Government promises clinical trials boost ahead of 10-Year Plan announcement

By Integrated Care Journal

The government is pledging to increase access to clinical trials for millions under its Plan for Change, which will eventually see NHS App notify users of clinical trials based on their health data and interests.

The government has pledged to increase access to clinical trials for millions as part of its drive to modernise patient care in the NHS and drive economic growth. The Plan for Change, set to be released as part of the upcoming 10-Year Health Plan, will enable NHS App users to browse and find trials suited their needs and interests, via the NIHR Be Part of Research service on the App.

The plan also aims to increase access to new treatments by accelerating trial set-up times and turning the UK into a ‘hotbed of innovation’. Through the App, public reporting will show which NHS trusts are delivering on trials and which area falling behind, with future funding set to be prioritised for the best performing trusts.

Eventually the plan will see the NHS App automatically match patients with studies based on their own health data and interests, sending push notifications to users’ phone about relevant new trials to sign up to.

It comes as the National Institute for Health and Care Research (NIHR) launches a UK-wide recruitment drive for clinical trials – the biggest ever health research campaign – to get as many people involved in research as possible. Adults across the UK are being urged to register, with underrepresented groups including young people, Black people and people of South Asian heritage particularly encouraged to sign up, at bepartofresearch.uk.

The 10-Year Health Plan will aim to bring transparency over which NHS trusts are performing well in clinical trials, and which are not. All NHS trusts and organisations will need to submit data on the number of trials being conducted and the amount of progress being made.

Public reporting will show the number of trials sponsored by both commercial and non-commercial sponsors at specific trusts and other organisations, including universities or primary care sites. It will reveal to the government, patients, investors, and Trust boards which NHS organisations are performing well and which are falling behind. Government investment will only be prioritised for the Trusts that can prove they can support the NHS to deliver the treatments of tomorrow.

Health and Social Care Secretary, Wes Streeting, said: “The UK has been at the forefront of scientific and medical discovery throughout our history. Some country will lead the charge in the emerging revolution in life sciences, and why shouldn’t it be Britain?

“The 10-Year plan for health will marry the genius of our country’s leading scientific minds, with the care and compassion of our health service, to put NHS patients at the front of the queue for new cutting-edge treatments.”

In recent years, the UK has fallen behind as a global destination for these trials, with patients and the wider economy missing out. It takes around 100 days to set up a trial in Spain, but around 250 days in the NHS. The plan will see commercial clinical trial set-up times fall to 150 days or less by March 2026 – this will be the most ambitious reduction in trial set-up times in British history.

The government is now pledging to cut set up times for clinical trials. Currently, trials have to agree separate contracts with each part of the NHS they want to be involved. The plan will introduce a national standardised contract which can save months of wasted time, as well as simplifying paperwork to remove duplication on technical assurances.

This means if any authority asks for evidence from a study, they can provide it once without having to spend time reframing that evidence differently to meet a separate criteria for another authority.

In the coming weeks, the government will publish its 10-Year Health Plan. The plan aims to restore the UK’s position as a world leader in clinical trials, enabling it to attract global talent and drive investment into the UK. The government hopes that this will spur economic growth, improve the standard of care to support a healthier population, and make the NHS more financially sustainable.

Professor Lucy Chappell, Chief Scientific Adviser at the Department of Health and Social Care (DHSC) and Chief Executive Officer of the NIHR said: “We know the benefits of embedding clinical research across the NHS and beyond. It leads to better care for patients, more opportunities for our workforce and provides a huge economic benefit for our health and care system. Integrated into the NHS App, the NIHR Be Part of Research service enables members of the public to be matched to vital trials, ensuring the best and latest treatments and care get to the NHS quicker.

“Ensuring all sites are consistently meeting the 150-day or less set-up time will bring us to the starting line, but together we aim to go further, faster to ensure the UK is a global destination for clinical research to improve the health and wealth of the nation.”

Dr Vin Diwakar, Clinical Transformation Director at NHS England, said: “The NHS App is transforming how people manage their healthcare, with new features letting them see their test results or check when prescriptions are ready to collect – all at the tap of a screen.

“We’re making it easier to sign up for clinical trials through the NHS App so patients can access new treatments and technologies earlier, improving their quality of care.

“The Medicines and Healthcare products Regulatory Agency (MHRA) – which makes sure that medicines and healthcare products available in the UK are safe and effective – has already improved its performance.”

Nicola Perrin, Chief Executive of the Association of Medical Research Charities, commented: “Clinical trials are good for patients, the NHS and the economy. But both commercial and non-commercial trials in the UK have closed because of failures to recruit.

“It’s encouraging to see the government recognise that boosting access to clinical trials must be a key part of the 10 Year Health Plan. Transforming clinical trials is an important step in truly embedding research in the NHS, securing the UK’s position as a leader in life sciences and offering a lifeline to patients.”

From diagnosis to remission: Delivering results at scale with T2DR

By Keren Miller

Diabetes and obesity cases in the UK are rising rapidly, putting increasing pressure on health and care services. But supported digital self-management tools are delivering measurable results, helping patients lose weight, increase physical activity, and in many cases, achieve remission, writes Keren Miller, Clinical Lead Dietitian for Diabetes and Diabetes Remission at Oviva.

Obesity and type 2 diabetes are among the most pressing health issues facing the UK. Today, around 12.5 million UK adults are estimates as living with obesity and more than 5.8 million with diabetes, numbers that are rising year-on-year. These conditions place a significant and growing burden on the NHS, both financially and in terms of long-term health outcomes. From heart disease to kidney failure, obesity-related complications are reducing quality of life and putting lives at risk.

A new way forward: evidence-based, digital-first care

We believe there’s a better way forward. As the obesity crisis escalates, scalable, evidence-based solutions are urgently needed, and digital programmes can play a crucial role. Oviva provides specialist digital type 2 diabetes and weight management programmes. Our mission is to empower people to make sustainable lifestyle changes, creating a healthier future for those living with weight-related conditions by offering highly accessible and effective technology-enabled support.

Delivering results: The NHS T2DR Programme

Through the NHS England Type 2 Diabetes Path to Remission Programme (T2DR), Oviva is supporting people living with diabetes to lose weight, reduce their need for medication and improve both their blood pressure and blood glucose levels.

An NHS assessment published in The Lancet showed that “remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery”.

Oviva was proud to feature as a lead provider, delivering strong outcomes reporting:

8.7 per cent average weight loss for patients
37 per cent of patients who completed the programme achieved remission status
18 per cent of patients lost at least 15 per cent baseline weight

This real-world evidence confirms that digital T2DR programmes can be an effective, scalable solution for people living with type 2 diabetes.

