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14th November 2024
The UK health secretary has promised to cut long hospital waiting times back down to the NHS 18-week target via financial incentives and performance league tables.
In a speech at the NHS Providers conference in Liverpool, Wes Streeting said there will be a ‘zero tolerance’ policy for failure and underperforming hospitals will no longer be rewarded, with a ban on senior managers receiving pay rises at these Trusts.
Under the plans, ‘persistently failing’ NHS managers will be replaced and ‘turnaround teams‘ sent to support improvement, Mr Streeting said, while Trusts deemed to be high-performing will be given greater freedom over funding to invest where they see fit, such as modernising buildings, equipment and technology.
Meanwhile, NHS England will carry out a review of hospital performance across the country, resulting in a league table that will be made public and regularly updated.
The Government is hoping that keeping hospitals to account financially will reduce waiting times for patients.
Mr Streeting said: ‘We are announcing the reforms to make sure every penny of extra investment is well spent and cuts waiting times for patients.
‘There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in.
‘Our health service must attract top talent, be far more transparent to the public who pay for it, and run as efficiently as global businesses.
‘With the combination of investment and reform, we will turn the NHS around and cut waiting times from 18 months to 18 weeks.’
NHS England chief executive Amanda Pritchard said: ‘While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development.
‘The extensive package of reforms, developed together with Government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients.’
The NHS Oversight Framework, which sets out how Trusts and integrated care boards are best monitored, will be updated by the next financial year ‘to ensure performance is properly scrutinised’.
However, the Royal College of Emergency Medicine (RCEM) has warned that league tables and incentivising hospital performance could ‘take away focus from deeper systemic issues affecting urgent and emergency care’.
Dr Adrian Boyle, president of the RCEM, said: ‘Measuring poor performance is challenging as hospitals have been merged into multi-site Trusts. For example, you might have a Trust that runs multiple emergency departments, and this can be difficult to compare. That is one of the reasons we are asking for data for each individual hospital to be made available. This would easily create the transparency that the secretary of state desires.
‘There is also the risk of short-term target chasing instead of focusing on wider systemic issues needed such as improvements in social care capacity, crumbling estate and poor IT.
‘We know that A&E staff are already working at maximum capacity in extremely challenging conditions, and we are worried this focus on performance could lead to recruitment and retention issues in already struggling hospitals.‘
He added: ‘We welcome to focus on giving more power to local health boards, but no amount of performance incentive can replace the need for more beds and staff. We hope these changes will be accompanied by the whole system improvements promised by the new Government.‘
Further plans to be put forward for consultation in the coming weeks include stopping NHS staff resigning and then immediately offering their services back to the health service through a recruitment agency.
The consultation will also include a proposal banning NHS Trusts from using agencies to hire temporary entry level workers in band 2 and 3, such as healthcare assistants and domestic support workers.
The Labour Party’s manifesto had pledged to ‘cut NHS waiting times’ with ‘40,000 more appointments every week’, including via greater use of the private sector.
At the Labour Party conference September, Mr Streeting announced a ‘Formula 1 pit stop’ strategy for UK operating theatres to tackle waiting lists in areas with the ‘highest numbers of people off work sick’.
A version of this article was originally published by our sister publication Pulse.
13th November 2024
Two doctors would need to assess terminally ill adults who wish to end their lives under proposed assisted dying legislation for England and Wales.
The bill, which will be subject to a ‘free vote’ among MPs on 29 November, states that doctors are not under ‘any duty’ to raise assisted dying with patients or to ‘participate in the provision of assistance’ if they do not wish to.
Published this week, the bill sets out the eligibility criteria for adults wishing to end their lives as well as requirements for doctors involved in the process.
The proposed legislation stipulates the involvement of both a ‘coordinating doctor’ and an ‘independent doctor’ who can attest to the person’s eligibility.
After confirmation from both doctors, as well as a ‘declaration’ from the person themselves, the High Court must then make a decision, and must ‘hear from’ at least one of the doctors.
Only adults whose death from terminal illness ‘can reasonably be expected’ within six months would be eligible to receive assistance to end their life.
But the definition for terminal illness does not include ‘mental disorders’ or ‘disabilities’, under the proposed legislation.
The process must also take at least three weeks, with ‘reflection’ periods built in for the person between clinical assessments and after the High Court’s decision.
Doctors must ensure that persons wishing to end their own life:
The draft legislation makes clear that a doctor providing assistance ‘in accordance’ with the requirements is not guilty of any criminal offence, nor do their actions ‘give rise to civil liability’.
However, if a doctor ‘induces another person’ by ‘dishonesty, coercion or pressure’ to make declarations or to self-administer a substance, this would be an offence punishable by a prison term of up to 14 years.
The bill also stipulates that employers ‘must not subject an employee to any detriment for exercising their right’ not to participate in assisted dying processes.
The new bill, put forward as a private members bill by Labour MP Kim Leadbeater, follows a Health and Social Care Select Committee inquiry looking into the current law and at international examples of assisted dying becoming legal.
Following the introduction of this bill to Parliament last month, the UK’s most senior medical leaders advised that it is ‘entirely reasonable’ for doctors to take part in the public debate around assisted dying.
However, the UK’s chief medical officers also warned doctors against ‘implying’ that they speak for the entire medical profession rather then ‘expressing their personal views’.
Over 3,400 doctors, nurses and other healthcare professionals have signed a letter to the Prime Minister to warn that assisted dying cannot be introduced safely while the NHS is ‘broken’, according to The Telegraph.
Organised by campaign group Our Duty of Care, the letter states: ‘The NHS is broken, with health and social care in disarray. Palliative care is woefully underfunded and many lack access to specialist provision. The thought of assisted suicide being introduced and managed safely at such a time is remarkably out of touch with the gravity of the current mental health crisis and pressures on staff.’
Health secretary Wes Streeting said in October that he was worried about palliative and end-of-life care ‘not being good enough to give people a real choice’ on Good Morning Britain, saying he would vote against changing the law on assisted dying.
Last autumn, a survey of General Medical Council-registered doctors revealed that nearly half of UK doctors think that a physician-assisted dying law ‘would negatively impact the medical profession’.
A version of this article was originally published by our sister publication Pulse.
The remanufacturing of single-use medical devices has the potential to significantly reduce greenhouse gas emissions from health systems, and while there are impressive examples of best practice, there is still a long way to go across much of Europe. Here, Bob Unwin and Josselin Duchateau share an overview of remanufacturing and describe how the practice works at Stepping Hill Hospital, part of Stockport NHS Foundation Trust, UK, and efforts to get programmes started in France.
A growing body of evidence finds that when it comes to harmful greenhouse gas emissions, hospitals are part of the problem.
