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3rd February 2023
Depression and poor mental health among young adults is more likely to lead to premature cardiovascular disease (CVD) and suboptimal cardiovascular health according to the findings of a large study of US adults by US and UK researchers.
A worrying trend over the past 20 years is the observed increase in the prevalence of recognised cardiovascular disease risk factors e.g., obesity, physical inactivity and a poor diet, among younger individuals in developed countries. Moreover, though not considered as a traditional CVD risk factor, the American Heart Association accepts that depression should be considered as a risk factor for adverse outcomes in patients with acute coronary syndrome. But to what extent does the presence of depression or even poor mental health, affect the risk of CVD among younger adults was the subject of the current study.
Researchers used data from the behavioural risk factor surveillance system which includes a nationally representative sample of non-institutionalised adults. The system assesses health-related risk behaviours and chronic health conditions, based on an annual telephone survey. The research team collected data on self-reported depression and poor mental health days (PMHDs), as well as CVD and suboptimal cardiovascular (CV) health, based on recognised risk factors, e.g., smoking, physical inactivity. In addition, self-reported PMHDs were categorised as 0, 1 – 13 or 14 to 30.
Depression and risk of premature cardiovascular disease
In total, data were collected from 593,616 with a mean age of 34.7 years (50.3% male).
The prevalence of depression was 19.6% and 2.5% for CVD. The researchers calculated that those with depression had a much higher odds of CVD compared to those without the condition (odds ratio, OR = 2.32, 95% CI 2.13 – 2.51). There was also a graded increased risk of CVD, depending on the number of reported PMHDs rising from an odds ratio of 1.48 (1 to 13 days) to 2.29 (14 to 30 days). These estimates were unaffected by gender or individual’s status (rural or urban). Suboptimal cardiovascular health was also higher among those with depression (OR = 1.79) and a similar graded relationship observed based on the number of PMHDs.
The authors concluded that based on their findings, prioritising mental health might help to reduce CVD risk and improve cardiovascular health in young adults.
Citation
Kwapong YA et al. Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States. J Am Heart Assoc 2023
Andreas Reif is Head of the Department of Psychiatry, Psychosomatic Medicine and Psychotherapy at the University Hospital, Frankfurt. He spoke to Rod Tucker about treatment-resistant depression and innovations in the management of the condition.
Andreas Reif’s main clinical areas of interest are mood disorders with a focus on bipolar disorders, suicidality, therapy-resistant depression and adult ADHD. From a research perspective, he is interested in personalised medicine in psychiatry as well as the neurobiology of mental disorders, with a focus on improving diagnosis and treatment. He was involved in establishing the German National Centre for Affective Disorders and sits on its board of directors.
Professor Reif described how the main reason for establishing the national centre (along with seven other institutions in Germany) was to ‘create a research and clinical studies network of centres of excellence for mood disorders.’ He believed that such a network was lacking in Germany, especially considering how ‘depression is the most prevalent disorder in the field of psychiatry and there are only a few hospitals that really specialise in mood disorders.’
The overarching aim he felt, was really to bring together existing expertise in the fields of neurostimulation, neuroimaging, genetics and psychopharmacology and therefore ‘create a network that leverages existing studies that are able to build up cohorts for research purposes as well as providing an existing network for both academic and industry sponsored studies on mood disorders in a larger network.’
Professor Reif described how unfortunately there is no single universally accepted definition, though existing ones are similar and vary slightly. He mentioned that the current definition used for regulatory purposes is ‘the failure of two antidepressant treatments that have been provided with an adequate dose and duration.’ This he explained was a rephrasing of the criteria for treatment-resistant schizophrenia which was used after the introduction of clozapine.
Despite this somewhat straight forward definition, Professor Reif noted that in practice, it was more difficult to interpret. For instance, non-medical treatments such as psychotherapy, and CBT are not included and there was some uncertainty over what constituted an adequate dose and duration of treatment. As he said, the current definition ‘gets messier and messier the longer you think about it.’ Nevertheless, he feels that at least two-thirds of the patients he sees in outpatient clinics have treatment-resistant depression.
In contrast, there are others who have been suboptimally managed with either an inadequate dose of treatment or the way in which the drug had been used was not guideline compliant. Fortunately, in such cases, treatment could be easily modified and patients discharged back into primary care.
