NHS waiting lists have soared to another record high, grim data revealed today.

Around 7.68million patients in England — or one in seven people — were in the queue in July for procedures such hip and knee replacements, official figures show. 

This includes almost 390,000 patients who have waited at least one year for treatment, often in pain.

NHS bosses blamed medic strikes for heaping extra pressure onto already struggling hospitals — with 400,000 appointments rescheduled this summer due to walkouts.

Health leaders warned that the service is ‘heading for even more extremely troubled times’ as winter approaches. 

NHS England monthly performance data released today that the waiting list grew by more than 100,000 between June and July. 

The 7.68million toll marks the highest figures logged since NHS records began in August 2007 and a rise of nearly three quarters of a million (742,000) on July 2022. 

For comparison, around 4.4million were stuck in the system when the pandemic reached the UK. 

Rishi Sunak made cutting waiting lists one of his 2023 priorities, pledging in January that ‘lists will fall and people will get the care they need more quickly’.

However, he claimed that strikes across the health service were making the task ‘more challenging’.

And the NHS said today that industrial action had piled pressure on the health service, with around 900,000 appointments cancelled since strikes began in December. 

It said the true impact of walkouts is much higher, as many hospitals avoid scheduling operations for strike dates.

Junior doctors have already staged 19 days of action since March and will undertake four days of joint strike action this autumn with coordinated walkouts in England over separate days next week and into October. 

Radiographers will walk out for 24 hours from 8am on October 3, joining medics on the picket lines. The strike days also coincide with Rishi Sunak’s first Tory party conference as leader and prime minister.

Emergency care – through A&E departments and 999 – is still available but patients have been told to contact NHS 111 or their local pharmacy for minor health worries. 

Professor Julian Redhead, NHS England’s national clinical director for urgent and emergency care, said: ‘Today’s figures show that despite ongoing pressures across the NHS, including record demand for emergency care this summer, and an increase in Covid cases during July and August, NHS staff are continuing to deliver for patients.’

He added: ‘But even as we talk about a summer of record demand we have already been preparing for winter, and the improvements seen in today’s data show the hard work of staff is already paying off.

‘Alongside expanding the use of out-of-hospital care – such as more virtual ward beds – and the rollout of our winter vaccination programme, we are doing all we can to prepare ahead of what has the potential to be another challenging winter with Covid and flu.

‘As ever, the public can also play their part by getting your winter vaccines when invited and use services in the usual way – 999 in an emergency and NHS111 online for other health conditions.’

Miriam Deakin, director of policy and strategy at NHS Providers, said: ‘Challenges including severe staff shortages, capacity constraints – including of beds and equipment – and ongoing strikes are hindering vital progress on performance targets.’

She added: ‘With more strikes on the horizon, including coordinated action between junior doctors and consultants for the first time, even greater disruption looms.’

Summer months usually offer hospitals a break ahead of the usual busy spell, when seasonal pressures like flu and norovirus typically kick in. But NHS England said this summer is ‘on trajectory to be the busiest in NHS history’. 

Separate data for A&E shows that patient care plummeted in August as emergency departments faced their busiest summer yet. 

Just under three-quarters of emergency department attendees (73 per cent) were seen within four hours in August, down from 74 per cent in July. 

NHS standards set out 95 per cent should be admitted, transferred or discharged within the four-hour window.

Meanwhile, 28,859 patients who sought help in emergency departments were forced to wait more than 12 hours, up from 23,934 in July.

There were more than 6.5million attendances in A&Es across June, July and August — 20,000 more than the previous record in 2019. 

Dr Tim Cooksley, president of the Society for Acute Medicine, said the figures show that there is ”a trajectory towards a winter equally as bad as last year’s ‘worst ever’.’

He said: ‘A small wave only is needed to deepen the crisis in urgent and emergency care; well-illustrated by the hot weather last week which caused many hospitals great challenges.’

Dr Cooksley pointed to the case of a 90-year-old Harold Pedley in Blackpool, who died waiting to be seen by a doctor in a chair in an overcrowded emergency unit.

He said: ‘His case not isolated and many more will sadly have similar experiences over the next few months.

‘There is a tacit acceptance and almost normalisation of poor urgent and emergency care heading in to this winter.

‘Corridor care, overcrowded and understaffed emergency departments and acute medical units, ongoing industrial action and a target that only one in four people wait more four hours. 

‘This is an environment perfectly designed to ensure there are more patients like Mr Pedley this winter.’

He warned the NHS was ‘inevitably’ heading for ‘more extremely troubled times’, but said ‘mitigation is possible’.

He added: ‘Resolving industrial action, a stronger commitment to funding the workforce plan and a significant emergency package to support social care are essential – but the window of opportunity to do so is getting increasingly narrow.’

Separate NHS data on ambulance figures for August however show response times improved — but patients were still left waiting too long.

Heart attack and stroke patients in England, known as category two callers, had to wait an average of 31 minutes and 30 seconds for paramedics to arrive, shaving 20 seconds off the previous month. 

However, this is still nearly double the NHS 18-minute target.

Ambulances took an average of eight minutes and 17 seconds to attend the most life-threatening category one calls, such as cardiac arrests. The NHS target stands at seven minutes.

Separate data shows 2.2million tests and checks were delivered in August, contributing to the busiest summer ever for diagnostics — a total 6.6million across June, July and August.

However, NHS figures on cancer waiting times showed that just six in ten cancer patients (62.6 per cent) were seen within the two-month target in July. 

NHS guidelines state 85 per cent of cancer patients should be seen within this time-frame. However, this target has not been met nationally since December 2015. 

Meanwhile, almost a quarter (74.1 per cent) of patients urgently referred for suspected cancer were diagnosed or had cancer ruled out within 28 days, up from 73.5 per cent the previous month. The target is 75 per cent.

The proportion of cancer patients who saw a specialist within two weeks of being referred urgently by their GP fell from 80.5 per cent in June to 77.5 per cent in July, missing the 93 per cent target.

