The duration reduction of around 10% could provide significant cost savings to health systems, limit unwanted drug side-effects, reduce overtreatment and reduce the development of antimicrobial resistance in individuals, across communities and internationally.

The study was commissioned and funded by the National Institute for Health and Care Research (NIHR), and its leading partners were The University of Manchester, Northern Care Alliance NHS Foundation Trust and Warwick Medical School’s Clinical Trials Unit,  who specialise in research in emergency and critical care.

Chief investigator Paul Dark, Professor of Critical Care at the University of Manchester will present the findings to a global online audience at the prestigious this week (10/12/24), where it will be scrutinised and debated by some of the world’s leading experts in the field.

The research team are also to publish their peer reviewed findings in JAMA-  one of the world’s leading medical  journals today

According to the charity Sepsis Research FEAT, around 50,000 people are estimated to die of sepsis in the UK each year, which develops when the body's immune system overreacts to an infection and starts attacking its own tissues and organs.

Accounting for 100,000 hospital admissions a year in the UK, it is estimated that there are 49 million cases and 1 million deaths a year globally.

Recognising sepsis and starting antibiotics  early are crucial but until now the recommended duration of such treatment has been uncertain.

The only available option recommended for doctors currently is to use their judgement  to decide when to discontinue the potent  broad spectrum antibiotics, usually reserved to treat the condition.

The new decision support system is based on a simple blood test, carried out daily and available in most  NHS hospital laboratories.

It tests for levels of a circulating protein called procalcitonin (PCT), which is produced as part of the body’s immune system responses to bacterial infections.

Higher levels indicate a greater likelihood of bacterial infection and sepsis, with subsequent falling levels indicating favourable responses to treatments

A computer automated response, based on the PCT levels from the blood test,    advises doctors whether to discontinue antibiotic treatment or not.  A further commonly measured circulating inflammation protein (C-reactive protein or CRP) was also tested.

The randomized controlled trial was based at 41 intensive care units across the UK, involving 2,760 adults from January 2018 to June 2024.

It compared 918 patients on a  PCT protocol with 924 patients on a  C-reactive protein (CRP) and 918 patients on current standard care.

Clinicians responsible for managing patients received daily standardized written advice on either standard care or on PCT or CRP biomarker-guided antibiotic discontinuation.

The protocols in the study were uniquely designed to  conceal laboratory test results  from clinical  staff to reduce potential bias and patients were randomly assigned to one of the three groups.

The team found that a PCT protocol reduced total antibiotic duration by 10% and all-cause mortality, a key patient safety measure, was the same as standard care .

There was no difference in total antibiotic duration between standard care and CRP protocols..

Professor Dark, who is also an NHS Consultant in Critical Care Medicine at Salford Royal, said: “This simple protocol, if implemented, could significantly change the way sepsis is treated and safely help to combat antimicrobial overuse and resistance-  one of the world’s leading health challenges.

“It is also a powerful illustration of how precision medicine can make a real difference to patient care  when treatment is tailored to  individual test results  of each patient.

“It’s also important to acknowledge that this study would not have been possible without the generous contribution  of patients with this life threatening condition who like all of us, are committed to finding better ways to deal with sepsis.”

He added: “Sepsis has been at the forefront of policy makers minds ever since the publication of 2013 Health Service Ombudsman report which focused on sepsis patients who were not treated urgently enough.

“Ever since then, developing better diagnostics and treatment guidance for GPs and hospital clinicians to help them recognise sepsis at an early stage has been a national priority.

“This trial has been planned to address NICEs recommendations so that its results will inform their future guidance on antibiotic duration in sepsis.”

Sepsis Research FEAT trustee Beth Budgen developed sepsis as a result of a seemingly innocuous Strep A infection on Christmas Day 2022, resulting in quadruple amputations.

She said: “Within 24hrs I was fighting for my life and have been left with life changing injuries as a result. If this can happen to me, it really can happen to anyone. It really is that scary

“The University of Manchester study is one of several significant projects currently being undertaken in the UK in the field of antibiotic treatment for sepsis patients - an extremely important area of research which Sepsis Research FEAT fully endorses.

“The priority setting partnership exercise that the charity recently completed with the James Lind Alliance will also now be crucial in ensuring that the best research into sepsis takes place UK-wide.”

Professor Gavin Perkins, Warwick CTU Trial Lead said: “Sepsis claims tens of thousands of lives each year in the UK.  The findings from ADAPT-sepsis will help doctors ensure that critically ill patients with severe infections get the right duration of treatment with life-saving antibiotics.”

• Critically ill patients recruited to the trial had already commenced antibiotics for sepsis, so the study does not provide evidence for biomarker use in initiating antibiotic therapy.
• The University of Manchester, University of Warwick and Northern Care Alliance NHS Foundation Trust researchers would like to thank the NIHR Clinical Research Network (CRN) for help delivering the study in the NHS and the NIHR Health Technology Assessment Programme for funding the trial.  The collaborative  co-investigator  funded team  in this national study are linked here    .  We would also like to thank Abbott and Roche Diagnostics for their contracted support to assist NHS laboratories participate in the study. 
• Beth’s story is available to read in full and she also appears on the Sepsis Research FEAT  . The PSP outcomes page on their  website can be found .

The technology will help patients answer a painfully difficult question asked by doctors, plaguing them since time immemorial: “How have you been in the last six months?”

The trial is funded by the () and Versus Arthritis.

The Remote Monitoring of Rheumatoid Arthritis () system allows patients to download a symptom tracking app to their smartphone or tablet and sign in at home via NHS login.

The system could revolutionize the care of people living with a long-term conditions, who are often asked by doctors to describe their symptoms since they were last seen.

Professor Will Dixon from The University of Manchester is co-lead for the REMORA study and is a consultant rheumatologist at Salford Royal Hospital.

He said: “It can be difficult for patients to recall and describe the ups and downs of their health in a few minutes during a consultation.

“By tracking symptoms day-to-day and making them automatically available at consultations within the electronic medical record, we will generate a clearer picture of how someone has been in the last six months which could have a transformative impact on treatment and care.”

The research team are about to start the clinical trial which will test whether tracked symptoms, integrated into the NHS, leads to better outcomes compared to usual care.

The trial will allocate patients at random to symptom tracking or not, and will run in 16 hospitals across Greater 91ֱ�� and North West London during 2024-25 with the results expected in 2026.

If successful, the team hope it will become a funded NHS service available for free to all patients with rheumatoid arthritis, and that it can be expanded to other long-term conditions.

Doctors and researchers agree that technology has big potential for improving healthcare, although strong evidence for its efficacy is often lacking.

This trial will test not only whether patients benefit from symptom tracking, but will also examine whether it is value for money, how to ensure certain patient groups are not ‘left behind’ because of the technology, how to get around the barriers for setting up this new technology in the NHS, and how the data generated can be re-used to support research as well as patients’ direct care.

The researchers will conduct interviews with patients, clinicians and other staff within the NHS to understand how to optimise symptom tracking in the future NHS

Areas they will consider include the views of older patients, those with dexterity problems, and those with lower digital access.

The study is also learning how best to allow patients to control who will have access to their data using an electronic consent system from home.

Prof Dixon added: “Smartphones and tablets provide a convenient way for patients to record their symptoms and health changes while living day-to-day with their long-term conditions.

“Real-time tracking from home allows patients and doctors to spot patterns that would otherwise have been missed or forgotten, like flares or gradual changes following treatment.”

Dr Sabine van der Veer, a senior lecturer in health informatics at the University of Manchester is the other co-lead for the study.

She said: “A major advantage of REMORA is that we have successfully sent patient’s data into the NHS.

“The data is available during a consultation, seen from within the electronic patient record that the clinician is already using to manage the patient’s care.

“Patient records have historically only included information entered by clinicians. We are changing this, by learning how patients can contribute information themselves and ultimately improve their long-term health.”

Karen Staniland, a patient with rheumatoid arthritis at Salford Royal, said: “It is very exciting to be involved in this research as one of the patient partners.

“I believe that REMORA could make a real difference to the patient consultation, as evidence provided directly from the patient will already be available to view in their medical record.

“It could also allow time for patients to plan future care with their health care professional and definitely help improve their quality of life.”  

More information about the REMORA study, including a short video, can be found here: and    here:  

One in 11 people over the age of 65 have in the UK, and more than 75% of people over 75 have hearing problems. This means hearing loss commonly occurs alongside dementia.

However, tests for dementia which assess memory, attention and language often include spoken questions that rely on hearing. People with hearing loss score worse in these tests, which could lead to a false diagnosis of dementia.

The new test developed and validated in the study could accurately diagnose dementia in people with hearing problems. It is an adapted version of a standard test – the – which is commonly used to diagnose dementia and mild cognitive impairment (a condition in which a person has minor problems with their mental abilities, such as memory or thinking).

Previously, other researchers have tried removing spoken questions from this test to accommodate hearing loss. However, this approach made the test less accurate.

In this study, the research team instead replaced 3 spoken questions from the MoCA test with written ones. One question assessed attention and the other 2 questions assessed language.

The team evaluated the revised test in a study of 256 people. It was found to be accurate and reliable in people with and without hearing loss.

This is the first fully validated and reliable cognitive test for people with hearing problems and is now .

Researchers say this meets an international need for a reliable test to identify cognitive impairment among people with hearing loss. The test is also being translated and validated in Arabic, Greek, German and Portuguese, and other languages will follow. The standard test is already available in more than 100 languages.

The study was led by Piers Dawes, Professor of Audiology at the University of Queensland in Australia and The University of Manchester, supported by the It was funded by the and involved researchers based across the world, including in the UK, Australia, Canada, Cyprus, France, Greece and Ireland.

As reported in , Professor Piers Dawes, co-lead for 91ֱ�� BRC’s Hearing Health project investigating the prevalence of hearing loss in people with dementia, said: “To maximise quality of life and ensure people get access to appropriate help, it is vital that cognitive difficulties are reliably differentiated from hearing difficulties. For example, a person may struggle with communication and functioning in daily life. Clinicians and family members may incorrectly assume that the person’s difficulties are due to dementia, when in fact they are due to treatable hearing loss.

“Conversely, cognitive impairment may contribute to a person’s difficulties with communication. The hearing loss version of the MoCA test offers the potential to help differentiate cognitive from hearing difficulties.”

Among the study participants, who were aged 60 years or more and recruited from 7 sites across England, Ireland and Australia:

• 159 people had hearing loss and took the revised test only; 83 of this group were known to have dementia.
• 97 people (with no hearing problems) took both the revised and the original versions of the test; 30 people in this group were known to have dementia.

The researchers found the new test was:

• accurate; it identified people with dementia and hearing problems with only small differences between the adapted and original versions of the test.
• reliable; 28 people (10 with normal cognition and 18 with dementia) were retested between 2 and 4 weeks after their initial test and scored similar results.

The test closely matches the standard MoCA test for identifying dementia. It asks similar questions, takes a similar length of time to complete and assesses the same cognitive areas.

People who had spent more than 12 years in education tended to score higher than those who had not. This effect is also found for the standard MoCA test. Adding 2 points to the scores of people who had spent 12 years or less in education (the adaptation made for the standard test) increased its reliability.

While the test could accurately diagnose dementia in people with hearing problems, researchers have identified areas for further investigatio

• To date, this test has been assessed only in people who developed hearing problems – it may not be an effective test in people who were born with hearing loss
• Another . Research is needed to develop a test for people with visual problems.

The , and the , can be found online.

The results of this study were published in the

Developed by 91ֱ�� based company genedrive, working with a clinical team from The University of Manchester and 91ֱ�� University NHS Foundation Trust (MFT), the test can quickly tell healthcare professionals if stroke patients will benefit from the current first line treatment, to prevent recurrence.

Strokes affect more than 6,000 people in Greater 91ֱ�� each year. Individuals carrying changes in a gene called CYP2C19 are twice as likely to have further strokes when treated with the first line preventative treatment, clopidogrel.  

Patients being treated for mini strokes, also called transient ischaemic attacks (TIAs), heart attacks, and peripheral vascular disease could also benefit from the technology, the 91ֱ�� clinical team says.

The genetic changes- which occur in about 25% of all patients in the UK (and up to 50% in different ethnic groups) reduce the effectiveness of clopidogrel – given as standard for most patients with stroke or TIA in the UK.

If these genetic changes can be detected before treatment, then doctors can use an alternative, more effective medicine. This would prevent further strokes, avoiding hospital admissions, saving lives, and reducing costs for the health service.

The technology this week formally receives the UK Conformity Assessed (UKCA) mark, the UK’s equivalent of the European CE mark after a process taking several years of development and validation.

Recent draft from the National Institute for Health and Care Excellence (NICE) recommended that patients who have had a stroke or TIA should be offered genetic testing for variants in a gene called CYP2C19.

Current genetic testing for CYP2C19 can only be carried out using expensive machines in specialist laboratories a process which can take several weeks.

However, the Genedrive® System uses a miniaturised technology for gene reading which can be performed locally in the ward or bedside, can be used with minimal training, and rapidly provides the clinician results in around an hour.

A cheek swab taken at a patient’s bedside is inserted into a testing cartridge and then the cartridge is inserted into the Genedrive System, which is about the size of a shoebox. The instrument interprets the genetic information on the patient and informs the clinician with options on the course of treatment.

The test will be used at 91ֱ�� Royal Infirmary and the 91ֱ�� Centre for Genomic Medicine, Saint Mary’s Hospital, both part of MFT, over the next six months, to further evaluate performance in the clinical setting.

Bill Newman, Professor of Translational Genomic Medicine at the University of Manchester and consultant in Genomic medicine at MFT leads the project.

He said: “Patients who have had a stroke, are likely to be at risk of further, more serious strokes. This is a worrying time for patients, their families and carers. Therefore, it is vital we use new approaches to ensure that patients get onto the right treatment as quickly as possible.”

Joseph, 29, who lives in London, had genetic testing at the 91ֱ�� Centre for Genomic Medicine to determine if clopidogrel is the right treatment for him following a stroke. He said:

“After suffering a stroke, I’ve been left with a lot of uncertainty around the cause, as well as apprehension that it could happen again. Confirming my ability to metabolise clopidogrel effectively has given me comfort in my ongoing management and prevention by providing reassurance that the medication is helping limit the risk of a secondary stroke.

“I was grateful that my genetic test results came back within a week but receiving that reassurance within an hour would have undoubtedly improved my experience.

“I feel fortunate to have had the genetic test and I hope that all patients being considered for clopidogrel medication will have the opportunity going forward. Having a bedside test to check the drug is working properly will revolutionise stroke aftercare and patient experience.”

Dr John McDermott, a National Institute for Health and Care Research (NIHR) Fellow from The University of Manchester and Clinical Geneticist at MFT said: “This work began with a grant from the Wellcome Trust four years ago, which supported development of a prototype system with Genedrive.

“A major challenge faced across healthcare is finding pathways develop, validate, and ultimately implement novel technology like this in the clinical setting.

“In April 2023, we were awarded £4.1million in funding from Innovate UK to launch the programme, which is coordinated by Health Innovation 91ֱ�� and provides a framework for us to do this across Greater 91ֱ��.”

DEVOTE represents a collaboration between industry, universities, and healthcare professionals to support the development and validation of time critical genomic testing technology, building on Greater 91ֱ��’s world leading reputation in this area.

The programme builds on research from the NIHR 91ֱ�� Biomedical Research Centre (BRC), which focuses on making pharmacogenetic testing more accessible to patients to improve clinical outcomes.

Using a simple cheek swab, the test can identify in 26 minutes whether a critically ill baby admitted to intensive care has a gene change that could result in permanent hearing loss if they are treated with a common emergency antibiotic, Gentamicin.

The test, developed by 91ֱ�� researchers was first piloted at Saint Mary’s Hospital and Liverpool Women’s Hospital in 2021.

Following its success, the test was implemented into routine clinical practice Saint Mary’s Hospital in 2022, which has now been extended to North 91ֱ�� General Hospital (NMGH) and Wythenshawe Hospital, part of Saint Mary’s Managed Clinical Service at MFT in July 2023.

It is estimated that approximately 1,700 babies a year will be tested at MFT, which has so far saved the hearing loss of six babies in Greater 91ֱ�� since the pilot in 2021 through to the implementation of the test in 2022.

This introduction follows the by the National Institute for Health and Care Excellence (NICE), earlier this year.

Dr Ajit Mahaveer, Consultant Neonatologist at Saint Mary’s Hospital, was involved in the initial research and has led the rollout across MFT. He said: “Since its introduction at Saint May’s Hospital in October last year, over 600 babies have been tested. Three babies tested positive for the gene change that would cause them to go deaf if given Gentamicin and were successfully given an alternative antibiotic within the NICE recommended ‘golden hour’.”

While Gentamicin is used to safely treat approximately 100,000 babies a year, one in 500 babies carry the gene change that can lead to permanent hearing loss when given the drug.

Dr Mahaveer continued: “As a doctor dealing daily with infection, it is important that we do not delay antibiotic treatment. The new swab test technique replaces a test that traditionally took several days and is the first use of a rapid point of care genetic test in acute neonatal care. It is fantastic to be involved with the rollout of the test across MFT hospitals, which will ensure even more babies do not lose their hearing for a preventable reason.”

Approximately 350 nurses have been trained to use the genetic testing machine across MFT at Saint Mary’s Hospital, Wythenshawe Hospital, and NMGH.

Rachel Parkinson, Senior Sister, Neonatal Unit, North 91ֱ�� General Hospital, said: “Babies can deteriorate so quickly that giving them antibiotics for proven or suspected infection is an absolute priority to ensure the best possible outcome. It is fantastic that in these situations we can now test quickly and easily for this gene change, day or night.

“It is also further reassuring to know that this result could not only have an immediate impact on their lives, but it could also ensure those babies with the genetic variant can further avoid treatment with Gentamicin over their lifetime.”

Dr Mahaveer concluded: “This straightforward non-invasive test is the future of individualised treatment. I am very proud of the team of researchers and clinical staff who have contributed to its success so far. Our ambition is to see this test rolled out across all maternity services in England so that all babies and families can benefit from this test, if needed.”

While MFT is the first trust to routinely use the test, other NHS trusts in Greater 91ֱ�� will soon follow. Bolton NHS Foundation Trust​, Northern Care Alliance NHS Foundation Trust, Tameside and Glossop Integrated Care NHS Foundation Trust​ and Wrightington, Wigan and Leigh NHS Foundation Trust are also set to introduce the revolutionary test in 2023.

91ֱ��-based firm genedrive plc developed the genetic based test with researchers based at MFT, supported by the National Institute for Health and Care Research (NIHR) 91ֱ�� Biomedical Research Centre (BRC) and The University of Manchester.

David Budd, CEO, genedrive, said: “The continued rollout of the Genedrive® MT-RNR1 test demonstrates the engagement with new technology by the MFT clinical teams as well as the positive health impact that point of care molecular testing can have on patients. By having their genetic susceptibility to aminoglycoside treatment rapidly and easily checked prior to treatment, the expanded availability of the Genedrive® MT-RNR1 test throughout the North West region will provide every newborn access to safer and more assured treatment.”