Professor Reif thinks that there is still much to be learnt about the underlying causes of treatment-resistant depression. He mentioned how there was a known relationship with certain factors such as ‘co-morbidity with anxiety disorder, ADHD, early onset depression, melancholic features such as early suicide attempts,’ however, but these were merely associated risk factors and not causative.
Delving into the neurobiology has also failed to provide satisfactory explanations, particularly in relation to genetics, with no obvious differences between those who have can be considered to have regular depression and those who eventually display treatment-resistant depression. It has been postulated that there is some degree of neurological imbalance between pro-inflammatory and anti-inflammatory markers or a disturbance in the connections between the limbic system and the prefrontal cortex.
Nevertheless, he thinks that a better understanding of possible mechanisms would arise from prospective studies that followed up on depressed patients and to identify those who enter remission and those who go on to become treatment-resistant, though sadly, there is an absence of such studies. Although inadequate adherence may be a factor in treatment-resistant depression, this could easily be identified with therapeutic drug monitoring.
Professor Reif feels that the burden upon both the individual and healthcare systems is enormous. Treatment-resistant patients have a higher level of hospitalisations and suicide attempts but there is also an economic impact. As he said, ‘individually, often these patients are unable to work or work with reduced ability’ and there is a high level of unemployment combined with a huge negative impact on their quality of life.
Currently, there are several recommended approaches. First, the patient’s existing therapy can be augmented with an atypical antipsychotic such as quetiapine or lithium. Another approach is to combine an SSRI or SNRI or a tricyclic with mirtazapine or trazadone. Treatment switches can also be effective but this is only recommended once. For instance, if patients have already been changed from an SSRI to a SNRI, there is no benefit from any further switches. Both transcranial magnetic stimulation or ECT have also been used and in some cases prove to be very effective. Finally, the addition of psychotherapy to the current medical treatment can also be tried.
Professor Reif said that the efficacy of these approaches, at least from an examination of the current evidence, is that between 20% to a third of patients should be helped. He is not overly convinced by these figures but this probably reflects how in practice he deals with more severely ill patients. Despite this, he does believe that with the combination of high-density psychotherapy, optimised medical treatment and neuro-stimulatory techniques, ‘over 90% of patients will ultimately remit.’ For those patients who fail to remit with such combination therapy, he thinks that experimental approaches such as deep brain stimulation or invasive vagus nerve stimulation are likely to be more successful.
Professor Reif mentioned the ESCAPE-TRD study in which nasal esketamine was compared to augmentation therapy with extended-release quetiapine in patients with treatment-resistant depression. Esketamine represents a first-in-class treatment targeting the glutamate system although Professor Reif had already been using the drug experimentally at his centre for severely ill patients and found it to be very effective.
While there were studies demonstrating that esketamine was effective, esketamine had only been compared to placebo plus newly initiated oral antidepressants, hence it has not been possible to determine whether it is more effective than any of the existing therapies. As he said, ESCAPE-TRD was really the first head-to-head study comparing esketamine with an active treatment, a move he thinks was ‘quite brave for Janssen because they could have failed.’ ESCAPE-TRD was conducted over 32 weeks and which he says, was a sufficiently long time to determine its effectiveness.
He described how the study found that ‘esketamine was significantly better in all outcomes but most importantly, met its primary outcome of remission at week eight in an acute setting.’ In fact, there was an almost 10% difference in the remission rate compared to quetiapine.
A further and relevant finding was in relation to the main secondary outcome, which found that a significantly higher proportion of patients given esketamine, who achieved remission achieved at week eight, maintained relapse free through to week 32. When asked to summarise the findings, he said that the overall conclusion was that ‘esketamine was superior to quetiapine in achieving remission in treatment-resistant depression.’
Professor Reif thinks that much more needs to be achieved in the management of treatment-resistant depression and believes that there are at least three initial steps required. Perhaps the immediate priority, he feels, is to ensure access to esketamine given how currently, few centres provide the drug.
Secondly, with only around a quarter of patients achieving remission after eight weeks, it was necessary to explore the development of relevant biomarkers, to identify those patients likely to respond, since this was impossible from a clinical perspective.
Thirdly, is the acknowledgement that depression is actually a heterogenous disorder with many underlying pathologies and the introduction of a wide range of therapies, affecting different biochemical pathways, would enable the treatment of a higher number of patients.
Finally, Professor Reif believes that a wider adoption of esketamine is needed, together with its incorporation into management algorithms. While accepting that the drug is not a panacea, he says that it represents a valuable addition to psychiatry’s therapeutic armamentarium and is hopeful that because of this innovation, the pharmaceutical industry will be spurred on to develop more effective treatments in psychiatry.
