The British government announced a multimillion dollar pharmaceutical partnership with Eli Lilly, including a trial that will study the impact of a weight-loss drug on work and productivity.Around one in four adults in Britain is obese, according to estimates from the country’s National Health Service, and the problem costs the public health care system billions every year.Now, the government says that weight-loss injections might be part of the solution, and might even help boost Britain’s productivity, which has been sluggish for years.Studies show that people with obesity are more likely to find that ill health affects their productivity and attendance at work.On Monday, the government announced a 279 million pound (around $365 million) investment from the pharmaceutical company Eli Lilly. Among other things, the investment will help explore new ways of delivering health services to people living with obesity, and include a five-year trial of the company’s drug tirzepatide, also known as Mounjaro, which is used to treat diabetes and for weight loss.The trial, in the Greater Manchester area in northern England, will study the effectiveness of tirzepatide in bringing about weight loss, preventing diabetes and tackling obesity-related health conditions. It will also aim to collect data on whether the drug leads to changes in participants’ employment status and sick days from work, according to a statement from the Health Innovation Network, the innovation arm of the N.H.S.The government said that up to 3,000 people could eventually take part in the study.Prime Minister Keir Starmer, speaking to BBC Breakfast on Tuesday, said he believed the drugs could be “very important for our economy and for health,” adding that tirzepatide “will be very helpful to people who want to lose weight, need to lose weight, very important for the economy so people can get back into work.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The British government said it would act after surveys showed that the number of young people trying vapes had risen sharply.The brightly colored packaging is a slick mix of ombré pink and lime green. The nicotine inside comes wreathed in a “strawberry kiwi” flavor.Increasingly, plastic disposable vapes like this one are making their way into the hands of children, with one in five young people in Britain between the ages of 11 and 17 trying vaping last year, according to Action on Smoking and Health, an independent public health charity.Soon, they will be banned in Britain, Prime Minister Rishi Sunak announced on Monday, as he unveiled a package of measures to ban single-use vapes, restrict flavors, and regulate packaging and displays.Britain is following several other nations, and a number of American states, that have already taken steps to curb underage vaping, as the colorful and trendy packaging and fruit or candy flavoring has proved appealing to teenagers and children.Mr. Sunak said that the ban, which is part of legislation that still has to be approved by Parliament, was intended to halt “one of the most worrying trends at the moment,” before it becomes “endemic.”“The long-term impacts of vaping are unknown and the nicotine within them can be highly addictive, so while vaping can be a useful tool to help smokers quit, marketing vapes to children is not acceptable,” he said in a statement.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

Since the trial of Lucy Letby, a nurse who murdered babies in her care, experts have warned of a culture of hostility toward whistle-blowers in Britain’s National Health Service.It was June 2016, and almost a year had passed since Stephen Brearey, the lead doctor at a neonatal unit in northwest England, first became concerned about a spate of troubling and unexpected deaths on his ward.Five babies had died, and at least six others had experienced unusual complications. The neonatal ward at the Countess of Chester Hospital cared for premature and vulnerable babies, but the number of deaths was far above average for the unit. Something was desperately wrong.Then, in the early evening of June 23, a baby boy — one of a set of newborn triplets — suddenly became sick and died. The following night, as the parents were still reeling, another of the triplets died.The infants had been in the care of Lucy Letby, a seemingly conscientious and well-liked nurse. Dr. Brearey had noticed that she was present in every other suspicious case and raised that fact multiple times with executives, but he felt his concerns were dismissed.After the second triplet died, he phoned a hospital executive and demanded that Ms. Letby be removed from the ward. The executive said there was no clear evidence against the nurse and insisted she was safe to work with, Dr. Brearey later told a court.It would be another week before Ms. Letby, now considered the most prolific killer of children in modern British history, was moved to clerical duties, and months before the hospital’s senior managers contacted the police.She was finally convicted last week of killing those boys by injecting air into their bodies, murdering five other babies and attempting