Health systems generate nearly 5% of all global greenhouse gas emissions and a staggering 71% of these emissions come from the supply chain. In a study looking at emissions from the UK’s NHS, single-use medical devices were found to have an outsized impact on the NHS carbon footprint.
A regulatory framework for commercial remanufacturing of medical devices labelled for ‘single use’, also known as SUDS, began in the United States in 1998, and Germany followed in 2002. Commercial remanufacturers – meaning the work is done by private industry outside of the clinical setting – are regulated under the EU Medical Device Regulation (MDR) 2017/245 in force since May 2021. Today, over 11,900 hospitals and surgical centres use reprocessed devices globally.
Remanufactured SUDs must be compliant with the MDR under Article 17. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) guideline regulated the remanufacturing of SUDs from 2016. CE marked remanufactured devices must obtain the same levels of cleanliness, sterility and functionality as required of a virgin device.
Remanufactured SUDs cost at least 30-50% less than the virgin devices, according to the Association of Medical Device Reprocessors (AMDR). They also reduce waste, greenhouse gas emissions, and reliance on the international supply chain that hospitals found to be vulnerable during the Covid-19 pandemic.
Commercial remanufacturers collect devices, decontaminate, function test, clean, repackage, sterilise and return the SUDs for reuse by hospitals and clinics. Thus, remanufacturing creates a circular economy.
Peer-reviewed life cycle assessments are a well-established resource for comparing environmental impact across numerous categories to examine the cradle-to-grave impact on air, water and land for choices between two or more products.
A research team from Fraunhofer – the prestigious German research society – confirmed through a well-designed life cycle assessment that a remanufactured electrophysiology catheter resulted in a 50% reduction in greenhouse gas emissions compared to its virgin alternative when shipped from the UK to Germany where the devices were remanufactured and returned to the UK. Numerous additional peer reviewed life cycle assessments confirm substantial CO2 reductions at an average of 41% from the use of remanufactured SUDs.
In 2022, Stockport NHS Foundation Trust staff initiated a Green Plan, which included targets such as reducing greenhouse emissions by 85% by 2032, a 75% cut in business travel emissions by 2030, and achieving a ‘net zero’ carbon footprint by 2040 in line with wider NHS ambitions.
Supply chain leadership had become aware that an inordinate amount of greenhouse gas emissions from hospitals resulted from the supply chain. They sought to implement initiatives proven to reduce greenhouse gas emissions.
The leadership team’s research included review of NHS support for SUD remanufacturing including NHS-funded research and the NHS ‘Device Remanufacture “How to” Guide’ for the use of commercially remanufactured devices that documented substantial savings and emissions benefits at other hospitals.
The remanufacturing programme launched at Stockport NHS Foundation Trust in July 2022 significantly reduced Stepping Hill Hospital’s waste stream and greenhouse gas emissions. The Trust generated savings of approximately £33,000 during the fiscal year 2022/23 and received an additional £350 through a collections agreement with their remanufacturing partner.
While switching products can be difficult, as surgeons always have preferred medical devices, they had no difficulties using the remanufactured products because they were using the same product make and model. In the fiscal year 2023/24, the programme saved £40,763.52. By replacing 183 virgin surgical Harmonic Scissors (devices) with their reprocessed counterparts, Stepping Hill eliminated the use of the equivalent of 209 kg of CO2.
The Stockport programme underscores the UK’s leadership in circular innovation in healthcare, standing out as a key example.
Taking this further, in October 2024, the UK’s Department of Health announced ‘a major crackdown on waste’ in an effort to save millions of pounds a year, helping to divert more resources to frontline NHS care. The ‘Design for Life roadmap’ strategy is a full-throttle approach to driving a circular economy. A commitment to use remanufactured SUDs plays a leading role, with plans to radically cut the number of SUDs in the health service and reduce its reliance on foreign imports.
Many European nations, such as Belgium, Germany, and Spain, have also embraced remanufactured devices. However, in the EU, the MDR only allows remanufacturing when permitted by national law within individual Member States, with the requirement to notify the European Commission of their regulations.
This ‘opt-in’ model does not incentivise countries to adopt the practice and adds extra regulatory hurdles before they may do so. As a result, in some European countries, concerned healthcare providers and other industry stakeholders must often raise their voices to advocate change in linear, outdated, or stagnant national policies. An illustrative example of this is France.
Outside of the hospital, France has long been a leader in the promotion of a circular economy – a 2023 policy saw the French Government pay people to repair old clothes rather than throw them away, for example. But French hospitals are given no such treatment, and the use of remanufactured devices has been banned in France.
This ban has been a thorn in the side of environmentally minded French clinicians and healthcare staff. In December 2022, a position paper published in Le Monde signed by representatives of different medical and pharmaceutical scientific societies called for a lift of this ban.
At the April 2023 European Heart Rhythm Association Congress in Barcelona, Spain, numerous French clinicians and researchers spoke forcefully in favour of the use of remanufactured devices. Then, in March 2024, a group of more than 20 doctors from the French Society of Cardiology published a position paper that similarly endorsed remanufacturing and advocated wider regulatory and professional acceptance of remanufactured devices across the continent.
Thankfully, French authorities appear to have seen the writing on the wall: in the Social Security Financing Bill for 2024, the Government included an article finally authorising the use of remanufactured devices as part of a two-year experiment.
In a recent report detailing how the experiment could work, the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of the Environment and Sustainable Development (IGEDD) situated the potential adoption of device remanufacturing as part of France’s broader efforts to reduce its healthcare sector’s environmental footprint.
According to the report, the experiment will examine commercial remanufacturing of SUDs for four French healthcare establishments. As France lacks any existing infrastructure for a medical device remanufacturing industry, the report further encourages working with an experienced commercial remanufacturing partner.
In its own report commenting on the experiment, the French National Academies of Medicine, Pharmacy and Surgery highlighted that stakeholders across the board support the idea, provided that safety, technical and regulatory standards are maintained.
It would seem, at last, that the regulatory and medical communities in France are on the same page about this critical issue. The success of this experiment could pave the way for more sustainable practices, aligning with France’s aspirations to be a leader in the sustainable transition of healthcare. All eyes will be on this two-year trial as it explores the safety, cost-effectiveness and sustainability of remanufacturing medical devices in one of Europe’s largest healthcare sectors.
While a firm date for the commencement of the programme has not been set, the Directorate General of Health has stated that the decrees implementing the experiment should be finalised by the end of 2024. The current working draft proposes to evaluate both CE and CS remanufacturing routes, therefore allowing the experiment to cover a wide number of devices.
The experimentation phase should last two years, and the evaluation of the experiment will result in either a prolongation of the ban, or a modification of the law legalising remanufacturing of SUDs in France.
