibilities will lie, and “whether bold promises will be matched with the resources required”.

The promise that the national cancer plan will “revolutionise the way we treat cancer” is both “bold and ambitious”, said Joshi on Sky News, but then the strategy “cannot afford to be anything else”.

Why is China clearing out its generals? Can the Conservatives win back the centre? And what’s gone wrong with Britain’s hearing aids?

Olly Mann and The Week delve behind the headlines and debate what really matters from the past seven days.

A podcast for curious, open-minded people, The Week Unwrapped delivers fresh perspectives on politics, culture, technology and business. It makes for a lively, enlightening discussion, ranging from the serious to the offbeat. Previous topics have included whether solar engineering could refreeze the Arctic, why funerals are going out of fashion, and what kind of art you can use to pay your tax bill.

You can subscribe to The Week Unwrapped wherever you get your podcasts:

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Britain’s resident doctors are embroiled in ongoing industrial action over an intractable pay dispute, which has been running since March 2023. Average pay for resident doctors (previously junior doctors) has risen, in total, by 28.9% since then, with a pay rise of 8.8% awarded by the last government, and three separate rises given by Labour since. But the doctors’ union, the British Medical Association, is demanding “full pay restoration”, arguing that the value of resident doctors’ pay has been eroded heavily by inflation since 2008/09, and that an additional 26% pay increase for members “over the next few years” is needed.

The dispute isn’t only about pay, however: there are long-standing gripes among resident doctors about working conditions. The BMA also complains that there are insufficient numbers of training posts. It is now demanding that UK medical graduates are prioritised for training posts in future.

Who are resident doctors and what do they earn?

They are the workhorses of the NHS, providing most day-to-day medical care in hospitals. There are 79,000 of them across the NHS, making up about half the doctors in secondary care (hospitals). They range from newly qualified “foundation” doctors to “core trainees” and specialised registrars, all working under the supervision of more senior doctors.

The government’s average full-time basic pay figure for resident doctors is £54,000. But this covers quite a range, from £38,830 for the newly qualified, to registrars who can earn as much as £74,000. Also, in practice they earn between a quarter and a third more than their basic salary from overtime, unsocial-hours pay, and so on.

Do they have a point about pay?

Doctors certainly suffered real-terms pay cuts between 2008 and 2024. The BMA says that pay remains a fifth lower than it was then, despite recent pay rises. (Pay for most UK jobs is about the same or slightly less than in 2008.) The exact proportion is, though, contested: the BMA uses the RPI measure of inflation for pay calculations, while the government uses the CPI, which is typically lower.

The proportion of UK doctors, particularly those trained abroad, leaving or considering leaving the UK has been rising, in part because of money. The independent pay review body found that resident doctors in Australia are paid 23%- 48% more; in Canada they are paid almost twice as much. In Ireland, France and New Zealand, though, they are paid about the same or less.

What is the government position?

Health Secretary Wes Streeting accepted the review body’s recommendation of a 5.4% rise for 2025/26. The government recognises the need to improve pay over time, but it doesn’t accept unconditional pay restoration claims, deeming them unrealistic when the NHS and public finances are struggling: besides, Streeting says resident doctors have received the highest pay rise of public sector workers in the past three years.

What about the other issues?

The BMA complains that supply of posts for core and speciality training has not kept pace with numbers. This is hard to dispute: figures for last year showed as many as 33,000 doctors chasing as few as 10,000 places. This means that many are stuck in lower-level roles and unable to progress.

Beyond this, resident doctors consistently report a range of workplace problems: excessive workload; staffing shortages; high levels of stress and burnout; poor access to basic facilities, such as rest areas and canteens.

What is Streeting’s response?

In December, the Health Secretary made an offer that included a rapid expansion of training posts, and emergency legislation to give UK medical graduates priority for the posts; before this they had competed on equal terms with foreign-trained doctors. He had earlier offered to pay resident doctors’ exam fees, and cover mandatory membership costs for medical royal colleges, which add up to several thousand pounds while doctors train to become consultants.

Streeting has also said that NHS trusts need to be “better employers”, and that he is open to negotiation on working conditions – but not on pay.

Why is the dispute so bitter?

Historically, strikes by NHS doctors have been extremely unusual. Before 2016, resident doctors hadn’t staged a national strike since 1975. But in 2022, a hardline group calling themselves “Doctors Vote” gained control of the BMA’s resident doctors committee, and there have since been 14 strikes – evidence of deep anger and disillusion. (Doctors Vote’s grip on the union has weakened to some extent in recent months.)

Labour, for its part, feels that it has committed fully to resolving this dispute – Streeting’s first meeting as Health Secretary was with the BMA – and has made generous offers. A war of words has escalated between the two sides. Streeting described the decision to strike during December, when flu was at record levels, as “morally reprehensible”, “reckless” and a threat to patient safety.

The BMA has accused the Health Secretary of “emotional blackmail”, “scaremongering” and “grandstanding”.

Can a resolution be reached?

We shall see, when the results of the latest BMA ballot on whether industrial action should continue over a further six months are revealed on 2 February. The two sides appear to be deadlocked. Streeting seems to have won the public argument. Polling suggests that support for the strikes had fallen from a majority in 2024 to around 30% by December; several high-profile doctors, including Sir Robert Winston, have quit the BMA in protest at its strategy.

However, he has not so far won over those who matter most: the resident doctors. The last ballot, in December, on a turnout of 65%, saw 83% of doctors vote to continue striking. Last week, negotiations were reported to be planned between the two sides. But at this stage, further walkouts over the coming months look likely

How strikes affect the NHS

During strikes, consultants are drafted in to “act down” and cover their more junior colleagues’ shifts. Non-urgent appointments are routinely postponed. At least 1.7 million appointments have been rescheduled owing to industrial action since the end of 2022, according to data from August – dealing a blow to the government’s efforts to cut waiting lists. The strikes also carry a large financial cost, as consultants are expensive (this is notoriously hard to estimate, but between April 2023 and May 2024 it is thought to have exceeded £1.7 billion). This diverts resources away from other parts of the health service, and potentially impacts patient care. It also places additional burdens on staff and morale.

However, NHS England has got better at dealing with walkouts. During the most recent 17-22 December strike, NHS figures indicate, over 90% of planned operations, tests and procedures were maintained – though that still meant that tens of thousands of procedures were disrupted. It was even reported that strikes by younger doctors before Christmas helped to forestall a winter crisis in the NHS, because senior medics are more confident in their decision making: they admitted fewer patients, were quicker to discharge them, and ordered fewer diagnostic tests.

Cases of scabies are rising across the UK, with health experts struggling to account for the sudden increase.

In the second week of January, GPs reported just under 900 cases of scabies across England, which was nearly 20% higher than the same period the year before. And as doctors are only required to report cases of scabies in communal settings, like nursing homes, the total number of cases in England right now is likely to be much, much higher.

What is scabies?

When you hear scabies mentioned, you may think of a “Victorian-era” disease, symptomatic of “dirty conditions” and “bad housing”, said Clare Wilson in The i Paper. “If so, you’d be wrong”: firstly, it is thought to have been identified in Roman times, and secondly, scabies can affect anyone, irrespective of hygiene levels.

The itchy rash is caused by microscopic mites that burrow, live, and reproduce in the skin. Invisible to the human eye, they are around 0.4mm in diameter, and can burrow around 2.5cm – roughly the length of a fingertip – into your skin. The mites can also survive up to 36 hours outside the body. Only 10 females are needed to cause a significant outbreak, which can linger for months, and even years, if not treated correctly.

The itchy bumps, rash and discoloured “burrow” lines are an allergic reaction to the faeces of the mites, and “while not a serious condition, scabies can be very itchy and irritating”, said the BBC. This can exacerbate existing skin conditions like eczema, or cause secondary bacterial and skin infections.

Why is it spreading so quickly now?

The short answer is that there is no one, simple, cause for the spread. While there is “no definitive reason” behind the scabies rise, the back-to-school rush in September can kick-start transmission, as can the Christmas season, where “close contact in shared spaces is common”, Donald Grant, GP and senior clinical advisor at The Independent Pharmacy, told Women’s Health.

Scabies is often mistaken for an STI, as the groin area is “one of the most commonly affected” places, said The Guardian. Between 2023 and 2024, sexual health services registered a 44% increase in diagnoses of scabies – 4,872 up from 3,393. The mites are often transferred through “prolonged skin-to-skin contact”, so sexual partners are much more likely to be infected.

Numbers have kept creeping up since the Covid pandemic, which has left doctors “scratching their heads”. More and more contact, and fewer constraints on socialising, could have led to a “potential ‘ping-pong’ effect”, where “individuals are continuously reinfested within households or close groups of friends”. As symptoms can take “four to six weeks to develop”, and are most contagious before symptoms show, bugs can “lurk undetected while those affected are most contagious”.

Other factors in the spread include the “strain on NHS GP waiting lists”, and “lack of guidance and redirection to pharmacies”, Michael Marks, Professor of Medicine at the London School of Hygiene & Tropical Medicine, told the newspaper.

How to prevent and treat it?

The most common treatment is permethrin cream – also known as Lyclear – which “paralyses and kills the mites”, Hanna Yusuf, prescribing pharmacist at Chemist4U, told Cosmopolitan. The online pharmacy saw “year-on-year sales almost double” in January, “reflecting how many people are seeking treatment right now”. Available on prescription, the cream is applied all over the body from the neck down, and left for eight to 14 hours before being washed off. It often needs to be reapplied a week later, to kill off any eggs that have hatched into mites during that period.

Contaminated items that can’t be washed “should be sealed in a plastic bag for at least 72 hours”, and it is recommended to “vacuum mattresses, sofas and carpets” if there has been any contact.

To mitigate and prevent outbreaks, the NHS advises washing bedding and clothing at 60C or higher, followed by hot tumble drying if available, said The Guardian. If an outbreak has occurred, you should avoid close contact, and stop sharing bedding, towels or other material until the mites have been eradicated.

Keir Starmer has told UK voters that the coming year will bring “positive change in your bills, your communities and your health service”. People across the country will “once again feel a sense of hope”, the prime minister said in his New Year message.

But a new Ipsos poll offers little evidence of faith in Starmer as the architect of change: fewer than half of those quizzed believed he would still be in No. 10 by the end of 2026.

What did the commentators say?

Pollsters have been “surprised” by the “level of apparent hostility” shown by respondents both towards Starmer and Chancellor Rachel Reeves, said George Parker, political editor of the Financial Times. But the PM’s allies believe he can “turn things around”, in part through renewed emphasis on reducing living costs.

There is “near-universal acceptance” among both Starmer’s “cheerleaders” and his “detractors” that the government must improve how it explains itself and defines its purpose, wrote the BBC’s political editor, Chris Mason. Downing Street is expected to launch a “blitz of public-facing activity” to this end. But the “key challenge” will be deciding what message they want to put out there, and, crucially, whether the government can stick to it. Core themes are likely to be “change”, “stability” and the cost of living

Starmer needs to carry out a “fundamental reset”, said former New Labour advertising guru Chris Powell in The Guardian. In 1995, Tony Blair’s team “planned scrupulously for a complete reorientation” of the party, involving “new strategy, new branding, new policy, new presentation and new organisation”. Starmer needs to embrace that same kind of “no-holds-barred thinking”, if he is to “win the daily war for attention”.

That could be easier said than done. Illegal migration is expected to “continue to dominate political debate”, said Sky News political correspondent Amanda Akass. Starmer hopes his tougher policies will “stop the boats”, but if progress is not made, “the pressure will only intensify”. “The moment of maximum jeopardy will come during May’s elections”: a poor showing “could lead to an open revolt against the PM”.

What next?

There are “good reasons to believe” Starmer may not last the year, said Patrick Maguire in The Times. But while many Labour MPs are attracted to the idea of a leadership change, there is far less enthusiasm for a full leadership contest. Even those “prone to silliness and self-indulgence” recognise that months of internal wrangling would be difficult to justify to the public.

That leaves only the possibility of a “bloodless coup and coronation”. But “Labour history suggests inertia is the most powerful force of all” and with no obvious alternative candidate, the question remains: who would replace Starmer? In the likely event that “the cabinet can’t agree on a challenger” after the May elections, it will be no surprise if the embattled PM survives the year.

Teeth have become Britain’s “biggest class divide”, said The Independent. With patients regularly “denied NHS appointments even in emergencies”, dental care has become “about hierarchy, not health”.

The government is hoping to change that, with newly announced reforms to NHS England dentistry that, it claims, will be “the most significant modernisation of the NHS dental contract in years”.

The reforms “will prioritise patients with most urgent dental needs and those requiring complex treatments” by changing the way NHS dentists are paid. Under the current payment scheme, complex dental care is “typically under-remunerated or even delivered at a loss”, according to the British Dental Association.

What did commentators say?

The changes mean patients with complex dental problems will be able to “book a package of treatment”, rather than having to arrange multiple appointments, and this could save them up to £225, said Lizzy Buchan in The Mirror. This is a “victory” after a “decade of Tory austerity” that left “people desperately struggling to get care”.

If the changes mean “fewer people” are “left to suffer with complex problems”, that would be a “big gain”, said The Guardian’s editorial board. But “it should not be mistaken“ for “a solution” to all the issues with dental care in England.

Before 2006, people had “the right to register with a dentist”, like you would with a GP, and the dentist would then receive “a payment for each patient on their list”. Then the NHS dental contract was changed, and dentists were paid instead per “unit of dental activity”. It wasn’t long before problems with this system emerged, “in particular the lack of access to dentists for poor people in poor places”. Labour’s reforms are “a big tweak” but they are “still a tweak and not the overhaul” of the fee structure “that most experts agree is needed”.

The new plan is a “welcome shift in direction”, said England’s former chief dental officer Sara Hurley on NHS Voices. But “it is important to be clear” that “this is not a new model of care, and it brings no new investment”.

What next? 

The reforms will be introduced in April, and Health Minister Stephen Kinnock said they mark “the first step towards a new era for NHS dentistry after a decade of decline”. A new dental contract is promised by the end of this Parliament, although it’s not clear if that will include the restoration of the right to register.

Dentists “broadly welcome” these new reforms, said Neil Carmichael, chair of the Association of Dental Groups. But it is essential that “necessary steps” are taken to “shore up the NHS England dental workforce” which is “currently short by over 2,500 dentists”.

Cases of the new “subclade K” super-flu are “ballooning” in the UK, said NHS England. Its latest figures show that the number of flu patients admitted to hospital is up 50% on the same period last year, and an “incredible” 10 times higher than in 2023.

This “troublesome mutant” flu virus is a variant of influenza A H3N2, said London’s The Standard. And H3N2 generally tends to cause more severe illness and hospital admissions than influenza A H1N1, which has been more dominant in the UK in recent years. Subclade K of H3N2 is now the predominant flu virus in the UK and Japan, and samples taken in the US and Canada seem to show a similar trend.

What exactly is subclade K?

It’s part of the H3N2 flu virus “family” but it has undergone several mutations that have caused a distinct “genetic drift”. This means it’s “differentiated” from the reference strain of H3N2 chosen for use in this season’s flu vaccine – and could have “changed sufficiently to escape the immunity that has been built up from previous infections and vaccinations”, said Antonia Ho, a consultant in infectious diseases at the University of Glasgow, on VaccinesWork.

“The good news” is that, this subclade K variant “does not seem to be more virulent or cause more severe disease” than other H3N2 strains, said microbiologist Ignacio López-Goñi on The Conversation.

So why the rise in cases?

H3N2 flu waves are “always hotter and nastier” than those caused by other strains, said The Telegraph’s science correspondent Joe Pinkstone. H3N2 is “inherently more severe and infectious than other types of flu, owing to more potent genes and a bigger ‘R rate’ – the number of people one infected person will pass the virus on to, on average”.

And then, as subclade K of H3N2 is different from previous strains and from the strain in the flu vaccine, people may be more “susceptible” to it, Giuseppe Aragona, a GP and medical adviser for an online pharmacy, told The Independent. In other words, our herd immunity and the NHS vaccine may offer us less protection than usual against this new flu strain.

