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25th November 2024
Professor Antonio Almeida has been at the forefront of clinical haematology for more than 20 years and last year he became president of the European Hematology Association (EHA). Speaking to Julie Penfold, he shares his plans for his second year as EHA president, key takeaways from June’s EHA Congress and his insights into the future of clinical haematology.
There’s never a dull moment when specialising in the field of haematology, with near-constant clinical developments emerging and an abundance of reasons to be optimistic for the future of patient care and outcomes.
‘Haematology is a very exciting specialty,’ explains Professor António Almeida, head of department at Hospital da Luz in Lisbon, founding dean of Portugal’s Catolica Medical School, and president of the European Hematalogy Association (EHA).
‘I think we are certainly a specialty in which scientific innovation hits the clinical ground very, very fast. And even now, when we know so much about genetic mutations, new treatments and targeted treatments, we’re always discovering new pathways for patients and promising treatment options.’
He adds: ‘Not only are we now targeting the genetic landscape but we’re also targeting all the immunological and all the microenvironments that surround the diseases. It really makes haematology a crest-of-the-wave type of specialty.’
One of Professor Almeida’s main aims when he took up the role of EHA president in 2023 was to foster greater recognition of haematologists throughout Europe. As such, the EHA has been working hard to promote the specialty within the European Union and with national authorities and societies.
‘Haematology is a very diverse subject, and we range from a huge variety of diseases from coagulation to benign to malignant, and from a huge range of activities from clinical to laboratory to research,’ Professor Almeida explains. ‘That’s why it’s really important with this diversity that people are recognised for their specialty.’
To reflect this diversity and demonstrate how the field is evolving, EHA shared a new vision statement at its 2024 congress, alongside the rollout of a new brand identity. The previous iteration of the vision statement, ‘Towards a cure for all blood diseases’, has been adapted and now reads: ‘Towards prevention, cure and quality of life for all patients with blood disorders’.
Professor Almeida explains that it was important for the vision statement to be updated as ‘many of our diseases are becoming chronic and not necessarily cured’. In addition, there was an agreement within the association for it to evolve to reflect ‘what our members would identify with’ in their day-to-day practice when supporting a variety of patients with differing needs and outcomes.
‘We really want to cater for the whole population including those who have chronic disease and the burden of chronic disease. We want to make sure that they really have their needs addressed and that we can look at preventing certain diseases too,’ Professor Almeida says.
‘For example, how can we improve screening, and how can we improve the quality of life of patients [who] are on chronic therapies and have side effects but want to continue living a normal life? How can we ensure their symptoms are mitigated? I think this is how the vision statement really translates into clinical practice. It’s fundamentally addressing the day-to-day needs that haematologists and patients have.’
Two other key aims for Professor Almeida’s presidency are to increase EHA members’ involvement in the association and for the EHA to become more active in promoting research. Both of these ambitions have progressed well, Professor Almeida says.
For example, at the EHA Congress in June 2024, more than 18,000 people attended – the biggest number yet for this annual event. ‘What we have seen with the greater participation of members at Congress is really the way forward that we’re working towards – that is to have members more involved and to be able to support them with new research grants and more educational offers, so they feel that the EHA is helping both their careers and practice in haematology,’ Professor Almeida says.
This is particularly important as Professor Almeida notes significant variations in funding for haematology research across Europe. ‘It’s very, very important that we recognise that most of the research grants and most of the research happens in the top five countries and the rest ends up not having much access,’ he explains. ‘Promoting research and facilitating access to research is a big flagship that we’re going to move forward with.’
As part of these efforts, over 3,000 abstracts were submitted for this year’s Congress, which was another record high, and this is something that Professor Almeida is particularly proud of. ‘This meant we had top quality work being presented and the haematology communities are now really looking at EHA Congress as one where they want to present their work,’ he explains. ‘We had presentations of trials that really are changing practice both in malignant oncology and also in benign oncology.’
For Professor Almeida, one of his personal highlights at the Congress was the scope of the presidential sessions. ‘Not only did we have oncology, coagulation and red cell diseases, but we also had a lot of innovation and translational science touching clinical, which was particularly exciting,’ he explains.
