The prime minister has picked a new health advisor, Nick Seddon, who poured cold water on the creation of clinical commissioning groups and appears to be focused on moving NHS management away from public bodies and into the private sector. Whatever the rhetoric might suggest, changing the NHS into a commercial insurance model appears to […]
Category: Columnists
Penny Campling: The last thing the NHS needs is a compassion “pill”
Reading the Francis Report for many of us is like looking in a mirror. The mirror is at an angle, magnifying the perversities in the picture, but it is all recognisable. We see our NHS reflected back at us, the NHS in England in the early years of the 21st Century. As the weeks since […]
Tiago Villanueva: Is there going to be a brain drain of doctors in Portugal?
I have already been invited twice this year to give a talk about emigration of doctors out of Portugal. I find this a sign of the difficult times we’re going through in Portugal. Doctors, like every citizen, have been subject to relentless austerity measures and to progressive impoverishment. But we’re not currently seeing doctors leaving […]
David Kerr: Signals from the crowd—making a diagnosis
For very many years making a medical diagnosis was based loosely on the application of the principle of Occam’s Razor otherwise known as diagnostic parsimony—look for the fewest possible causes to explain a patient’s symptoms. However, with the increase in longevity of the background population, Occam’s Razor was eventually superseded by the Hickam’s Dictum which […]
Richard Smith: The irrationality of the REF
The Saturday before last I was rung up by a fellow of the Royal Society who was having trouble with the New England Journal of Medicine, and our conversation soon moved to the irrationality of “the REF” [research excellence framework]. We made the move because I asked why the results of a major trial undertaken […]
David Lock on integrated care experiments: at last some sensible thinking from the government for the NHS
The HSJ reports that the government is about to signal a series of large scale integrated care “experiments,” which could result in a movement away from the straightjacket of payment by results, with all of the biases towards activity, and away from prevention that have been reported on so often. Is this a first step […]
Richard Smith: Stop jumping from “is” to “ought”
Last week for the first time I examined a PhD, and one of my co-examiners, a moral philosopher, told us of “Hume’s guillotine” and taught us a lesson that all doctors should know. The defence of the PhD was in Copenhagen and in public, as is the custom in Denmark. Around 80 people were there, […]
Desmond O’Neill: Gerontolysis
In an era when didactic teaching in medical education is frowned upon and where workshops and problem based learning rule supreme, it is refreshing to be reminded of the powerful impact of a high quality lecture. A superb overview of how good lectures tap into expectation, ritual and theatre posits that lectures are particularly effective […]
Julian Sheather: Francis—the ethical challenge
Medical ethics has positioned itself as a decision making tool, a philosophical spanner if you like in the clinician’s toolbox. For understandable reasons it has concentrated on practical dilemmas: even those landmark legal decisions—the removal of treatment from Anthony Bland comes to mind—are buttressed by intense philosophical scrutiny. In the process medical ethics has attracted […]
David Lock: Spot the legal howlers—picking over the assurances given by Lord Howe to the House of Lords
Healthcare lawyers have a new game—it’s called “spot the errors.” A number of us have been through the speech made by Lord Howe in winding up the debate in the House of Lords on the new NHS procurement regulations, on Wednesday 24th April, in order to count the legal howlers. This was, after all, the […]