Delaying the use of catheter ablation for those with atrial fibrillation (AF) and or heart heart failure, leads to worse cardiovascular outcomes such as mortality, stroke and AF recurrence according to an analysis by US researchers.
AF is the most clinically significant arrhythmia in practice, affecting between 1 and 3% of the population though this rises to 17% in those 80 years of age and older. AF often co-exists with heart failure and the presence of both conditions, exerts a major detrimental effect on patient’s cardiovascular health and overall wellbeing. Atrial fibrillation can be managed medically with anti-arrhythmic drugs although catheter ablation therapy is also an option. However, a recent study has indicated that among AF patients with stable heart failure, the use of catheter ablation was superior, with respect to survival, freedom from AF recurrence and quality of when compared to drug treatment. With clearly beneficial effects from ablation therapy, one unanswered question is when the ablation should be undertaken in relation to the AF diagnosis. In other words, might delaying catheter ablation, affect the subsequent risk of death or other outcomes such as hospitalisation for heart failure. In a 2013 study, researchers found that delaying ablation worsened the success of the procedure. Moreover, does the impact of any delay affect patients with differing levels of heart failure, based on the extent of left ventricular dysfunction? This was the subject of the current study by the US team.
Researchers studied patients with at least 12 months follow-up data following their ablation procedure and who were then stratified based on their ejection fraction as either < 35% or > 35%. The team then compared several adverse outcomes such as mortality, heart failure (HF) hospitalisation and AF recurrence in relation to the delay between the initial AF diagnosis and the time of ablation. These delays were categorised as 30 – 180 days, 181 – 454 days, 546 – 1825 days or > 1825 days.
Catheter ablation delay and adverse outcomes
Data were available for 9,979 patients with the overall time delay between diagnosis and the first ablation being a median of 2 years and this figure was not significantly different between the two categories of ejection fraction (p = 0.66).
When considering patients with an ejection fraction > 35%, a delay of 181 – 545 days (compared to 30 – 180 days) was associated with a significantly higher mortality risk (hazard ratio, HR = 2.02 (95% CI 1.38 – 2.96) and this risk was more than double, among those waiting longer than 1825 days (HR = 4.39). In addition, there were elevated risks for HF hospitalisations and AF recurrence incurred by delaying ablation therapy.
Among those with an ejection fraction < 35%, there were also elevated risks of mortality, HF hospitalisation and AF recurrence associated with ablation delays, e.g. HR = 3.77 for mortality.
The authors concluded that catheter ablation delays among those with AF increased the risks for adverse events in patients either with or without structural heart disease, highlighting the need for earlier ablation therapy.
Citation
Sessions AJ et al. Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes in patients with and without structural heart disease. J Cardiovasc Electrophysiol 2023
2nd February 2023
Moderna has announced that mRNA-1345, its investigational vaccine, met its primary endpoint and demonstrated a high vaccine efficacy against RSV-associated lower respiratory tract disease and which was defined by two or more, as well as three or more, symptoms.
The ConquerRSV trial is a randomised, double-blind trial, designed to evaluate the safety and tolerability of the mRNA-1345 vaccine. The study sought to demonstrate the efficacy of a single vaccine dose in the prevention of a first episode of RSV-associated lower respiratory tract disease when compared to placebo, 14 days after vaccination, through to 12 months. In a site dedicated to the study, individuals are invited to screen for inclusion, highlighting how in the US alone, the virus causes 14,000 annual deaths.
ConquerRSV was reported to have recruited more than 37,000 adults 60 years of age and older. The study’s primary efficacy endpoints were based on two definitions of RSV-lower respiratory tract disease with either two or three or more symptoms.
According to Moderna, the efficacy of the vaccine was 83.7% (95% CI 66.1 – 92.2%, p < 0.0001) against RVS-associated disease as defined by two or more symptoms. The reported interim analysis was based on a total of 64 cases, 55 of which occurred in those given placebo. In addition, there were 20 cases of RSV-associated lower respiratory tract infections where patients presented with 3 or more symptoms, of which only 3 occurred in patients given the vaccine. This gave a vaccine efficacy of 82.4% (95% CI 34.8 to 95.3%, p = 0.0078) against RSV-associated disease with 3 or more symptoms.