The test rollout at MFT and across Greater 91ֱ�� has been made possible with funding from and its . The programme will collect data for the NICE evidence generation plan which supports the long-term recommendation of the test across England.

Jonathan Massey, Programme Director for Academia at HInM said: “Health Innovation 91ֱ�� funding is supporting the wider adoption across the city-region, ensuring that the work done to date will translate to better and equitable patient outcomes, wherever a child is treated in Greater 91ֱ��.”

Image caption: Rachel Parkinson, Senior Sister on the Neonatal Unit at North 91ֱ�� General Hospital is one of 350 nurses trained to use the device at MFT

More than £74 million has been awarded by the NIHR to 91ֱ�� BRC and 91ֱ�� CRF to improve people’s lives and reduce health inequalities through translational and cutting-edge research

91ֱ�� BRC received a £59.1 million award from the NIHR for 2022-27 – the largest single research award given by the NIHR to the city region and more than double the previous award – to translate scientific discoveries into new treatments, diagnostic tests, and medical technologies to improve patients’ lives in Greater 91ֱ��, Lancashire and South Cumbria.

91ֱ�� CRF was awarded £15.5 million by the NIHR for 2022-27 – a 24 per cent uplift on 2017-2022 and the largest funding award given to a CRF by the NIHR – to boost the delivery of innovative clinical trials across phases, treatment types and conditions, throughout Greater 91ֱ��.

To mark this new round of funding, the official launch of the 91ֱ�� BRC and 91ֱ�� CRF 2022-27 was held at the Whitworth Art Gallery in 91ֱ�� in March.

Andy Burnham, Mayor of Greater 91ֱ��, officially opened the event, followed by key speakers Professor Ian Bruce (Director of NIHR 91ֱ�� BRC), Professor Jacky Smith (Director of NIHR 91ֱ�� CRF), Professor Dame Nancy Rothwell (President and Vice-Chancellor of The University of Manchester), Professor Jane Eddleston, Group Joint Medical Director at 91ֱ�� University NHS Foundation Trust), Professor Dermot Kelleher (Chair of the NIHR 91ֱ�� BRC International Scientific Advisory Board), and Nazir Afzal OBE (Chancellor of The University of Manchester).

With its new funding, 91ֱ�� BRC – hosted by 91ֱ�� University NHS Foundation Trust (MFT) and The University of Manchester – is increasing research capacity by expanding its partnership to include five NHS trusts; Blackpool Teaching Hospitals NHS Foundation Trust, The Christie NHS Foundation Trust, Greater 91ֱ�� Mental Health NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, and the Northern Care Alliance NHS Foundation Trust.

The five-year award also allows 91ֱ�� BRC to further expand its research themes, within the areas of cancer (prevention and early detection, radiotherapy, personalising cancer medicines and living with and beyond cancer) inflammation (arthritis and related conditions, chest diseases, skin disorders and heart disease) high burden under researched conditions (hearing health, mental health and rare conditions) and disease complexity (new ways to diagnose illnesses and developing new treatments). 

With a vision of providing opportunities for people of all ages and backgrounds to take part in clinical research across Greater 91ֱ��, the new funding will enable 91ֱ�� CRF to further grow its experimental medicine provision, within MFT and with partners at The Christie NHS Foundation Trust and Northern Care Alliance NHS Foundation Trust.

91ֱ�� CRF’s world-class facilities and staff are now operating at six sites across Greater 91ֱ��: The Christie, 91ֱ�� Royal Infirmary, North 91ֱ�� General Hospital, Royal 91ֱ�� Children’s Hospital, Salford Royal Hospital and Wythenshawe Hospital.

Andy Burnham, Mayor of Greater 91ֱ��, said: “This is a hugely significant milestone in the building of a 21st century research-based economy in Greater 91ֱ��. I am pleased to see the broad areas of research being focussed on, which includes mental health. We have a new reality when it comes to the health of the nation post-pandemic, and cutting-edge research will enable us to understand what it takes to build a healthier population. If we can make our research ever more relevant to the times we live in and the health challenges we face, then we will continue to build that success story right here in Greater 91ֱ��.” 

Professor Ian Bruce, Director of NIHR 91ֱ�� BRC, said: “We have had an incredible journey over the last 10 to 12 years, growing from a single speciality Biomedical Research Unit, to where we are today – the largest BRC outside the South East of England. This success has only been achieved thanks to a monumental team effort. We have been able to bring together many more world-leading researchers, increase our research themes and expand our geographical reach across Greater 91ֱ��, Lancashire and South Cumbria. This will enable us to make real advances towards improving patients’ lives and reducing health inequalities.”

Professor Jacky Smith, Director of NIHR 91ֱ�� CRF, said: “It is amazing to think that from a single CRF, we now operate six world-class facilities at NHS teaching hospitals across Greater 91ֱ��. As a proud partner within the Greater 91ֱ��, North West, and national research and innovation infrastructure, this collaborative approach means 91ֱ�� CRF can now provide our diverse communities with even more opportunities to take part in clinical research. This success was only possible thanks to tremendous teamwork and our shared goal; that by reducing health inequalities, we can help people to live better lives.”

Professor Dame Nancy Rothwell, President and Vice-Chancellor of The University of Manchester, said: “The University of Manchester is very proud to be a key part of this. 91ֱ�� has received the largest increase in funding of any BRC across the country. This has been made possible by three things: incredible longstanding partnership and collaboration; vision and ambition; and amazing leaders. I don’t know anywhere else in the UK, or in the world, where there is the strength of that partnership – across the University, the NHS trusts, regional government, other regulators and many other organisations. Together with that ambition, vision and leadership, this has led to the success we are rightly celebrating.”

Professor Jane Eddleston, Group Joint Medical Director at 91ֱ�� University NHS Foundation Trust (MFT), said: “Research and innovation has been at the heart of everything we have done in our 350-year history – at MFT and at our predecessor Trusts – and we are absolutely delighted to be part of this journey. We are so proud of the benefits it has given over the last five years – from discovery, to development, through to delivery and the benefits for our patients. This next phase is so exciting because it will allow us to take this across the North West, for the whole of the population to benefit from the opportunity to take part in research

Professor Dermot Kelleher, Chair of the NIHR 91ֱ�� BRC International Scientific Advisory Board (ISAB) and Dean of Faculty of Medicine, University of British Columbia, said: “91ֱ�� BRC has become a true leader of translational research not just in the UK, but internationally. This award is truly outstanding, but it is not unexpected, given the very real commitment of all the partners. It was evident from the very first meeting of the ISAB that all those involved – from Greater 91ֱ��, the NHS and The University of Manchester – were in this together with the intention of driving successful translational research, striving towards health equality and putting the patients of Greater 91ֱ��, and now beyond in Blackpool and Lancashire, at the centre of the BRC.”

Closing remarks were delivered by Nazir Afzal OBE, Chancellor of The University of Manchester. He said: “This award is the continuation of an extraordinary journey and I share the pride of everyone who is part of Manchester BRC and 91ֱ�� CRF, at what they have achieved so far and what they will undoubtedly achieve in the years ahead. The focus on reducing health inequalities, sharing this research, and ultimately preventing people from harm is so important. I hope the people of this country, and of the world, can look to what the BRC and CRF are going to deliver to keep them safe.

The event was attended by academic and clinical research delivery and operational staff from 91ֱ�� BRC, 91ֱ�� CRF and The University of Manchester, colleagues from partner Trusts, industry associates and Greater 91ֱ�� dignitaries.

Watch the video below to find out more about 91ֱ�� CRF and the difference research can make to patients both now and in the future: https://www.youtube.com/watch?v=bQ1Fc41ZWKM Hear from the keynote speakers on the launch event recording on Vimeo: https://vimeo.com/event/2879850/65ef37e072

The study, published in the British Journal of General Practice links the prescribing behaviour of GPs to signs of burnout such as emotional exhaustion, feeling detached from colleagues and patients, lower job dissatisfaction, working longer hours and intentions to leave your job.

The NIHR Greater 91ֱ�� Patient Safety Translational Research Centre (GM PSTRC) is a partnership between Northern Care Alliance NHS Foundation Trust and The University of Manchester.

Researchers found that:

• Increased emotional exhaustion was associated with 1.2 times greater risk of higher strong opioid and 1.2 times greater risk of higher antibiotic prescribing.
• Feeling detached was associated with 1.1 times greater risk of higher strong opioid prescribing and 1.2 times greater risk of higher antibiotic prescribing.
• Low job satisfaction was associated with 1.3 times greater risk of higher strong opioid prescribing and 1.1 times greater risk of higher antibiotic prescribing.
• Intention to leave the job was associated with 1.3 times greater risk of higher strong opioid prescribing and 1.4 times greater risk of higher antibiotic prescribing.

The risk of increased strong opioid and antibiotic prescribing was also found in GPs:

• Working longer hours (4 times and 5 times greater risk respectively)
• Based in the north of England compared to the south (2 and 1.6 times greater risk respectively).

The team analysed UK Oxford-Royal College of General Practitioners (RCGP) Research Surveillance Centre (RSC) data for 13,483 patients on strong opioids and 26,744 patients on antibiotics- a total of 40,227 patients - from December 2019 to April 2020.

The RSC is the oldest sentinel network in Europe and an internationally renowned source of information, analysis, and interpretation of primary care data in England.

The prescribing data from the RSC were linked to the burnout scores of 320 GPs across 57 practices surveyed over the same four-month period.

The study comes as non-medical use, prolonged use, and the misuse of opioids have risen significantly in recent years, leading to dependence, other serious health problems and death.

Similarly, antibiotic resistance is threatening modern medicine, which depends on the effective control of communicable diseases, of which many are bacterial in their origin.

Dr Alexander Hodkinson, NIHR Senior Fellow who works with the GM PSTRC at The University of Manchester said: “This is the first study to assess the association of prescribing of strong opioids and antibiotics with GP burnout as a practice-level problem.

“Over a four-month period we found higher prescribing of strong opioids and antibiotics among GPs experiencing more feelings of burnout.

“These included job dissatisfaction and intentions to leave their job, working longer hours and working in practices in the north of England that serve more deprived populations.

“That is why policies are urgently needed to help mitigate burnout in general practice.”

Dr Maria Panagioti, the principal investigator of the study, and Theme Lead at the GM PSTRC, said: “More and more research studies in other countries find that GPs who feel burnt out often decide to overprescribe drugs, which in the long term could harm instead of cure patients.

“However, thanks to our study, we now have such evidence in the UK on antibiotics and strong opioid prescribing.”

Dr Hodkinson added: “Strong opioids and antibiotic overuse can harm patients in the long-term which is why it is important to prevent their overprescribing.

“Our findings suggest that one possible way to prevent overprescribing maybe to encourage practices to take care of the well-being of their GPs.

“Perhaps more regular monitoring of the well-being of GPs through health-related surveys, wellness programmes and other measures to improve the working climate might be a helpful way to promote safe and appropriate prescribing strategies.”

Professor Tony Avery theme lead for ‘Improving Medication Safety at the GM PSRC  said: “As a practising GP, the priority here must be to do everything we can to minimise the risk of burnout in GPs. However, the association between workload, burnout and the use of medicines that may be overprescribed suggests that preventing burnout may help to improve prescribing quality.”

The study involved a collaboration of researchers at The University of Manchester, Keele University, Exeter Medical School, University of Southampton, University of Oxford, and was supported by Oxford’s Royal College of General Practitioners Research Surveillance Centre.

Government is investing £100 million to accelerate the growth of three high-potential innovation clusters, Glasgow, Greater 91ֱ��, and the West Midlands. This investment will ensure they become major, globally competitive, centres for research and innovation. 

As part of a two-year programme, Greater 91ֱ�� will launch innovative projects in sectors where it has existing research strengths, including advanced materials, artificial intelligence (AI), diagnostics, and net zero.

The health innovation accelerator will focus on tackling some of the most challenging disease areas through early diagnosis using novel approaches and holistic treatment aligned to people’s specific needs. It is hoped this will help to save more lives and improve health outcomes for people at high risk or living in the most disadvantaged communities.

The health accelerator will focus on enhanced diagnostics and genomics, delivered through a partnership between Health Innovation 91ֱ��, 91ֱ�� University NHS Foundation Trust, and the University of Manchester.

Further significant investment has also been leveraged through partnerships with businesses in life sciences, digital and creative industries, which is a testament to the strength of Greater 91ֱ��’s partnerships with industry.

The following projects will be funded as part of the GM health accelerator programme:

1.   Liver disease – Building on the existing ID LIVER research project to find and treat liver disease in patients much earlier.

2.   Heart failure – Developing a new approach for finding more people at risk of heart failure, focusing on communities most in need.

3.   Lung cancer screening – Building on the well-established Lung Health Checks programme to develop digital approaches for more targeted screening and community outreach.

4.   Chest pain – Working with the North West Ambulance Service to develop diagnostic tools to be used by paramedics before patients reach hospital.

5.   Community diagnostics – Deploying proven point of care tests and diagnostic tools to improve the identification of people at risk of lung disease, heart disease, and other cardiometabolic conditions, focused on underserved communities.

Each project will be underpinned by a shared ethos to reduce inequalities, forge new relationships with communities, and drive productivity through innovative collaborations with business and industry, as well building on assets already in existence within the GM system.

Professor Ben Bridgewater, Chief Executive at Health Innovation 91ֱ��, said: “The health innovation accelerator programme will develop a step-change in the development and deployment of novel diagnostics in GM, targeted towards the needs of local people. It will add value to academic research and sector strengths and leverage existing data assets to transform patient care, unlock new market opportunities for businesses, and strengthen GM’s position as a world-leading centre for health innovation.”  

Professor Jane Eddleston, Group Medical Director for 91ֱ�� University NHS Foundation Trust, said: “Delivering earlier and more accurate detection, diagnosis, and prognosis, through collaboration, is key to tackling the health inequalities across Greater 91ֱ��. Through our clinical research excellence and joint working with our city-region health innovation accelerator colleagues and strategic global corporate partners we will be able to identify the most prevalent issues affecting our communities and develop targeted patient-centred care and treatment.”

Professor Graham Lord, Vice-President and Dean of the Faculty of Biology, Medicine and Health at The University of Manchester, said: “We are delighted that our city region has been recognised as a powerhouse for healthcare and life sciences innovation and proud of The University of Manchester’s part in this success. The innovation accelerator programme has great potential to transform healthcare for the better in our region and more generally.”

In addition, a programme to develop a pipeline of new genomic technologies will be established, in collaboration with the University of Manchester. The Development and Validation of Technology for Time Critical Genomic Testing (DEVOTE) Programme will bring together academic, industry and clinical partners from across the region to deliver enhanced genomic diagnostics to prevent stroke; rapid genetic point of care devices to detect genetic changes; and the development of ‘pharmacogenetic passport’ to optimise precision medicines for patients.

Bill Newman, Professor of Translational Genomic Medicine at UoM, Consultant in Genomic Medicine at MFT, and a researcher with the National Institute for Health and Care Research (NIHR)  91ֱ�� BRC, said: “This is a great opportunity to enhance GM’s status as a world leader in creating genetic tests that can give rapid results in minutes. We expect that the DEVOTE projects will lead to the adoption of new tests by the NHS to make drug prescription safer and more effective. This will be good for patients and good for GM by creating jobs and a centre for investment in this cutting-edge science.”

Councillor Bev Craig, Leader of Manchester City Council and Greater 91ֱ��’s Economy Lead, said: “The Innovation Accelerator programme is a tremendous vote of confidence in the world-leading research that goes on across Greater 91ֱ��’s innovation ecosystem.

“Rebalancing R&D spending is an important element of levelling up our national economy. Providing funding and support for regional innovation ecosystems will lead to higher levels of private sector investment, creating high-quality jobs and stimulating economic growth.”

The number means 91ֱ�� bagged more of the  27 new appointments announced by The National Institute for Health and Care research -  or NIHR for short –than any other University.

are among the most prominent and prestigious researchers funded by the NIHR and receive an award of £20,000 per year to fund activities supporting their research.

The awards were made by  independent expert committee chaired by senior professors from across the country.

The NIHR also announced the reappointment of 29 Senior Investigators, 4 of whom  were from 91ֱ��.

That means in total, there are 29  Senior Investigators from 91ֱ��; including 7 with Emeritus status.

The new investigators include four Professors from the Division of Nursing, Midwifery and Social Work: Penny Bee, Jo Dumville, Janelle Yorke and Alys Young.

The 91ֱ�� sextet will be completed by Corinne Faivre Finn,  Professor of Thoracic Radiation Oncology and Katherine Payne, Professor of Health Economics.

The reappointed investigators are: Kathryn Abel, Professor of Psychiatry, Timothy Illidge, Professor of Targeted Therapy and  Oncology, Kevin Munro, Professor of Audiology and Chris Todd, Professor of Primary Care and Community Health.

Professor Graham Lord, Vice-President and Dean of the Faculty of Biology, Medicine and Health said: “This fantastic news for the University and a powerful endorsement of our world leading research.”

Professor of Nursing, Dame Nicky Cullum, said: “This brilliant news couldn’t land at a better time.  It will be International Women’s Day on 8 March and recognising our outstanding women researchers is  a great way to celebrate it.”

Collectively, Senior Investigators constitute the NIHR College of Senior Investigators, and are members of the NIHR Academy.

They help guide research capacity development and enhance the career paths of NIHR researchers. This includes participating as mentors in the NIHR mentoring programme.

NIHR Senior Investigators can complete up to two terms and then gain Emeritus status.

NIHR Senior Investigator status is  awarded according to a number of including quality and volume of internationally excellent research, relevance to patients and the public and impact on improvements in healthcare and public health.

The criteria also include research leadership, engagement of patients and the public and engagement of healthcare policy makers and planners with their research.

The analysis, carried out by University of Manchester researchers shows that when controlling for the characteristics of participants, the risk of Diabetes progression was 20% lower in people with pre-diabetes referred to the NHS Diabetes Prevention Programme (NDPP) when compared to similar patients not referred to NDPP.

, funded by the National Institute for Health and Care Research (NIHR), and hosted by Northern Care Alliance NHS Foundation Trust, is published today in the journal PLoS Medicine.

The NHS Healthier You Diabetes Prevention Programme in England is offered to non-diabetic adults with raised blood sugars – or pre-diabetes - providing exercise and dietary advice to help reduce people’s risk of developing the disease.

Across the 2,209 GP practices for which the researchers had data, over 700,000 people were identified with pre-diabetes and around 100,000 had a code in their health records indicating they were referred to the programme.

18,470 patients referred to NDPP were matched to 51,331 similar patients not referred to NDPP.

The probability of converting to Type 2 Diabetes at 36 months after referral was 12.7% for those referred to the NDPP and 15.4% for those not referred to the NDPP.

