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Keyhole surgery is perhaps a misleading term: despite the technology, expertise and extreme finesse involved, it’s also hugely physical. 

Sky News watches as surgeon Luke Jones performs an anterior cruciate ligament reconstruction in an operating theatre in King Edward VII’s hospital in central London.

Mr Jones (male surgeons are referred to as Mr rather than Dr) doesn’t just remove a hamstring: he pulls it out with force.

Drills bore through bone. Flesh smokes as it is cauterised. There’s a fair amount of hammering: “Mallet, please,” Mr Jones asks his assistant.

The ACL is a small band of tissue running through the middle of the knee that keeps it stable.

But watching the operation, it’s easy to understand why tearing it is so devastating. Even though the patient will only have three tiny scars, their knee has taken a pummelling.

“There’s 90 minutes in theatre with me,” Mr Jones tells Sky News, adding: “And then there is one year of rehabilitation with your physiotherapist afterwards.”

That’s why ACL injuries are so feared, especially by one type of athlete: female footballers.

‘Way too many’ women’s players with ACL injuries

Between 25 and 30 players – enough for an entire extra squad – will miss the upcoming World Cup because of ACL injuries. England stars Beth Mead and Leah Williamson have been ruled out. Data from ACL Women Football Club suggests 195 elite players have suffered the injury in the last year.

It has been described as an “epidemic”. And it is an epidemic that affects women far more than men: they are 2.5 to 3.5 times more likely to rupture an ACL than a male athlete. And we don’t really know why. Even as the women’s game has boomed, research has lagged behind.

One player who is going to the World Cup is England defender Jess Carter. Speaking before departure at St George’s Park, England’s national football centre, she tells Sky News: “There’s been way too many women’s players who have had ACL injuries and not enough research that’s been done about it.

“Why are there so many injuries? How can we prevent it? Why are they happening? A question I sometimes ask is: if this was happening to high profile men’s players, would more work be going in to try and improve things?”

England's Leah Williamson. Pic: AP
Image:
England’s Leah Williamson. Pic: AP

Nature versus nurture

The problem is that there isn’t just one answer.

“I’ve made a list the other day, and I think there are 30 reasons that have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher at St Mary’s University Twickenham and a medical researcher for FIFA.

“And I think we can split it into two main categories. And I like to call them nature and nurture.

“So the nature is like the biology: the genes, the way the body is shaped and muscle mass, etc… But also the nurture of the environment that the women are in. So the way that young female players are managed compared to male players, the facilities, the professionalism around the sport, the quality of the staff that they have available.”

I ask whether research into injuries in the women’s game has received as much attention as men’s.

“Attention? No. But generally that’s across all research in football and in sports medicine. The male has been the norm,” she adds.

Research will end up benefiting the men’s game too

Take one issue from the realm of ‘nurture’ that Kat is studying: football boots. The male foot was the norm. It’s only in recent years that boots designed specifically for women have become available. And even then we don’t understand the differences properly, which is why Kat has done 3D scans of hundreds of feet, to map them.

That research will end up benefiting the men’s game too because Kat is also charting the differences between ethnicities. Because the default foot isn’t just a man’s, it’s a white man’s.

The male is also the norm when it comes to other environmental factors, like booking a pitch.

On a Thursday evening in Kent, the Gravesham Girls and Women’s Football Club, founded in 1999, is training ahead of the start of the season. About 20 players, kitted out in yellow, are doing shooting drills and balls are flying. A Sky News camera operator cops one in the belly but bravely continues.

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Toni Allen and Keylie Oliver have both ruptured their ACL in the past. “I just screamed – everyone thought it was a fox,” Allen says. Both were out for a year.

“It’s quite daunting, and especially when you realise it’s not just football that it can impact, Oliver says.

“We have lives outside of football and it impacts that as well… At grass roots, the ladies always have a two o’clock kick-off. And that is because in our world, men’s football takes priority over women. We always have to play after – so the pitch is always ruined.”

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Women’s football: The ACL epidemic

The importance of the factors can change

Another difficulty is not just that there are lots of factors involved, it’s that the importance of the factors can change.

Professor Kirsty Elliott-Sale is professor of female Endocrinology and Exercise Physiology at the Manchester Met Institute of Sport.

She works closely with clubs, including Arsenal, to study how the menstrual cycle, or taking the Pill, can influence injuries. Research seems to suggest that some hormones can make ligaments looser, increasing the risk of rupture.