Other factors that have contributed to the spike in UK cases include the flu season starting earlier this year, giving the virus more time to spread, and the fact that “fewer people have been exposed to flu in recent years, especially children, which leaves more people vulnerable”.

What should you do?

NHS bosses, warning of “a tidal wave of flu” in the run-up to Christmas, are encouraging everyone who is eligible to get the free NHS flu vaccine – including children (who can take it in the form of a nasal spray). You can also pay to get the vaccine privately at most pharmacies.

Data published by the UK Health Security Agency shows that the current vaccine is 70%-75% effective at preventing hospital attendance in children aged two to 17 years, and 30%-40% in adults. However well-matched to subclave K of H3N2 or not, it’s still “the best form of defence”, said Thomas Waite, UKHSA deputy chief medical officer.

There are three times as many people hospitalised with flu in London than at this time last year, said NHS England – and yet fewer than half of Londoners who are eligible for the flu vaccine have taken it up.

A series of high-profile scandals and independent reviews has painted a bleak picture of NHS maternity services. But Baroness Amos, who is leading the National Maternity and Neonatal Investigation into 12 NHS trusts, said “nothing” prepared her for the “unacceptable care families were receiving”. “I have been shocked,” she told Sky News, discussing her initial findings.

A “staggering” 748 recommendations have been made about maternity services in recent years, she said in an interim report. “Why are we in England still struggling to provide safe, reliable maternity and neonatal care everywhere in the country?”

What did the commentators say?

Amos found common themes: women being “disregarded” when they raised concerns, or not given the right information to make informed choices, as well as “discrimination against women of colour”, leading to far higher rates of maternal deaths, and similar prejudice against working-class and younger parents.

The problem is “systemic”, said Hannah Barnes in The New Statesman. The Care Quality Commission found last year that nearly two-thirds (65%) of England’s maternity units required improvement or were inadequate. There is “something bigger going on – something unique that cannot simply be explained by staff shortages, low morale or a lack of funding”. Many hospitals with inadequate maternity units provide good care in other departments. “This is a problem of culture.”

One hospital under investigation for poor maternity care spent a decade pursuing a “normal birth” ideology, said The Sunday Times. Leeds Teaching Hospitals Trust’s maternity strategy directed services to “actively promote” vaginal births with “minimal medical interventions”. This has been “repeatedly blamed for contributing to poor care”, with staff waiting “too long to intervene”.

Between 2012 and 2023, the trust had “the lowest rates of caesarean sections in the country” – and its rate of stillbirths and newborn deaths “soared” to the highest. Other NHS trusts where inquiries into poor maternity care uncovered “catastrophic failures” have similar patterns.

The Royal College of Midwives abandoned its “normal birth” campaign in 2017. But a Sunday Times investigation last month found that almost two-thirds of universities still promote “normality” in midwifery courses. “It’s become like a religion,” said a senior midwife at a teaching hospital.

Public inquiries have “repeatedly exposed systemic issues such as poor communication, a reluctance to learn from mistakes and knee-jerk defensiveness”, said lawyer Sara Stanger in The Times. The Ockenden review also noted that “midwives and obstetricians too often work in silos”, while concerns from families are “routinely downplayed or dismissed”.

But in my experience as health secretary, said Jeremy Hunt in The Guardian, “the biggest barrier to safer care in the NHS” was “a blame culture that stopped people being open about mistakes”. More than a third of NHS staff say they “don’t feel comfortable speaking up about safety concerns”. “That prevents professionals from learning from tragedies and condemns the system to repeating them.”

What next?

Amos’ investigation is due to publish its full report in the spring. But some victims say they are “disappointed” by the interim findings, said Sky News.

It appears to be “a bullet point list of failings that actually we’ve seen time and time again in independent reviews”, said Rebecca Matthews, who leads a campaign for families who claim they were failed by Oxford University Hospitals, one of the trusts Amos is investigating.

It seems as though it will lead to “some recommendations but no teeth”, she said. “We need some mechanisms that are going to hold people and systems to account.”

Previous reports have a “common message: policies and protocols alone cannot change outcomes”, said Stanger. Change “must start with trust and the freedom to speak up without fear of reprisal”.

“A woman gets to a certain age and all she wants is to be left alone,” said Viv Groskop in The Guardian. Well, no chance of that – because the “menopause gold rush” is in full flow.

Public awareness of menopause and perimenopause has improved in recent years but with that has come a “rapid expansion” of companies and individuals who “see menopause as a lucrative market”, said University College London researchers. The results of their survey of 1,596 women, published in Post Reproductive Health, suggests that women may be “vulnerable to financial exploitation” from the “marketing of unregulated menopause products”, and from menopause information on social media “that may not be grounded in evidence”.

Menopause has ‘hit prime time’

The menopause industry is now worth billions globally. Women are promised cures for some of the most debilitating symptoms – night sweats, hot flushes, fatigue, brain fog and anxiety – if they buy “specially branded supplements, teas and even pyjamas”, said Kirsty Wark in a BBC Panorama investigation last year.

Once something that women dealt with “in isolation”, menopause is now being experienced by a generation who are “less willing to suffer in silence” and more “proactive” about their health, said Courtney Rubin in Women’s Health. They engage openly with their symptoms. And when, all too often, their doctor dismisses their worries, they “ravenously” consume information online and demand “better solutions”.

“The slow-dawning realisation that women might be slightly underserved after centuries of demonising female ageing has unfortunately coincided with the high-water mark of aggressive capitalism”, said The Guardian’s Groskop. So the market is flooded with celebrity-endorsed menopause products, and treatments follow fads, rather than being rooted in science and tailored to a woman’s specific needs. "Menopause influencers” dominate Instagram timelines, the menopause “hits prime time” in special NFL Superbowl adverts, and Gwyneth Paltrow, Serena Williams and Drew Barrymore are all partnered with companies that sell menopause products.

The speed of change from taboo topic to something that’s constantly discussed can arguably make it harder to navigate the menopause. The streams of new opinion and “menopause management” products don’t make it easy to find accurate information or make helpful choices.

‘Happy medium’

Last week, the government announced that “menopause checks” would routinely be incorporated into the free NHS Health Checks for women, ensuring those “experiencing perimenopausal or menopausal symptoms get the right information and support”.

Perhaps, with this shift to make doctors actively address menopausal concerns that often go unrecognised, we can arrive at a “happy medium in the world of menopause, where it is a phenomenon that is neither constantly being marketed at us nor swept shamefully under the carpet”, said Groskop. As it is, “we have gone from a time when the word was barely spoken aloud to an era when it’s hard to find a podcast that is not discussing testosterone gel”.

“Football-style” NHS league tables, which rank the best- and worst-performing hospitals and trusts in England, have now arrived despite warnings that they “would not help patients choose where to seek care”, said The Guardian.

The rankings, which list short-term care or acute trusts, non-acute trusts and ambulance trusts separately, are available to the public and will be reassessed every three months.

Health Secretary Wes Streeting said he hopes league tables will increase transparency and end the postcode lottery in medical treatment, taking “the best of the NHS to the rest of the NHS”.

Health experts, on the other hand, have warned that it is “impossible to capture correctly whether any hospital” is “good or bad”. The new system “could prompt patients to avoid seeking help at lower-rated ones”.

What do the ratings represent?

Last November, the government approved a new framework for assessing the quality of care provided by NHS trusts. Providers are now evaluated on their performance across six domains: access to services, effectiveness and experience of care, patient safety, staff wellbeing, fiscal responsibility, and improving health and reducing inequality.

These measure waiting times for elective care, promptness of cancer diagnoses, ambulance response times and A&E wait times, mental health access rates, and the ease of booking appointments. The facilities’ finances are also taken into account “and it is possible that a hospital rated highly for clinical care will be marked down if they are running up a larger than expected deficit”, said the BBC.

Currently, specialist trusts including Moorfields Eye Hospital, the Royal National Orthopaedic Hospital and The Christie NHS Foundation Trust top the list. The Queen Elizabeth Hospital in King’s Lynn, Norfolk, received the worst rating.

Each trust is assigned a score between one and four, with lower numbers representing higher rankings – Moorfields was rated 1.39 and the Queen Elizabeth Hospital received 3.35, for example. The trusts are “then sorted into four categories called segments, with the best overall performers in segment one and the worst in segment four”, said the BBC. Trusts facing financial challenges will not be able to rank higher than segment three.

While comparing trusts based on their ratings “can be a helpful indicator of potential areas of disparity for further investigation”, it should be done “cautiously”, keeping in mind factors like trust size and merger history, said NHS England.

Why are some experts urging caution?

Since the plan’s announcement, critics have raised several issues with how effective and trustworthy NHS league tables will be. Streeting “accused health think tanks of ‘elitist nonsense’” after claims that the tables would be “difficult to interpret”.

But the tables “don’t tell you in simple terms” how a hospital is performing, Sarah Woolnough, chief executive of the King’s Fund, told the BBC. “It’s not elitist to say these rankings risk confusing people, rather than helping them choose where to get great care.”

There is also a risk that “trusts will focus only on the measures that immediately boost their ranking", even if those measures aren’t necessarily best for their patients, Thea Stein, chief executive of the Nuffield Trust, told The Telegraph. “As finances have a particular sway on the rankings”, the tables are “of limited use” for patients seeking care.

What will happen to low-ranked trusts?

The newly published league tables show that 80% of England’s acute hospital trusts “are considered to be failing because they are ‘off-track’ on performance targets or running financial deficits”.

While NHS executives and leaders at top-ranked trusts may be offered bonuses, more flexibility with budgeting, or temporary pay raises “to go into the lower-ranked organisations and turn them around”, those leading the “worst performers” might see their pay frozen or docked.

Some health experts have expressed “fears that those serving poorer or more isolated areas will be stigmatised”, said The Mirror. Divides between urban and rural areas, and the north and south of England, have already emerged in the tables.

“There’s more work to do” before staff and patients can fully trust the league tables, said Daniel Elkeles, chief executive of NHS Providers, an organisation that represents trust leaders.

The tables need to be accurate and fair – “anything less could lead to unintended consequences, potentially damaging patient confidence in local health services, demoralising hard-working NHS staff and skewing priorities”.

Resident doctors have "squandered the goodwill" of the government with their "self-defeating" strike action, said Health Secretary Wes Streeting.

The medics' five-day strike over pay finished on Wednesday but the British Medical Association, which represents them, has not ruled out further action. In a letter to the BMA, the health secretary said the strike was "deeply disappointing and entirely unnecessary".

What did the commentators say?

The industrial action may have achieved less than the BMA hoped, said Ella Pickover in The Independent. "Fewer resident doctors, formerly known as junior doctors, took to picket lines" than those who took part in previous strikes and "it's expected that fewer patients were affected" because "hospitals were ordered to press ahead with as much pre-planned care as possible".

The "word in the corridors" is that the BMA is "losing support across the NHS and among its own members", said Polly Toynbee in The Guardian. History may have reassured the BMA "that the public will always trust doctors over politicians" but currently the public seems to be backing "those trying to cut waiting lists more than the strikers who are adding to them" .

"A return to the negotiating table had seemed almost impossible," said Nick Triggle, health correspondent at the BBC, but, now the strike has ended, "both sides have shown signs of softening". It's "not gone unnoticed" by the BMA that public opinion seems to have "swung against resident doctors".

People "close to Streeting" say "he wants to get a deal done" but there may not yet be "enough common ground": the BMA wants to win a big pay rise, and Streeting "is adamant this is not an option". Instead, the government may offer non-pay-related concessions, such as covering the cost of (compulsory) exam fees, making rotas and rotations "less brutal" and giving resident doctors "student loan repayment holidays".

What next?

Streeting has been playing into "divisions" between the BMA and other healthcare unions to weaken the BMA's hand, said Novara Media's Polly Smythe in The Guardian. The Royal College of Nursing has called the government's pre-strike offer to doctors of a 5.4% pay increase, while offering nurses 3.6%, "grotesque".

The health secretary's tactic brings its own dangers. Resident doctors aren't the only ones that can "wreak havoc" on the NHS, said Alexa Phillips in The i Paper. Paramedics are as "unhappy" with their pay offer as nurses, and "hospital consultants are also threatening to strike in the autumn".

Just five years on from "Clap for Carers", public support for resident doctors and their upcoming strikes is dwindling.

A YouGov poll published this week showed that public support for the strike "has dropped five points" since May, with 52% of the 4,954 adults surveyed opposed to the strikes, and 34% in favour.

The British Medical Association has confirmed that industrial action will begin on Friday over demands for a 29% pay rise. Discussions with the government appear to have completely broken down, with reported "fury inside the Department of Health and Social Care" over the BMA's decision not to postpone the strike for further talks, said The Guardian.

Resident doctors, formerly known as junior doctors, have demanded the pay increase because, they say, their salaries have been "eroded by inflation".

What did the commentators say?

Last year's doctors' strike had widespread public backing "despite the 1.3 million healthcare appointments lost", said Polly Toynbee in The Guardian. There was a "strong sense" that "this was about defending the state of the service". Now, with the NHS still "under intense strain" and in a world "where growth and pay have long stagnated", people may struggle to feel the same way.

We are seeing the NHS under threat after "finally getting back on its feet", said Kevin Maguire in The Mirror. Most of us agree that "hard-working, skilled and stressed life-savers are worth even more" than they're being paid, but further industrial action could end up "squandering bedside trust", as well as "respect".

In media appearances, the BMA has been "insufferable" and "self-righteous" over this, said consultant physician Druin Burch in The Spectator. Most resident doctors are "excellent" and hardly ever convey "the self-satisfaction seen in recent media calls for more money".

Most of them are young and struggling with economic squeezes but this has "little to do with the wages of junior or even senior doctors" and more to do with a "twisted housing market". Like many young people, they are "not slow to feel the world is treating them unfairly" but I see "no widespread conviction about these strikes".

Most people do not realise "how long it takes to become a specialist in the UK", said former NHS resident doctor Benyamin Deldar in the Financial Times. It can "easily" be "13 to 14 years post-graduation before you can work independently as a consultant" and earn more decent money.

What next?

A favourable outcome for the public would be "no strikes followed by an agreed independent review to improve earnings long-term", said The Mirror's Maguire. "Wages, jobs and lives are in the balance."

A solution like "pay rises for the first year or two", when resident doctor wages are at their lowest, could be affordable, said The Spectator's Burch, but "no serious government could accept a huge precedent-setting pay rise".

Keir Starmer today promised shorter waiting times, neighbourhood healthcare hubs and greater use of technology to move from an "analogue" NHS to a "truly digital health service".

But the NHS has been in a state of near-constant revolution for years as successive governments have tried to heal what former chancellor Nigel Lawson called "the closest thing the English people have to a religion". Will this 143-page, 10-year plan be yet another sticking plaster instead of a cure?

What did the commentators say?

"These ambitions have appeared in NHS plans for decades," said Jennifer Dixon, chief executive of the Health Foundation, a non-profit that works to improve health and care. The problem lies in "the relationship between the government and the NHS", said the Financial Times. "The wiring of the British state" is at fault, Dixon told the FT, due to the ongoing "churn" of ministers and civil servants. and policy "swerves".

Of Health Secretary Wes Streeting's decision in March to scrap NHS England and take operational control back into the Department of Health and Social Care, Dixon told the FT: "If you want long-term policymaking, it's very difficult to square that with putting the leadership of the NHS back into the Department of Health. We haven't considered the right vehicle for this national asset."

Few argue against the plan to do more in community settings and less in hospitals, which have become overwhelmed in recent years. But there are risks to the proposed changes, including "staff shortages, tight public finances, a lack of premises in which to host one-stop-shop-style 'neighbourhood health services' and a public backlash at hospitals being downgraded", said The Guardian.

Dr Becks Fisher, director of research and policy at health think tank the Nuffield Trust, told BBC Radio 4's "World at One" that there are "lots of bold ambitions in this plan that we welcome". If they are delivered, they could be "game-changers". "Our big question is: Is this plan going to be deliverable?"

Ministers say the proposed "neighbourhood centres" will be staffed by doctors, nurses, pharmacists and other health professionals, as well as "specialists in debt advice and employment".