Using a figure of 1,000 people referred to NDPP and 1,000 not referred to NDPP, by 36 months after referral, the team calculate they would expect 127 conversions to Type 2 diabetes in the group referred to the programme and 154 in the group not referred.

The mechanism for the difference is likely to be through weight reduction, with previous work showing that people who attended the NHS DPP were associated with a significant reduction in weight - the key factor in reducing risk - of 2.3 kg on average.

In addition, prior work also showed levels of HbA1c - the average blood sugar levels for the previous two to three months - reduced by a significant 1.26 mmol/mol.

Most of the previous trial results have shown that weight loss is the key factor in reducing risk of the disease; increased BMI was also a key factor.

Dr Rathi Ravindrarajah from The University of Manchester said: “Our findings show that the NDPP appears to be successful in reducing the progression from non-diabetic hyperglycaemia to Type 2 Diabetes.

“Even though we were only able to examine referral to the programme, rather than attendance or completion, it still showed a significant reduction in risk of 20%.

“That suggests the decision to implement programme quickly and at scale in England was the right one.

“And as the results are reproducible, it also supports the continuation of similar programmes to Northern Ireland, Scotland and Wales.”

Professor Evangelos Kontopantelis from The University 91ֱ�� said: “Type 2 diabetes is a major public health concern which has been rising globally, with over 3 million people in the UK currently diagnosed with it.

“Previous studies have shown that both lifestyle modifications through diet and physical activity and medication can prevent progression to this condition.

”This study is good news for the Healthier You Diabetes Prevention Programme which we show beyond doubt is a powerful way to protect your health.”

Health and Social Care Secretary Steve Barclay said: “The NHS Diabetes Prevention Programme has seen promising results with a 20% reduction of risk to those taking part developing Type 2 Diabetes, empowering people suffering with pre-diabetes to take control of their own health. 

“Diabetes costs the NHS around £10 billion a year, but this evidence-based programme is an example of how we can help people make lifestyle changes to prevent the disease progressing, whilst ensuring value for the taxpayer.”

NHS national clinical director for diabetes and obesity, Professor Jonathan Valabhji, said: “This important study is further evidence that the NHS is preventing type 2 diabetes and helping hundreds of thousands of people across England to lead healthier lives.

“We completed roll out of the NHS Diabetes Prevention Programme in 2018, and now over 1.2m people have been offered support with lifestyle changes including better quality nutrition, weight loss, and increased physical activity, which this study shows is preventing development of this life-changing condition.

“You can easily check your risk through the &�Բ�����;�ٴǴDZ�.”

The paper Referral to the NHS Diabetes Prevention Programme and conversion from non-diabetic hyperglycaemia to type-2 diabetes mellitus in England: a matched cohort analysis is available

The findings are published in the British Journal of General Practice as more and more people face the prospect of ear wax removal services being discontinued at their GP surgeries.

However, despite the withdrawal services, impacted ear wax is still a major reason for GP consultations; more than 2 million people in the UK needing ear wax requiring removal, say the research team led by Professor Kevin Munro at The University of Manchester and National Institute for Health and Care Research (NIHR) 91ֱ�� Biomedical Research Centre (BRC).

Ear wax is a particular problem in care homes, affecting up to 44% of residents with dementia.

The research team, surveyed 500 adults who used NHS ear wax removal services and found the most common and troubling symptom of blocked ears was hearing difficulty.

The study supported by the NIHR 91ֱ�� BRC found:

• 9 out of 10 of those surveyed said hearing difficulty was at least moderately bothersome.
• 6 out of 10 reported it to be very/extremely bothersome.
• After removal of the ear wax, more than 8 out of 10 people reported an immediate improvement.

Ear wax impacts on the ability to communicate with others but also affects listening to TV and monitoring sounds in the environment.

Additional symptoms caused by impacted ear wax includes discomfort and tinnitus (ringing in the ears).

Kevin Munro, Professor of Audiology at The University of Manchester and 91ֱ�� BRC Hearing Health Theme Lead said: “If anyone tries simulating the effect of impacted wax by walking around with their fingers plugging their ears for a few days, they’ll soon realise that it is a serious issue.

“The recommendations from the National Institute for Health and Care Excellence (NICE) could not be clearer- NHS ear wax removal services should be provided in the community.

“There are multiple reasons why GP surgeries are ceasing to provide ear wax removal services. The traditional method of syringing ears is no longer recommended but there are newer and safer methods for flushing wax out of the ear.

“There is also a misunderstanding that using ear drops to soften the wax will be enough to resolve the problem but there is little evidence to support this claim.   Once the wax has been softened, it needs to be flushed out of the ear or vacuumed up, neither of which can be done at home without expertise.

“Perhaps one solution is that GP surgeries could collaborate as a network as the portable nature of modern ear wax removal equipment is ideal for moving to different locations.”

Though there are a variety of home ear wax treatments on the market, NICE argues there is either no, or insufficient evidence, to support any of these.

Concerns over why people are being referred to hospital-based ear wax clinics - resulting in long waiting times and poor use of specialist services - have even been raised in parliament.

This and a 2022 Royal National Institute for Deaf People (RNID) report called Access blocked: the impact of cutting NHS ear wax removal services, described how many people are being forced to pay £50 to £100 every time they need the ear wax to be removed.

More than a quarter of people told RNID they couldn’t afford to get their ear wax removed privately.

Ear wax is a normal substance made by our body to clean, protect and keep our ears healthy. Movement of the jaw, as well as the skin that lines the ear canal, causes the wax to move to the entrance of the ear where it then flakes off or is carried away when we wash. Sometimes this doesn’t work, and the ear wax becomes impacted.

The paper, “Ear wax management in primary care: what the busy GP needs to know” is published in the British Journal of General Practice is available . 

Part of nearly £800 million awarded to 20 new Biomedical Research Centres across England by the NIHR, Greater 91ֱ��’s award is part of a significant boost to the city-region, increasing the coverage of early-stage research across the nation and ensuring everyone has access to cutting edge clinical trials. 

NIHR Biomedical Research Centres are partnerships between healthcare professionals and academics in the country’s leading NHS trusts and universities. The centres, part of NIHR’s research infrastructure, receive substantial levels of sustained funding to attract the best scientists and create an environment where experimental medicine can thrive, while also providing opportunities for a diverse range of professionals to undertake research, expanding research expertise.

Formed in 2017 with a £28.5 million five-year award from the NIHR, 91ֱ�� BRC is the largest BRC outside the South East of England and brings together world-leading academic clinical researchers. 91ֱ�� BRC is hosted by and The University of Manchester (UoM), in partnership with and the . With this new 2022-27 award, 91ֱ�� BRC will increase research capacity by expanding our partnership to include three new NHS trusts; , and . The new funding also allows 91ֱ�� BRC to expand from our current research areas of cancer, dermatology, hearing health, musculoskeletal, and respiratory, into further areas of relevance to our diverse populations including heart disease, mental health, and rare conditions.

Professor Ian Bruce, Director of NIHR 91ֱ�� BRC, said: “We are absolutely delighted to receive this award from the NIHR – which more than doubles our previous award. This is a testament to our achievements over the past five years and also to our vision for the future; expanding both our research themes and our geographical reach. This will ensure that communities across our region’s urban, rural and coastal settings will now be able to participate in cutting-edge research. This award also allows us to further build our workforce to develop and deliver research across our region and to involve many more of our citizens and local patients in our research planning.

“We know that our region has high levels of deprivation and was disproportionately affected by the COVID-19 pandemic, which further widened health inequity. It is therefore imperative that 91ֱ�� BRC continues to bridge the gaps between new discoveries and personalised care, to ensure that we are levelling up health and care for all.

“I would like to thank everyone involved with our bid over the last two years. It has taken a monumental effort of hard work and dedication from our BRC Faculty and Core Team, and our partners, who were all singularly driven in our vision to drive health improvements and lasting change for all.”

Davine Forde, from Moss Side, is an Associate at the 91ֱ�� BME (Black and Minority Ethnic) Network CIC, and the Patient Involvement Representative for the 91ֱ�� BRC Governance Board. She said: “91ֱ�� has some of the poorest health outcomes in the country, especially in ethnic minority communities. I want to be part of the solution to fixing this, and I’m delighted to be working with 91ֱ�� BRC who share that vision.

“91ֱ�� BRC doesn’t just talk about equality – it lives it, by giving value to the lived experience of our diverse population and communities. We are not just patients, but partners on par with academics and clinicians to help overcome these problems. We can all learn from each other, and 91ֱ�� BRC’s commitment to inclusivity means we are on the road to discovery together.

“As an individual living with several long-term conditions, we may not find the treatments for my conditions, but the legacy of Manchester BRC will be improving health outcomes and reducing health inequalities for my children, and grandchildren.”

Sir Michael Deegan CBE, Group Chief Executive of MFT, said: “Clinical research and innovation are key to Greater 91ֱ��’s reputation as a world-class healthcare setting. We are very proud to host one of the largest NIHR portfolios in the country as part of our ‘One 91ֱ��’ vision, and the new expanded 91ֱ�� BRC will help us to deliver even more cutting-edge treatments to our patients in Greater 91ֱ��, and beyond.”

President and Vice-Chancellor of The University of Manchester, Professor Dame Nancy Rothwell, said: “This announcement is another example of the strength and depth of Greater 91ֱ��’s provision as a world leading centre for biomedical and health research.

“This funding will further enhance the rightly deserved reputation for the city-region and contribute to improving the health outcomes and inequalities for our residents, and many more people beyond. As a University, we are extremely proud of the work we have done over the past five years as a fundamental part of the BRC collaboration and very much look forward to working with our partners in the future.”

Professor Graham Lord, Vice-President and Dean of The University of Manchester’s Faculty of Biology, Medicine and Health, said: “Over the last five years we have been able to demonstrate that our clinical academic research not only provides excellence, but also value for money. Through our leveraged grant income, output of highly citated papers, and strategic collaborations with key industry partners, we have established 91ֱ�� BRC as a powerhouse of translational research.

“When we look back on this award, we will see it as critical upward turn for our entire ecosystem”

Andy Burnham, Mayor of Greater 91ֱ��, said: “Greater 91ֱ�� is big enough to matter, but small enough to know each other and driven enough to make a difference. 91ֱ�� BRC encapsulates this perfectly. Bringing together our brilliant clinical and academic minds to collaborate on the healthcare challenges our region faces, driving those discoveries through into treatments, and sharing them with the rest of the world.

“This is a truly exciting time for everyone in Greater 91ֱ��, and 91ֱ�� BRC is pivotal to creating a better future for all of us.”

Paul Dennet, Salford City Mayor and Greater 91ֱ�� Integrated Care Partnership Chair, said: “Integrated care means starting with the person, understanding they’ll have different needs as they move through life, and connecting them with the right care. 91ֱ�� BRC’s mission is to bring new discoveries into individualised, personalised care, and I’m delighted this funding will allow for new research and treatments, improving the health, wealth and wellbeing of the 2.8 million people living in Greater 91ֱ��”.

Sir Richard Leese, Chair, NHS Greater 91ֱ�� Integrated Care (IC), said: “91ֱ�� BRC’s award is a major boost to our research capabilities in the Integrated Care system and it provides us with a clear line of sight to help us deal with many of the major health and care needs of our city-region. It will also help us reduce many of the health inequalities that are evident in our diverse population.”

BRCs have supported almost 60,000 studies and published 55,000 research papers, as well as supported the career development of more than 14,000 junior doctors and research scientists.

Professor Lucy Chappell, Chief Executive of the NIHR, said: “Research by NIHR Biomedical Research Centres has led to a number of ground-breaking new treatments, such as new gene therapies for haemophilia and motor neurone disease, the world-first treatment for Creutzfeldt–Jakob disease, a nose-drop vaccine for whooping cough, and the first UK-wide study into the long-term impact of COVID-19.

“This latest round of funding recognises the strength of expertise underpinning health and care research across the country and gives our nation’s best researchers more opportunities to develop innovative new treatments for patients.”

Read more about the 2022 BRC funding announcement via the .

Patients and staff who appear in the collection were interviewed by volunteers in the five year study coordinated by historian Professor Stephanie Snow.

Since 2017, the ‘NHS at 70’ team at the University of Manchester has recorded over 2,000 audio interviews with 1,300 people across the UK about the history of the NHS and its place in everyday life and work, supported by The National Lottery Heritage Fund.

A £1m grant from UK Research and Innovation through the Arts and Humanities Research Council in July 2020 enabled the researcher team to link up with the British Library’s oral history department to form this permanent public resource which will also inform policy and practice.

The interviews are being preserved for posterity at the British Library and the Library will make the full collection available online in early 2023. 

Voices of Our National Health Service sits within the British Library’s wider Covid-19 collecting initiative which includes other streams of Covid-related content spanning broadcasting, websites, video, and written accounts.

Unique accounts from Voices of Our National Health Service are highlighted in a web resource ‘Covid Stories’: to which content will be added in the coming months. 

The project has involved more than 160 volunteers across the UK and is supported by a diverse group of stakeholders including the NHS, the TUC, Age UK, the Stroke Association and many other health, community and heritage organisations

Other participants in the project include patients, policymakers, frontline NHS staff, young people and individuals with high-risk conditions.

Historian Professor Stephanie Snow from the University’s Centre for the History of Science, Technology, and Medicine is the project’s principal researcher.

She said: “Until this project, there was no detailed historical record of the people who depend on the NHS, and those who work in it.

“The focus of historians of the NHS was always on policy and politics but the incredible range of voices from across different communities who were affected by the NHS were not captured.

“That is why Voices of Our National Health Service is an invaluable record for anyone - from patients to policy makers to historians – who is trying to understand and learn about the unique place of the NHS in our everyday lives from routine treatments to caring for people with new diseases such as HIV and Covid.”

Interviews were conducted face to face until March 2020 when Covid-19 began to impact on lives and communities and the team, including volunteer interviewers, switched to telephone interviews.

She added: “Covid has produced seismic shifts across lives and communities and its social significance in terms of a public health crisis was unprecedented in living memory.

“It was a watershed moment in the longer history of the NHS which prompts the question how have public attitudes to the NHS changed, what does care mean and who should provide it?

“These are some of the vital questions that the personal testimonies captured in this collection respond to.”

Mary Stewart, Lead Curator of Oral History at the British Library said: “We are delighted to have worked with the team at the University of Manchester to archive Voices of Our National Health Service.  These important and moving personal accounts add to our rich collections on the National Health Service, and the interviews conducted throughout the pandemic document a major moment in British history.”

Included in the collection are:

• Dame Elizabeth Nneka Anionwu, a British nurse, health care administrator, lecturer, and Emeritus Professor of Nursing at . An advocate for equality and diversity, in 1979, she became the United Kingdom's first sickle-cell and thalassemia nurse specialist, helping establish the Brent Sickle Cell and Thalassaemia Counselling centre
• Mary Good who was interviewed in 2019 aged 106 – the collection’s oldest contributor. Born before women got the vote, the former nurse remembers her father working as a GP before the NHS was launched. Mary has recently died.
• Norman Sharp, who had the first hip replacement on the NHS in November 1948. Norman died in August 2021
• Perpetual Uke, is a Rheumatology Consultant at Birmingham City Hospital. Her premature twins were delivered by caesarean while she was in a coma with Covid.

Clips from these interviews are available for reuse and accessible at:

Louise Sutherland, Head of Engagement, England, North at The National Lottery Heritage Fund, said: “We are really proud that The National Lottery Heritage Fund has been able to support the Voices of Our National Health Service project to ensure these heartfelt and inspiring stories - from the creation of our enviable health service through to pivotal moments in our contemporary history such as the Covid-19 pandemic – have been captured and safeguarded for future generations. The heritage of the UK is always evolving, and it’s fantastic to see how this wonderful project has grown and progressed to showcase the important stories of the NHS that will define our history.

“A huge congratulations to the project team and also the hundreds of volunteers for all their hard work, in creating such a fascinating and important collection from across the UK.”

The Memorandum of Understanding (MoU) between , Healthineers and The University of Manchester (UoM), will formalise already close working relationships between the three organisations.

Indeed, in January 2021, – with a value of approximately £125 million.

The Value Partnership between Siemens Healthineers and the Trust ensures the provision and replacement of key radiology equipment across nine of MFT’s hospitals, and represents a strong investment in the future of the UK’s largest NHS trust and the 750,000 people it delivers care for.

Key priority areas encompassed within the new, tri-party MoU include:

• earlier detection and intervention for cancer patients
• data-driven approaches to early diagnosis – ensuring patients receive the right treatment sooner
• integrative diagnostic approaches (testing) for conditions which disproportionally affect the Greater 91ֱ�� (GM) population, such as heart disease and preventable cancers

Dr Katherine Boylan, Head of Innovation at MFT, said: “91ֱ�� University NHS Foundation Trust is delighted to sign this new agreement with our close partners Siemens Healthineers and The University of Manchester.

“It will provide a formal framework for joint working, bringing the power of industry, academia and the NHS together to deliver benefit for the populations we serve, enabling us to collaboratively deliver outputs at pace.

“It is widely recognised that there are deep-rooted health inequalities and high levels of long-term conditions across GM, and our three organisations are committed to working to address these persisting issues.”

Professor Neil Hanley, Vice-Dean covering Research and Innovation in the Faculty of Biology, Medicine and Health at The University of Manchester, said: “This new partnership is really exciting and further evidence of our strength in working across university, NHS and commercial boundaries to translate research into innovations that make a real difference not just locally, but also out in the wider world."

Dr Craig Buckley, Head of Research and Development at Siemens Healthineers GB&I, said: “91ֱ�� has recognised that it faces considerable population health challenges, highlighting the need for a healthcare system focussed on rapidly delivering improved patient outcomes.

“Pioneering breakthroughs in healthcare is at the heart of what we do. This partnership marks a joint commitment to tackling the burden of cancer and other prevalent diseases in the region, with the aim of delivering cutting-edge detection and diagnosis, as we seek new ways of delivering care.”

GM has one of the largest National Institute for Health and Care Research (NIHR) infrastructures in the country.

This includes the , which was during the next five years. 

The GM research portfolio also encompasses the , co-hosted by MFT and UoM, which translates scientific breakthroughs into diagnostic tests and life-saving treatments.

Photo shows Professor Neil Hanley; Vice-Dean covering Research and Innovation in the Faculty of Biology, Medicine and Health at The University of Manchester, Dr Katherine Boylan, Head of Innovation at MFT, and Dr Alexandra Olaru, Research Collaborations Lead at Siemens Healthineers.

The paper’s authors believe its findings highlight the importance of investing time and effort into strategies to ease burnout across all areas of medicine, particularly in emergency medicine, to ensure doctors can deliver safe and effective treatment.

The paper, Associations of Burnout with the Career Engagement of Physicians and the Quality of Patient Care: A Systematic Review and Meta-analysis* was published today in The BMJ. The paper was funded by the National Institute for Health and Care Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between The University of Manchester and Northern Care Alliance NHS Foundation Trust. The paper was also funded by the NIHR School for Primary Care Research.

