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19th December 2023
Professor Robert Morgan has been at the forefront of interventional radiology for more than 30 years. He caught up with Helen Gilbert to reflect on key moments that have shaped his career as an interventional radiologist, his future plans and his hopes for the profession.
It has been 30 years since Professor Robert Morgan chose to pursue a career in interventional radiology (IR) and the clinical director of St George’s Hospital’s internationally renowned IR department certainly has no plans to slow down yet.
Over the past few months, the vascular specialist has co-authored and published a high-profile report into radiology services, been appointed president of the British Society of Interventional Radiology (BSIR) and awarded the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Gold Medal for his ‘outstanding contribution’ to the practice and science of IR worldwide.
Not to mention the day job where he and his 25-strong team perform a myriad of minimally invasive vascular and non-vascular imaging procedures from angioplasty and stenting to embolisation.
This is just a tiny glimpse into the professional life of the Swansea-born consultant whose desire to study medicine was partly ignited by his mother, who worked as a midwifery sister, as well as with the family GP.
However, the IR flame only sparked when Professor Morgan began working as a junior doctor after graduating from medical school in 1983.
‘I enjoyed going to radiology departments and seeing how interventional radiologists worked,’ he explains.
‘I was very impressed with the atmosphere and thought that this looks like a cool thing to do.’
Back then IR – sometimes referred to as image guided surgery – was in its infancy, yet Professor Morgan was captivated by it.
He completed his radiology training in Plymouth and St George’s Hospitals, obtaining his Membership of the Royal Colleges of Physicians (MRCP) and Fellowship of the Royal College of Radiologists diplomas in 1988 and 1991 respectively, before penning his first peer-reviewed radiology paper ‘Pancreatic and renal mobility’ in 1992.
There followed a stint at the University of Texas in 1993, where the vascular disease specialist learned his skills in IR, before returning to the UK as a lecturer in IR at Guy’s and St Thomas’ Hospitals.
He joined St Mary’s Imperial NHS Trust in 1996 as a renal and interventional radiology consultant before returning to St George’s in 1999 as a consultant in interventional radiology and the rest – as they say – is history.
To date, Professor Morgan has authored 201 peer-reviewed papers, written 47 book chapters, edited five books and delivered more than 330 guest lectures on topics such as the treatment of endoleaks and the management of multiple pathological conditions by embolisation.
In 2010, he played an instrumental role in creating the European Board of Interventional Radiology exam, which evaluates interventional radiologists on their clinical and technical knowledge worldwide.
‘I was asked to set the examination up by the president of CIRSE at the time,’ he explains. ‘Since 2010, the exam has matured and expanded to be open to interventional radiologists anywhere in the world. It can be taken digitally and in more than one language.’
During his time as CIRSE president between 2017 and 2019, Professor Morgan was also instrumental in establishing the European Conference on Embolotherapy – an annual congress that brings together interventional radiologists from across the globe to discuss the most recent data on embolotherapy and review the latest devices and materials.
Professor Morgan’s passion for research, analysing and sharing information to educate and inspire colleagues is evident at St George’s, too, where he leads an Imaging Research Group, something he admits that he is ‘very proud of’.
‘This was set up a couple of years ago and involves all disciplines – radiologists, radiographers, nurses and physicists. We have meetings twice a year where people come and present their work and they seem to be very popular,’ he says.
‘Some topics presented at the recent meeting included trialing an abbreviated MRCP protocol for gallstones and quasi-diffusion MRI for the imaging of traumatic brain injuries.’
Professor Morgan is also imaging lead of the South West London Integrated Care System and is working to join up imaging services between the five trusts in the area: St George’s University Hospitals NHS Foundation Trust, Kingston Hospital NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, Croydon Health Services NHS Trust and the Royal Marsden nhs Trust.
The imaging network project began in 2020 and Professor Morgan estimates that they are halfway to the stage of maturation of an imaging network, which is expected to occur by March 2025.