The figure is one of several cancer targets that are being discontinued from October, after the NHS vowed last month to diagnose and treat cancer patients quicker, with  ministers accepting its request to streamline performance targets.

The controversial reforms will see the number of cancer waiting time indicators that hospitals are measured against slashed from ten to three.

Cancer Research UK’s chief executive, Michelle Mitchell, said: ‘Today’s data is yet another snapshot of the challenges facing England’s cancer services and a message to the UK Government that things need to change. 

‘These figures are amongst the worst on record and represent anxious delays faced by patients and the immense pressure on NHS staff.

‘People affected by cancer deserve more. With strong leadership and proper funding, the UK Government has the power to put an end to these unacceptable delays for tests and treatment in England.’

It comes as data published on Tuesday also showed the number of Brits paying for private medical treatment has now hit a record high. 

Around 227,000 people in the UK sought private treatment in the first three months of 2023. 

It marks a four per cent jump on the previous record of 219,000 set in the final quarter of 2022. 

The rise in demand for paid-for care is being driven by continuing growth in insured treatments — 156,000, up from 149,000 in the fourth quarter of 2022 — as more businesses and households turn to private healthcare plans to safeguard the health of employees due to the growing difficulties in getting treatment on the NHS. 

Sir Keir Starmer is branded untrustworthy and timid by union barons as they warn him not to ‘go down the route of Tony Blair’

• The Labour leader also came under pressure to repeal all anti-strike laws

By Martin Beckford Policy Editor

Published: 17:37 EDT, 11 September 2023 | Updated: 18:37 EDT, 11 September 2023

Leading retailers warn Chancellor against £400m business tax hike

By John-Paul Ford Rojas

Updated: 19:05 EDT, 10 September 2023

Some links in this article may be affiliate links. If you click on them we may earn a small commission. That helps us fund This Is Money, and keep it free to use. We do not write articles to promote products. We do not allow any commercial relationship to affect our editorial independence.

Claims that the world is becoming ‘overpopulated’ have been in the zeitgeist for decades, but it’s a lack of new babies that really concerns experts in developed countries.

Japan announced this week that as many as a third of 18-year-old women may never have children due to a ‘sex recession’ that has plagued the country for decades.

One out of every 10 Japanese men in their 30s is still a virgin, and the country’s fertility rate has plummeted from 1.5 in 1992 to 1.34 births per woman in 2020.

The lack of babies being born is already having real-world impacts — Japan’s economy has stalled and caused the country to lose its place as an economic superpower. 

And experts warn the US is barreling towards the same fate, with fertility rates at a historic low and an increase in sexless relationships.

As well as having one of the lowest birth rates in the world, Japan also has one of the highest life expectancies, meaning it is left with a rapidly aging society, a shrinking workforce and fewer taxpayers.

Experts told DailyMail.com that America could be in store for a host of problems, such as a slump in economic growth and difficulties for retirement systems, if the birth rate does not pick up.

A baby boom in the mid-20th century saw the average woman in the US give birth to between three and four children. Today, that rate is just 1.6 — the lowest level recorded since data was first tracked in 1800. 

And there is ‘nothing in the data to suggest this trend is going to reverse itself anytime soon,’ Dr Phillip Levine, a professor of economics at Wellesley College in Massachusetts, told DailyMail.com.

He added that financial incentives — such as those promised in Japan for families with three or more children — are ‘unsuccessful’ at significantly raising a country’s birth rate, and we may have to ‘learn to live in a world in which the birth rate is low.’

In January 2023, Japan increased its financial incentives and offered 1m yen ($7,500) per child to families who moved out of greater Tokyo.

It topped an existing relocation fee of 300,000 yen ($2,000). It is too early to tell if it will make a lasting difference, but experts are not optimistic.

Dr Levine told DailyMail.com there will need to be economic reorganization to keep the country afloat, adding ‘jobs will be lost’ in manufacturing, construction and other fields and move into care and other services for the elderly.

This will ‘eventually have a damaging impact both on social cohesion and general wellbeing, and on economic dynamism’, he warned.

Dr Christopher Murray, a global health expert from the University of Washington, told DailyMail.com: ‘Since most purchases of real estate or consumer durables are in the working age adults, it will tend to put downward pressure on these types of assets.

‘In the long run, societies have to adapt to having more grandparents than grandchildren.

‘We are actually only just beginning to understand the myriad [of] challenges that sustained low fertility will have on societies.’

Previous research has revealed Americans are having far less sex than former generations.

A study from 2017 found that married or live-in couples had sex 16 fewer times per year in 2010-2014 compared to 2000-2004.

And couples had nine times more sex in 1995-1999 than they do now.

Experts have many theories as to why our interest in sex is dwindling – including porn addiction, lipido-sapping drugs like antidepressants, low testosterone levels among men, obesity and other factors.

Dr Stuart Fischer, an internal medicine physician in New York, told DailyMail.com that there needs to be a public mind shift where Americans start thinking about sex as a productive activity for the greater good and have more ‘goal-directed’ sex to increase the birth rate. 

In Japan, the falling birth rate has been attributed to a waning appetite for marriage and parenting and growing financial worries, leaving couples questioning whether they can afford children.

It is also due to a vicious cycle of fewer children who then have fewer children, said Takuya Hoshino, senior economist at Dai-ichi Life Research Institute.

As people have less children, they are able to spend more on each child than families have in the past. That drives up the average cost of raising a child for the broader population, putting some people off from having children, he said.

In the US, similar problems are blamed, as well as women prioritizing careers and the rise of fertility treatments, leaving many to think they can wait.

But Dr Levine said the evidence for these theories ‘isn’t really that great’ and admitted that researchers don’t have a ‘firm grasp’ on why American women are having fewer children.

‘States where housing costs are rising more or childcare costs are rising more don’t have birth rates that are falling more rapidly than other states,’ he said.

