NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the National Health Service in England as set out in the Health and Social Care Act 2012. It directly commissions NHS general practitioners, dentists, optometrists and some specialist services. The Secretary of State publishes annually a document known as the NHS mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate.NHS England employs around 6,500 staff in 50 sites around England. Most of its staff previously worked for the decommissioned primary care trusts and strategic health authorities.In 2018 it was announced that the organisation, while maintaining its statutory independence, would be merged with NHS Improvement, and seven "single integrated regional teams" would be jointly established.Sir Simon Stevens held the role of Chief Executive from 2014 to July 2021, and it was announced that he would receive a peerage for his work. Amanda Pritchard, the Chief Operating Officer of NHS England, was promoted to Chief Executive on 1 August 2021.
Background Patients with symptoms of suspected cancer usually present to general practice; however, they may present to other healthcare providers, such as community pharmacies. The clinical role of pharmacy staff has significantly increased in England in recent years. Aim To describe the range of interventions targeting early cancer detection in community pharmacies globally; to summarise the outcomes of these interventions; to report on barriers and facilitators to delivering the interventions and on service users' and stakeholders' experiences with such interventions. Design and setting Systematic review with narrative synthesis, of international literature, on community pharmacy-based early cancer detection.Method Online searches of Medline, CINAHL, Cochrane CENTRAL, PsycINFO, and Embase and UK-based relevant grey literature were performed. Interventions were defined as any intervention, initiative, or programme that focused on community pharmacy-based early cancer detection programmes. Results In total, 14 134 titles and abstracts were screened, and 330 full-text publications were reviewed by two independent reviewers. Of these, 52 publications were included in the review. They reported on interventions focusing on early diagnosis of colorectal (n = 19), skin (n = 8), lung (n = 4), cervical (n = 3), breast (n = 2), head and neck (n = 2), and mixed (n = 14) cancers. The feasibility and acceptability of such interventions by communitypharmacy staff and customers/ patients have been demonstrated in the included studies. Studies involving opportunistic identification of customers with suspected cancer symptoms in pharmacies recruited only a few participants. Conclusion Robust, large-scale clinical trials are needed to demonstrate costeffectiveness, delineate and inform the use of relevant clinical outcomes, and to explore arrangements for information sharing between community pharmacy and other healthcare settings.
The use of Artificial Intelligence (AI) in healthcare is increasing in Indonesia, but faces challenges related to Indonesia’s communal and hierarchical cultural context. Ethical issues are becoming increasingly complex, not only in terms of the principles of beneficence and non-maleficence, but also in relation to humanization and care in doctor-patient relationships. The position of AI in healthcare is determined by doctors’ perceptions. This study captures doctors’ perceptions of the use of AI in healthcare services in relation to the principles of bioethics and ethics of care, within the context of Indonesia’s culture. The study used a descriptive qualitative approach through in-depth semi-structured interviews with twenty-five doctor participants practicing emergency services in Indonesia. The results revealed four spectrums of AI integration within the clinical autonomy of doctor: (1) as a doctor’s assistant/tool, (2) as a co-pilot with a specific role, (3) as a doctor’s discussion partner, and (4) as a reinforcement of doctor recommendations. These four spectrums reflect ethical issues between the basic principles of bioethics and the humanism of doctor-patient relationships influenced by communal and hierarchical culture. A collaborative approach between the basic principles of bioethics and the ethics of care is seen as more contextual to Indonesia’s communal and hierarchical culture, to minimize the risk of dehumanization. The practical implication of these findings is the need for training for doctors, not only about AI, but also ethics of care and empathetic communication.
Objectives Medication errors are a leading source of preventable harm in healthcare, affecting approximately 1 in 30 patients, with a substantial proportion resulting in severe outcomes. In response, the European Association of Hospital Pharmacists convened a Special Interest Group (SIG) to propose comprehensive and sustainable strategies for reducing these errors across Europe, employing a systems approach.Methods 89 anonymised medication error reports, and empirical data from the SIG members' daily practice, were analysed to identify root causes, classified into system-level and individual errors. Expert subgroups then linked root causes to targeted preventive measures. A literature review was conducted, searching PubMed and Embase databases, to assess existing standards and identify gaps in medication safety practices, which informed the analysis.Results Analysis revealed that governance deficiencies and inconsistent implementation of existing legal standards contribute significantly to medication errors. System-level issues, including inadequate oversight, understaffing and insufficient technical infrastructures, along with individual errors from cognitive lapses, were prevalent. The literature review supported these findings and highlighted the variability in medication safety practices across systems, underscoring the importance of strategic improvements in healthcare policies.Conclusions Findings highlight the critical need for robust governance, comprehensive policy frameworks and enhanced safety cultures to prevent medication errors. Automation and improved human-machine interfaces are recommended to mitigate active failures and enhance system reliability. This systems-thinking approach, supported by strengthening legislation and better resource allocation, is essential for reducing medication errors and improving patient safety.