So over the course of the season Prof Elliott-Sale measures the laxity of players’ knees, charting that against their hormones, and cross referencing it with other factors like match congestion.

“It’s definitely a jigsaw,” she says. “And it’s about sort of putting all the pieces together.

“But once we have all the pieces, we don’t necessarily know which factor is going to play a bigger role on any given day. So it’s not like all of the pieces are the same size. Some days, a particular factor that might influence this type of injury might be amplified, whereas on another day, it might be turned down.”

Biology remains a large part of the answer

But even then the difference between female and male body types – which in the past led to some dismissing women as too “fragile” to play traditionally male sports – may not be as much of a factor as previously thought.

Because in some sports, the ACL injury discrepancy disappears.

“If you compare sports, where males and females start at the same age, have the same training intensity throughout their sporting life, and perform the same movements during that sport, then actually, the rupture rates equalise,” Mr Jones, the surgeon, says.

“And a very good example for that is elite dancers. So elite dance athletes, where the males and females start their training at the same age, they perform the same pivoting, jumping, twisting movements, and they have the same intensity of training and the same conditions. If you compare their rupture rates, they’re actually equalised.”

“And what that suggests is the impact of your training and your conditioning is really essential and avoiding this injury.”

Every expert I spoke to stressed the role of strength and conditioning in preventing injury. Here, nurture influences nature.

“We have that attitude of, you know, women do yoga, and pilates and men lift heavy things in the gym,” Ms Kryger says.

“But the reality is everyone needs to lift heavy things occasionally to prevent injuries and have a healthy body.”

England's Beth Mead has also been ruled out due to injuries. Pic: AP
Image:
England’s Beth Mead has also been ruled out due to injuries. Pic: AP

Read more:
Women’s World Cup warm-up match abandoned after 20 minutes
World Athletics criticised over decision to exclude trans women from female events

The good news is that quantifiable progress is being made here.

Matt Whalan is a sports scientist who works with the Australian men’s and women’s football teams – the Matildas who will be competing in the World Cup. He spoke to me from the men’s under 23s camp there.

Football Australia introduced a programme called ‘Perform+’, which can be worked into warm ups, that has reduced injuries, including ACLs, by 40%.

And crucially, it’s not just for elite players.

“This is designed so that mom and dad coaches can just go online, take down the programme, all the videos are there, there’s information about how you can deliver it with your athletes, and from under-sevens through to 55-year-olds, 95-year-olds, if you want to, you can do these exercises,” Mr Whalan says.

“The benefit of that for us at the higher end level, working with national teams, is if we have players that have been doing that, since they’re 12,13,14 years old, it makes our lives a lot easier.”

That remains in the future. When the World Cup starts next week, it will do so without a host of stars.

As England forward Chloe Kelly tells Sky News: “Having suffered the ACL injury myself, it’s so sad when you see so many players suffering that injury. Hopefully, we get the research that we need to stop these injuries happening so often.”

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Labour accused of another manifesto breach after major workers’ rights U-turn

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Labour accused of another manifesto breach after major workers' rights U-turn

The Labour government is facing accusations of two manifesto breaches in as many days after turning its back on a promise to protect workers from unfair dismissal from day one in a job.

A day after Rachel Reeves confirmed an extended freeze on income tax thresholds that critics said amounted to a manifesto-breaching tax hike on working people, the business secretary announced a key measure in the flagship Employment Rights Bill would be watered down.

The qualifying period for unfair dismissal is currently two years, and Labour said in their manifesto they would bring it down to one day.

But Peter Kyle announced on Thursday it would now be six months, having faced opposition from businesses.

Mr Kyle defended the change, insisting “compromise is strength”, but Tory leader Kemi Badenoch described it as “another humiliating U-turn” and a number of Labour MPs aren’t happy.

Andy McDonald, MP for Middlesbrough and Thornaby East, branded the move a “complete betrayal”, while Poole MP Neil Duncan-Jordan said the government had “capitulated”.

Former employment minister Justin Madders, who was sacked in Sir Keir Starmer’s reshuffle earlier this year, also disputed claims the move did not amount to a manifesto breach.

“It might be a compromise,” he said, “but it most definitely is a manifesto breach.”

What did the manifesto say?

The Employment Rights Bill was a cornerstone of Labour’s 2024 election manifesto, and also contains measures that would ban zero-hours contracts.

