NHS, defence, education and more in focus for voters in government's Spending Review
Chancellor Rachel Reeves is facing more difficult choices in the Spending Review on Wednesday.She will sets the budgets for all government departments over the next few years.The review will confirm how much taxpayers' money will be spent on the NHS, defence, police, education and other public services used by millions, as well as how much money the government plans to invest in projects like new public transport.As she makes her final preparations, people living in Cleckheaton in West Yorkshire outlined what they think her priority should be.
'The NHS is on its knees'
Melissa Marley, 32, has spent the last two years studying at the University of Huddersfield to become a midwife but has quit her course after amassing debt of £60,000 and said there was "no hope for jobs at the end of it".The mother-of-three would like the chancellor to put more money into the NHS because it is "on its knees" and added "people abroad would kill for a system like that, so it needs protecting". Originally from Wakefield, she went back into education in 2021 to provide a better life for her children.She began training as a nurse in 2022 before training as a midwife in 2023.As well as £20,000 of tuition fees, she also owes about £40,000 in her maintenance grant accrued through her studies over the past few years.She was originally going to defer due to health issues but decided to stop her course and is now hoping to become a maternity support worker.This role supports midwives, rather than being a midwife herself.Melissa said the lack of jobs in midwifery was "sad because there are so many people putting so much work in. "They are working hard, having to miss times with their family, their children and then to have nothing at the end of it is sad".
'A less stable world'
Pensioner John Addison agreed that a big part of the Spending Review had to be more funding for the NHS .He said that it was "hard work getting appointments".Mr Addison expressed his concern about spending on defence - and how more money was needed for that. He explained that he worried about the future for his grandchildren and younger people growing up in a less stable world.He said that the Army had "been run down lately so we need to up it a bit because you never know what is around the corner with what's going off in the world." Earlier this month, a British defence review published recommendations which welcomed the government's ambition to spend 3% of Gross Domestic Product by 2034 but warned "as we live in more turbulent times it may be necessary to go faster."Several Nato allies have already committed to spending more than 5%.
School buildings 'in a terrible state'
Bill and Pauline Wardlaw would like to see funds focused on the education system and investing in the future. Bill was particularly concerned about problems with school buildings.He said they were in "a terrible state" which meant "children are going to school in inadequate buildings and a lot of money should be spent getting them up to a decent standard".Pauline agreed with her husband but would also money spent on ensuring infrastructure around new housing estates is in place. She said when new housing is built "they need to make sure there is provision for the people that they are going to put in those houses - like doctors, education, schools etc because it is just not there".Ms Wardlaw was also frustrated with trying to get a GP appointment: "It's three weeks before you can see a doctor unless you ring up at 08:00 and then you are in a queue."
'Support for mums is needed'
Beth Flannagan-Jones was out with her 16 month old daughter Maeve.She wanted to see more cash targeted at activities and support groups for mothers and babies. She said toddler groups could help mums who felt "alone".Ms Flannagan-Jones said there were "a couple of options but many of them are private and you have to pay for them"."If you have not got a lot of money and are on a budget I think a few more council groups and mum groups are missing," she added.
'Green investments need oversight'
Pensioner David Lumb acknowledged the cuts to winter fuel allowance had been damaging to Labour party as some older people relied on the payment. He backed a more targeted approach to the benefit - which seemed to chime with the chancellor.She announced on Monday changes to the level the benefit would be paid at, meaning 75% of pensioners would now be eligible. His biggest priority was the NHS citing "the way the nation relied" on the service during the pandemic. However, Mr Lumb said he would also like to see more investment in green initiatives, but when it comes to home insulation he said it depended on "how efficiently it is done". "Quite often the government sponsor these things and they aren't properly monitored," he added.
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BBC News
an hour ago
- BBC News
TB: India brought forward its tuberculosis elimination deadline - but can it meet it?
