The Emerging Challenges and Strengths of the National Health Services: A Physician Perspective.

The National Health Services (NHS) is a British national treasure and has been highly valued by the British public since its establishment in 1948. Like other healthcare organizations worldwide, the NHS has faced challenges over the last few decades and has survived most of these challenges. The main challenges faced by NHS historically have been staffing retention, bureaucracy, lack of digital technology, and obstacles to sharing data for patient healthcare. These have changed significantly as the major challenges faced by NHS currently are the aging population, the need for digitalization of services, lack of resources or funding, increasing number of patients with complicated health needs, staff retention, and primary healthcare issues, issues with staff morale, communication break down, backlog in-clinic appointments and procedures worsened by COVID 19 pandemic. A key concept of NHS is equal and free healthcare at the point of need to everyone and anyone who needs it during an emergency. The NHS has looked after its patients with long-term illnesses better than most other healthcare organizations worldwide and has a very diversified workforce. COVID-19 also allowed NHS to adopt newer technology, resulting in adapting telecommunication and remote clinic. On the other hand, COVID-19 has pushed the NHS into a serious staffing crisis, backlog, and delay in patient care. This has been made worse by serious underfunding the coronavirus disease-19coronavirus disease-19 over the past decade or more. This is made worse by the current inflation and stagnation of salaries resulting in the migration of a lot of junior and senior staff overseas, and all this has badly hammered staff morale. The NHS has survived various challenges in the past; however, it remains to be seen if it can overcome the current challenges.

Extracting Self-Reported COVID-19 Symptom Tweets and Twitter Movement Mobility Origin/Destination Matrices to Inform Disease Models

The emergence of the novel coronavirus (COVID-19) generated a need to quickly and accurately assemble up-to-date information related to its spread. In this research article, we propose two methods in which Twitter is useful when modelling the spread of COVID-19: (1) machine learning algorithms trained in English, Spanish, German, Portuguese and Italian are used to identify symptomatic individuals derived from Twitter. Using the geo-location attached to each tweet, we map users to a geographic location to produce a time-series of potential symptomatic individuals. We calibrate an extended SEIRD epidemiological model with combinations of low-latency data feeds, including the symptomatic tweets, with death data and infer the parameters of the model. We then evaluate the usefulness of the data feeds when making predictions of daily deaths in 50 US States, 16 Latin American countries, 2 European countries and 7 NHS (National Health Service) regions in the UK. We show that using symptomatic tweets can result in a 6% and 17% increase in mean squared error accuracy, on average, when predicting COVID-19 deaths in US States and the rest of the world, respectively, compared to using solely death data. (2) Origin/destination (O/D) matrices, for movements between seven NHS regions, are constructed by determining when a user has tweeted twice in a 24 h period in two different locations. We show that increasing and decreasing a social connectivity parameter within an SIR model affects the rate of spread of a disease. © 2023 by the authors.

Global value chains for medical gloves during the COVID-19 pandemic: Confronting forced labour through public procurement and crisis

This paper evaluates ways in which labour issues in global value chains for medical gloves have been affected by, and addressed through, the COVID-19 pandemic. It focuses on production in Malaysia and supply to the United Kingdom's National Health Service and draws on a large-scale survey with workers and interviews with UK government officials, suppliers and buyers. Adopting a Global Value Chain (GVC) framework, the paper shows how forced labour endemic in the sector was exacerbated during the pandemic in the context of increased demand for gloves. Attempts at remediation are shown to operate through both a reconfigured value chain in which power shifted dramatically to the manufacturers and a context where public procurement became higher in profile than ever before. It is argued that the purchasing power of governments must be leveraged in ways that more meaningfully address labour issues, and that this must be part of value chain resilience. © 2022 The Authors. Global Networks published by John Wiley & Sons Ltd.

The impact of the COVID-19 pandemic on referral numbers, diagnostic mix, and symptom severity in Eating Disorder Early Intervention Services in England.