For example, Massachusetts has the most expensive childcare but has the fourth lowest fertility rate out of the states.

‘It doesn’t seem like it’s about the finances; it seems like it’s about what people want out of their lives.’

He said: ‘The Great Recession definitely started the ball rolling in the US and births are routinely linked to economic activity. 

‘But when the recession ended, births didn’t rebound, they just kept going down. So that clearly played a role at the beginning, but not an ongoing role because the recession did end.’

Instead, Dr Levine thinks the falling birth rate is likely due to ‘changing preferences, life goals and aspirations’ among women and their partners.

‘Marriage and childbearing may not be quite as much of a priority among more recent waves as young people, as they have been in the past,’ he said, but added that this is not ‘country-specific.’

An erosion of family values and religious principles might also be a factor, Dr Fischer said.

In Japan, the number of children has been falling for more than four decades, which is having a disastrous effect on GDP and productivity. 

Japan’s population of 126.15 million in 2020 is projected to fall to 87 million by 2070, according to the National Institute of Population and Social Security Research.

In China, the infamous one-child policy had catastrophic effects. Described as the worst policy in history, it caused China’s fertility rate to crash by more than half, from 5.8 births per woman in 1970 to 2.7 births per woman in 1979. 

And the effects are still being felt. Government data estimates showed China’s fertility rate dropped to a record low of 1.09 in 2022 — the lowest of any country with a population over 100 million.

A falling birth rate is detrimental to a country for several reasons. Fewer births means fewer workers, which has ‘implications for economic activity and economic growth,’ Dr Levine said.

‘It causes problems for retirement systems that are based on current workers paying benefits for current retirees,’ he said, as well as difficulties ‘funding and managing a school system.’

Dr Fischer agreed that the reasons for America’s falling birth rate are sociological.

‘People are more anxious than ever,’ he said. ‘People are in more desperate conditions; the economy is obviously very, very unstable. This is not the situation that would have occurred after winning a World War, let’s say, where you’re happy and you want to start a family. This is the antithesis of that.’

The rising cost of living has been a deterrent for people to start a family, Dr Fischer said.

He also noted how dating has changed over the years. ‘In the old days, that would be arranged marriages,’ he said.

Dr Fischer said the pandemic, technological advances, and increasing use of the internet have caused people to become ‘more insular.’

‘It’s easier to become isolated from society on the internet… and you don’t really want to go out because you’re depressed,’ he said, pointing to America’s growing mental health crisis, with one in five adults currently clinically depressed.

He added that rising obesity rates could be having an impact on fertility for both men and women.

‘When you have obese men, the balance of testosterone and estrogen isn’t correct, so there can be fertility problems,’ he said.

Canary Islands officials beg residents to lose their ‘tourismphobia’ and warn growing resentment towards holidaymakers such as Brits could see a slump in their crucial tourist economy

• The islands have seen resident protests against holidaymakers this summer

By Christian Oliver

Updated: 21:13 EDT, 31 August 2023

The social services department involved in the case of tragic Amber Gibson has ‘blood on its hands’, according to relatives of the young girl murdered by her elder brother.

The accusation came as it was announced that an independent review of the circumstances of Amber’s death while under the care of South Lanarkshire Council will be completed after further interviews with witnesses in the criminal case.

Connor Gibson, 20, was yesterday convicted of attacking his sister Amber, 16, in woodland in Hamilton, South Lanarkshire, in November 2021.

He removed her clothing, sexually assaulted her with the intention of raping her, inflicted blunt-force trauma to her head and body, and strangled her.

Even after her death, the sickening ordeal was not yet over as Stephen Corrigan, 45, the man who discovered the body in woodland violated her remains and was convicted of attempting to defeat the ends of justice by intimately touching and concealing the body, instead of contacting the emergency services.

Amber and her brother had spent much of their lives in care, but a source from their extended biological family today told MailOnline that social workers from South Lanarkshire Council blocked their maternal grandparents’ efforts to have the children stay with them.

‘The social work department has blood on its hands,’ claimed the family member who asked to remain anonymous.

‘Ambers’ grandparents, Mr and Mrs Adams, are lovely people and did their best for the children, but they needed more help from the authorities and didn’t get it.’

‘It put an enormous financial strain on the Adams, when they had the kids, but they were offered no help. The council seemed to prefer to spend hundreds and hundreds of pounds placing Amber and Connor with foster parents, rather than their own family.’

Mr and Mrs Adams refused to comment when approached by MailOnline.

Amber was aged just three, and her brother five, when they were removed from an abusive family household where they would witness their father Peter Gibson beating their mother Anne-Marie Adams black and blue, dragging her by the hair, putting his hands around her throat.

Peter Gibson was jailed for 10 years only a few months ago for a litany of violent sexual crimes.

Now his son Connor also awaits a life sentence for the brutal killing of his own sister. By the time she was murdered, blameless Amber had spent almost all her life in the care system and had already been a victim of rape.

Amber, said foster parents Craig and Carol Niven, was the ‘most giving, caring, loving supportive and admirable person’ who had ‘the most amazing outlook on life’.

The devastated couple said they believed the siblings had been ‘let down throughout their lives by the system’.

Just five months before her death, Amber had been raped by 20-year-old Jamie Starrs at his home in Bothwell and her statement proved crucial in bringing the rapist to justice.

Giving evidence at the trial of Connor Gibson, Mr Niven described the siblings as ‘not a good mix’ and said that he wouldn’t feel comfortable leaving them in each other’s company.

It was while they were together in November 2021 that Gibson pounced on his little sister, strangling and attacking her. He had also ripped off her clothes.

Her story began on New Year’s Day 2005 at Wishaw General Hospital in Lanarkshire where her brother and eventual killer had been born two years earlier.

Her parents, Peter Gibson and his much younger partner Ann Marie Adams, are believed to have met online and, by the time Amber arrived, a pattern of abuse was well-established. At their home in North Berwick Crescent, East Kilbride, Gibson inflicted appalling violence on the mother of his children – punching her in the face and kicking her in the body – between August 2001 and August 2007.