Burnout is a reaction to prolonged or chronic work-related stress and involves exhaustion, feelings of not being able to do the job, and cynicism. It is becoming more common among doctors, and this is the largest review to critically assess published studies on the effects of the quality of care given to patients and the engagement of doctors with their career.

Dr Alexander Hodkinson, NIHR Senior Fellow at the Centre for Primary Care, and lead for this research at the GM PSTRC, said: “We understand that doctors are under a number of pressures and with burnout taking the form of an epidemic, particularly since the COVID-19 pandemic, it’s important to understand its impact on the quality of care doctors give. The fact that both general practitioners and hospital doctors with burnout are twice as likely to be involved in a patient safety incident and are three times as likely to leave their job is significant. Therefore, for organisations such as the NHS, addressing burnout needs to be a priority.

“Also, understanding how burnout affects a doctor’s engagement with their career is valuable.  If doctors aren’t engaged, they’re more likely to leave the profession, leading to an increase in staff turnover which can negatively impact patients and healthcare organisations.”

The research involved analysing 170 papers and revealed that doctors experiencing burnout are up to four times more likely to be dissatisfied with their job and more than three times as likely to regret their career choice. In addition, they are twice as likely to receive low satisfaction ratings from patients.

Aneez Esmail, Professor of General Practice at The University of Manchester who was involved in this study, said: “The pressures that many clinicians face in the NHS is impacting on their ability to deliver safe and effective care. In relation to general practice, the impact of this stress is causing doctors to experience burnout so they become despondent and think about leaving the profession (either by retiring early or leaving the NHS). This also impacts on how they deliver care to patients, with doctors who experience burnout more likely to make errors that result in patient harm. By addressing burnout, this research helps to show that care could be safer.”

*Associations of Burnout with the Career Engagement of Physicians and the Quality of Patient Care: A Systematic Review and Meta-analysis –

The findings, published in the Journal of Health Economics and funded by the National Institute of Health and Care Research, are the first to show evidence of income-related inequalities in access to timely and appropriate emergency care in England.

Using national data on patients arriving by ambulance at all major English A&E departments during 2016/17, the researchers compared waiting times, treatments, and health outcomes for patients.

They found that patients from more deprived areas waited longer to receive treatment, and received less complex treatment than those from more affluent areas, even when presenting with the same health conditions and at the same hospital.

Though the inequalities in waits were small for an individual patient (2.2% increase in waiting time for the start of treatment), the differences were systematic and represent a substantial amount of delay at the population level.

Patients from deprived areas were also less likely to be admitted to hospital (2% less) and less likely to be referred on for follow-up care (7% less).

Previous research has found patients from more deprived areas also wait longer for planned operations such as knee replacements despite having the same level of need for treatment, but this is the first study to look at waiting times for emergency care.

The observed inequalities were present even when A&E departments were less crowded, indicating that inequalities aren’t concentrated in periods when staff are under greater time pressure. It is possible, say the researchers,  that unconscious bias is the reason that lower priority is given to patients from deprived areas.

Waiting times are likely to be more important in an A&E setting, where the severity of conditions may have very serious health consequences for patients, and prioritisation decisions must be made quickly. This pressure may also lead to higher fear of litigation, which could subconsciously affect how doctors interact with some patients.

, Patients from the most deprived areas, who are more likely to have underlying health conditions, accounted for more than twice as many attendances as those from the least deprived areas, and were equally or more severe on arrival, despite being younger on average.

But inequalities in timely and appropriate care in A&E may also exacerbate these existing health inequalities, with patients from the most deprived areas almost 6% more likely to attend A&E again within 7 days and almost 5% more likely to die within 30 days, compared to the least deprived.

Lead author Dr Alex Turner from The University of Manchester said: “Our results suggest the NHS principle of “equal access for equal need” is not being upheld in English Emergency Departments.

“Adding to evidence from previous studies that patients from more deprived areas wait longer for planned operations, we find these patients also wait longer for care in A&E where extended waits are more likely to have severe consequences for health”

“And though the magnitudes of inequalities are smaller in an A&E setting than in planned care, we also found patients from deprived areas were substantially more likely to choose to leave without treatment while waiting in A&E.

“Not only do patients from more deprived areas receive less timely care, they also receive different care, with physicians less likely to provide these patients with complex care within the A&E and less likely to refer them for subsequent care.”

Co-author Dr Ruth Watkinson added: “We find evidence that suggests patient-staff interactions, and particularly unconscious bias towards patients from deprived areas, may contribute to unfair inequalities in A&E. Policies designed to improve these interactions should be prioritised.

“Inequalities in mortality following A&E attendance suggest the healthcare system may be exacerbating already-entrenched inequalities.

“Addressing this is especially important given reducing health inequalities is a key priority for the NHS.”

‘Smart pumps’-  which automatically calculate the dose and rate of different drugs before they are pumped into a vein  - prevent potentially fatal errors by stopping the administration of the wrong rate.

But according to the study published in BMJ Open Quality, though the technology probably saved the lives of 110 people in two Trusts over a year, it has largely failed to be adopted by hospitals.

Though many IV pumps used in hospitals have a smart capability, most trusts do not utilise the functionality because they are difficult to configure and maintain.

Smart pumps are usually configured by a pharmacist and checked by a consultant or senior nurse. Conventional pumps, however, are set by ward staff who calculate and input infusion rates themselves - increasing the risk of drug errors.

The risks are illustrated by previous work from the 91ֱ�� team, who demonstrated that 1 in 10 IV drug administrations are associated with an error, and up to 1 in 10 of those were associated with harm.

In the BMJ Open Quality study, almost 1.5 million IV infusions were administered over one year (644 052 patient bed days), but only 45% (745,170) of these were administered with smart pumps capability enabled.

There were 6,067 infusions that exceeded the dose limits of the pumps. Subject matter experts were asked to rate severity of all adverse events on a scale of 0-no harm to 10-death and they found 89% of these events were unlikely to cause patients any harm.

However, smart pumps prevented 668 moderate to severe harm administration errors (a rate of 0.9/1000 IV administrations) and included blood thinning medication, drugs affecting heart rhythm and drugs used to stop epileptic seizures.

Of 17.9/1000 intercepted drug administration errors, the most common drugs to trigger an alert were antibiotics (2,979 alerts in 134,821 infusions) but there was a relatively low potential for harm from these infusions (1.01/1000 administrations). 

The highest incidence of potentially harmful adverse events was for parenteral anticoagulants (24.16 per 1000 administrations which risks severe bleeding. There have been reports of these events in the NHS recently.

Drugs with greatest potential for harm with an adverse event were parenteral anticoagulants at 24.16/1000 administrations, antiarrhythmics at 21.8/1000 administrations and antiepileptics at 20.86/1000 administrations. 

Some alerts were triggered because the pumps were programmed with limits that did not reflect practice in the clinic, which suggested routine practice might contribute to patient harm.

In another paper published in the journal Drug Safety at the same time, the research team collaborated with academics, patient advocacy groups and senior clinicians to develop and publish guidelines to support organisations in their adoption of smart pumps, so they are used to their full potential across the NHS and infuse drugs at standardised concentrations.

A symposium of 36 clinical and academic medication safety experts proposed strategic recommendations to support the implementation of medication administration technology to improve medication safety.

Both papers were the result of collaborations the University of Manchester, pump manufacturers Becton-Dickinson - who funded the study- and the NHS who shared their data with the team.

Lead author is a researcher at The University of Manchester based in the division of pharmacy and optometry and a practising pharmacist.

He said: “Intravenous infusion errors leading to fatalities are extremely  rare event; the vast majority of IV infusions are safe.

“But avoidable harm associated with medication is a persistent problem in health systems and the use of preprogramed infusion devices can mitigate and reducing their incidence

“Configuration of these pumps is often poorly implemented – with little consistency between hospitals.

“Even though smart pumps have been available for around 20 years and are routinely used in the USA - we only 20 to 30 trusts use them in some way, and even fewer to their full capability. Within a few years, all IV pumps will have smart functionality, so it makes sense for hospitals to make full use of them.”

He added: “Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, so a strategic human-centred approach is needed to support their implementation.

“Smart functionality has a role in intravenous medication safety, but only as part of a programme of interventions to standardise intravenous medication practice.

“They aren’t a panacea but like a seat belt in a car in that they can avoid catastrophic injuries to patients.”

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety is available

The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study is available

According to a study led by and researchers – in collaboration with –  almost three quarters of the stillbirths officially certified as being of, “unknown cause of death,” in fact had an identifiable cause.

Proper understanding of the causes of stillbirth play an important role in determining how care is provided to women and babies in the future. Therefore, to inform this, it is vital reporting processes on MCS are accurate.

Of 540 certified unexplained stillbirths studied, only 119 remained unexplained following the analysis: the majority were re-designated as either fetal growth restriction (FGR; 195 deaths), or placental insufficiency (184 deaths).

Overall, FGR, at 306 cases, was the leading primary cause of death after review, yet only 53 of the cases were originally attributed correctly.

The paper is published in International Journal of Epidemiology today (insert date).

Though its causes are still unclear, FGR predominantly occurs when the placenta is not working well enough to provide a baby with the nutrients to grow normally, and is linked to an increased risk of complications in pregnancy and stillbirth.

Most babies that are born smaller than expected will grow up healthy, but some will have high blood pressure, diabetes or heart disease in adulthood.

Over 80 per cent of MCS in the study contained errors; 55.9 per cent had a major error that would alter their interpretation.

Other findings included:

• The inaccuracies occurred irrespective of geographical location
• Hospitals in regions where certificate audits had previously been carried out were less likely to contain major errors, possibly due to increased error awareness.

The team gathered data from 76 UK obstetric units, examining Medical Certificates of Stillbirth issued from 1 January 2018 to December 31 2018.

Systematic case note reviews of stillbirths were carried out by the – a network of non-consultant grade Obstetrics and Gynaecology doctors who work jointly on large audit and research projects..

After review, UKARCOG doctors generated ideal “mock” certificates which were then compared to the actual document issued.

Lead author Dr Lucy Higgins, a Senior Lecturer in Obstetrics at The University of Manchester and Consultant Obstetrician at MFT’s , said: “This study demonstrates widespread major errors in the way Medical Certificates of Stillbirth are completed across the UK.

“Once redesignated, fetal growth restriction became the leading cause of death in these stillborn babies.

“The study did not examine the standard of care received prior to the baby’s death, simply whether the data reported on the Medical Certificate of Stillbirth accurately reflected the facts surrounding the baby’s death.

“That is why we argue these documents should only be completed following a structured case note review, with particular attention to fetal growth trajectory.”

Co-author Professor Alex Heazell, Director of the at The University of Manchester and Consultant Obstetrician at Saint Mary’s Hospital, said: “Data from Medical Certificates of Stillbirth inform healthcare service strategy, funding, research and public health initiatives. It is imperative to identify preventable stillbirths to aid future strategies to reduce deaths."

Kath Abrahams, Tommy’s Chief Executive, says: “With every baby loss, devastated parents most commonly ask ‘why?’. They want to know why their baby died and what could be done in future to reduce the risk of it happening again.

“Without an accurate cause of death, parents are left without an explanation and researchers working to find the causes of stillbirth and how to prevent it are left without the information they need to inform their work. It is not always possible to know why a stillbirth happened, but this review shows that ‘unexplained’ should not be the norm. Accuracy alongside compassion should be prioritised when certifying stillbirth.”

Sands supports anyone affected by the death of a baby. Sands’ free Helpline is available on 0808 164 3332 10am to 3pm Monday to Friday and 6-9pm Tuesday and Thursday evenings. You can also email helpline@sands.org.uk for support.  

In GPs over 50 the figure was 61%; among GPs under 50, one in every six (16%) said they were planning to leave.

The average level of overall job satisfaction, measured between 1 (extremely dissatisfied) and 7 (extremely satisfied), decreased by 0.2 points from 4.5 in 2019 to 4.3 in 2021

However, over half of respondents (51%) said they were satisfied with their job overall.

Decreased satisfaction was particularly acute around the areas of ‘recognition for good work’ and ‘satisfaction with variety of job’.

Overall, hours of work showed a slight decline for the second consecutive survey, falling from 40 hours per week in 2019 to 38.4 hours per week in 2021.

The GP Worklife Survey has been assessing job satisfaction and job stressors amongst GPs in England since 1999.

Participating GPs are asked to complete a questionnaire which asks them to rate their job satisfaction and the aspects of their jobs which they find particularly stressful or satisfying, as well as their intentions as regards their future work.

The survey has run approximately every two years since 1999, and so provides evidence about changes over time.

The evidence it provides is used by the Department of Health and Social Care to inform their evidence to the Doctors’ and Dentists’ Pay Review Body.

The survey was run for the 11th time in 2021. It reports on responses from 2,227 GPs from across the country.

The survey, carried out by the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning, has run approximately every two years since 1999, and so provides evidence about changes over time.

Professor Kath Checkland, who led the study said: ‘We’re very grateful to the GPs who took time out to respond to our survey during this difficult year.

“It is not really surprising that job satisfaction has dropped amongst GPs during the pandemic, but the survey provides some evidence about the areas of work they are finding more stressful, which may help in designing ways to support them.

“The fact that 16% of GPs under the age of 50 are thinking about leaving their jobs is worrying, and suggests that work is still needed to ensure that general practice is sustainable for the long term.”

The Eleventh National GP Worklife Survey was carried out by the Health Organisation, Policy and Economics (HOPE) research group at The University of Manchester on behalf of the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). PRUComm is funded by the Department of Health and Social Care Policy Research Programme.

This report is independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm's length bodies, and other Government Departments

The survey is accessable here: 

Nationally, , expanding the delivery of early phase clinical research in NHS hospitals across England.

are a key part of the UK’s leading early stage clinical research infrastructure and play an important role in making the country a global hub for life sciences.

They support the delivery of early translational and experimental medicine research, from studies testing new treatments in patients for the very first time (first-in-human trials) through to early safety and efficacy trials (Phase IIa trials). They provide dedicated purpose-built facilities and expertise for the delivery of high-intensity studies funded by the NIHR, the life sciences industry and other organisations.

A total of 28 NIHR CRFs have been awarded funding in this latest round – five more than previously. These CRFs, which will run from 2022 to 2027, will play a key role in realising the ambition in the vision for the to bolster the delivery of innovative trials across all phases, all treatment types and all conditions.

NIHR 91ֱ�� (MCRF) was founded in 2017 and is hosted by . This new funding award – A 24 per cent uplift on 2017-2022 – will allow MCRF to further grow its experimental medicine provision across Greater 91ֱ�� during the next five years, along with partners at and NHS Foundation Trust .

Professor Jaclyn Smith is Director of MCRF, Honorary Consultant at Wythenshawe Hospital (part of MFT), Professor of Respiratory Medicine at , and Programme Lead for  within the .

Professor Smith said: “We are absolutely delighted to receive this funding award – which includes a £3 million uplift – and is testament to the world-class staff and facilities we have within NIHR 91ֱ�� CRF.

“We now look forward to offering opportunities to take part in early phase clinical research to a broader range of our diverse communities across our region, as part of our aim to reduce health inequalities.

“I would like to extend my thanks to the NIHR and everyone involved in our MCRF funding bid.”

Professor Lucy Chappell, Chief Executive of the NIHR and Chief Scientific Adviser to the Department of Health and Social Care, said: “NIHR’s CRFs scheme has been a key force in translational research across England, helping to position the nation as internationally competitive in early stage clinical research.

“This new funding, a 43 per cent increase, will allow the CRFs to continue to drive forward innovation in experimental medicine and support translation of exciting discoveries into new treatments for patients.”
 

Minister for Innovation, Lord Kamall, said: “Clinical research has been vital in our fight against COVID-19 and in saving thousands of lives – whether through the rapid creation of vaccines or the identification of life-saving treatments like dexamethasone.

“Funding more CRFs across the country means we can continue to build on this innovation to transform our health service and ensure the NHS is able to deliver world-class care.

“As we build back better from the pandemic, I am committed to ensuring the UK remains a world leader in diverse, ground-breaking research.”

Read more about the 2022 CRF funding announcement via

The study, commissioned by the Chartered Society of Physiotherapy, argues that the hybrid model – as it is known- will also allow physiotherapists to provide more personalised care.

Based on the study, the CSP recommends a mix of in-person and remote consultations, arguing they are best for future service delivery models.

The University of Manchester’s evaluation includes a literature review, national survey and in-depth interviews with 12 service leads across the UK.

Time and cost savings were key factors in making remote consultations attractive to patients, the report found. However, although very high levels of satisfaction and positive experiences with remote consultations were reported by patients who were able to access them during the pandemic, they were not a “one-size fits all” or long-term solution.

An understanding of a patient’s communication needs, resources and digital literacy – together with the nature of treatment - should determine whether they have a digital or on-site consultation, the report concluded.

The CSP commissioned the National Evaluation of Remote Physiotherapy Services in 2020 after all non-essential in- person physiotherapy stopped and moved to remote service delivery.

It compared the benefits and challenges of in-person and remote physiotherapy to determine how physiotherapy services can be equitable and effective for patients while making the best use of resources.

And though the report showed overwhelming support for this option from patients who chose remote consultations, people still expressed a preference for some in-person consultations if there was no risk of catching Covid.

There was no evidence to show cost savings from the digital switch, either, because none of the 1,620 survey respondents had gathered data comparing the cost of remote and in person physiotherapy.

The report concluded that people should be given the choice to receive physiotherapy in person, remotely or a combination of both.

However, this must be based on shared decision making, taking into account a person’s needs, their communication needs and their ability to access online healthcare.

Based on the findings, the CSP do not recommend an ideal ratio of remote/in-person, instead saying that it should be based on the patient population, individual need and available local resources.

Lead researcher Helen Hawley-Hague said: “Our evaluation of remote physiotherapy during the pandemic provided a very mixed picture around the success of remote physiotherapy.

“There were both great advantages to delivering remotely such as increased access to physiotherapy for some patients and a reduction in travel, but equally great challenges in terms of adequate connectivity and access for others.

“Remote methods of delivering physiotherapy should be an important part of a health professional’s toolkit and should be utilised where it can enhance treatment based on a person-centred approach to decision making.”

Rachel Newton, Head of Policy at the CSP, said: “Person-centred care means being responsive to patient needs – whether their preference is for remote or in-person consultations, or combination of the two.

“The CSP has long supported the expansion of patient choice with new digital options that can save people time and money, and for some people help make services easier to access.

“At the same time we recognise that for some people, in some situations, in-person services will be the best option.

“It is also critical to ensure that those without internet access or help to navigate online healthcare are not missing out on essential services.”

The commercially-available health sensors and devices produce a digital fingerprint of vital signs that could allow doctors to assess the progress of their patients.

Called, EMBRaCE, (Enhanced Monitoring for Better Recovery and Cancer Experience), the trial is a collaboration between , and The University of Manchester.