Another highlight was a talk on sickle cell disease, looking at how the landscape has changed with new emerging therapies such as anti-sickling agents and antibodies. He recalls: ‘It’s really changing the outlook for patients with sickle cell disease and helping us decide where we should be treating, who we should be treating, and who we should be aiming to change therapies in.’
A session on coagulation looked at how pregnant women can be treated with anticoagulants and what the evidence is, which Professor Almeida found both interesting and helpful. ‘In general haematology, we get lots of referrals about this area so it could make a difference for these patients,’ he says.
While the EHA Congress highlighted significant progress and innovations that have the potential to revolutionise the care of blood disorders, it also underlined the ongoing challenge of managing haematology patient needs as their conditions change and, at times, worsen.
‘How we deal with patients that have relapsed multiple times, and how we deal with patients with chronic disease is now really becoming a big challenge,’ says Professor Almeida. ‘The way that we’re tackling this is really by reducing side effects and by trying more and more to reduce toxicity. For example, stopping certain treatments, if that’s an option; looking at ways of reducing doses; and improving combinations so that patients experience [fewer] side effects from their treatments.’
In chronic myeloid leukaemia, for example, many treatments are available, and each have different side effect profiles. Professor Almeida says clinicians are increasingly tailoring these treatment choices to optimise patients’ care. ‘We can choose which treatment to use based on what the disease presents but also what the patient is most likely to have as a side effect profile and [we can] avoid this to minimise the toxicity,’ he says.
Targeting treatments to specific mutations in certain diseases is also becoming a reality. Professor Almeida says: ‘With this, we are moving more and more towards personalised medicine in which patients can be treated not only for their disease specificities, but also for their own specificities.’
This personalisation of care is only set to improve as the use of technology in haematology is anticipated to really take off. Professor Almeida believes this will include the escalation of using artificial intelligence within clinical trials and using registry and synthetic data to determine the best treatment aims for patients.
‘I think we will also see the advent of new therapies to look at and modulate the immune system to treat all sorts of blood disorders,’ Professor Almeida suggests. ‘We’ve seen this very effectively in CAR T-cells in lymphomas, and I’m sure we will see this in other haematological diseases, and it’ll certainly make a huge difference for patients.’
22nd November 2024
Maintaining a good level of fitness could help prevent dementia, especially among people who are genetically susceptible to the disease, new research suggests.
The study published in the British Journal of Sports Medicine found that people with a genetic predisposition to dementia can reduce their risk by up to 35% by increasing their cardiorespiratory fitness. High levels of fitness are also associated with better cognitive ability, the researchers noted.
Involving 61,214 people, the study is one of the largest to assess the effect of fitness on cognitive function and dementia risk. Researchers at the Karolinska Institutet in Sweden used data from the UK Biobank to identify people without dementia between the ages of 39 and 70 and tracked their health over 12 years.
At enrolment, all participants took part in a fitness test that involved cycling on a stationary bike for six minutes. Cognitive function was also assessed using neuropsychological tests, and genetic susceptibility to dementia was determined using a genetic risk score for Alzheimer’s disease.
Over the 12-year study period, 553 people (0.9%) were diagnosed with dementia, identified through patient medical records. The researchers used statistical methods to calculate the link between physical fitness and cognitive health, as well as how genetic predisposition influenced the development of the disease.
Participants who had a higher level of cardiorespiratory fitness had a 40% lower chance of developing dementia compared to people with low levels of cardiorespiratory fitness. High levels of cardiorespiratory fitness were associated with a delayed onset of all dementia by 1.48 years.
For people who had a moderate or high genetic risk of developing dementia, high levels of cardiorespiratory fitness reduced all dementia risk by over a third.
Professor Weili Xu, professor in geriatric epidemiology at the Karolinska Institutet and author of the paper, said: ‘Our study shows that higher fitness is linked to better cognitive function and reduced dementia risk. In addition, high fitness could attenuate the effect of genetic risk for all dementias by up to 35%.’
