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Alistair Cameron MacDonald (“Sandy”) was born in Elgin, Morayshire, where his father was a general practitioner. His earliest memories were of exploring the garden of the TB sanatorium and of playing at being a doctor at home: “I’d borrow my Dad’s trilby hat and a small version of his doctor’s bag, and I’d get on my tricycle and go and visit my patients in the garden. My patients were mostly the hens at the bottom of the garden—many of them survived.” Educated at Elgin Academy, during the summer holidays Sandy attended camps run by the Scripture Union. At Aberdeen University, for which he boxed and swam, he joined the Evangelical Union and during his houseman’s year was recruited as a missionary by the Church of Scotland. …

The government plans to continue using NHS funds to contract with commercial healthcare providers in the second phase of the independent sector treatment centre programme, but Allyson M Pollock and Sylvia Godden argue that no good evidence is available to support this policy

To investigate if published studies tend to report favourable cost effectiveness ratios (below 20,000 dollars, 50,000 dollars, and 100,000 dollars per quality adjusted life year (QALY) gained) and evaluate study characteristics associated with this phenomenon.Systematic review. Studies reviewed 494 English language studies measuring health effects in QALYs published up to December 2001 identified using Medline, HealthSTAR, CancerLit, Current Content, and EconLit databases.Incremental cost effectiveness ratios measured in dollars set to the year of publication.Approximately half the reported incremental cost effectiveness ratios (712 of 1433) were below 20,000 dollars/QALY. Studies funded by industry were more likely to report cost effectiveness ratios below 20,000 dollars/QALY (adjusted odds ratio 2.1, 95% confidence interval 1.3 to 3.3), 50,000 dollars/QALY (3.2, 1.8 to 5.7), and 100,000 dollars/QALY (3.3, 1.6 to 6.8). Studies of higher methodological quality (adjusted odds ratio 0.58, 0.37 to 0.91) and those conducted in Europe (0.59, 0.33 to 1.1) and the United States (0.44, 0.26 to 0.76) rather than elsewhere were less likely to report ratios below 20,000 dollars/QALY.Most published analyses report favourable incremental cost effectiveness ratios. Studies funded by industry were more likely to report ratios below the three thresholds. Studies of higher methodological quality and those conducted in Europe and the US rather than elsewhere were less likely to report ratios below 20,000 dollars/QALY.

Experts are common but not well understood. This guide introduces novice expert spotters to the essentials of artifexology—the study of experts

Economic evaluations in health and medicine usually ignore the possibility of future advances in treatment. But when technological innovation is rapid such considerations can have major implications

Understanding your study group is key to getting a good response to a questionnaire; dealing with the resulting mass of data is another challenge The first step in producing good questionnaire research is getting the right questionnaire.1 However, even the best questionnaire will not get adequate results if it is not used properly. This article outlines how to pilot your questionnaire, distribute and administer it; and get it returned, analysed, and written up for publication. It is intended to supplement published guidance on questionnaire research, three quarters of which focuses on content and design.2 Questionnaires tend to fail because participants don't understand them, can't complete them, get bored or offended by them, or dislike how they look. Although friends and colleagues can help check spelling, grammar, and layout, they cannot reliably predict the emotional reactions or comprehension difficulties of other groups. Whether you have constructed your own questionnaire or are using an existing instrument, always pilot it on participants who are representative of your definitive sample. You need to build in protected time for this phase and get approval from an ethics committee.3 During piloting, take detailed notes on how participants react to both the general format of your instrument and the specific questions. How long do people take to complete it? Do any questions need to be repeated or explained? How do participants indicate that they have arrived at an answer? Do they show confusion or surprise at a particular response—if so, why? Short, abrupt questions may unintentionally provoke short, abrupt answers. Piloting will provide a guide for rephrasing questions to invite a richer response (box 1). ![][1] #### Box 1: Patient preference is preferable I worked on a sexual health study where we initially planned to present the questionnaire on a computer, since we had read people were supposedly more comfortable “talking” to … [1]: /embed/graphic-1.gif

