This editorial comments on the paper by Martin McBride and the UK REACH team (published in 2023) investigating financial concerns in UK healthcare workers and depressive symptoms. The research concludes that reporting future financial concerns at baseline increased the odds of depressive symptoms at follow-up around 18 months later. We discuss these findings in the context of the cost-of-living crisis and pay disputes within the NHS, important policy implications and directions for future research.

The fair allocation of scarce resources for health remains a salient topic in health care systems. Approaches for setting priorities in an equitable manner include technical ones based on health economic analyses, and ethical ones based on procedural justice. Knowledge on real-world factors that influence prioritisation at a local level, however, remains sparse. This article contributes to the empirical literature on priority-setting at the meso level by exploring how health care planners make decisions on which services to fund and to prioritise, and to what extent they consider principles of fair priority-setting. It presents the findings of an interview study with commissioners and stakeholders in South London between 2017 and 2018. Interviewees considered principles of fair prioritisation such as transparency and accountability important for offering guidance. However, the data show that in practice the adherence to principles is hampered by the difficulty of conceptualising and operationalising principles on the one hand, and the political realities in relation to reform processes on the other. To address this challenge, we apply insights from the policy and political sciences and propose a set of considerations by which current frameworks of priority-setting might be adapted to better incorporate issues of context and politics.

This commentary is a response to three articles on integrated care systems in this journal. It explores some aspects of the latest transformation of England's National Health Service (NHS) and raises some questions on the extent to which the proposed NHS Long Term Plan can deliver on the current challenges.

This article analyses the development of Italian health policies in the post-Second World War period. Shortly after the setting up of the ‘Beveridge model’ and the creation of the British National Health Service, Italy also introduced a new approach to health, which became part of the Constitution. However, the implementation of the necessary reforms was delayed due to resistance from the country's institutions and government parties. The introduction of a radical health reform became possible only in 1978 through pressure generated from social conflicts, trade unions and left-wing parties. The implementation of the National Health Service encountered a number of obstacles due to the specific conditions of Italy, but also owing to changes at the international level. The neoliberal policies started in the 1980s introduced restrictions in health spending, the regionalisation and privatisation of services, and a new selective approach to health. In spite of these limitations and contradictions, the Italian healthcare system has been considerably successful, leading to strong improvements in health and to a life expectancy at birth among the longest in Europe. The recent developments – and the experience of the pandemic – confirm the important impact of a public, universal health service and, at the same time, the persistent policy efforts aimed at weakening its reach.

Financial inclusion depends on providing adjusted services for citizens with disclosed vulnerabilities. At the same time, the financial industry needs to adhere to a strict regulatory framework, which is often in conflict with the desire for inclusive, adaptive, and privacy-preserving services. In this article we study how this tension impacts the deployment of privacy-sensitive technologies aimed at financial inclusion. We conduct a qualitative study with banking experts to understand their perspectives on service development for financial inclusion. We build and demonstrate a prototype solution based on open source decentralized identifiers and verifiable credentials software and report on feedback from the banking experts on this system. The technology is promising thanks to its selective disclosure of vulnerabilities to the full control of the individual. This supports GDPR requirements, but at the same time, there is a clear tension between introducing these technologies and fulfilling other regulatory requirements, particularly with respect to “Know Your Customer.” We consider the policy implications stemming from these tensions and provide guidelines for the further design of related technologies.

The present study elucidates the association of intrinsic sugars and free sugars (FS) from all relevant sources with all-cause mortality in the prospective UK Biobank cohort. Sugar intake was assessed in 186 811 UK Biobank participants who completed at least one web-based 24-h dietary recall (Oxford WebQ). Cox proportional hazard regression models for all-cause mortality were used with sugar intake from different sources included as penalised cubic splines to allow non-linear predictor effects. Over a mean follow-up of 12·3 years, 8576 (4·6 %) deaths occurred. FS but not intrinsic sugars were significantly and dose-dependently associated with hazard ratio (HR) for all-cause mortality. The association with all-cause mortality was significant and dose dependent for FS in beverages, but not in solids with the mean (CI) HR at 50 g/d v. 0 g/d consumption at 1·10, 95 % CI (1·07, 1·14) and 1·01, 95 % CI (0·98, 1·03), respectively. Within the beverages subcategories, a significant dose-dependent association with mortality was detected for FS in soda/fruit drinks and milk-based drinks whereas this relation was NS for FS in pure juice and tea/coffee. FS in four different subtypes of solids, i.e. treats, cereals, toppings and sauces, were not positively associated with all-cause mortality. Major findings were robust in sensitivity analyses. In conclusion, only some FS sources were associated with all-cause mortality. Interventions targeting FS subtypes might be most effective concerning mortality if focused on the reduction of soda/fruit drinks and milk-based sugary drinks; however, the present results need to be confirmed by independent studies.