Importance:Understanding the reasons for variations in population-level survival differences in childhood cancer is important to guide improvement efforts. Collaboration between population-based cancer registries (CRs) to apply the international consensus Toronto guidelines to record tumor stage at diagnosis is a key first step. Objective:To test whether survival probabilities by tumor stage vary internationally, using 6 childhood solid tumors as exemplars. Design, Setting, and Participants:The International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) population-based retrospective cohort study included all incident cases of neuroblastoma, Wilms tumor, medulloblastoma, osteosarcoma, Ewing sarcoma of bone, and rhabdomyosarcoma diagnosed between January 1, 2014, and December 31, 2017, with 3-year follow-up for survival. A total of 73 CRs from 27 countries (23 European as well as Australia, Brazil, Canada, and Japan) constituted the dataset. Analyses were conducted from June 2023 to December 2024. Main Outcomes and Measures:Three-year overall survival (OS) by stage for each tumor type, with comparisons between countries grouped into 5 predefined European areas. Multivariable Cox and logistic models estimated each area's hazard or odds ratio of death compared with Central Europe (Austria, Belgium, France, Germany, Switzerland, and the Netherlands), adjusted by age group and stage. Results:A total of 9883 cases were included; 4452 (45%) were girls and overall median (IQR) age was 54 (22-122) months; stage completeness was 93% (9199 of 9883). Three-year OS rates were as follows: Wilms tumor, 95% (95% CI, 94%-96%); neuroblastoma, 83% (95% CI, 81%-84%); medulloblastoma, 79% (95% CI, 77%-81%); Ewing sarcoma, 78% (95% CI, 75%-80%); rhabdomyosarcoma, 77% (95% CI, 74%-79%); and osteosarcoma, 75% (95% CI, 73%-77%). Geographical variations in age-adjusted OS were found for neuroblastoma, medulloblastoma, Ewing sarcoma, and rhabdomyosarcoma. Following additional adjustment for stage, differences were no longer significant for neuroblastoma (in the UK and Ireland) and rhabdomyosarcoma (in Eastern Europe) while becoming significant for neuroblastoma in Eastern Europe (hazard ratio, 1.36; 95% CI, 1.05-1.76) and medulloblastoma in Southern Europe (hazard ratio, 1.42; 95% CI, 1.03-1.94). However, no mitigation of survival variation was observed for Ewing sarcoma in the UK and Ireland (hazard ratio, 2.06; 95% CI, 1.39-3.04) and Eastern Europe (hazard ratio, 1.87; 95% CI, 1.22-2.86) as well as for medulloblastoma in Eastern Europe (hazard ratio, 1.68; 95% CI, 1.13-2.49). Conclusions and Relevance:In this BENCHISTA cohort study of 6 solid tumors, international variation in population-level OS was associated with differences in tumor stage distribution for some cancer types and regions. Additional factors are suggested for further investigation. The results have important implications for national health systems for monitoring early diagnosis efforts and supporting collaboration between CRs and clinicians to sustain standardized use of Toronto guidelines to improve understanding of survival variation in childhood cancer.
Background: Elective surgical postponements and cancellations adversely affect patient experience, clinical outcomes, and theatre efficiency within the UK NHS. The Postponement and Cancellations in Elective Care study aimed to establish the national incidence and underlying causes of elective surgical postponements at preoperative assessment and cancellations occurring within 24 h of planned surgery. Methods: This 7-day prospective service evaluation (November 11-18, 2024) collected data from participating NHS England trusts via an online platform. Preoperative assessment postponements were defined as any factor preventing a patient with a 'to come in' date from undergoing surgery as planned, or preventing preoperative assessment completion as 'good to go' within 2 weeks for those without a 'to come in' date. Cancellations were defined as a decision not to proceed within 24 h of planned surgery. Results: Seventy-eight trusts provided complete incidence data covering 22 573 preoperative assessment appointments and 19 905 planned procedures. The national preoperative assessment postponement incidence was 8.7% (95% confidence interval, 6.9-10.8%), most commonly attributable to further investigation or tests (n=595, 27.2%). The national cancellation incidence was 9.9% (95% confidence interval, 8.7-11.3%), most frequently associated with acute medical conditions (n=515, 23.8%) and list overruns (n=315, 14.5%). Conclusions: The Postponement and Cancellations in Elective Care study provides the first national overview of elective surgical pathway disruption in the UK. Nearly half of postponements were attributable to requirements for additional investigation or specialty review, indicating the importance of earlier optimisation and robust preoperative assessment fit to proceed criteria. Acute medical conditions continue to impact short-notice cancellations. Standardised pathways, improved scheduling, and strengthened perioperative coordination could reduce disruption and improve theatre utilisation.