The party manifesto promised to “consult fully with businesses, workers, and civil society on how to put our plans into practice before legislation is passed”.

“This will include banning exploitative zero-hours contracts; ending fire and rehire; and introducing basic rights from day one to parental leave, sick pay, and protection from unfair dismissal,” it said.

Angela Rayner was a key driver of the bill before she left cabinet, but Peter Kyle (below) is now calling the shots. Pic: PA
Image:
Angela Rayner was a key driver of the bill before she left cabinet, but Peter Kyle (below) is now calling the shots. Pic: PA

Pic: Reuters
Image:
Pic: Reuters

How did we get here?

But the legislation – which was spearheaded by former deputy prime minister Angela Rayner – has been caught in parliamentary ping pong with the House of Lords.

Last month, some peers objected to the provisions around unfair dismissal, suggesting they would deter some businesses from hiring.

They also opposed Labour’s move to force employers to offer guaranteed hours to employees from day one, arguing zero-hour contracts suited some people.

Ministers said reducing the qualifying period for unfair dismissal turned the bill into a “workable package”.

Read more:
Budget 2025: The key points at a glance
Starmer insists Labour ‘kept to our manifesto’

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Employment Rights Bill is ‘anti-growth blueprint’

Businesses have largely welcomed the change, but unions gave a more hostile response.

Sharon Graham, the general secretary of Unite, said the bill was now a “shell of its former self”.

“With fire and rehire and zero-hours contracts not being banned, the bill is already unrecognisable,” she said.

The TUC urged the House of Lords to allow the rest of the legislation to pass.

Paul Nowak, the general secretary, said: “The absolute priority now is to get these rights – like day one sick pay – on the statute book so that working people can start benefitting from them from next April.”

‘Strikes the right balance’

The Resolution Foundation said the change in the unfair dismissal period was a “sensible move that will speed up the delivery of improvements to working conditions and reduce the risk of firms being put off hiring”.

It said the change “strikes the right balance between strengthening worker protections and encouraging businesses to hire” and deliver “tangible improvements to working conditions”.

The Confederation of British Industry (CBI) added: “Businesses will be relieved that the government has agreed to a key amendment to the Employment Rights Bill, which can pave the way to its initial acceptance.

“This agreement keeps a qualifying period that is simple, meaningful and understood within existing legislation.

“It is crucial for businesses confidence to hire and to support employment, at the same time as protecting workers.”

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Budget 2025: Reeves urged to ‘make the case’ for income tax freeze – as PM hits out at defenders of ‘failed’ policy

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Budget 2025: Reeves urged to 'make the case' for income tax freeze - as PM hits out at defenders of 'failed' policy

Rachel Reeves needs to “make the case” to voters that extending the freeze on personal income thresholds was the “fairest” way to increase taxes, Baroness Harriet Harman has said.

Speaking to Sky News political editor Beth Rigby on the Electoral Dysfunction podcast, the Labour peer said the chancellor needed to explain that her decision would “protect people’s cost of living if they’re on low incomes”.

In her budget on Wednesday, Ms Reeves extended the freeze on income tax thresholds – introduced by the Conservatives in 2021 and due to expire in 2028 – by three years.

The move – described by critics as a “stealth tax” – is estimated to raise £8bn for the exchequer in 2029-2030 by dragging some 1.7 million people into a higher tax band as their pay goes up.

Rachel Reeves, pictured the day after delivering the budget. Pic: PA
Image:
Rachel Reeves, pictured the day after delivering the budget. Pic: PA

The chancellor previously said she would not freeze thresholds as it would “hurt working people” – prompting accusations she has broken the trust of voters.

During the general election campaign, Labour promised not to increase VAT, national insurance or income tax rates.

Sir Keir Starmer has insisted there’s been no manifesto breach, but acknowledged people were being asked to “contribute” to protect public services.

He has also launched a staunch defence of the government’s decision to scrap the two-child benefit cap, with its estimated cost of around £3bn by the end of this parliament.

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Prime minister defends budget

‘A moral failure’

The prime minister condemned the Conservative policy as a “failed social experiment” and said those who defend it stand for “a moral failure and an economic disaster”.

“The record highs of child poverty in this country aren’t just numbers on a spreadsheet – they mean millions of children are going to bed hungry, falling behind at school, and growing up believing that a better future is out of reach despite their parents doing everything right,” he said.