An analysis of safety data showed that mRNA-1345 was well tolerated and there were no safety concerns identified, although this will continue to be monitored as the trial progresses. Commonly reported adverse effects were generally mild to moderate in severity e.g., injection site pain, fatigue, headache, myalgia and arthralgia. In fact, only 4% of systemic adverse reactions reported for the vaccine were grade 3 or higher (i.e., severe) and overall, there were only 3.2% of localised adverse reactions, at grade 3 or above.
Moderna also announced that these findings will be submitted for publication and presented at an upcoming conference and hope to submit all the data for regulatory approval in the first half of 2023.
1st February 2023
The incidence of sudden cardiac arrest (SCA) among older adults during sporting activities is low and not related to either co-morbidities or cardiovascular risk factors in comparison to non-exercising sudden arrests according to the findings of a prospective study by US researchers.
Sudden cardiac death is due to a cardiovascular cause and occurs within one hour of symptom onset. While possible triggers include factors such as vigorous exercise, interestingly, habitual vigorous exercise appears to reduce the risk of such deaths.
In other work focusing on middle-aged people engaging in sporting activities, it was has found that the level of sudden cardiac arrests is relatively low illustrating the high-benefit, low-risk of sporting activities in such individuals.
However, there is lack of studies examining the incidence of SCA among older adults who participate in sporting activities.
In the current study, researchers turned to two large prospective US studies to more closely examine the incidence of SCA among adults 65 years of age and older.
They identified information on the presence of any potential warning signs prior to the arrest, the circumstances under which the arrest occurred and collected detailed information on the patient’s clinical history.
They defined a SCA as occurring either during or within one hour of stopping a sporting activity and compared the incidence to sudden arrests that occurred among older adults but who were not exercising.
Data were available for 1.85 million individuals and there were a total of 4,078 SCAs among those aged 65 and older (1.9%) and of these, 77 occurred during exercise, with 91% of cases in men, mainly during cycling, gym activity and running.
When comparing SCAs among those who exercised to non-exercising controls, individuals whose arrest happened while exercising had a significantly lower burden of cardiovascular risk factors such as hypertension (e.g., 57.8% vs 80.1%), diabetes or obesity (p = 0.03) and co-morbidities such as asthma or COPD (p < 0.005).
Interestingly, only 26% of those with a SCA during exercise had prior warning signs, mainly chest pain (55%) in the 24 hours before the arrest. Moreover, survival was higher among the exercise group compared to the non-exercising group (43.8% vs 11.1%).
The authors concluded that the risk of a sudden cardiac arrest was uncommon among older adults and probably outweighed by the benefits of exercise.
Citation
Holmstrom L et al. Sudden Cardiac Arrest During Sports Activity in Older Adults. JACC Clin. Electrophysiol 2023.
Danish and UK researchers examining data from the Copenhagen General Population Study, have determined that higher LDL triglyceride levels are linked to an elevated risk of atherosclerotic cardiovascular (ASCV) disease and its components such as myocardial infarction, ischaemic stroke and peripheral artery disease.
It is well recognised that a higher low-density lipoprotein (LDL) level is directly linked with the development of ASCV. Moreover, it has previously been shown that LDL contains a mixture of phospholipids, cholesterol and its esters and around 6% triglycerides. However, the role of triglycerides in ASCV has achieved much less attention in comparison to LDL, possibly because of a lack of randomised, clinical trial evidence.
As a result, in the current study, researchers wanted to better understand the potential role of LDL triglycerides (LDLT) in the development of ASCV and hypothesised that it was likely that higher LDLT levels would in fact be linked to greater risk of ASCV. The team used data obtained in the Copenhagen Population study, in which the lipid levels were measured in nearly 70,000 patients, either by a direct assay or from assessment by nuclear magnetic resonance. The researchers then performed a meta-analysis incorporating their findings from the Copenhagen study with previous studies.
LDL triglycerides and atherosclerotic cardiovascular disease
Levels of LDLT had been measured via a direct assay in 38,081 individuals and by NMR in 30,208 and who were followed for a median of 3 and 9.2 years respectively.
Using the results from measurement of LDLT direct assay, researchers calculated that for every 0.1mmol/l increase in LDLT, there was a 26% higher risk of ASCV (hazard ratio, HR = 1.26, 95% CI 1.17 – 1.35). The risks were similarly elevated for ischaemic heart disease (HR = 1.27), myocardial infarction (HR = 1.28), ischaemic stroke (HR = 1.22) and slightly higher for peripheral artery disease (HR = 1.38). Using the NMR-derived data gave rise to similar elevated risks for ASCV and its components.