The trial opens initially for blood cancer, lung, and colorectal cancer patients and will run across Greater 91ֱ��.

The technologies under investigation include:

• a smart ring, worn on any finger made by the company Oura
• the Withings ScanWatch, a hybrid smartwatch
• the Isansys system, which is worn on the chest.

The technologies can assess a range of vital signs, including electrocardiogram (ECG), heart rate, temperature, physical activity levels and sleep.

Dr Anthony Wilson, Consultant in Anaesthesia and Critical Care at , part of  MFT, is the clinical lead for the project.

He said: "Cancer places a huge burden on the lives of people everywhere. This study uses cutting-edge technology that can monitor people during their treatment, with devices that they can wear all the time.

“We hope that it will provide new insights into how people cope with cancer treatment and what we can do to improve their recovery.”

Dr Michael Merchant, Senior Lecturer in Proton Therapy Physics, at The University of Manchester, said: “This trial will assess if the latest wearable technology has a role in cancer care.

“It will help us to identify ways that clinical staff can individualise treatment before, during, and after therapy.

“We will find out if 24/7 data from these wearable sensors can be used to support patient recovery and provide accurate measurement outside clinic.

“It could even support the development of new cancer treatments by developing a digital platform for clinical trials in cancer involving wearable devices or fitness trackers.”

Thomas Westworth, 70, is from South Lakeland in the Lake District. Now retired, he was self-employed within the building trade for 40 years, and has been receiving care for lymphoma at 91ֱ�� Royal Infirmary, part of , for three months.

Mr Westworth will be taking part in the trial in the next couple of weeks when he receives his first infusion of – a personalised medicine used to treat patients with certain types of leukaemia and lymphoma.

Mr Westworth said he is ‘fascinated by technology’, and was happy to consent to taking part in EMBRaCE when he was approached by the study team.

“I said if could be of any help I’d be happy to take part,” said Mr Westworth.

“I think the actual idea behind the trial is fantastic, I think it should help people.

“All the staff here at 91ֱ�� Royal Infirmary and other hospitals where I have been cared for have been fantastic, everyone is absolutely brilliant.”

EMBRaCE is funded by the GM Cancer Digital Innovation Fund, and the in collaboration with and .

Steve McConchie, CEO of Aptus Clinical, a clinical contract research organisation based in Alderley Park, Cheshire, said: “We are delighted that the clinical data collection and curation infrastructure we initially created to support an important piece of exploratory research into COVID-19 is being expanded to assess the utility of patient wearables to improve the care of cancer patients across 91ֱ��.

“We look forward to continuing this collaboration with our partners at MFT , The Christie, and Zenzium and are pleased to be supporting research with the potential to make a real difference to patient’s care.”

EMBRaCE is partnered with the health and biomedical data science company Zenzium Ltd to harness the power of Artificial Intelligence (AI) to analyse and identify key patterns within patient data.

Anthony D. Bashall, Managing Director of Zenzium, said: “We firmly believe the future of healthcare will be driven by continuous rather than episodic measurements to improve patient outcomes on an individual basis.

“We are excited to be part of this ground-breaking collaboration with some of the best entities in the field, which gives us the opportunity to bring our technology, knowledge and expertise in wearable devices enabled by AI to potentially make a real difference in the lives of patients.”

Mr Steve Sweeney, cancer survivor and chair of the group of patients who have advised the project commented: "A cancer diagnosis is fraught with a variety of challenges for patients, way beyond the clinical treatment pathway itself.

“We know patients have anxiety around ongoing monitoring and the gap between GP and hospital cancer care, issues with fatigue and sleep disturbance, problems maintaining fitness and the need for greater psychological support.

“The EMBRaCE programme addresses these challenges head on, allowing participants to take more proactive control of their cancer journey through wearables and the data they provide clinicians. These patient pioneers will help shape the future of cancer care in the UK.”

Professor Dave Shackley, Director of Greater 91ֱ�� Cancer Alliance and the Senior Responsible Officer for Cancer in Greater 91ֱ�� said: "We are delighted in Greater 91ֱ�� to have such a fantastic study taking place. The smart use of digital technology is going to be pivotal for high quality, personalised cancer care for our patients. We look forward to hearing the outcomes of this exciting research project and in particular implementing any key findings."

Images:

1.      the smart ring and smart watch

2.      Thomas Westworth wearing the smart ring and watch

3.      Senior Clinical Research Nurse, Sindhu Sibin, with Thomas Westworth

At a national level, the use of locums was low and stable between 2017 and 2020 though some practices and areas used significantly more locums than others.

The proportion of locum GPs, compared to other GPs in rural practices was 25% greater than in urban locations.

Practices that were single handed- where a lone GP works- used locums at a rate 4.6 times higher that of practices employing more permanent GPs.

Practices rated as inadequate by the Care Quality Commission used locums at a rate 2.1 times higher than practices rated as outstanding.

The findings, say the team, are likely to reflect the difficulties many practices have in recruiting doctors and sheds light on the challenges facing primary care.

Locum GPs also tend to be male and younger, with an average age of 42, and more likely to have qualified outside of the UK when compared to other GPs.

The analysis, funded by the National Institute for Health Research (NIHR), used data from NHS Digital on almost 34,000 doctors and found:

• Locums made up on average 3.15% of the GP workforce in December 2017 and 3.31% September 2020, figures adjusted for full time equivalent
• Around 65% of the locums were UK qualified and around 54% were male
• Around 74% of the locums were used to cover long term absences or vacancies
• Locums were concentrated in parts of the North West, Greater London, West Midlands, Essex and the Isle of Wight.

Locum GPs are defined as doctors who provide cover for permanent staff including maternity/paternity leave, sick leave, annual leave, suspended doctors or vacancies.

Lead author Dr Christos Grigoroglou from The University of Manchester said: “Locum GPs have an important role in the delivery of primary care services, particularly in the delivery of out-of-hours care and in helping to address short-term workforce shortages.

“Despite expectations that locum GP numbers are rising we found that locum use in primary care has remained stable over time though their use seems to vary substantially across different practice types and areas of the country.”

 He added: “In recent years, the NHS has suffered from insufficient long term workforce planning, prolonged shortfalls in funding, and a high number of doctors leaving the profession early which have contributed to the current workforce crisis.

 “Before we conducted this study, research on the extent of GP locum use in general practice and the composition of the GP locum workforce was sparse.

“So identifying the drivers behind variation in locum use in English primary care provides useful context for those involved in workforce planning, especially in areas with high GP turnover.”

 Dr Thomas Allen from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform future workforce planning.”

&�Բ�����;“We suggest that relatively high and sustained levels of locum use may be an indicator of wider problems which are affecting recruitment and retention.”

“Practices in rural areas and those with inadequate CQC inspection ratings may face substantial challenges in recruiting and retaining permanent GPs, and this study highlights this.”

 Professor Kieran Walshe from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform workforce planning.

“This can be particularly useful to meet local health care needs with sufficient resources for training and deployment of GPs which will help ensure that the targets set out in the NHS long-term plan are met.”

The study of over 160 million consultation events from 12.3 million patients, in 845 general practices between 2000 and 2019 showed four out of ten of the workload at GP clinics were with frequent attenders.

Frequent attenders were patients making a disproportionately higher number of visits to GP clinics each year, defined as more than 90% of all other patients in the same practice.

The study, published in BMJ Open also found that among frequent attenders, consultations at GP clinics have doubled in the last 20 years.

Consultations with GPs increased from a median of 13 in 2000 to 21 in 2019 and consultations with all staff members of GP clinics increased from 27 to 60.

Also, according to the study, face-to-face GP consultations were relatively stable over the study period, whereas other forms of consulting such as telephone or online consultations have become more common.

In 2018/19 there was an average of 3.3 face-to-face consultations per patient per year with GPs. However. the number rose to 8.7 consultations with GPs, including non-face-to-face, like telephone and online.

That means, say the researchers, that GPs are consulting more with patients but using a variety of means.

Frequent attenders, though, are an exception because their face-to-face consultations continues to increase over time.

The findings show the traditional model of patients consulting with GPs face to face is being replaced by a new model of work in general practice: increasing numbers of consultations are conducted by other staff members, rather than GPs, using alternative means to face-to-face consultations.

Co-author Professor Evan Kontopantelis from The University of Manchester said: “This is the first study to show that frequent attenders, the top 10% of consulters, have largely and progressively contributed to increased workload in general practices across the UK over the last 20 years.”

Co-author Professor Aneez Esmail from The University of Manchester said:  “Our findings show that frequent attenders account for an increasing proportion of face-to-face consultations with GPs and are responsible for nearly 40% of consultations fairly constantly over time.”

Co-author Dr Maria Panagioti from The University of Manchester said: “But these findings may also suggest the increase in multi-disciplinary staff working in general practices is perhaps the only solution for sustaining a viable primary care.

“Indeed, the large increase in the general practice workload over the last 20 years means having extended multidisciplinary teams is necessary to meet a wide range of patient needs through a range of ways such as remote consultations.”

Professor Kontopantelis added: “We feel the increasing demand for consultations from frequent attenders also needs to be evaluated in the context of the COVID 19 pandemic.

“Frequent attenders also may have special health and social care needs but for a variety of reasons we do not yet fully understand how best to meet them.”

In addition, they found that:

• All consultations by GPs per person increased from a median of 5 to 8 pr person per year and all consultations by all staff increased from 11 to 25.
• However, face-to-face consultations by GPs and face-to-face consultations by all staff remained static and may even have decreased.
• Distribution of face-to-face consultations with GPs was highest in Scotland and the distribution of face-to-face consultations with all staff was highest in Northern Ireland.
• There was little evidence of regional variability elsewhere in the attribution of all consultation types in study, across all categories of consulters.

 Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices is published in BMJ Open

The implantable pacemakers and defibrillators contain multiple sensors that allow continuous monitoring of a patient’s heart health, 24 hours a day.

The study published in and funded by the is a collaboration between The University of Manchester, 91ֱ�� University NHS Foundation Trust (MFT), and – which manufactures implantable devices.

The research team examined remotely monitored health related data from 439 patients being cared for at , part of MFT, over two years.

The study reported a three-fold increase in the odds of mortality for patients who spent at least one day in ‘high-risk’ status. The risk status is determined by a combination of up to nine factors.

There was also a 26 per cent increase in the odds of mortality for patients who had 14 consecutive days or more in a high-risk status – compared with those whose high-risk episodes were shorter.

The researchers are currently investigating if integration of the remotely-monitored device data into healthcare pathways can reduce hospitalisations and mortality.

Dr Fozia Ahmed, Honorary Reader in Cardiovascular Sciences from The University of Manchester and Consultant Cardiologist at , part of the MRI, said: “Remote monitoring capabilities of modern-day cardiac devices enables continuous monitoring of health-related data in the patients’ own homes.

“The data can help identify when there is a potentially significant shift in a patient’s clinical condition, helping to predict future adverse clinical events, such as hospitalisation and death.

“Historically, cardiologists have seen patients at six to 12-month hospital-based appointments. If a patient with heart failure is unwell between appointments, then we rely on the patient getting in touch. But patients don’t always know they are unwell until it is too late.”

“We believe this technology could be a game-changer in the management of cardiac patients, particularly those with heart failure.

“In Greater 91ֱ��, based on the data from the research, we have started to use the device-derived alerts, which notify the care team when a patient is detected by the device as ‘high-risk’, prompting a telephone consultation with a specialist.

“The whole process from detection of a high-risk episode, through to assessment and follow-up is known as the TriageHF Plus care pathway – originally developed in 91ֱ��, it is now being used more widely.”

In recognition of their outstanding contribution to healthcare in the HealthTech Partnership of the Year category, announced in June at the HSJ Partnership Awards 2021.

Dr Camilla Sammut-Powell, from the at The University of Manchester and lead statistician for the research, said: “This is the first prospective study to show that remotely monitored cardiovascular implantable electronic device (CIED) data, summarised as a risk score, can be used to predict mortality.

“This routinely monitored data, automatically collected every day, can help discriminate between patients at high and low risk of death.

“Such information may personalise a clinician’s decision making towards ensuring that the patient is in receipt of therapies designed to improve their long-term prognosis.”

A spokesperson from Medtronic, the industry collaborators which manufactures the device, said: “The increased mortality identified in the evaluation justified the need for an industry and NHS collaboration in this space, to create a digital solution to that aims to ensure that the high risk notifications are sent direct to heart care teams who can take action as clinically indicated, based on the health-related data from the patient’s device and patient reported symptoms.”

The researchers, with support from the NIHR Applied Research Collaboration Greater 91ֱ��, are undertaking a follow-on study to evaluate the costs and resources of implementing the new heart failure care pathway, :

Remote Monitoring Data from Cardiac Implantable Electronic Devices Predicts All-cause Mortality is published in .

The global research lead for the study, Professor Jacky Smith, Consultant at Wythenshawe Hospital, part of ,and Professor of Respiratory Medicine at The University of Manchester, has played an integral role in the worldwide search for a treatment of chronic cough (a cough lasting eight or more weeks).

Chronic cough can be caused by an underlying respiratory condition, such as  (COPD) or , or by a non-respiratory underlying condition, such as  (GORD). There are also some people who suffer from a chronic cough that is unexplained.

Coughing is a way in which our bodies get rid of foreign particles, irritants, microbes, mucus and bacteria – among other allergens from the throat – and is an important defence mechanism. Sensory nerves in the airways play a role in generating the body’s cough response and are activated in response to cough stimuli.

Dr Paul Marsden is the study lead at NIHR 91ֱ�� CRF. He, and the other searchers involved in this clinical trial, sponsored by , believe that when inhaled, using a nebuliser, the study drug, NOC-100, might be able to reduce cough by directly targeting and reducing the activation of the sensory nerves in airways.

Joan, from Stockport, who is the first global participant in the study, said: “I am taking part in this research for mainly selfish reasons – I want a cure for my persistent cough!

“I’ve lived with my cough for 30 years, and in that time, I’ve had people show concern for me, offering various forms of help, from cough sweets to hot herbal drinks. However, I’ve also been asked to leave shops, move seats on public transport, or sit outside at restaurants and bars.”

“Even when people try to be kind it can be really humiliating. On one occasion I was in a nice restaurant and I couldn’t stop coughing. A waiter rushed to my aid mistakenly thinking I was choking on some food and used the Heimlich Manoeuvre on me. Unfortunately, as I didn’t have a blockage in my throat, I was violently sick in front of the whole restaurant. I was so embarrassed I had to leave.

“I can laugh about that incident now and I know this research might not help me directly, but many people with a cough are so embarrassed by it – they limit where they go and what they do in public places – and this is such an unhappy situation to be in. We need to find a cure.”

Professor Smith, who is Director of Manchester CRF and Programme Lead for Improving Respiratory Symptoms within the , said: “Long-term chronic cough can have a huge impact on someone’s life. It is more than just an annoyance. It can cause a list of unwelcome effects, including anxiety, depression and exhaustion.”

Prof Smith, who is also Professor of Respiratory Medicine at The University of Manchester continued: “I've spent my career seeing patients in my specialist clinic for the investigation and treatment of chronic cough, and conducting clinical research aimed at finding therapies for those patients whose cough is resistant to treatment.

“If proven to be safe and effective, NOC-100 has the potential to have a beneficial impact on the lives of people with this distressing condition.”

The study is being carried out in the United Kingdom and Germany.

Dr Christopher Silber, Chief Medical Officer at Nocion Therapeutics, said: “We are very excited to begin clinical investigation of NOC-100 in patients suffering from chronic cough.

“Cough is a common and debilitating symptom that affects millions of people with few available treatment options. We believe NOC-100 may have broad potential in the treatment of cough, including chronic cough.

“As we evolve to this next stage of development, we are extremely pleased to be working with premier research centres like the NIHR 91ֱ�� Clinical Research Facility, under the direction of global cough experts such as Professor Jacky Smith and Dr Paul Marsden, and their experienced clinical research team.”

Images:

• Research participant Joan second left, with some members of the cough study team at 91ֱ�� CRF at Wythenshawe Hospital. Joan is linked up to machines that check her blood pressure and heart rate and wears a cough monitor around her waist that counts the number of times she coughs.
• Joan relaxing at home.
• Dr Jenny King, Clinical Research Fellow, sub investigator on the study, checking on Joan after she’s received a dose of the study drug.

The innovative digital system brings together the required components for the effective remote management of chronic wounds in a community setting, as well as facilitating self-care for people with wounds (and their carers).

WoundPad enables community teams, and patients themselves, to upload photos of their wounds to a cloud-based platform, via an app. These images, along with other clinical information inputted by community teams, is available to all those providing specialist care across the whole of Greater 91ֱ�� (GM).

It is already being piloted within three community teams in north, south and central 91ֱ��, and was , which will assist its GM-wide roll-out.

In 2018, the project received funding from to develop WoundPad. This support enabled the team to fully develop and test the system, in close collaboration with the three pilot sites.

Dr Ken Dunn said: “The community has been searching for something like this, and I am very grateful to colleagues across 91ֱ�� Local Care Organisation, who have played a huge role in helping in testing and refining WoundPad.

“Having all the information in one place allows district teams to look at the history of a patient’s wound and enable colleagues at 91ֱ�� Centre for Plastic Surgery and Burns and in other specialist clinics, to see what care and interventions district teams have enacted.

“Crucially, this prevents patients undergoing unnecessary tests, or having to repeat their care history themselves.

“While we were developing this system prior to the onset of the COVID-19 pandemic, remote management and self-care tools such as this are more useful than ever, for example for patients or clinical colleagues who are required to shield.”

Dr Rob Hollingsworth, Managing Director at MDSAS Ltd, said: “Complex wounds are painful, at risk of infection and amputation, and have significant impact on the quality of life. WoundPad supports clinicians in delivery of care, optimising the use of stretched community resources, identifying patients most in need and enabling earlier communication and intervention to improve patient outcomes.

“The project aligns directly with MDSAS’ core ethos, to put patients at the heart of healthcare services, support healthcare professionals in the provision of better care, and drive efficiencies through innovative IT.

“Expanding the implementation of WoundPad across more of Greater 91ֱ�� will bring significant benefits for patients, clinicians, and services.”

Within the Trust, Dr Dunn and colleagues are being supported by the MFT’s Innovation Team, which is providing ongoing Intellectual Property (IP) advice and will ensure that the Trust receives royalties when WoundPad is commercialised by MDSAS.

Richard Deed, Associate Commercial Director – Industry at Health Innovation 91ֱ��, said: “Health Innovation 91ֱ��’s Momentum awards are part of the Office for Life Science commission, which enable evaluation and subsequent spread and adoption of innovative healthcare technologies based and developed on clinical needs.

“WoundPad is a great example of an NHS wide need being solved by local clinicians working closely with a local SME.”

During the period studied, the proportion of practices with high turnover (10% to 40% within a year) almost doubled from 14% in 2009, to 27% in 2019.