The aim of this network is to increase efficiency and to give patients quicker access to diagnostic facilities.
Some of the key features of an imaging network will be the ability to view each trust’s images without having to physically transfer them, and to share scanning and reporting workloads. ‘For example, if there is a backlog of reporting in one trust and people available to report in another trust, then you may be able to actually enlist people in the second trust to tackle the backlog in the first trust,’ Professor Morgan explains.
‘Similarly, if there is a scanning capacity issue at one or more trusts, this can be shared with the other trusts who will be able to address some of the backlog by scanning patients from the trusts with the backlog.’
Another bonus, he says, is shared employment as ‘people may be able to move from one trust to another without having to get separate contracts.
This allows for ‘increased accuracy in demand and capacity modelling so that you can assess the demand of the whole sector and try and increase your capacity to meet that demand’, explains Professor Morgan. ‘There are all sorts of things that you can do better in theory as a group than you can as individual trusts.’
As with all specialties in the NHS, Professor Morgan admits that there is a nationwide shortage of interventional radiologists due to a range of factors.
‘We have increased demand in all hospitals, we do not have enough IRs to cope with the demand and people seem to be retiring earlier from the specialty than they did 10 years ago. I think that this has a lot to do with burnout and excess work due to excess demand so it is a little bit of a catch 22 situation.’
Indeed, some of these findings were highlighted in the ‘Provision of Interventional Radiology Services 2023’ report, which was co-authored by Professor Morgan and published in November 2023.
It showed that in 2022, 39 whole time equivalent consultants left the IR workforce, compared with 19 consultants in 2021. The mean age of departing consultants was also shown to have reduced over a five-year period from 55 years in 2018 to 44 years in 2022.
So, what is the solution?
‘There has been great progress made in the last few years by the Royal College of Radiologists (RCR) to make it easier for people to go into IR by having what we call run-through training,’ Professor Morgan explains.
This means that instead of going into radiology training in year one and then starting IR training at year four, run-through IR training can be entered from the start.
‘This is now in its third year, and it seems to be going well, although more needs to be done to highlight the availability of this, both to radiologists and heads of schools who are in charge of allocating posts, and also to potential applicants who may not know about the existence of this stream,’ he says.
Ultimately, increased promotion of this training route will be key to bolstering the IR workforce for the future.
Another factor that could support this is the reassessment of IR being a subspeciality of radiology under the RCR.
Indeed, the Provision of Interventional Radiology Services 2023 report found drawbacks with this current demarcation, stating: ‘A change of this model to an interventional radiology speciality or a separate IR faculty within the RCR would provide substantial benefits for interventional radiology, not least by establishing the autonomy to increase the IR workforce to meet the demands of patients.’
Professor Morgan wholeheartedly agrees with this statement, saying: ‘I think that a faculty for the IRs would be very beneficial for interventional radiology in the UK in general.’
And particularly, as he points out, IR as a speciality ‘does not really have control over its workforce or training numbers’ because of this existing design.
‘We do not know how many people we have doing IR. If we were a faculty or speciality, we would know because you would have to sign up to become an IR member of a faculty or speciality.’
It will be a case of watching this space as Professor Morgan supports this agenda going forwards.
As part of his new role as president of the BSIR – a two-year position he commenced in November 2023 – Professor Morgan will be responsible for representing interventional radiologists in the UK before other clinical bodies including the Royal College of Surgeons and the Vascular Society.
The possibilities are endless.
Professor Morgan’s dedication to the profession over the past three decades has not gone unnoticed.
In October, he received the highest honour an interventional radiologist can achieve in Europe when he was awarded the CIRSE Gold Medal.
The equivalent of a lifetime achievement award, this marked his outstanding contribution to the practice and science of IR worldwide, and he says ‘it is a great privilege to be awarded it’.
With that accolade under his belt, cementing the role of research and academia in college policy, and promoting research and academic careers for radiologists in the UK, will be a key focus of his going forwards.