"The radical change would be delivering the vision," said Sarah Woolnough, chief executive of the King's Fund think tank. "History has shown us that you can't simply co-locate different health professionals in a building and expect a neighbourhood health service to flourish."

What next?

Just one in five Britons are satisfied with the NHS, the lowest since data was first collected in 1983 by the British Social Attitudes survey. But Julia Grace Patterson, CEO of Every Doctor, warned about the dangers of private sector involvement. "Starmer and Streeting will decide to partner heavily with the private sector to realise their plans, and I expect they'll try very hard to sell these ideas to the public," she told Big Issue. But "public-private partnerships have been a disaster for the NHS".

The stakes are high. Turning NHS England into a digital service is expected to cost £15 billion over five years and reforms to social care have been delayed until 2036 largely "because they are deemed unaffordable", said The Economist.

The NHS has lower administrative overheads than other systems and its centralisation of data could be key to reaping the potential benefits of AI. To leverage these strengths, Labour's plan must achieve the miracle cure of "reform without new money".

The NHS will not be rolling out two new drugs that have been hailed as landmark treatments for Alzheimer's disease. Lecanemab and donanemab are the first drugs to slow the progress of the disease but the independent body that decides which medicines should be available on the NHS has concluded that neither has benefits that justify their high cost.

"Neither drug can be recommended," said the National Institute for Health and Care Excellence in its final assessment last week, because the "overall costs of purchasing and administering the drugs remain high and the benefits too small". Both lecanemab and donanemab have been approved as medicines in UK, so will be available privately.

How do the new drugs work?

Both lecanemab and donanemab are monoclonal antibodies, created in a lab to target amyloid beta proteins, which accumulate in clumps, or plaques, in the brain of people with Alzheimer's disease. Delivered through an IV infusion, the drugs bind to the amyloid proteins and then attract the body's own antibodies to attack and break them down. The two drugs operate similarly but lecanemab targets the amyloid proteins as they begin to clump together, while donanemab binds to the proteins once they've clumped together to form larger plaques.

How effective are the new drugs?

Neither drug reverses or stops the disease but it's thought they could potentially delay the cognitive decline of patients in the early stages of Alzheimer's by between four and seven months. Trials have shown that lecanemab can slow decline in memory and thinking by 27%, and donanemab by 35%.

But there are some caveats. The benefits seem to be better for men than women and, as the trial participants were generally young, white and with no other health conditions, it's likely that real-world effectiveness on older, frailer, more diverse Alzheimer's patients might be less impressive. By selecting participants the way they did, the researchers "were giving the drugs the best possible chance to show an effect", Seb Walsh, a doctoral fellow specialising in dementia and public health at Cambridge University told Unherd. And yet, even so their impact was "so small, it probably wouldn't be noticeable to a doctor".

"I understand the benefits of the drug are modest and that is as much as we can expect from any of these new Alzheimer's drugs at this point," Peter Almond, a clinical trial participant, told The i Paper last year. "But if it has been stopping my condition developing into Alzheimer's, then it has had a significant impact on my life."

Why are the drugs so expensive?

It's down both to the cost of the drugs themselves, and the way they need to be administered.

Before starting treatment, an Alzheimer's diagnosis must be confirmed via an expensive positron emission tomography scan or a lumbar puncture. Then each patient needs an IV infusion every two weeks, along with regular brain scans and check-ups to monitor effectiveness and potential side effects (which are known to include potentially fatal brain swelling and brain bleeds or haemorrhages). These processes effectively double the cost, from roughly £20,000 to £25,000 per patient per year for the medicine itself to at least £50,000.

Should the NHS fund the drugs?

There are roughly 70,000 people in the UK with mild Alzheimer's disease who could be eligible for the new drugs, if they were to be funded by the NHS. The cost to the health service of such a rollout was estimated, in a 2024 NHS briefing paper, at between £500 million and £1 billion a year.

"The substantial resources the NHS would need to commit" mean that "if they were approved, they could displace other essential treatments and services", said the National Institute for Health and Care Excellence.

Those frustrated by the decision see this not only as a disappointment for those affected by Alzheimer's disease but also as a setback in research into an eventual cure. Others contend that the price-per-patient, not to mention the social benefit of people remaining independent for longer, pales in comparison to the vast expense of supporting people in the latter stages of Alzheimer's disease and in care homes.

But all the focus on so-called "wonder drugs", Tom Dening, director of the Centre for Dementia at the University of Nottingham, told The i Paper, is "a bit of a distraction from the main issue – which is to help people live the best lives they can with the diagnosis".

Chronic staff shortages, low pay and demanding working conditions have long made it difficult to recruit care workers in Britain. For years, migrant workers have kept the sector afloat but now government immigration reforms could put further pressure on an already overstretched industry.

Social care providers will no longer be able to recruit staff from abroad on a Health and Care visa, under plans outlined in the government's immigration white paper. Instead, providers will have to employ domestic workers, immigrant care workers already here legally or immigrants on other visas. The government says these changes will reduce reliance on overseas workers, crack down on "rogue care providers" and cut immigration by 7,000 a year.

Care England, the body representing the adult social care sector, has described the plans as "a crushing blow to an already fragile sector."

How much do we rely on migrant care workers?

Migrant workers hold 32% of adult care worker roles in England, according to a 2024 Skills for Care report, with 26% coming from outside the EU and another 6% from an EU member state. Most foreign-born workers were recruited from Nigeria, India, Zimbabwe, Romania and Ghana.

In 2022, the Conservative government added care workers to the Health and Care visa list to allow overseas recruitment, following the twin shocks of Brexit and the Covid-19 pandemic. By 2023, more Health and Care visas were being granted than any other skilled worker visa – over 336,000 in total – but, last year, numbers fell to 27,174, after successful applicants were no longer allowed to bring dependants with them and the government cracked down on abuse of the scheme.

How did it get this way?

The problems facing social care are "deep-rooted" said The Bureau of Investigative Journalism. Austerity-era cuts from 2010 slashed council budgets, limiting funding for social care. And the challenges of the job – "stressful and sometimes exploitative conditions, a lack of career progression and high turnover" – have been cited in reports "as far back as 2015".

Health think tank The Nuffield Trust has also cited Brexit as "adding fuel to the fire of severe challenges" facing social care. "Shutting off the 'relief valve' of EU migration has put additional pressure" on staffing shortages in a system that "has relied heavily" on recruitment abroad and lacks an effective training and retention plan for British workers.

Yet workforce shortages aren't a recent problem, said the Centre for Health and the Public Interest. The NHS and the wider economy "have been dependent on migrant labour to fill job shortages for decades", with the root causes of staff shortages "deeply embedded into how we have chosen to run and organise" our healthcare sector.

Why do we struggle to recruit British carers?

Between 2022 and 2024, the number of British care sector employees dropped by 70,000. Even with over 100,000 immigrants filling care worker roles during that time, the sector's vacancy rate of 8.3% is still nearly three times higher than that in the wider economy, according to the Skills For Care report.

According to research published in Frontiers in Public Health, the sector struggles to recruit and retain workers for several reasons, including low pay, the prevalence of zero-hours contracts, limited opportunities for training and care progression, and the low social status of the work itself.

What does the future look like for the sector?

It's not a pretty picture, unless the government can solve the domestic recruitment crisis. Given Britain's ageing population, the demand for carers will only increase. Skills For Care estimates an additional 540,000 care jobs will be needed by 2040. But without urgent reform, including better pay, training and working conditions, few believe these roles will be filled domestically.

"International recruitment wasn't a silver bullet but it was a lifeline," said Care England's CEO Martin Green. "Taking it away now, with no warning, no funding and no alternative, is not just short-sighted; it's cruel."

The landmark assisted dying bill could be in jeopardy after the Royal College of Psychiatrists withdrew its support.

The college, which represents psychiatrists across the UK, cited "serious concerns" about the already limited capacity of NHS mental health services, as well as the role psychiatrists would play in assisted dying decisions.

MPs voted in favour of legalising assisted dying last year, but the Terminally Ill Adults (End of Life) Bill has generated "huge controversy" while progressing through Parliament, said Sky News. The bill will return to the House of Commons tomorrow, where MPs will vote once again, after first reviewing the 150 amendments that have been made to it.

But at least 15 MPs "who either abstained or supported the bill previously are now considering voting against it", said The Telegraph, leaving the bill's fate in the balance. "Interventions from medical bodies" like the royal college "have prompted more MPs to come forward with concerns about the bill".

What did the commentators say?

The Royal College of Psychiatrists' (RCPsych) move is a "major blow to the bill's credibility", said Dan Hitchens in The Spectator.

Originally, Kim Leadbeater, the Labour MP sponsoring the private member's bill, said a judge should approve each assisted dying case, but the Ministry of Justice dismissed the idea.

The "replacement" is a panel of experts made up of a lawyer, a psychiatrist and a social worker, but "remarkably, Leadbeater seems not to have consulted" RCPsych about the change, said Hitchens. "It seems she is dragging them into a process they regard as fundamentally flawed."

The group is apprehensive about the bill's "inadequate" conscientious objection clause – which gives professionals the option to opt out of participating in assisted dying procedures – as well as concerns regarding the duty of care psychiatrists have towards their patients.

The impact that assisted dying could have on the medical profession's "do no harm" principle could be "seismic", said Nadia Khan, a palliative medicine consultant and spokesperson for the British Islamic Medical Association, in The Yorkshire Post. Legislation that "compromises this moral safeguard" risks "disrupting the very nature of healthcare".

The British Medical Association, the union representing doctors in the UK, maintains a neutral stance on whether laws around assisted dying should change, but the bill still has a wide base of support among the medical profession.

One supportive GP, Susi Caesar, told the BBC she "will be at the front of the queue" to help terminally ill patients have the death they choose. "I think that's the core joy of my job – being with people to the very end of their health journey."

What next?

A final vote is "possible" when the bill returns to the House of Commons, but "MPs have put forward so many amendments to discuss that they are unlikely to get through them and progress to the next stage", said The Telegraph.

The "flurry of amendments" has brought more criticism from opponents of the bill, who worry lawmakers will not have enough time to review the proposals before Friday's debate. The next stage, a third reading, "is now expected next month" on either 13 June or 20 June.

Even if the bill does pass, it won't take effect until 2029. Initially, there was a "two-year 'backstop' between the legislation being passed and put into practice", but Leadbeater recently extended the period to four years, said Sky News.

The National Health Service is often held up as the defining achievement of the post-war British state. But more than 75 years on from its founding, the NHS is, according to the government, "broken" with a waiting list of nearly 7.5 million patients and public satisfaction at a record low of 21%.

For Health Secretary Wes Streeting, a focus on holistic health provision in individual neighbourhoods represents a pathway to repairing the NHS at the national level. And one such scheme in a deprived area of Birmingham – Washwood Heath – offers a potential blueprint for the rest of the country.

A 'blueprint' for the NHS

Washwood Heath Health & Wellbeing Centre presents Whitehall health policy professionals with a "living, working example" of what neighbourhood health provision might look like, said the BBC.

A community clinic set up in the east Birmingham suburb two years ago brings together hospital doctors, GPs, nurses, occupational therapists, physiotherapists, council social care teams, mental health professionals and charity staff, all under one roof.

Offering medical services, including ultrasound scans and X-rays, alongside non-medical interventions, the centre's staff work "collaboratively to ensure patients receive the care they need at the right place and time, significantly enhancing patient outcomes and experiences", said the National Health Executive (NHE).

"The target is the most frequent users of health services – and the aim is to keep them well and out of hospital," said the BBC. In practice, this means tackling social issues like access to housing or "arranging support for daily tasks such as washing and dressing", alongside medical treatment.

The result, said the Birmingham Mail, has been a reduction in waiting times and ambulance delays, and a significant drop in local GP calls and hospital A&E admittances.

On a visit to the centre in February, Richard Meddings, chair of NHS England, said, "there is a really good argument this is the model for the future".

The Washwood Heath clinic "combines data about the patients, it connects various parts of the health centre together to wrap care around the patient", he said, as well as helping the NHS "get more of our resources into primary and community" and collaborate more effectively with social care services.

Lorraine Galligan, chief of nursing for Birmingham Community Healthcare NHS Trust, said: "We see it as a blueprint for what the NHS could look like and should look like in the future."

A tough sell

Community-based care was a key part of Labour's election-winning manifesto and health ministers are "keen to see the soundbite being worked up into practical proposals", said Chris Naylor, senior policy fellow at health think-tank The King's Fund.

"Neighbourhood health is not a new 'thing' at all", said Anna Charles, also for The King's Fund, and "this could be one of its greatest strengths". Existing data on community-focused approaches show that improvement "isn't achieved through a single policy solution, but instead through the aggregation of many simultaneous changes to the way in which care is organised and delivered".

Yet there remain huge financial and political challenges ahead. While research suggests that every £100 spent on community care would save £131 in hospital care, "part of the problem with making the whole system buy into it is money", said the BBC.

Those in charge of managing local NHS funding are focussed on "making sure it goes on where they immediately need it," Ruth Rankine, an NHS Confederation primary care director, told the broadcaster.

The other issue is that the hospital sector has, in places, "been a bit cynical" she added. "The problem is that it takes time to get results – you need to invest in front and then it can be years before it has an impact."

A "perplexing" feature of our age is that the more our society spends on healthcare, the "gloomier the statistics around ill health" become, said James Le Fanu in Literary Review.

Funding for the NHS has grown sixfold in the past 50 years; and while there have been clear benefits – including better recovery rates from many life-threatening diseases – it's notable that the increase in investment has not made us less sick overall. Quite the contrary, in fact: since 2010, the "number of people labelled as having a long-term health condition – whether physical or mental – has leapt by six million". In her wide-ranging book, Suzanne O'Sullivan suggests that this glut of ill health has been driven by a culture of "overdiagnosis". Rather than actually "getting sicker", she writes, we are "attributing more to sickness", so that millions who once would have been considered healthy are now classed as unwell. The costs are considerable – to individuals and to society – and O'Sullivan's assessment of how this situation came about is "masterful" and "immensely persuasive".

As O'Sullivan sees it, overdiagnosis most often occurs in two forms, said Hannah Barnes in The New Statesman. First, there's "over-detection" – where improvements in our ability to identify signs of disease lead to unnecessarily early interventions (this has happened, she claims, with certain cancers). Secondly, there's "expanded disease definitions" – an ever-greater number of symptoms being classed as evidence of a condition. O'Sullivan believes the latter is chiefly responsible for the dramatic recent rise in diagnoses for conditions such as autism and ADHD. Historically, these may have been underdiagnosed, but now the opposite is true, and "almost nobody is denied a diagnosis". This, she argues, can do "more harm than good" – leading people to attribute all the problems in their life to their "condition", when the actual solutions may lie elsewhere.

Long Covid is another contentious illness that O'Sullivan considers, said Adam Rutherford in The Guardian. Here, uniquely, diagnosis has "been led by the public, often via social media". Exploring such areas is "incredibly difficult", and it would have been easy to be "sneering or dismissive". Thankfully, O'Sullivan is neither; her writing is "full of compassion, care and grace". The central argument of this excellent book is that diagnosis is a tool that should be "wielded with the utmost caution".

NHS England is being abolished under plans announced by Keir Starmer today aimed at centralising control of the national health service.

The arms-length body is being axed to "cut bureaucracy" and bring management of the health service "back into democratic control", the prime minister said. The creation of NHS England in 2012 by the Tory-Lib Dem coalition government "created burdensome layers of bureaucracy without any clear lines of accountability".

What did the commentators say?

"It’s hardly surprising that ministers want more control" of the NHS given its importance to voters, said the BBC's chief political correspondent Henry Zeffman. But there is also a "broader philosophical point" being made, "that significant decisions ought to be made by those with democratic authority, that is to say the government".

"As soon as Wes Streeting took charge", said the broadcaster's health correspondent Nick Triggle, it was clear that "NHS England was on borrowed time". Streeting shares the sentiments of Tory health ministers of yesteryear who "privately expressed frustration that the single-biggest part of their brief was outside of their control".