One of the key elements of the NHS information strategy of 1998 was the development of electronic patient records.1 These were expected to be developed within organisations and to be capable of being linked into a patient focused electronic health record, which would form a lifetime record of health and health care for each patient within the NHS.1 This vision has been modified slightly by updates of the strategy, and the electronic health record has been renamed and redefined as the NHS Care Record Service, but in many ways the original concept has remained the same.2 The purpose of the electronic health record—now the NHS Care Record Service—is twofold. Firstly, to provide support for the clinical team to help them recall and communicate health status and treatments for patients in a coordinated way, and, secondly, to act as the source of statistical information on types of patients seen and the process and outcomes of their treatment. Although there was much expectation that these goals could be achieved, there was little evidence to prove that this was the case for the original strategy and its subsequent refreshes.2 For that reason, the NHS Information Authority sponsored 18 pilot projects which ran from April 2000 to March 2003 to test the concepts in several locations. The central Hampshire electronic health record pilot project was supported from September 2000 to March 2003. During that time it evaluated the practicality of linking records from a wide range of organisations to support emergency and out of hours care, as well as providing information that could support data analysis and clinical governance. The project, originally based at North and Mid-Hampshire Health Authority, linked with several key organisations within the area, which included three general practices (one in Eastleigh and Test Valley South primary …

Objective To assess the current international representation of members of editorial and advisory boards and authors in the leading peer reviewed literature on tropical medicine. Design Systematic review. Main outcome measures Country affiliations, as classified by the human development index, of editorial and advisory board members of all tropical medicine journals referenced by the Institute of Scientific Information (ISI) as of late 2003 and of all contributing authors of full articles published in the six leading journals on tropical medicine in 2000-2. Results Sixteen (5.1%) of the 315 editorial and advisory board members from the 12 ISI referenced journals on tropical medicine are affiliated to countries with a low human development index and 223 (70.8%) to countries with a high index. Examination of the 2384 full articles published in 2000-2 in the six highest ranking tropical medicine journals showed that 48.1% of contributing authors are affiliated to countries with a high human development index, whereas the percentage of authors from countries with a low index was 13.7%. Articles written exclusively by authors from low ranked countries accounted for 5.0%. Our data indicate that research collaborations between a country with a high human development index and one that has either a medium or a low index are common and account for 26.5% and 16.1% of all full articles, respectively. Conclusion Current collaborations should be transformed into research partnerships, with the goals of mutual learning and institutional capacity strengthening in the developing world.

Objective To examine the prevalence of a risk of bias associated with the design and conduct of cluster randomised controlled trials among a sample of recently published studies. Design Retrospective review of cluster randomised trials published in the BMJ, Lancet , and New England Journal of Medicine from January 1997 to October 2002. Main outcome measures Prevalence of secure randomisation of clusters, identification of participants before randomisation (to avoid foreknowledge of allocation), differential recruitment between treatment arms, differential application of inclusion and exclusion criteria, and differential attrition. Results Of the 36 trials identified, 24 were published in the BMJ ,11 in the Lancet , and a single trial in the New England Journal of Medicine . At the cluster level, 15 (42%) trials provided evidence for secure allocation and 25 (69%) used stratified allocation. Few trials showed evidence of imbalance at the cluster level. However, some evidence of susceptibility to risk of bias at the individual level existed in 14 (39%) studies. Conclusions Some recently published cluster randomised trials may not have taken adequate precautions to guard against threats to the internal validity of their design.