And much of that is likely to be connected to the subject of artificial intelligence (AI).
Professor Morgan is encouraged by emerging technology such as AI, which although in its early stages, has already made ‘great steps’ with diagnostic radiology, he says.
Although Professor Morgan expects ‘similar progress’ to be made with AI in interventional radiology, he believes that robots could play a greater role.
The ‘full potential’ of robotics has yet to be explored ‘because the technology is quite expensive’, he says, but with new innovations constantly evolving, the possibilities are endless.
It is a whole new world from 1993 when Professor Morgan first dipped his toe into the world of interventional radiology, and many of the developments over the years have seen his valuable involvement or support.
As one of the most innovative and fastest-growing specialities in the field of medicine, there will be much more to come, and it will certainly be a promising and fascinating area to watch and be part of.
A new app designed to reduce isolation and mental burden among young cancer patients is to undergo a national rollout across Denmark in 2024 after a successful pilot.
The ‘Kræftværket‘ (The Cancer Forge) app provides teenagers and young adults in cancer treatment with a comprehensive suite of features including symptom tracking, access to health information and a supportive online community with whom to share treatment experiences.
The app aims to alleviate loneliness and enhance young people‘s mechanisms for coping with their disease and was developed in collaboration with young cancer patients and healthcare professionals.
It is the first digital health solution of its kind in Europe targeted at young cancer patients for national health system implementation.
Professor Helle Pappot, professor in clinical oncology at University of Copenhagen and clinical professor at Rigshospitalet, University Hospital of Copenhagen, Denmark, was instrumental in the app‘s development.
She said: ‘The app has proven to be a good tool for creating an overview of and mastering one‘s illness, that both the healthcare system and the patients can benefit from. Our research shows that young people find the app supportive and meaningful.
‘The solution has been a crucial tool in empowering patients to manage their disease, and through our clinical research we have been able to document the positive impact on a patient’s quality of life.‘
A pilot study led by the University of Copenhagen, which was published in the journal JMIR Mhealth Uhealth in 2019, investigated the feasibility of a smartphone app among adolescent and young adult patients with cancer in active treatment and post-treatment.
A total of 20 participants, 10 in active treatment and 10 in post-treatment, were recruited at Rigshospitalet and asked to use the Kræftværket app as they deemed appropriate over a six-week period.
The participants were asked to complete the 30-item European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire before and after the six-week period.
The post-treatment group experienced a significant increase in overall QoL after the six-week period (global QoL: baseline 62.5, SD 22.3; after six weeks 80.8, SD 9.7; P=.04).
For the group in active treatment, the QoL remained stable throughout the six weeks.
The researchers concluded that use of the smartphone app in this patient population was feasible and had a possible effect on QoL and therefore was ‘warranted for this population‘.
The app will be implemented across all five Danish regions in the new year, with the developers hoping that international expansion will be possible in future.
Andreas Dam, CEO of Daman – the digital health company behind the app‘s development – said: ‘Our work in co-creation with patients has been pivotal in creating a space that not only provides technological solutions but also emotional support for young cancer patients.‘
The UK’s devolved nations could detect greater numbers of lung cancer cases with improved screening programmes, new analyses by Cancer Research UK have found as the charity calls for governments to ’urgently implement’ such programmes.
Lung cancer is the leading cause of cancer death in England, Scotland, Wales and Northern Ireland and smokers and former smokers aged 55-74 are at greatest risk.
In November 2022, the National Screening Committee (NSC) recommended that everyone in this group be screened but, to date, only England has initiated a screening programme on this advice.
Almost 900,000 people were invited for checks during the pilot stages in England. Of the 200,000 scans carried out, more than 2,000 people were detected as having lung cancer, and 76% of those were identified at an earlier stage (stage 1 or 2) compared to 29% identified outside of the pilot programme in 2019.