Atul Kumar (name changed) anxiously paced the corridor of a public hospital in India's capital Delhi.A small-appliance mechanic, he was struggling to secure medicines for his 26-year-old daughter who suffers from drug-resistant tuberculosis (TB). Mr Kumar said his daughter needed 22 tablets of Monopas, an antibiotic used for treating TB, every day. "In the past 18 months, I haven't received government-supplied medicine for even two full months," he told BBC Hindi in January, months before India's declared deadline to eliminate the infectious to buy costly drugs from private pharmacies, Mr Kumar was drowning in debt. A week's supply cost 1,400 rupees ($16; £12), more than half his weekly income. After the BBC raised the issue, authorities supplied the medicines Mr Kumar's daughter needed. Federal Health Secretary Punya Salila Srivastava said that the government usually acts quickly to fix medicine access issues when Kumar's daughter is one of millions of Indians suffering from tuberculosis, a bacterial disease that infects the lungs and is spread when the infected person coughs or home to 27% of the world's tuberculosis cases, sees two TB-related deaths every three minutes. India's TB burden has long been tied to poor case detection, underfunding and erratic drug this grim reality, the country has set an ambitious goal. It aims to eliminate TB by the end of 2025, five years ahead of the global target set by the World Health Organization (WHO) and United Nations member as defined by the WHO, means cutting new TB cases by 80% and deaths by 90% compared with 2015 visits to TB centres in Delhi and the eastern state of Odisha revealed troubling gaps in the government's TB Odisha's Khordha district, around 30km (18.6 miles) from state capital Bhubaneshwar, 32-year-old day-labourer Kanhucharan Sahu is struggling to continue his two-year-old daughter's TB treatment, with government medicines unavailable for three months and private ones costing 1,500 rupees a month - an unbearable burden."We can't see her suffer anymore," he says, his voice breaking. "We even thought of abandoning her."At Odisha's local TB office, officials promised to review Sahu's case, but a staffer admitted, "We rarely get the medicines we need, so we ration them." Mr Sahu says he hasn't received the promised 1,000 rupees monthly support from the federal government and at the local TB office, officials admit to chronic shortages, leaving families like his adrift in a failing Routray, who runs the patient support group Sahyog, says medicine shortages are now routine, with government outlets often running dry. "How can we talk about ending TB with such gaps?" she are other hurdles too - for example, changing treatment centres involves navigating complex bureaucracy, a barrier that often leads to missed doses and incomplete care. This poses a major hurdle for India's vast population of migrant a hospital near Khordha, 50-year-old Babu Nayak, a sweeper who was diagnosed with TB in 2023, struggles to continue his treatment. He was regularly forced to travel 100km to his village for medicines as officials insisted he collect them from the original centre where he was diagnosed and first treated. "It became too difficult," he to travel so often, Mr Nayak stopped taking the medication altogether."It was a mistake," he admitted, after contracting TB again last year and being his hospital, no TB specialist was available, highlighting another critical gap in India's fight: a shortage of frontline health BBC shared its findings with the federal health ministry and officials in charge of the TB programme in Delhi and Odisha. There was no response despite repeated reminders.A 2023 parliamentary report showed there were many vacant roles across all levels of the TB programme, affecting diagnosis, treatment and follow-up - especially in rural and underserved vaccines help India triumph over tuberculosis?In 2018, when Prime Minister Narendra Modi brought forward India's TB elimination target to 2025, he cited the government's intensified efforts as a reason for optimism. Two years later, the Covid pandemic disrupted TB elimination efforts globally, delaying diagnosis, diverting resources and pausing routine services. Medicine shortages, staff constraints and weakened patient monitoring have further widened the gap between ambition and these challenges, India has made some the past decade, the country has reduced its tuberculosis-related mortality. Between 2015 and 2023, TB deaths declined from 28 to 22 per 100,000 people. This figure, however, is still high when compared with the global average which stands at number of reported cases has gone up, which the government credits to its targeted outreach and screening programmes. In 2024, India recorded 2.6 million TB cases, up from 2.5 million in 2023. Federal Health Minister JP Nadda recently touted innovations like handheld X-ray devices as game-changers in expanding testing. But on the ground, the picture is less optimistic."I still see some patients come to me with reports of sputum (phlegm) smear microscopy for TB, a test which has a much lower detection rate as compared to genetic tests," says Dr Lancelot Pinto, a Mumbai-based tests, which includes RT-PCR machines - widely used to diagnose HIV, influenza and most recently, Covid-19 - and Nucleic Acid Amplification Testing, also examine the sputum sample but with greater sensitivity and in a shorter the tests can reveal whether the TB strain is drug-resistant