However, the proportion of practices with very high turnover (above 40%) remained stable at around 8%.

The study assessed changes in turnover, since high turnover is a marker of poor fiscal and organisational “health”.

Turnover costs are attributed to GPs leaving the profession, when it costs approximately £250,000 to fully train a GP, to the rehiring process, and to the length of time a GP needs to be familiarised with the processes and needs of a new practice.

The paper is published in and supported by the Health Foundation through the Efficiency Research Programme.

Practices in the most deprived areas had higher turnover rates compared to practices in the least deprived areas.

The team calculated turnover by rates and region using NHS data from all English general practices which numbered 8,085 in 2007 and 6,598 in 2019.

According to the study:

• The number of practices with persistent high turnover (at least 3 consecutive years) increased from 2.7% in 2007 to 6.3% in 2017.
• The 75^th percentile for turnover in 2009 was 11%, increasing to 18% in 2014, and coming back down to 14% in 2019.
• There was high regional variability in mean turnover rates in 2007 and in their changes over time. Practices in the (former) NHS West Midlands Strategic Health Authority reported the largest increase and the highest levels in 2019 (from 6% to 12%).
• Practices in the most deprived areas (quintile) had turnover rates that were up to 10% higher compared to practices in the least deprived areas, even when accounting for differences across NHS regions.

Co-author Professor Evan Kontopantelis from The University of Manchester said: “We already know the GP workforce in England is going through a major crisis. Rates of early retirement are increasing, as are intentions to reduce hours of working or leave their practice in the near future.

“Though in 2015, the government promised 5,000 more doctors in primary care by 2020, the number of full-time equivalent GPs per 1000 patients continues to decline.

“Quantifying GP turnover and understanding how it is distributed is fundamental to addressing challenges for the national health service, and for ensuring that quality and continuity of care are available to patients.”

He added: “We reveal worrying trends in GP turnover. High levels may affect the ability to deliver primary care services; and undermine continuity of care which in turn may affect the quality of patient care.

“And healthcare received from multiple GPs can lead to conflicting therapeutic treatments and fragmented care.

“Differential turnover across practices and regions could also lead to a maldistribution of GPs, exacerbating retention problems and health inequalities.”

A graph showing regional rates of turnover is available.

Rates of turnover among general practitioners in England between 2007-2019: a retrospective study is published in BMJ Open.

Turnover was defined as the number of GPs who leave a practice divided by the average of the number of GPs at the start and the number of GPs at the end of the year

The MoU, signed at the Royal College of Physicians by Health and Social Care Secretary Sajid Javid and Kenya’s Cabinet Secretary for Labour Cooperation, Simon Chelugi, was also attended by President Uhuru Kenyatta.

As part of the agreement, prevention and management of cancer in Kenya will be improved through a partnership between Kenyatta University Teaching Referral and Research Hospital (KUTRRH) and the University of Manchester, Christie NHS Foundation Trust and 91ֱ�� University NHS Foundation Trust.

This will see the promotion of KUTRRH as a regional hub for cancer treatment, linking to eleven regional cancer centres across Kenya and The Christie hospital through telemedicine. It will also monitor clinical outcomes to support innovation and improvement in cancer treatment.

The hub and spoke model will mirror the clinical service in Greater 91ֱ��, which has seen cancer outcomes improve faster than anywhere else in the UK.

The Alliance’s first grant application, which is submitted to National Institute for Health Research, seeks to establish such a service for squamous cell carcinoma of the oesophagus, a poorly understood cancer that is common in Kenya.

They also propose the development of a world-leading cancer research centre at KUTRRH to develop novel personalised therapies for East Africans. And they will help create a centre of excellence for health education and training at Kisii University using modern educational and pedagogical approaches to train nurses, doctors and pharmacists.

The Christie and 91ֱ�� University Foundation Trust will also provide training places for current healthcare workforce to obtain specialised oncology training and an understanding of how the hub and spoke model for cancer care services works in Greater 91ֱ��.

To mark the launch of the Alliance, The University of Manchester and The Christie will establish two scholarships each, the President Jomo Kenyatta scholarships to help support Kenyans to undertake Masters level studies at the University or a clinical fellowship at The Christie.

The collaboration with Kenya follows the naming of The University of Manchester in April as the world's best university for action on sustainable development in the Times Higher Education (THE) Impact Rankings.

The University topped the table of more than 1,200 universities from around the world on action taken towards the United Nations (UN) Sustainable Development Goals (SDGs).

Professor Graham Lord, Vice-President and Dean of the Faculty of Biology, Medicine and Health at The University of Manchester said: “Not only do we strive for research and teaching excellence like all universities but we also have a third and unique goal around social responsibility. We want to see our research and teaching make a difference, locally in 91ֱ��, nationally in the UK and internationally.

“It is now time for us to build on this success and take on bigger challenges and leading and successfully delivering the Kenya UK Healthcare Alliance is one of these challenges, as we seek to make a difference to the healthcare system of an important strategic ally to the UK through clinical services, research and education.

“So as an institution with long standing links with Kenya, we look forward to working with the country to developing a modern and resilient healthcare workforce capable of dealing with the rising tide of all forms of non-communicable diseases in the country.”

The President’s visit to the UK delivers on the Strategic Partnership between the two countries, agreed by President Kenyatta and Prime Minister Boris Johnson in January 2020.

kenyan Principal Secretary for Health, Susan Mochache said: “The Kenya UK Healthcare Alliance is a key achievement in the development of the Health Sector in Kenya. The agreement on health workers will not only avail employment opportunities for the many unemployed Health workers, it will in a big way build their capacity to further improve Health Service Delivery in Kenya and enhance their global competitiveness. It is a big win for Kenya; the Health Workers Exchange programme will help strengthen Health Human Resource capacity in the country and will help accelerate attainment of the Universal Health Coverage goal . The donation of the Astrazeneca vaccine will boost Kenya’s COVID-19 response efforts.”

Jane Marriott, the British High Commissioner to Kenya, said: “Our Health Partnership with Kenya is 30 years old and growing stronger by the month. This new agreement on health workers allows us to share skills and expertise even further, and is a fantastic opportunity for Kenyans to work in the UK.

“From COVID-19 vaccines and genomic sequencing, to exchanges on cancer research and treatment to help Kenya treatment more cancer patients at home, the UK has a long and proud history of support for Kenya’s health sector. The signing of the Kenya-UK Health Alliance is the latest chapter in our flourishing partnership.”

James Ongwae, Governor of Kisii county which one of the regions where a teaching hospital will be located, sent a message of thanks to the University and the other agencies involved in the plans.

Images:

• Two images of President  Kenyatta with the British delegation from last year
• This year's ceremony from left to right Professor Graham Lord, President  Kenyatta, Kenyan Cabinet Secretary for Labour Cooperation, Simon Chelugi, Health Secretary Sajid Javid and Professor Keith Brennan.
• Professor Graham Lord chatting to Health Secretary Sajid Javid and President Jomo Kenyatta
• The President delivering his speech

The study’s authors believe the research indicates the need to improve access to primary care, including GPs, along with implementing other interventions for people experiencing homelessness.

The research was led by Charlie Moss from The University of Manchester and the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC).

The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

The researchers calculated that for patients experiencing homelessness emergency admissions were 2.08 times higher, and annual admissions 1.79 times higher than housed patients.

The team also investigated differences in ambulatory care-sensitive admissions (ACSCs), admissions for certain conditions, such as diabetes, asthma, and pneumonia, that could potentially be avoided with timely and effective primary care.

They found that these admissions were 1.65 times higher in patients experiencing homelessness than housed patients.

Researchers from The University of Melbourne and The University of Southern Denmark were also involved in the work.

Compared to 1,000 housed patients with similar characteristics, they found, 1,000 patients experiencing homeless would collectively have 225 more emergency admissions per year, and 25 more ambulatory care-sensitive emergency admissions per year.

Ambulatory care-sensitive conditions that were more common in patients experiencing homelessness were cellulitis (skin infections), convulsions/epilepsy, and chronic angina.

The study, published in BMJ Open, compared data collected from 16,161 hospital patients registered as having no fixed abode with 74,780 housed patients.

Lead author Charlie Moss from The University of Manchester said: “This study is one of the first to quantify the higher rates at which patients experiencing homelessness use hospital services compared to housed patients in England.

“Our analysis shows that some of the admissions may be potentially preventable with improved access to primary care, though these comprise a small share of the total.

She added: “There is likely to be a complex array of factors which lead to the differences we observe.

“But other research suggests that people experiencing homelessness face barriers to healthcare because services are less accessible to them.

“There is a perception that stigma and discrimination from health professionals may lead to poor or delayed engagement with services.

“People experiencing homelessness often face many complex challenges making it harder for them to use services and for health care professionals to manage conditions that may need multiple appointments.”

Professor Matt Sutton from The University of Manchester said: “Addressing structural factors such as improved access to primary care could potentially reduce some of these admissions.

“However, the fact that only 11% of the additional emergency admissions experienced by the cohort including people experiencing homelessness were ambulatory care-sensitive suggests that other approaches are also needed if the goal is to reduce hospital admissions for people experiencing homelessness.

“Our results may suggest that interventions which strengthen support for people experiencing homelessness when they attend A&E could have the potential to reduce future hospital admissions.”

Dr Sudeh Cheraghi-Sohi from the Greater 91ֱ�� Patient Safety Translational Research Centre, added: “The study shows the need to make sure that we collect data routinely on characteristics that make people more vulnerable to worse health outcomes. In this case, recording people’s housing status is important to understanding the specific health needs for this population.”

The paper “Comparative four year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018” is published in BMJ Open.

The figure was 63% in GPs over 50.

Even among younger GPs (under the age of 50), more than one in every ten (11%) said they were planning to leave.

These figures show a slight decline since 2017, but this remains a concern, and intentions to quit within 5 years in those over 50 have increased from 62% in 2017.

The mean level of overall job satisfaction, measured between 1 (extremely dissatisfied) and 7 (extremely satisfied), increased by 0.24 points from 4.25 in 2017 to 4.49 in 2019, with more than half of the respondents (59%) stating that they were satisfied with their job overall.

Mean levels of satisfaction increased between 2017 and 2019 to varying degrees in all nine domains of job satisfaction, although this remains lower than the peak of satisfaction found in 2005.

Overall hours of work showed a slight decline, and respondents indicated a slight decline in negative job attributes and an increase in positive job attributes since 2017.

The GP Worklife Survey is a longitudinal survey which has been assessing job satisfaction and job stressors amongst GPs in England since 1999.

A sample of GPs are asked to complete a questionnaire which asks them to rate their job satisfaction and the aspects of their jobs which they find particularly stressful or satisfying, as well as their intentions as regards their future work.

The survey has run approximately every two years since 1999, and so provides evidence about changes over time.

The evidence it provides is used by the Department of Health and Social Care to inform their evidence to the Doctors’ and Dentists’ Pay Review Body.

The survey was run for the 10th time in 2019.

The survey, carried out by the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning, has run approximately every two years since 1999, and so provides evidence about changes over time.

It analyses two samples in 2019: 605 GPs responded to a random sample of 4976 people and 772 responded (out of 1917) after being followed up having responded to the 2017 survey.

Professor Kath Checkland, who led the study said: “It is encouraging to see that there was a small increase in job satisfaction between 2017 and 2019, but the high levels of GPs planning to leave patient care even before the pandemic hit is very concerning. We are now carrying out a further round of the survey to try to capture changes in job satisfaction driven by the pandemic. It is really important that we get as many responses as possible, and I would encourage all GPs receiving a link to the survey to respond, so that we get as complete a picture as possible.”

The Tenth National GP Worklife Survey was carried out by the Health Organisation, Policy and Economics (HOPE) research group at The University of Manchester on behalf of the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). PRUComm is funded by the Department of Health and Social Care Policy Research Programme.

This report is independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm's length bodies, and other Government Departments

The , which was codesigned and co-authored with people who have lived experience of self-harm and mental health services, found negative experiences were common, and revealed stigmatising comments about injuries from some hospital staff. Some participants reported being refused medical care or an anaesthetic because they had harmed themselves. This had a direct impact on their risk of repeat self-harm and suicide risk, as well as their general mental health.

The research, ‘Relieved to be seen - patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses’*, was published today in the journal BMJ Open. It was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

According to the research, the participants who received supportive assessments with healthcare staff reported feeling better, less suicidal and were less likely to repeat self- harm.

Dr Leah Quinlivan, from The University of Manchester, a Research Fellow at the GM PSTRC’s Mental Health theme, led the study, and said: “Our research looked at the care people received at A&E following self-harm. It’s part of an overall programme of work that aims to improve patient safety in mental health services. This research highlights the importance of learning from the experiences of individuals to help improve care for people who have harmed themselves. We involved patients and carers throughout the entire process and this enabled us to gain a greater insight into what patients want after they present to hospital having harmed themselves. ”

According to NICE guidelines anyone who arrives at A&E following a self-harm episode should receive a psychosocial assessment. The research has revealed how important these assessments are for people who harm themselves. For participants in the study, if the assessments were delivered correctly and with compassion, they reported being less likely to harm themselves in the future. The research also revealed that assessments can be helpful when staff work alongside the person affected by self-harm, and are empathetic to their emotional distress.

Participants in the research revealed what a negative experience looked like and this was when waiting times were unduly long, assessments overly standardised and a lack of compassion was shown by staff.

Elizabeth Monaghan, one of the co-authors with lived experience in this area said: “The research demonstrates the value of involving patients and carers throughout the research process. Our varied experiences of assessments in A&E during and after crises meant we were able to add helpful insights into the research design and findings.

“These insights shaped the research team’s understanding of what factors are helpful for A&E staff to be able to carry out assessments more effectively and with compassion. Being part of the research process all the way through has given me an opportunity to use my experiences to improve care as well as giving me valuable skills in being part of a team carrying out research in this sensitive area.”

Jenny Groves has 35 years of lived experience of self-harm and is the CEO and Founder of Battle Scars, a survivor led charity for people who have self-harmed. She, said: “This research shows the discrepancies in the procedures not just in different parts of the country but the huge differences in attitude and treatment even within the same emergency department.

“Ticking boxes, dismissing, judging and invalidating people who present at A&E following self-harm cause long-term damage and increase risk. Acceptance, compassion and a true person-centred approach, acknowledging the individual and their needs, can make a world of difference to someone who is struggling and resorting to self-harm to manage life.”

The Phase 3 study is testing the safety and effectiveness of a new two-dose vaccine regimen, versus a placebo, in preventing moderate to severe/critical coronavirus disease.

The vaccine candidate has been developed by , as researchers around the world continue to work to secure a range of vaccines and treatments to help tackle coronavirus.

Dr Tim Felton, an Honorary Consultant at MFT’s Wythenshawe Hospital, is the Trust’s Clinical Lead for all COVID-19 research, as well as the Principal Investigator at MFT for the Janssen Phase 3 study.

Dr Felton, who is also a Senior Lecturer at The University of Manchester and a researcher within Respiratory Theme, said: “Throughout all the research we have undertaken into COVID-19 at MFT, finding a safe and effective vaccine has been the top priority.

“Recruiting our final participant into this study is a major step forward in our fight against coronavirus – and I’d like to thank every person who has volunteered to take part in this vital research.

“It is critical that we explore a range of vaccination options to give us the greatest chance of protecting as many people as possible, as we continue to the global effort to tackle the COVID-19 pandemic.”

Dr Claire Cole, the Head of Research Delivery at MFT, was the .

MFT has now recruited 405 participants to the study, exceeding its target of 400 within just eight weeks. Globally, recruitment into the study is due to complete in March 2021, with 6,000 volunteers taking part in the UK and 30,000 worldwide.

Dr Cole said: “Although I have worked in health research for a number of years, I never cease to be amazed by the life-changing – and sometimes lifesaving – impact research can have.

“I wholeheartedly believe in the importance of taking part in research and was honoured to be the first person in the world to be recruited to the study, as part of this vitally important COVID-19 vaccine trial.

“But I am especially proud of the resilience of the multidisciplinary study team here at MFT, who have managed to recruit the required number of participants and start administering second doses within just two months – an incredible achievement considering the current global landscape.”

Across the UK, volunteers from a variety of age groups and backgrounds – including some of the thousands who registered to be contacted about vaccine studies through the – have been taking part in the study.

Stephanie Gill, a headteacher, was contacted to take part in the study at MFT after signing up to the vaccine registry.

The 51-year-old from Sale, 91ֱ��, said: “When I received my invite to take part, I was really excited.

“I’ve never taken part in research before, but all the research staff here have been absolutely brilliant.”

Having now received two doses as part of the blind study, Stephanie does not know whether she received the vaccine candidate or the placebo.

“While I of course hope I received the vaccine, the blind element is the whole point of the trial. I just wanted to contribute, so even if I’ve had the placebo, I’ve contributed to this important research.”

All study participants will be monitored for 112 weeks after vaccination.

At MFT the trial is being delivered in collaboration with the

More about the Janssen (Ad26.COV2.S) vaccine

Like other vaccines, Ad26.COV2.S is expected to prepare the body to defend itself against infection. It contains genetic instructions for what is known as ‘the spike protein’, which is present on the surface of the coronavirus.

When a person is given the vaccine, their cells will read the genetic instructions and produce the spike protein. The person’s immune system will then treat this protein as foreign and produce natural defences – antibodies and T-cells – against it.

If the vaccinated person later comes into contact with COVID-19, their immune system will recognise the virus, with antibodies and immune cells working together to kill it and prevent its entry into the body’s cells.

• The UK public can support the national effort to speed up vaccine research and receive more information about volunteering for clinical studies by visiting:

• The ENSEMBLE 2 Janssen study is trialling a two-dose Janssen COVID-19 vaccine regimen. The results of a separate study, ENSEMLBE, which trialled a single-dose Janssen COVID-19 vaccine candidate, .

Picture: Dr Claire Cole – Head of Research Delivery at MFT –who was the first global recruit to the trial. The photo has taken in November when she had her first dose.

The study ‘Follow-up and structured monitoring for adults offered an NHS hearing aid for the first time (FAMOUS): a cluster randomised controlled trial’ is a major collaboration of the NIHR’s three BRCs with specialist hearing themes: 91ֱ��, Nottingham and University College London Hospital (UCLH). The key aim of the research is to understand and resolve the thousands of instances of low-use of hearing aids in adults with hearing loss.

91ֱ�� BRC bridges the gap between new discoveries and individualised care through pioneering research. The BRC’s Hearing Health theme is improving the lives of adults and children by preventing potentially devastating congenital deafness, diagnosing acquired age-related hearing deficits, and developing new treatments.

Professor Kevin Munro, NIHR 91ֱ�� BRC Hearing Health Lead and Professor of Audiology at The University of Manchester said: “Hearing loss is the most common sensory problem in the world, experienced by one in six people in the UK. Every year in the UK around 355,000 adults are fitted with hearing aids for the first time, at a cost of £450 million to the NHS.