Cancer Research UK’s latest analyses suggests that equivalent lung cancer screening programmes in the devolved nations could diagnose around 4,000 more lung cancer patients in Scotland at an early stage over the next decade, as well as 2,400 more people in Wales and 1,400 in Northern Ireland.
If just 50% of eligible people took part in screening, earlier lung cancer diagnosis could save 2,300 lives in Scotland, 1,000 lives in Wales and 600 lives in Northern Ireland over the next 10 years, Cancer Research UK said.
Professor David Weller, professor of general practice at the University of Edinburgh, believes a nationwide screening programme ’has the potential to be a game changer when it comes to reducing the burden of lung cancer in Scotland’.
He said: ’For too long, lung cancer has been perceived as a disease you can’t do anything about, but we know that diagnosis at an early stage really can make a difference.
’Major trials of targeted lung cancer screening show significant reductions in mortality from lung cancer. Pilot studies in the UK and internationally consistently show people being diagnosed with lung cancer at an earlier stage.’
In Scotland, a pilot project called LUNGSCOT – of which Professor Weller is the principal investigator – is exploring the challenges for local lung cancer screening. It is running in Lothian with funding released for Grampian, Greater Glasgow and Clyde, and the Highlands and Islands.
A pilot is also running in Cwm Taf Morgannwg in Wales, where charities including Cancer Research UK are running a public petition in the hopes of raising the issue in the Senedd.
In Northern Ireland, there are no plans or pilots to report due to the lack of a Northern Irish Executive following the 2022 elections. That said, authors of the Northern Ireland Cancer Strategy 2022-2032 have said they intend to implement all NSC recommendations.
Debbie King, Cancer Research UK’s senior external affairs manager in the devolved nations, said: ’Lung screening matters because it means more people can be diagnosed at an earlier stage, when treatment is more likely to be successful.
’A fully-funded national targeted lung cancer screening programme in Northern Ireland, Scotland and Wales is a real chance to reduce the toll of this disease.
’There have been big improvements in how we diagnose and treat other forms of cancer, but long-term lung cancer survival in the UK isn’t much higher than it was 50 years ago. This is unacceptable when evidence shows that earlier diagnosis through targeted lung cancer screening can potentially help thousands of people live longer healthier lives.’
These latest analyses were published shortly after Cancer Research UK released its manifesto for reducing cancer deaths by 20,000 a year by 2040.
While overall cancer deaths have halved over the last 50 years, progress is at risk of stalling in the UK, the charity said.
As part of the manifesto, Cancer Research UK has called on the next UK Government to address variation in treatment across different geographical areas, which includes optimising cancer screening programmes and accelerating the roll-out of the lung cancer screening programme in England.
On the manifesto, former national cancer director at the Department of Health and chair of the National Screening Committee, Professor Sir Mike Richards, said: ’Cancer outcomes in the UK are lagging behind comparable countries like Denmark. We need consistent funding and long-term strategies to make the UK the best in the world for cancer survival.’
Healthcare professionals prescribing aripiprazole for schizophrenia and bipolar disorder should be alert to the known risk of patients developing addictive gambling, according to a new drug safety update.
This reminder about aripiprazole from the Medicines and Healthcare products Regulatory Agency (MHRA) comes after a rise in the number of reports of gambling or gambling disorder it received in 2023.
Between 1 January and 31 August 2023, the MHRA’s Yellow Card scheme received 32 reports of gambling or gambling disorder where aripiprazole was suspected to be the cause.
In the last 14 years, there have been 69 reports, making the 2023 figures over 46% of the total.
The MHRA asked gambling clinics in March 2023 to report any suspected cases, which may account for some of the rise, it said.
The UK reports of this suspected addictive behaviour occurred in patients both with and without a history of problem gambling and most reported that the urges resolved on reducing the dose or stopping treatment with the drug.
