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…

“We need to think about networks and define if they are commissioner or provider led.” I heard this said a few weeks ago. I also heard it said 3 years ago. I think the first time I heard it said was well over 10 years ago.

Creating a taxonomy for networks seems to be a labour for Sisyphus. Having been involved, more than once, in trying to define and clarify the role for networks I have begun to wonder if we are approaching this with the wrong question. Perhaps we should be wondering not what a network is but why do we need networks? more…

Opening up NHS data to all will bring jobs, economic growth, innovation, a better health service, reduced health costs, and a new age in science. That was the heady message heard by a long dinner table of the good and the great in the House of Commons last week. Most of them seemed to be competing with each other to announce the wonders that transparency will bring. But can it be true and will a few dissenters spoil the vision? more…

Despite the widespread concern and opposition to the coalition government’s NHS reforms, the Health and Social Care Bill continues on its way towards royal assent, which is likely to happen in the spring of 2012. Opponents of the reforms, including the BMA, are concerned that the legislation will lead to increasing commercialisation, fragmentation, and privatisation of the NHS. The recently leaked DH document on commissioning confirmed fears about privatisation of commissioning support, which led to the BMA Council taking a decision to oppose the whole bill and abandon its “critical engagement” policy. The ongoing issues around the duties and powers of the Secretary of State to provide a comprehensive service, which has been deferred to the Lords report stage next month, also raises serious concerns that denationalisation of the NHS is an intention of the reforms, as described in a recent BMJ article by Pollock and Price. When seen from a wider political perspective, it is clear the intention of the bill is to replace large swathes of the public sector with the private sector. This is also in keeping with the recent White Paper on public services reform. more…

No frills: Basic services. Fast, efficient, and result driven. If you want business class comfort, you pay for a business class hospital. The NHS would provide hospital not hotel service. No optional extras—no lifestyle, cosmetic, or non core surgery. A non negotiable list of essential medications generated centrally. If you want medications not on the list—you pay. No more, no less. more…

The operating framework for the NHS has now been published. Reading through the detail I was struck by the tasks laid at the door of PCT clusters. These transitional organisations know the date of their death. Despite that, there is an expectation they will continue to deliver, whilst acting as a catalyst for the reforms: go to paragraph 3.7, paragraphs 3.18 and 3.21, paragraphs 3.22 and 3.24 (and help me understand what the rules around that last paragraph are?). Paragraph 3.25 has enormous implications. More work is detailed in paragraphs 4.36 & 4.37, and so on. more…

David Cameron’s oft-quoted assertion that the Health and Social Care Bill has now won the support of NHS professionals is much derided. And last week’s volte face from the BMA to actively oppose the bill only further undermines his optimism. In fact it’s hard to find much support anywhere.

But support there is and most of it was congregating at the NHS Alliance conference in Manchester this week. The NHS Alliance is the perky puppy dog of primary care. Its conferences are always unusually optimistic for a gathering of NHS dwellers – it’s an organisation built largely in the image of its cheerful bow-tied GP chairman Michael Dixon, who set the upbeat tone for the conference by bursting onto the stage through a paper banner screaming “Breakthrough.” Yes, it was as odd as it sounds, but for many delegates at this conference (GPs and primary care management on the whole) the Health and Social Care Bill is what they’ve spent 14 years pushing for. This is their moment. more…