The children were taken out of their parental home and put into care and in 2008 the Nivens were approached to look after the pair in another Lanarkshire town. Amber and her brother moved into their Larkhall home but concerns about the older sibling’s behaviour soon arose.

For a time they attended separate schools. Amber went to Moore House Academy, around 25 miles away in West Lothian’s Bathgate, while her brother was a pupil at Kear Campus in Blantyre, Lanarkshire – a secondary school for those with social, emotional and behavioural needs.

Former school friends described him as a loner who was prone to sudden fits of rage.

‘He would talk about killing other pupils which, to be fair, I saw as an over-exaggeration, but looking back on it now maybe the stuff he said wasn’t exaggeration at all,’ one classmate said.

A former female pupil described him as a ‘disgusting human’ who ‘threatened to rip’ her baby from her while she was pregnant.

Ultimately, the foster care arrangement broke down and Amber moved into Hamilton-based Hillhouse children’s unit when she was 14. Her brother remained with the Nivens until his 18th birthday in 2020.

It was while in the care of the state that Amber was raped by 20-year-old Jamie Starrs, who attacked her in June 2021 after being released on bail for another sex attack.

At the time of her murder, her brother was a resident at Hamilton’s Blue Triangle project, a hostel for homeless youngsters in Lanarkshire, while she was living at the Hillhouse unit.

Angel McKean, 19, a friend of Amber’s there, said the siblings’ relationship was turbulent.

But she said when she last spoke to Amber, hours before she was killed, she had been looking forward to seeing her brother.

Care home manager Ian Currie, 55, said Connor Gibson called the Hillhouse unit to speak to his sister on the day she was killed.

A short time later, Amber left with him, despite Mr Currie’s attempts to discourage her from doing so. She was never seen alive again.

Four days later, Gibson wrote a tribute to his sister on social media: ‘Amber. You will fly high for the rest of time. We all miss you. Especially me. I love you ginger midget, GBNF [gone but not forgotten] xx.’ Hours before he was arrested for her murder, he shared another post in which he urged townsfolk to ‘leave a light on’ for Amber.

It was while Connor Gibson was awaiting trial for murder that his natural father, aged 62, was jailed for physical and sexual abuse.

The High Court in Glasgow heard how he had raped a woman in East Kilbride, after tying her up and blindfolding her. He also grabbed this victim by the neck restricting her breathing.

Peter Gibson was also convicted of indecently assaulted a young boy and punching and kicking him to his injury. Other convictions included lewd and libidinous behaviour towards another boy.

Mr and Mrs Niven were in court yesterday to hear the guilty verdict on their former foster son. In a statement, they said: ‘When they arrived at our home, Amber was three and Connor aged five.

‘Connor stated “We are safe” – they were until he took the safety away.’

They added: ‘Amber deserved to live a life of hope and opportunities.

‘As a family, we will never be able to get over how this was taken from her. We are relieved the people involved in what happened to her are now behind bars.’

South Lanarkshire Council described the case as ‘truly tragic’ and confirmed that in 2021 it established an independent review of the circumstances, which can now conclude since the court case has been closed.

Professor Soumen Sengupta, Director of Health and Social Care for South Lanarkshire, said: “This has been a truly tragic case, and our thoughts remain with all those who knew and loved Amber. There are established procedures in place for tragic events of this nature which are designed to ensure that events are fully understood and, if necessary, learned from.

‘In this case, after Amber’s death the Care Inspectorate and the Chair of the Child Protection Committee (CPC) were informed. The CPC acted to establish an independent review under an extremely experienced independent expert in the field. They have already carried out most of the work involved and will now be able to conclude the review, including interviewing people who were witnesses in the criminal case.

‘The results of the review will be delivered to the CPC once complete and then shared with the Public Protection Chief Officer Group. It is anticipated that the findings will be publicly reported in an appropriate format.’

South Lanarkshire Council declined to comment on the family’s claims but a source with knowledge of the case insisted there had never been an application from members of Amber’s family for custody of her or her brother. 

Madonna‘s grueling preparation for her epic 80-show world tour may have left her vulnerable to falling ill, doctors warned today after news broke that the 64-year-old icon was hospitalized with a ‘serious bacterial infection’.

The legendary hitmaker — whose chart-topping career has spanned four decades — is expected to make a ‘full recovery’ after being intubated in intensive care.

Details over the exact cause of the ‘Material Girl’ singer’s health scare have yet to be released by her family, who were left ‘preparing for the worst’.

They claimed the star believes she is ‘invincible’ and has ‘been wearing herself thin’ over the past few months to ensure her upcoming five-month tour of the US, Britain, Canada and Europe went perfectly.

Doctors today said it was possible Madonna’s punishing preparations — thought to involve rehearsing and exercising six days a week — may have worn her immune system down and left her vulnerable to infection. Any stress she may have faced due to the tour also ‘doesn’t help the picture’, they added.

Bacterial infections are usually mild, with their symptoms clearing naturally or with the added punch of antibiotics.  

Yet they can pose a much more serious threat to those with a weakened immune system. 

Dr Thomas Moore, an infectious diseases expert at the University of Kansas, said it was possible the singer was run down.

‘Exhaustion, certainly when you are run down, can be an issue,’ he said. ‘It is generally true that if you are very run down and not getting enough rest your immune system can be challenged.’

Madonna’s exercise routine may have actually worked against her, he said. 

‘A vigorous workout [or lifestyle] is not inherently dangerous as long as you take care of yourself,’ Dr Moore added.

‘But say your immune system is challenged [by a bacteria], if you have been working too hard this makes it more difficult for it to respond and insults arise.’

Madonna’s partying lifestyle has also likely not helped matters, Dr Moore added.

‘Your body is designed to be taken care of, and with this it can do amazing things and achieve physical feats,’ he said. 