The MHRA is advising patients to tell their doctor if they or their family and friends notice they are having unusual urges or cravings that they cannot resist, including behaviours such as addictive gambling, excessive eating or spending, or an abnormally high sex drive.
And it warned that patients should continue taking aripiprazole as advised, as stopping the drug without medical advice can be harmful.
Alison Cave, MHRA chief safety officer, said: ‘The number of reports for suspected gambling and other impulsive behaviours associated with aripiprazole are small in comparison to the frequency with which it is prescribed, but the consequences for any patient developing these conditions can be significant.
She also highlighted that ‘aripiprazole is an effective and acceptably safe drug for many people.’
Professor Henrietta Bowden-Jones, director of the National Problem Gambling Clinic, added: ‘Clinicians prescribing aripiprazole must commit to consistently alert patients about these potential risks, both during the initial prescription and follow-up reviews.’
This includes asking patients if they have a personal history of excessive gambling or any other impulsive behaviours before prescribing aripiprazole.
18th December 2023
Etrasimod (brand name Velsipity) has received a positive opinion from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) for use in eligible patients with ulcerative colitis (UC), its manufacturer Pfizer has announced.
The oral, one-daily selective sphingosine-1-phosphate (S1P) receptor modulator selectively activates S1P receptor subtypes 1, 4 and 5, with no detectable activity on S1P.
It has been given the green light in the EU for the treatment of patients aged 16 years and older with moderately to severely active ulcerative colitis who have had an inadequate response, lost response, or were intolerant to either conventional therapy, or a biological agent.
If etrasimod were to subsequently be approved by the European Commission, it would represent the first global approval of an oral advanced ulcerative colitis therapy for use in older adolescents.
Velsipity is currently approved in the US, to treat adults with moderately to severely active ulcerative colitis.
Michael Corbo, chief development officer, inflammation and immunology, Pfizer Global Product Development, said: ‘Ulcerative colitis is a chronic condition that affects over 2.6 million people in Europe, and can have a debilitating effect on patients’ lives. If approved, Velsipity could offer patients with moderately to severely active ulcerative colitis the opportunity to achieve steroid-free remission.
‘This positive recommendation is a significant step forward in Pfizer’s efforts to bring this convenient once-daily oral treatment to appropriate patients in the EU affected by ulcerative colitis who require an advanced treatment option with a favourable benefit-risk profile.’
The CHMP positive opinion was based on results from the phase 3 ELEVATE UC 52 and ELEVATE UC 12 trials.
They evaluated the safety and efficacy of etrasimod 2 mg once daily on clinical remission in ulcerative colitis patients who had previously failed or were intolerant to at least one conventional, biologic or Janus kinase inhibitor therapy.
The coprimary endpoints in ELEVATE UC 52 were the proportion of patients who achieved clinical remission at week 12 (induction period) and week 52 (maintenance period).
The researchers found a significantly greater proportion of patients in the etrasimod group achieved clinical remission compared with patients in the placebo group at completion of the 12-week induction period (74 [27%] of 274 patients vs 10 [7%] of 135 patients) and at week 52 (88 [32%] of 274 patients vs 9 [7%] of 135 patients).
The primary endpoint for ELEVATE UC 12 was the proportion of patients in clinical remission at the end of the 12-week induction period.
Some 55 (25%) of 222 patients in the etrasimod group had clinical remission compared with 17 (15%) of 112 patients in the placebo group at the end of the 12-week induction period.
Both studies also achieved all key secondary efficacy endpoints, with a favourable safety profile consistent with previous studies of etrasimod.
The most common adverse reactions were lymphopenia (11%) and headache (7%).
The drug also demonstrated improvement in the total inflammatory bowel disease questionnaire score, which measures health-related quality of life.
Patients given transitional care before and during discharge from hospital are less likely to be readmitted, according to new research from the University of Manchester.
The systematic review and network meta-analysis was published in the journal JAMA Network Open considered data from 126 trials with 97,408 participants.