When these results were included into the meta-analysis, giving a total participant population in excess of 110,000, a comparison of the highest to lowest LDLT quartile, revealed a risk ratio (RR) for ASCV of 1.5 (95% CI 1.35 – 1.66). Again, the risk ratios were also significantly elevated for ASCV components.
The authors concluded that elevated LDLT were robustly associated with an increased risk of ASCV and its components.
Citation
Balling M et al. Elevated LDL Triglycerides and Atherosclerotic Risk. Am J Coll Cardiol 2023
In a study published in Science Advances, researchers from the Institute of Cancer research in London, have identified how cancer cells can either shrink or become super sized as a means of survival, in the face of drug treatment or any other challenges that might occur within their environment.
Although it is acknowledged that there are differences in the size of cell types, there is also a recognition that for proliferating cell types, there is little variation in cell size. This implies that there is some mechanism or checkpoint, responsible for ensuring that cells maintain a particular size during the proliferative phase. Clearly, this checkpoint is disturbed in cancer and it is known that cancers will arise due to the accumulation of mutations in genes and which alter the normal proliferation, differentiation and death process.
In the current study, researchers used a combination of biochemical profiling and mathematical analyses, to examine how genetic changes affect the size of cancer cells. They focused on skin melanoma cells which are known to be driven by two genetic mutations, a BRAF gene (60%) and an NRAS mutation (20 – 30%) and examined differences in the size and shape of these cells with the two mutations.
Interestingly, the team found that BRAF-mutant cancer cells were very small, whereas NRAS-mutant cells were much bigger and larger still, when the cells were drug resistant. It seemed that small cells were able to better tolerate DNA damage, due to high concentrations of DNA repair proteins such as PARP, BRCA1 or ATM1.
The researchers believed that their findings might help clinicians to decide upon the choice of treatment. For instance, small cells were likely be more vulnerable to PARP inhibitors, i.e., drugs affecting the proteins responsible for DNA repair. In contrast, the larger NRAS-mutant cells, already had lots of DNA damage, which the cells were unable to repair and hence unlikely to respond well to PARP inhibitors, whereas immunotherapy might be a better option. The team think that both the BRAF and NRAS mutations may cause changes in cell size by affecting levels of a protein known as CCND1, which is involved in cell division, growth and maintenance of the cytoskeleton, as well as its interactions with other proteins.
Commenting on the study, lead author, Professor Chris Bakal, from the Institute of Cancer research, said ‘Cancer cells can shrink or grow to enhance their ability to repair or contain DNA damage, and that in turn can make them resistant to certain treatments.’ He added that the study had a potential diagnostic value. For instance, ‘by looking at cell size, pathologists could predict whether a drug will work, or if the cells will be resistant. In the future, it might even be possible to use AI to help guide the pathologist, by making a rapid assessment about the size of cells and so the treatments that are most likely to work.’
Using a single low-dose computed tomography scan and a deep learning model enabled predictions of lung cancer risk over one to six years.
US and Taiwanese researchers have shown that the use of a single low-dose computed tomography (CT) scan, together with a deep learning algorithm, allows for a prediction of an individual’s risk of lung cancer over the next six years.
The use of low-dose CT screening has been shown to reduce mortality from lung cancer. Such screening allows for the early detection of the disease and hence the potential for better patient outcomes, although it has been suggested that the current screening guidelines might overlook vulnerable populations with a disproportionate lung cancer burden.
Nevertheless, the efficiency of lung cancer screening could be improved by individualising the assessment of future cancer risk. The problem is determining how this can achieved. To date, there are some data to support the use of clinical risk assessment models that incorporate various factors compared to simply using age and cumulative smoking exposure.
However, there are enormous possibilities created by greater use of artificial intelligence and deep learning models. In fact, it has become possible to utilise low-dose CT scan results and the presence of pulmonary nodules, into a model and to therefore optimise the screening process. But how useful are other pieces of information gathered from a CT scan beyond the presence of nodules, and could this other information be used by a deep learning model to predict future cancer risk?
This was the aim of the current study in which researchers developed a model, which they termed ‘Sybil’ using the entire volumetric low-dose CT data, without clinical and demographic information, to predict an individual’s future cancer risk.