‘But when you start to abuse your body with drugs or alcohol or stay awake for long periods when your brain wants you to go sleep, these can have an indirect effect on its ability to fight a viral infection.’

Exhaustion raises inflammation and stress levels in the body, which can suppress the number and function of immune cells making them less able to tackle infections.  

Poor sleep also has an impact, leading to a decline in the number of immune cells in the body because it has less time to manufacture new ones.

Dr Stuart Fischer, an emergency doctor in New York City, said it was possible that stress had also weakened her immune defenses.

He said: ‘Any stress due to the concert doesn’t help the picture.

‘Stress is immunosuppressive. Her stress is from going on tour and fans waiting to see her. This could have an impact.’

It was also suggested that Madonna’s age, at 64 years, could also have been involved.

Dr Moore said: ‘As you age your immune cell function… begins to decline,’ he said. ‘The immune system also becomes less nimble.’

Both doctors wished Madonna well with her recovery, saying ‘thank goodness she is out of the woods’ and congratulating her for bringing generations happiness with her music. 

Madonna is well-known for her ‘punishing’ fitness regime, which sees her exercise six times a week with a personal trainer to maintain her ‘dancer’s physique’.

The singer, who is known for being a perfectionist, has also had a six-day working week since April to gear up for her shows, those close to the star revealed.

Lee Mitchell, a personal trainer at www.jogger.co.uk, told MailOnline that Madonna’s intense exercise routine may have contributed to her unspecified illness. 

He noted that her workout plan — which includes strength training, cardio exercises and Pilates — can ‘yield positive results when appropriately managed’.

But he cautioned that ‘it is crucial to strike a balance between pushing physical limits and allowing for adequate recovery’.

Mr Mitchell said: ‘Intense exercise can temporarily suppress the immune system due to various factors, such as increased stress hormones, elevated levels of inflammation and oxidative stress. 

‘Pushing the body beyond its limits may lead to physical exhaustion, compromised immune function, hormonal imbalances and increased susceptibility to infections.’

He noted that it is ‘challenging to definitively attribute her health situation to her extreme exercise routine alone’.

Mr Mitchell added: ‘It is possible that other factors — such as her overall health, immune system, stress levels or lifestyle choices — may have contributed to her current condition. 

‘It serves as a reminder that even highly trained individuals should listen to their bodies, prioritize recovery and seek professional guidance to ensure long-term health and wellbeing.’

One of Madonna’s family members has told DailyMail.com that the shocking collapse was a wake-up call for Madonna, who believes she is ‘invincible’ and has been pushing herself extremely hard to prepare for the tour.

They said: ‘She has not been living as healthy a life as she should be for her age, and she has been wearing herself thin over the past couple of months. 

‘She thinks that she is still young when, in fact, she is not. She also believes that she is invincible.’ 

It is currently unclear exactly what infection or complications the Michigan-born singer is suffering from.

But bacterial infections can affect various parts of the body, including the skin, lungs and blood. 

While most bacteria are harmless, some can enter the body through an opening in the skin — such as a cut, insect bite or surgical wound. Others get into the body via the airways, eating contaminated food or through sex.

Antibiotics, which can come in pill, liquid, cream or IV form, are used to treat such infections. 

While most cases are mild, some untreated bacterial infections can lead to serious complications, such as sepsis.

It occurs when the immune system, which helps fight off infections, overreacts to an infection and starts attacking the body’s tissues and organs.

Professor Robert Read, chair of infectious diseases at the University of Southampton, told DailyMail.com that being under psychosocial stress increases the risk of sepsis and its severity. However, he noted that it is not fully understood why this is the case.

Surgery can be another trigger of bacterial infections.

Madonna seemed to admit to undergoing cosmetic surgery this year after she looked almost unrecognizable while presenting an award at the 2023 Grammy’s in February. 

Leading plastic surgeons said at the time that she may have had ‘excessive filler’, Botox, a facelift and nose job, as her skin appeared ‘tight and pulled back’.

Later that month, the singer posted a picture of herself on Twitter stating that her ‘swelling from surgery has gone down’.

It is unclear if she has undergone any further cosmetic procedures.

But any surgery that breaks the skin can lead to an infection, usually within 30 days of an operation.

They are usually caused by bacteria infecting the wound through touch from a contaminated medic or surgical instrument or germs in the air or already on the body that spread to the wound.

The singer is also famed for her intense partying lifestyle and has been pictured in nightclubs and parties and was previously hailed as the ‘nightlife queen’ in the 1990s.

Decades of drinking alcohol are known to hamper health.

One recent study by Oxford University researchers found that drinking alcohol can increase the risk of developing 60 ailments, including infections.

Madonna’s health scare was shared with the world by her long-time manager Guy Oseary, who revealed on Instagram that Madonna has been forced to postpone her hotly-anticipated 40th-anniversary tour as a result of her medical struggles. 

Oseary insisted in his post that the singer is ‘expected to make a full recovery’ and that her ‘health is improving’, but added that she is ‘still under medical care’.

While Madonna used to play tours featuring around 40 shows earlier in her career, she has upped her commitments in recent years and has performed twice as many.

On her most recent Madame X tour, Madonna performed 75 dates from September 2019 until March 2020 and put her ‘blood, sweat and tears’ into the performances.

Jose Extravaganza, a dancer who used to work with Madonna, told how the star had been exercising ‘a lot’ ahead of the tour.

He told DailyMail.com: ‘I think she’s exercising a lot. I mean, the rehearsals. Rehearsals are six days a week from what I hear, you know, like the only day off is Sunday.’

Mr Extravaganza also revealed how Madonna had planned to incorporate her love of boxing and fitness into her concerts by bringing martial arts into her upcoming shows, showing how important fitness is in the star’s life. 

The star was previously forced to cancel more than a dozen shows during her 2019 and 2020 The Madame X Tour after injuring her coccyx on stage. 