It showed that interventions were associated with significant reductions in readmissions at 180 days post-discharge.
While the types of changes implemented differed across the studies, common changes included improved discharge planning, medication review, case management, multi-agency team meetings, psychological support, home visits and peer support.
Low complexity interventions comprised of one to three changes to usual care applied together and were associated with a 55% reduction in readmissions at 180 days post-discharge.
The medium complexity interventions, with four to seven changes to usual care, were associated with a 42% reduction during the same time period.
Even at 30 days, the low complexity interventions were associated with a 22% decrease in the odds of readmission and the medium complexity interventions were associated with a 18% decrease.
For high complexity interventions, which included eight or more changes to usual practice applied together, were associated with a 24% reduction in readmissions at 180 days post-discharge.
Principle investigator Maria Panagioti, senior lecturer from The University of Manchester, said: ‘This study shows that more changes to usual practice are not always better to reduce health care needs and prevent emergency department visits for patients transitioning from hospital to the community.
‘We need to think about what changes to the usual care are truly meaningful for patients, whether professionals can implement those changes and how those changes can work together as a coherent bundle of care.
‘We strongly recommend that the NHS develops of a set of patient and staff-reported outcomes to better capture the full range of benefits and impacts of transitional care interventions especially those of high complexity.’
Natasha Tyler, research fellow from the University of Manchester and lead author of the study, added: ‘This study shows that transitional care arrangements are a powerful way to avoid readmission to hospital because patients feel more involved in decisions and supported during a particularly vulnerable stage in the care pathway.
‘It is well known that an increased demand for urgent hospital care has created pressure to discharge patients to the community. We know some of those patients are discharged too early or without necessary support to recover in the community.
‘There is also evidence that one in five patients may experience suboptimal or unsafe care around the time of discharge from hospital mainly because of the prompt reduction in continuity of care and co-ordination challenges of multiple independent professionals and agencies.
‘This is why it is important to understand the value of intermediate care and how best that is delivered.’
Cardiovascular diseases are one of the main driving factors in an ongoing increased level of excess deaths seen since the pandemic, particularly in middle-aged adults, an analysis of UK data has concluded.
Figures from the Office for Health Improvement and Disparities (OHID) showed that between June 2022 and June 2023, excess deaths for 50-to-64-year-olds were 15% higher than normal.
For this age group, deaths involving cardiovascular diseases such as heart disease and stroke were 33% higher than expected, the commentary in The Lancet Regional Health journal said.
A more detailed look showed deaths involving ischaemic heart diseases were 44% higher than expected, cerebrovascular diseases 40% higher and heart failure 39% higher.
Acute respiratory infections were also related to significant excess deaths in the 50-64 age group with a 43% excess as well as diabetes which showed 35% excess.
Across all ages, deaths in a private home were 22% higher than expected and deaths from cardiovascular causes in private homes were 27% higher than expected, the authors said.
Overall, excess deaths were 11% higher than expected for 25-49-year-olds and under 25s, and only 9% higher for over 65s, the team from the Department of Health and Social Care, the Office for National Statistics and Continuous Mortality Investigation found.
Excess deaths in the data are likely to relate to direct and indirect impacts of the pandemic, including worsening pressures on NHS urgent care services, the direct effects of Covid-19 infection, and disruption to chronic disease prevention, detection and management, the commentary said.
The detailed breakdown by age and cause built on previous reports from the Office for National Statistics, which found over 7% more excess deaths in 2022 compared with the five-year average.
This more granular data can help inform cardiovascular disease prevention and management efforts, the authors said.
The ongoing impact on younger age groups contrasts with the excess deaths seen in older adults in the acute phase of the pandemic, they noted.
Earlier this year, the British Heart Foundation (BHF) also published an analysis showing almost 100,000 more people had died in England with cardiovascular disease than would be expected in the three years since the pandemic began.