In addition to the UK successes and the French experiment, remanufacturing of SUDs is currently permitted in Belgium, Croatia, Germany, Ireland, the Netherlands, Spain, Portugal, Sweden and Israel. Globally, commercial, regulated remanufacturing of SUDs also takes place in the US, Canada, Japan, Israel and Australia.
The AMDR – the nonprofit trade association representing the remanufacturers – hopes to remove the ‘opt-in’ language in the EU MDR in a move that will make it easier for more countries in Europe to benefit from this sustainable option and reduce greenhouse gas emissions within their health systems.
Authors
Bob Unwin, registered nurse, directorate manager, theatre and critical care at Stepping Hill Hospital, Stockport NHS Foundation Trust, UK
Josselin Duchateau, clinical electrophysiologist, University Hospital of Bordeaux, France
12th November 2024
The effect of climate change on public health is becoming increasingly evident, and the need to act is perhaps more urgent than ever. But it’s not just global governments at the COP summits who can influence sustainable change. As the Royal College of Emergency Medicine’s GreenED initiative highlights, all hospital staff can play their part. Katherine Price investigates.
Emergency healthcare systems are already having to manage the consequences of climate change, with associated air pollution and extreme weather events on the rise and increasing pressure on services. The recent catastrophic floods in southeastern Spain and heatwave in the UK in 2022 are just two examples.
While the impact and repercussions of the floods are still being assessed, the UK heatwave caused an estimated 2,985 excess deaths in England alone and also led to IT failures at one of London’s largest NHS hospital trusts, demonstrating a significant logistical and human cost.
Focus groups at the recent European Emergency Medicine Congress rated the severity of the impact of climate change on health systems, and specifically on emergency care, both now and in the future, at an average of seven on a scale of zero to nine. This highlights widespread concern and the need for the emergency medicine community to mobilise around the climate agenda.
‘There’s broad recognition in the health community that climate change is the biggest threat to public health,’ says Dr Zoe Steley, emergency medicine registrar, co-founder of the Royal College of Emergency Medicine’s (RCEM) Environmental Special Interest Group and clinical co-lead of its GreenED initiative. ‘That’s a big part of why GreenED is a priority, because it’s connected to the broader care crisis.’
Launched in September 2023, GreenED aims to measure and reduce the environmental impact of emergency departments (EDs) in the UK, thus driving environmentally sustainable practices within the specialty of emergency medicine and contributing to NHS England’s ambition of achieving net zero by 2040.
Its open-source framework has been designed to hit a ‘triple bottom line’ within secondary care: quantifiable sustainable changes that also reduce costs, improve efficiency and maintain or improve patient care outcomes.
‘Climate change is a health emergency, and the NHS has a pivotal role in tackling this issue for the benefit of our patients,’ says Chris Gormley, acting chief sustainability officer for the NHS. ‘With the dedication of our clinical staff and the collaborative efforts of the RCEM, we are making significant strides towards safely and sensibly decarbonising the care we provide, and we are proud to support this work.
‘Our goal is to ensure that NHS EDs can deliver not only high-quality, efficient and cost-effective care but also environmentally sustainable solutions. We are committed to enhancing patient outcomes while improving health now, and for future generations.’
As part of these efforts, in September 2024, the RCEM awarded five EDs in the UK GreenED accreditation for environmental sustainability. The first accreditations of their kind, these align with the three levels of the GreenED sustainability framework – bronze, silver and gold.
Providing evidence of achieving or sufficiently addressing specific actions across the three levels leads to respective accreditation for 12 months, with an annual £2,000 fee per site to take part in the support and accreditation scheme. According to Dr Steley, accredited sites have, on average, saved around £10,000 per year by implementing the changes.
For Dr Daisy Stevens, a specialty doctor in emergency medicine and GreenED lead at the newly bronze-accredited Derriford Hospital in Plymouth, keeping the patient front and centre of all sustainability efforts is imperative. ‘[It’s] making sure that everything that we do request for a patient is appropriately indicated, getting rid of any excess or duplication that isn’t going to change patient management or isn’t in their best interests.’
And she advises starting small. ‘Evidence the victories and use this to gain momentum to target some of the bigger actions,’ Dr Stevens says.
Kate Whittaker, a junior sister in the ED at Great Western Hospital in Swindon, which received both bronze and silver accreditation, agrees. ‘It’s just looking at where you can make those small changes first that can make quite a big impact… and then you can start building on it from there,’ she says.
At this Trust, in conjunction with Royal United Hospitals Bath NHS Foundation Trust and Salisbury NHS Foundation Trust, all employees can sign up to ACT – an interactive programme aimed at supporting action on climate change. Staff earn ‘green points’ for registering positive environmental actions on the ACT app, with top scorers receiving rewards such as vouchers, which helps keep motivation high.
‘Persistence is key, especially getting off the ground,’ adds Dr James Walton, consultant in emergency medicine at Northumbria Specialist Emergency Care Hospital, which also achieved both bronze and silver accreditation. ‘Once there’s momentum, it’s been really easy to run with it… Our initial plan was just bronze and then we actually looked and we were 90% of the way to silver.’
The GreenED framework lists 13 bronze, 13 silver and 14 gold actions that EDs can use as starting points on their sustainability journey, which include things as simple as switching off equipment and lighting when not in use and using reusable medical devices where possible.
One bronze action is to set up a multidisciplinary working group. RCEM recommends including a mix of junior and senior, as well as clinical and non-clinical roles. This encourages shared responsibility and accountability, the inclusion of different ideas and perspectives, and creates a space for feedback.
‘If you are making things harder for someone else to do their job, then that’s not a sustainable change,’ points out Dr Stevens. ‘We need to make sure that we’re not doing any harm by the changes that we’re doing.’
For example, ensuring that any sustainable alternatives are suitable for all patient cohorts involves cross-departmental input.
Another bronze action is to make dry powder inhalers (DPIs) available within the ED. Inhalers contribute to 3% of the total NHS carbon footprint, and DPIs have a carbon footprint 20 to 30 times smaller than metered-dose inhalers. Since introducing DPIs into the ED formulary at Northumbria, approximately a third of dispensed inhalers are now DPIs – a projected saving of 665kg CO2 equivalent (CO2e) per year.
It’s the kind of project that often also has huge potential outside the ED, Dr Steley points out. ‘If you know that not only your successes but the challenges you encounter are going to be informative to unblocking yourself, but also others, that mindset is incredibly motivating,’ she says.