or sensitive, something that microscopic testing can't do, Dr Pinto gap, he adds, stems not just from lack of awareness but from limited access to modern tests."Genetic testing is free at government hospitals but not uniformly available, with only a few states being able to provide it."In May, Modi led a high-level review of India's TB elimination programme, reaffirming the country's commitment to defeating the the official statement notably skipped mention of the 2025 deadline. Instead, it highlighted community-driven strategies - better sanitation, nutrition and social support for TB-affected families - as key to the government has also prioritised better diagnosis, treatment and prevention at the core of its elimination approach mirrors the WHO's view of TB as a "disease of poverty". In its 2024 report, WHO chief Tedros Adhanom Ghebreyesus called it "the definitive disease of deprivation", noting how poverty, malnutrition and treatment costs trap patients in a vicious cycle. As India pushes toward its goal of eliminating the disease, deep health and social inequalities remain just six months left until India's self-imposed deadline, new complications have fallout from US President Donald Trump's withdrawal from the WHO and suspension of USAID operations has raised concerns about future funding for global TB efforts. Since 1998, USAID has invested more than $140m to help diagnose and treat TB patients in India. However, India's federal health secretary insists there is "no budgetary problem" hope lies on the horizon. Sixteen TB vaccine candidates are currently in development across the world, with the WHO projecting potential availability within five years, pending successful trials.
The Guardian
an hour ago
- The Guardian
UnitedHealth faces federal scrutiny into whistleblower claims
US lawmakers on both sides of the aisle are raising concerns and seeking investigations in the wake of Guardian reporting on whistleblower claims about practices within UnitedHealth Group's nursing home partnership programs. One US senator has announced he is launching an investigation and two US representatives are now calling on the US Department of Justice to expand its reported investigations of the nation's largest healthcare conglomerate. Others said they are troubled by whistleblower allegations reported by the Guardian – including claims that UnitedHealth paid bonuses to nursing homes to help reduce residents' hospital transfers and used improper sales tactics to get nursing home residents to sign up for the company's Medicare Advantage plans. Two Democratic members of Congress – representatives Alexandria Ocasio-Cortez of New York and Lloyd Doggett of Texas – filed a letter on Monday that urges the Department of Justice to 'thoroughly review new revelations from investigative reporting and whistleblower complaints, which suggest that UnitedHealth may have engaged in illegal activities'. 'The Guardian's findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth,' the letter read. The lawmakers are demanding a briefing on current and planned investigations by 14 July. UnitedHealth vigorously denies the whistleblowers' allegations and says the Guardian's reporting on these issues is 'blatantly false and misleading'. In response to a question about the two representatives' letter, the company said the Department of Justice 'has already declined to pursue the matter' – a reference to the agency's previous decisions not to intervene in two whistleblower lawsuits against UnitedHealth filed under the US False Claims Act. One of those lawsuits was ultimately dropped and the other is pending in federal court in Georgia. Another Democrat, the Oregon senator Ron Wyden, announced last month on X that his office was 'launching a full investigation to verify these whistleblower accounts'. 'This reporting demands further inquiry – nobody deserves to have their medical care jeopardized to pad insurance company profits,' Wyden, the ranking member of the Senate's finance committee, said. 'My staff on the Finance Committee have a decade-long record of thorough and objective investigations that follow the facts towards solutions that improve federal health care policy for all Americans.' Senator Josh Hawley, a Missouri Republican who sits on the Senate investigations subcommittee, said it is 'alarming to hear these serious allegations' about the company's practices. 'I look forward to securing justice for patients, policyholders and whistleblowers alike who've been harmed by insurance companies.' Another Republican, Georgia representative Buddy Carter, expressed similar concerns. 'If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients,' Carter, chair of the House subcommittee on health, said in a statement. 