Whisper it quietly, says The i Paper's Katy Balls, but has Starmer and his government "gone a bit Tory"? Today's announcement follows a series of moves that have left some "wondering whether Starmer has swerved slightly to the right".

In a post on X, Tory peer and former health minister James Bethell said: "I wish we'd had had the guts to do this." A former Tory government adviser told Balls that “it’s the kind of thing that if we went near everyone gets hysterical and says we are privatising the NHS and becoming the US, but Wes might have a shot”.

That said, "Streeting is taking a big risk", said ITV's political editor Robert Peston. Streeting "has ordered a 50% reduction in NHS England’s 15,300 headcount straight away" before the body is wound down in two years time and "managing job cuts while trying to improve NHS performance" will be no easy task.

What next?

That "only Labour can deliver this reform is borne out in polling and something that Streeting and his advisers are deeply aware of", said The Spectator's Isabel Hardman. But once the health service is back in house, "it really is Labour’s problem".

"So the government must really think that it can reform the NHS properly, as it will have to answer directly for any failure."

Health Secretary Wes Streeting said there must be a "new relationship" between the Department of Health and the NHS after the abrupt departure of the chief executive of NHS England earlier this week.

Streeting has been battling for "tighter Whitehall control", as part of his "vow to fix the 'broken' NHS". He insisted he did not ask Amanda Pritchard to quit her NHS England leadership role but her replacement, James Mackey, has been given "a remit to radically reshape" how NHS England works with the Department of Health and Social Care (DHSC), said the Financial Times.

The overhaul is evidence of Streeting's "frustrations" with the system's "resistance to change", said The Telegraph. But some worried NHS England staff see the ousting of their leader – and the signalled "significant" job cuts to come – as a "a power grab", said The Guardian.

What did the commentators say?

Streeting and Pritchard have "gone to great pains" to paint her departure as "amicable" but the "wider context" of her resignation "cannot be ignored", said an editorial in The Times. The government has "spoken loftily of its plans to end inefficiencies and waste" in the NHS, and must believe a "major structural shake-up" that brings NHS England "back under ministerial control" will give it the power to make the "radical change" it has pledged.

Pritchard's position became "quite untenable" after "attacks by two parliamentary committees on her performance", and Streeting will hope her successor can help deliver the NHS reforms needed to "help win the next election", said Sean O’Grady in The Independent.

As part of Streeting's move to "gain and assert much more control", the first focus will likely be on "shrinking the size" of NHS England, the body that's "in operational charge of the health service", through "deep cuts to its 13,000-strong workforce", said Denis Campbell in The Guardian.

The health secretary will "end the situation" in which officials at the DHSC and NHS England "cover the same area of health policy". This "unnecessary duplication of roles" has led to "disagreements" that sometimes "held up key policy initiatives", a Whitehall source told The Guardian.

Streeting has already "removed" NHS England's Conservative-appointed chair, Richard Meddings, and replaced him with Dr Penny Dash, a "no-nonsense character" who shares Streeting's "zeal to radically reform the NHS".

And the health secretary has also made it clear that those in charge of failing NHS hospitals will be "sacked and blocked from taking another job in the sector", said Dr Emma Jones at UnHerd. So far, though, there has been "no evidence of this actually happening". There is still a "jumbled approach to who really matters" in the NHS. "Incompetent managers" should "face the same consequences as incompetent doctors", and the health service "urgently needs a total overhaul of management recruitment".

What next?

New leadership at NHS England is an "opportunity for a reset" and, hopefully, one that will "stand the test of time", said The Times. Mackey is likely to oversee a "drive" towards a "leaner" organisation that will hand "more autonomy" to "local health providers".

But the government will still have to grapple with the "high demand and budget pressures" in the health service, said the FT. It is "an extremely critical time for the NHS", so it is "crucial" that the DHSC and NHS England "work well together", and "NHS leaders retain operational and clinical independence for the day-to-day running of the service", Sarah Woolnough, chief executive of health think-tank The King’s Fund, told the paper.

Observers have called for Lucy Letby to be released on bail after a panel of medical experts working with her defence team said they believe she did not commit the murders.

Letby, who is serving 15 whole life sentences for murdering seven babies and attempting to murder seven others, has lost two bids to appeal against her convictions, but the report offers her fresh hope in her quest to clear her name.

Who are the experts?

The 14 senior clinicians were gathered from around the world, and they include British doctor Neena Modi, a former president of the Royal College of Paediatrics and Child Health.

The panel was assembled by Dr Shoo Lee, a retired doctor based at the University of Toronto, who heads the Canadian Neonatal Foundation.

What did they say?

Dr Lee said there were alternative explanations for each of Letby's convictions for murder or attempted murder, after the panel found that "in all cases death or injury were due to natural causes or just bad medical care".

For instance, he said infection killed Baby Seven, chronic lung disease complicated by antibiotic-resistant bacteria caused the death of Baby Nine, and traumatic delivery led to the death of Baby 15.

He accused the Countess of Chester Hospital of a "litany of failures", said Sky News, including "unsafe delays in diagnosis and treatment, poor skills in resuscitation and incubation, and the misdiagnosis of diseases".

He called into question the evidence of Dr Dewi Evans, who was the prosecution's lead medical witness, but Dr Evans has insisted that criticism of his evidence is "unsubstantiated".

The panel also questioned the prosecution's claim that Letby injected air into babies' bloodstreams, causing an air embolism that blocked the blood supply. Dr Lee said this claim has "no basis in evidence".

What does this mean for Letby?

The panel's findings have been sent to the Criminal Cases Review Commission, which investigates alleged miscarriages of justice. The commission said yesterday that it's formally examining the case.

A barrister close to the case told The Guardian the report was so "game-changing" that Letby could be released on bail if the "court of appeal believed there was a real possibility of her convictions being quashed".

But such a development would be at least 12 months away and would be "strongly opposed" by the Crown Prosecution Service, added the broadsheet.

What did the families say?

A mother whose baby son Letby was convicted of trying to murder criticised the panel's "upsetting" and "disrespectful" report. "They said the parents want to know the truth, but we've had the truth", she told the Daily Mail, adding that "we believe the jury made the right decision".

Dr Lee said the report was intended to give the relatives "comfort and assurance in knowing the truth about what really happened".

Adult social care covers a large range of services given to the frail and disabled, from home visits to end-of-life care.

The sector employs 1.6 million people in England (about the same as the NHS). There are many concerns about the sector: staff shortages, low pay, rising costs, poor conditions, patchy quality etc. But with a rapidly ageing society, the main area of worry is old-age care, and how to pay for it.

What's wrong with the system?

Unlike the NHS, care is not free: there is both a needs assessment and a means test; only those with high needs and few assets qualify. Those with "healthcare needs" – cancer, say – have their treatment paid for by the state, but most with "social care needs" – trouble with eating, washing, mobility, etc. – pay for them, even though the dividing line is often unclear.

With health, the costs are pooled across society; with care, the unlucky ones pay very large bills. Polls suggest that more than a quarter of Britons are unaware of this situation.

How does the current system work?

In most cases, only people with assets worth less than £23,250 get any state support in England and Northern Ireland – the threshold is £35,000 in Scotland and £50,000 in Wales. Below that, there is a sliding scale: those with £14,250 or less receive full funding. Provided you still live in it, the value of your home isn't included in the calculation; but if you have to move out to go into residential care, it is taken into account (unless your partner is still living there).

Publicly funded social care is provided by local authorities, and mainly outsourced to thousands of private providers. For those who pay, residential care costs on average more than £1,000 per week. In many parts of the country it is higher than that, and there may be many additional costs. Care at home costs from £23-34 per hour, though again it can be higher.

And what effects does this have?

Those without state support have to rely on friends or family, go without care, or pay for it themselves. The most recent official estimate is that one in seven adults aged 65 and over face lifetime care costs of over £100,000; some 20,000 families sell homes to pay for it every year.

Yet despite high costs, the quality of care is often low: stories of ill-treatment are common; many people receive disjointed care from different providers. The dysfunctional system means that there is thought to be a large amount of unmet need. The Nuffield Trust estimates that fewer than half of older people with care needs receive support. This puts great pressure on the 5.7 million self-identified unpaid carers in England and Wales. And the situation is likely to get worse.

Why will it get worse?

Because elderly sections of the population are growing much faster than the working-age population; the number of people over 75 has grown by over 20% in the past decade. In the meantime, state funding has fallen in real terms, because the threshold of £23,250 has stayed the same since 2010.

The current system needs cash just to stay afloat. In 2023/24, £27 billion was spent on adult social care by local authorities in England, split between the elderly and the disabled of working age; 858,720 people received long-term care.

This is only the tip of the iceberg. The scale of the unmet need is massive: over two million requests for social care were made last year. And many authorities are already in dire financial straits.

Why hasn't this been fixed?

Many governments have tried, though half-heartedly: there have been two major commissions and dozens of official inquiries and papers on reforming social care since 1997.

Politically, it is very difficult. In 2010, the then Labour health secretary, Andy Burnham, outlined plans for a National Care Service funded from a £20,000 levy on estates at death. This was branded a "death tax", and Labour lost the election. At the 2017 election, Theresa May's Tory manifesto unexpectedly proposed that the value of a person's home should be included in the calculation of assets for care assessments, though to soften the blow, the means-testing threshold would be raised from £23,250 to £100,000. This "dementia tax", as it was dubbed, contributed to May's disastrous campaign.

As George Osborne once noted, working out who pays for social care "is incredibly unpopular. It's much more straightforward politically to keep kicking the can down the road." He should know: as chancellor, he delayed what is widely seen as the most promising attempt at reform.

What reforms did Osborne delay?

In 1999, the Sutherland Commission argued for free personal care funded by general taxation; a minority of commissioners rejected this as unaffordable. In 2011, the Dilnot Commission instead recommended a cap: no one should have to contribute more than £35,000 (over £50,000 in today’s money) towards the cost of care over a lifetime, nor more than £10,000 per year for food and accommodation. Beyond that, the state should pay; those with less than £100,000 would pay nothing.

The idea was that if people knew the state would step in when costs become catastrophically high, they would be encouraged to save for their own care; at the same time private insurers, who won’t currently get involved because costs can be so high, could be coaxed into the market. The Dilnot proposals partially made it into law in 2014, but councils objected to the cost, and the plans were delayed by Osborne until 2020.

Have they now been abandoned?

In theory, no; but in 2017 they were postponed indefinitely. They were revived by Boris Johnson; in 2022, under Rishi Sunak, a less generous version of the Dilnot cap was set to be introduced in October 2025 – safely after the next election.

This month, Keir Starmer's government announced it would not introduce the cap, and instead appointed a new commission. It will not report in full until 2028.

Baroness Casey's challenge

Baroness Casey, a former civil servant and Whitehall "troubleshooter", has been charged with leading the new commission. Its remit is to "rebuild the adult social care system to meet the current and future needs of the population". An interim report will be delivered in 2026; this will identify the main problems with the current system. The final report, which will cover funding, is not expected until 2028.

The response from the sector was fairly uniform. The attempt to break the cycle of failure, and reach a cross-party consensus, was welcomed. But the plan to report by 2028 was, said the King's Fund health think-tank, "far too long to wait for people who need social care. The issues and the potential solutions to this are clear and do not require years to consider."

Age UK estimates that 2.6 million people in the UK cannot access the care they need to go to the toilet, eat and wash. Care failures also have a major knock-on effect on the NHS. The NHS Confederation estimated that in 2019/20 alone, 855,000 emergency admissions to hospital of older people could have been avoided with the right care at the right time. And as of September 2024, 13% of NHS hospital beds were occupied by people waiting for social care.

The UK's first legal drug consumption room opens in Glasgow today, following a decade-long legal battle between the city's council and Westminster.

The initiative "marks a significant, if contested, moment for British drugs policy after years of debate" about the best way to reduce overdose deaths and "take consumption off the streets", said The New York Times.

With Scotland recording the highest drug death rate in Europe, "all eyes are on Glasgow", Allan Casey, the city council's addictions convener told The Guardian, with "a huge amount of pressure to make sure we get it right".

How does it work?

The Safer Drugs Consumption Facility, to be known more informally as The Thistle, will offer some of the city's most vulnerable addicts a clean and safe environment in which to take their own drugs, under nurse supervision.

Open from 9am to 9pm, 365 days a year, The Thistle has eight open-plan injecting booths, as well as a lounge area, and shower and laundry facilities. Those wanting to use The Thistle do not have to give their full name at the reception desk but will be required to have a brief discussion with a member of staff about which drugs they are taking and how they plan to use them. Users will then be given access to clean syringes, needles and swabs.

Designed in consultation with a group of former addicts, the centre will "steer clear of what would often be found in conventional health services – which plenty of drug users have had traumatising experiences of", said the Big Issue. "A lived-experience team" helped decide things "like the way reception staff will greet people", as well as the choice of furniture and colour schemes (think lots of light wood, greens and turquoise)". Staff will not wear NHS uniforms.

The three-year pilot scheme will cost about £2 million a year to run, and has been funded by the Scottish government.

But aren't drugs illegal?

Drug legislation is reserved to Westminster, and the previous Conservative government repeatedly dismissed calls from Glasgow city council, backed by the Scottish government, for the legal powers to pilot such a scheme. The green light was finally given in 2023 after Scotland's most senior law office confirmed that the centre's users would not be prosecuted under the Misuse of Drugs Act 1971 for simple possession offences committed within the confines of the facility.

Clarifying the ruling ahead of The Thistle's opening, Lord Advocate Dorothy Bain KC said "it would not be in the public interest to prosecute people for simple possession offences when they are already in a place where help with their issues can be offered". This statement of prosecution policy "does not extend to people on their way to and from the facility, or anywhere else in Glasgow", said Scottish Legal News.

How will it help drug users?

There are now over 100 drug consumption rooms around the world, including in Europe, Canada, the US and Australia. Supporters of these facilities claim they "cut the risk of overdose and infection, reduce the costs of acute hospital admissions, and put users in touch with healthcare professionals who can offer drug addiction treatment", said The New York Times.

It is part of a "harm-reduction approach to problem drug use", said the Big Issue, which "means treating it as a public-health matter, rather than trying to shame or criminalise people into abstinence". Supervision at The Thistle is "deliberately light touch" said The Guardian, and it's hoped the centre will "engage drug users who have proved hardest to reach", given the "extra support for wider healthcare, housing and benefits also available". Staff "accept its reach will be limited but see it as a starting point", said Channel 4 News.

So is this the future of drugs policy?

The opening of the country's first legal drug consumption facility is a "potentially transformative moment in UK drugs policy", said The Guardian. Indeed, "such is the level of cross-UK interest" that Glasgow city council is working with other British cities to lobby Westminster "to allow further pilot schemes".

Not everyone is behind the initiative, however. Some local residents fear it could bring more drug dealing into the area, while "other critics worry that it will be counterproductive", said the New York Times. The addiction charity Faces & Voices of Recovery UK, for example, warned that there was "nothing kind" about offering "a place to continue destructive behaviours" that keep people "trapped in cycles of chaos, compulsion and despair".

The government has announced its first steps towards tackling the adult social care crisis in England. Health Secretary Wes Streeting said that an independent commission "will work to build a national consensus around a new National Care Service able to meet the needs of older and disabled people into the 21st century".

Baroness Louise Casey is to lead the commission, which will begin work on a two-stage report this spring, with the second phase slated for completion by 2028.

What did the commentators say?

Fixing social care will be "no-nonsense civil servant" Casey's "toughest challenge yet", said Andrew Gregory in The Guardian. "Leading voices in the sector" have already warned the government that social care provision is facing collapse, with high employment costs and lack of funding "threatening its overall sustainability".

Many care providers are "struggling to keep the lights on", said Steven Swinford and Poppy Koronka in The Times, and the industry is "chronically understaffed". A House of Lords report last September found that, in 2023 to 2024, there were more than 130,000 vacant posts. Services once "relied heavily on overseas workers" but the previous government's policies preventing carers from overseas bringing their families to the UK have made the problem worse. Pay is poor, and the widespread use of zero-hours contracts means there is little job security for people who are "expected to comfort our loved ones during some of their lowest moments in old age", said Daniel Keane in London's The Standard.