Strong forces are operating that may change radically the world of scientific and medical publishing. These include

Problem: The NHS is perceived to have a poor record of learning from incidents. Despite efforts of the Medical Devices Agency, which issues safety warnings, adverse incidents with medical devices continue to occur, some of which result in serious injury or death through device failures, user errors, and organisational problems. Design: Introduction of feedback notes on a supportive investigation that seeks to determine latent factors, immediate triggers, causes, and positive actions taken by staff that minimised adverse consequences. Background and setting: Medical physics department providing equipment management services in a major NHS teaching trust. Key measures for improvement: Reduction in repetitions of adverse incidents and improved staff competency in using devices. Strategy for change: A feedback note was developed to describe the incident and generic details of the equipment, summarise the investigation (focusing on latent causes and immediate triggers), and describe lessons to be learnt and positive actions by staff. Effects of change: Feedback notes have been used in teaching sessions and given to ward link nurses. Despite being new, the positive supportive approach has encouraged an open reporting culture. Lessons learnt: Adverse incidents are typically caused by alignment of different factors, but good practice can prevent errors becoming incidents. Careful analysis of incidents reveals both the multifactorial causes and the good practices that can help minimise repetitions.

Objectives: To systematically review cost benefit studies of telemedicine. Design: Systematic review of English language, peer reviewed journal articles. Data sources: Searches of Medline, Embase, ISI citation indexes, and database of Telemedicine Information Exchange. Studies selected: 55 of 612 identified articles that presented actual cost benefit data. Main outcome measures: Scientific quality of reports assessed by use of an established instrument for adjudicating on the quality of economic analyses. Results: 557 articles without cost data categorised by topic. 55 articles with data initially categorised by cost variables employed in the study and conclusions. Only 24/55 (44%) studies met quality criteria justifying inclusion in a quality review. 20/24 (83%) restricted to simple cost comparisons. No study used cost utility analysis, the conventional means of establishing the “value for money” that a therapeutic intervention represents. Only 7/24 (29%) studies attempted to explore the level of utilisation that would be needed for telemedicine services to compare favourably with traditionally organised health care. None addressed this question in sufficient detail to adequately answer it. 15/24 (62.5%) of articles reviewed here provided no details of sensitivity analysis, a method all economic analyses should incorporate. Conclusion: There is no good evidence that telemedicine is a cost effective means of delivering health care.

This is the first of a series of five articles Development and introduction of new diagnostic techniques have greatly accelerated over the past decades. The evaluation of diagnostic techniques, however, is less advanced than that of treatments. Unlike with drugs, there are generally no formal requirements for adoption of diagnostic tests in routine care. In spite of important contributions, 1 2 the methodology of diagnostic research is poorly defined compared with study designs on treatment effectiveness, or on aetiology, so it is not surprising that methodological flaws are common in diagnostic studies.3–5 Furthermore, research funds rarely cover diagnostic research starting from symptoms or tests. Since quality of the diagnostic process largely determines quality of care, overcoming deficiencies in standards, methodology, and funding deserves high priority. This article summarises objectives of diagnostic testing and research, methodological challenges, and options for design of studies. #### Summary points Development of diagnostic techniques has greatly accelerated but the methodology of diagnostic research lags far behind that for evaluating treatments Objectives of diagnostic investigations include detection or exclusion of disease; contributing to management; assessment of prognosis; monitoring clinical course; and measurement of general health or fitness Methodological challenges include the “gold standard” problem; spectrum and selection biases; “soft” measures (subjective phenomena); observer variability and bias; complex relations; clinical impact; sample size; and rapid progress of knowledge Diagnostic investigations collect information to clarify patients' health status, using personal characteristics, symptoms, signs, history, physical examination, laboratory tests, and additional facilities. Objectives include the following.