'Patients should always come before profits.' Senator Richard Blumenthal of Connecticut, ranking member of the Senate investigations subcommittee, said the 'courage and conviction' of the whistleblowers will serve as 'an impetus for reform. Shining a light on abuses of consumer trust is a call to action – and a demand for accountability.' UnitedHealth says its partnerships with nursing homes ensure better care for seniors 'through on-site clinical care, personalized treatment plans, and enhanced coordination among caregivers'. The company says these arrangements have been highly successful in helping nursing homes prevent unnecessary hospital stays that can lead to serious issues such as delirium, falls, pressure injuries and 'sometimes even fatal consequences'. Two whistleblowers who worked for UnitedHealth as nurse practitioners submitted sworn declarations in May alleging that the company had used improper tactics to reduce hospital transfers for ailing nursing home residents. Their declarations were submitted to the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), the Washington state attorney general's office and Congress, according to Whistleblower Aid, the non-profit assisting both nurse practitioners. Whistleblower Maxwell Ollivant's declaration, first reported on by the Guardian in May, says he witnessed UnitedHealth 'delay and deny medically necessary emergency care' to vulnerable nursing home residents in order to 'retain more money' from the payments that the company was receiving from the US government's Medicare Advantage program. Under Medicare Advantage, a private alternative to traditional Medicare, the federal government pays insurers a fixed sum to cover seniors' medical services. The less insurers spend on covering medical expenses, the more in public dollars they have left over. Ollivant's declaration alleges that UnitedHealth 'actively avoided medically necessary hospitalizations – hospitalizations in serious life-threatening situations, or situations to avoid imminent death or incredibly catastrophic results – to keep their costs down, and drove vulnerable patients toward signing Do Not Resuscitate (DNRs) and Do Not Hospitalize orders to avoid providing hospital services for life threatening illnesses'. UnitedHealth noted that the Department of Justice declined to join the lawsuit that Ollivant filed against the company and later dropped. The company said Ollivant 'is not in a position to assess the effectiveness of our programs – he lacks both the necessary data and the expertise'. The second whistleblower, whose declaration was filed anonymously, worked with UnitedHealth for several years. Her declaration says her experiences as a nurse practitioner within its nursing home programs gave her 'first-hand insight into the evolution and impact of substandard care practices resulting from the training, culture, processes and bonus system of delays and denials of medically necessary care'. That declaration criticizes the company's '[a]ggressive [p]ush for DNRs' and says 'the decision to receive life-saving care should rest with the patient or their legal representative, not myself, and certainly not the insurance company'. UnitedHealth said the allegations in the anonymous whistleblower's declaration show she 'did not fully understand our clinical model' and that her perspective 'does not reflect the dedication and excellence of the many outstanding clinicians who understand the impact they have in supporting their patients and improving health outcomes'. The company also denies the claims regarding DNRs. 'At no time have we encouraged or pushed' nursing home residents 'to sign a DNR directive', a UnitedHealth representative said. 'Our health care providers are ethically bound to respect patient autonomy and support informed decision-making without coercion.' The Guardian's previous reporting also references allegations relating to the legal claims of a third whistleblower, Brook Gonite, a former salesperson for UnitedHealth's nursing home program. Gonite alleges in a lawsuit in federal court in Georgia that UnitedHealth wrongly solicited and enrolled vulnerable, elderly patients for its nursing home programs through improper marketing tactics, including violations of Hipaa, the federal medical privacy act, and paid kickbacks to nursing homes to obtain illegal referrals of their residents. UnitedHealth denied those allegations and moved to dismiss Gonite's lawsuit. The Department of Justice, which declined to formally intervene in the case, opposed UnitedHealth's motion to dismiss. In April, federal judge Marc Treadwell denied UnitedHealth's motion to dismiss, finding that Gonite's lawsuit puts forth 'substantial and concerning' factual allegations that 'plausibly' assert violations of federal protections meant to ensure vulnerable nursing home residents can make informed decisions about their medical care. The company continues to deny those claims and says Gonite was fired for engaging in illegal sales tactics similar to those alleged in his suit. In a statement, the company said its employees 'are trained on compliant interactions with nursing home staff and nursing home residents, in accordance with the Medicare Marketing Guidelines and other applicable laws'. Last week, shortly before the Guardian was to publish a second story providing additional detail about Gonite's pending lawsuit and the other two whistleblowers' declarations, UnitedHealth filed a lawsuit against the Guardian in Delaware state court, claiming the allegations were false and libelous. In a statement, the company said 'the article published by The Guardian is not only riddled with inaccuracies – it is so blatantly false and misleading that we have filed a defamation lawsuit to hold the publication accountable and bring the full truth to light'. The Guardian has said it stands by its 'deeply sourced, independent reporting, which is based on thousands of corporate and patient records, publicly filed lawsuits, declarations submitted to federal and state agencies, and interviews with more than 20 current and former UnitedHealth employees – as well as statements and information provided by UnitedHealth itself over several weeks'.