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.

With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.

Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students’ achievement of the General Medical Council (GMC) Outcome for Graduates.

As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.

The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Service integration is a global trend aiming to create partnerships, cost-effectiveness and joined-up working across public and third sector services to support an ageing population. However, social policy research suggests that the policy making process behind integration and implementation is complex, contradictory and full of tension. This paper explores social policy integration at the ground-level of services in the health and housing sector within a new integrated model for housing for older people. The paper applies a critical Lipskian approach to show that housing can promote integration for both users and wider stakeholders. Front-line workers were central to service integration, often working to integration principles despite policy changes and uncertainty. Challenges of social policy integration include the gaps between policy and practice and the developing nature of interaction at the ground-level – most notably, the role of technology. Technology and digital health platforms could enhance service user and practitioner interactions at the ground-level. The paper calls for renewed focus on policy processes in relation to service integration and consideration of new forms of service user, practitioner and policy maker interaction.

During the COVID-19 lockdown the initial British Government mantra of ‘Stay home. Protect the NHS. Save lives’, the ritualistic weekly public clapping for the National Health Service (NHS) and the overall tone of the media coverage led several commentators to raise the question of whether the NHS had become a religion. This question is legally significant. The question of whether the lockdown breached Article 9 has already been the subject of litigation. R (on the application of Hussain) v Secretary of State for Health [2020] EWHC 1392 (Admin) concerned the then prohibition on private prayer in places of worship. Swift J refused an application for interim relief to allow Friday prayers at Barkerend Road Mosque. Lockdown did infringe the claimant's Article 9 rights but this interference was only with one aspect of religious observance and the interference had a finite duration. The legitimate difference of opinion between the claimant and the British Board of Scholars and Imams was relevant to the question of justification. There was no real prospect that the claimant would succeed at obtaining a permanent injunction at trial because the pandemic presented ‘truly exceptional circumstances’ that meant that the interference would be justified on grounds of public health. Swift J was satisfied that there was a sufficiently arguable case to grant permission to apply for judicial review but he did not order that the claim be expedited. In Dolan, Monks and AB v Secretary of State for Health [2020] EWHC 1786 (Admin), an application of a judicial review of the lockdown regulations and schools closure was refused. However, in relation to Article 9, Lewis J adjourned consideration of this discrete issue because regulations had just been made that allowed communal worship which may have made the argument academic. English law provides the right to manifest religion or belief under the Human Rights Act 1998 and the right not to be discriminated against on grounds of religion or belief in relation to employment and the provision of goods and services under the Equality Act 2010. This raises the point: during the lifting of lockdown, when authorities require people to go back to their workplace or send their children to school, could individuals who refuse say they were legally entitled to decline on the basis that such a requirement breached their belief in protecting the NHS?

The aim of the study was to assess the accuracy and readability of Internet prenatal nutrition advice. Between August and December 2018, 130 Internet pages returned from Google searches on foods to avoid, foods to eat and supplements use were compared with UK government advice for pregnant women. Readability was assessed using the Flesch Readability Ease (FRE) tool. Descriptive and non-parametric tests were used. Spearman’s correlation explored associations between accuracy and readability. Kruskal–Wallis tests with Bonferroni correction were used for multiple pairwise tests and Mann–Whitney U tests for two-sample differences in medians. A total of 130 Internet pages were examined: 48 % from publishers, 27 % from other commercial organisations, 22 % from charities and 3 % from governments. Eighty-three (64 %) pages contained inaccurate and accurate advice, twenty-three (18 %) were accurate and complete, twenty-one (16 %) were inaccurate, and three (2 %) lacked any relevant advice. The median percentage accuracy of all advice was 83 (lower quartile, upper quartile: 48, 100). Median FRE was 55 (46, 61) ‘fairly difficult’. Eighty-seven pages (67 %) scored below the recommended FRE for public Internet pages. There was a weak positive correlation between accuracy and readability of Internet pages (rho = 0·241, P = 0·006). Accuracy of Internet pages did not differ by dietary theme. Pages on supplements were the most difficult to read. Internet pages from publishers and other commercial organisations were significantly less accurate than those from not-for-profit organisations (median percentage difference –8 (–29, 0·00), P = 0·019). Much pregnancy-related dietary advice online is inaccurate and difficult to read. Advice should be developed in consultation with qualified nutritionists and dietitians.