Dr Jonathan Pearson-Stuttard, head of LCP health analytics who collaborated on the commentary, said: ‘Our commentary provides a data-driven review of the analyses with more detailed insights than previously available to assess the drivers of persisting excess deaths since the Covid-19 pandemic.
‘From summer 2022-23, excess deaths were most prominent in relative terms in middle-aged and younger adults, with deaths from heart disease and deaths in private homes being most affected.
‘Granular insights such as these provide opportunities to mitigate what seems to be a continued and unequal impact on mortality, and likely corresponding impacts on morbidity, across the population.’
Dr Sonya Babu-Narayan, associate medical director at the BHF and a consultant cardiologist, said: ‘These figures raise obvious concerns. Amongst a range of issues likely driving a persistent excess of deaths from cardiovascular disease includes the consistently extreme pressure on the NHS.
‘Long waits for heart care are dangerous – they put someone at increased risk of avoidable hospital admission, disability due to heart failure and premature death. Yet people are struggling to get potentially lifesaving heart treatment when they need it due to a lack of NHS staff and sufficient, appropriately kitted out space, despite cardiovascular disease affecting record numbers of people.
‘As more and more heart patients wait longer and longer, it has never been more urgent for Government to deliver heart disease prevention and cut long waiting lists for people who need lifesaving heart and stroke care including through transformative, innovative care – and for the UK to power scientific breakthroughs to unlock revolutionary new tests and treatments.’
A version of this article was originally published by our sister publication Pulse.
A new app providing information on blood clots and how to reduce the risk of developing one has been developed by Oxford University Hospitals NHS Foundation Trust and Thrombosis UK for at-risk patients.
The ‘Let’s Talk Clots’ app will be advertised on discharge paperwork for patients hospitalised with thrombosis, deep vein thrombosis, pulmonary embolism and venous thromboembolism (VTE).
It shares medically-approved, key information about clots, including reducing risk, the signs and symptoms, diagnosis and UK approved treatments and therapies.
There are also details on recovery, including pain and breathlessness, managing anxiety and worry, regaining wellbeing, fitness and returning to everyday activities.
The app also aims to help prevent hospitalisations from blood clots by outlining considerations around risk factors such as pregnancy, family planning, travel and work and managing other conditions or treatments alongside risk factors or a personal medical history of thrombosis.
The app is also being promoted via postcards and posters around the trust‘s hospital sites in Oxford and Banbury, and the team hopes to include the app‘s details on patients‘ admission paperwork in future.
Sarah Havord, a VTE prevention nurse at Oxford University Hospitals and blood clot prevention specialist, said: ‘This resource is very much needed, providing free access to medically-approved information across the blood clot journey and, I believe, will help to save lives and restore lives affected by blood clots.
‘The app started simply as an idea of mine, and has been developed in collaboration with Thrombosis UK, allied healthcare professionals, individuals who have been diagnosed with a blood clot, and their family members. I have been overwhelmed by the amount of support and help provided.‘
The NHS estimates that one in 20 people will experience a VTE during their lives. It is also linked with hospitalisation, with an estimated 55-60% of VTE cases occurring during or after a hospital stay.
Covid-19 has particularly affected awareness of thrombosis, with a paper published in the journal Thrombosis Research reporting a 31% incidence of thrombotic complications in ICU patients with Covid-19.
The app is now available for download for both Apple and Android users.
15th December 2023
Senior doctors should get flexible or part-time working options and from the age of 60 should opt into on‐call only if they wish to, according to joint guidance from the Royal College of Physicians (RCP), the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow.
The new ‘Later Careers 2023’ guidance aims to support senior doctors aged 50 and over – some 47% of the physician workforce – to continue working sustainably and help to mitigate the current NHS workforce crisis.
Supporting the retention of senior doctors in this way ‘brings benefits to patients, the individual doctor, the hospital, and the wider medical community‘, the RCP said.
The document is an update of similar guidance from 2018 and is based on findings from a survey of doctors aged 50 and over conducted in 2022 by the three Royal Colleges.