The researchers cautioned that the study was observational only, and suggested that the rate of dementia cases may be underestimated by the UK Biobank population, which tends to be healthier than the average population.
Acknowledging the need for further research, Professor Xu added: ‘Our findings suggest that maintaining good fitness may be a strategy to prevent dementia, even among people with high genetic susceptibility.’
A version of this article was originally published by our sister publication Nursing in Practice.
Rapid Response Systems (RRS) used by hospitals to stabilise in-patient deterioration in children varies considerably between European countries and hospitals. A new study has revealed significant differences in how Paediatric Early Warning Systems (PEWS) and RRS processes are used and evaluated across the continent.
Researchers aimed to describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals by conducting a web-based survey across a number of European hospitals with paediatric in-patients between September 2021 and March 2022.
In total, 185 surveys were returned from 21 European countries. Over three-quarters (n=153, 83%) of respondents reported having written policies, protocols or guidelines to detail the measurement of physiological observations.
A PEWS was used by over half of the hospitals (n=120, 65%) and over two-thirds (n=75, 41%) reported having a Rapid Response Team (RRT).
The survey also revealed that just over half (54%) of hospitals provided regular training for their staff on RRS, and 38% collected data on the effectiveness of their system.
Significant differences existed across European regions in both PEWS utilisation (North = 98%, Centre = 25%, South = 44%, p < .001) and process evaluation (North = 49%, Centre = 6%, South = 36%, p < .001).
The use of RRS has increased globally, and this study highlights the need to reduce variance in practice in hospitals across Europe. The researchers suggest that a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and ensure ongoing quality improvement.
In November 2023, the NHS rolled out a single standardised early warning system for paediatric teams in hospital settings in England to ensure that paediatric deterioration is detected and escalated quickly.
Reference
Gawronski, O et al. European survey on Paediatric Early Warning Systems, and other processes used to aid the recognition and response to children’s deterioration on hospital wards. Nurs Crit Care 2024; Jun 12: DOI:10.1111/nicc.13096.
21st November 2024
A recent study in Italy found that switching between biosimilars when treating patients in oncohematology centres for non-Hodgkin lymphoma or chronic lymphocytic leukaemia does not increase the risk of adverse events. It also confirmed the clinical safety of using rituximab biosimilars.
The findings should alleviate concerns about the use of biosimilars and could lead to a broader acceptance of their use and an awareness of their potential to reduce healthcare costs.
The study authors suggest that regulators and prescribers should share guidelines to encourage their adoption.
The clinical safety and efficacy of rituximab biosimilars compared to the reference rituximab (brand name MabThera) have been well established in randomised trials, but concerns remain around switching from the reference product, and particularly between different biosimilars.
This analysis showed that only 22% of patients were given different biosimilars during treatment, and most were only treated with the biosimilars Rixathon and Truxima.
The multicentre observational study involved across 13 oncohematology units in Italy. Only patients with newly diagnosed non-Hodgkin lymphoma or chronic lymphocytic leukaemia who had not had rituximab treatment were included in the study (n=505).
A total of 3,681 rituximab infusions were administered as either the reference product or a biosimilar, and 16.8% of the patients experienced at least one adverse drug reaction (ADR). These were observed most frequently during the first infusion (44 patients, 52%) and the second infusion (17 patients, 20%) From the third to the fifteenth infusion, the incidence remained below 2%. The most frequent reactions were general disorders and administration site conditions (n=50, 8% serious).
Of the 85 ADRs, four occurred in ‘switcher’ patients, whereas 81 occurred in ‘no-switcher’ patients.
These findings support the clinical safety of rituximab biosimilars and suggest that switching between biosimilars does not increase the risk of adverse events, the authors concluded.
Reference
Urru, S et al. The Importance of Real-World Data in Evaluating the Safety of Biosimilars: A Descriptive Study of Clinical Practice in an Oncohematological Italian Population. Cancers 2024; Oct 8th: DOI: 10.3390/cancers16193419.
A new survey by the European Society of Paediatric Research (ESPR) has examined how widely lung ultrasound is used in neonatal intensive care units (NICUs) across Europe to better understand what it is used for and how this may be improved.