She wrote on Instagram at the time: ‘If only knees didn’t twist and cartilage didn’t tear and nothing hurt and tears never fell out of our eyes.

‘But alas they do and thank god for this important reminder that we are human.’

Madonna was left on crutches for ten months following the injury and operation she underwent and other ‘physical challenges’, she said at the time.

As the Covid pandemic put the final nail in her tour’s coffin, Madonna decided to undergo knee surgery in April 2020 followed by hip surgery in November 2020 as well as ‘regenerative treatment for missing cartilage’.

E-cigarettes have been linked to five deaths in Britain, MailOnline can reveal today.

None of the fatalities, which have all occurred since 2010, are proven to have been caused directly by vaping. No ages were mentioned for any of the deaths.

But health chiefs tasked with policing the safety of e-cigs admit there is ‘a suspicion’ the gadgets may have been to blame.

Two were put down to heart disorders, including one cardiac arrest.

Respiratory complications were blamed for the other three deaths, with one caused by inhalation of fat — a known potential consequence of vaping.

Almost 1,000 serious adverse reactions to e-cigs have also been logged by Britain’s health watchdog including blood, nervous system and respiratory disorders, as well as cancer and injuries such as burns.

Leading experts today told MailOnline the figures we uncovered ’emphasise vaping is not safe’ and warned the data may only represent ‘the tip of the iceberg’.

But others insisted the gadgets are ‘substantially less harmful than smoking’.

It comes amid growing fears over Britain’s burgeoning child vaping crisis, with rates having doubled within years.’

Colourful displays of the gadgets, sold for as little as £5, litter high streets across the UK. 

Predatory manufacturers lure kids in with flavours such as bubblegum and cotton candy and some shops even sell the devices next to sweets.

Rishi Sunak has vowed to crackdown on the crisis. 

Other experts have also demanded a total ban on disposable vapes such as Elf bars, popular with teenagers. New Zealand has already announced such a move.

The five fatalities from vaping are logged through the Yellow Card system, set up in the 1960s in the wake of the thalidomide scandal.

Officials use the same database to track the safety of Covid vaccines.

It allows doctors, pharmacists and patients themselves to report adverse reactions believed to be caused by prescription and over-the-counter drugs, implants and alternative medicines.

This can lead to them being reviewed, having warnings added to the label or even being taken off the market.

Since 2016, the scheme, run by The Medicines and Healthcare products Regulatory Agency (MHRA), has also covered e-cigarettes and refill containers.

However, a yellow card report – named after the yellow forms initially used in the 1960s – does not prove the product in question was to blame.

Regarding e-cigs, the MHRA says: ‘It may be difficult to tell the difference between something that has occurred naturally and an adverse reaction.

‘Sometimes reactions can be part of an underlying condition rather than being caused by the e-cigarette.’

It adds: ‘Many factors have to be considered when assessing whether an e-cigarette has caused a reported adverse reaction.’ 

Experts however fear the true toll of vaping adverse reactions could be far higher if swathes of the population are unaware of the yellow card scheme.  

Authorities track the database closely to spot any ‘potential patterns of concern’.

Similar issues surrounding blood clots caused by AstraZeneca’s Covid vaccine were found months into the historic immunisation drive.

According to the drug watchdog’s 25-page document of adverse reactions for e-cigs, some 942 reports of reactions have been logged since January 1, 2010. 

Almost half (405) of all reports logged cited respiratory disorders, including 47 with oropharyngeal pain and 57 with shortness of breath. 

Some 120 were for gastrointestinal disorders, while 114 general disorders, including chest pain, fatigue and malaise, were also noted. 

One report of laryngeal cancer, three of atrial fibrillation – a condition that causes an irregular heart rate – and one anaphylactic shock, were also logged by the MHRA. 

An MHRA spokesman told MailOnline: ‘We keep the safety of e-cigarettes under close review and convene working groups when required to review data and evidence surrounding suspected adverse reactions associated with e-cigarette usage.’

They added: ‘If you have purchased a product that is not published on our website, you should return it to the retailer or your local trading standards service.

‘If you experience an adverse effect from use of a nicotine-containing e-cigarette product, please report it to us via our yellow card scheme. 

‘It is important to note that a report of an adverse reaction does not necessarily mean that the e-cigarette has caused the reaction, only that the submitter suspects it may have. 

‘Many factors have to be considered when assessing whether an e-cigarette has caused a reported adverse reaction.’

In 2019, a 57-year-old British factory worker was named as the first e-cig user in the world feared to have developed a fatal disease directly linked to his vaping habit.

Terry Miller, 57, from Gateshead, Tyne and Wear, died in 2010 after developing lipoid pneumonia, with medics confirming oil from vaping fluid was found in his lungs.

After smoking around 20 cigarettes a day for 41 years, he decided to give up and bought an e-cigarette from his local pharmacy, believing it was an healthier option. 

He began vaping every day and would often buy nicotine liquid refills and new e-cigarettes on the internet from a company based in the South of England. 

But around eight months after he switched to vaping in 2010, Terry’s lungs began to fail and he was diagnosed with fibrosis. 

E-cigs allow people to inhale nicotine in a vapour — which is produced by heating a liquid, which typically contains propylene glycol, glycerine, flavourings, and other chemicals.

Unlike traditional cigarettes, they do not contain tobacco, nor do they produce tar or carbon — two of the most dangerous elements.

Vaping has risen rapidly over the past decade to reach record levels in the UK, with an estimated 4.3million people who are regular vapers, according to a report last year. 

The data suggested that 8.3 per cent of adults in England, Wales and Scotland vape, up from 1.7 per cent a decade ago, which equated to about 800,000 people. 

Health chiefs say e-cigarettes carry a fraction of the risk of smoking and believe they can play a key role in weaning the remaining five million smokers in Britain off tobacco and putting an end to the killer habit.

Although widely viewed as safer than smoking, the long-term effects of vaping still remain a mystery.