As the NHS continues to evolve in response to rising obesity and diabetes rates, it’s clear that effective, scalable solutions like NHSE’s T2DR programme are more important than ever. The results of the T2DR programme show that real change is possible, not just in research trials, but across the country.

Oviva is proud to support the NHS with programmes that work. Our digital model removes barriers to access, reaches underserved communities, and empowers people to take action in a way that feels achievable and sustainable.

Paul’s story: Transforming health, one step at a time

Paul, 59, from North London, was stunned to learn he had been diagnosed with type 2 diabetes and a heart condition – a wake-up call that inspired him to take action.

Like many, Paul’s weight had crept up during the Covid pandemic, made worse by a sedentary desk job. Determined to make a change, he joined the NHS T2DR programme and embraced the opportunity to transform his health.

Paul admitted the total diet replacement phase was challenging, but his perseverance and discipline paid off. Supported by Oviva coaches, Paul committed to the programme and saw incredible results. Even two months after completing the programme, he continues to use the Oviva App to track his progress and access learning content, keeping his motivation high.

*Paul, 59, lost 50kg after 14 months on the T2DR Programme*

After just 14 months, Paul’s progress has been remarkable:

Weight loss: 50kg, now maintaining a healthy weight of around 92kg
BMI: Reduced from 47 to 29 kg/m²
HbA1c: Improved from 81 mmol/mol to 38 mmol/mol, well into the target range
Activity: Paul is walking at least an hour a day, adjusted cardio due to his heart condition

Paul’s story is a testament to the transformative power of the T2DR programme, and a reminder that, with the right support, patients can take control of their health and reverse type 2 diabetes.

To find out more about how we’re empowering people to achieve lasting improvements in their health and wellbeing, visit oviva.com.

North West extends digital support for up to 275k unpaid carers

By Integrated Care Journal

The move sees Wigan Council join a growing number of local authorities aiming to better support unpaid carers through accessible, round-the-clock digital tools and resources.

Up to 275,000 unpaid carers living across the North West of England can now access an expanded range of support services, including an online community forum and tools to help claim financial support, as the region looks to boost help for this vital community.

This milestone comes as Wigan Council announces it has become the latest local authority in the North West to roll-out a tech-powered initiative designed to connect and support those looking after friends, family and neighbours. This support is being delivered in partnership with the UK’s largest community of unpaid carers, Mobilise.

This latest backing from Wigan Council takes the number of North West carers able to access the digital support to up to 275,000.

At least 31,442 people identify as unpaid carers in Wigan, comprising 1 in 10 of the local population. The new initiative will provide an added layer of on-demand support for anyone who looks after someone in the area, including those who may not identify as ‘carers’ or realise they are entitled to support.

As part of this, the initiative aims to uncover and widen access to support for 3,900 people who have not previously engaged with any support in Wigan.

Wigan Council follows nine local authorities in Cheshire and Merseyside who joined the same initiative in October last year. This saw 243,000 unpaid carers in Cheshire and Merseyside gain access to the tech-powered support. 8 in 10 (79 per cent) Cheshire and Merseyside carers had not accessed any support prior to the digital initiative rolling out across the region.

The new services can be accessed remotely via an online hub and include:

An online peer community of hundreds of thousands of fellow carers from across the UK, with a community forum and regular events to share experiences and advice
Self-service tools to help carers understand the different benefits they may be entitled to (including Carer’s Allowance), check their eligibility, and access different support
Tailored support guides on everything from how to balance caring with full-time work, to managing personal health and wellbeing while looking after someone else
Information on carers’ rights and relevant social care law, in line with the latest government guidance

An AI-powered ‘Mobilise Assistant’ is also available to help carers quickly and easily find the specific information, resources or support that they need, using their own words.

In Cheshire and Merseyside, the majority (51 per cent) of carers currently accessing these digital services rely on the support outside of working hours. Now also available to carers living in Wigan, the on-demand offering will supplement existing support in the region, including in-person services provided by local organisations such as the Wigan & Leigh Carers Centre.

Councillor Angela Coleman the Cabinet Member for Adult Social Services at Liverpool City Council, commented: “Our priority is ensuring that all carers living in Liverpool can access the support they need, when they need it. Partnering with Mobilise to offer on-demand, remotely available services have helped extend our ability to deliver this support. With more carers engaging with support for the first time, and the majority accessing the new services outside of working hours, the impact is already clear to see.”

The initiative in both Wigan and Cheshire and Merseyside is being funded by the Government’s Accelerating Reform Fund.

For more information about the support now available in Wigan, see here. For more information about the support available across Cheshire and Merseyside, see here. To start accessing support today, the Mobilise app can be downloaded via the Apple App Store or Google Play, with more information available on Mobilise’s website.

Case study 1:

Alison Lodder, who cares for her husband in the North West, said: “My husband was diagnosed with MS almost thirty years ago, just two years after we got married. I’ve cared for him ever since. During my caring journey, I’ve found different forms of support have helped at different times. For example, my local carers centre has been a lifeline in the past, and a care worker now comes to the house to provide more regular support whilst I get ready for work in the mornings. Juggling part-time work with my caring role restricts the times that I can access wider support. But, since joining Mobilise, I’ve always had another carer to chat to when I find a moment for myself in the evenings, or an expert on hand to offer advice when I need it the most.”

Suzanne Bourne, co-founder and Head of Carer Support at Mobilise, commented: “As unpaid carers, it’s vital we get the support we need to protect our own wellbeing, and continue to look after our friends or family at the same time. But caring responsibilities don’t always start and stop in line with traditional working hours, or allow us to leave those in our care alone. This is where on-demand digital support can help.

“I’m grateful that, alongside local carers organisations like Wigan and Leigh Carers Centre, Mobilise is now able to help more carers across the North West access support whenever and wherever they need it. Our new partnership with Wigan Council, and our continued work with local authorities across Cheshire and Merseyside, will help ensure that no one has to navigate the daily realities of caring alone.”

Case study 2:

George, who cared for his mother in the North West

George Smith who cared for his mother and lives in Cheshire, said: “I moved in with my mum in 2023 after a nasty fall led to mobility issues and various complications that left her unable to look after herself.

“You don’t expect to become a carer. I certainly wasn’t prepared for how it would impact me physically and mentally. There were many times when I felt lonely, guilty, and like I was losing my sense of identity. Talking to other carers helped me realise it was okay to take time out for myself. The Mobilise community also helped me realise I wasn’t alone. They opened my eyes to how many of us look after loved ones who we might once have relied on ourselves, and how many of us will come to rely on those around us in future.