Sybil was able to run in the background of a radiology reading station and did not require annotation by a radiologist. The model was validated using information from three independent screening datasets which included individuals who were non-smokers.
In total, data were retrieved from over 27,000 patients held in three separate databases. Sybil achieved an area under the curve (AUC) of 0.92, 0.86 and 0.94, for the one-year prediction of lung cancer for each of these datasets. In addition, the concordance indices over six years were 0.75, 0.81 and 0.80 for the same three data sets.
The authors concluded that Sybil was able to accurately predict individual’s future risk of lung cancer based on a single low-dose CT scan and called for further studies to better understand Sybil’s clinical application.
Citation
Mikheal PG et al. Sybil: a validated Deep learning model to predict future lung cancer risk from a single low-dose chest computed tomography. Clin Oncol 2023.
Yescarta (axicabtagene ciloleucel) is a CAR-T cell therapy that has been approved by for use by NICE in adult patients with relapsed or refractory diffuse large-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL) who have already received two or more lines of systemic treatment.
Chimeric antigen receptor T-cell (CAR-T) therapy is a form of personalised immunotherapy that utilises the patient’s own immune which are modified and designed to destroy cancer cells. DLBCL is a non-Hodgkin lymphoma (NHL) and while in the UK alone, there are around 14,200 annual cases of the NHL DLBCL accounts for around 40% of all NHL cases or roughly 5,500 patients. In contrast, PMBCL is much rarer, accounting for 2 to 4 % of all NHL cases (around 330 cases in the UK).
Following initial chemotherapy, up to 45% of those with DLBCL require a second-line treatment such as a stem cell transplant and of these, around 50% ultimately relapse. Moreover, it has been estimated that only 60% of patients will survive for longer than 5 years after their diagnosis.
The decision to approve yescarta was based information from the cancer drugs fund, which showed that a total of 318 patients received treatment and showed a median overall survival of those given axicabtagene ciloleucel was 28.5 months and 45% of people were alive after three years.
The full guidance issued by NICE is expected to the published at the end of February 2023.
31st January 2023
NHS 111 will be expanded offering greater access to specialist paediatric advice and urgent mental health support.
The UK Government said that urgent care provided in the community will be expanded to ensure ‘people can get the care they need at home,’ without the need for a hospital admission and that the measures will be ‘aligned with priorities for primary care,’ including the forthcoming GP access recovery plan and the implementation of the Fuller stocktake report.
The two-year delivery plan for recovery announced today comes amid ‘record demand for NHS services’ and promises ‘boosted frontline capacity’, with 800 new ambulances, including 100 mental health vehicles and 5,000 more hospital beds, backed by a £1bn fund.
The new plans will see an increased number of clinicians – including retired staff and returners – working in NHS 111.
The services will run for at least 12 hours a day – responding to calls normally requiring an ambulance crew – and will mean people who have fallen or are injured can get care and treatment at home within two hours.
Parents and carers seeking health advice for children and young people using NHS 111 will have increased access to specialist advice, including support from paediatric clinicians who can help them manage illness at home or decide the best route for their care.
This will see some children referred directly to a same-day appointment with a specialist rather than attending A&E, which NHS England said would avoid unnecessary hospital admissions.
Direct access to urgent mental health support using NHS 111 is also being rolled out with people being able to select the mental health option when they call up for help.
NHS 111 will also be integrated into the NHS app to make it even easier for people to use, the plan said.
Same day emergency care units, staffed by consultants and nurses, will be open in every hospital with a major A&E, allowing thousands of people to avoid an overnight hospital stay.
The plans will also see a new scheme embedding family support workers across selected A&E sites – with at least one in every region – to provide support to children with non-urgent issues.
Amanda Pritchard, the NHS chief executive, said: ‘The NHS has experienced the start of a winter like no other – the threat of the flu and covid ‘twindemic’ became a reality and that was alongside huge demand for all services – from ambulance and A&E services to mental health and GP appointments.
Health secretary Steve Barclay said: ‘Every day of every week, tens of thousands of people receive safe, high-quality urgent and emergency care. However, with the NHS under unprecedented pressure from high Covid and flu cases and the backlog from the pandemic, too many people are waiting too long in A&E or for ambulances. ‘Today’s plan which is backed by record investment aims to rapidly cut waiting times, helping to deliver on one of the Government’s five priorities, while giving patients the confidence that health and social care services will be there for them when they need them.
This article first appeared in our sister publication Pulse.
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