OBJECTIVE: First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway which aims to provide timely, well-coordinated, developmentally informed and evidence-based care for young people with eating disorders (EDs). This article investigates the impact of the COVID-19 pandemic on FREED patient presentations and service provision in England. METHOD: Data from three services spanning the pre- to post-pandemic period were included (January 2019-September 2021; n = 502 patients). Run charts were created to analyze changes in monthly baseline patient data (e.g., referral numbers, duration of an untreated ED, diagnostic mix, and average body mass index for patients with anorexia nervosa [AN]). RESULTS: Significant increases in referral numbers were found from September 2020 onward, coinciding with the end of the first UK national lockdown. The percentage of AN presentations significantly increased after the onset of the first national lockdown (April 2020-December 2020). No other significant change patterns were identified. DISCUSSION: There have been substantial increases in referral numbers and presentations of AN to FREED services whereas illness severity seems largely unchanged. Together, this suggests that increased referrals cannot be attributed to milder presentations being seen. Implications for the implementation, funding, and sustainability of the model are discussed. PUBLIC SIGNIFICANCE: Our research suggests that early intervention eating disorder services across England faced significant increases in patient referrals and presentations of anorexia nervosa over the COVID-19 pandemic. This increase in referrals is not due to a rise in milder eating disorder cases, as baseline symptom severity remained stable across the pandemic. Investment in early intervention for eating disorders must therefore match increased referral trends.

Good continence care: tips for nurses working in any setting: How to ask the right questions, assess symptoms and provide support before offering pads to patients with continence issues

The article offers tips for nurses on providing care for patients with continence issues. Topics discussed include the consequences of pressures on continence services, the lack of confidence among nurses in continence, tools used for initial assessment of bladder symptoms in adults, and the lack of services for younger patients with bladder and bowel issues in the Untied Kingdom.

Predicting and Characterizing Legal Claims of Hospitals with Computational Intelligence: the Legal and Ethical Implications

In this paper we propose a fuzzy logic-based approach to analyze UK National Health Service (NHS) public administrative data related to pre-and post-pandemic claims filed by patients, analyzing the legal and ethical issues connected to the use of Artificial Intelligence systems, including our own, to take critical decisions having a significant impact on patients, such as employing computational intelligence to justify the management choices related to Intensive Care Unit (ICU) bed allocation. Differently from previous papers, in this work we follow an unsupervised approach and, specifically, we perform an analysis of UK hospitals by means of a computational intelligence algorithm integrating Fuzzy C-Means and swarm intelligence. The dataset that we analyse allows us to compare pre-and post-pandemic data, to analyze the ethical and legal challenges of the use of computational intelligence for critical decision-making in the health care field. © 2022 IEEE.

NHS values, ritual, religion, and Covid19 death

Of paramount importance to the major British response to the Covid19 global pandemic was a dramatic intensification of the pre-existing significance of the National Health Service as the prime carrier of the core cultural value of life itself. A theoretical model accounting for how emotions generate 'values' and belief-like constructs from otherwise ordinary 'ideas', in a process embracing notions of identity and even of destiny, parallels innovative popular responses that ritualised gratitude to self-sacrificing health-care workers. This applause from countless doorsteps, along with daily medical-scientific-political bulletins, and a distinctive address from the Queen, generated both a diffuse and highly focused ritualization of British society, all at a time when major religious buildings were actually closed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The positive impact of GIRFT (getting it right first time) on arthroplasty services in times of COVID-19.