An artist’s impression of the new headquarters of the European Medicines Agency in Amsterdam, to be constructed specifically for the EMA in the south of the city The European Medicines Agency will move from the UK to the Netherlands after Amsterdam was chosen ahead of Milan in a tiebreaker vote. The relocation, a consequence of the UK’s impending withdrawal from the European Union, was decided after a vote by the 27 member states at the EU’s General Affairs Council on 20 November. The EMA, which has been based in London since it was established in 1995 and currently employs nearly 900 staff, now has just …

MPs are calling for examples of cases where GPs from outside the European Economic Area have been unable to work or have been forced to leave the UK because of visa problems. The Health Select Committee has invited the public to submit examples of cases where GPs have been forced to leave the UK because of Tier 2 visa …

Scotland will become the first country in the world to set a minimum price for alcohol, after the final rejection of legal attempts by the drinks industry to block the move. Judges at the UK’s Supreme Court dismissed an appeal by the Scotch Whisky Association, which has argued that minimum pricing breaches European law. The decision brings an end to a five year fight to establish the legality of minimum pricing and was hailed by Alcohol Focus Scotland as a “fantastic day for public …

Are the doom laden headlines that warn of imminent NHS collapse justified, asks Nigel Hawkes—and are we making progress on plans to prevent it?

McCartney asks when she can start running again after a microdiscectomy.1 I wonder if she missed an alternative approach to finding the best advice. Following guidance based on evidence from randomised controlled trials is recognised to …

Public engagement with NHS changes went into “paralysis” when plans for sustainability and transformation partnerships (STPs) were launched in December 2015, the deputy director of Healthwatch England has said. Neil Tester said that communications between NHS bosses and the public went into “lockdown” and a “period of stasis” at a local level as plans for STPs were rolled out. The head of the organisation set up to represent NHS patients’ views was speaking at an event at the King’s Fund on 7 November. Tester spoke …

The NHS will have a workforce plan for the first time since 2000, England’s secretary of state for health has announced. Speaking at the NHS Providers conference in Birmingham on 8 November, Jeremy Hunt said that a draft plan would be published by the end of the year. He said that recent initiatives, such as plans to increase medical student numbers, would form part of a wider NHS workforce …

A GP who sought to end a professional relationship with a patient while pursuing an “improper emotional relationship” with him has been suspended for three months by a medical practitioners tribunal. Julien Nash, 54, a civilian doctor working at an air force base, RAF Cosford, urged “Patient A,” a serviceman, to find a new doctor when she realised that “a line had been crossed” after sharing a kiss with him in November 2015. But, the tribunal found, this approach breached the General Medical Council’s good practice guidance, …

I welcome Wright and Kelly’s Editorial on the health implications of environmental plastics,1 but I disagree with the conclusion that we need to establish safe thresholds for exposure—the urgent need is to stem the tide of plastic entering the environment in the first place. We must …

The viability of general practices is threatened by failings by the private company Capita, which provides primary care support services for NHS England, the BMA has warned. In a letter sent on 30 October to Simon Stevens, chief executive of NHS England, the BMA highlighted what it called Primary Care Services England’s “ongoing issues due to poor delivery” by Capita. However, Capita said that the BMA’s letter did not accurately reflect its role and involvement in providing the services. Richard Vautrey, chair of the BMA’s general practitioners committee, wrote that significant issues were affecting the practice support system, which had been “causing much distress to practices and putting patients at risk” for over two years. In the letter, Vautrey said that the BMA was very concerned about preparations for Capita to run new systems for cervical screening and for …

The NHS is struggling to cope because demand has grown much faster than anticipated, MPs have been told. Jeremy Hunt, health secretary for England, acknowledged the heavy pressures that NHS staff were working under when he appeared before the parliamentary health committee in a one-off evidence session on 31 October. MPs asked whether the health secretary agreed with the criticisms made in a report from the House of Lords about poor long term planning, published in April.1 Hunt agreed that some of the criticisms were fair, saying, “The area where I feel the biggest lack of long term planning has been is around workforce needs and the failure to understand over many years the lead times necessary to increase capacity in the …