"Three things are needed" to get the sector back on track, said Sarah Woolnough, chief executive of The King's Fund policy think-tank, in the Financial Times. The government must first address the financial challenges, then "take forward long-term reforms" that address the current reality of "people with modest means" having to pay for care – "previous administrations have frozen in the face of this challenge". Thirdly, they should "get on with putting in place the building blocks" that will make these reforms possible. These could include Streeting's already-mooted NHS transition "from analogue to digital", and shift in focus "from sickness to prevention".

Streeting has already announced an extra £86 million for the Disabled Facilities Grant in this financial year, to help 7,800 more elderly or disabled people adapt their homes – widening doors or installing stairlifts, for example – to better fit their needs.

Care workers will also be given "guidance and support" to perform routine at-home health monitoring, such as blood-pressure checks, on the people they're looking after, to reduce strain on GP services. Confronting the problem of care-worker pay, however, will take time. "We need to get to a position where pay rises are possible," Streeting told ITV's Good Morning Britain. "The government's only been in for six months; give us a chance."

What next?

The first phase of the commission, which will identify the critical issues facing adult social care, begins in April and is due to report back with its recommendations in 2026. The second phase, reporting by 2028, will make longer-term recommendations for the transformation of adult social care. Opposition parties have been invited to take part in the commission.

Care bosses have criticised the length of time the recommendations will take."The people in care today cannot afford to wait any longer," Professor Martin Green, chief executive of Care England told Care Home Professional. "Their lives depend on action now."

But Streeting defended the timescale and said he would "go faster", if possible. "Louise Casey isn't known for being backwards in coming forwards," he told Good Morning Britain.

A new NHS call for blood donors to make – and keep – appointments in the run-up to Christmas has reignited the debate around how to increase rates of donation, including the use of financial incentives.

For many, the idea of paying for blood plasma "elicits concerns about the commodification of the human body", said Politico. For others, "paying donors a flat fee for their time and trouble should be part of the solution" to what is a growing global shortfall.

How often does the UK run low on blood?

The festive period is an annual crunch time for blood stocks "as cold weather, seasonal illnesses and busier diaries lead to more unfilled and missed appointments, while demand from hospitals can rise", according to the NHS Give Blood website. Last December, donations were 10% below the monthly average, with demand for the vital O-negative blood type – the universal type used to save lives in emergencies – exceeding collections.

It is not just a winter problem. This summer, the BBC reported that blood stocks had dropped to "unprecedentedly low" levels in England, following a "perfect storm" of no-show appointments as donors went on holiday, as well as increased demand following a cyber-attack which affected services in London. At the time, there was a 1.6-day supply of O-negative blood in England, well below the six-day target.

Which countries allow blood donors to be paid?

According to the World Health Organization (WHO) about 118.5 million blood donations were collected worldwide in 2023. Of these, 40% were drawn from high-income countries, home to just 16% of the world's population.

The US, Germany, Austria, Czech Republic and Hungary currently allow for a flat-fee payment for donating blood, and these five nations account for 80% of the global supply of plasma, the main component of blood, and a crucial ingredient in a range of medicines. In the US, the average payment per plasma donation is $80-$85 (£63-£67), said Matthew Hotchko of the Marketing Research Bureau, while blood and plasma donors in Austria receive an average of €30 (£25) per donation, with a maximum of 50 donations permitted per year.

Many other countries offer "non-monetary compensation like time off work or vouchers", said Politico.

Would paying donors boost donations in the UK?

Only around 7% of people in the UK donate blood on a regular basis, according to a YouGov poll from 2022, with most of these aged 45 or older. According to the survey, more than a third of Britons who do not currently donate blood said they would do so if they were paid.

Young people, in particular, are more likely to state they would donate blood if they were paid, with the number of potential donors rising to 47% of non-donors aged 18-24, and 46% of those aged 25-49 if money were involved.

What are the drawbacks?

Despite evidence suggesting paying donors could help solve global blood plasma shortages, the WHO wants to move towards "100% voluntary, non-paid blood donation in every country, as blood-borne infections are lowest among voluntary, unpaid blood donors", said The Independent.

Concern over safety is, however, not "well founded", said The Economist. In places such as Britain, scandals involving infected blood "loom large in the public consciousness". Yet there is "little evidence that plasma that is paid for is more likely to transmit disease than plasma from unpaid sources", said the magazine, "and even if it was, plasma can be heavily processed to ensure it is safe".

Another worry is that the privatisation of blood services leads to the exploitation of donors. The US made $37 billion (£29 billion) from exports of blood products last year, more than from coal or gold, and with a "large and growing population of people on the economic ropes", the business of Americans' blood plasma has become a "hugely profitable one", said The Guardian.

In Hungary's case, paid donations have led to "some troubling unintended consequences", reported Balkan Insight. Although by law donors can be paid only 7,500 forints (£15) in cash, there is no regulation on additional incentives, such as shopping vouchers and entry into prize draws and lotteries. In left-behind regions, home to the "most vulnerable, racialised and financially disadvantaged segments of societies", a "wild west" of private donation centres has turned plasma donation into a "regular, if dangerous, form of income".

If all the women waiting for NHS gynaecological appointments in the UK were to stand in line, they would stretch from London to Exeter.

That's according to a report by the Royal College of Obstetricians and Gynaecologists (RCOG), which found that about 750,000 women across the four nations are waiting for NHS appointments – a number that has more than doubled since February 2020, according to the BBC. And the real number "could be considerably more"; these are just the women who have already been referred onwards by a GP.

Women are waiting for treatment for conditions from "fibroids and endometriosis to incontinence and menopause care", but also for urgent appointments for suspected cancer. "Women are being let down," said Dr Ranee Thakar, president of the RCOG. Change is "urgently needed".

Why is the waiting list so long?

"Gynaecology is the only elective specialty that solely treats women," said Thakar. The disproportionately long waiting list reflects the "persistent lack of priority given to women and women's health".

The reasons for that are "complex and multi-faceted", she told the i news site. But the problem predates the Covid-19 pandemic. The growth of gynaecological waiting lists has been "outstripping other specialties since April 2018".

Women's health has long been "under-treated and under-researched", said the news site. Although one in three UK women suffer from a gynaecological health problem, less than 2.5% of publicly funded research is dedicated to reproductive health.

"There is apparently five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which affects 90% of women."

This contributes to long diagnosis times and "poor treatment options", said Thakar, leaving women "struggling" with symptoms that impact their health and quality of life. Every month more patients are referred to gynaecology services than are seen, driving "a steady increase in waiting lists".

In fact, waiting times have tripled over the past decade, according to analysis by the Nuffield Trust and the Health Foundation. Between 2014 and 2024, the waiting list for gynaecological care rose by 223%: "faster than the overall NHS waiting list", said The Telegraph.

What is the impact?

One woman told The Times she suffered from "excruciating" non-stop pain and near-constant bleeding. She was diagnosed with endometriosis in 2020, and is still waiting for surgery.

More than three-quarters of women waiting for care reported worsening mental health, Thakar wrote in The Guardian. More than two-thirds said they were "unable to take part in daily activities", including work, socialising and caring responsibilities, due to severe pain or symptoms. Many experience exhaustion, dizziness, anaemia and infections because of "worsening conditions".

This "dire situation has repercussions for the whole NHS". A quarter of the women surveyed for the report had been to A&E, many needing "emergency interventions" – when they could have been treated as outpatients had they been seen earlier. This is "costing the country millions".

Women's absences from work due to health conditions like severe period pain and ovarian cysts cost the economy nearly £11 billion per year, according to a recent report by the NHS Confederation. Unemployment due to menopause symptoms also costs about £1.5 billion a year.

For every additional pound invested in gynaecology services per woman in England, there would be a return of about £11 for the economy, the report found. "That's an additional £319 million of gross value added across the whole economy," wrote Thakar, "just from prioritising women's health."

What can be done?

The NHS Confederation report recommended "allocating ringfenced funding" to women's health, to help close the "gender health gap at pace".

It also recommended additional funding throughout the country, improved education and training for doctors on women's health conditions, and an ambassador for women's health focused on improving outcomes for Black, Asian and minority women, which are significantly worse.

The RCOG is also calling on Labour to deliver "an urgent package of support for women" on the waiting list, said The Times.

"Too many women are facing unacceptable waits for gynaecology treatment," a Department of Health and Social Care spokesperson told the paper.

Labour is "overhauling women's healthcare". A 10-year plan backed by a £22.6 billion increase in day-to-day health spending will bring down waiting times, so women get "the support they need when they need it".

The King's Duchy of Lancaster estate makes £829,000 a year renting a warehouse to an NHS trust to keep ambulances.

That's just one of the findings from a joint investigation by The Sunday Times and Channel 4's "Dispatches" into how the monarchy's centuries-old property portfolios are used in lucrative contracts with public bodies and charities. The investigation also revealed how the royal duchies receive millions from the armed forces, schools, prisons and fire and ambulance services.

Adding to the royal family's woes, a separate investigation by The Mirror and "Dispatches" found "scores" of rental properties owned by Prince William as part of his Duchy of Cornwall estate are riddled with damp and mould and fail to meet the minimum legal energy efficiency standards for landlords.

What did the commentators say?

The royal family making millions of pounds a year in rent from the NHS and the armed forces is a "PR disaster" that could have serious consequences for the future of the monarchy, said Libby Purves in The Times.

The 185,000 acres that make up the Duchies of Lancaster and Cornwall have over time become "cash cows", raking in more than £50 million a year for King Charles and Prince William. That neither pay capital gains or corporation tax is already contentious, but the "real embarrassment" lies in the detail of their tenants – covering some of the most venerated public institutions in Britain.

For the modern monarchy, "perception is everything, and underpinning its popular support is the expectation that the royal family use their position for the public good", said Craig Prescott, a lecturer at Royal Holloway, University of London, also in The Times.

"Any suspicion that the monarchy is pursuing its public functions for private gain would be incendiary", something senior royals are "acutely aware" of.

While the Crown's vast land holdings are "no secret," said Zoë Grünewald on the i news site, "the scale of profit and hypocrisy is striking". The public outrage is "unsurprising" especially at a time of "widespread sacrifice for citizens" and when Labour is raising taxes on corporations and wealthy individuals.

There's nothing unusual about the royals' tax affairs, Ben Goldsmith, a British financier and environmentalist, told The Telegraph. "The Duchies of Cornwall and Lancaster are private assets which generate an income for members of the royal family, on which they pay full tax," he said. "The royal family owns stuff, like many families in this country. And?"

While there is no question of impropriety, it's "not a good look" for the monarch and heir to the throne, said The Express, "especially not making money from mining activities in Cornwall" given their much-touted green credentials.

What next?

The King is "under growing pressure" to refund the cash-strapped NHS, said the Daily Mail. But the revelations have "raised fresh questions" over the royal family's wider tax arrangements, said The Telegraph.

Their tax exemptions are, in fact, "outdated and indefensible" said Grünewald. It is time for Labour to "harness the public's frustration" and build on the momentum of its "redefining budget and the appetite for change" by ensuring the monarchy pays its share of corporation and capital gains taxes.

This would "benefit the Crown as well". By taking a lead in supporting national unity and public services, "the royals could redefine their role in modern Britain".

Keir Starmer has promised "the biggest reimagining of our NHS since its birth" after a new report concluded the health service is in a "critical condition".

In a speech following the publication of independent peer Lord Darzi's report, which was commissioned by the government, the prime minister described the failings uncovered by the report as "unforgivable". But he insisted there would be no extra funding for the NHS without major reforms, saying that the NHS must "reform or die".

The nine-week long review found that A&E services are in an "awful state", with long waits likely to be causing an additional 14,000 more deaths a year. It also found stalling progress on cardiovascular diseases, high cancer mortality rates compared to other countries, and "crumbling" infrastructure, with mental health patients left in "Victoria-era cells infested with vermin" and "parts of the NHS operating in decrepit portacabins". 

The report also said that ministers must stop "throwing money" at hospitals, which have failed to increase productivity despite a major increase in staff numbers since 2019.

Starmer said that the government is "working at pace to build a 10-year plan", framed around three "big shifts" in the NHS, which will focus on improving technology, moving care from hospitals to communities, and illness prevention.

What did the commentators say?

Darzi's report makes "grim reading", said Politico. And as the country faces "an ageing population, a dejected workforce and poor productivity", the question of whether the NHS can improve in the coming years "will become a defining one for the Labour government".

The report has allowed Labour to "return to its favourite themes – trashing the Tories' record and promising to fix the foundations of public services", said the BBC's political correspondent Leila Nathoo. But Labour will need to set out exactly how its promise to "reimagine" the NHS will have markedly different consequences from the reforms of 2012, "which they claim were catastrophic for the health service". 

And while there is the promise of investment in technology and infrastructure, the prime minister has said the additional money will be "tethered to reforms", said Nathoo. "We'll have to wait for this autumn's Budget and the longer term Spending Review to find out how much money there is to back up these plans."

While the government has insisted that reform is needed before any more taxpayers' money is pumped into the NHS, there "seems to be a dearth of detail on what this 'reform' might look like", said Eliot Wilson in The Spectator. 

Health Secretary Wes Streeting has spoken "airily" of three "shifts" in the health service – from "hospital to community", from "analogue to digital", and from "treatment to prevention". But "how are these shifts to be achieved, and how much will they cost?".

"Perhaps the government has a cunning plan," said Wilson. "If Streeting can achieve dramatic improvements in care quality and outcomes through reform without enormous investment, he will be as much in demand as if he had achieved perpetual motion."

What next?

The prime minister has promised "big reform for the NHS", said the BBC's health correspondent Nick Triggle, but the exact details of those reforms won't be clear until the spring, when the new 10-year plan will be published.

Yet it seems inevitable that the Labour government's three "big shifts" will require "upfront investment – and it's not clear where that will come from". Yet with Starmer ruling out tax rises, despite the NHS "now accounting for more than 40p out of every £1 spent on day-to-day public services", many in the health service are "wondering how this will be paid for".

An inquiry examining what exactly happened at the Countess of Chester Hospital during the time convicted murderer Lucy Letby worked there will begin this week.

Former neonatal nurse Letby was convicted in 2023 of murdering seven babies and attempting to kill seven others at the hospital between 2015 and 2016. She has been sentenced to multiple whole life sentences for her crimes.

What is the scope of the Thirlwall Inquiry?

The Thirlwall Inquiry is an independent public inquiry that aims to "examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital". 

The inquiry will look into how Letby was able to carry out these crimes within the NHS hospital, as well as investigate how the NHS handled the case and its response to doctors who raised concerns. 

The inquiry, which will begin tomorrow at Liverpool Town Hall, will be chaired by Court of Appeal judge Lady Justice Thirlwall. Proceedings are expected to last four and a half months. Once the inquiry concludes, Lady Thirlwall will provide a final report with recommendations to the health secretary. 

Why was the Thirlwall Inquiry ordered?

Following Letby's conviction in August 2023, there was a public outcry and deep concern over how she was able to operate undetected. Steve Barclay, the then health secretary, ordered the inquiry, which he said would "seek to ensure the parents and families impacted get the answers they need". 

"Following on from the work already under way by NHS England, it will help us identify where and how patient safety standards failed to be met and ensure mothers and their partners rightly have faith in our healthcare system." 

What will the inquiry focus on?

While the inquiry has no power to determine criminal or civil liability, it will try to highlight where failings have occurred. The inquiry has said that its "key objectives" are to "seek answers for the victims' families and ensure lessons are learned". 

It will also "examine the wider circumstances, including the response and conduct of the NHS, its staff and its regulators", according to the inquiry's website.

The inquiry will be split into three areas, with Part A focused on exploring the "experiences of the Countess of Chester Hospital and other relevant NHS services, of all the parents of the babies named in the indictment". 

Part B will then look at the conduct of those working at the hospital, run by Countess of Chester Hospital NHS Foundation Trust, and how concerns raised by staff members about Letby were handled.