“We know that hearing aids improve communication and quality of life in adults with hearing loss, however, our previous research has shown that 30 per cent of people given hearing aids don’t use them as often as recommended and a further 20 per cent don’t use them at all.”

Hearing loss has significant impact on communication, wellbeing, quality of life and economic independence (including employment) and left untreated may increase the risk of developing mental health and cognitive problems. This research aims to increase hearing aid use – testing efficient and cost-effective measures to encourage and support this.

To increase the amount of time that new users wear their hearing aids, the researchers, in collaboration with patient and public panels have devised a four step strategy (intervention) for audiologists and people with hearing loss. The strategy includes encouraging patients to reflect on situations in which hearing is difficult and where hearing aids may help, and an individualised action plan to reinforce where and when to use the hearing aids.

The three year, multi-centre study will recruit around 6,000 adults who will either follow the new strategy to improve hearing aid use or the current care plan, when fitted with a hearing aid. The primary aim is to learn if the intervention results in a higher level of hearing aid use one year after initial fitting compared to adults who receive the current standard care.

The research is sponsored by 91ֱ�� University NHS Foundation Trust and grant funded by the NIHR Health Technology Assessment (HTA) Programme. The HTA funds research around the clinical and cost-effectiveness and broader impact of healthcare treatments and tests for those who plan, provide or receive care from NHS and social care services.

Professor David Baguley, NIHR Nottingham BRC Deputy Hearing Theme Lead said: “This grant success represents a step-change in research into hearing aid provision in the UK, and the breadth and depth of the project is unprecedented in Audiology. The benefit of hearing aids come when worn in the ear, not when kept in a drawer, and this work to optimise pathways of NHS hearing aid follow-up holds great promise. The Nottingham Clinical Trials Unit, the BRC Hearing theme, and University of Nottingham Hearing Sciences will be working in close partnership with the NIHR 91ֱ�� and UCL BRC Hearing Themes to deliver this transformational and innovative trial.”

Anne Schilder Professor and Director NIHR UCLH BRC Hearing Theme and National Specialty Lead of the NIHR Clinical Research Network ENT said: “We are looking forward to working with audiologists from NHS hearing aid services across the UK. Their involvement will not only drive the success of this research but also the uptake of the evidence it produces into future hearing practice.”

A significant number of patients reported a deterioration in their hearing when questioned eight weeks after discharge from a hospital admission for COVID-19, according to University of Manchester audiologists, in a study supported by the NIHR 91ֱ�� Biomedical Research Centre (BRC).

One hundred and twenty one of the adults admitted to Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, took part in the survey by telephone. When asked about changes to their hearing sixteen people (13.2%) reported their hearing was worse. Eight people reported deterioration in hearing and another eight reported tinnitus (hearing noises that are not caused by an outside source).

The results, published in a letter to the International Journal of Audiology, adds to a growing body of anecdotal evidence that the strain of coronavirus which causes COVID-19, SARS CoV-2, has long-term impacts on health, and possibly hearing.

Professor Kevin Munro, Professor of Audiology at The University of Manchester and NIHR 91ֱ�� BRC Hearing Health Theme Lead said: “We already know that viruses such as measles, mumps and meningitis can cause hearing loss and coronaviruses can damage the nerves that .”

“It is possible, in theory, that COVID-19 could cause problems with parts of the auditory system including the middle ear or cochlea.

“For example, auditory neuropathy, a hearing disorder where the cochlea is functioning but transmission along the auditory nerve to the brain is impaired could be a feature.”

People with auditory neuropathy have difficulty hearing when there is background noise, such as in a pub.

A condition called Guillain-Barre syndrome is also linked to auditory neuropathy which is also known to have an association with SARS CoV-2.

However, the researchers say more research is needed to be able to identify why there is an association between the virus and hearing problems.

Their observation follows a rapid systematic review of coronavirus and the audio-vestibular system by Professor Munro’s team in June.

The review identified reports of hearing loss and tinnitus, but there were only a small number of studies and the quality of evidence was low.

Professor Munro added: “While we are reasonably confident in the differentiation of pre-existing and recent changes in hearing and tinnitus, we urge caution.

“It is possible that factors other than COVID-19 may impact on pre-existing hearing loss and tinnitus.

“These might include stress and anxiety, including the use of face masks that make communication more difficult, medications used to treat COVID-19 that could damage the ear or other factors related to being critically ill.

“That is why we believe there is an urgent need for high-quality studies to investigate the acute and temporary effects of COVID-19 on hearing and the audiovestibular system.

“Timely evidence for decision-makers is urgently needed, so we need to be able to act quickly.”

The letter, ‘Self-reported changes in hearing and tinnitus in post-hospitalisation COVID-19 cases’ is published in .

91ֱ�� doctors have played a leading role in global coronavirus research, which has found the first drug shown to increase survival rates in people hospitalised with COVID-19.

The peer-reviewed results of the RECOVERY trial, indicate that the low-cost drug, dexamethasone, ‘significantly lowers’ death rates in patients hospitalised with severe respiratory complications of COVID-19.

Dr Tim Felton, a Senior Lecturer in the Division of Infection, Immunity and Respiratory Medicine at The University of Manchester, and  Honorary Consultant at Wythenshawe Hospital – part of – co-authored the paper and

Dr Andrew Ustianowski, Honorary Senior Lecture at The University of Manchester and  Consultant in infectious diseases and tropical medicine at North 91ֱ�� General Hospital (MMGH) and the Deputy Clinical Director in , is also a co-author. NMGH is run by MFT as part of a management agreement prior to its formal transfer from the .

is currently taking place at 176 sites across the UK and is sponsored by the . It is funded by the and , and is one of a number of COVID-19 studies that have been given urgent public health research status by the .

Dr Felton, who is Clinical Lead for all COVID-19-related research studies at MFT played an instrumental role in ensuring dexamethasone became part of standard care at MFT from 26 June. This followed shortly after the announcement of

He said: “Dexamethasone, which is a type of steroid used in a range of conditions – typically to reduce inflammation – is the first drug to improve survival rates in hospitalised coronavirus patients, which truly is a breakthrough.

“The short timeframe between our first MFT participant being recruited to the RECOVERY trial in March, to our first COVID-19 patient receiving dexamethasone as a standard NHS treatment in June, is an incredible turnaround.

“This could not have happened without patients consenting to take part in research – which is now directly benefitting all patients admitted to our hospitals with suspected coronavirus – and I’d like to thank everyone who played their part in this priority COVID-19 research.”

Another drug, remdesivir, which , was also introduced into standard care at MFT on 26 June. Like dexamethasone, it had previously been part of a research trial at MFT.

Dr Felton said: “MFT has an established history of delivering cutting-edge clinical research, with the infrastructure, expertise, and staff to enable opening nationally-prioritised COVID-19 studies rapidly and safely, while providing high-quality care for care for trial participants.

“This meant we were able to add to the global evidence base, but also make changes here on the ground at MFT very promptly, underlining the vital importance of health research and the rapid impact it can have in a pandemic situation.”

At The University of Manchester, our people are working together and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives.  to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

Researchers from and The University of Manchester (UoM) are to assess the effectiveness of tests that may give doctors COVID-19 results in minutes rather than days.

Testing for coronavirus infection could become quicker, more convenient and more accurate, following the launch of the multicentre national programme of research – of which the 91ֱ�� project is part – that will evaluate how new diagnostic tests perform in hospitals, general practices and care homes.

The COVID-19 National DiagnOstic Research and Evaluation Platform (CONDOR) – funded by the , and and – will create a single national route for evaluating new diagnostic tests in hospitals and in community healthcare settings. This programme of research brings together experts who are highly experienced in evaluating diagnostic tests and generating the robust evidence required for a test to be used in the NHS.

Determining who has been infected with the novel coronavirus is a key part of the response to the COVID-19 pandemic. Getting quick and accurate test results when people show symptoms ensures that they receive appropriate care and reduces the chance of the disease being passed on.

The main test currently used to detect coronavirus infection (reverse transcription polymerase chain reaction [RT-PCR]) often involves sending samples away to laboratories, which can take up to 72 hours to provide results.

The research team will work with the government and its scientific advisors to identify which new commercially developed diagnostic tests could be most valuable in the NHS.

The effectiveness of the prioritised tests will then be evaluated in a number of possible health and care settings – emergency departments, critical care, acute medical care, primary care, care homes and hospital at home teams. The research will assess multiple diagnostic tests at once at sites across the country and can be adapted to add in new tests as they become available.

CONDOR will take place across Greater 91ֱ��, including – part of 91ֱ�� University NHS Foundation Trust – and Salford Royal, part of the .

The hospital-setting arm of the study, FALCON, is led by Co-Primary Investigator, Professor Rick Body, Professor of Emergency Medicine at the University of Manchester, Consultant at 91ֱ�� University NHS Foundation Trust and Director of DiTA – the 91ֱ��-based NHS Diagnostics and Technology Accelerator.

It will evaluate the accuracy of between 10 to 20 new COVID-19 tests – already identified as a high priority for the NHS – in hospitals. Approximately 30 hospital sites are expected to recruit patients to the FALCON study, which aims to start by the end of June 2020.

Professor Body said: “By validating the accuracy of new clinical tests through CONDOR, we can get novel tests out across the health and care system that are more convenient for patients and get more accurate results. This will mean that patients get better care and we can make more informed, early decisions about how to control spread of the virus.

“One application of CONDOR will be to follow-up patients who test positive with an antibody test, to find out whether they develop new infections, and help to understand whether people with antibodies are immune to reinfection and how long this immunity might last.”

Professor Body added: “The FALCON study could mean that clinicians can make fast, accurate decisions about a patient’s care – sometimes within minutes. That includes decisions about which wards or areas a patient can receive care in, rather than the standard laboratory tests, which can take 24 hours or more.

Lord Bethell, Minister for Innovation at the , said: “We need the fastest, most accurate tests in the NHS to help keep COVID-19 under control.

“I’m delighted we’re committing £1.3 million to this brilliant new national research programme, to evaluate how new diagnostic tests perform in health and social care settings – so we can track levels of infection and immunity across the country and help keep people safe.”

“That’s important because it will reduce the risk of infection for patients without COVID, while ensuring that those with COVID can get specialist care at an early stage.”

Professor Graham Lord, Vice-President and Dean of the Faculty of Biology, Medicine and Health at The University of Manchester said: “In a matter of weeks, clinical and research communities have worked hard to create new diagnostic testing for COVID-19 and then rapidly increase our capacity to perform them.

“Now we move on to CONDOR as a platform which aims to improve the efficiency and accuracy of the way testing is carried out.”

Professor Neil Hanley, Director of Research and Innovation at 91ֱ�� University NHS Foundation Trust, said: “I am delighted by this success for Rick and DiTA. This is exactly why we set up the Accelerator and to have such backing from UK Government is immensely reassuring.

“I am confident Rick and his team will build on this with highly impactful results.”

CONDOR co-investigator, Professor Paul Dark, is Honorary Critical Care Consultant at Salford Royal, Professor of Critical Care Medicine at The University of Manchester and NIHR National Specialty Lead for Critical Care.

Professor Dark said: “Making rapid diagnostic decisions for patients who are critically ill remains a significant challenge. I am delighted to support the CONDOR programme to help develop the best evidence for the best diagnostic tests available for use with front-line healthcare staff and their patients aimed at delivering the safest and most effective care."

At The University of Manchester, our people are working together and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives.  to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

A partnership of Manchester’s NHS and academic organisations will continue accelerating world-leading health research after once again receiving the prestigious Academic Health Science Centre (AHSC) designation.

91ֱ�� Academic Health Science Centre (MAHSC), part of Health Innovation 91ֱ��, has officially been designated by National Institute for Health Research (NIHR), NHS England and NHS Improvement from 1 April 2020 up to 2025.

AHSCs are partnerships between top universities and outstanding NHS organisations working together to undertake world-leading research to tackle diseases, develop new treatments and transform patient care.

MAHSC brings together The University of Manchester, 91ֱ�� University NHS Foundation Trust (MFT), The Christie NHS Foundation Trust, Salford Royal NHS Foundation Trust (part of the Northern Care Alliance NHS Group) and Greater 91ֱ�� Mental Health NHS Foundation Trust (GMMH) in a partnership working to drive health research and benefit our citizens.

It follows the news that scientists and clinicians across Greater 91ֱ�� have formed a research rapid response group to find ways to beat COVID-19 and save lives. The group will harness the power of hundreds of researchers from The University of Manchester as well as clinical colleagues at MFT and the Northern Care Alliance NHS Group, all backed by Health Innovation 91ֱ�� (HInM).

Over the next five years research and innovation within MAHSC will be delivered by six domains, each led jointly by an academic and an NHS clinician and chaired by a Chief Executive from a partner Trust. The domains are:

• Cancer (The Christie) Supporting transformational change in cancer-related life sciences to provide outstanding healthcare.
• Cardiovascular and Diabetes (MFT) Working to eliminate the inequalities in cardiovascular-related outcomes that affect the local population.
• Inflammation and Repair (MFT) Supporting work in dermatology, musculoskeletal, respiratory, gastroenterology, infection, orthopaedics, trauma, renal, and regenerative medicine.
• Mental Health (GMMH) Supporting priorities of dementia, self-harm, digital mental health.
• Neuroscience (Salford Royal) Harnessing the local expertise and excellence in neuroscience to improve outcomes.
• Women and Children (MFT) Incorporating the clinical specialities of paediatrics, obstetrics, gynaecology and genomics, linking the core specialties that are relevant to promote improvements in health from birth to old age.

Domains provide expert horizon scanning and strategic oversight that enable disruptive innovations to be tested and prioritised such as prevention and early detection of disease, new diagnostic tests and treatments and personalised care for patients.

MAHSC, which was first designated in 2009, also works in close collaboration with 91ֱ��’s thriving scientific community, research infrastructure and Greater 91ֱ��’s other higher education institutions.

Professor Graham Lord, MAHSC Executive Director and Vice President and Dean of the Faculty for Biology, Medicine and Health at The University of Manchester, said: “We have the most advanced integrated system in the UK for aligning academic research with local health needs to speed up the translation of discoveries into patient treatments and care at scale. Taking a singular One 91ֱ�� approach, this five-year AHSC designation will enable us to enhance innovation and make faster decisions that will directly impact and improve the lives of the 2.8 million population of Greater 91ֱ�� – as evidenced today by the magnificent mobilisation at pace of hundreds of researchers, scientists and health care professionals in support of efforts to fight the Covid-9 coronavirus.”

Professor Peter Clayton, MAHSC Clinical Director and Chief Academic Officer, Health Innovation 91ֱ��, said: “The designation of MAHSC for a further five years is recognition of the excellence within our NHS, academic and research organisation within 91ֱ��. The world-leading work taking place in these organisations and our domains will benefit our patients, clinicians and our wider community within Greater 91ֱ�� and beyond.”

Professor Neil Hanley, Group Director of Research and Innovation at MFT, said: “In the current challenging times, it is great news that 91ֱ�� has been re-designated again as an Academic Health Science Centre.

“We must seize the opportunity to make maximum difference over the next five years to the health and prosperity of our local communities, to connect more deeply to our incredibly diverse and talented academic and healthcare sectors, and to fly the flag for 91ֱ�� on the national and international stage.”

Raj Jain, Group Chief Executive Officer of the Northern Care Alliance and MAHSC’s lead for the neuroscience domain, said: “I am delighted that the 91ֱ�� Academic Health Science Centre has been re designated and will continue to work with Salford Royal, part of the Northern Care Alliance NHS Group, and other partners to improve health by giving patients and clinicians rapid access to the latest research discoveries and improving the quality and effectiveness of patient care.

“Delivering excellence in research and education is a key priority for the Northern Care Alliance and our partnership with MAHSC is important as we combine our expertise to establish Greater 91ֱ�� as a world leader in health research.”

Sarah Leo, Head of Research & Innovation, for Greater 91ֱ�� Mental Health NHS Foundation Trust, said: “We are looking forward to continuing to collaborate with our MAHSC partners over the next five years to further enhance research and innovation activity, particularly within mental health for the benefit of our service users.”

Find out more about MAHSC on our website: 

Oldham based doctor, has developed a new blood test which could help local rheumatoid arthritis patients to better manage their illness by keeping to their medication regimes.

Methotrexate is the most commonly prescribed drug for the 400,000 people in the UK suffering from this autoimmune disease. However, around 40% of rheumatoid arthritis (RA) patients do not take the drug as prescribed and, currently, clinical staff have no way of knowing whether a patient is taking their medication as advised.

Thirty eight year old, Dr Bluett practises at the borough’s which provides care for patients in orthopaedics, rheumatology and chronic pain. He is also a researcher for the and a Clinical Senior Lecturer at The University of Manchester.

The new test, developed, refined and assessed over 4 years, measures the methotrexate levels in a patient’s blood over the previous seven days. The final research results from 138 RA patients showed that the test has a 95% sensitivity in detecting whether someone took their methotrexate in the preceding week.

The initial evaluation of the blood test’s effectiveness was carried out in the with 20 patients from the North West.

“Patients may not take their methotrexate as prescribed for several reasons” said Dr Bluett, who splits his time equally between clinical practice and academic research at The University of Manchester. “Methotrexate is a weekly treatment, taken over a long period and can have side effects. Non-adherence means the drug won’t work as effectively and risks a patient’s condition worsening.

“Our new marker will enable doctors to start supportive conversations with patients about the difficulties they may be experiencing with the medication and how to resolve them.”

Dr Bluett was appointed as a consultant at the specialist musculoskeletal service, on New Radcliffe Street, in April 2018. The service, commissioned by NHS Oldham Clinical Commissioning Group, receives nearly 15,000 new referrals a year, mainly from local GPs and provides long term support for nearly 1,500 people with rheumatoid arthritis.

Dr Bluett’s  was published this month in the world’s leading rheumatology journal: the Annals of the Rheumatic Diseases.

“We need to see whether RA patients’ adherence improves when they receive feedback on their methotrexate levels. So, the next step will be a feasibility study to assess how we can gauge this in a clinical trial.

“I hope this further work validates our approach which could then, after appropriate regulatory approval, be incorporated into routine clinical practice. I want to ensure the best outcomes for RA patients” concluded Dr Bluett.

The Medical Research Council  funded 91ֱ�� Molecular Pathology Innovation Centre part funded the work.

Around 1,000 patients with heart failure across Greater 91ֱ�� will be monitored by a new digitally-enhanced service that will use data from existing implantable devices to transform care and better meet their needs.

Health Data Research UK (HDR UK) has today (31 January 2019) announced that ten innovative data solutions will receive a share of £3 million Government funding following a UK-wide competition, with £338,000 being allocated to Greater 91ֱ��. The projects are funded by UK Research and Innovation (UKRI) as part of the government’s modern Industrial Strategy, which aims to tackle the big societal and industrial challenges of today such as an ageing population.

has developed the heart failure project through an innovative partnership between 91ֱ�� University NHS Foundation Trust, the University of Manchester, global medical devices company Medtronic and clinical trials specialists North West EHealth.