“I cared for my mum up until she passed away earlier this year. And I wouldn’t have had it any other way.”

Councillor Keith Cunliffe, Portfolio Holder for Adult Social Care at Wigan Council, said: “We are proud to be working with Mobilise alongside Wigan and Leigh Carers Centre in this innovative partnership to better support unpaid carers across Wigan Borough. Unpaid carers are vital to our communities and it is so important that we continue to find new and effective ways to support them. By embracing digital innovation, we are ensuring carers can access the help they need, when they need it and in a way that fits around their busy lives.”

Christine Aspin, Chief Officer at Wigan and Leigh Carers Centre, said: “As Chief Officer at Wigan and Leigh Carers Centre, I am announcing our partnership with Mobilise. This collaboration alongside our ongoing work with Wigan Council will enable better support for unpaid carers in the Wigan Borough. By utilising innovation and technology, we aim to address carers’ needs effectively, providing essential resources, support, and assistance at a time and convenience suitable for the carers.

“This partnership emphasises the importance of collective efforts in fostering positive community engagement and improving wellbeing. We aim to offer support beyond conventional hours, ensuring targeted assistance for working carers and those who cannot access daytime services. Caring does not fit a 9-5 model, so support will be available to carers as and when needed. Our goal is to ensure that every carer in our community has access to the help they need, precisely when they need it most.”

Royal Pharmaceutical Society unveils Greener Pharmacy Toolkit

By Integrated Care Journal

The new RPS Greener Pharmacy Toolkit provides prompts to introduce more sustainable practices to reduce emissions, improve patient care, prevent ill health, tackle medicines waste and achieve efficiency savings.

A new digital self-assessment tool, designed to help community and hospital pharmacy teams take practical action to reduce the climate impact of pharmacy services, pharmaceutical care and medicines, has gone live.

The Royal Pharmaceutical Society’s (RPS) Greener Pharmacy Toolkit outlines three levels of accreditation – bronze, silver and gold – based on various actions that pharmacy staff can voluntarily take to make their pharmacies more sustainable, while supporting patient care. Achieving the target accreditation triggers a certificate, which can be displayed to demonstrate the pharmacy’s commitment to environmental sustainability.

Commissioned by NHS England and supported by Greener NHS, the Toolkit is free and open access, available for use by hospital and community pharmacy teams throughout Great Britain. The digital toolkit and accompanying guidance align closely with RPS’ work on sustainability which recognises the impact of climate change on health.

Minna Eii, RPS lead on the Greener Pharmacy Toolkit, acute medicine Advanced Pharmacist Practitioner and co-Founder of Pharmacy Declares, commented: “This pioneering resource is the first-ever toolkit to help pharmacy teams reduce their carbon footprint and a real step forward in using technology to improve practice and patient care. It’s backed by a wealth of expertise and the stages of accreditation make it the ideal starting point for those who want to reduce their environmental impacts but don’t know where to start, as well as driving improvements for teams already on that journey.”

President of the Royal Pharmaceutical Society Professor Claire Anderson, said: “Medicines account for 25 per cent of carbon emissions within the NHS so doing nothing is not an option. This free to access and easy to use toolkit will help hospital and community pharmacies across the country to promote sustainable practice and reduce their environmental impact. It’s another step in our strong commitment to enabling more sustainable pharmacy services.”

Community pharmacist Mrs Patricia Ojo, from Stevens Pharmacy, said: “Our pharmacy is an early adopter of the Greener Pharmacy Toolkit, progressing through the bronze level. We’ve appointed a sustainability lead and completed all clinical practice, people, operations, and strategy bronze descriptors. We’re halfway to attaining bronze and proud that much of what we are doing already helps to combat climate change. It’s great for the team to see how actions like teaching correct inhaler use and encouraging repeat dispensing contribute to better patient care and environmental sustainability. Despite being busy, we’re keen to continue making progress with the toolkit.”

Laura Stevenson, Associate Chief Pharmacist and Medicines Sustainability Lead at King’s College Hospital, London said: “At King’s we are delighted there is now a dedicated Greener Pharmacy Toolkit for hospital pharmacy. We can now engage our pharmacy teams with clear, practical guidance on sustainability; the toolkit supports teams in making informed decisions that promote a greener, more responsible pharmacy service. It will now be easier for pharmacy teams to play their role to combat climate change and we’ll be exploring how this can support our environmental sustainability efforts and make a real difference in our hospital’s journey to net zero. Together we can make pharmacy greener and more resilient for the future.”

The project was led by healthcare professionals with expertise in environmental sustainability and involved multi-stakeholder engagement and feedback. The RPS Greener Pharmacy Guide scoping review underpins the development of the toolkit, using an evidence-based approach to offer insights into its rationale, content, and structure.

Start using the Greener Pharmacy Toolkit.

Read more about RPS work on sustainability.

Community care critical for improving diabetes outcomes: ICB diabetes lead

By Navodi Kuruppu

Dr Naomi Chinn, Clinical Diabetes Lead at NHS Humber and North Yorkshire ICB, sat down with PPP to discuss her advocacy of community-based diabetes care, its positive impact on both patients and the workforce, and the role of integrated neighbourhood teams, collaboration and networking.

2025 has ushered in a seismic shift across the UK health and care landscape. The abolition of NHS England is resetting the shape of health and care for the coming years. Integrated care boards (ICBs) are under increasing pressure following the mandate to cut costs by 50 per cent, anticipated mergers, and the publication of a new model ICB blueprint. Under this model, systems will be expected, among many other responsibilities, to commission new care pathways and services in support of the key strategic shifts outlined in the 10-Year Health Plan. The Plan, currently expected to be released at the beginning of July, is set to clarify several questions created by these reforms and how they will impact access and delivery of care, including diabetes.

Public Policy Projects (PPP) recently spoke to Dr Naomi Chinn, Clinical Diabetes Lead at Humber and North Yorkshire ICB. Dr Chinn, who took on her role in December 2024, has been working with her team on re-establishing the system’s diabetes work programme, and has long been an advocate for the strategic shift towards community-led care approaches.

Ahead of her appearance at PPP’s Diabetes Care Conference 2025, Dr Chinn shared some insights into current picture of community-led diabetes care within Humber and North Yorkshire.

The role of INTs and LESs

NHS Humber and North Yorkshire ICB is one England’s 42 ICBs, covering the second largest geography in the country and serving a population of 1.7 million people. According to the 2023/2024 QOF diabetes prevalence data, 117,062 people are living with diabetes in the region.