Part C will look at broader issues in the NHS, including management and governance structures, to assess if enough is being done to protect vulnerable patients like newborns while in hospital. 

Who will be involved in the inquiry?

The core participants giving evidence will include the families of Letby's victims, the Countess of Chester Hospital NHS Foundation Trust, several NHS bodies like NHS England, and key hospital staff who were in leadership roles while Letby worked at the Cheshire hospital. 

The inquiry, which was not initially given full statutory powers, was upgraded last year to have greater powers to compel witnesses to give evidence.

Why is the inquiry controversial?

Despite Letby's conviction, concerns have been raised by some medical experts and media outlets over the evidence presented at her trial. In August, two dozen scientists, medics and statisticians wrote to the health secretary, Wes Streeting, calling for the inquiry to be postponed, to "allow for further investigation and to hear wider professional concerns", said The Telegraph.

They were concerned the inquiry's terms of reference "may unintentionally deflect from multiple potential causes of neonatal deaths at the Countess of Chester Hospital and thus miss the opportunities to draw the correct wider lessons for the NHS". 

They said there were concerns over how the legal system could be "particularly vulnerable to errors when dealing with intricate scientific evidence, especially in cases involving statistical anomalies in healthcare settings, and the complex physiology of neonates".

In May 2024, The New Yorker magazine in the US published a controversial 13,000-word investigation that questioned the legitimacy of the Letby case. 

A solicitor representing the families of six Letby victims said online speculation about the safety of the nurse's conviction was "upsetting" for all of her clients. Speaking to BBC "Breakfast" this morning, Tamlin Bolton said: "I can't stress enough how upsetting that has been for all of the families that I represent."

The government has been accused of prioritising unions over pensioners after it announced a £100 million pay deal with train drivers.

Pensioners are "being deprived of the winter fuel allowance, taxpayers are facing tax hikes and passengers are facing higher fares", Helen Whately, the shadow transport secretary, told The Times – "all as a result of this government's choice to put the unions first".

Transport

The government believes that the pay deal with train drivers' union Aslef – worth about £9,000 to the average member – is "ultimately better value" for taxpayers than allowing strikes that have cost the railways £850 million in lost revenue to "drag on", said The Times.

Drivers at London North Eastern Railway (LNER) still intend to carry out a series of strikes in September, October and November, but this is a "separate" action relating to a "breakdown in industrial relations" with the operator, said the BBC.

The government deal could have a "knock-on effect" with other rail unions, which have made clear they expect to be offered the same terms given to train drivers, said The Times. Negotiations will resume this week with the RMT union, which represents workers such as guards, station staff and signallers.

Elsewhere, 650 passport control staff will strike at Heathrow airport from 31 August to 3 September, raising the prospect of "misery" for travellers flying over the last weekend of the summer holidays, said The Telegraph. Border Force employees are said to be "unhappy with changes to rosters and shift patterns".

Doctors and nurses

Last month, the new government announced a deal with junior doctors for a 22% pay rise to end industrial action, following negotiations between the health secretary, Wes Streeting, and BMA leaders. But the Daily Express claimed that "rotating and newly qualified" junior doctors plan to launch more pay strikes next April.

Senior doctors in England ended their pay dispute with the government this April, when consultants belonging to two major trade unions backed a deal that saw some receive a pay increase of nearly 20% for the financial year 2023-24.

Meanwhile, thousands of nurses in the RCN union have until September to vote on whether to accept the government's proposed 5.5% pay award. It would be a "mistake" to accept it, said Socialist Worker, because such a "marginal gain will do nothing to improve the recruitment crisis, short staffing and overwork that nurses endure now".

Teachers

Teaching unions said that more school strikes in England are "now unlikely" after they welcomed the government's offer of a 5.5% pay rise from September. The offer, which is being funded by an additional £1.2 billion from the government, is a "welcome step in the right direction", the National Education Union told the BBC.

The calmer rhetoric came after Britain's biggest teaching union had earlier warned Keir Starmer that strikes are almost "inevitable" unless the government agreed to pay rises.

Local government

"Two of the three unions representing local government workers have rejected this year's pay offer and are considering strike action," said the Local Government Chronicle.

After ministers promised other public sector workers pay rises, the Local Government Association told the LGC that it will "continue to make the case" for additional funding to enable higher pay for local government staff.

A ballot on further strike action will open on 4 September and close on 16 October.

Rubbish collection 

Unions have suspended planned strike action by waste workers in Scotland after a new pay offer from council leaders. The proposed deal would usher in a 3.6% increase for all grades of staff, with a rise of £1,292 for the lowest paid, equivalent to 5.63%.

Edinburgh breathed a sigh of relief at the news as the city "faced a repeat" of strikes seen during the Edinburgh Festival in 2022, said The Guardian. Then there were "mounds of uncollected bin bags, overflowing recycling bins and unsightly food-covered pavements".

But bin workers in Birmingham could go on strike if the council goes ahead with plans to cut their roles and pay by thousands of pounds a year, said Birmingham Live. The restructuring plans would "downgrade" the role of the city's 150 waste recycling and collection officers, cutting their pay by an average of £8,000 per year.

NHS staff treating a woman with ME didn't understand the condition, a doctor has told an inquest into her death.

Dr Lucy Shenton, the GP who treated Maeve Boothby-O’Neill, has joined calls for better funding of research into people suffering from myalgic encephalomyelitis, or ME, which is also referred to as chronic fatigue syndrome.

What happened to O'Neill?

Boothby-O’Neill had suffered with the condition for a decade before she died at home in October 2021. She was 27. The inquest at Exeter coroner's court is examining whether different clinical decisions could have saved her life.

Dr Shenton, who took over Boothby-O'Neill's care in April 2021, said that many of the health professionals involved in caring for O'Neill were not doctors and their "lack of understanding" of severe ME may have been "relevant".

Just days before O'Neill died, Shenton wrote an email about the nurses that said: "This is so far out of their comfort zone." She added that one consultant even "expressed doubt" that ME was a physical illness.

Why does the NHS struggle with ME?

ME affects about 250,000 people in the UK but it is "poorly understood", said The Times, with "no diagnostic test or treatment". Symptoms of the condition include extreme tiredness, problems sleeping and difficulty concentrating.

"It is not known what causes ME/CFS," said The Independent, but a new study in the US earlier this year "indicates that rather than physical exhaustion or a lack of motivation, fatigue may arise from a mismatch between what someone thinks they can achieve and what their bodies perform".

O'Neill's "harrowing" case "highlights clashing NHS narratives" on ME, said Alastair Miller, a consultant physician, in The Observer. "Having been involved in the diagnosis and management of this condition since the mid 1980s," he said, "I know of no other disease that provokes such controversy – pitting clinicians, researchers and patients against one another rather than in support."

There is "no consistent laboratory test or imaging (scan)", or biomarker, that will "definitively establish or exclude" a diagnosis of ME, Miller said, and "despite years of well-funded research, we do not yet have the unifying biomedical explanation of the symptoms that patients so desperately want". But doctors and researchers are "trying to do their best", he added.

How can ME care improve?

A woman is campaigning for better care for people with ME after her husband's life was "decimated" by the disease, she told The Times. Karen Hargrave said that her husband, James Herring, 37, a former marathon-running civil servant, struggles to speak, can't eat solid food, is on the highest level of disability benefits, and can only get out of bed once a day in a wheelchair to go to the bathroom.

A report for the campaign she has launched (#ThereForME) highlights how "failings" in NHS care are "the norm", said The Times. A survey of 328 patients found that not a single one with very severe ME felt the NHS "had been there for them". There are "no treatments" for ME, and no "specialist" inpatient NHS services.

"If ME had been taken seriously decades ago," said Hargrave, "there probably would be treatments by now."

A Department of Health and Social Care spokesperson said the government "will ensure that patients receive the care they deserve" and is "committed to improving the care and support for people with myalgic encephalomyelitis and chronic fatigue syndrome".

The coroner's findings on O'Neill's care will be delivered on Friday, and campaigners hope it will mark a "turning point" in the way ME patients are treated, said The Times.

The news that Rachel Reeves will cancel Winter Fuel Payments might have made headlines early this week but the announcement that she will be "finally killing off the beleaguered cap on social care costs" is the "bigger story", said Isabel Hardman in The Spectator. 

Addressing the Commons on Monday, Reeves announced the anticipated social care reforms would be scrapped, citing lack of funding by the previous Conservative government. She criticised the "costly commitments" and delays to the reforms made by the last government, stating that scrapping the reforms would save £1bn by next year, helping her drive to plug a £22bn "black hole" in government finances.

Labour plans 'worryingly distant-sounding'

"Outrageous!" shouted opposition MPs, but most parliamentarians "probably weren't surprised". The £86,000 care cost cap, first suggested in 2011 by Andrew Dilnot's Commission on Funding of Care and Support, had been repeatedly delayed by the Conservative government, who also "got rid of the National Insurance rise which was meant to fund" the cap, said the BBC. The plans would have introduced an £86,000 cap on the amount an elderly or disabled person would have to pay towards their support at home or in care homes from October 2025.

Although Wes Streeting promised a cap during the election campaign, the Labour manifesto committed only to "build consensus for the longer-term reform needed to create a sustainable National Care Service", a prospect which is "worryingly distant-sounding", said Hardman.

"The only surprise, really, is that Labour bothered to pretend it would revive it," said Hardman. "History is repeating itself," one care provider told The Independent's Andrew Grice. Dilnot told the BBC the decision is a "tragedy", adding: "We've failed another generation of families."

While the National Care Service "might take 10 years to achieve" Streeting "genuinely wants to forge a cross-party consensus", said Grice, and is expected to set up a commission. "Consensus is the right route," he added. "It would stop a repeat of the Tories branding Labour's plans a 'death tax' (at the 2010 election) and Labour attacking Theresa May's 'dementia tax' (2017)."

'Outdated, unfair' and 'crying out for reform'

With around a million people in England receiving services that support them in care homes as well in their own homes, "many who rely on the care system want to know why the major political parties aren't talking about it more", said the BBC's home affairs editor Alison Holt. The current system is "outdated, unfair and crying out for reform – and on that there is broad political agreement". 

Both major parties avoided "detailed plans" on social care during the election, likely due to "nerves" over past campaign failures, with Labour's 2010 universal care plan and the Conservatives' 2017 proposal.

But to "get from where we are now to a place where public and political debate is fruitful, we need to start with a clear vision of what can be achieved and to build public support around a positive narrative of investment and strength", said Natasha Curry, writing for the Nuffield Trust. 

"Instead of reducing social care to a 'life and limb' service for older 'vulnerable' people, there is an opportunity for politicians to frame it as the essential service that will support us all to live well whatever our circumstances", said Curry. But "embedding this positive framing in the mainstream political debate" is a task that will require "bold political leadership".

Keir Starmer's Cabinet ministers outlined their policy priorities this week, following Labour's landslide victory in the general election. 

The immediate focus appeared to be on economic growth, housebuilding and improving the NHS. In her first speech as Chancellor, Rachel Reeves promised to "get Britain building" by reinstating housebuilding targets for councils and reviewing green belt boundaries. However, she warned of "difficult choices" ahead as she ordered the Treasury to draw up an analysis of the state of the public finances. Separately, the Health Secretary, Wes Streeting, declared the NHS to be "broken" after 14 years of Tory rule, but said that he'd held "positive" talks with unions about a deal to end the junior doctors' strikes.

'Stability and expertise'

In his first days as PM, Starmer appointed a Cabinet that included record numbers of female and of state-educated ministers. He visited Scotland, Wales and Northern Ireland – vowing to "reset" relations with the devolved administrations – and hosted 12 regional mayors at No. 10. On Tuesday, he flew to the Nato summit in Washington. He reiterated his promise to raise defence spending to 2.5% of GDP, but did not say by when. In a call with Israeli PM Benjamin Netanyahu, he'd earlier stressed the "urgent need" for a ceasefire in Gaza.

Starmer promised change, said The Observer – and his initial decisions as PM suggest that he was serious. By giving most of his former shadow ministers their equivalent Cabinet posts, he has prioritised "expertise and stability" over "favours for allies". And he has made some "inspired" appointments from outside Parliament: James Timpson, the businessman known for employing ex-prisoners at his keycutting firm, was made Prisons Minister; Sir Patrick Vallance, the former chief scientific adviser, is the new Science Minister.

'Remarkable accomplishment'

 Britain has its first Labour PM in 14 years, and with a huge majority to boot. That's a "remarkable accomplishment" for Starmer, said The Times – and testament to the diligence with which he set about transforming his party after its defeat in 2019. But this was a "loveless landslide", said the Daily Mail. Labour won 63% of seats, on 34% of the vote – the lowest for an incoming PM since 1832. Yes, Labour won plenty of seats; but it didn't win voters' "hearts and minds".

The new Government faces formidable challenges, said The Daily Telegraph: Britain is mired in debt, the NHS is in "crisis", and growth has been sluggish for years. Starmer says that "actions not words" are needed to solve those problems and restore trust in politics; but his promise of "change" may soon "crash into a wall of economic reality".

The NHS can now offer patients with a rare blood disorder a "transformative" new treatment after the UK's medicines watchdog gave its funding the green light.

Around 200 people with haemophilia B will be eligible for the gene therapy, which helps their body produce blood-clotting factors and "frees" them from regular treatments, said Bloomberg.

What is haemophilia B? 

This genetic disorder is much rarer than haemophilia A, said Great Ormond Street Hospital (GOSH). Around 2,000 people in the UK have the condition. 

Due to a mutation in their DNA, patients with haemophilia B either can't produce enough of factor IX – a specific protein that makes blood clot – or lack it entirely. "Without this crucial clotting component, bleeds are bigger and longer," said the BBC. 

Treating haemophilia B requires constant care and monitoring. As a preventative course of treatment, people with the blood disorder receive weekly injections of factor IX to enable their blood to coagulate, said GOSH. On-demand injections are also administered if a patient injures themselves or undergoes surgery.  

How does this gene therapy work? 

The drug, Hemgenix, has been found to have long-term benefits for those with the condition. Clinical trials began in 2019, with 54 male patients from the US, EU and UK taking part. Then the gene therapy was "still just an experimental idea", said the BBC.

The therapy is administered as a "one-off infusion, lasting about an hour". Patients receive "engineered viruses" with "copies of the fully functional factor IX instructions". The viruses then "act like a fleet of microscopic postmen, delivering those blueprints to the liver". The organ is then able to follow the instructions to produce the clotting protein. 

What impact will the treatment have? 

NHS England's national medical director Professor Stephen Powis described the therapy as "transformative". Its impact, he said, could be "truly life-changing". 

Five years after being part of the clinical trial, Elliott Collins, 34, told the BBC: "I feel cured." Before, "I would have to think about it all the time". Now, "for it to completely disappear", it's changed me "mentally and physically". 

The therapy may not prove as effective for all patients, however. Of the 54 men who took part in the clinical trial, two continued to need factor IX injections. "And nobody knows how long it will last." Some research has suggested it could be more than 10 years. 

The therapy is also "not considered a true 'cure'", said the BBC, as it won't stop people with the disorder from passing it on genetically.

What's the price tag? 

The gene therapy comes at a hefty cost: £2.6 million, making it "one of the world's most expensive" treatments. "England's thrifty drug-cost regulator" (the National Institute for Health and Care Excellence, or Nice) has endorsed the investment for "a limited period" while the drug's efficacy "remains under scrutiny", said Bloomberg. 

The financial "deal" between the manufacturer CSL Behring, NHS England and Nice is "bound up in confidentiality agreements", said the BBC, but it is "essentially a performance-related pay for drugs", the "first such deal" that the health service has struck. 

Now that its funding has been approved, the therapy will be made available at centres in London, Manchester, Leeds, Bristol, Cambridge, Birmingham and Oxford.

Britain's most prolific child killer in modern history goes on trial today accused of attempting to murder a baby girl.

Former neonatal nurse Lucy Letby was convicted last August of murdering seven babies and attempting to murder six others at the Countess of Chester Hospital between June 2015 and June 2016. The 34-year-old was sentenced to 14 whole life terms in prison.