Meg Hillier, chair of the House of Commons Public Accounts Committee, has warned the government of the serious potential risks of pressures in the NHS this winter, despite the Department of Health’s reassurances of better planning. Hillier, the Labour MP for Hackney South and Shoreditch, wrote to Chris Wormald, permanent secretary of the Department of Health, after an oral evidence session on 16 October, saying it was a “worrying time for already overstretched services.” Hillier, who has chaired the committee since 2015, said that Wormald had acknowledged that more remains to be done to put the NHS in England on a sustainable …

Sweden’s top ethical review board has called for six papers published by the disgraced surgeon Paolo Macchiarini to be retracted. They include a key 2011 paper published in the Lancet in which Macchiarini and colleagues claimed success in transplanting an artificial trachea seeded with the patient’s own cells into a 36 year old man.1 The operation took place at the Karolinska University Hospital in Stockholm. Since doubts first emerged about Macchiarini’s work, a series of reviews has been carried out.23 At first the Karolinska Institute, which employed him, declined to accept that there was evidence of misconduct but was …

After finding that most new cancer drugs appear to confer little clinical benefit, The BMJ’s Tessa Richards reflects on her cancer journey and argues that decision making in cancer must improve, to involve patients at every level

Climate change is already having significant effects on health, an international team has reported in the Lancet .1 An increase in the number of weather related disasters, greater exposure to heatwaves, and an increased risk of dengue fever because conditions are more favourable for mosquitoes are cited in support of the contention from the Countdown on Climate Change and Health team. But four members of the team, appearing at a briefing at the Science Media Centre in London, said that they had not attempted to draw up a balance sheet that included possible benefits of increasing temperatures. “We’re not ducking the potential benefits,” said Hugh Montgomery, co-chair of the group and director of the Institute for Human Health and …

Experts have told MPs that research is suffering from complacency, a lack of transparency, poor statistical skills, and too much weight being given to “exciting” research. The concerns were raised during an evidence session of the parliamentary science and technology committee’s inquiry into research integrity, held on 24 October. MPs asked witnesses for their opinion on the current state of research integrity, to which Ottoline Leyser, former chair of the steering group on the culture of scientific research at the Nuffield Council on Bioethics, said that a culture had developed “where people are rewarded for being right and being exciting.” She added, “Those things have nothing to do with science and the research method that we want to espouse. These norms of science that everybody would agree to if you pushed them are being not …

Pressure to achieve arbitrary targets is not a valid improvement strategy and leads to perverse incentives and use of resources, claims Peter Campbell, but Adrian Boyle and Ian Higginson say no alternative exists to keep emergency departments working

A hundred million pounds is a lot of money. NHS England has pledged to spend as much as this on recruitment agency fees to bring in GPs from abroad. The aim is for 5000 extra GPs. Overseas recruitment will make up a large portion of this new wave of doctors. In the 1960s, general practice in the NHS was saved by Indian and Pakistani doctors, at a time when a third to a half of UK medical graduates were emigrating themselves.1 But these doctors were not always well cared for. They often found themselves in the most deprived parts of the country, frequently without much support, discriminated against, and in the least competitive posts (but often the hardest).2 …

A study that linked aluminium vaccine adjuvants to genetic changes “homologous with biomarkers of autism” in mice is to be retracted by the Journal of Inorganic Chemistry .1 The retraction comes after readers of the website PubPeer claimed to have found image alterations in the paper. The study authors Christopher Shaw and Lucija Tomljenovic of the University of British Columbia then reviewed the data and found evidence of western blot image alterations. They contacted the journal and asked for the retraction, Shaw told The BMJ . The journal’s editor, John Dawson of the University of South Carolina, told the website Retraction Watch, “The paper by Shaw and co-workers is being retracted jointly by the authors …

Henry Francis Valentine Riddle (“Val”) was born in Galashiels. After national service in the Royal Navy (1946-48), he studied at Liverpool University and obtained a BSc in biochemistry in 1951 and in physiology in 1952. He completed his PhD thesis on the respiratory muscles, their function, and integration in 1957 and followed this with MB ChB in 1959. After marrying Pam in Liverpool in 1956, he moved to Dysart in Fife as a GP with specialist interests including dermatology and ophthalmology. He was principal from 1962 …