With regards to this demography, Dr Chinn states that both patients and workforce would benefit from a shift towards community-led diabetes care. She believes that integrated neighbourhood teams (INTs) can provide vital support to staff across the system, ultimately optimising the quality of patient care delivered. This approach has already shown positive results through a prevention programme implemented in the region.

“The programme is delivered in local community centres and is supported by trusted community figures and attended by individuals living in the same neighbourhoods,” explains Dr Chinn. “Through this programme, we are holding annual diabetes reviews regularly and they are easily accessible at a nearby health centre, with retinal screening available in the room next door. Where needed, patients can be referred to specialist services such as podiatry, ultimately creating a joined-up, community-based care experience.”

Recently, the ICB has also introduced a programme of Local Enhanced Services (LES) for patients with type 2 diabetes, accessible through general practice. LESs are locally developed schemes designed to supplement core practice services, with variations in scope and funding across the country according to local need. This targeted investment is a result of the ICB’s recognition of the value of delivering better care closer to home, bringing both clinical and social benefits through this ‘left shift’ in care. An additional advantage is the potential to relieve pressure on secondary care services, allowing them to prioritise patients who require more specialised expertise and facilities.

“We know that both hospital and community teams are working harder than ever,” Dr Chinn adds, “so, this has to be about more than simply shifting patients and populations between settings; prevention must also be a core and continuous part of our service from the very beginning.”

The need for collaboration

As ongoing reforms ultimately aim to deliver a more integrated approach to care, collaboration with wider partners is key to make this vision a reality. Dr Chinn emphasises the value of working closely with ICS stakeholders, including primary care, secondary care and Voluntary, Community and Social Enterprise (VSCE) stakeholders, and the importance of engagement with patients.

An example of this collaborative approach is a recent design workshop led by Dr Chinn, which convened system partners to identify barriers to accessing diabetes care, share best practice and generate new ideas. Alongside this, Dr Chinn and her team launched a patient engagement questionnaire, asking patients who might be interested to participate in the work going forward. The feedback, combined with insights from recent GIRFT reviews for both adults and children and young people, has directly informed the development of the region’s diabetes work programme.

To support delivery and ongoing development, the team is establishing bimonthly advisory groups, in addition to a broader network meeting. This approach aligns closely with the ICB’s core principles and wider strategic initiatives, including recommendations from Lord Darzi’s Independent Review, to simplify and innovate care delivery at the neighbourhood level, re-engage staff, and re-empower patients.

“A problem shared is a problem halved”

Given the large population and geographical footprint it serves, Dr Chinn highlights that regional variation is one of the biggest challenges facing Humber and North Yorkshire.

“We are an ICB with a large geographical area and a highly diverse population,” Dr Chinn explains. “Achieving continuity across these regions, while also meeting local needs, is probably our biggest challenge. In some places, like Hull, we face one of the lowest GP-to-patient ratios in the country, which makes workforce development even more difficult.”

Despite these challenges, Dr Chinn acknowledges the importance of connection and collaboration in overcoming them, through the integration of workforce, patients, and partners and underpinned by prevention and local knowledge: “Bringing people together makes a real difference.”

Dr Chinn adds: “Sometimes it’s as simple as remembering that a problem shared is a problem halved. A challenge in Whitby today might be something Willerby overcame last year. Within the ICB, we are a small team, so building connections and keeping communication open, whether it’s asking for help or flagging concerns, is essential. Through networking, we’re starting to achieve this.”

As publication of the 10-Year Health Plan approaches, local systems like Humber and North Yorkshire ICB are already demonstrating the value of prevention and community-led care. Dr Chinn’s vision offers a scalable blueprint for a collaborative, community-led approach to diabetes care, that will be further discussed at PPP’s Diabetes Care Conference 2025 on Wednesday 25 June in London.

Holding our nerve: Making the ‘left shift’ a reality in health and care

By David Duffy

At a recent dinner hosted by Public Policy Projects and HealthPathways, senior NHS executives and leaders gathered to reflect on one of the most urgent challenges in health and care today: how to deliver a meaningful ‘left shift’ – moving care out of hospitals and into community settings, as outlined in the forthcoming 10-Year Health Plan. The conversation offered a candid look at the structural barriers that continue to impede progress, while also spotlighting the leadership, collaboration, and bold action required to overcome them.

The discussion was chaired by Len Richards, who stepped down as CEO of NHS Mid Yorkshire Teaching Trust in April 2025. With executive leadership experience in healthcare systems across both the UK and Australia, Richards has been a consistent advocate for integrated system working and for modernising health services through partnership-driven reform.

As Richards noted at the outset, much has changed in recent months. Financial pressures have deepened across the board, with providers and systems increasingly asked to deliver more with fewer resources. Meanwhile, major structural reform looms, including the anticipated merger of NHS England with the Department of Health and Social Care, and a sweeping review of the core functions of integrated care boards.

Despite these developments, many long-standing challenges remain unresolved. Hospital congestion and ever-growing waiting lists continue to plague the NHS, despite multiple central reorganisations. These pressures have fuelled a crisis in public confidence and severely undermined staff morale.

Drawing on his leadership experience in Australia, Wales, and the UK, Richards emphasised that real progress depends on genuine system-wide change. He highlighted his longstanding use of HealthPathways as a practical tool to support integration – a model that draws on clinical expertise, community knowledge, and patient experience. For Richards, HealthPathways’ system-wide approach to care pathway redesign has consistently delivered clarity, confidence, and hope during times of change.

This sentiment feels more poignant than ever, as the system now requires a whole-of-system approach to left shift – one that builds additional capacity, boosts productivity, and firmly places patients at the centre of care.

The reality of the left shift

Despite years of policy promises and widespread rhetorical backing, there was a shared acknowledgement that the shift towards community-based care has yet to take meaningful form. System leaders expressed frustration that, while the vision is widely accepted, progress on the ground remains slow. With funding still disproportionately directed toward hospitals, acute care continues to be treated as the default care setting, despite decades of political commitments to reallocate resources toward prevention and community services.

The message was unmistakable: the current approach is falling short – and in some cases, actively worsening outcomes for patients. Long waiting times, increasing health-related anxiety, and ongoing challenges in mental health services are eroding public trust. Transitioning to a community-based, preventive, and integrated model of care is no longer just an aspiration – it is fundamental to the sustainability of the NHS.