to murder six others in her care.The harrowing case has not only horrified the nation but raised profound questions about the workplace culture that allowed her to continue working, even after doctors raised alarms.Since the trial, clinicians who worked alongside Ms. Letby have spoken out, describing a culture of hostility toward whistle-blowers and a fear of scandal that they say meant their alerts were ignored.A November 2020 police photograph of Lucy Letby.Cheshire Constabulary, via Getty ImagesThe hospital delayed contacting the police.In England, hospitals that are part of the National Health Service, or NHS, are operated by individual trusts that have their own management teams. The Countess of Chester Hospital Foundation Trust did not contact the Cheshire Constabulary, the police force responsible for the area, until early May 2017, a year and a half after doctors first began reporting their suspicions.During the trial, the court heard that a number of pediatricians who worked alongside Ms. Letby, 33, including Dr. Brearey, had repeatedly alerted hospital executives to their concerns about the nurse.Dr. John Gibbs, who worked in the department, told Channel 4 news that there had been “resistance on the senior management side to involving the police, but I don’t know quite why.” He added, “We pediatricians were certainly concerned that someone — and suspicions fell on Lucy Letby — could have been harming and perhaps killing patients on the unit.”After Ms. Letby left the unit, she began a grievance case against the hospital, claiming she was being victimized. In January 2017, some of the doctors were made to apologize to the nurse and asked to attend mediation sessions, including Dr. Brearey and Dr. Ravi Jayaram, a pediatrician at the hospital for nearly two decades.Dr. Jayaram had spoken up about Ms. Letby as early as October 2015 and recently told ITV he believed “babies could have been saved” if the situation had been reported to the police earlier.“There are things that need to come out about why it took several months from concerns being raised to the top brass before any action was taken to protect babies,” Dr. Jayaram said in a statement on Facebook on Friday, “and why from that time it then took almost a year for those highly paid senior managers to allow the police to be involved.” He declined an interview request from The New York Times.The case highlights a problematic culture in the health service, experts say.Medical professionals say the fact that the trust failed to involve the police sooner underlines a broader failing in the NHS. Rob Behrens, an ombudsman who investigates complaints about government departments and the health service in England, said the trial revealed how, for too long, nobody listened despite repeated alarms.Mr. Behrens was clear that the type of intentional killing seen in Ms. Letby’s case was extremely rare in the health service. But he said that senior managers’ ignoring warnings was “depressingly familiar.”“I see this time and time again in the cases I investigate,” he said, noting that a number of independent reports in recent years pointed to a defensive culture and hostility to those who disclosed safety issues.Dr. Claudia Paoloni, an executive member of the hospital doctors’ union in Britain, said that the case followed a longtime pattern in which whistle-blower clinicians were ignored or victimized.“Every single trust should be reviewing their existing systems to make sure they are robust and effective,” she said.Dr. Jayaram said in his Facebook statement that there was a long history of whistle-blowers in the NHS, “not only being ignored but then being portrayed as the problem, sometimes to the point of their careers being destroyed.”“What happened here was history repeating itself,” he wrote, “but the patient-safety issue that was ignored was beyond anything that the NHS has tried previously to cover up.”The case has prompted calls for change.Tamlin Bolton, a lawyer at Switalskis Solicitors, is representing the families of seven babies who were victims of Ms. Letby in civil claims against the Countess of Chester trust.“We really need to look at what was known and what the trust knew during that timeline, to know what they could have done and what they should have done with what was presented,” Ms. Bolton said.Immediately after the Letby verdict, the British government ordered an independent inquiry “to ensure vital lessons are learned and to provide answers to the parents and families impacted.”But many experts, and representatives of the victims’ families, said this type of inquiry would not go far enough.Mr. Behrens, the ombudsman, sent a letter to the health secretary on Wednesday calling for the government to set up a statutory inquiry, which would compel those involved to give evidence, rather than the weaker independent inquiry, which will allow people to opt out. He also requested better protection for whistle-blowers.“This is a critical, pivotal moment in the history of our health service,” Mr. Behrens said. “And we need to understand why patient safety is not considered as important as the reputation of the trust.”