Anaesthetic gases can be a carbon hot spot, but methoxyflurane (brand name Penthrox) has a climate change impact of 117.7 times less CO2e than Entonox. Making methoxyflurane available in the ED and reducing Entonox use by 30% fall under silver actions, while gold involves reducing Entonox use by 60%.
Northumbria has introduced methoxyflurane as its first-line trauma analgesic and turned off nitrous manifolds in the ED, saving 7,200kg CO2e while maintaining excellent patient outcomes. Previously, 38% of patients with shoulder dislocations were discharged within four hours, which has since increased to 75%, and while nearly half of these patients were being sedated, this is now less than 10%.
‘That hits the triple bottom line fully because it’s a shorter length of stay, which is better for the patient; there’s less sedation, which is better for the patient; it’s cheaper; and it’s less environmentally harmful,’ emphasises Dr Walton.
The hospital pharmacy team also reviewed discharge medication to eliminate any unnecessary dispensing – and found very little needed to be changed to maintain sustainable practices.
Despite GreenED involvement being encouraged across all staffing levels, and a statement of support from a clinical lead being a silver action point, the 2022 GreenED pilot report highlighted limited or no senior support as a challenge, particularly sites that did not have consultant involvement.
‘Sites that have senior buy-in from the outset are able to get a lot more done more effectively,’ says Dr Steley. A senior clinician doesn’t have to lead the work, but their support is essential.
A lack of protected time for carrying out the actions was also flagged as problematic, particularly when trying to juggle clinical and other pressures, and the University Hospital of North Tees polit site therefore called for effective resourcing to enable the initiative to progress effectively.
Another key challenge is waste. Having recycling bins throughout Derriford ED saw items ending up in the wrong bins, so instead, a single recycling station has been set up. Northumbria, meanwhile, is conducting bin placement audits.
Also at Northumbria, achieving the bronze action of eliminating single-use plastic cups and cutlery was not as straightforward as hoped. ‘It was really much more complex for patients,’ says Dr Walton. ‘We weren’t able to fully eradicate disposables, but we’ve made a significant improvement.’
There was, however, unexpected success when it came to the logistics of recycling crutches, which had been a concern. Input from the physiotherapy team led to a simple sustainable solution which is expected to become standard operating procedure before the end of the year – ticking off the silver action of creating pathways to return loaned equipment.
More than 35 hospitals across the UK have registered for GreenED accreditation – including all EDs in Wales – since it was launched in 2023, and now the first international pilots have also been set up in Australia. ‘The framework itself doesn’t need structural changing really to accommodate different national contexts,’ explains Dr Steley, which means progress in the UK has the potential to be replicated across the world.
Accreditation has been a great motivator, says Dr Walton, with the changes projected to save an estimated 37,500kg of CO2e a year. ‘There’s been a real culture shift and now everybody’s aware of it and knows who to speak to and that it’s everybody’s responsibility to try and make things better. And I think there’s a sense of pride in the whole team,’ he says.
Dr Stevens has a similar sentiment: ‘As a healthcare provider, we have got the ability to deliver this message as a respected member of society. It’s not just altruistically doing it for the environment and for future generations, it’s actually empowering people to see the benefits in their own health care right now.’
8th November 2024
Adding in just five minutes of vigorous exercise to a daily routine can help lower blood pressure, a large study has concluded.
Analysis of data from more than 14,700 people across five countries found that short periods of exercise that increases heart rate, such as cycling and climbing stairs, had a measurable benefit.
Using fitness tracker data, the UK and Australian researchers also calculated that as little as 20 additional minutes of exercise per day could lead to clinically meaningful cardiovascular risk reduction at the population level.
Writing in the journal Circulation they said walking was not enough and it had to be more vigorous exercise, including short bursts of running, to have an impact.
To look at the relationship between movement and blood pressure, they split the data into categories of sedentary behaviour, such as sitting, as well as slow walking, fast walking, standing and more vigorous exercise.
An average 24-hour day was made up of around seven hours of sleep, 10 hours of sedentary behaviour, three hours of standing, one hour of slow walking, one hour of fast walking, and just 16 minutes of exercise activities such as running and cycling.
Looking at the impact of replacing one type of activity with another, they found switching any less active behaviour with more vigorous exercise could lower systolic blood pressure by 0.68 mmHg and diastolic blood pressure by 0.54 mmHg.
To put this in context, at a population level, a 2 mmHg reduction in systolic blood pressure and a 1 mmHg reduction in diastolic blood pressure is equivalent to around a 10% reduction in cardiovascular disease risk, they said.
They estimated this could be achieved with around 20 minutes of exercise a day.
Study lead Dr Jo Blodgett, a senior research fellow at University College London, said for most people, exercise is key to reducing blood pressure, rather than less strenuous forms of movement such as walking.
‘The good news is that whatever your physical ability, it doesn’t take long to have a positive effect on blood pressure.
‘What’s unique about our exercise variable is that it includes all exercise-like activities, from climbing the stairs to a short cycling errand, many of which can be integrated into daily routines.’
Among those who do not do a lot of exercise, walking did still have some positive benefits for blood pressure, she added.
‘But if you want to change your blood pressure, putting more demand on the cardiovascular system through exercise will have the greatest effect,’ she said.
Professor Emmanuel Stamatakis, joint senior author and professor of physical activity, lifestyle, and population health at the University of Sydney, said despite high blood pressure being one of the biggest health issues globally, there may be relatively accessible ways to tackle the problem in addition to medication.
‘The finding that doing as little as five extra minutes of exercise or vigorous incidental activities per day could be associated with measurably lower blood pressure readings emphasises how powerful short bouts of higher intensity movement could be for blood pressure management.’
In May, research showed that even light physical activity in children can mitigate the ‘ticking time bomb’ of cardiac health in later life.
A version of this article was originally published by our sister publication Pulse.
A new iPhone app and device are to be piloted across the UK‘s West Midlands to help patients detect and rule out suspected throat cancer.
The adapter device is a 32mm lens which, when paired with an accompanying app, can turn an iPhone into a portable diagnostic gadget, according to NHS England.
The device can capture live endoscopy examinations of the throat in high definition, which can be instantly shared with specialists via a secure data cloud. The consultant can then review the video to detect any traces of cancer.
Developed by Endoscope-i Ltd, the device is one of 14 projects to have received a share of £25m as part of the NHS Cancer Programme Innovation Open Call.
NHS England said the device could be used in ‘any NHS setting’ such as diagnostic centres and community settings, meaning people can be tested closer to home.
An initial trial of the device, which was done on low-risk patients at North Midlands University Hospitals NHS Trust, found that no cancers were missed using the device and that patients received results within 23 hours of the tests taking place. Around one in 100 patients were discovered to have cancer within this group.