Yet, under the weight of existing system pressures, achieving this transformation feels increasingly out of reach. There was a strong call in the room for political rhetoric to be matched by bold, system-wide action, and for local leaders to be genuinely empowered to make decisions that reflect the needs of their communities.

A system that still thinks in silos

Leadership, risk, and public trust

Some leaders did highlight that large sections of the public still maintain that the hospital is the safest and most effective place within the sector to receive care. It is up to leaders, political and otherwise, to have a frank conversation with the public to address this trend and clearly articulate how health and care services can be accessed.

Leaders must be clear of purpose, instil confidence, and perhaps most importantly, hold their nerve in the face of political and institutional pressure. But bravery cannot stop at the hospital board room.

Several attendees emphasised the need for political courage at the national level. Without it, the system will remain risk-averse and locked into a cycle of short-term performance management at the expense of longer-term transformation.
There was strong consensus that DHSC needs to be brave in redistributing resources away from acute settings, even when these efforts run counter to entrenched assumptions or public sentiment.

Rebuilding public trust is paramount, and confidence in the NHS is closely tied to waiting times and access. When people don’t know how long they’ll have to wait or to whom to turn, anxiety grows among the public. Leaders present at the dinner stressed the importance of clear, honest communication with the public – explaining not only what is changing, but why. People want simplicity, not bureaucracy; certainty, not confusion.

Reimagining metrics and accountability

A fundamental rethink of how success is measured was also discussed. Many of today’s key performance indicators are designed for performance monitoring, not for meaningful change. Attendees called for metrics rooted in health economics, place-based outcomes, and patient experience, rather than just ‘activity focused’ hospital throughput or financial balance.

The discussion also explored wider issues of financial governance. Some questioned whether systems should be permitted to run short-term deficits in order to unlock longer-term savings and improved outcomes. Others highlighted the pressing need for greater clarity and transparency in place-based spending—an area where the NHS still falls short. What became clear is that NHS financial structures remain rigid and poorly suited to support innovation or invest in preventative approaches that may not yield immediate performance gains, demand reduction, or visible returns. There is still discomfort within the system when benefits are not directly or immediately felt by the organisation itself.

Stop talking. Start doing

The dinner closed with a sense of urgency. The opportunity presented by the 10-Year Plan is real, but so too are the risks of continued inaction. Siloed thinking, limited risk appetite, and cultural inertia are holding the system back. Leaders agreed that it’s time to stop talking about integration, co-production, and shifting left, and time to start doing them.

This means creating space for genuine community engagement, sharing risk across sectors, and aligning incentives to patient outcomes rather than institutional survival. It means trusting others in the system to deliver value, even when they sit outside the NHS’s traditional structures. Above all, it means holding our collective nerve.

The future of general practice depends on documented care pathways

By Dr David Hambleton

UK general practice is under intense strain, with rising demand and limited resources pushing many surgeries to the brink. Documented care pathways are emerging as a key solution, offering a practical route to more efficient, consistent, and sustainable care.

General practice in the UK stands at a critical crossroads. Faced with unsustainable workloads, rising patient expectations, and a shrinking workforce, many practices are nearing a breaking point. The NHS is stretched thin, and primary care – the front line of the healthcare system – is bearing the brunt. Without immediate and effective strategies to boost efficiency, general practice risks becoming overwhelmed, fragmented, and unable to meet the demands of the communities it serves.

One of the most powerful, yet underutilised tools available to avert this crisis, is the implementation of documented care pathways. These structured, evidence-based frameworks can streamline patient care, reduce unnecessary workload, and save valuable time and money – resources general practice can no longer afford to waste. In an era where every second counts and every appointment matters, documented care pathways offer a lifeline to clinicians drowning in complexity.

Documented care pathways are not new, but their potential impact has never been more vital. These protocols lay out the ideal steps for diagnosing and managing specific conditions, ensuring patients receive consistent, high-quality care. In general practice, they serve as clinical blueprints, cutting through the noise and providing clarity in a system often plagued by inefficiencies and inconsistencies.

By guiding practitioners through evidence-based steps, these care pathways dramatically reduce the cognitive burden on GPs. Instead of second-guessing clinical decisions or navigating an ever-changing landscape of guidelines, clinicians can rely on streamlined processes to act swiftly and decisively. This clarity allows more patients to be treated efficiently, improving access and reducing backlogs that currently threaten to paralyse the system.

The time savings alone are monumental. In a healthcare environment where GPs are routinely forced to manage overbooked clinics, anything that allows more time for patient care is invaluable. Research has shown that much of a GP’s day is consumed not by patient care, but by operational failures, unclear workflows, and redundant tasks. Documented care pathways eliminate many of these pain points, creating breathing room for practices under siege.

But the case for care pathways isn’t just about time – it’s about survival. Financial sustainability is another growing concern. With budgets tightening and demand increasing, general practices must cut costs without compromising care. Documented care pathways can do exactly that. By minimising unnecessary referrals to secondary care, avoiding redundant diagnostics, and enabling early interventions for chronic conditions, they keep patients healthier and the system more affordable.

One Health Board in Wales who implemented documented care pathways experienced a 25 per cent reduction in referrals for urgent colorectal cancer surgery. At the same time the Health Board also saw a 30 per cent increase in community Faecal Immunochemical Tests (FIT) testing, which is an important test for identifying bowel cancer early – care pathways are not only about reducing activity – they help GPs know what to do and when.

The NHS has recognised the urgency. A recent initiative offers general practices in England £20 for each patient managed without hospital referral – an incentive that not only saves money but promotes smarter care delivery. This type of thinking is essential if the system is to weather the storm. It’s a signal that the future of healthcare is not in working harder, but in working smarter.

There is a growing body of evidence that supports the implementation of documented care pathways. Systematic reviews confirm that care pathways improve outcomes, reduce errors, and enhance coordination between care providers. Integrated care models using these frameworks have already shown reductions in wait times and hospital admissions, proving that streamlined processes translate into real-world impact.

Despite the benefits, uptake has been slow – often due to misconceptions that these care pathways are restrictive or inflexible. In reality, the best-documented care pathways allow for clinical judgement and adaptation while still offering a dependable foundation for decision-making. They are not scripts, but scaffolds – supporting clinicians as they deliver the best care possible.
The stakes could not be higher. Without intervention, general practice risks becoming a bottleneck in the healthcare system, plagued by burnout, inefficiencies, and unmet patient needs. But with documented care pathways, there is a clear path forward. Practices can regain control, improve outcomes, and operate within their means – before the tipping point is reached.