The survey results, published on behalf of the ESPR Pulmonary Research Consortium, found that although lung ultrasound is available in NICUs throughout the continent, uptake is highly variable.
To improve implementation, the authors suggest the development of learning opportunities for healthcare professionals, as well as the establishment of international guidelines.
The researchers analysed lung ultrasound use in NICUs using an international online survey undertaken in 2023, collecting data from 560 NICUs in 24 countries.
The percentage of NICUs using this technique varied widely between countries, ranging from 20% to 98%. Of the NICUs surveyed, 76% of the units used it for patient care, while 6% used it only for research purposes.
Where lung ultrasound was used in a clinical context, it was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%).
Respiratory conditions diagnosed by in this way most commonly included pleural effusion, pneumothorax, newborn transient tachypnea and respiratory distress syndrome.
In all NICUs, lung ultrasound was mainly used by neonatologists. The researchers found that experience using it varied widely across Europe, with only 13% of the units having more than five years of experience using the machines. One-third of the units had less than two years’ experience.
The most common reasons for not using lung ultrasound were a lack of technical experience and uncertainty around image interpretation.
Survey respondents and authors suggested that specific courses and an international guideline on neonatal lung ultrasound could promote the uptake of this technique.
Reference
Alonso-Ojembarrena, A et al. Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research. Archives of Disease in Childhood. Fetal and Neonatal Edition 2024; Apr 11: DOI: 10.1136/archdischild-2024-327068.
An app to assist with asthma self-management could save the NHS up to £25m in a year if it were used by 100,000 patients for three months, a report has found.
The digital asthma tool could also help tackle health inequalities, with 54% of users from deprived communities, according to the evaluation by UCLPartners.
The Digital Health Passport (DHP) – an asthma/allergy self-management app designed for teenagers, young adults and the parents/carers of pre-teens – is designed to make it easier for patients to monitor and control their condition.
The evaluation of the digital tool found that the 1,106 users had an average increase of 2.24 points in their Asthma Control Test (ACT) score.
By improving asthma control, the report said DHP could result in fewer out-of-hours and emergency appointments and fewer face-to-face annual reviews.
And the reduced healthcare cost as a result of enhanced asthma control has a potential return on investment of £9.28 for every £1 spent over three years, the report said.
DHP rollout is currently at ‘Level 1’, which means the app links to regional services and resources but is not interoperable with other NHS digital services, such as the NHS app, local shared care records, or individual practice systems.
The app, which has been created by Tiny Medical Apps, focuses on achieving better asthma outcomes by optimising the delivery of the key elements of the asthma care pathway, specifically for children and young people.
This includes making asthma plans smarter with signposting from symptom trackers and improving medication adherence by ordering repeat prescriptions within the app, automated medication reminders, inhaler videos and tracking diaries.
The digital asthma tool also helps patients avoid triggers with air quality alerts and personalised allergy education. And it improves knowledge about asthma by focusing on seven core learning modules and regular reinforcement.
The report also highlighted that TikTok had been particularly effective in engaging young people, demonstrating the importance of targeted digital outreach.
Last month, a report by the Nuffield Trust and Health Foundation revealed that respiratory waiting lists had increased by 263% between May 2014 and May 2024, which is thought to be a consequence of increasing emergency care needs diverting resources away from planned care.
At this year’s European Respiratory Society Congress, a trial showing vocal changes recorded on a smartphone could signal the start of a COPD exacerbation was among the research presented under the Congress’s humans and machines theme.
A version of this article was originally published by our sister publication Healthcare Leader.
20th November 2024
Cancer patients in the north of England are benefitting from a new nuclear medicine and molecular radiotherapy suite that is streamlining and personalising their care. Professor Jon Wadsley discusses the unmet patient need that instigated its development, the multidisciplinary efforts involved in maintaining its safety and plans for future research projects to further support patients and optimise their treatment.
In March 2024, a state-of-the-art nuclear medicine and molecular radiotherapy suite opened at Weston Park Cancer Centre, bringing a range of high-precision technologies to cancer patients in Sheffield, UK.