Dr Cally Palmer, NHS England national cancer director, said: ‘Detecting cancer early is key to providing treatment as soon as possible to help give patients the best chance of survival. For those needing tests to investigate suspected cancer, it can be an extremely worrying time and being able to rule out the disease sooner can make a huge difference for people and their families.
‘While staff have been working hard to see and treat more people with cancer than ever before, we know that some people are still waiting too long to receive a diagnosis or the all-clear.
‘The NHS continues to adopt the latest technologies with the potential to benefit patients, and through pioneering new innovations like this iPhone device which could be used in any setting, we hope we’ll be able to detect many more cancers sooner and in ways that are more convenient and less invasive for patients.’
Health minister, Karin Smyth said: ‘This new technology is a shining example of how innovation and research can tackle waiting lists, improve patient experience and speed up diagnosis.
‘Using the app, patients can access a potentially lifesaving consultation. By catching cancer earlier and treating it faster, we can ensure more people survive this horrible disease.
‘Harnessing technology to support the NHS is a key part of our 10-Year Health Plan, and will shift the NHS from analogue to digital, equipping the health service with more cutting edge-technologies to catch cancers on time.’
Last month, a report into waiting times by the Nuffield Trust and Health Foundation found that those waiting for ear, nose and throat services were facing some of the longest waiting lists in the NHS system.
In the spring, NHS England announced a pilot project to help diagnose Barrett’s oesophagus using a capsule sponge test, which was part of the same NHS Cancer Programme Innovation Open Call. This freed up endoscopy capacity for higher risk patients and those referred for urgent tests for oesophageal cancer, helping to reduce waiting lists.
In September, research was published revealing that a new hand-held 3D photoacoustic scanner can produce detailed microvascular images in seconds, with the technology having the potential to assist with earlier detection of conditions such as cancer.
A version of this article was originally published by our sister publication Healthcare Leader.
Moving medical supplies via drone was once a farfetched idea, but there are now multiple projects working to make it a reality. Kathy Oxtoby considers five case studies from the UK and the Netherlands to determine the benefits for clinicians, patients and healthcare systems, as well as the remaining challenges and future potential of drone transportation within the healthcare landscape.
With rising waiting lists, ongoing staff shortages and mounting pressure on hospital teams, it is increasingly vital that care is delivered faster and more efficiently to patients. Greener, more sustainable care is also a priority, with the drive to achieve a net zero NHS by 2040.
One approach that has the benefits of both faster delivery and sustainability is the use of drones – also known as unmanned arial vehicles or UAVS. Drones are already transporting medicines to remote areas in such countries as Rwanda, the United States, Australia and India.
In recent years, the NHS has been trialling the use of drones for a variety of purposes, including delivering medical supplies of blood packs and chemotherapy, transporting lab specimens, and more.
For Professor Claire Anderson, Royal Pharmaceutical Society president, the Covid-19 pandemic and recent advancements in technology have made the drone transportation of medical supplies eminently possible, and the benefits are clear.
‘Drones offer timely access to medicines, especially in remote areas, and the pandemic highlighted their potential for safe, contactless delivery of essential supplies,’ she says.
‘It can reduce costs and travel time, improve access to healthcare for patients in rural or hard to reach areas, and free up staff time for direct patient care. Drones are also more environmentally sustainable, emitting less carbon dioxide than cars or trucks.’
For patients with chronic conditions, using drones to deliver critical medicines can ‘help reduce waiting times and ensure more consistent access to healthcare’ and ‘alleviate some of the pressures caused by long waiting lists’, she adds.
However, in their current form, there are some inevitable drawbacks. Drones can only carry light items – typically around two to four kilograms – which limits their use for transporting a wide range of items. Additionally, they have limited range and battery life, which affects the numbers of deliveries that can be made on one flight.
In addition, some medicines need to be stored in specific conditions, such as controlled temperatures and multilayer packaging, which must also be taken into consideration. ‘Regulations require these conditions to be met throughout transport to ensure the product is safe to use,’ says Professor Anderson.
As the need and momentum for the use of drones in healthcare builds, the list of projects assessing the benefits, challenges and future potential of drone transportation is growing.
So what projects are currently underway, and what insights are they giving into this innovative movement of medical supplies?
The weather and geography of Cornwall, southwest England, present unique challenges when it comes to the collection and delivery of pathology samples and time-critical medicines, particularly on the Isles of Scilly – 28 miles off the coast.
Poor weather conditions mean flights to and from the islands can be grounded for two to three days, delaying transit of crucial items.
The Open Skies Cornwall project is a consortium of technology providers and end users. It includes exploring conceptual use cases involving the transport of pathology samples and blood products, point of care equipment and consumables, and Royal Cornwall Hospital Pharmacy service provision via drones.
‘We wanted to level up the provision of care and build a reliable and robust service for the island community,’ says Jo Walsh, pathology optimisation project lead at Royal Cornwall Hospitals NHS Trust.
Samples can be adversely affected by the time it takes to transport them, and often repeat testing is required as a result. ‘We’re looking to prevent any repeated testing and provide timely and accurate results for clinicians, that are not adversely affected by transport delays,’ says Ms Walsh.
‘We also want to enable patients to receive treatment at home, rather than having to travel to the main hospital – a journey that is especially problematic for those living off the mainland, as they have to travel by plane.’
As well as focusing on island healthcare connectivity, the Open Skies Cornwall project also involves working with Falmouth Harbour to integrate autonomous drone solutions and enable infrastructure for ship-to-shore delivery, remote healthcare, telemedicine and flying defibrillator applications to support residents and maritime visitors.
Lisa Vipond, pathology services manager at the Trust says that the team sees ‘this project as a complimentary element to our courier system, assisting their challenges.’
A key part of the project is looking at maintaining the validity of samples, and the impact of environmental factors, such as heat, cold, pressure and vibrations on samples transported by drone.
There are plans to do testing flights at the end of this year, but ‘we need to ensure the regulatory and legislative requirements are all in place ahead of this’, says Ms Vipond.
Ms Walsh believes many other areas of the NHS could benefit from drones, including emergency care.
‘Working in the NHS, patient care is at the centre of what you do,’ says Ms Walsh. ‘When you see a solution to gaps in service provision due to elements beyond your control – such as geographical and weather limitations – you want to push that solution forward.
‘We can’t just use this project as a “proof of concept”. We need to embed drone transport within our infrastructure long-term.’
Project CAELUS (Care & Equity – Healthcare Logistics UAS Scotland), aims to develop and trial the UK’s first national distribution network using drones to transport essential medicines, blood, organs and other medical supplies throughout Scotland to eliminate land transport issues.
