The healthmatters blog; commentary, observation and review
We are so used to the attacks on the NHS from the Daily Mail that we forget that it can be merciless to private medicine too. A critical article by Lois Rogers for the Mail’s on-line edition on June 12th provoked the Association of Independent Healthcare Organisations (AIHO) to respond.
Rogers’ attack begins with the story of a man (a Director of a high-end car company) who underwent surgical removal of the prostate (no small procedure) in a private hospital, only to be told years later that the surgery had not been necessary. According to the Mail’s journalist he is just one of at least 66 people, many of whom were treated privately, who believe they were misdiagnosed or underwent unnecessary surgery at the hands of the same surgeon, Manu Nair.
EXPOSED: How the NHS is paying millions to private surgeons for operations that we may not need – and could even HARM us
The quality of care received by NHS patients in private hospitals is under review
Insiders fear countless people are paying for needless, expensive operations
There’s also been a sharp rise in complaints from unhappy or worried patients
Those treated in private hospitals are often not compensated if things go wrong
By Lois Rogers for The Daily Mail Published: 22:06, 12 June 2017 | Updated: 13:57, 14 June 2017
This story is the tip of a much bigger iceberg in private hospital care, Rogers asserts, citing a number of experts who express concern about patients being at risk of needless treatment or botched surgery in the private sector. Whilst the NHS is far from immune, says the Mail story, the private sector seems to face particular problems with lack of scrutiny of what surgeons are doing.
Doctors working in private hospitals earn more if they do more treatment, and so have a financial incentive to be interventionist, even ‘gung ho’, about operations. They are not subject to the same monitoring and scrutiny as in the NHS, according to Brian Toft, visiting professor of patient safety at Brighton and Sussex Medical School. And private hospitals don’t have to monitor outcome trends to detect substandard surgeons either, he claimed. According to the Mail’s story, the Royal College of Surgeons published an open letter to the Government calling for private hospitals to be required to disclose data on botched operations, so rogue surgeons can be identified.
Professor Toft is joint author of a 2015 report, ‘How safe are NHS patients in private hospitals?’, published by the Centre for Health and the Public Interest think-tank, which the Mail journalist reported as saying that risks to patient safety ‘remain widespread’.
The report argued that NHS patients should be made aware of these risks before being treated in private hospitals. Linda Millband, a lawyer representing 500 patients who underwent unnecessary breast surgery, said to the Mail: ‘NHS hospitals have regular multi-disciplinary team reviews of patient care, but there is no requirement for anything similar in private hospitals. Private hospitals consider themselves above the law and above the standards followed by the NHS.’ The article then goes on to mention by name NHS consultants who have been accused of over-treating patients in the private sector. Read more at: http://www.dailymail.co.uk/health/article-4597524/EXPOSED-NHS-pays-millions-private-surgeons.html#ixzz4l1HcaqS)
While surgeons in the NHS are covered by the NHS Litigation Authority, in the private sector it is the surgeons themselves who bear financial responsibility if things go wrong. They are legally required to arrange their own insurance cover, but in some cases have operated without this, says the Mail. About £10 million was paid from public funds to compensate 250 NHS patients in a recent case of botched surgery, but Rogers believes that many private patients who have undergone unnecessary surgery may never be compensated.
Unsurprisingly the AIHO was not pleased by these claims and responded sharply, pointing out that surgeons in the private sector are all responsible to the General Medical Council, mostly work for the NHS (where they are scrutinised), and work privately in hospitals that are inspected by the Care Quality Commission.
The AIHO insists that the ‘independent’ (private) sector is actively working with NHS England and other relevant bodies to bring the level of reporting of surgery in line with the NHS’s own. Independent hospitals are already required to provide detailed data on every private episode of care, and they are beginning to publish performance measures for 149 common procedures at over 250 hospitals. That is just a beginning, says the AIHO, but it is of immediate benefit to patients, and is better than anything that has existed before. More will soon follow, according to the AIHO, including measures of consultant performance in 2018.
The AIHO says “failings of a handful of rogue surgeons does not represent the high quality and compassionate care delivered day in and day out by the independent sector as a whole”.