Background: This observational study evaluates the trends in arthroplasty services across National Health Services (NHS) following the COVID-19 pandemic about GIRFT (Getting it Right First Time) guidelines concerning National joint registry data (NJR data). Introduction: Since the advent of the COVID-19 crisis sustainability of elective arthroplasty services have become a burning question in NHS. Capacity crisis, unknown COVID-19 infection status, lack of ring-fenced beds, winter crisis, and unprecedented trauma have aggravated the situation further leading to severe impairment in quality of life and service provision. GIRFT guidelines have suggested a few solutions to this crisis and one of them is dividing the hospitals into Hot (trauma) and cold (elective) sites. Objectives: To review NJR data for pre and post COVID era along with the service structure of the hospital and test the hypothesis that whether redistribution of services into hot and cold sites is a possible solution for sustainable arthroplasty service across NHS. Methodology: A search was made into the NJR data from 2019, 2020, and 2021. The First 7 months were taken from each year I.e. From Ist January to 31st of July. A review of entries for arthroplasty was considered for all hospitals across England and Wales. Hospitals in Scotland, Ireland, and Isles of Man and major trauma centers were excluded.Any hospital that was recording at least 15 arthroplasty cases for 4 out of 7 months in 2021 was considered for review. A brief evaluation of their service structure was made, and hospitals were divided into Elective Centres (EC), Urgent Care Centres (UCC), and District General Hospitals (DGH) with in-house emergency services based on the information provided on their official website. In NJR data "completed operations by submission date" column was considered as a reference for data collection. A total of 1807, 1800, and 1810 were identified for 2019, 2020, and 2021 respectively.However, after applying inclusion criteria total number of entries was reduced to 120 hospitals. Data analysis and selection of hospitals were reviewed twice by two authors (MMK and AP) at different times to avoid any bias and reduce the chances of human error that can affect the outcome. A sub-analysis of data for the last 3 months (May, June, and July) was also performed for the respective years to get a better picture of arthroplasty trends and reduce the flaws of data interpretation. Ethical approval and data consideration: A formal approval was taken from the NJR team in the UK before the data processing was initiated. The data source being used was available for public review on the NJR website. The team was happy for us to process and evaluate the data as per needs of our study. However, they requested a disclaimer and appreciation note for the members of the NJR team and hospital personnel across the UK that have made the provision of data and subsequent analysis leading to this study feasible. Results: 18 EC were included. The mean number of cases recorded per center was 427, 68, 348 for 2019, 2020, and 2021 respectively.20 UCC were identified. The mean number of cases performed were 213, 24, and 195 in 2019, 2020, and 2021 respectively.Similarly, 60 DGH with emergency services were included and the average number of cases recorded were 194, 27, and 166 for 2019, 2020, and 2021 respectively. Compared to 2019 out of 148 DGH in 2019 only 60 can provide a sustainable arthroplasty service signifying a drop of 40% in 2021 in the number of DGH which are contributing to elective services. Conclusions: The overall productivity of theatres in terms of arthroplasty services has decreased since the reinitialization of services in 2021. There is a need of hour to divide the services into hot and cold sites in terms of A/E and elective centers to provide safe and uninterrupted provision of arthroplasty services and address long waiting times for patients. Provisional of ring-fenced beds and arthroplasty wards is more technically feasible in centers that are not providing in-house emergency admission pathways or are specialist, dedicated elective centers.

Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases.

The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa's outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.

TREND ANALYSIS AND COMPARISON OF COVID - 19 CASES BEFORE AND AFTER ADMINISTRATION OF VACCINE USING MACHINE LEARNING

In this study we draw a comparison between the trends in the growing cases of novel coronavirus after the administration of vaccine doses. We compare two scenarios where how the trends have changed after the vaccine has been administered and how the trend would have looked if there were no vaccines present. This study can be used to determine the early changes that the vaccines have brought about in the trends and how much reliability do they show in preventing the cases from rising further. The predictions are made using a Weibull based Long-Short-Term-Memory approach which is also being used by the National Health Service of the UK on a dataset that takes into account features like age groups, air traffic, developmental index of the country, average temperatures of a country, which are detrimental in determining the rate of infection and deaths accurately. The model is tested on data gathered from multiple countries and the results are drawn after analyzing the result for each country as an individual entity for the conclusion to be reliable. With an increasing market competition and not so long testing period given to these vaccines which have made it to the common masses we feel this study can help predict how effectively the vaccines will be able to improve immunity against this virus and is it a viable option to invest such large capital in development and purchase of these vaccines preferring it over the organically decreasing curve following the traditional methods and natural processes. © 2021 IEEE.