Last month Letby lost an appeal against her convictions after three senior judges rejected claims that she was wrongly refused legal applications during her trial.

What are the charges against her?

The jury in the original 10-month trial at Manchester Crown Court was unable to reach a verdict on six counts of attempted murder in relation to five children.

After one of the longest trials in British legal history, today the same court will hear how Letby tried to murder a baby girl, known as Child K, in February 2016.

Letby, who denies all the charges, was cleared of two counts of attempted murder in August 2023.

Following the trial, Chief Crown Prosecutor, Jonathan Storer, said the decisions to seek retrials on the remaining counts of attempted murder were "extremely complex and difficult" and had been agreed only after consultation with "the families affected, police and prosecution counsel".

The retrial is expected to last for up to four weeks.

What are the reporting restrictions?

In September last year, the Crown Prosecution Service said in a statement that "there should be no reporting, commentary or sharing of information online which could in any way prejudice these proceedings".

The court order "prohibits reporting of the identities of the surviving and dead children who were the subject of the allegations", said The Independent.

For this reason, neither the appeal judges' decision nor full details of the appeal hearings, which took place over three days in April, were made public.

The aim of reporting restrictions is to prevent the publication of material that might prejudice trial proceedings and members of the jury. Journalists found guilty of contempt of court can face imprisonment.

British-based news publications and social media users can report only on the outcome of the original trial, the determination that Letby was not guilty on two counts of attempted murder and the jury's failure to return a verdict on a further six charges of attempted murder, one of which is the subject of the retrial.

International media are not bound by such restrictions, however. This has led to the possibility of a "showdown" between UK courts and publisher Condé Nast, said the Press Gazette, after a New Yorker story revisiting the Letby conviction was blocked on its website for UK users but made available in print and on mobile app editions.

ITV News said the 13,000-word article "questioned the evidence used in the trial which convicted Letby".

Conservative MP David Davis – a long-time free speech advocate – criticised the web block on the story. "It seems to me in defiance of open justice," said Davis, who called on the government to review the orders restricting publication.

The British state "knowingly exposed" about 30,000 people to disease via contaminated blood in what is widely regarded as the worst treatment disaster in NHS history.

Yesterday the Infected Blood Inquiry (set up in 2018) published a 2,000-page report accusing the government of "hiding the truth" over the scandal for decades. The victims had been failed "not once but repeatedly" by doctors, the NHS, the civil service and the government, the report concluded. Sir Brian Langstaff, who chaired the inquiry, said the scale of the scandal was "horrifying".

Between 1970 and 1991, about 30,000 patients were given blood infected with diseases like hepatitis and HIV. About 3,000 people have died, and thousands more are living with potentially lethal diseases. Prime Minister Rishi Sunak told the House of Commons yesterday that he was "truly sorry" for the "decades-long moral failure at the heart of our national life". He called it "a day of shame for the British state", and promised to pay "whatever it costs" in compensation. 

What did the commentators say?

"This is not some bland historical study," said Politico's "London Playbook" newsletter. "Those infected didn't just die. They endured years of stigma at a time when an Aids diagnosis inspired terror and smears. Their relatives fought for decades for justice."

The government has already made interim payouts of £100,000 each to about 4,000 survivors and bereaved partners. Today it has set out a £10 billion compensation package for victims and their families. Children were left without parents, while tens of thousands – perhaps hundreds of thousands – were infected with hepatitis (symptoms can take years to manifest). Money remains "the only currency in which recognition of fault can be paid", said The Independent, but ultimately any financial compensation will be "far too little, far too late".

The tragedy is also only one aspect of a wider scandal, said The Telegraph. The government's response to the "unfolding calamity" was not to halt the treatments, but to engage in a "large-scale cover-up". The inquiry found that there had been elements of "downright deception", including destroying documents. 

Former health secretary Ken Clarke was also "heavily criticised" by the report, said Sky News. In 1983, he said there was "no conclusive proof" that Aids was being transmitted in blood products, although the report found that there was such evidence by 1982.

In 1985, Clarke described infections as "unavoidable adverse effects" from medical procedures. This was "indefensible", the report concluded. It gave "false reassurance" and, by "not telling the whole truth", it did not "spell out the real risk". Victims are calling for Clarke to be stripped of the peerage he was awarded in 2020 by Boris Johnson. 

Overall, the report "highlights a culture of defensiveness" at the heart of the British state, said The Times, "a familiar theme" of scandals from the Hillsborough disaster to the two recent NHS maternity care catastrophes. 

The former health secretary and now Greater Manchester mayor Andy Burnham is calling for a "Hillsborough law" to impose a legal "duty of candour on public servants" to avoid future cover-ups. He said such a law would break the cycle that has led to "Whitehall cover-ups" such as the Post Office scandal and the Grenfell tragedy.

John Glen, the Cabinet Office minister dealing with the scandal, has also refused to rule out criminal proceedings for those involved. It is "welcome" that prosecutions may follow, said The Telegraph's assistant editor Sherelle Jacobs. "But it is likely that too many will go unpunished."

Delayed justice has become "a grim ritual", while a succession of public inquiries has revealed that the state's secrecy is "so prolific, so compulsive, so endemic that it threatens to effectively render Britain a failed democratic state".

Taken in isolation, national outrages like the infected blood disaster and the Post Office scandal "elicit an impotent shiver of revulsion" from a disillusioned nation, said Jacobs. "Taken together, they are dynamite."

What next?

There will be "some satisfaction" for survivors that organisations and individuals were criticised, said Sky News's science and technology editor Tom Clarke.

But they must "wait for another day" for prosecutions because the Inquiries Act prohibits public inquiries from finding criminal or civil liability. If prosecutions are to come, it will be through the courts.

And the NHS's "institutional defensiveness", which the report criticised, is still "all too evident", said The Telegraph. The ongoing "persecution of NHS whistleblowers" shows how "institutional malpractice can be allowed to fester".

The years-long inquiry also shows that there is still "no quick mechanism" for addressing institutional failures. "The next such scandal may already be unfolding; will we once again be too slow to avoid it?"

For many people, the arrival of spring heralds hefty doses of antihistamines, nasal sprays and eye drops to relieve hay fever symptoms.

Allergic reactions to pollen typically include a runny nose, itchy eyes and persistent sneezing, but for some, the symptoms can be debilitating and life-altering, and common remedies may have little effect. 

Hope is at hand, however, in the form of immunotherapy. The most acute hay fever sufferers are sometimes referred for the treatment, and now new research "highlighting its effectiveness" may lead to immunotherapy becoming "more widely available on the NHS", said the Daily Mail.

What is immunotherapy?

In essence, immunotherapy aims to "induce a shift in the immune response" of a patient, said Samuel J. White and Philippe B. Wilson from Nottingham Trent University on The Conversation. So instead of producing histamines that cause the classic symptoms of hay fever, the body produces "antibodies that can neutralise the allergen" and prevent an allergic reaction from occurring.

The process of immunotherapy trains the body to "avoid its overreaction" to a specific allergen, said Healthnews, and instead build a "tolerance" to it.

That usually begins with a three- to six-month "build-up phase", during which small doses of the allergen are administered to induce T-regulatory cells, which prevent the release of histamines. Doses are then gradually increased until the target dose is reached, at which point the "maintenance phase" begins, lasting for three to five years or longer.

Immunotherapy can be administered in two ways: under the skin via an injection (subcutaneous), or via the newer method of under the tongue using liquid drops or tablets (sublingual).

How effective is it?

Both types of immunotherapy treatment have demonstrated effectiveness in research. Subcutaneous has been used for much longer and so has a greater history of evidence showing it works. While it is considered safe, uncommon side effects include allergic reactions and a rash around the injection site.

The oral method has be shown to be "marginally less effective" than injections, said White and Wilson, but is considered "slightly safer".

The treatment usually begins a few months before the pollen season starts. Research has shown that treatment over three to five years can have longer-lasting benefits and is "effective in reducing symptoms and use of medications such as antihistamines". Sublingual treatment has been shown to be "particularly effective for hay fever caused by grass or tree pollens".

How do people access the treatment?

Despite the evidence of the effectiveness of immunotherapy in treating hay fever, it is currently "not available to the majority of people" with the condition in Britain, said The Sun.

Only 2,839 people in the UK out of the estimated 13 million hay fever sufferers are receiving three years of immunotherapy treatment, according to research by the British Society for Allergy & Clinical Immunology. The use of immunotherapy in the UK "severely lags behind the US and Europe", consultant paediatrician Dr Tom Dawson told the Daily Mail, despite the UK being "at the forefront of allergy research".

Most people need to demonstrate severe hay fever symptoms that can't be relieved with standard treatments before a GP may refer them for immunotherapy.

The treatment costs around £2,000 a year per patient, but supporters argue that in the long term, immunotherapy could save the NHS money, by resulting in fewer people succumbing to more severe conditions such as seasonal asthma.

Despite evidence of its efficacy, not all patients will experience a complete relief of symptoms through immunotherapy, and it "may not be a suitable option for everyone", said White and Wilson. It also requires a long-term commitment to regular treatment and can often take "several months or even years to see the full benefits". For many people, though, immunotherapy could prove a "valuable tool" in easing their hay fever symptoms.

Lucy Letby is back in court this week seeking permission to appeal against her conviction for the murder of seven babies and attempted murder of six others.

The former neonatal nurse was found guilty of committing the offences at the Countess of Chester Hospital between June 2015 and June 2016. She was first arrested in 2018 and convicted last year after one of the longest trials in British legal history.

Dubbed the UK's "most prolific baby killer", Letby was sentenced to 14 whole life terms, meaning she is ineligible for parole, although The Sun reported in January that the Surrey prison in which she is being housed is "really no different to living in a hotel".

What is the basis of her appeal?

Letby, represented by Ben Myers KC, first applied for leave to appeal against her convictions shortly after her original 10-month trial ended in August 2023, but was refused permission by a single judge.

Letby is now asking three senior judges at a further hearing at the Court of Appeal in London this week. Her legal team will say there are four grounds of appeal and that the judge at her original trial wrongly refused applications made during the case.

It has been reported that she appeared via video link on Monday from Bronzefield prison in Surrey, but information related to the appeal hearing at this stage is limited. This is because Letby is due to face a retrial in June on one count of attempted murder and so the media is not permitted to publish details "to avoid the risk of prejudicing jurors", said The Guardian.

What will happen next?

The appeal court hearing is due to sit again on Tuesday and Thursday this week. If the three judges decline to give permission "it will mark the end of the appeal process for Letby", said Sky News.

The 34-year-old former nurse faces a retrial on one count of attempted murder of a baby girl, known as Child K, at Manchester Crown Court from 10 June. The jury in Letby's trial in Manchester last year were unable to reach verdicts on six counts of attempted murder in relation to five children. ITV News reported that a court order "prohibits reporting of the identities of the surviving and dead children who were the subject of the allegations".

Letby was struck off the Nursing and Midwifery Council (NMC) register in a fitness to practice hearing in December, the Nursing Times reported. At the NMC hearing, Letby "maintained her innocence and indicated she sought an appeal".

Now detectives are probing Letby's "entire career", said The Sun, including her placement at Liverpool Women's Hospital. "More families have been told that their babies could have been killed by the evil nurse," said the paper.

Following an outcry about how Letby was able to carry on undetected for so long, a public inquiry into events at the Countess of Chester Hospital is also under way. Led by Lady Justice Thirlwall, herself a Court of Appeals judge, the inquiry's first hearings are expected to begin in the autumn.

As with inquiries into previous healthcare killers like Harold Shipman, the Letby case could lead to "big changes in the way NHS staff are vetted and scrutinised", said The Spectator's Isabel Hardman.

Clinicians should use "extreme caution" when prescribing gender medical treatment to children, a new report has said.

The Cass review, led by consultant paediatrician Dr Hilary Cass, was commissioned in 2020 to assess international research into puberty blockers and to review gender services provided to children by the NHS. The key finding is that children have been let down by a "lack of research and evidence on medical interventions in a debate that has become exceptionally toxic", said The Guardian.

Warning that gender medicine is "built on shaky foundations", Cass said young people questioning their gender should be given a "holistic assessment", including a mental-health assessment and screening for neurodevelopment conditions such as autism, instead of being routinely prescribed puberty blockers.

The newly published 388-page report made 32 recommendations overall. Interim findings published in February 2022 have already led to the closure of the "inadequate" Gender Identity and Development Service (Gids). And the NHS has altered its policies so that puberty blockers and cross-sex hormones can "only be given to gender-distressed children as part of clinical trials", said the BBC.

What did the commentators say?

Cass initially expected her review to be a "short, straightforward task", said Amelia Gentleman in The Guardian, but she found herself at the centre of a "vortex of a debate she describes as toxic, politicised and ideological". Cass's report is written in a "calmly clinical tone", but here "anger" over the level of treatment for children with gender identity issues is "barely disguised".

 Cass was aware her recommendations would be "hugely controversial", wrote Gentleman, and that some children awaiting treatment would be "dismayed by her conclusions", but insists that she has "young people's best interests at heart".

She clearly believes that while for a "minority of young people medical transition will be the right option", there is "no solid evidence basis justifying the use of hormones for children and adolescents".

The report's recommendations have not been universally welcomed. Its conclusions represented “an agenda from up on high that things need to be more difficult”, a mother of a 17-year-old trans girl told The Guardian. The report has already led to the closure of Gids at the Tavistock and Portman NHS Foundation Trust, leaving her child's care "up in the air".

Indeed, there are significant questions about how successfully the recommended level of care will be implemented. Regional care hubs, which opened this month, were described by sources as "nowhere near ready", said The Pink News. The director of the independent gender service, Gender Plus, Dr Aiden Kelly, told the site that he had "no doubt" that "much of what's been written in these reports won't be able to be fully implemented".

Others welcomed the implication of the report that treatment would begin to take a more evidence-based approach and that young people "will not be given life-altering drugs and surgery without proof that it will leave them happier and healthier than before", said Allison Pearson in The Telegraph.

It is clear that it continues to be an extremely "complex area of health", wrote Paul Gallagher at the i news site, but there is "hope that those children can look forward to much better care".

What next?

In response to the Cass review, NHS England said it would conduct a "systemic review of adult gender services" and lay out further plans for its services when children turn 18. 

The report also suggested that people using gender services should be asked to be part of research that will allow for greater, long-term understanding of patients' outcomes and evidence of treatment.

Prime Minister Rishi Sunak also suggested that an evidence-based approach to treatment was needed because "we simply do not know the long-term effects of these things". Shadow Health Secretary Wes Streeting said the report should be a "watershed moment" that leads to an "evidence-led framework" that is "free from culture wars".

Satisfaction with the NHS has fallen to the lowest level in 40 years, with the once sacred cow of British life now facing widespread criticism.

The newly published results of the latest British Social Attitudes survey reveal that only 24% of 3,374 respondents in England, Scotland and Wales were satisfied with the health service in 2023.

"Satisfaction with every service – from A&E to dentistry – is at or near historic lows," said Thea Stein and Sarah Woolnough, chief executives of the Nuffield Trust and the King's Fund think tanks, which conduct the annual poll. "These are shocking figures for a service that is seen as a crowning jewel in the British state, for which immense sacrifices were made during the Covid-19 pandemic, and which attracts such significant political and media interest." 

What did the commentators say?

The previous lowest level of satisfaction was 34% in 1997, just before Labour swept to a landslide election victory with a campaign that promised to "save the NHS", said The Times.

Dan Wellings, senior fellow at the King’s Fund, said that with another general election now looming, "political leaders should take note of just how far satisfaction with this celebrated public institution has fallen". And the NHS is "the number one issue that people are flagging for the election".

Dennis Reed, director of Silver Voices, an over-60s campaign group, told The Telegraph that the "sad state of affairs" it made him "want to cry". The NHS "has plunged from being the pride of Britain to an organisation that people moan about nearly as much as the weather", he said.

Strikes by junior doctors and consultants, "many already on enviable pay-and-pension deals, have exacerbated the problems facing patients", said the Daily Mail in a leader article. In addition, "too much money and time is wasted on bloated bureaucracy, creaking IT systems and wokery". 