Led by AGS Airports, it brings together 16 partners, including NHS Scotland and is funded by the UK Research and Innovation Future Flight Challenge and other partners. The consortium has developed a virtual model, or digital twin, of the proposed delivery network, which connects hospitals, pathology laboratories, distribution centres and GP surgeries across the country.
A number of live flight trials are taking place across the country as part of the project. For example, this August, laboratory specimens were flown between NHS Lothian and NHS Borders by drone.
In October, drone technology was used to connect the island community of Arran with the mainland. Further trials are planned in the NHS Highland and NHS Grampian areas of Scotland later in the year.
And the Scottish Ambulance Service has also researched whether a drone could transport defibrillators to the location of a cardiac arrest faster than an ambulance.
Dr Jamie Hogg, clinical lead for Project CALEUS for the north of Scotland and a retired GP, says the team hopes that the use of drones to transport medicines, blood samples and equipment will enable patients living in more rural areas to be ‘treated closer to home and more quickly’.
Requesting quick deliveries of medicines for patients via a drone network would have significant benefit, he says, however, a change in regulations to allow the move from the currently segregated to integrated airspace will be key.
The project ends in December, and then there will be ‘a period of reflection to take in everything that’s been done and decide on next steps’, Dr Hogg explains.
Blood packs have been successfully flown by drone in a series of ‘beyond visual line of sight’ flights, for the first time in the UK.
In a research study to check the viability of flying blood via drone, run jointly by NHS Blood and Transplant (NHSBT) and the medical logistics company Apian, 10 units of packed blood cells were transported on a 68km journey across Northumbria’s skies, while an identical 10 packs were transported concurrently by road.
After assessment, results showed both sets remained viable, with no significant difference in the biochemical or haematological profiles of the blood, which determine if it has maintained quality and can be used for clinical purposes.
‘We’re proud to drive innovation that could improve patient outcomes, and this trial could do exactly that,’ says Mike Wiltshire, component development laboratory manager at NHS Blood and Transplant.
‘Drone travel would be especially useful in transporting items – whether blood packs, blood samples or other – to more remote locations, or via routes that normally suffer from traffic congestion, meaning the products are available for patients faster than they would be by road and ensuring patients are treated as quickly as possible.’
If drones are able to deliver blood products faster, then ‘more patients will be able to be treated or receive results the same day’ than at present, which ‘may reduce patients having to return to the hospital at a different time, should the medicine or test results not be available same day’, Mr Wiltshire adds.
The UK has clear guidelines on the transport of blood components and maintenance of product temperature. ‘We needed to source a suitably sized and specified transport container, along with cool packs, to ensure the temperature of the blood was maintained as required,’ explains Mr Wiltshire.
The number of items and weight that can be transported at any one time is limited by the drone load capacity. Drone operators are therefore exploring different types of drone to determine the best one for the transportation of blood, which may in turn be dependent on the specific requirements of the transport route.
The flying of drones like those used in this study is currently ‘very tightly regulated’ meaning that drones cannot simply fly directly between any given two points – permission must be granted, which may not be guaranteed, depending on the locations in question. ‘Drone operators are looking to overcome this significant challenge for the use of drones for this and many other uses,’ he says.
NHSBT is currently in discussions around a similar trial for platelets, to understand how platelets for transfusion will react to drone transportation and whether their use will be viable in the NHS for this purpose.
The Welsh Blood Service (WBS) is interested in exploring what role drones might play in enabling efficient, sustainable transport of blood products between north and south Wales as well as faster, on-demand delivery of blood products and other medical supplies in rural Wales.
The organisations involved in the Welsh Health Drone Innovation Partnership are the WBS – part of Velindre University NHS Trust –the Welsh Ambulance Service University NHS Trust, Snowdonia Aerospace Centre and the technology company Slink-Tech.
Currently, the partnership is undertaking a foundation study for drone-based blood delivery service between WBS stock holding units at Talbot Green in the south and Wrexham in the north to establish its potential for supporting the Welsh NHS, including specific use cases for the WBS, and to test the basic premise with the Civil Aviation Authority.
‘Drone-based infrastructure has the benefit of not being tied to pre-existing infrastructure on land, which due to geographical constraints has often unintentionally left rural communities underserved,’ says a spokesperson for Velindre University NHS Trust.
‘Drone technology provides the opportunity to tackle inequalities by improving accessibility to communities and regions which may be left behind by traditional logistic infrastructure.’
The primary challenge is to establish ‘a robust business case for early deployment of drone technology to improve the quality and resilience of health and care services in Wales’, the spokesperson adds.
Alan Prosser, the director of the WBS, says: ‘Technology is advancing at pace in this area, and we acknowledge that drone capability still needs to mature in terms of carrying capacity and battery payload before this becomes a viable option for our service.’
The UK isn’t the only country trialling the use of drones to transport medical supplies. In the Netherlands, researchers have investigated the impact of medical drone transport on the stability of monoclonal antibodies (mAbs).
The study findings revealed ‘no significant differences between car and drone transport’, indicating that the stability of mAbs in both vials and infusion bags was adequately maintained during transportation regardless of the mode.
As such, medical drones are ‘a viable and reliable means for the inter-hospital transport of mAbs, paving the way for more efficient and predictable logistics in healthcare delivery’, the authors say.
In fact, the researchers concluded that the integration of drone technology into healthcare logistics ‘has the potential to significantly enhance’ the crucial transport of this treatment type.
With so many ongoing trials and success stories demonstrating the benefits of drone technology in healthcare, the future looks bright, and Professor Anderson says it really does have ‘the potential to ‘revolutionise the way we deliver medical supplies, especially in remote or hard-to-reach areas’.
She is keen to point out, however, that ‘as with any transport around medicines, safety and security must remain a priority’.
The use of drones will ‘undoubtedly increase over the next five to 10 years, for a variety of applications,’ according to Mr Wiltshire. ‘However, there are challenges to overcome – such as restrictions on airspace – before this use is widespread’.
In the meantime, Dr Hogg is encouraging healthcare professionals to ‘think about what they could do if they had drones available to them’ to support patients in accessing vital medical supplies.
‘We are getting to the point where drone transport for medical products could become a reality,’ he says. ‘In three- or four-years’ time, we could be saying to a [resident] doctor: “Can you “drone” this down to Aberdeen?”, and the answer will be: “Yes, sure.”’
7th November 2024
An ‘early warning system’ for future pandemics is to be rolled out in the UK to monitor threats, prevent disease and protect the public, the Department of Health and Social Care (DHSC) has announced.
The surveillance system will be created via the expansion of NHS England’s respiratory metagenomics programme, led by Guys and St Thomas’ NHS Foundation Trust. It uses technology created by life sciences company Oxford Nanopore to analyse genes and pathogens to rapidly diagnose cancers and rare and infectious diseases and match patients with the right treatments within six hours.