This spat matters. Treating NHS patients is big business for private hospitals. 530,000 surgical procedures were carried out on NHS patients in the private sector in 2016. A third of all NHS-funded hip and knee replacements are now being carried out in private hospitals. The NHS paid the private sector £8.7 billion for services last year, amounting to 28 per cent of private hospitals’ income. The private hospital sector constitutes a source of spare surgical capacity for the NHS, which is obliged to ensure that private hospitals are inspected and judged as closely and critically as NHS hospitals. Private hospitals are in effect in the NHS’s public domain (as distinct from the state-run public sector) when they do NHS work. They are, then, like GPs, dentists, pharmacists and other contractees to the NHS, and they have to perform according to NHS rules. That is why the Mail sees them as fair game for the critical journalist.
Steve Iliffe 26/6/17
At the time of writing Britain is basking in glorious sunshine and we are in the midst of a record breaking heatwave. The media is full of “sun safety” tips and advice – but did you know hiding from the sun can be as dangerous as getting too much exposure?
Most of us in the UK are Vitamin D deficient. This is mainly because during the dull and dreary months – which let’s face it, is most months – we don’t get enough sunlight.
While Vitamin D levels are generally higher in summer, it’s not the same for everyone. The process of producing Vitamin D becomes less effective with age, meaning older people are more likely to be Vitamin D deficient, as are pregnant or breastfeeding women, people with certain chronic medical conditions (affecting the kidneys or bowel), or on certain medications.
Also, the darker your skin tone, the more sunshine your body requires for this process – meaning people of Mediterranean or African heritage require more sunshine to maintain good Vitamin D levels, and are more likely to be deficient in the UK.
Why is Vitamin D important?
You know that Vitamin D is good for our bones, but most of us don’t realise the true importance of Vitamin D, and how a lack of this Vitamin can affect our health.
Our skin plays a big role in producing Vitamin D, which is activated by sunlight. In more technical terms, Vitamin D regulates the levels of two important minerals associated with bone health – calcium and phosphate. These are absorbed via a gut, in a diet rich, and are used in bones, teeth and muscles.
That’s why, a deficiency in Vitamin D can result in bone pain, muscle weakness and general tiredness. In severe cases, this can even lead to conditions such as brittle bones, rickets in children and osteomalacia in adults.
The Need For Vitamin D vs Staying Safe in The Sun!
When we talk about ‘sun exposure’, simply sitting by a window isn’t good enough – you’ve got to actually go outside to properly expose your skin to sunlight! But don’t worry, we’re not insisting on an hour’s sunbathing every day to get sufficient exposure – many doctors recommend that spending just ten minutes a day outside with good sunlight exposure on your arms (and legs, if possible!) is sufficient in maintaining a good level of Vitamin D.
However, there’s a fine line between getting enough sunshine and over-doing it!
Spending too much time in strong sunshine can lead to sunburn, where too much UV radiation from the sun damages the skin. This doesn’t just result in the short-term effects of pain and redness (and if you’re really unlucky – blistering, swelling and a splitting headache too!), but can have significant long-lasting, harmful effects on your skin. It’s estimated that getting sunburn, even just every couple of years, can triple your risk of developing skin cancer.
To prevent sunburn, make sure you wear sunscreen (at least factor 30, with UVA and UVB coverage!) when spending more than ten or so minutes in the sun. Reapply this every few hours, or after taking a dip in the pool or sea. Cover up with appropriate clothing, especially hats and sunglasses with UV protection, and avoid direct sun exposure in the hottest hours of the day during summer – usually between 11am and 3pm.
It’s difficult to maintain the right balance of sun exposure all year long, but it’s also incredibly important in the maintenance of your skin and bone health! Your GP is a great source of advice on any regarding sunburn, skin cancer, or Vitamin D deficiency, if you had any concerns regarding these topics.
If you do happen to be Vitamin D deficient, for whatever reason, your doctor will usually recommend taking supplements, such as “colecalciferol” or “ergocalciferol”, available from most pharmacies and even supermarkets. Kids who are deficient can take ‘vitamin drops’, as a Vitamin D supplement.
For more information visit www.londondoctorsclinic.co.uk
Dr Seth Rankin, Founder of London Doctors Clinic (www. Londondoctorsclinic.co.uk)
Ruth Powell, Clinical Negligence specialist at the law firm BL Claims Solicitors, said: “Most of those people would be shocked to discover that dermal fillers are only subject to the same level of regulation in the UK as ballpoint pens and toothbrushes. When it comes to those who carry out filler procedures it’s rather like the Wild West out there – pretty much anybody can do it.