Its aim is to pair sophisticated imaging techniques, which can detect and image tumours and visualise organ systems in real time, with targeted therapies to potentially improve the efficacy and lessen the side of effects of cancer treatments.
With a host of new targeted treatments set to come on board in the next few years, the new facility is designed to optimise their delivery over the longer-term, as well as allowing patients to benefit from current innovations and to take part in pioneering cancer research trials, which was a key driver of the initial plans.
Professor Jon Wadsley is a consultant clinical oncologist at Weston Park Cancer Centre and was heavily involved in the design, delivery and now running of the suite. ‘Planning for the new suite began about five years ago, recognising the growing demand for nuclear medicine therapies, both for existing treatments such as lutetium oxodotreotide for neuroendocrine tumours, and for new therapies in development for many other more common types of cancer,’ he says.
‘The new facilities have significantly expanded our capacity to deliver these treatments, created a more pleasant environment for our patients, and also include scanning facilities,’ he adds.
Neuroendocrine tumours (NETs) are a particular clinical interest of Professor Wadsley, and Sheffield Teaching Hospitals NHS Foundation Trust, of which the Weston Cancer Centre is a part, is accredited as one of 14 European Neuroendocrine Tumour Society Centre of Excellence in the UK and one of 68 globally.
This new suite builds on this reputation and puts them in good stead to hopefully renew the centre status at the next review point. ‘To gain accreditation, centres are required to demonstrate that they can provide a full range of multidisciplinary services for NET patients, including nuclear medicine therapies, as well as demonstrating active participation in research to further improve treatments,’ says Professor Wadsley. ‘There is a programme of renewal of centre status every five years to ensure that standards are being maintained.’
The multidisciplinary element of this status is something that Professor Wadsley champions and he notes that ‘the safe delivery of nuclear medicine therapies requires very close teamwork between a number of different professionals’.
‘The key personnel involved in the actual delivery of treatment include oncologists, nuclear medicine technologists and clinical scientists, as well as input from radiopharmacy within the nuclear medicine department,’ he says. ‘However, we rely on a much wider team including endocrinologists, radiologists, gastroenterologists, surgeons and specialist nurses to ensure that the most appropriate treatment is chosen for each patient.’
Keeping these staff members safe is of paramount importance and this was a key consideration when designing the suite. ‘Since these treatments involve the administration of radioactive substances to patients, specially designed facilities are essential with appropriate shielding and drainage to ensure that patients can be treated safely and staff exposure to radiation is kept as low as possible,’ Professor Wadsley explains.
Patient safety is improved further with the inclusion of specialist scanning facilities available within the new suite ‘to ensure patients are deriving the most benefit possible from the treatments’. Previously, patients had to travel to another site to be scanned but now they have access to each part of their treatment journey in one place – something that Professor Wadsley says is one of the most significant developments.
The single-photon emission computed tomography (SPECT/CT) scanner allows the team to detect exactly where in the patient’s body the treatment has gone. ‘This confirms that tumours are being treated, and that normal organs are not being adversely affected,’ Professor Wadsley says. ‘This also opens up opportunities for further research into how our treatments can be individualised to derive the greatest benefit from treatment for each patient.’
Making better use of existing therapies in this way will undoubtedly have a positive impact on patients going forwards, and this is just one avenue of research that the team is pursuing to improve access to the latest treatments and innovations.
‘We are in discussion with a number of organisations who are developing new treatments in this field and keen to work with us to test these treatments in clinical trials, allowing our patients early access to novel therapies,’ Professor Wadsley explains. ‘We are also working with colleagues in other UK centres to develop research studies aiming to better personalise treatments for our patients.’
Having made a significant difference to patients in the few short months since the suite opened and with so much research potential and a dedicated multidisciplinary team driving efforts forwards, the future is bright for cancer patients in Sheffield and the wider region.
18th November 2024
With training for gastroenterologists varying greatly across Europe, Drs Sophie Schlosser-Hupf and Jonas Staudacher discuss United European Gastroenterology‘s efforts to encourage collaboration and consensus and ensure high-quality care reaches all patients across the continent.