The expansion of the programme will also allow potential outbreaks of bacterial or viral diseases to be monitored across the country, alongside antimicrobial resistance.
The technology was initially piloted at St Thomas’ hospital and will be rolled out across 30 NHS sites. Data will be given to the UK Health and Security Agency to allow for quicker detection and action on emerging infectious diseases.
The programme is a partnership between the government, Genomics England, UK Biobank, NHS England and Oxford Nanopore.
Health secretary Wes Streeting said: ‘If we fail to prepare, we should prepare to fail. Our NHS was already on its knees when the pandemic struck, and it was hit harder than any other comparable healthcare system.
‘We cannot let history repeat itself. That’s why this historic partnership with Oxford Nanopore will ensure our world-leading scientists have the latest information on emerging threats at their fingertips.’
Professor Dame Sue Hill, chief scientific officer for England, said: ‘This strategic partnership will build upon our expertise in infectious disease genomics, representing a significant leap forward in our ability to protect public health and save lives.
‘By integrating cutting-edge technology into 30 NHS sites across the country, we are not only enhancing our capacity to rapidly diagnose and treat severe respiratory infections, but also creating a crucial early warning system for new and emerging infectious diseases.’
Professor Susan Hopkins, chief medical advisor at the UK Health Security Agency, said: ‘Enhancing the capacity for the NHS to determine new and emerging pathogens causing severe acute respiratory infections will improve the detection and emergence of infections.
‘As part of the 100 days mission, this will enable the development of effective diagnostics for novel pathogens and enhance our pandemic preparedness.‘
Professor Ian Abbs, chief executive of Guy’s and St Thomas’ NHS Foundation Trust, said: ‘We’ve been working on the respiratory metagenomics programme for over four years and have clearly seen the benefit to our patients. It’s a momentous day now that we can ensure other hospitals, and more patients, can also benefit from faster and more accurate treatment for severe respiratory conditions thanks to new genomic technology.’
A version of this article was originally published by our sister title Healthcare Leader.
6th November 2024
The Royal College of Paediatrics and Child Health’s new ‘landmark’ blueprint is shining a light on what can be done to improve the provision of child health services both on the frontline and with support from the Government. Saša Janković investigates.
Earlier this year, The Academy of Medical Sciences described what it called ‘a crisis in child health’, with the UK ‘failing too many of its children’. And The Children’s Commissioner for England noted that access to children and young people’s healthcare services is a ‘postcode lottery’. Yet while the need for care is rising, the capacity for, and quality of, care is not always keeping up.
NHS Providers points to evidence suggesting children and young people’s services are ‘recovering at a slower rate post Covid-19, in comparison to adult services, impacting on waiting lists and the availability and accessibility of services’.
According to NHS Provider’s ‘Forgotten Generation’ report, in May 2024, 356,200 children and young people were waiting for planned acute care – an increase of 110,000 in just three years. A further 282,000 children and young people were on the community health services waiting list, with 88,900 of this group waiting over 52 weeks.
The latest data for mental health services also paints a concerning picture. The Care Quality Commission’s ‘Monitoring the Mental Health Act in 2022/2023’ report highlights that almost half a million children and young people were waiting for mental health services in November 2023 – a record number that the CQC says had increased by almost 20,000 by January 2024.
The Royal College of Paediatrics and Child Health (RCPCH) has gone further in stating that we are ‘failing a generation of young people’ through a lack of dedicated focus and attention, blaming ‘a decade of chronic underinvestment and lack of national prioritisation in children’s health’.
According to the RCPCH, over three-quarters of respondents to a snapshot poll of its members reported regularly seeing children who have waited over 18 weeks for an appointment, with 83% saying there is not ‘an appropriate level’ of capacity locally to meet demand.
‘The impacts of long waits are as devastating as they are far-reaching,’ says Dr Ronny Cheung, consultant general paediatrician at Evelina London Children’s Hospital, and RCPCH officer for health services. ‘Children and their families are denied child disability payments until seen by a paediatrician. Mild symptoms progressing into much more complicated conditions and a reduced quality of life, school exclusions and wider family stress are impacts that will have life-long consequences and, tragically, are repeated hundreds of thousands of times across the UK.’
In a bid to tackle these issues, the RCPCH’s newly published policy report, entitled ‘From left behind to leading the way: a blueprint for transforming child health services in England’, highlights how the lack of investment in children’s health is having severe consequences. It provides a blueprint which, if taken forward, the Royal College says leaves it ‘hopeful for change’.
The blueprint makes a series of evidence-based recommendations to the new UK Government for change across seven key areas of child health services in funding, workforce, integration, data and digital innovation, urgent and emergency care, community services and primary care. It urges key actions to address the longstanding underinvestment in children’s health services in England built on four national foundations: fair funding, workforce sustainability, improved data systems and prioritisation of children within integrated care systems (ICSs).
Suggestions include developing a child health workforce strategy, introducing a children and young people specific waiting times standard for ICSs, prioritising the development of a digital child health record, and adequately investing in community paediatrics and health visiting and school nursing services.
It also calls for a Children’s Health Investment Standard to address the disparity in funding between adult and child health services and recommends expanding paediatric training posts to ensure a sustainable child health workforce.
One major recommendation in the blueprint is to reduce pressure on urgent and emergency care by embedding paediatric-specific advice and assessment services within NHS 111 – known as Paediatric Clinical Assessment Services. The report says this model has shown significant potential to manage cases earlier, increase self-care rates and reduce emergency department attendances.
Dr Helen Stewart is the RCPCH’s officer for health improvement, as well as a consultant in paediatric emergency medicine at Sheffield Children’s Hospital NHS Foundation Trust, which is one of only three dedicated children’s hospital Trusts in the UK. She says reducing pressure on urgent and emergency care requires properly funded and staffed community services.
‘We get a number of families attending who say they can’t get a GP appointment, and we know primary care is overwhelmed, but there has been a reduction in health visitor numbers as well, so families don’t have anywhere to turn when they are worried and come to the emergency department as a last resort,’ she explains. ‘Then there are young people waiting years for assessments for ADHD across the country and families struggling to access mental health services and so they present to [the emergency department] in crisis.’
A key focus of the RCPCH 2024 blueprint is significant concern around respiratory services, particularly childhood asthma, where the UK has some of the highest emergency admission and death rates in Europe.
To address these issues, the blueprint recommends several key actions, including the expansion of structured asthma care reviews delivered in both primary and secondary care settings, to ensure every child has a personalised asthma action plan and access to specialist support when needed.