E-data Utilization on National-Health Service Performance Assessment during Covid-19 in Bangladesh: New evidence using data envelopment analysis (DEA) technique

Making the entire world extremely nervous, more than the quarter of a year has gone past since the global breakout of deadly respiratory illness, named Coronavirus Disease-2019 (CoViD-19), over nine million people across the globe have already been infected with more than five percent death rate, and the number is still ascending at a tremendously frightening rate. This study has been driven to identify the adequacy and quality of responses from national health facilities in Bangladesh during this epidemic and discern the stimulates that influence the entire system. With an in-depth exercise of a nonparametric statistical method for proficiency weighting, namely the Data Envelopment Analysis (DEA) technique, the objective of this study of evaluating the thorough response and performance of the Bangladeshi National Health Service has been placed in efforts to be achieved. With the outcome, the method and operation of assessing the effective responsiveness, capability, and appropriate organization of the national health services (NHS) in Bangladesh during the ongoing COVID-19 pandemic have been revealed. It has also been specifically identified that this country’s health system does not possess material mastery on input variables;neither do they have strong dominance over output variables. With a view to minimizing the expenditure, they should have decreased input variables alongside enhancing input resources thoroughly to deal with this pandemic with stringent governance. Direction and limitation of future research endeavors in this area may be indicated by this study. National responses across the globe can also be benchmarked. © 2021 International Consortium for Electronic Business. All rights reserved.

Omicron causes increasing pressure on NHS but general practice overlooked -- again

The article reports that the BMA leaders have warned that general practice is being overlooked in Government discussions about pressure on the NHS caused by the increasing rate of omicron infections.

Incorporating human behavior in VR compartmental simulation models

A novel strand of Coronavirus has affected a large number of individuals worldwide, putting a considerable stress to national health services and causing many deaths. Many control measures have been put in place across different countries with the aim to save lives at the cost of personal freedom. Computer simulations have played a role in providing policy makers with critical information about the virus. However, despite their importance in applied epidemiology, general simulation models, are difficult to validate because of how hard it is to predict and model human behavior. To this end, we propose a different approach by developing a virtual reality (VR) multi-agent virus propagation system where a group of agents interact with the user in a university setting. We created a VR digital twin replica of a building in the University of Derby campus, to enhance the user’s immersion in our study. Our work integrates human behavior seamlessly in a simulation model and we believe that this approach is crucial to have a deeper understanding on how to control the spread of a virus such as COVID-19. © 2021 Copyright held by the owner/author(s).

Academic urges former nurses to return to practice

The article discusses a course plan created to provide an opportunity for nurses whose registration has lapsed after a break in practice of three years or more to return to practice and renew their registration.

Impact of COVID-19 on UK stress echocardiography practice: insights from the EVAREST sites.

INTRODUCTION: Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential. Stress echocardiography is one of the most widely used cardiac tests in the NHS. We assessed the impact of the first (W1) and second (W2) waves of the pandemic on the ability to deliver stress echocardiography. METHODS: Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked to complete a survey on the structure and delivery of stress echocardiography as well as its impact on patients and staff in July and November 2020. Results were compared to stress echocardiography activity in the same centre during January 2020. RESULTS: 24 completed the survey in July, and 19 NHS hospitals completed the survey in November. A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2. The major change was in the mode of stress delivery. 70% of sites stopped their exercise stress service in W1, compared to 19% in W2. In those still using exercise during W1, 50% were wearing FFP3/N95 masks, falling to 38% in W2. There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2. CONCLUSION: Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardization of protocols for patient screening and PPE may help further improve consistency of practice within the United Kingdom.