“It is reported that fillers, laser hair removal and Botox account for nine in 10 procedures, and approximately 75 per cent of the market in terms of money spent. There is a widely held view that this market is partly driven by pressure to look good from TV, magazines and social media – particularly the “selfie culture”. It is perhaps not surprising that people are tempted by advertising for a quick fix to their wrinkles after seeing perfectly-posed pictures of smooth-skinned celebrities on Facebook, Snapchat or Instagram.”
Responding to the Queen’s Speech, Mental Health Network chief executive Sean Duggan said: “We welcome the Government’s commitment to prioritising mental health and the planned reform of mental health legislation which is much needed. The Mental Health Act has played an important role in supporting people who have reached the point of crisis, but it is nearly 35 years old and clearly needs refreshing.
“It would have been a mistake to scrap it and start from scratch without undertaking a full review. So we support the proposal for reform and in particular identifying why the number of detentions under the act have risen by around 10 per cent year-on-year since 2010/11.”
Alzheimer’s Research UK, the UK’s leading dementia research charity, has called for the new government to renew its commitment to funding research into the condition. The charity’s call comes amid speculation that the Great Repeal Bill – aimed at ensuring EU law will no longer apply in the UK after Brexit – could see other issues fall from the political agenda.
In the run-up to the election, a commitment to invest in dementia research was included in the Conservative Party manifesto, although the document did not detail what level of funding could be expected, or how this commitment would be maintained beyond the 2020 Challenge on Dementia. With uncertainty around the detail of the new government’s planned programme of work, Alzheimer’s Research UK is urging the Prime Minister to ensure that a focus on dementia research will form part of the plans for this parliament.
Dr Matthew Norton, Director of Policy and Strategy at Alzheimer’s Research UK, said:
“The Conservatives’ manifesto ahead of the election included a commitment to invest in dementia research, and the new government must make good on this promise. We’ve seen the start of real political action against dementia in recent years, but dementia research is still playing catch-up compared to other serious conditions and we cannot afford to lose momentum now. It’s clear that preparations for our exit from the EU will dominate this parliament, but it’s absolutely vital that dementia should not slip from the agenda as a result.
“Already 850,000 people in the UK are living with dementia, and with this number set to increase, research offers our best hope for tackling this devastating condition. We recognise that there will be many issues on the agenda for the new government, but research has to remain a priority if we are serious about reducing dementia’s impact, both on those affected by the condition and on the UK economy. The government must confirm its commitment to investing in dementia research, and set out its detailed plans for a long-term strategy to defeat the condition.”
- 24% of UK workers are active for less than an hour per day-
- Tradespeople are active for 7 hours and burn 2,500 calories, on average-
TRADESPEOPLE are the healthiest workers in the UK, according to new research.
The survey of 2,014 UK adults by IronmongeryDirect revealed that those working in the trades such as, plumbing, construction, and electrical installation are the healthiest workers in the UK.
Due to the nature of their job, a tradesperson is active for up to 7 hours per day, burning up to 2,500 calories – more than any other type of worker.
Health and fitness professionals such as personal trainers are the second healthiest workers in the UK, and are physically mobile for 5 hours per day.
Unsurprisingly those working in offices are the most sedentary, with marketing, information and communications, and call centre workers all failing to be active for an hour per day, burning less than 300 calories through work related activity.
However, almost one in five (19%) UK workers ‘top up’ their activity levels with a weekly gym session.
More than half (51%) blame work pressures for their lack of activity, stating stress and busy schedules.
Office-based workers were also more likely to succumb to sugary treats, with 23% admitting to a daily indulgence, as sweets and biscuits are passed around.
Wayne Lysaght-Mason, managing director of IronmongeryDirect said: “Incorporating elements of a healthy lifestyle into your working day is essential. A balanced diet, regular breaks from your desk, tools or computer screen, fresh air, and moderate exercise are important.
“Those with active jobs should ensure they are getting the correct levels of calories to avoid running out of fuel during busy days, while those with lower activity levels should also be conscious of what they eat.”