Telegraph
an hour ago
- Telegraph
Royal College of Pathologists comes out against assisted dying
The Royal College of Pathologists, which represents medical examiners, has come out against assisted dying. It said it could not support Kim Leadbeater 's Terminally Ill Adults (End of Life) Bill because of the role that it was expected to play in the assisted dying process. Under the Bill, assisted deaths will not be automatically referred to a coroner, which is usual practice for potentially unnatural deaths and when a drug, authorised or otherwise, brings about death. This will mean that it is for medical examiners to scrutinise assisted deaths. The professional body that represents them says that they are not qualified to do so and warn that a lack of resourcing means that medical examiners may be pulled away from other parts of their vital work. Ms Leadbeater on Tuesday defended not involving coroners in the process. She said there was 'no justification for putting the family and loved ones of the deceased through an unnecessary and potentially traumatic coroner's inquiry' because adequate safeguards were in place. It comes as the Bill returns to the Commons for a debate on Friday, and a vote on the legislation is expected next week. Dr Suzy Lishman, senior adviser on medical examiners for the Royal College of Pathologists, said that the college had no position on the 'ethical issues' of legalising assisted dying. In a statement, Dr Lishman said: 'The college's concerns relate only to the involvement of medical examiners after an assisted death has taken place. 'As part of their scrutiny, medical examiners would need to review the process leading up to the decision to authorise an assisted death and the circumstances of the assisted death, which they are not qualified to do. 'Notification to the coroner following an assisted death would ensure independent judicial review, which is particularly important given the concerns raised by many individuals, organisations and medical royal colleges about the lack of adequate safeguards in the Bill for vulnerable people. 'Lawyers, not doctors, are the most appropriate professionals to review these deaths. The medical examiner system was implemented to detect problems with medical care, not to identify discrepancies or malintent in the legal process required for assisted deaths.' Dr Lishman also raised concerns about the need of 'significant' training and resources needed for medical examiners to be able to perform the role in the process. She said that this would risk 'potentially taking medical examiners away from their current important role'. The Royal College of Pathologists concluded: 'Coronial referral for assisted deaths would be in line with current regulations, with all deaths due to a medical intervention or medicinal product being notified.' Last year, Thomas Teague KC, the former chief coroner for England and Wales from 2020-24, expressed concern about the lack of coroner involvement in the Bill. In a letter to The Telegraph, he wrote: 'Since the coroner's jurisdiction affords a powerful deterrent against misfeasance, the public may wonder why the Bill proposes to abandon such a robust safeguard.' A letter signed by around 1,000 doctors from across the NHS published this week said that the Bill is a 'real threat to both patients and the medical workforce'. They said: 'We are concerned that the private member's Bill process has not facilitated a balanced approach to the collection of evidence and input from key stakeholders including doctors, people with disabilities and other marginalised groups.' The Royal College of Pathologists is the latest royal college to come out against the legislation, after the Royal College of Psychiatrists voiced their opposition to the Bill last month. Ms Leadbeater said: 'The Bill does not prevent any assisted death being referred to a coroner, however this would not be required in the majority of cases. 'Coroners investigate deaths that have been reported to them if they think that the death was violent or unnatural, the cause of death is unknown, or the person died in prison or in custody. None of these would apply to a legal, assisted death under the terms of this Bill. 'Eligibility for an assisted death would have been assessed in advance by two independent doctors and a multi-disciplinary panel overseen by a commissioner who would be a High Court judge or retired judge. 'Each of these assessments would be subject to the extensive safeguards contained in the Bill to protect everybody, including the most vulnerable. 'Consequently, most cases would not require a judicial investigation after a person has died, and there would be no justification for putting the family and loved ones of the deceased through an unnecessary and potentially traumatic coroner's inquiry. 'However, in the event of any doubt at all, it would be open to a medical examiner, a family member or anybody with concerns to ask a coroner to investigate.'