It is time to act. Documented care pathways are more than a helpful tool – they are a strategic necessity. The survival of general practice may very well depend on their widespread adoption. In the face of crisis, clarity and consistency are not luxuries; they are lifelines. The future of healthcare begins with the decisions made today, and embracing care pathways could be the most important step the NHS takes to secure it.

The NHS efficiency dilemma: Is AI really the answer?

By Peter Corpe

Despite the major digital transformation efforts ongoing across the NHS, money alone will not solve the challenges the health service faces. Neither will simply bolting AI solutions onto outdated processes, writes Peter Corpe, Industry Leader, UK Public Sector at Appian.

Despite the Government’s commitment to ‘bring the NHS into the digital age’ in its AI Opportunities Action Plan, healthcare organisations overwhelmingly still rely on legacy systems that aren’t fit for purpose. The recent State of Digital Government Review from the Department for Science, Innovation and Technology (DSIT) highlighted, the technology resource gaps that continue to derail work, waste time and delay essential services.

This is not just an inconvenience – it’s a growing crisis. A recent UK Public Sector Efficiency Survey revealed that NHS employees lose an average of five hours per week to clunky, inefficient systems. That adds up to a staggering 7.5 million hours of wasted work every single week. These valuable hours could be reinvested in treating patients, improving safety, and providing a better service. By addressing these systemic inefficiencies, we can improve healthcare services and enhance patient outcomes.

The UK Government announced the much needed £3.25bn Transformation Fund to boost public service efficiency in its latest Spring statement. It’s poised to drive productivity in public services, including the NHS, at a time when efficiency is under immense scrutiny. Backing a range of initiatives, the fund will include the introduction of AI tools to revolutionise front line service delivery.

But if we are serious about modernising the NHS, money alone will not solve the problem – we need targeted, measured reform. AI and automation are rightly gaining momentum in the sector. However, AI is not a magic solution on its own. Its effectiveness depends on the quality of the data it receives, and how well and quickly we act on insights. If we aren’t prepared to act on its findings quickly, we create bottlenecks instead of breakthroughs. Without the right groundwork, AI risks producing noise instead of value. AI must be embedded into well-designed processes to ensure it delivers real economic benefits.

I am often asked what are the biggest technology challenges in healthcare today, and what are the opportunities and barriers for the sector to use AI effectively. My response typically focuses on the following areas:

Manual services and outdated processes

Despite ongoing digital transformation efforts, most departments still rely on manual processes. The DSIT report reveals that 45 per cent of NHS services lack a fully digital pathway, with very few eliminating manual processing entirely.

The impact of outdated processes is felt directly by patients and healthcare workers alike. When services remain paper-based or rely on fragmented systems, productivity suffers, and resources are stretched thin. The functioning of these fragmented systems relies on ‘human glue’ – workers manually bridging siloes of data and process, which prevents recognition of the core deficiencies.

Streamlining these processes through digital transformation is not just a matter of convenience. It’s essential for improving efficiency, reducing administrative burdens, and ultimately enhancing service delivery for the public.

Process modernisation and automation is the most powerful lever available to drive service reform for such tasks. A process orchestration solution can automate time-consuming tasks such as data entry, appointment scheduling, progress tracking, compliance, and reporting. Automating these actions would enable a shift towards time spent on value-driven activities that can improve both internal efficiency and service delivery.

Fragmented and underused data

When data is scattered across multiple outdated legacy systems, information access and related processes slow down for everyone. This impacts productivity and the ability to resolve case work at speed. This lack of data integration also limits the potential of AI, machine learning, and advanced analytics. These data-driven technologies can only work with seamless access to high-quality data, to drive innovation and improve decision-making.

For the NHS to be truly AI-ready, the data must be in order. Solving this starts with adopting a platform that connects data and processes woven into a single framework. A data fabric, for example, creates a virtualised layer that links data across systems without needing to migrate it.

With advanced data management, organisations can train, refine, and deploy AI models more effectively, transforming vast amounts of information into valuable insights. High-quality data is the fuel AI needs to enhance decision-making and drive efficiency. Without it, the potential of a modern digital NHS will remain out of reach.

The future of AI-driven processes in the NHS

Optimism about AI is growing within the healthcare sector. 64 per cent of NHS workers have some or high confidence in AI’s potential to improve their organisation’s efficiency.

The key to unlocking AI’s full potential is embedding it within existing processes. Process is where actions happen. It’s where healthcare professionals make decisions, allocate budget and resources, serve patients, and move things forward. When AI operates within processes, it gains purpose, governance, and accountability – all vital to delivering value from AI.

While organisations are under pressure to integrate AI, its success depends on strong data infrastructures and human oversight. AI should be a partner, not a replacement, ensuring efficiency and innovation without compromising security or accountability.

To sustain long-term growth, healthcare organisations must invest in agile platforms that adapt to rapid AI advancements with process orchestration technologies. A platform approach can streamline operations, enhance decision-making, and improve service outcomes. Embracing these tools isn’t just about modernisation, it’s essential for efficiency, stability, and better healthcare service delivery.

Now is the time for the NHS to seize the opportunity. Every part of our health service runs on processes – from patient referrals to hospital workflows. When we improve these processes with automation technologies like AI and process orchestration, we create better working environments for our healthcare workers, improving service delivery for our NHS, for the betterment of patients.

Frailty: A silent crisis

By Dr Jon Tose

The time for a coordinated, pathway-driven response to frailty is now, writes Dr Jon Tose, GP at Northern Moor Medical Practice and Clinical Lead at HealthPathways UK.

The UK is facing a crisis that’s growing silently, relentlessly – and dangerously: frailty. It’s not a dramatic headline-grabber. It doesn’t spark protests or fill news cycles. But frailty, particularly among older adults, is quietly becoming one of the most serious threats to the long-term survival of the NHS.

Unless we act now with a coordinated, system-wide response, frailty could push our healthcare system to the brink – and cost billions in avoidable care.

The numbers are alarming – and getting worse

Right now, around one in 10 people over 65 and more than half of those over 85 in the UK are living with frailty, according to the British Geriatrics Society. And with the UK’s ageing population growing fast, the Office for National Statistics predicts that over a quarter of the UK will be over 65 by 2043. These figures are just the beginning.

Without urgent action, the number of people with moderate to severe frailty could double in the next 20 years. That means more falls, more hospital admissions, longer hospital stays, more care needs – and massive strain on already stretched NHS services.

Frailty isn’t just a health problem. It’s an economic one

The cost of ignoring frailty is staggering. Older adults living with frailty are far more likely to end up in A&E, often after a fall, infection, or medication issue. But, critically, NHS England estimates that up to 40 per cent of these emergency admissions are preventable.

