I am the chief medical officer of our family. I am the bridge between my family members, some of them eccentric and one of them demented, and an unforgiving health system. Many doctors—indeed, anybody familiar with the strange language and rigidities of health systems—fulfil the same role, and it gives us some useful bottom up views of our health service.

Most of my endeavours are on behalf of my mother, a marvellous woman who is strong on joy and humour, but who has no short term memory. Together we are on track to write an NHS equivalent of Rumpole of the Bailey (in case you don’t know, hilarious stories of legal absurdities). more…

We are working through trying to understand exactly how commissioning support (CSS) will work with Clinical Commissioning Groups (CCGs). At a recent time out the lead manager for the CSS presented on the progress being made with Greater East Midlands CSS (GEM). They highlighted the scale of work that is required with the 277 tasks in the development plan. One of the Chief Operating Officers presented the programme of work required to see through the transition from a CCG. As they pointed out, this was a transition plan—for which the work required for authorisation is a component, not the be all and end all. There is as much to do to develop the CCGs as there is to develop the CSS—and they are mutually dependent. more…

The recent Cambridge University Leadership Programme looked at sustainable development in health services worldwide. It was an opportunity to hear the evidence and arguments which were both persuasive and alarming. The link between population growth and our reliance on a carbon-based economy, leading to rising levels of CO2 in the atmosphere, and the consequent changes in climate was compelling. This is relevant to healthcare systems, and the professionals that work within it, not only because climate change itself is having significant consequences on the health of populations, but because healthcare systems themselves have a significant carbon footprint. more…

It is all over now. The Health and Social Care Bill has been passed. The politicians have moved on, content to leave professionals and managers to pick up the pieces. Whichever side of this exhausting, divisive, and passionate argument you favoured, we are in a different place now. It is no longer a question of should we or shouldn’t we? Instead it is: how do we make this radically different NHS work for our patients? And how do we avoid reasonable fears about the bill from becoming a reality? more…

David Cameron and Andrew Lansley assert that a large majority of GPs support their bill. Is it true? Where is the evidence? Is the profession lined up in willing support, eager to take on responsibility for managing the NHS through its greatest crisis? Perhaps we all took the King’s Shilling while in our cups in the taverns and only now are waking up to find ourselves press-ganged aboard a merchantman across uncharted seas in the government’s service. more…

So why would a retired professor of public health decide to write a protest song, get his kids to help him record it, his wife to help him with the graphics, and take his first plunge into the dangerous world of YouTube? Isn’t this the fellow that usually writes dusty academic works about evidence-based practice? The answer is that the song was indeed an attempt at evidence-based practice, just one more tool in the struggle to prevent a major threat to the people’s health, namely Andrew Lansley’s Health and Social Care Bill. more…

Biology A level classes in the 1970s often involved frogs making the ultimate sacrifice for the benefit of their dissector’s knowledge of what lies beneath the amphibian skin. As far as I remember, it was not however common practice to test the widely-held belief that a frog in a water bath would tolerate a slowly rising temperature and die from heat exposure before attempting to escape. Dedicated scientists have proved that this is not the case. Hot frogs jump. more…

The e-petition calling on the government to drop its Health and Social Care Bill has now reached 153 000 signatures to become the second most popular campaign on Number 10’s official petition site. It already qualified for a debate in the House of Commons, when it passed the 100 000 signatures milestone. Some 90% of general practitioners, celebrities including Stephen Fry, Rio Ferdinand, and Jamie Oliver, three Cabinet ministers, and a good part of David Cameron’s own party (see Tim Montgomery’s blog) don’t want the bill. Rarely have doctors, nurses, and the public been so united on a political question. Sadly, David Cameron is closing his eyes and ears. more…

The Prime Minister’s summit on implementing the NHS reforms has provided a new focus for debate about what the reforms will mean in practice. The government’s critics maintain that competition will undermine the core values of the NHS to the detriment of patient care. Some of these critics go further to claim that competition will result in the privatisation of much healthcare provision and the end of the NHS as we know it.

History suggests the need to treat these claims with caution, if not scepticism. Ever since the Conservative government introduced the internal market reforms in the early 1990s, opponents of choice and competition have warned that the future of the NHS is under threat, and yet it is performing better today than ever before. And as Nick Timmins showed in a recent analysis for the Financial Times, the private sector’s share of the market for elective care for NHS patients has remained stable,  giving the lie to the argument that widespread privatisation of provision is inevitable. more…

One story has dominated my first year as news reporter for BMJ Careers: pensions. And what a compelling story it has been. 

The issue kicked off way back in March this year when Lord Hutton set out a raft of changes to public sector pensions, which included ending final salary schemes in favour of career average schemes, increasing the normal retirement age in line with stage pension age (due to creep up to 68 in the next 35 years), and increasing the amount employees pay into their pensions. Come summer the government gave the green light to Lord Hutton’s proposals and set out the details of the contribution increases for 2012-13. It has however remained tight lipped on increases planned for 2013-14 and 2014-15, which could bring the total increase in contributions up to 3.2 percentage points for high earners such as doctors. These suggestions were met with fury from the BMA, which said that doctors were being asked to pay more and work longer for a worse pension. It has also pointed out that the NHS scheme has already undergone an overhaul in 2008 and is filling the treasury’s coffers to the tune of £10.7 billion over the next five years rather than depleting stocks. more…