The guidance also advises that the appraisal of senior doctors should be ‘sensitive and proportionate to their working arrangements‘, and that clinical leads ‘should begin discussions about doctors’ intentions for the next 10 years as early as felt necessary’, and certainly by the time a doctor turns 55.
Recommendations set out in the guidance include:
The survey underpinning the guidance found that one in three consultants who are not yet retired express they wish to retire early.
But over half of respondents (58%) said they would delay retirement and continue to work if they could reduce hours and/or work flexibly.
RCP censor and consultant gastroenterologist Dr Harriet Gordon said: ‘Senior doctors are incredibly valuable to the NHS and have much to contribute clinically, but also in teaching and mentoring the next generation of physicians.
‘Our survey showed that a large proportion of senior consultants have a strong interest in continuing working if it was possible to work more flexibly.
‘Considering the significant demands facing health services due to workforce shortages, this finding is encouraging. The guidance offers key recommendations that would support experienced hospital doctors to continue working sustainably in the NHS.‘
The Royal Colleges said they ‘will continue to promote this approach to governments and employers‘.
Earlier this year, data showed that one in five (19%) of consultant physicians are at risk of burnout, and an NHS consultant missing three days of work for mental health reasons is 58% more likely to leave three months later.
In June, NHS England published its own guidance for retaining doctors in late stage career within the NHS and supporting them to stay well.
After the publication of NHS England’s long-term workforce plan in July, Amanda Pritchard admitted that there were no ‘specific costs’ associated with retention elements of the plan.
The senior doctor workforce is a major concern for the NHS and last month the UK Government offered a 4.95% investment in pay for this financial year, on top of the 6% uplift, in order to avert further strike action.
But a 2023 survey showed that pay increases alone will only have ‘a modest impact’ on NHS staff retention because the main problems are stress and high workload.
One-off payments to reduce delayed hospital discharge ‘come with insufficient advance notice for effective planning’, forcing providers to resort to short-notice residential care rather than supporting patients at home, a new King’s Fund report has found.
The report, ’Hospital discharge funds: experiences of winter 2022-23’, looked in-depth at six health and care systems. The authors spoke to local authorities, integrated care system leads, acute trusts, Healthwatch and local care provider associations.
Commissioners and providers across each area ‘strongly criticised burdensome monitoring requirements’ and said funding was rarely available to prevent hospital admissions.
Areas did manage to use the funding to put services in place and support social care, but ‘were not confident they were spending funding as effectively as possible’.
The funding in question was provided in two tranches: the Adult Social Care Discharge Fund of £500m from the Department of Health and Social Care, and a further hospital discharge fund of £250m from NHS England. Each had different conditions, which were not known in advance, authors pointed out.
The report found that the six sites ‘did not all have a shared understanding of local causes of delayed discharges’ or ‘priorities for action’. Authors heard of more than 20 reasons for delayed discharge, although lack of staffing was a consistent theme.
The report also highlighted NHS England data which found that although many more patients were discharged home simply – seen in 85% of cases – compared with the predicted 50%. In addition, three times more patients needed 24-hour bed-based care on discharge (3%) compared with the predicted 1%.
Simon Bottery, a senior fellow at the King’s Fund and co-author on the report, said: ’Delayed hospital discharge is a widespread and longstanding problem that affects thousands of patients, their families and loved ones. The underlying reasons for delays are often complex and vary between local systems, though workforce issues are often at the root of them.’
He added: ’Our analysis makes clear that the Department of Health and Social Care should only use short-term, ring-fenced funding on an exceptional basis and should ensure sufficient notice to sites so that they can plan for it. It’s welcome that this has been largely done for 2023/24 and 2024/25.
’It’s also clear that places should invest effort in developing shared understanding of discharge performance, the causes of delays and the priorities for action to tackle them, as we found that these were often lacking between system partners.’
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