Those admissions come with a price tag. One study estimated that frailty-related hospitalisations cost the NHS around £5.8 billion a year, and that figure is climbing (Gale et al., 2020). If we don’t shift from reactive, crisis-driven care to a proactive, preventative model, we’ll be pouring money into a system that can’t keep up.

The system is buckling

Right now, the NHS treats frailty like it does many complex health issues – after the crisis hits. We wait until someone falls, gets acutely ill, or becomes too weak to cope at home. Then we send them to hospital, treat the immediate issue, and discharge them – often without enough support.

This model isn’t just inefficient – it’s harmful. Hospital stays can actually worsen frailty, especially for older adults. Even a few days in bed can lead to permanent declines in mobility and independence. And when discharged into poorly coordinated community or social care, many bounce right back into hospital.

This revolving door is exhausting staff, draining resources, and failing patients. We have to do better.

We have the tools. We just need to use them

There is a solution, and it’s not theoretical. It’s already working in parts of the country. It’s called a frailty care pathway – a structured, evidence-based approach that identifies and manages frailty before it becomes a crisis.

Frailty pathways typically include:

Early identification using tools like the electronic Frailty Index (eFI).
A Comprehensive Geriatric Assessment (CGA) that looks at medical, psychological, and social needs.
A personalised, multidisciplinary care plan.
Regular review and monitoring to prevent deterioration.
A ‘map’ of the services that can promote ageing well and those that can step in if the patient deteriorates.

When implemented effectively, these care pathways don’t just improve outcomes – they save money. A Cochrane review by Ellis et al. (2017) found that proactive, structured geriatric care reduced hospital admissions and improved quality of life. It’s simple – the earlier we intervene, the more we prevent.

Policy is starting to catch up – but it’s not fast enough

There’s been some good news. NHS England’s Long Term Plan includes a strong focus on ageing well, frailty, and anticipatory care. Initiatives like Urgent Community Response (UCR) and the Enhanced Health in Care Homes (EHCH) model are helping local teams manage frailty without sending patients to hospital.

Primary Care Networks (PCNs) are now expected to identify patients with moderate and severe frailty and provide proactive care. That’s a great step. But implementation is patchy, and many clinicians still lack training, tools, or time to deliver it well.

As the British Geriatrics Society puts it – we can’t afford for these care pathways to remain optional or unevenly applied. This needs to become the national standard.

What’s holding us back?

Despite the evidence and policy momentum, uptake of frailty pathways has been inconsistent. Why?

Workforce capacity is stretched thin.
Many GPs and community teams lack specialised training in frailty management.
The Voluntary, Community and Social Enterprise (VCSE) sector is not used to its maximum.
Managing frailty is multidisciplinary and navigating the system is challenging for patients and those who support them.
IT systems don’t talk to each other, making coordination across services difficult.

However, these are solvable problems. What’s really missing is urgency. We need to treat frailty like the system-wide emergency it is.

What needs to happen now

If we want to avoid a full-blown crisis in the next decade, we must:

Make frailty identification and pathway implementation mandatory across the NHS.
Invest in workforce training so GPs, nurses, paramedics, and allied health professionals can deliver proactive care.
Integrate digital systems to allow seamless sharing of care plans and patient status.
Fund community, VCSE, and social care services that are critical to keeping people out of hospital.
Track outcomes and iterate – because good care pathways evolve as needs change.

This is a ticking time bomb – there is no second chance

Frailty doesn’t come with sirens. It doesn’t flood wards overnight. It builds slowly and quietly until the weight becomes unmanageable. But make no mistake – the frailty crisis is already here, and the NHS is on the edge of being overwhelmed.

We already have the knowledge, evidence, and tools to address this. We just need to act.

Because when it comes to frailty, doing nothing is the most expensive option of all – for the system, for society, and for the people we serve.

Health Inequality, News May 27, 2025

NHS risking lives of millions with hearing loss – report

By Integrated Care Journal

A new report from SignHealth finds that the NHS is potentially flouting equality law, leading to serious failings that have left deaf people and people with hearing loss in the dark about their own health.

A new report from leading charities, the Royal National Institute for Deaf People (RNID) and SignHealth, has revealed serious and potentially widespread failings affecting the more than six million adults in England who are deaf or have hearing loss.

As part of the report, Still Ignored: The Fight For Accessible Healthcare, the charities surveyed 1,114 people who are deaf or have hearing loss and live in England, to better understand their experiences in accessing and receiving NHS healthcare. A survey of patient-facing professionals working in NHS healthcare settings in England was also conducted by Censuswide on behalf of RNID.

It reveals that 7 out of 10 (70 per cent) deaf people and people with hearing loss have never been asked about their information and communication needs when accessing NHS care – something that all healthcare providers should offer under the NHS Accessible Information Standard (AIS), a legal document setting out patients’ rights under the Equality Act.**

Health services like the NHS, as well as social care services across England, are required by law to offer extra support if people with hearing loss struggle when accessing services. For example, being provided with an accessible alternative to the telephone to be able to book appointments or receive test results, or communication support, such as a qualified British Sign Language (BSL) interpreter to ensure they can understand appointments and procedures.

According to RNID, more than 6 million adults in England have hearing loss severe enough that they would have difficulty in noisy environments, while an estimated 1 million would not be able to hear most conversational speech. More than half of the UK population aged 55 or over have hearing loss, while there are approximately 73,000 deaf users of BSL

Philippa Wynne, Director of Engagement at SignHealth, said: “This report has confirmed what our community has known for a long time: the NHS is not working for deaf people.

“Every day the health of deaf people is put at risk because their right to accessible information is being ignored. This is not good enough. It must stop. And it must stop now.”

Lack of communication support harming patients

The report makes clear the impact that a lack of communication support is having on deaf people and those with hearing loss across the NHS. Findings include:

Almost 1 in 10 have avoided calling an ambulance or attending A&E
1 in 4 have avoided seeking help for a new health concern
1 in 7 say a health problem they were experiencing was made worse
1 in 7 felt that their health was put at risk

Even when people are asked about their communication needs, too few receive the support they ask for. Of those who indicated they need a communication support professional to be present during an appointment (e.g. a BSL interpreter or lipspeaker), only 7 per cent said this is always provided for them.

More than half (54 per cent) of people who are deaf or have hearing loss have had to rely on either a partner, family member, or friend to relay information or interpret for them at a healthcare appointment, effectively removing their right to privacy and dignity in their own healthcare.