For more information, please visit: www.IronmongeryDirect.co.uk
Top Five Healthiest Jobs
1. Trades (construction, plumbing) – 7 hours of activity per day
2. Health and fitness – 5 hours of activity per day
3. Agriculture – 4.5 hours of activity per day
4. Retail – 3.5 hours of activity per day
5. Manufacturing – 3 hours of activity per day
Top Five Unhealthiest Jobs
1. Information and communication – 0.4 hours of activity per day
2. Marketing – 0.6 hours of activity per day
3. Professional service (law accountancy) – 0.7 hours of activity per day
4. Utilities – 1 hour of activity per day
5. Government – 1.4 hours of activity per day
*Macmillan Cancer Support launches joint campaign with the building and construction sector aimed at providing support to men who need it*
20% of men with cancer experienced a loss of masculinity while going through treatment
- 25% of men with cancer who are in a relationship and rarely or never talk to their spouse about their feelings in relation to their cancer say this is because they want them to think they can “handle it”
- 17% of men with cancer say they feel like “less of a man” since diagnosis
New research, released today by Macmillan Cancer Support, reveals that one in five men (20%) with cancer experienced a loss of masculinity while going through their treatment[i] – the equivalent to an estimated 180,000 men in the UK[ii], and around one in six (17%) say they feel like less of a man since they were diagnosed. To combat these, and other issues around male cancer, Macmillan is launching a campaign with the building and construction industry, bringing cancer support to men from the sector.
Macmillan say that talking is an important part of dealing with cancer, yet around half of men with cancer who are in a relationship (49%) rarely or never talk to their partner about their feelings or emotions in relation to cancer. Of these men, a quarter (25%) say this is because “they want them to think they can handle it”. A similar number (23%) say they keep their concerns private from their spouse or partner because “they don’t want to become someone who is pitied.”
The new research, conducted by YouGov and including more than 800 men with cancer, also suggests that many men with cancer are facing an emotional burden following their diagnosis, with almost half (49%) of men surveyed reporting anxiety while they were going through treatment, and one in four (25%) experiencing feelings of depression.
The research also reveals that many men still feel pressured to fulfil traditional ‘male’ roles at work and at home. For men, factors such as being able to provide for their family (49% of men with cancer said this was important to their identity as a man before their diagnosis), physical strength (34%) and having a successful career (33%), were important aspects of their identity, prior to a cancer diagnosis. Something that a cancer diagnosis can take away either temporarily, or permanently.
A second survey conducted by Toluna UK, of 536 men from the building and construction industry reveals that almost two in five men (38%) from the sector who report being in good health believe that as a man it is important to keep emotions in check so others view them as strong[iii]. This survey also reveals that almost one in five men (18%) who work in the industry and have a serious illness such as cancer, feel like less of a man since being diagnosed.
Antoine Henningham, 39, is showroom Manager at Benchmarx Kitchens & Joinery in London and was diagnosed with bowel cancer in 2007. He says: “When I was diagnosed, I just shut down. I was fortunate to have my Aunt there because when I heard the ‘C’ word I took nothing in. While I was going through treatment I saw myself as vulnerable and my physical appearance deteriorated, and I wasn’t as open as I should have been because I thought people would view me differently, and treat me differently, but they didn’t. Lots of people have been through cancer and are accepting. It helps to talk and my family helped me stay positive and it was nice to have people to bounce stuff off. Macmillan were really helpful emotionally and financially, they helped me understand cancer and my situation, and appreciate what I was going through.”
Today, Macmillan Cancer Support is calling on men to seek the support they need. Senior Macmillan Information Nurse John Newlands says, “Cancer can affect men in ways they didn’t expect, like a loss of masculinity and the feeling that you are losing who you are, but a life with cancer is still a life. By 2020, almost one in two people will get cancer at some point in their lives, and with more and more people living longer after cancer, we want people to have a better understanding of the reality of cancer diagnosis and to find the support they need.”
Because we know many men don’t want to talk about their health, Macmillan Cancer Support is starting the conversation by bringing together six of its partners from the construction sector: Benchmarx Kitchens & Joinery, ISG Plc, Selco Builders Warehouse, Topps Tiles, Travis Perkins, and Wolseley UK, to form the ‘Construction Cancer Coalition’. Through this campaign, Macmillan hopes to reach and empower men from the sector and beyond to take control of their health and seek the support they need.
For more information about the campaign and the support services Macmillan Cancer Support is offering, visit www.macmillan.org.uk/saytheword
In the final keynote address of day one at Confed17, Niall Dickson offered his reflections on current challenges facing members, and called for the new UK parliament to take the opportunity to ‘reset the clock,’ and have a national conversation to consider what can be achieved in the months and years ahead.
Acknowledging the response to the terror attacks in London and Manchester and today’s devastating fire in West London, Niall praised the remarkable things being achieved by the NHS.