"A serious debate is needed on how the health service is funded beyond general taxation, and whether more private provision and competition can be introduced," said the paper. NHS patients are "surely less concerned about how they get their treatment, as long as it is timely, of a high standard – and free." 

Last week Labour's shadow health secretary Wes Streeting told the Financial Times that he wanted to end the NHS's reliance on the private health sector – albeit by using its capacity in the short term to reduce NHS waiting times. Evidence for New Labour's "ideological conviction" that competition in public services drives up standards was "patchy", he said, and the aim should be to return to a time when "the NHS was so good that people didn't feel the need to go private".

What next?

Despite "understandable" dissatisfaction with long waiting times, the survey findings also show that the public "fully support NHS staff who they feel are doing a good job under extremely difficult circumstances", said Sky News' health correspondent Ashish Joshi. The public remains "fiercely loyal"  to the institution and its founding principles: that it is free at the point of use "for all from cradle to grave". 

And the majority are willing to pay more tax to preserve it, the survey found. Almost half (48%) of respondents said that ministers should increase taxes and spend more on the health service.

The results suggest that "changing the model of the NHS is not something the public wants – they just want the model they have got to work", said the British Social Attitudes survey. 

Michael Sheen is "in his element" as the architect of the NHS, Aneurin Bevan, in Tim Price's "rousing" new play "Nye", said Dominic Cavendish in The Telegraph.

Sheen is "by turns down to earth and messianic, tender and full of clenched tenacity". And there is "no faulting the rest of the company either", Cavendish added.

Younger audience members "may know next to nothing about" Bevan, known as Nye, "the honourable member for Ebbw Vale, the left-wing orator who oversaw the creation of the National Health Service", said Clive Davis in The Times.

This production will "hopefully change that", said Rhiannon Lucy Cosslett in The Guardian. In 1948, when the NHS was founded, "almost everyone in Britain knew his name", and his death in 1960 "led to an outpouring of national mourning".

Like the former Labour MP and health minister, Sheen is "something of a Welsh folk hero, and his embodiment of the role astonishing", said Cosslett. Yes, the play "verges towards the sentimental at times", but it gets away with its slightly saccharine note "because it's also inventive, surreal and at times very funny".

There's some "skating over historical detail" as we follow him "from cradle to grave in a morphine-induced fever-dream amid Bevan's hospitalisation with terminal stomach cancer in 1960", said Cavendish. At one point, he sings a rendition of "Get Happy" in his pyjamas, with medical staff dancing around him.

Having an "ageing famous figure reliving his life in convenient vignettes" like this is a little "tired" as a format, said Alice Saville in The Independent, but director Rufus Norris "keeps things nimble and strange".

There are "poignant biographical insights". Initially, Sheen is "touchingly delighted to be treated by the public health system he helped dream into existence", but is soon "lost in post-operative hallucinations: the sadistic schoolteacher who beat him for his stammer, the black lung-afflicted miner father who – ironically – he couldn't or wouldn't help".

We also learn how Bevan's wife, Labour MP Jennie Lee, "sidelined her own ambitions to support her husband's career", said Cosslett in The Guardian. With the NHS currently crumbling, "the timeliness of the play, and some of its lines about Tory interests and ideology, were not lost on the audience".

National Theatre, London SE1 (020-3989 5455) until 11 May. Wales Millennium Centre, Cardiff, 18 May to 1 June. Screened live in cinemas via NT Live on 23 April. 

Families of children harmed by a drug that caused up to 20,000 babies to be born with disabilities have welcomed calls for compensation after their plight was compared to the thalidomide scandal.

The Patient Safety Commissioner has said in a new report that "thousands of women, children, and families have been harmed" by the epilepsy drug sodium valproate and "there is a compelling case for the government to award them redress".

'Bigger than thalidomide'

Sodium valproate is a medication used to treat epilepsy. It is also sometimes used to treat bipolar disorder and migraines. Although research papers from as early as the 1980s suggested valproate medicines were dangerous to developing babies, it was given to women with epilepsy for decades without proper warnings.

It has caused autism, learning difficulties and physical disabilities in an estimated 20,000 babies in Britain over the past five decades. The statistics are clear: among women who take valproate during pregnancy, around 10 in every 100 babies are born with birth defects, compared to two to three out of 100 of the general population.

The range of disabilities in babies born to those who took the drug include spina bifida, facial and skull malformations including cleft lip and palate, as well as distortions of the limbs, heart, kidneys, urinary tract and sexual organs.

The Patient Safety Commissioner for England, Dr Henrietta Hughes, who was asked by the government to look into a potential compensation scheme for those affected, has called on ministers to act quickly to help victims.

Speaking to the BBC, she said she believed the sodium valproate scandal was "bigger than thalidomide". She was referring to the severe birth defects caused by a morning sickness drug, which was licensed in the 1950s in the UK and was only withdrawn after William McBride (pictured above), an Australian doctor, alerted the world to its dangers. Thousands of mothers had given birth to disabled babies.

Dr Hughes said she had "heard so many heartbreaking stories" and many of those born with disabilities – known as foetal valproate syndrome – had been unable to work or look after themselves as adults, meaning their parents had to give up work to care for them.

Emma Murphy, whose children suffer from cerebral palsy, autism, deafness, hypermobility and sensory processing disorder, told The Guardian that she's "been told so many times – by midwives, by doctors, by consultants – over so many years that it was safe to keep taking".

"We know it's not our fault," said Murphy. "We know it's the government that chose not to warn women of the risks." But "the guilt remains with every single mother this has happened to".

Karen Buck, whose 25-year-old daughter, Bridget Coyle, is severely brain damaged, bed bound and has disabilities in her organs and spine, told The Times she is "always on call" for her.

Buck received little help until she fell down the stairs while carrying her daughter six years ago. But the part-time carers she now has are not trained to do everything Bridget needs, so Buck still cannot work. At night, Buck is the sole carer and can herself have several epileptic seizures a week.

Families like these are "subjected to degrading questions again and again" to prove they "really need state help", said the paper.

'Callous disregard'

Dr Hughes has suggested initial payments of £100,000 for victims. A failure to help victims of the scandal would show "a callous disregard for the pain and the suffering" of those harmed, she said. So a redress scheme is "a question of justice" for families who had "been fighting for years or even decades".

A UK government spokesperson told ITV News that "our sympathies remain with those affected", adding that "the government is carefully considering the Patient Safety Commissioner's recommendations and will respond to the report fully, in due course".

Meanwhile, the full scale of suffering might still not be known. Although the number of those badly affected by sodium valproate has been put at 20,000, some campaigners believe the figure could be significantly higher. Janet Williams, co-founder of In-Fact (the Independent Fetal Anti Convulsant Trust), said she doesn't think we are "ever going to find out and pinpoint an actual number of children that's been harmed by this".

Hospitals in England will give families the right to an urgent second opinion on the condition of seriously ill patients under the new "Martha's Rule".

The rule will be adopted in 100 hospitals from April, with plans for a national roll-out, and allows a patient's family to access a review by other "doctors and nurses not involved in the medical team treating them", said The Guardian.

How did Martha's Rule come about?

The initiative is named after Martha Mills, the 13-year-old who died from sepsis after "catastrophic failings" by doctors at a south London hospital in 2021, said The Times. Doctors at King's College Hospital had failed to move her to "intensive care quickly enough to get treatment that would save her life".

Martha's parents, Merope Mills and Paul Laity, had concerns over Martha's "rapidly deteriorating" condition – which began after a holiday cycling accident injured her pancreas – but they were "brushed aside" by doctors. 

Mills wrote in The Guardian that clinicians had tried to placate her anxiety over Martha's condition and that she and her husband were "not told the full truth" about what doctors knew. Medical staff had established that Martha had contracted sepsis but they did not tell the couple, saying she had an "infection". 

"It's easy to feel cowed," Mills wrote, "but hold your ground". No matter how "indebted you feel to the NHS", it is right to "challenge decisions if you have good reason to".

A coroner ruled that Martha would "most likely have survived" if doctors had heeded warning signs and moved her to intensive care earlier, said The Telegraph. After years of campaigning, her parents said that the implementation of Martha's Rule meant their daughter had not died "completely in vain".

What will it change?

The key change that Martha's Rule will establish is that doctors and nurses will be "obliged to accept any request for a second opinion". They will also be told to note the observations of those closest to the patient, who spend the most time with them, and to "formally record daily insights and information", as well as "take account of changes in behaviour or condition".

The initiative will entitle patients' families to a "rapid review" from a critical-care team if the condition is worsening.

Amanda Pritchard, chief executive of the NHS, said the rule will "hopefully only be needed in a small number of cases", but had the "potential to save many lives in the future". It will also be advertised on leaflets and posters in hospitals to ensure awareness.

How will it be rolled out?

The implementation costs of a 24/7 escalation service will initially be funded by £10 million of government funding for the first 100 hospitals, which account for around "two-thirds" of those in England, said the BBC. After evaluation, further funding may be unlocked to expand the scheme across all hospitals with seriously ill patients.

Health Secretary Victoria Atkins told the BBC that while the initiative was something the government believes in "very strongly", it would be rolled out "step by step" to ensure that the "service is as we'd all expect it to be".

A successful first year could see Martha's Rule adapted for "community hospitals and mental-health trusts", the broadcaster reported.

What are the concerns?

There is a "background fear" from doctors that the rule could see them "overrun" with patients calling for a second opinion "all the time", Mills told The Guardian's "Today in Focus" podcast. But patients and families should not be "afraid to challenge decisions" by doctors, she said, adding that it is "not a way of casting blame" over patient care.

Evidence from similar schemes around the world, including in Australia, showed that doctors did not get "inundated with requests from patients or relatives for an urgent review", said the paper.

ITV's new Covid drama "Breathtaking" is "breathtakingly good". 

That was Carol Midgley's assessment in The Times. She said "it's the best I have seen" from the lead actor, Joanne Froggatt, because "her performance as the consultant Abbey Henderson was more powerful for being restrained".

This is a "tour de force, exposing political complacency and reminding us how, despite all the clapping, NHS staff, many of whom died in the line of duty, are still taken for granted".

'Unparalleled attention to detail'

"Rarely does television feel so visceral," said Rachael Sigee on the i news site. "The attention to detail is unparalleled," she added, "from the scuffs on the walls to the red imprints of mask outlines on faces", and "that authenticity carries into the performances".

Sigee added a "big caveat", though. "It might be essential viewing but it is equally essential to do so with care. It may make you want to scream, but it's more likely you will watch in stunned silence."

As a polemic it is "powerful", said Anita Singh in The Daily Telegraph. But it does at points become "so caught up in the fierceness of its message that it forgets the basics of hooking an audience".

Lucy Mangan, in The Guardian, had a similar take. "By the end, despite great performances from the whole cast, Breathtaking feels more like a cathartic rush for the writers, rather than something that deepens our understanding of what doctors and patients – and to some extent what we all – went through."

'Sad and authentic'

Ultimately, though, it is a "deeply sad and often triggering drama", said Sean O'Grady in The Independent. It is also a "highly authentic" one, based as it is on the book by Dr Rachel Clarke, who worked in hospitals during the pandemic.

"Without lapsing into heavy-handed propagandising, the drama has the voice of Boris Johnson in 'Mayor in Jaws' mode floating above the traumatic scenes, with the juxtaposition between lazy spin about 'sending the coronavirus packing', and the "frantic reality of people basically drowning, adding to the tragedy."

The contaminated blood scandal is widely regarded as the worst treatment disaster in the history of the NHS. From the 1970s until 1991, up to 30,000 people in the UK were given blood infected with HIV and hepatitis. 

At least 4,689 of those affected suffered from haemophilia, a rare genetic disorder in which the blood fails to clot, meaning that small injuries can result in dangerous blood loss. These patients were given contaminated blood-clotting agents. More than 3,000 people have died as a result, and thousands are still living with potentially lethal diseases. 

In terms of human life, it was a disaster much more costly than Grenfell or Hillsborough. Furthermore, the victims of this appalling scandal, and their relatives, have had to wait decades for justice. In 2018, a full public inquiry was launched. After many delays, its report is finally due to be published on 20 May.

How did the scandal come about?

Most people who suffer from haemophilia lack a protein, factor VIII, that enables their blood to clot. Until the 1940s, when transfusions of blood plasma were first administered, there were no effective treatments. But in the 1960s, Dr Judith Graham Pool, a US scientist, made an important discovery: plasma could be broken down to produce a concentrate of clotting factors. In time, factor VIII concentrate could be administered at home, by injection, to haemophiliacs. This changed their lives and was soon in high demand: by 1973, doctors were warning that the UK wasn't producing enough of it to meet patients' needs. That same year, Britain started importing factor VIII from the US – a step that was fraught with risk, and had terrible consequences.

Why was it risky?

Unlike in Britain, where blood was donated voluntarily, donors in the US were paid. Pool had warned as early as 1974 that this was a "dangerous" and "unethical" practice: prisoners, sex workers, drug addicts and alcoholics did it to make easy money, despite their high risk of carrying blood-borne diseases. Batches of blood were mixed; one could include blood from up to 40,000 donors; one disease-bearing donor could infect the whole batch.

In one Louisiana prison, the journalist Cara McGoogan was told, "people who had turned yellow" from hepatitis carried on donating, bribing the inmates who worked in the plasma centre with cigarettes. In 1975, a World in Action documentary revealed that the NHS was buying blood harvested from drug users and "vagabonds" causing a surge in hepatitis cases among haemophiliacs.

When were the first infections?

There was an outbreak of hepatitis B in British haemophiliacs in the 1970s, soon after US blood products were first used. In December 1983, a British haemophiliac tested positive for HIV as a result of blood products, dying 18 months later of Aids-related illnesses. By April 1984, a memo showed that the Department of Health "conclusively" knew that HIV was in blood products. The WHO and The Lancet had already sounded warnings to the same effect.

The true scale of the UK disaster, however, only became clear in 1985, when Dr Peter Jones, director of the Newcastle Haemophilia Reference Centre, tested 99 of his patients. All but one had received commercial factor VIII; 76 tested positive for HIV. By 1986, UK patients were receiving much safer treatment: donors were vetted, and blood products were heat-treated. (Today, synthetic clotting factors are available.)

Why did it take so long to act?

This is what the inquiry was set up to analyse. There were some legitimate reasons for the failures. Many doctors were aware of the risk of infections, but felt that the great benefits of factor VIII outweighed them. And it was not established that HIV was blood-borne until the first deaths of haemophiliacs in 1982. Nevertheless, a long series of warnings was ignored.

In 1975, the then Labour health minister, David Owen, promised Britain would become self-sufficient in blood products to reduce infections. It never happened. It seems that a combination of governmental indifference, professional malpractice and commercial greed was responsible: factor VIII was very profitable for companies such Baxter International and Bayer. Many doctors did not inform their patients of the risks.

How did the inquiry come about?

Victims and their families have campaigned tirelessly for justice over a 40-year period, but with limited success: some have received annual support payments, but no organisation or individual in Britain (unlike in other affected countries) has been held to account, and, until recently, no substantial formal compensation had been agreed. In Scotland, the Penrose Inquiry, which reported in 2015, made only one recommendation after seven years of work, and was widely dismissed as a "whitewash". In 2017, Theresa May finally bowed to intense pressure from campaigners to announce a full inquiry into the scandal.

What will it achieve?

It has already laid bare the scale of the scandal. At least 1,250 people in the UK contracted HIV from contaminated blood; about half of them died from Aids-related illnesses. About 30,000 more contracted hepatitis C; 2,050 of these died of liver failure or cancer. Perhaps most significantly, the inquiry has heard testimony from the victims and their relatives. Colin and Janet Smith told how they lost their son, Colin, at the age of seven in 1990, after he was treated with HIV-infected blood; the words "Aids-dead" were painted on their home.

They believe their son was knowingly used as a guinea pig by the haematologist Professor Arthur Bloom. In 2022, the inquiry's chair, Brian Langstaff, also took the unusual step of calling for interim compensation of £100,000. The total compensation bill is expected to exceed £20bn.