People who have been denied the basic information and communication support they need say it has resulted in situations such as:

Giving up trying to make an appointment (47 per cent) or missing an appointment (21 per cent)
A delayed or incorrect diagnosis (23 per cent)
Failure to understand their diagnosis (33 per cent), the outcome of their appointment (33 per cent) or how to take medication or treatment prescribed (25 per cent)
Almost half felt it has resulted in them not getting the follow-up care they need (44 per cent)

The consequences are particularly felt by those who use sign language and those who require a communication support professional – around half of sign language users (48 per cent) report not understanding their diagnosis or how to take medication/treatment given (47 per cent).

These failures are leading to dangerous and devastating consequences. One example cited in the report is of a woman who, owing to a lack of interpreter support, was left unaware that she had suffered a miscarriage.

The patient said: “I went into A&E for blood loss but no interpreters turned up after asking several times. I went through so many tests and wasn’t sure what it was all about. I was given medication, but I refused because I didn’t know why I needed them. The staff seemed gobsmacked, so I took it and was not sure how serious it was. The next thing a nurse took me into a bereavement room and sat me down with a leaflet that said ‘miscarriages’. I was in shock. They had not explained what the test was for. It was a massive misunderstanding and lack of communication.”

A further example includes a patient who did not receive any food or water during a hospital stay as they could not hear staff offering them.

The failure to provide adequate communication support is also feeding, and directly impacting, complaints procedures for deaf patients and those with hearing loss. Nearly 1 in 5 patients (19 per cent) reported that they have made a complaint to a healthcare provider about their information and communication needs not being met. A further 37 per cent said that they had a good reason to complain but have not pursued it, usually because they felt it would not change anything or lead to change.

NHS staff need more support

The report clearly shows that the NHS Accessible Information Standard (AIS) is not being met across England; awareness is low among NHS staff, with one third (32 per cent) saying they are unaware of the AIS. Only a quarter (24 per cent) of NHS staff say they can always meet the information and communication needs of patients who are deaf or have hearing loss.

NHS staff who do not feel confident that they can always meet patient needs face four main barriers: a lack of training (34 per cent), a lack of time or capacity in workload (32 per cent), a lack of standardised processes (31 per cent) and a lack of functionality of IT systems (30 per cent).

Crystal Rolfe, Director of Health at RNID, commented: “Imagine not being able to understand a cancer diagnosis, or having to rely on a family member to tell you that you’re seriously ill or even dying. The horrifying truth is that too many deaf people in England today don’t have to imagine it – it’s happening to them in real life.”

“The NHS is systematically discriminating against people who are deaf or have hearing loss: it’s a national scandal. It is not acceptable that deaf people and those with hearing loss are being routinely failed by an NHS that neglects their communication needs. Lives are being put at risk because of communication barriers, delays and out of date systems that are not fit for purpose.

“It is time to give deaf people more access and control over their physical and mental healthcare. We are calling on Ministers to bring NHS accessibility into the 21st century. The government needs to urgently address these issues, make staff training mandatory and overhaul current NHS systems, so that everyone can access their own health information in a way that makes sense – equal access to healthcare is a human right.”

Calls for urgent government action

RNID and SignHealth are calling for major changes to ensure the NHS meets the needs of deaf people and those with hearing loss. Key recommendations include:

DHSC (Department of Health and Social Care) to ensure that work to improve the NHS Accessible Information Standard (AIS) is properly resourced and prioritised, and lead on a transformation plan to ensure that people with communication needs can access the healthcare they need
Mandatory training for NHS staff in deaf awareness, as well as the AIS
The AIS to be made legally enforceable for the NHS, through the strengthening of legislation on NHS information standards

Finally, the report suggests that people with lived experience of communication needs should be at the heart of plans for change.

Philippa Wynne, Director of Engagement at SignHealth, added: “This report shows that serious diagnoses or instructions for taking medication are given without an interpreter present or provided only in English rather than BSL. This is not just dangerous; it is life-threatening. People have died because of inaccessible information and healthcare. These are not statistics – they are real people.

“In 2021, our survey showed that the AIS was not working properly for deaf people. Sadly, four years later nothing has changed. The evidence suggests that deaf people’s health is getting worse, with 88 per cent saying lack of accessible communication affects their mental health and 82 per cent saying it impacts their physical health.

“Deaf people’s health cannot be ignored any longer. Patients are being misdiagnosed. Lives are being put at risk. And, yes, people are dying. Enough is enough. The NHS must provide better access, and they must do this now.”

You can read the full report here.

Below is a selection of quotes from the report, detailing the lived experience of deaf people and those with hearing loss in accessing and receiving NHS care:

Kate Boddy is the child of a deaf adult (CODA) and was required to act as an interpreter for her own father, Richard Boddy, during a series of medical appointments, as communication support was either unavailable, haphazard, or actively denied. The impact for Kate, her father, and her wider family, was devastating. She said:

“Dad Face-Timed me in a panic and just said ‘I can’t see. Everything is black.’ I drove him to a hospital which has an A&E especially for eyes – but no interpreter. They did lots of tests and at the end of the day they said to me: ‘can you tell your dad he’s got cancer?’ So I told him. We went home in complete shock.”

Dr Natasha Wilcock is a deaf doctor who works in palliative care. She shared her experiences: “Legally, professionally and ethically, deaf insight training should be compulsory for all doctors. Right now, the experiences of deaf people and people with hearing loss are shocking. I have met patients who have been referred to palliative care services who have not understood that they will no longer be receiving cancer treatment – they haven’t understood that they are dying.”

Suffolk-based Pip Lee, a hearing aid user and lipreader, said: “It came to my appointment time and my pager hadn’t buzzed, so I sat tight. I vaguely heard someone shouting, and when I looked up everyone was looking at me. I waved at the shouting nurse, and it turned out she had been calling out my name. I explained that my pager hadn’t buzzed, and she apologised, repeating what the receptionist had told me; that nobody knew how to use the pagers, even though they’re really simple.

“But the situation got worse when I went in to see the consultant. He refused to take off his facemask, so I couldn’t hear anything he was saying. He picked up his iPad to use the speech-to-text function, but the text it produced was gobbledygook. I left only knowing that I would need an MRI of my brain, but when the post-appointment letter came, I was shocked to read it was to look for a possible tumour associated with my hearing loss and tinnitus. Because the medical staff did not meet my communication needs, I missed that important information. Thankfully I didn’t have a tumour, but the experience was up there as one of the most stressful, frustrating and patronising appointments I’d ever had.”

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