He highlighted that the NHS has continued to provide good care to millions of people, despite record highs in demand and record lows in funding growth, but strains are also evident.
In terms of current political uncertainty, Niall suggested that constraints of parliamentary numbers may in fact present an opportunity. He called for the government to take the chance to work differently, finding areas of common agreement on the issues that matter most to the public, which last week’s general election showed to be health and social care.
Start fixing the ship
A national conversation, which recognises the scale of the coming challenge, is urgently needed to agree a vision for the future of health and care services, said Niall.
“Our message to the politicians is that when it comes to the NHS, we have to stop launching life rafts and start fixing the ship,” and he stated these fixes come in three challenges: Money, transformation and workforce.
“We need clarity on funding, we need political courage on transformation and a new approach on securing and supporting our workforce,” he said.
United and unambiguous
Rallying support from the audience and Confed members, he summarised: “In these uncertain times, more than ever, we need to be united and unambiguous – clear what our offer is to the British people and what we need to deliver it. Some of this will be uncomfortable and we must be honest about what can and cannot be achieved and what is needed to bring about the transformation to which we are all committed.”
Stephen Dorrell, chairman of the NHS Confederation, gave the opening speech at Confed17 today and told the audience of more than 1,000 NHS leaders that a thorough review of long term demand patterns in health and care is needed. His speech follows.
“Wonderful professional care …. on a daily basis”.
The words of Alex on the film you have just seen.
Alex expressed far more eloquently than I ever could the reason why we are here.
We shall talk about challenges and targets and budgets and deficits, but we do ourselves and our patients a great disservice if we allow those important but secondary concerns to cloud or obscure the central fact of our health and care system, which is that it provides to those who need it “wonderful professional care …. on a daily basis”.
So before we degenerate into management speak, let us begin by saluting those who have chosen to devote their lives to providing care and support to their fellow human beings.
I think of the young nurse who has accepted the personal responsibility of dealing with her contemporary who suffers from an eating disorder; I think of the healthcare assistant who has accepted the personal responsibility of caring for the elderly man who was once a sporting hero, but now suffers from advanced dementia; and I think of the doctor who has to break the news to the young couple that their newly born baby will never enjoy the life chances we all want for ourselves and our families.
In the aftermath of the terrorist attacks in Manchester and London, I also think of the staff who were doing a routine A&E shift, and were presented without warning with young people who had been on a night out and found themselves in a battle zone. I think of the staff who were themselves off duty on those nights but who saw what was happening and ran not away from but towards the danger; and I think particularly in that connection of Kirsty Boden, the off duty nurse from Guy’s hospital whose selfless courage cost her her life.
The extraordinary thing about these examples is precisely that they are not extraordinary – they are the daily practice of those who work in the health and care system; their commitment is an inspiration and we should never ever allow ourselves to take it for granted.
There is also something else that we should not take for granted.
Each clinician takes personal responsibility for the care they provide; but they are part of a team, and the effectiveness of the team depends on both its clinical and non-clinical members. The hospital Chief Executive, the practice manager, together with the porters, the estates staff, the catering and administrative staff, as well as those who working in the management hierarchy, are all part of the team which delivers healthcare.
So, as we open our conference, we must be clear that healthcare is a people business.
It must be more than an incantation. We must mean it.
At the most basic level we need to ensure that we have enough people, and that they have access to the right skills and personal development.
We need to ensure that our workforce reflects the diversity of the society that it serves – which is why the Confederation is a strong supporter of Yvonne Coghill’s work in promoting the NHS Workforce Racial Equality Standard.
We need to ensure that the NHS continues to be part, as it always has been, of the global health community and continues to recruit in and contribute to the global health talent pool. We do that both because it is a way of meeting specific workforce requirements, and because we know that our patients benefit when we ensure that our version of best practice reflects experience elsewhere in the world.
We need to ensure that our people work in a culture which empowers and motivates them. Too often our organizations and structures feel like obstacles to great care; we must ensure they are redesigned when necessary to make it easy for our staff to do the right thing.
And, critically, we need to ensure that our staff are fairly rewarded for the commitment they make. We all know that financial resources are stretched, but we cannot expect to benefit from the continued commitment of our staff if they feel that public sector pay policy offers them no reasonable prospect of meeting their private needs and aspirations.
Which brings me neatly to the role of the NHS Confederation.
