PURPOSE: The purpose of this study was to evaluate clinical and economic outcomes during the first year following ostomy formation. DESIGN: Single-center retrospective audit. SUBJECTS AND SETTING: The sample comprised 200 patients who underwent surgery leading to ileostomy or colostomy at a large English National Health Service (NHS) Trust. METHODS: Clinical complications, medicine prescriptions, and interactions with healthcare services were reported over 12 months postsurgery, and interactions with the NHS were matched to the closest NHS unit cost to determine mean patient cost. RESULTS: The most common ostomy-related surgical site complications were high output (35.0%; n = 70), followed by moderate/severe peristomal skin complications (24.5%; n = 49) and bleeding (23.5%; n = 47). Ostomy management–related complications included general difficulties with ostomy management (50.0%; n = 100) and leakage-related mild peristomal skin issues (48.5%; n = 97). Clinical complication rates were highest in the first quarter following ostomy formation, except parastomal hernia, which increased in incidence over time. Ileostomy patients more frequently experienced high output, acute renal failure, and ostomy management–related complications and had increased length of inpatient admission. However, healthcare resource use was high in both groups, with a median of 13 inpatient admission days and 12 outpatient contacts overall within the first year. Mean cost per patient was £20,444.60 (US $26,018.41); 90.5% of these costs were attributed to ostomy-related factors. CONCLUSIONS: Patients are likely to experience at least one clinical complication following intestinal ostomy formation and have multiple interactions with the NHS. While a number of complications are more frequent in patients with ileostomies, both groups experienced considerable costs within the first year following surgery associated with ostomy management and recovery.

Vaccine hesitancy does not only concern human vaccines but incorporates One Health policies also; including vaccination of cattle and badgers as part of the government’s bovine tuberculosis eradication strategy for England. Both digital and social media can propagate healthcare misinformation and thus affect vaccine policy support. The use of social media monitoring to understand real-time public perceptions of One Health policies is crucial to identify misinformation and address public concerns appropriately to achieve successful policy implementation. Digital and social media data surrounding two government announcements regarding the bovine tuberculosis eradication strategy for England were collected and screened using the Meltwater media monitoring platform. Communication patterns were studied using InfraNodus. Twitter analysis was conducted to identify key influencers, public engagement, and trending communications. Online social media activity increased rapidly after each announcement. Initially, badger culling took primary public concern and major influencers were identified. Cattle vaccination dominated discussion after the second announcement, with public perception being influenced by increased online activity from news sites, animal welfare charities, governmental bodies, and medical professionals. The greatest ambiguity towards the strategy was detected within farming communities, with the main disparity existing between cattle vaccination and badger culling opinions. Social media monitoring has potential use in surveying public perception of government policy, both prior to, and after implementation to identify and address areas of miscommunication and misinformation to improve public support for One Health policies.

Elective surgical hubs at acute hospital trusts in England aim to increase productivity and efficiency in planned (elective) surgeries, reduce cancellations, and improve patient and staff experiences by ring-fencing care and focussing on High-Volume, Low Complexity (HVLC) surgeries. Using patient-level hospital data from April 2018 to December 2022, we evaluated the impact of new hubs (operational from 2019 onwards) and established hubs (operational before 2019) on trust-wide rates of total and HVLC elective surgeries using a generalised synthetic control methodology. Here, we show that during the first year of operation, the average rate of HVLC elective surgery in trusts with new hubs was 21.9% (95% CI 11.7%, 32.2%) higher than expected. After the COVID-19 pandemic, trusts with established hubs demonstrated greater resilience, with 11.2% higher than expected rates of total (1.3% to 21.2%) and HVLC (1.7% to 20.7%) elective surgery and 0.17 days (0.28 to 0.061) shorter than expected inpatient lengths of hospital stay. Our evaluation provides robust evidence to inform future priorities for elective care delivery.

Background: Patient experience is a key indicator of healthcare quality. Access to general practice (GP) has shifted with increasing use of digital tools for contacting practices and more remote consultations. These changes may improve patient experience, but unequally across sociodemographic groups. This study examines how patient experience of GP varies by access mode and sociodemographic characteristics. Methods: Retrospective cross-sectional analysis of 759 149 responses from the 2023 GP Patient Survey in England. Mixed-effects logistic regression was used to examine associations between patient experience outcomes—appointment booking and healthcare professional communication—and access modes (online, telephone, in-person), adjusting for sociodemographic factors and practice-level clustering. Results: Online-only appointment booking methods were associated with a better experience of making an appointment (OR=1.14, 95% CI 1.11 to 1.17; p<0.001) than traditional booking methods. All patient groups, except older adults and those not reporting male or female gender identities, reported better experiences with online-only appointment booking. Inequalities narrowed by age and ethnicity, with greater improvements for younger, Asian and mixed ethnicity patients, but widened for gender as non-binary and other identities reported poorer experiences. Remote consultations were associated with a poorer experience of healthcare professional communication (OR=0.52, 95% CI 0.51 to 0.52; p<0.001) compared with face-to-face. This trend was consistent across all groups, with differences between most and least positive groups reducing for gender but remaining similar for deprivation, ethnicity and age. Implications: Digital tools are associated with more positive experiences when contacting GP and may help reduce sociodemographic disparities, especially among groups who traditionally report poorer experience. Conversely, remote consultations are associated with worse experiences of healthcare professional communication. These patterns highlight the need for tailored approaches that offer choice across access modes, considering clinical need, urgency and patient preferences. Training for healthcare professionals should include remote communication skills. These insights can inform policies and service design aimed at modernising primary care while promoting equity.