Referral pathways into the NHS Digital Weight Management Programme for musculoskeletal and perioperative patients: rapid process evaluation.

BackgroundTo be authorized for use in the National Health Service (NHS) in England, digital health technologies (DHTs) must meet 2 mandatory clinical risk management standards, Data Coordination Board (DCB) 0129 and 0160, demonstrating that risks from design and use have been assessed and mitigated. NHS organizations must not procure a DHT without DCB0129 assurance and must not deploy one without DCB0160 assurance. Despite legal requirement, no public data exist on how many DHTs are in use in the NHS or how many are assured.ObjectiveThis study aimed to determine the number of DHTs in use in the NHS in England and assess their assurance status against mandated clinical safety standards.MethodsIn early 2025, 239 NHS organizations in England received a freedom of information notice requesting information on the number of DHTs they were using and their assurance against DCB0129 and DCB0160 standards.ResultsOf the 239 NHS organizations, 204 (85.4%) responded, of which 178 (87.3%) provided full or partial data, covering 14,747 DHT deployments. The mean number of deployed DHTs per organization was 82.8 (SD 146.1; 95% CI 61.4-104.3) with substantial variation between NHS provider trusts (mean 107.1, SD 161.1; 95% CI 79.8-134.3), ambulance trusts (mean 13.0, SD 8.2; 95% CI 7.6-18.4), and integrated care boards (mean 8.1, SD 16.0; 95% CI 2.8-13.5). Overall organizational compliance rates were low, with a median of 25.6% (IQR 7.8%-55.7%) deployed DHTs being fully assured; for NHS provider trusts compliance was lower at 24.5% (IQR 8.1%-50%). A total of 13 (6.4%) of the 204 organizations reported that all their DHTs were fully assured, while 16 (7.8%) reported that none were assured. Across all DHTs with reported assurance data, 17.3% (95% CI 16.6%-18.1%) were fully assured against both standards, 13.3% were partially assured against one standard, and 70.1% (95% CI 69.1%-71.1%) had no documented assurance.ConclusionsThis is the first study to quantify both the scale of DHT deployment in NHS organizations in England and the extent of compliance with mandatory safety standards. More than 10,000 DHTs currently in use lack documented assurance against clinical safety standards. In a typical NHS trust, 3 out of 4 digital tools influencing patient care do not demonstrate compliance with minimum legal or clinical safety requirements. These findings raise significant concerns about the risks posed to patients by these technologies; the capacity of organizations to assess and mitigate them; and the legal ramifications of when, not if, harm occurs. Crucially, failure to assure digital technologies poses a significant risk to one of the core ambitions of the NHS 10-Year Health Plan for England; safely transitioning from analogue to digital care models. These findings are unlikely to be unique to the NHS and should prompt health care systems worldwide to assess the risks posed by their DHT deployments.

The wider impacts of the coronavirus pandemic on the NHS

Will politicians be architects or destroyers of the NHS?

The National Institute for Clinical Excellence (NICE) responds to requests by the Department of Health for guidance on the use of selected new and established technologies in the National Health Service (NHS) in England and Wales. This paper asks whether the NICE methodological guidelines help NHS decision makers meet the objectives of maximum health improvements from NHS resources and an equitable availability of technologies. The analytical basis of the guidelines is a comparison of the costs and consequences of new and existing methods of dealing with particular conditions using the incremental cost-effectiveness ratio. We explain why information on the costs and consequences of a particular technology in isolation is insufficient to address issues of efficiency of resource use. We argue that to increase efficiency, decision makers need information on opportunity costs. We show that in the absence of such information decision makers cannot identify the efficient use of resources. Finally we argue that economics provides valid methods for identifying the maximisation of health improvements for a given allocation of resources and we describe an alternative practical approach to this problem. Drawing on the experience of Ontario, Canada where an approach similar to that proposed by NICE has been in use for almost a decade, and recent reports about the consequences of NICE decisions to date, we conclude that instead of increasing the efficiency or equity of the use of NHS resources, NICE methodological guidelines may lead to: uncontrolled increases in NHS expenditures without evidence of any increase in total health improvements; increased inequities in the availability of services; and concerns about the sustainability of public funding for new technologies.

The sustained governmental assault on the National Health Service (NHS) in England during post-1970s financialised or rentier capitalism has received considerable attention by the research community. There is some evidence, however, that many of those members of the public who have not had occasion to use the NHS remain largely ill-informed about the extent of, and reasons for, its present troubles. In this paper I offer an auto/biographic account of my own recent experiences as a patient with type 2 diabetes and subsequent polymyalgia in both primary and secondary care. I then deploy analytic induction to consider, and explain, my personal travails against the background of the shifting nature of doctor-patient interaction occasioned by governmental politics in relation to the NHS. The result is an illustrated story of the decline of health care at a political juncture when the ever-expanding capital assets of a tiny minority of the population trumps the health care needs of the population as a whole. The present impoverishment of management and care must be understood with reference to wider aspects of macro-social change. The paper concludes with some ideas about how to (re)fund a severely ailing NHS.