The two-child limit restricts child tax credit and universal credit to the first two children in most households.

The government believes lifting the limit will pull 450,000 children out of poverty, which it argues will ultimately help reduce costs by preventing knock-on issues like dependency on welfare – and help people find jobs.

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Budget winners and losers

Speaking to Rigby, Baroness Harman said Ms Reeves now needed to convince “the woman on the doorstep” of why she’s raised taxes in the way that she has.

“I think Rachel really answered it very, very clearly when she said, ‘well, actually, we haven’t broken the manifesto because the manifesto was about rates’.

“And you remember there was a big kerfuffle before the budget about whether they would increase the rate of income tax or the rate of national insurance, and they backed off that because that would have been a breach of the manifesto.

“But she has had to increase the tax take, and she’s done it by increasing by freezing the thresholds, which she says she didn’t want to do. But she’s tried to do it with the fairest possible way, with counterbalancing support for people on low incomes.”

Read more:
Labour’s credibility might not be recoverable
Budget 2025 is a big risk for Labour’s election plans

She added: “And that is the argument that’s now got to be had with the public. The Labour members of parliament are happy about it. The markets essentially are happy about it. But she needs to make the case, and everybody in the government is going to need to make the case about it.

“This was a difficult thing to do, but it’s been done in the fairest possible way, and it’s for the good, because it will protect people’s cost of living if they’re on low incomes.”

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Prostate cancer: NHS screening programme could come one step closer today

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Prostate cancer: NHS screening programme could come one step closer today

An NHS screening programme for prostate cancer could come one step closer if it’s backed today by a key committee that advises the government.

The National Screening Committee, comprised of doctors and economists, will reveal whether it now believes the benefits of screening outweigh any risks, and whether testing could be done at a reasonable cost to the NHS.

When it last looked at the evidence in 2020, it rejected calls for screening, even though prostate cancer kills 12,000 men a year.

But in recent months, there has been growing pressure for screening from high-profile public figures such as Olympian Sir Chris Hoy and former Sky News presenter Dermot Murnaghan.

Both have been diagnosed with advanced prostate cancer, yet the disease is curable if detected in its early stages.

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Sir Chris Hoy and Dermot Murnaghan on facing cancer

Former prime minister David Cameron has also backed the campaign for screening this week after revealing he had been treated for the cancer.

The committee will decide whether new research has tipped the scales in favour of screening older men, or whether to target only those at higher risk, such as black men and those with a family history of the disease.

The case for…

Lithuania is currently the only country to screen all men aged 50-69 with a blood test for PSA, a protein released by prostate cells.

A low level is normal. But levels can rise steeply in men with cancer.

A recent study showed that regular PSA testing of men over 50 could reduce deaths by 13%.

That’s about the same survival benefit of breast screening.

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Cameron treated for prostate cancer

…and the case against

But the PSA blood test isn’t completely reliable.

One in seven men with prostate cancer actually have a normal PSA level.

And even those with a high level may have a cancer that is so slow growing that it’s just not a threat.

That’s why the National Screening Committee has warned in the past that PSA screening could lead men to have surgery or other treatment that they don’t actually need. Treatment can result in incontinence or impotence.

But the evidence has moved on.

These days men with a high PSA should have an MRI scan of their prostate, which significantly reduces the risk of unnecessary treatment. And the treatment itself is getting safer.

But the committee may judge that the risks and benefits of screening all men in their 50s and 60s are still too finely balanced to give the go-ahead.

They may wait for results from the Transform trial, which has just been launched and will compare different screening strategies. That could take many years.

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‘When I was diagnosed, it was too late’

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U-turn over unfair dismissal policy

But campaigners are hopeful that the committee will recommend the screening of men at higher risk of prostate cancer in the meantime.

Black men have twice the risk of those from other ethnic groups.

Men whose father or brothers have had prostate cancer are two and a half times the risk.

And there is also an increased risk for men whose mother or sisters have had breast or ovarian cancer.

Roughly 1.3 million men fall into one of the risk groups.

But identifying and inviting them for screening could prove tricky. GPs don’t always note a patient’s ethnicity in their medical records, and they would usually only know about a patient’s family history if they have been told.

If the committee recommends screening in some form, it is likely to go out to a public consultation before landing on the desk of Health Secretary Wes Streeting for a final decision.

Ultimately, it is his call whether at least some men are screened for what is now the most common cancer in England.

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