Additionally, the report stresses the importance of improving the availability of community-based asthma management services, which can reduce pressure on emergency departments. Another key recommendation is to standardise the approach to early intervention, particularly in schools and community settings, to identify and manage early signs of poorly controlled asthma, thus preventing avoidable flare-ups and hospital visits.
To this end, Amanda Allard, co-chair of the Children and Young People’s Health Policy Influencing Group and director of the Council for Disabled Children, says improvements in information sharing across agencies – for example schools, children’s social care services and the health system – have proven to be ‘essential’ to safeguard children’s health outcomes, wellbeing and safety, but more work needs to be done to optimise this.
‘At the moment, little communication between these services often means not all necessary information is shared about a child who then may not get the care they require,’ she says. ‘More information sharing, as well as using a single child identifier – such as a child’s NHS number – across agencies will significantly improve health outcomes for children and young people, as well as have other positive effects on other aspects of their care and wellbeing. And we also need to improve the quality of the data that we are sharing [otherwise] commissioners don’t have a complete picture of need when they are planning services.’
On the subject of cross-sector integration, Ms Allard adds: ‘We would like to see health professionals working more closely with colleagues in primary care and other agencies such as education and social care to support those colleagues in meeting lower-level needs without the need for referral to secondary care. There are some brilliant examples of this happening such as the Balanced System and Connecting Care for Children. We need these to become universally available.’
NHS Providers is also calling for a cross-government plan to improve the wellbeing of children and young people, with its outgoing CEO Sir Julian Hartley saying that Trusts are ‘ready to play their part in making things better for children and young people’.
But he also stresses that ‘it will require concerted, joined-up working between Trusts, Government, NHS England and local partners including councils, schools and the voluntary sector.’
From Ms Allard’s perspective, ‘the Darzi review acknowledges that “the patient voice is simply not loud enough”, so more must be done to listen to the voices of children, young people and their families, for example by including them in the co-production of guidelines and policies.’
Since most change is reliant on Government funding and top-down approaches, the RCPCH report says if the new UK Government is serious about improving the health of children and young people to raise the healthiest generation of children in our history, then the children’s health workforce needs ‘greater support and changes are needed at a national level to restore and improve health services for children’.
Until there’s movement on this, there are ways in which clinicians and other healthcare professionals in both secondary and primary care can bolster their support for children’s health. According to Dr Stewart, one such way to achieve this is to hone in on ‘the approach that every contact counts’. This, she says, is particularly important as ‘it can be hard for families, especially those in difficult socioeconomic circumstances, to access healthcare – for instance if they are in insecure employment, it’s hard to take a day off work.’
As such, making every contact count can streamline access to healthcare information and make a positive difference to children and their families. ‘If healthcare professionals were able to signpost to relevant services and address other things in their consultations that would be very helpful – such as are vaccinations up to date, healthy eating advice, mental health support – a lot of these only take a very short conversation and some information about where they can access support,’ Dr Stewart says. ‘It can be hard to do when you are really busy but each time we do it, [we] might be helping a family in an important way.’
5th November 2024
The Government has introduced ‘historic’ legislation to phase out smoking among young people, extend the smoking ban to outdoor spaces, and clamp down on vaping.
The Tobacco and Vapes Bill, introduced in Parliament, will ‘create a smokefree generation’ by banning the sale of tobacco products across the UK to anyone aged 15 or younger this year.
Legislation for this same ban was first introduced under the previous Conservative Government but did not progress after the election was called, with the new Labour Government confirming over the summer that it will proceed with similar laws including new additions to strengthen the bill.
As part of the new bill, the Government will ‘be given powers’ to extend the current indoor smoking ban to specified outdoor spaces, which could include children’s playgrounds and outside schools and hospitals, subject to consultation.
However, the announcement confirmed that the Government has decided against pursuing plans floated earlier this year to ban smoking in outdoor hospitality areas including nightclubs and sports venues,
To tackle vaping, the new legislation will ban advertising and sponsorship of vape products, and give the Government powers to ‘restrict flavours, display and packaging’.
This follows a recently-announced ban on disposable vapes, which will come into force from June next year under separate laws.
The Government is particularly focused on preventing youth vaping, with the Department of Health and Social Care (DHSC) citing figures showing that a quarter of 11- to 15-year-olds tried vaping in 2023.
Current restrictions on smoke-free areas may also be extended to become ‘vape free’, with a focus on areas where there are children and young adults.
The new legislation will allow the Government to introduce a licensing scheme to sell tobacco, vape and nicotine products in England, Wales and Northern Ireland, as well as ‘on the spot fines’ of £200 for retailers found to be selling these products to people underage.
Health secretary Wes Streeting said the Government is taking ‘bold action’ to create a smoke free generation, to ‘clamp down’ on vaping, and to protect children from the ‘harms of second-hand smoke’.
He added: ‘This historic legislation will save thousands of lives and protect the NHS. By building a healthy society, we will also help to build a healthy economy, with fewer people off work sick.’
Chief medical officer Professor Chris Whitty said that a ‘smokefree country’ would prevent disease, disability and premature deaths for future generations.
He continued: ‘The rising numbers of children vaping is a major concern and the Tobacco and Vapes Bill will help prevent marketing vapes to children, which is utterly unacceptable.
‘This is a major piece of legislation which if passed will have a positive and lasting impact on the health of the nation.’
The BMA ‘welcomed’ the new measures on smoking and vaping, in response to the bill’s introduction in Parliament, following its calls for a ban on disposable and non-tobacco flavoured vapes in August.
Chair of the union’s Board of Science Professor David Strain said the new measures are a ‘significant step forward’ to creating healthier environments for the populations while also reducing the burden on the NHS.
He added: ‘But we also need to see the detail of the Government’s consultations on these measures to make sure they can, in reality, deliver what Ministers are promising they can and alongside these new measures, there is an urgent need for investment in the smoking cessation services to help smokers quit.
‘Bringing in more stringent rules to stop people smoking and vaping will lead to a healthier population but for those who are still smoking, many will need support to stop and that means greater investment in the services and staff to give that support.’
Professor Lion Shahab, director of the University College London tobacco and alcohol research group, said the bill includes ‘a number of world-leading measures’, highlighting in particular the ban on smoking for future generations.
‘If parliament passes this new bill, it would put the UK at the very forefront of the fight to eradicate one of the most harmful inventions of modern times and protect the future of the next generation to allow them to live a full life, unencumbered by entirely preventable cancer, cardiovascular and pulmonary disease,’ he said.
But on vaping, he said that ‘legislation to protect youth has to be balanced with the need to support smokers to quit, including with e-cigarettes’, and that the Government must ‘monitor unintended consequences’ of the bill.
A version of this article was originally published by our sister publication Pulse.
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