The growing burden of gastrointestinal (GI) diseases in Europe1 demands a highly trained workforce of gastroenterologists. However, the pathway to becoming a GI specialist varies significantly by country,2 with new research from United European Gastroenterology (UEG) revealing that only 52.5% of European countries have training centres accredited by the European Board.3
This creates an exciting opportunity for collaboration in further developing gastroenterology training across Europe to ensure high standards of care.
Under the initiative of Dr Henriette Heinrich, UEG Education Committee chair, and Professor Martina Müller-Schilling, National Societies Committee chair, along with support from the Young Talent Group under the lead of Paula Sousa and the National Societies Forum, GI training programmes of all UEG National Societies Members were collected for the research.
Lead project members Drs Sophie Schlosser and Jonas Staudacher then evaluated the curricula to identify their respective structures and differences. The analysis showed that while the median duration of gastroenterology training was a substantial 60 months, the structure and content of this training were highly variable across Europe.
‘Many countries are working hard to provide competency-based learning, with 80% of curricula including such objectives and 77.5% outlining detailed learning goals,’ says Dr Schlosser-Hupf. ‘This sets a strong foundation.’
Endoscopic competencies were found to be a universal requirement, and 70% of programmes provided specific target numbers for procedures. For example, the median expected numbers were 300 oesophagogastroduodenoscopies and 200 colonoscopies.
Furthermore, 65% of curricula required experience in advanced endoscopy techniques such as endoscopic retrograde cholangiopancreatography or endosonography. These represent areas where sharing best practices could help build training excellence.
Dr Staudacher advocates for fostering collaboration across UEG member states to improve gastroenterology training.
‘Analysis of training programmes does not imply developing identical programmes across countries, but rather the inclusion of core competencies and experiences in every European gastroenterology training programme,’ he says. ‘This is about building on the unique strengths of each country’s approach and ensuring all European gastroenterologists receive comprehensive training that prepares them for the challenges of clinical practice.’
Building on this idea, Drs Schlosser-Hupf and Staudacher suggest developing a European consensus on training standards that could establish recommendations for minimum requirements for training durations, clinical experiences and subspeciality opportunities.
Organisations such as UEG are crucial for collaboration in GI education across Europe. ‘UEG is uniquely positioned to champion competency-based curricula development,’ says Professor Müller-Schilling. ‘They can play a pivotal role in building bridges between national systems, ensuring that the next generation of gastroenterologists continues to receive high-quality, comprehensive training.
Dr Heinrich adds: ‘No organisation can do this alone. Realising the vision of optimal training across borders requires collaboration among educational institutions, healthcare professionals and European societies to ensure that future gastroenterologists are fully prepared to meet the evolving needs of patients.’
Fixing the working relationship with primary care is one the key priorities for secondary care providers, who must not rely on GPs to do so, NHS England’s chief executive has said.
Addressing the NHS Providers conference in Liverpool last week, Amanda Pritchard went as far as listing this as one of five key priorities for secondary care managers.
The other priorities were living within their financial means and making resources go as far as possible; embedding continuous improvement into strategies; maintaining quality and safety; and making the most of opportunities flowing from ability to act as ‘one NHS‘, such as the Federated Data Platform.
According to Ms Pritchard, realisation of the Government’s ‘neighbourhood health service’ plan will rely on improving the interface between primary and secondary care. Speaking to a room full of NHS managers, she noted that ‘frustrations can run both ways’ but warned that ‘relying on GPs to solve it won’t work and it’s not fair’.
Ms Pritchard said: ‘We have to make this work better for all parties, because it’s patients who suffer when it doesn’t. So we’re working on this centrally; looking particularly at streamlining referrals. But it’s about much more than that.
‘Patients unable to get information from hospitals, pushing them to GPs. Clinics asking GPs to refer to other clinics, to chase test results ordered by the clinic.’
She called on all providers to ‘commit to this now’ and said this is ‘particularly important as a first step to make integrated neighbourhood teams and neighbourhood services work’, as they rely on ‘well-functioning’ relationships.