Emergency responders in Ukraine’s capital offer not only physical care to the victims of airstrikes, but also mental health support for survivors in crisis.Hands shaking as she covered her mouth, a woman looked toward a gaping hole in the side of a high-rise, the contents of apartments spilling out of its side.Standing alongside her was Ivanka Davydenko, 29, wearing a blue uniform with “Psychologist” emblazoned in yellow on both sides, her arm placed gently across the woman’s back.She handed her a paper cup of water and asked how she could help. The woman’s son lived on the building’s 18th floor, she explained, and he was not answering his phone. Most of that floor was gone.“We help people because they are in a state of shock and do not always understand what they need at the moment,” Ms. Davydenko said. “We offer banal things: water, coffee, a blanket.”A woman searching for her son, who lived in the building in Kyiv that was hit by a missile on June 24, talked with emergency responders.Brendan Hoffman for The New York TimesMs. Davydenko is a member of a small team within Ukraine’s State Emergency Services, delivering psychological first aid at moments of crisis in the capital, Kyiv. She arrived minutes after a Russian attack, early on the morning of June 24, in which Ukrainian air defenses destroyed incoming missiles, causing fragments to careen into apartments.Russia’s attacks on Ukraine have forced its emergency crews to face not only fire, smoke and blood, but also the rippling psychological effects felt by people experiencing war. Public health experts warn that millions of Ukrainians will probably develop a mental health condition because of the invasion, and that the number will only grow as the days of bombardment, violence and grief go on.So Ukraine’s emergency crews include not only firefighters, paramedics and police officers, but also psychologists, including Ms. Davydenko, to help people dealing with the immediate effects of shock or other acute mental health care needs. There are similar efforts in other cities, but with Russian missiles persistently raining down horror on the capital, the Kyiv team is perhaps the busiest.“Before, we used to respond to serious and large-scale emergencies, like a gas explosion and where a lot of people needed to be evacuated,” said Liubov Kirnos, the Kyiv unit’s manager. “When the war started, we were on duty all the time, we didn’t leave the city.”Liubov Kirnos in June in Kyiv. “When the war started, we were on duty all the time, we didn’t leave the city,” she said.Brendan Hoffman for The New York TimesLike other emergency workers, the psychologists are on call. When an attack happens, a coordination center sends a team racing to the site. There, psychologists often find people crying, frozen in shock or breaking down.“When we meet a person for the first time, we ask, ‘What do you need right now? How are you feeling right now?’” Ms. Kirnos said. Some people simply ask the psychologists to stay close for a while. “They might be expecting their loved ones to be taken out from the rubble,” she said.That was the case on June 24 with the mother Ms. Davydenko was supporting. The psychologist walked with her as she consulted a list of people taken to hospitals or missing.Outside the building that was struck. City officials said five people had been killed.Brendan Hoffman for The New York TimesBut as they walked away, a firefighter said in a low voice that there was nothing left on the 18th floor, where her son had lived.Residents had been sleeping when the strike tore open their building before dawn. The bodies of at least two victims had been thrown from the building along with twisted metal, insulation and fragments of furniture, scattering into the parking lot below.Dozens of people stood in shock, Ms. Davydenko said, including some who had seen dead bodies and others who were wounded but did not fully understand they were bleeding.Ms. Davydenko and another colleague at the site would help around 45 people over some 12 hours. Iryna Kuts, 62, went to Ms. Davydenko with her daughter, still trembling from shock, asking for some water and a moment to speak.Ms. Kuts described being jolted from sleep in her 19th-floor apartment, and then her room filling with smoke.Ivanka Davydenko, a psychologist with the Kyiv Emergency Services, at the scene of the damaged apartment building.Brendan Hoffman for The New York Times“We were just hugging, thinking we would suffocate,” she said. They eventually made their way down the stairs, helped by police officers, but were surveying the ruins of their apartment building in a stupor.“We provide psychological first aid to people with anxiety, stress, crying, aggression,” Ms. Davydenko explained. “Then we work with people who stay on the benches, in the yard, because it’s like a second emotional wave is hitting.”A young woman in a white tank top who had been wandering the parking lot sobbing was led over. The woman’s father, a resident, had survived the strike but was refusing to come out.“Don’t worry, everything will be fine,” Ms. Davydenko told her, holding her arm, adding that firefighters would help her father out. “But you cannot go in — no one can.”She waited until the father finally emerged, and the young woman threw her arms around his neck, weeping.A woman waiting for her father to emerge from the damaged apartment building.Brendan Hoffman for The New York TimesNot everyone would have such a happy reunion. Later in the day, Ms. Davydenko accompanied the mother and her husband, who had been looking for their son, to examine the badly mutilated remains of a body.They were still awaiting official DNA confirmation, but the remains were most likely her son’s, the psychologist explained.The next day, city officials confirmed that five people had been killed in the strike.Public health experts like Dr. Jarno Habicht, the head of the World Health Organization’s office in Ukraine, have warned of the war’s long-term and widespread effects on mental health. In an interview, he said that an estimated 10 million people would most