Clinical research in the National Health Service in England

Quantifying the health-care burden of temperature in the National Health Service in England: an economic analysis of resource use and costs.

External audit in the National Health Service in England and Wales: A study of an oversight body’s control of auditor remuneration

The annual clinical negligence bill against the National Health Service (NHS) in England has increased substantially from £0.3 billion ($0.4 billion) in 2004 and 2005 to £2.3 billion ($3.0 billion) in 2019 and 2020.1 Clinical negligence accounts for more than 1.5% of the annual NHS budget in England (£148.8 billion, $193.4 billion).2 The rising costs have been attributed to increases in both claim volume and costs.2

The UK has been an early adopter in the use of ambient assisted living technology for social care and this experience has helped to shape the approach to the use of technology in healthcare. The National Health Service (NHS) in England has benefited from a series of policy measures, supported by grant funding, that have resulted in a significant uptake of ambient assisted living technologies in both health and social care. Over the period 2005–2010 the NHS has moved from a few small scale pilots toward a situation where a growing proportion of local health authorities have implemented some form of service, and a few have moved on to plan or deploy technology on a large scale.

Introduction: The National Health Service (NHS) in England is the first to offer whole genome sequencing (WGS) as part of standard care. As a high-income country with a universal healthcare system, England contributes a valuable perspective to global developments in WGS. Methods: We used an implementation science approach with mixed methods to characterise delivery of WGS for paediatric rare diseases: observations and field notes of consent appointments in clinical genetics and mainstream settings and follow-up qualitative semi-structured interviews with the clinical team. Process maps were developed for each department to identify similarities and variations between sites and thematic analysis of interview data to understand barriers and facilitators. Results: Data collection occurred in 12 departments (7 genetic, 3 neurology, 1 cardiology, and 1 general paediatric) across 7 NHS Trusts. 26 observations of 21 healthcare professionals were conducted, alongside 19 follow-up interviews. Two master maps were developed – one for clinical genetics and one for the mainstream. We identified 11 steps involved in delivering WGS, including 9 variations and 9 similarities. We identified most variation in the processes related to the “who,” “when,” “how,” and “where” as these were aspects that could be adapted to fit into the specific set-up of the department. Barriers included reluctance to uptake in the mainstream and difficulties tracking samples. Conclusion: Recommendations include developing standard operating procedures and hiring healthcare professionals responsible for facilitating consent alongside administrative aspects. These would reduce the burden on clinical geneticists and improve turnaround times as well as contribute to streamlining and standardisation of the service.

The aim of this study was to examine the impact of the National Institute for Health and Clinical Excellence's (NICE's) negative and restricting technology appraisals on the number of prescription items dispensed and the corresponding total net ingredient costs for drugs from 2000 to 2004 in the ambulatory care of the National Health Service (NHS) in England and Wales. In addition, it is discussed whether the NICE approach could be a role model for Germany. The number of prescription items dispensed and the net ingredient costs of thirty-one drugs reimbursed by the NHS were analyzed, thereof thirteen drugs descriptively and twenty-one drugs with regression analyses. Data were extracted from the "Prescription-Costs-Analysis-Statistics" for the ambulatory care of the British Department of Health (England 1993-2005). In the case of the twenty-one drugs analyzed by regression analyses, predictions were established how the prescribing and the costs would have developed without NICE's drug appraisal. Finally, conclusions were drawn whether NICE's negative and restricting drug appraisals had a decreasing effect or not. For 97 percent of the drugs analyzed in this study, the publication of NICE's fourteen negative and restricting technology appraisals of drugs between 2000 and 2004 did not reduce the number of prescription items dispensed and net ingredient costs in the ambulatory care of the NHS in England and Wales. Cost-effectiveness appraisals as performed by NICE or the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) are a useful and important tool to enhance the discussion about methods and acceptance of evidence-based medicine in general.

Pinnaplasty - A dwindling art in today's modern NHS

Guest editorial

The National Health Service (NHS) in England and Wales has embarked upon a radical and far–reaching programme of change and reform. However, to date the results of organizational quality and service improvement initiatives in the public sector have been mixed, if not to say disappointing, with anticipated gains often failing to materialize or to be sustained in the longer term. This paper draws on the authors’ recent extensive research into one of the principal methodologies for bringing about the sought after step change in the quality of health care in England and Wales. It explores how private sector knowledge management (KM) concepts and practices might contribute to the further development of public sector quality improvement initiatives in general and to the reform of the NHS in particular. Our analysis suggests there have been a number of problems and challenges in practice, not least a considerable naïvety around the issue of knowledge transfer and ‘knowledge into practice’ within health care organizations. We suggest four broad areas for possible development which also have important implications for other public sector organizations.