Speaking at the same conference, health secretary Wes Streeting said realising the new neighbourhood health service should be the key focus of integrated care boards (ICBs) going forward.
His speech focused on a number of reforms focused on provider performance, including trust league tables, but he also said ICBs would be measured on their ability to deliver neighbourhood services.
Suggesting ICBs are unclear on their ‘purpose’, he said: ‘I want ICBs to focus on their job as strategic commissioners and be responsible for one big thing: the development of a new Neighbourhood Health Service.
‘It will focus on building up community and primary care services with the explicit aim of keeping patients healthy and out of hospital, with care closer to home and in the home.’
Those ICBs making the most progress towards this goal should ‘enjoy greater freedom and flexibility’, the health secretary said.
Earlier this year, a survey run by Hospital Healthcare Europe and its sister titles revealed that the primary-secondary care interface is not effective at ensuring efficient continuity of patient care between settings.
In June, NHS England asked integrated care boards (ICBs) to act as ‘referees’ to resolve ‘tension’ between primary and secondary care around workload and referrals.
And in April, hospital Trusts were informed by NHS England of a requirement to have ‘a designated lead for the primary-secondary care interface’ and ICBs were tasked with regularly reviewing this progress.
A version of this article was originally published by our sister publication Pulse.
15th November 2024
Folic acid will be added to non-wholemeal flour in the UK from the end of 2026 to prevent birth defects, the Government has announced, making the country the first in Europe.
Ministers said the UK-wide legislation would prevent around 200 cases of neural tube defects every year and improve health of pregnant women.
It has been estimated that the move to include folic acid in flour will reduce neural tube defects by 20% in the saving the NHS £20m over 10 years and boosting the economy by more than £90m.
NHS recommendations that women who are trying to conceive a baby take folic acid supplements for around three months before getting pregnant and for at least 12 weeks after will remain in place.
But with around half of all pregnancies in the UK being unplanned, it is hoped the new regulations will help to provide women with a higher baseline intake of folic acid.
The move follows a public consultation in 2022 on the amount of folic acid that should be added to flour.
Flour is already fortified with calcium, niacin, thiamine and iron to improve public health, the Government added.
But experts said the measures were too ‘timid’ and did not go far enough to prevent more cases of anencephaly and spina bifida.
Andrew Gwynne, minister for public health and prevention, said: ‘Shifting care from sickness to prevention is one of the leading ambitions in our 10 Year Health Plan, as we work to make our NHS fit for the future.
‘These measures are a simple and effective intervention to improve health outcomes in babies, giving them the best start in life.’
Professor Chris Whitty, England’s chief medical officer, said: ‘The fortification of flour is a simple and effective way to help to reduce cases of neural tube defects, although it is important that women who are pregnant or intending to become pregnant continue to take folic acid supplements before and during the first 12 weeks of pregnancy.’
Professor Ian Young, chair of the Scientific Advisory Committee on Nutrition, said they welcomed the move having consistently recommended folic acid fortification since 2006.
Professor Sir Nicholas Wald, professor of preventive medicine at University College London, who conducted the original 1991 study that showed folic acid deficiency to be a leading cause of neural tube defects, said the decision was ‘good news’.
‘However, more could be done to prevent an estimated 800 cases [of neural tube defects] instead of 200 if all flour and rice were fortified (unless labelled as unfortified) and the level of fortification mandated by the Government were increased,’ he said.
Dr Jonathan Sher, former deputy director of Queen’s Nursing Institute Scotland, said fortification was long overdue but the plans in their current form were ‘timid, unscientific and will predictably fail to prevent most of the harm currently caused by neural tube defects’.
Professor Neena Modi, professor of neonatal medicine at Imperial College London, said the good news was tempered by the decision to restrict fortification to non-wholemeal flour only ‘as this will disadvantage groups such as women who are sensitive to gluten, eat rice in preference to bread, and products made from wholemeal flour, excluding them and their babies from benefiting, and thus add to the considerable health inequities that already exist in the UK’.
A version of this article was originally published by our sister publication Pulse.
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