This month we published a report on risk of type two diabetes in East London, with an accompanying paper in BMJ Open, and underpinned by a previous systematic review in BMJ. We took a risk scoring algorithm, the QDScore, and used it on just over half a million electronic records to identify high risk groups. QDScore is validated based on certain risk factors. For example, deprivation, body mass index, and certain ethnicities result in a higher score.   more…

Last year I blogged about the commission set up by Lord Falconer on assisted suicide.  It was clear from the outset that this commission was fatally flawed, not least because of the pro-assisted suicide stance of almost every member of the committee. 

Unsurprisingly the collection of evidence and hearings was unlikely to have a major impact given its biased beginnings. Most notably the British Medical Association refused to give evidence, and at the annual representative meeting in Cardiff in 2011, the association spoke clearly against the commission. more…

Last month we drew attention to three critical pieces of data that painted a picture of the piece by piece dismantling of the public health specialist workforce. Consultant appointment processes have dropped considerably in the last three years, registrars at end of training are failing to get substantive full time consultant posts, and academic public health seems to be declining. 

What’s really behind this is not clear, but findings in an important paper in this month’s Journal of Public Health continue to show this is a real stealth attack on the public health specialist workforce, and not just disparate pieces of unconnected information. Harrell and colleagues present a scholarly piece of research directly comparing recruitment in public health to that of hospital consultants.  more…

It’s great to see patient safety getting such a prominent focus on bmj.com this Christmas with support for the charity Lifebox. Lifebox’s first aim is trying to ensure a pulse oximeter gets into every operating theatre across the world. I hope we’ll all manage to give generously http://www.bmj.com/multimedia/video/2011/12/02/lifebox-appeal-atul-gawande

The desire for safer surgery has gathered momentum in recent years, especially with the interest shown by the World Health Organization’s Patient Safety Programme. I had the privilege in mid-2006 when working with WHO of meeting with Atul Gawande’s two wingmen in a quiet corner of L-Building at WHO headquarters in Geneva. They outlined an impressive vision for a surgical checklist and within months international consensus building was underway. I always thought this drive for patient safety in surgery would go a long way, but never quite imagined just how far in only five years. Once the American drama Emergency Room had featured it in one of their episodes success seemed certain.  more…

As I lay in Regents Park on Saturday 1 October showing my one year old daughter the falling autumnal leaves and conkers it hardly felt like winter was approaching. Not least because it was thirty degrees Celsius, and there was more ice cream on sale than climate change proponents could swallow. Yet, winter is on the way and unofficial reports suggest it may be as cold as last year.  more…

The recent riots in London and across the UK have been an awakening for many to realise the deep seated social problems in post modern British society.  The right look for thugs to be prosecuted, while the left demand further description and analysis of the complex “causes of the causes.” Both approaches are polarised and neither is satisfactory.  more…

The pause ended in dramatic fashion last week with the publication of the NHS Future Forum’s recommendations. 

Most interesting was the orthopaedic surgeon at Guys Hospital who confronted the prime minster and deputy prime minister in a rage because the camera crew were not suitably dressed for a hospital. 

It hit home on all sorts of levels.  more…

The 3rd BMJ Group Awards took place on 18th May. All the great and good in healthcare, national and international, assembled for 13 awards, including the prestigious lifetime achievement award. As the medical bigwigs entered the palatial Hilton Metropole Ballroom in triumphal procession, they were greeted with flashing multicoloured lights, rock music, and a definite sense of occasion. Stella Dutton CEO of BMJ Group appropriately dubbed the ceremony as the “medical oscars” in her opening remarks.  more…

Talk to almost any public health specialist and they’ll express their biggest concern about the current NHS reforms in England as fragmentation of the public health service. To understand why fragmentation is a bad thing, we first need to know what it is that could be broken up. 

Public health has traditionally consisted of three main domains of practice.  more…

A few weeks ago I attended a conference for GPs on commissioning in the brave new world of GP consortia, proposed in the recent health bill. 

The day started with a very upbeat GP seeking to enthuse the audience of about 70 participants with a reverberating war cry: “commissioning! who’s up for it?” One hand shot up like Hermione’s from Harry Potter. A few awkward seconds passed and slowly another hand went up with a turn of the head hoping they weren’t alone. They were. Two out of 70. What a start!  more…