Doctors fear there could be a wave of lung disease, dental issues and even cancer in the coming decades in people who took up the habit at a young age.

Dr Salim Khan, head of department for public health at Birmingham City University, told MailOnline: ‘The MHRA analysis is welcomed as it provides additional evidence of the potential harm that e-cigarettes and vaping can cause.

‘In addition to more than half of the reports relating to respiratory disorders, there are several non-respiratory health events listed which is consistent with published research findings.

He added: ‘Whilst e-cigarettes and vaping are assumed to be the causal factor, it is important to recognise that there may be other contributing factors which could have resulted in the health events listed.

‘It is also important to note that the volume and pattern of adverse respiratory and other health events associated with e-cigarette use or vaping in the UK may not be fully represented by the data.

‘The data may only represent the tip of the iceberg.

‘To establish the potential impact that e-cigarettes and vaping are having on people’s health, we require continued data collection and reporting. We need rigorous evidence that clearly demonstrates the detrimental impact of e-cigarettes and vaping on health.’

Professor Jamie Brown, director of University College London’s Tobacco and Alcohol Research Group, meanwhile told MailOnline: ‘These new data emphasise that vaping is not safe and never smokers should not vape. 

‘However, to put these numbers in context, cigarette smoking causes about 76,000 deaths a year in the UK.

‘So, in the same period, cigarette smoking caused approximately 1million deaths in the UK.’

Equally, Professor John Britton, who sits on the Royal College of Physicians Tobacco Group, said the figures show reactions ‘are very rare’.

He told MailOnline: ‘These reports demonstrate adverse events from vaping, and in particular serious adverse events, are very rare. 

‘In contrast, since 2010 tobacco smoking has killed around one million people. 

‘We can thus be confident that vaping is substantially less harmful than smoking.’ 

Under its position statement, the Royal College of Physicians Tobacco Group acknowledges that while e-cigarettes ‘are probably more hazardous than nicotine replacement therapy, the harm is unlikely to exceed 5 per cent of that from smoking tobacco’. 

Mark Oates, founder of consumer advocacy group We Vape, also told MailOnline it is ‘important to keep the MHRA findings in perspective’ but acknowledged the research into the health impact of the devices.

He said: ‘We welcome detailed and continuous research into the health effects of vaping so the safest possible devices are available to smokers trying to quit.

‘Some 4.3million people now vape in the UK and there have been no confirmed deaths as a result. 

‘In contrast, since 2010, more than a million people have been killed by smoking. It’s therefore important to keep the MHRA findings in perspective.

‘Following the Covid vaccine rollout and booster scheme, for example, there were more than 11,500 reports of side effects from the jab using the Government’s yellow card system, yet we didn’t halt a programme that has invariably saved countless lives.’

He added: ‘Vaping is helping millions of people avoid a preventable and often agonising death, around the world, every year from smoking. 

‘This excellent news should not be overlooked when studying self-reported side effects in a significant minority of vapers.’

Earlier this month however, leading paediatricians also warned children were being hospitalised with vaping-induced breathing difficulties amid a ‘disturbing’ youth vaping epidemic.

The Royal College of Paediatrics and Child Health (RCPCH) warned that e-cigarettes ‘are not a risk-free product and can be just as addictive, if not more so than traditional cigarettes’.

It called for urgent action to protect youngsters, saying experts agree that longer-term data is needed on the effects of vaping, particularly in regard to cardiovascular disease.

Under an anti-smoking push, last month health minister Neil O’Brien revealed a £3million taskforce would be established to enforce the current rules of selling of vapes.

But one million cigarette addicts will also get e-cigarette ‘starter kits’ as part of a ‘swap to stop’ scheme.

The free kits are set to be offered to almost one in five of all smokers in England at an estimated cost of £45million over two years. 

Health chiefs hope the world-first policy will make England smoke-free.

But Mr O’Brien also acknowledged No10’s ambition to crackdown on the sale of e-cigarettes to under-18s as well as the colourful packaging and candy flavours they use to lure kids in.

It is illegal to sell vapes to under-18s but social media carries posts from teenagers showing vapes and discussing flavours such as pink lemonade, strawberry, banana and mango. 

A damning MailOnline expose in April laid bare the true scale of the problem and the marketing tactics of vape retailers trying to target children. 

Tom Padley, now 19, from Putney, London, told MailOnline at the time that he had been using vapes since the age of just 13.

Tom, who picked up the habit in boarding school, said ‘it’s not like cigarettes, where you would have to find a place to go outside and do it — you can just do it non-stop indoors’. 

But six years into vaping, he has begun to suffer health issues.

‘I get ill a lot more. I get ulcers occasionally in my mouth. I have a lot of coughs. I guarantee it’s massively increased due to vaping,’ he told MailOnline.

Last month, the BBC also discovered ‘highlighter vapes’, confiscated from youngsters at a college in Kidderminster, contained dangerous levels of lead, nickel and chromium.

The gadgets, which can cost as little as £5, were over 9.6 times the safe level of nickel and 6.6 times the safe level of chromium.

Exposure to lead can impair brain development, while the other two metals can trigger blood clotting. 

Britain’s ‘overcomplicated and burdensome’ tax system is holding back UK growth, MPs warn.

The system is an ‘obstacle to economic dynamism’, a report by the Commons Treasury committee found.

It criticised the decision by Chancellor Jeremy Hunt to abolish the Office for Tax Simplification and called on the Treasury to subject itself to regular scrutiny on how it is improving the system.

The report casts a fresh light on how taxes are stifling Britain’s economic progress.

Britain’s tax burden is already on course to rise to the highest level since the Second World War.

The MPs make clear that the way the system is set up, miring firms and individuals in red tape and confusion, is also taking its toll.

It finds that they are faced with 1,180 separate tax reliefs as well as numerous ‘cliff edges’, such as income thresholds for being entitled to tax-free childcare and a sales threshold above which firms are obliged to register for VAT.