It is not an accident that NHS Employers, as part of the Confed, organized the workforce summit yesterday – so that our meeting this week opened with a focus on workforce issues. We all know that unless we address those issues our fine words will be just that – fine words.
As Shakespeare put it “a tale, told by an idiot, full of sound and fury, signifying nothing”.
It is the role of the Confed to ensure that the tale is heard – and acted on.
It was heard and acted on last autumn when we spoke up about the urgent need to respond to the issues facing social care.
We welcomed the steps taken before the election to address the short term needs of the sector, and most particularly we welcomed the commitment to a longer term review of social care funding options.
The election debate highlighted the complexity of issue, but Pandora’s box is open and cannot be closed.
Nor can it be confined to considering funding options purely for social care. At the beginning of the election campaign the Confederation set out our view of the priorities which would face the incoming government.
The parliamentary arithmetic changes none of that.
Most fundamentally it does not change the need to undertake a thorough review of long term demand patterns in health and care – and the associated resource implications.
I well understand the pressures which ministers face, particularly in a difficult parliamentary situation. I have the T shirt.
But real life will not wait; we all know that demand pressures within the system are building and it is a key part of the role of the Confederation to ensure that uncomfortable facts are understood and acted on.
It is also not just a matter of resources.
We know that part of the answer lies in the need to develop better structures which allow the NHS to become more integrated into the full range of local public services.
We need to build on the work done by STPs and local authorities which offers the prospect of more joined up services which reflect local needs.
At a time when Whitehall will continue to be distracted by other priorities, we are beginning to see new partnerships with local government in which people are willing to make decisions which our traditional structures find difficult. We need to build on those partnerships, and implement solutions which work.
The Confederation will continue to facilitate these developments. It is where the breadth of our membership and networks give us a unique opportunity.
We bring together the whole range of the health and care system – the NHS provider community; NHS Commissioners, NHS Primary Care together with Public Health, Local Government, the ambulance service, and the independent sector.
None of us can any longer work in isolation; it is time for all of us to smell the coffee and change the way we work.
The key for us is to engage with members. That means we bring members together to learn from each other, and we provide external stimulus to ensure that it does not become a closed conversation. It also means we ensure that the results of those conversations are shared with decision makers, in private when appropriate and in public when necessary.
As the UK moves into negotiations with the EU, a new alliance has been formed to safeguard the interests of patients and the healthcare and research they rely on.
The Brexit Health Alliance brings together the NHS, medical research, industry, patients and public health organisations. It will be co-chaired by Sir Hugh Taylor, the former permanent secretary of the Department of Health, and Niall Dickson, the Chief Executive of the NHS Confederation.
The Alliance will seek to make sure that issues such as healthcare research, access to technologies and treatment of patients are given the prominence and attention they deserve in the Brexit negotiations.
The Alliance will argue that it is in both Europe and the UK’s interests to maintain co-operation in research and in handling public health issues.
It will also call on the UK government to make sure there is a commitment to medical research and providing alternative funding, and that UK citizens’ right to receive healthcare in EU countries is preserved.
The Alliance’s co-chair, Sir Hugh Taylor, said:
“We wish to support the government to achieve the best result for patients and for healthcare across the UK.
“We hope that the combined expertise and insight of the alliance will prove useful in helping to secure this.
“Our aim will be to ensure a strong focus on health as Brexit approaches, and that we offer views from across the health sector to negotiators to ensure that patient care and the population’s health and wellbeing will be protected as we leave the EU.”
Niall Dickson added:
“There is a risk that healthcare will become forgotten alongside the vast number of issues that the negotiators will have to address.
“It is vital we protect world leading research, that patients have access to medicines when they need them and that co-operation between the UK and Europe continues to protect all our citizens.
“These vital issues will have a profound impact on the future health and wellbeing of patients both here and in Europe.”
Brexit Health Alliance founding members:
• NHS Confederation – Co-chair of alliance
• Welsh NHS Confederation
• Northern Ireland Confederation (NICON)
• Association of UK University Hospitals (AUKUH)
• Academy of Medical Royal Colleges (AOMRC)
• NHS Providers
• National Voices
• Association of the British Pharmaceutical Industry (ABPI)
• Association of British Healthcare Industries (ABHI)
• The Richmond Group of Charities
• BioIndustry Association (BIA)
• Faculty of Public Health (FPH)
• Association of Medical Research Charities – (AMRC)
• Scottish NHS Chief Executive Group