Heart failure means that the heart is unable to pump blood around the body properly, usually because it has become too weak or stiff, and requires intervention such as medication, a medical device or surgery. In one year alone, 4,330 admissions to hospitals in Greater 91ֱ�� were related to heart failure, with treatment costing more than £17 million. However, by better understanding and supporting the patient to manage their condition this could be much less.

The new digital innovation project builds on the existing heart failure and device service at 91ֱ�� Heart Centre, at 91ֱ�� Royal Infirmary. Around 1,000 Greater 91ֱ�� patients already have an implantable device such as a pacemaker or defibrillator which captures information about their health. As part of the project, the clinical team will work closely with Medtronic, the company which provides the devices, to use the data to try and detect signs of deterioration earlier and to transform care for the patient.

Dr Fozia Ahmed, Consultant Cardiologist at 91ֱ�� University NHS Foundation Trust and clinical lead for the project, said: “We have been evaluating the use of this novel device-based pathway to identify patients with worsening heart failure for nearly three years. This project looks at how we can potentially align the technology that sits within implanted devices to benefit the patient by identifying potential problems at an earlier timepoint. To date, 7/10 patients were found to have issues that required treatment. By making better use of the patient data available we hope to radically improve the effectiveness and accuracy of patient care, ultimately improving care pathways.”

Prof Ben Bridgewater, Chief Executive of Health Innovation 91ֱ�� and a former cardiac surgeon, commented: “We are maximising the benefits of digital technology to deliver 21^st century healthcare to the 21^st century patient, which can only be delivered through a collaboration between the NHS, academia and industry. This is precisely what Health Innovation 91ֱ�� was set up to do, further strengthened by our uniquely devolved health and social care system, digital capabilities and life sciences cluster. Once tested, we will seek to adopt and spread the model so that all patients with heart failure benefit.”

Jackie Fielding, Vice President UK and Ireland Medtronic Ltd, said: “We are delighted to be partnering with the 91ֱ�� Health Economy, Dr Fozia Ahmed and Health Innovation 91ֱ�� to explore the use of our remote monitoring technology in improving health outcomes for patients living with heart failure. TRIAGE HF and the Medtronic CareLink System have a high diagnostic accuracy to identify patients with worsening heart failure and are currently being used as a heart failure management tool at 91ֱ�� Royal Infirmary.

“By identifying patients at an earlier time-point it creates a window of opportunity in which to optimise heart failure therapies, and there is a strong signal that it could prevent a problem, such as worsening heart failure, from turning into a crisis resulting in an unplanned heart failure admission. Greater 91ֱ��’s devolved healthcare system creates a unique opportunity to scale up digital health opportunities at pace to the benefit of the wider population. As our systems move towards a more sustainable, value based healthcare approach, it’s crucial that healthcare providers are reimbursed on outcomes that matter to patients and thus improve their quality of life.”

, from The University of Manchester, Professor of Health Informatics and project academic lead, said: “Together with our NHS and industry partners, we will test a new way of working that promises to enable rapid translation of data science research into practice leading to better care and improved outcomes for patients.”

North West EHealth will support the project by identifying other patients who may benefit in future using data analytics. Prof Martin Gibson, Chief Executive Officer, commented: “We are delighted to be involved in this important project and to be able to support patients being able to access these exciting new technologies and systems of care”

The project is set to go live in February.

A University of Manchester study of care provisions for patients diagnosed with Barrett’s Esophagus, a pre-cancerous condition, has resulted in improvements in local NHS care, which may form a blueprint for other hospitals.

The condition where cells lining the food pipe grow abnormally, is often linked with acid reflux and, in a small number of patients, can progress to cancer.

Barrett’s is the only known precursor to a type of cancer called oesophageal adenocarcinoma which, unlike most other cancers, is currently increasing in the number of people affected every year.

Patients diagnosed with Barrett’s have been identified as a key at-risk group for monitoring to improve early diagnosis rates for oesophageal cancer.

The study, led by Dr James Britton, found that provisions and support for patients diagnosed with this condition were inadequate.

It is published in the journal  

Due to insufficient and inconsistent care, many patients felt poorly informed with some lacking confidence in their ability to self-manage their condition.

The study was supported by Covidien and led by researchers based at Wrightington, Wigan and Leigh NHS Foundation Trust and The University of Manchester.

Patients spoke to researchers about their condition and treatment experiences in semi-structured and in-depth one-to-one interviews.

Dr Britton said: “Listening to patients’ experiences and concerns has contributed towards significant changes in care provisions for Barrett’s patients at this NHS trust, with a dedicated service now in place.”

If caught early, oesophageal adenocarcinomas are treatable using minimally invasive endoscopic techniques. This treatment is very effective and durable with only 1-2% of patients subsequently developing invasive cancer.

However, prognosis is very poor if the condition is not caught early.

Long-term monitoring means that these patients need to undergo regular invasive endoscopic procedures, which can have a significant impact on their quality of life.

“These patients carry a heavy burden of regular invasive procedures, symptom flare-ups, and worry of disease progression to cancer,” says Dr Britton.

“Despite this burden, they remain a forgotten patient group. Many don’t receive adequate information about their condition and their care is often inconsistent with no central lynchpin.

“This current standard of practice for Barrett’s patients is likely to be endemic across NHS hospitals”

The minority of patients in this study who self-reported as having adequate knowledge of their condition and its implications, showed a lower tendency towards cancer-related worries.

This suggests that well informed patients are less likely to experience reduced quality of life due to chronic and unnecessary cancer related worry.

“This should be the norm,” said Dr Britton

Patient-centred care and tailoring services around patient’s needs has already led to improved care for patients living with other chronic conditions, for example Inflammatory Bowel Disease.

These improvements have been shown to enhance patient self-management of disease flares, reduce hospital admissions, GP appointments and hospital appointments leading to large cost savings.

Dr Britton added: “We found a clear appetite for a Barrett’s focused services which could bridge the gap between GP and hospital care; providing information and dedicated patient support between surveillance tests”

“We now want to take our findings to other hospitals. We hope that a large multi-centre study will enable us to influence clinical guidelines and provisions for Barrett’s care across the UK, and improve more patients’ experiences with this condition. ”

The NHS in England has saved an additional 1,600 patients with severe injuries since major trauma centres were established in 2012.

New findings show the creation of major traumas centres has led to the survival of more than 1,600 patients who have suffered some of the most severe and complicated injuries thanks to top teams of surgeons, doctors and clinical staff. Patients also spent fewer days in hospital and had improved quality of life after receiving critical care.

The independent report, which features in the latest issue of EClinicalMedicine published by The Lancet, has been compiled by the (TARN) based at The University of Manchester supported by experts at the Universities of Leicester and Sheffield.

Major trauma centres have played a vital role in saving the lives of many victims of knife, gun and acid attack crimes that have seen a sharp increase in London and other inner city areas in recent months.

Research into the outcomes of more than 110,000 patients admitted to 35 hospitals between 2008 and 2017 represents an increase of nearly a fifth in the odds of survival from severe injury in the five years from 2012.

The findings endorse the shake-up of NHS trauma care in 2012 with seriously injured patients sent direct to newly designated major trauma centres, bypassing smaller, local hospitals that offered less specialist care.

Professor Keith Willett, NHS England’s Medical Director for Acute Care, who led the changes in 2012 and now leads the wider NHS urgent and emergency care review, said: “We have made major advances in urgent care over the last five years as this study demonstrates. As the NHS develops its ten year plan, the success of major trauma centres will help inform how we deliver better care for patients through the use of specialist clinical networks.”

Professor Chris Moran, NHE England’s National Clinical Director for Trauma Care, said: “This study shows that changes to trauma care, designed by clinicians, are saving hundreds of lives every year. Patients suffering severe injury need to get to the right specialist centre staffed by experts, not simply the nearest hospital. Thanks to the skills of NHS staff, we are confident that we will continue to see further increases in survival rates for this group of patients.

“Major Trauma Centres deal with the victims of stabbings and acid attacks as well as car and motorbike accidents. We have all seen the terrible increase in knife crime in our cities, especially in London, and there is no doubt that the new trauma system has saved many lives as these patients receive blood transfusion and specialist surgery much quicker than before. The whole system, from prehospital care through to recovery and rehabilitation, has improved.”

Professor Timothy Coats, Professor of Emergency Medicine at the University of Leicester, said: “We used patient outcomes data in the first four years prior to 2012 as the baseline, then looked at the five years since 2012. The baseline was flat, whereas the five years since the reorganisation of trauma care showed improved outcomes.

“These findings demonstrate and support the importance of major trauma networks to urgent care with figures showing there were 90 more survivors in 2013 rising to an additional 595 in 2017. Over the course of the five years 1,656 people have survived major trauma injuries where before they would probably have died. It’s a fantastic achievement.”

“It takes between five and 10 years for a trauma system to 'mature' and reach its full potential. So 595 additional survivors in 2017, five years after the systems started, is ahead of the target for the eventual 450 to 600 additional survivors that NHS England were predicting when the reorganisation was announced.

“It also shows that with changes to the way patients are treated from the moment doctors and paramedics get to them, with pre-hospital intubation, improved treatment for major bleeding and advances in emergency surgery techniques, there has also been a significant reduction from 31% to 24% in the number of patients needing critical care, and their length of stay on critical care wards reduced from four to three days on average.”

The study states that its analysis shows the whole system change to major trauma centres can be ‘associated with significant improvements in care and outcomes for patients with severe injury’.

It concludes: “A change in the organisation of care for patients with severe injuries, including the development of Major Trauma Networks that cover the entire national population, was associated with a significant 19% increase in the odds of survival for trauma victims who reach hospital alive.”

For those under the age of 40 in England, trauma remains the commonest cause of death, with survivors often suffering long-term disability. The National Audit Office estimates there are 20,000 major trauma cases a year, with 5,400 deaths.

A 2007 report ‘Trauma, who cares?’ identified serious failings across England and since its inception 70 years ago the NHS had based emergency care on ambulances taking patients to the nearest A&E, irrespective of the hospital’s capability to provide resuscitation and the care needed.

The Trauma Audit and Research Network had also identified great variation in the standard of care across the country and other studies showed England’s trauma care did not meet the standards of other countries, with almost 60% of major trauma patients receiving care that was less than good practice and avoidable deaths still occurring. This led the NAO to recommend the setting up of regional trauma networks.

The NHS reorganisation created 27 designated Major Trauma Centres, with the London network launched in April 2010 and networks across the rest of the country operating since April 2012.

In the largest ever trial of an intervention to treat people with multiple long-term conditions (multimorbidity) in primary care, researchers at the Universities of Bristol, 91ֱ��, Dundee and Glasgow found that the patient-centred approach taken improved patients’ experience of their care but did not improve their health-related quality of life. This is a challenge to current thinking on which UK and international guidelines are based.

In a study involving 1,546 patients from England and Scotland, they found that by making health reviews more patient-centred, such as involving patients in the planning and delivery of their care, overall patient satisfaction improved significantly. However, their health-related quality of life, which included measures of mobility, self-care, pain and discomfort, and anxiety and depression, did not.

The findings, published in The Lancet today [Thursday 28 June], provide the best evidence to date of the effectiveness of a person-centred approach for multimorbidity, for which there is international consensus but little evidence.

One in four people in the UK and the US have two or more long-term health conditions, increasing to two-thirds for patients aged over 65, placing a major strain on health services. Conditions include diabetes, heart disease and asthma, and can include mental health conditions such as depression and dementia. Multimorbidity is associated with reduced quality of life, worse physical and mental health, and increased mortality. Treatment for multimorbidity places an additional burden on patients, who may have to take large numbers of drugs, make lifestyle changes and attend numerous appointments for health care.

The study, funded by the National Institute for Health Research (NIHR), tested a new approach to caring for people with three or more long-term conditions, which aimed to improve their health-related quality of life and experience of patient-centred care, and reduce their burden of illness and treatment compared with usual care. The ‘3D’ approach, which encourages clinicians to think broadly about the different dimensions of health, simplify complex drug treatment and consider mental health (depression) as well as physical health, was designed to treat the whole person and overcome the disadvantages of treating individual conditions in isolation.

, from the University of Bristol’s and lead author of the study, said: “Existing treatment is based on guidelines for each separate condition meaning that patients often have to attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. Patients with multiple physical health problems frequently get depressed and they also sometimes complain that no-one treats them as a ‘whole person’ or takes their views into account.

“Internationally, there is broad consensus about the key components of an approach to improve care for people with multimorbidity but we found little evidence about their effectiveness. We incorporated these components in the 3D approach, including a regular review of patients’ problems according to their individual circumstances. We were surprised to find no evidence of improved quality of life for patients as a result of the intervention but this was balanced by significant improvements in patients’ experience of care.

“The question now is whether improved patient experience is sufficient justification for this approach. Given that improving patient experience is one of the triple arms of health care, alongside improving health and reducing costs, our view is that providing care that significantly improves patients’ experience is justification in itself.”

Patients from 33 primary care practices in Bristol, Greater 91ֱ�� and Ayrshire in Scotland took part in the study. Roughly half of the practices offered the 3D intervention (to 797 patients) and other half offered usual care (to 749 patients). Patients were aged 18 and older. The 3D intervention replaced disease-focused reviews of each health condition with one comprehensive ‘patient-centred’ review every 6 months with a nurse and doctor. These reviews focused on discussing the problems that bothered the patients most, how to improve their quality of life and how to improve management of their health conditions. A pharmacist reviewed the patient’s medication. A health care plan was then devised with each patient and reviewed six months later.

All measures of patient experience showed benefits after 15 months, with patients widely reporting that they felt their care was more joined up and attentive to their needs. However, there was no difference between the two groups in their reported quality of life at the end of the study period.

‘Improving the management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach’ by Chris Salisbury et al in The Lancet

A survey has estimated that around three million Britons - or 7.6 % of the country - believe they have experienced a harmful or potentially harmful but preventable problem in primary healthcare.

The research by University of Manchester epidemiologists and patient collaborators, also estimates that 1.5 million people believe their health has been made worse by a problem which could have been prevented.

The findings revealed a large divide between the opinions of patients and clinicians: of the preventable-problems reported by patients, clinicians said only a small percentage might be potentially harmful.

The figures are based on a representative survey of 4000 people which looked at the experience of respondents over the previous 12 months. The survey was carried out in England, Scotland and Wales, and was designed and analysed by the 91ֱ�� team, which includes patients.

It is published in BMJ Open and funded by the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre..

Problems reported by patients which could have been avoided included:

• A patient prescribed medication without necessary blood tests resulting in hospital admission and cardiac arrest
• Dentists extracting the wrong teeth.
• A GP failing to spot the dangers of chronic nose bleeding over several months, which turned out to be cancer
• A GP failing to identify that a new mum had a retained placenta – a potentially life threatening condition.

Around 20% of the problems reported by patients involved prescribing of medicines and 12% involved late, and missed or wrong, diagnoses.

A further 15% were communications problems – such as apparent lack of interest, not listening to patients and not passing on important information.

Around 70% of the problems reported had occurred in general practice, and another 9% in dental surgeries.

Problems were also reported by the respondents in A&E, ambulance service, walk in clinics, pharmacy, community or district nursing, opticians and community mental health services.

from The University of Manchester, who led the study, said: “Our survey suggests there are probably a large number of patients in Great Britain who believe they have experienced a potentially-harmful preventable problem in primary care.

“Importantly, only around half of the patients discussed their concern with somebody working in primary care yet those that did retained a higher level of confidence and trust in their GP.”

Patient research partner and study team member Ailsa Donnelly said: “Our respondents told us they want more patient centred care, more resources and better communication.

However, we need to develop ways for patients to raise problems in care easily and discuss them with clinicians, not only to make primary care safe but, crucially, to ensure it is felt to be safe by patients. Trust is an essential part of safe care.

Professor of General Practice from The University of Manchester, was also part of the research team.

He said: “This study shows that the views of patients are important when something goes wrong, irrespective of whether significant harm is caused.

“We also show that working with patients when something has gone wrong can help re-build trust with the GPs and other clinicians.”

’ Stocks SJ, et al is published in BMJ Open 2018;0:e020952. doi:10.1136/bmjopen-2017-020952

A little-known medical aid society in South Wales inspired Aneurin Bevan to create the NHS, according to unique audio on a launched today, one month before the service’s seventieth anniversary.

The work of University of Manchester historians will for the first time document the experiences of NHS patients and staff over its history with recordings, photos and other memorabilia.

NHS at 70, led by from University’s and supported by the Heritage Lottery Fund, contains audio of a patient who was helped by the Tredegar Workmen’s Medical Aid Society.

The interview recorded by NHS at 70 team member James McSharry is with 79-year-old Philip Prosser from Tredegar, home town of the Labour Minister who masterminded the health service’s creation.

Philip was born with ‘club foot’, a condition where one or both feet point down and inwards.

In the footage, he describes how his father paid a small weekly subscription to the Society formed by miners and steelworkers, which entitled him to surgery on his feet at around 1939.

By the time of the Second World War, around 95% of people in Tredegar were covered by the service.

“At the time my father was paying in to the Medical Aid Society so I was taken to one of the top orthopaedic doctors in Wales and that was the start of my treatment for quite a few years. When the NHS came in in 1948, I was transferred over. It was exactly the same as the NHS in 1948. We already had it in Tredegar before that,” he told the interviewer.

Other interviews in the archive also cover:

• Charles Howe, born at Park Hospital, Trafford in 1934 which was later to be the birthplace of the NHS.
• Joyce Thompson, born in 1928 in Padiham, near Burnley, who reflects on healthcare before the NHS.
• Jane Milne, born in 1946 in Kingston in Hull, who talks about her experience of living in the Nurses’ Home in 1964.
• David Jones, born in 1956 in Finley Woods near Coventry, who trained at Liverpool Medical School at the end of the 1970s.

Dr Snow said: “Philip’s interview shows that the principles underpinning the NHS - a health service available to all, free at the point of use and financed from subscriptions according to peoples’ means - were around before its creation in 1948.

“It also shows how Bevan’s home town helped formed his ideas which would shape healthcare in the whole of Britain.

“Bevan saw it worked in Tredegar and felt it would work across the UK- and 70 years later, people’s commitment to the idea of an NHS remains steadfast.”

She added: “Anyone can visit the project at  which is about working with volunteers from all walks of life to capture people’s stories and memorabilia to mark the seventieth anniversary of the NHS and create an Archive that will be there for future generations.

“And the NHS has an advantage over other significant historical anniversaries, because we still have access to people who participated in its 1948 creation

“Thanks to National Lottery players we have the opportunity to collect this history before it’s too late.”

Professor Jane Cummings, Chief Nursing Officer for England said: “The NHS’s 70th birthday is an ideal opportunity to share the stories and memories of the NHS, and the NHS at 70 archive will mean generations of patients and staff can continue to look back on decades of progress as we all look forward to the future of our health service.”