The byzantine system can all add up to a disincentive to work or grow a business, the MPs found.

Tory MP Harriett Baldwin, the committee’s chairman, said: ‘It’s widely acknowledged – including by the Chancellor – that our tax system is over-complicated, confusing and inefficient.

‘It contains numerous cliff edges which disincentivise work, business growth and personal development.

‘Disbanding the office established to champion tax simplification risks signalling the Government is not serious about the task at hand.

‘Action needs to be taken, and public scrutiny of government efforts are vital.

‘That’s why we’re calling for the Government to report to our committee each year on the success of the Treasury’s tax simplification efforts.’

The report said: ‘The complex tax system is an obstacle to economic dynamism. Its morass of tax reliefs and exemptions create compliance burdens and confusion.’

The report comes at a time when millions of workers are being dragged into paying higher rate income tax because thresholds have been frozen – even though pay rises are failing to keep pace with the rising cost of living.

And businesses are being hit by higher corporation tax, which climbed from 19 per cent to 25 per cent this year.

The swelling tax burden comes on top of the pain being caused by very high inflation and soaring interest rates.

The report comes after the closure of the Office for Tax Simplification was announced by Kwasi Kwarteng in his disastrous mini-Budget last autumn when he was chancellor briefly.

It was one of the few measures that was not reversed by his successor Mr Hunt – who insisted that did not mean that simplifying tax was no longer a priority.

The body had been set up by George Osborne when he became chancellor in 2010. He had intended it to be ‘a permanent force for a simpler tax system’.

However, the MPs found evidence that it had not been as effective as might have been hoped.

Bill Dodwell, tax director of the OTS, told the committee that the tax system had not become simpler over the period of its existence, the report said. In fact, the tax code had become longer as new levies were introduced.

But a trade body, the Association of Accounting Technicians, defended its work saying that without its input there would have been far fewer ‘successful tax simplifications’.

Even the taxman has admitted that the system was too complicated.

Jonathan Athow, a director general at HM Revenue and Customs, admitted to the committee that ‘most commentators would say that the tax system has, over time, become more complex’.

A survey by the British Chambers of Commerce this year found that nearly one in three businesses (30 per cent) were regularly finding themselves caught up in tax and red tape problems.

The survey revealed that 65 per cent will raise prices due to cost pressures.

HM Treasury spokesperson said: ‘Tax simplification remains a priority for this Government and is considered central to our work, as seen with the recent abolition of the pensions Lifetime Allowance.

‘We have embedded tax simplification into the institutions of Government to make sure the tax system fosters the right conditions for businesses to prosper and the economy to grow.’

As the smog from Canadian wildfires begins to dissipate across the United States, experts warn that the pollution doesn’t just impact your lungs but your skin as well. 

Nearly 120 million Americans are exposed to potentially life-shortening air pollution in their life, a report from the American Lung Association said.

Medical researchers have found that exposure to air pollution is a risk factor for skin disorders such as eczema, dermatitis and psoriasis.

The ‘toxic’ smog is also associated with hyperpigmentation spots and wrinkle formation.

Last week, wildfire smoke from Canada caused air quality levels to skyrocket to ‘hazardous’ levels.

Online calculators suggested breathing in the air in New York City for 24 hours was equivalent to smoking 22 cigarettes at the height of the crisis. 

Dr Christine Ko, a professor of dermatology from Yale School of Medicine, told DailyMail.com: ‘Wildfire smoke can contain tiny, particulate matter that can be breathed into the lungs; for skin, the particles are often too big to truly penetrate healthy skin.’

She recommended maintaining skin health by ‘keeping the outermost layer strong (no picking or excessive rubbing) and washing gently but thoroughly.’ 

Dr Ko said: ‘If skin is not healthy, meaning the skin barrier is not completely protective — as in if you have eczema or acne or psoriasis, more care should be taken to protect the skin from pollutants by covering skin, as an example.’

Dr Shari Lipner, dermatologist from Weill Cornell Medicine, told DailyMail.com: ‘The impact of wildfire smoke on the skin needs to be studied more rigorously, but it is likely one of the first place that you can see signs of damage from pollution. 

‘Since one study showed that there was an increase in medical visits for eczema and psoriasis during the California wildfires, wildfire likely causes flares in people who have eczema and psoriasis.’

Dermatologist Dr Doris Day told FOX Weather the wildfire smoke can have a ‘powerful impact on your skin.’

She said: ‘You might see it as dry skin, dull skin, acne, light breakouts, uneven skin tone, and then with continued long-term exposure. We see accelerated skin aging and even skin cancer.’

Protecting skin from pollutants is ‘so important,’ she said, and getting rid of them by washing your face as soon as possible is ‘critical.’

She said: ‘Washing off makeup and washing your face when you get home is really helpful because sleeping with those pollutants and makeup on your skin accelerates that toxicity and increases it over time.’

The smoke filled the air with tiny particles called PM2.5, measuring around 2.5 micrometers. 

In comparison, according to the Environmental Protection Agency, a single human hair is about 70 micrometers, and the human eye can’t see anything smaller than 25 micrometers. 

The health impact of a particle concentration of 22μg/m3 per 24 hours is equivalent to about one cigarette. 

Inhaling these particles can cause inflammation in the heart and lungs, leading to chronic illnesses such as asthma and Chronic Obstructive Pulmonary Disease (COPD). 

The particle matter can also penetrate the skin and, when it does so, leads to an immune reaction causing inflammation.

This can, in turn, damage skin cells and cause them to lose their structure, raising the risk of wrinkles.

It can also lead to other skin diseases.  

A 2021 study in JAMA Dermatology, for example, found that short-term exposure to this smoke can cause flare-ups of skin disorders like psoriasis and eczema. These could even show up weeks later.

Additionally, a study published last year linked short-term exposure to pollution from California wildfires to an increase in eczema and itchy skin in adults over age 65.