likely develop some form of mental health condition because of Russia’s invasion.The W.H.O. estimate, based on an analysis of how other conflicts had affected mental health, will probably increase the longer the war drags on, he added. Stress-induced disorders, including anxiety and depression, are among experts’ main concerns.The key to addressing mental health concerns in Ukraine, Dr. Habicht said, “is not waiting until the war is over.”A handful of programs have sought to help Ukrainians, including one spearheaded by Olena Zelenska, the first lady, that aims to make high-quality, affordable mental health services available to people across the country.Much of the apartment building’s 18th floor was destroyed.Brendan Hoffman for The New York TimesUkraine’s Ministry of Health, the W.H.O. and more than a dozen other partners have also begun a program to train primary care physicians on how to treat patients with depression, anxiety, post-traumatic stress disorder, suicidal behavior and substance abuse.But programs like the emergency team of psychologists try to provide an early intervention in moments of crisis.“If you don’t deal with stress right away, it can turn into long-term stress, which can turn into P.T.S.D.,” said Ms. Kirnos. “It’s aimed at helping bring home the idea to people that, ‘You were in danger, but now you’re safe.’ If we don’t do this right away, people might get stuck in this state.”Still, the burden can also be heavy for those giving psychological care. Days after the missile attack on Kyiv, Ms. Davydenko said team members were working with their own therapists to process what they had seen.“Of course,” she said, “I am also a human being.”Oleksandr Chubko

The walkout is just one of a series of industrial actions across Britain this month as ballooning inflation, rising interest rates and a recession put pressure on workers.LONDON — Nurses across Britain went on strike on Thursday demanding a raise and better working conditions, the first such walkout by nurses in the history of the country’s revered National Health Service.Despite freezing temperatures across much of Britain, nurses picketed outside a number of hospitals as the 12-hour strike began. Wearing hats and gloves and holding signs that read “Staffing shortages cost lives,” they called for higher pay and more workers.Nurses will still be staffing the most vital services, such as intensive care units and chemotherapy, dialysis, and some pediatric services, but nonurgent medical attention will be much less available. Hospitals and other health facilities say that they have tried to manage schedules to ensure the safety of patients during the action.The nursing strike is one of a series of industrial actions taking place across Britain this month as sky-high inflation, rising interest rates and a recession put pressure on workers. Rail employees, airport baggage handlers and ambulance workers are among the others scheduled to stage walkouts over the next several weeks.The strike comes as the N.H.S. is in crisis, with declining working conditions for clinical staff and amid the spillover pressures of the pandemic. There have been record delays for ambulance response times and a major backlog for medical procedures, among many other problems.The nurse’s union, the Royal College of Nursing, has asked for a 19 percent raise, noting that small increases in the past have made it hard to attract and retain workers. Nurses are leaving the profession at high rates, citing low pay and staff shortages that force them to work long hours, according to union representatives.The government has said such a raise is unaffordable and has offered a much smaller increase.Pat Cullen, general secretary of the Royal College of Nursing, said in a video statement ahead of the strike that her members were “committed to our patients and we always will be.”But, she added: “When as a society did we stop valuing the very basics of human care and dignity? This is not who we are. It is not unreasonable to demand better.”The union came to the decision to strike after polling its more than 300,000 members, who make up about a third of the health service’s work force.Nurses and doctors at a clinic in central London last year. The nursing strike is one of a series of industrial actions taking place across Britain this month.Andrew Testa for The New York TimesOn Thursday, nurses were striking across England, Wales and Northern Ireland after negotiations broke down, though nurses in Scotland called off their strike after a new pay offer. An estimated 100,000 nurses are expected to take part in England alone across 53 different N.H.S. organizations. Nurses in all but one area were striking in Wales, and nurses across Northern Ireland all walked out.Representatives for the union met with the British health secretary, Steve Barclay, on Monday, but union representatives said that the meeting had been brief and had failed to achieve any of their stated aims.Prime Minister Rishi Sunak of Britain, speaking on Wednesday in Parliament, said that the nurses had been offered a “fair” pay deal and that the government had “consistently spoken to all the unions involved in all the pay disputes,” referring to the various strikes planned for this month.Mr. Sunak added that he wanted to “put it on record what we’ve done for nurses,” noting that they were given a 3 percent raise last year, even as many other public sector wages were frozen.But amid soaring inflation, that raise does not amount to much, union representatives say, adding that the sector has long been underfunded, leaving nurses struggling to get by.“It’s pay recovery, it’s not asking for additional monies, if you break it down,” said Ms. Cullen, the union head, speaking to the BBC from a picket line early Thursday. She said that the union had been were unable to come to an agreement because the government had refused to consider a further raise.More industrial action in the N.H.S. is expected. Nurses plan to strike again on Dec. 20, while the ambulance service has walkouts scheduled for Dec. 21 and Dec. 28.