John Percival Barham qualified just before the end of the second world war and, after a casualty officer appointment at King’s, received his call-up papers on VE day. He joined the Royal Navy and set off for the Far East, a trip he referred to as his “world cruise on the grey funnel line.” After a short while …

The Department of Health in England has issued a warning to GPs who opt for cut price indemnity cover. On 12 October the health secretary, Jeremy Hunt, announced plans to develop a state backed scheme for general practice indemnity in England.1 Shortly after the announcement the Medical Defence Union (MDU) said that it would reduce indemnity subscriptions for GPs in England by around 50%. It said that, from 1 November 2017, GPs who renew their membership and new joiners will receive subscription quotes around 50% lower than current levels, under a transitional benefits scheme. The …

The goal of eliminating measles from Europe was dealt a blow last week after new data showed how outbreaks continue to sweep the continent. Nearly 19 000 cases of measles were reported in the European Union between January 2016 and October 2017, including 44 deaths, show figures collected by the European Centre for Disease Prevention and Control.1 The new figures were released as the centre steps up its initiatives in response to a rise in so called “vaccine hesitancy” in Europe. Speaking to The BMJ , the centre’s director, Andrea Ammon, said that governments and doctors needed to engage head on with parents over safety concerns. She praised Denmark, where rates of human papillomavirus (HPV) vaccination have plummeted, for taking its message to social media in a campaign that is showing some early promise. “Safety is the most important determinant in deciding whether to vaccinate or not,” said Ammon. “People’s perception of …

Trainee GPs will be offered £20 000 (€22 000; $26 000) “golden hellos” if they opt to work in parts of England that are struggling to recruit, the health secretary, Jeremy Hunt, has said. Speaking at the Royal College of General Practitioners’ annual conference in Liverpool on 12 October, Hunt said that the “salary supplements” would be available to 200 GPs from next year in areas of the country where training places had been unfilled for three or more years. Similar schemes running in areas hard to recruit to had so far used “golden hellos” 126 times, with a success …

A project that aims to generate the largest dataset on antimicrobial resistance has been launched as part of a global effort to tackle the growing problem of drug resistant “superbugs.” The Global Burden of Disease AMR project is a collaboration between the UK government, the UK health research charity the Wellcome Trust, the Bill and Melinda Gates Foundation, the University of Oxford, and the Institute for Health Metrics and Evaluation, an independent research centre at the University of Washington, Seattle. Over the next four years the project will gather and publish data on the spread and effects of antimicrobial resistance around the world. England’s chief medical …

John B Nichols came to Fakenham as a young doctor and quickly made his mark in the local community. He was a considerable sportsman who had played cricket for Cambridge University, had played hockey at a high level, and had been heavyweight boxing champion of the British Army of the Rhine (BAOR) during his pre-Cambridge national service. …

The pay cap for NHS staff has been scrapped, the health secretary has said. Speaking in the House of Commons on 10 October, Jeremy Hunt replied to a question about the effect of the NHS pay cap on staffing and waiting lists. He said, “The pay cap has been scrapped.” At a conference in June, Hunt had said that he would put the case to the chancellor for lifting the current 1% pay cap.1 In September it was announced that the cap on public sector pay …

Only a small fraction of the people who have died in Puerto Rico as a result of Hurricane Maria, which struck the island on 20 September, have been included in official statistics, reports indicate. The category 4 storm forced 51 of the island’s 69 hospitals temporarily to close their doors to new patients. Sixty four hospitals are now at least partly operating, though only 17 have grid power and the rest are using generators. The 1000 bed US navy hospital ship Comfort arrived in San Juan harbour on 4 October to help with the relief effort. With roads closed and phone services down, however, transfer and triage of patients at the most overcrowded emergency rooms is a major challenge. “We can’t communicate with anybody,” said Carlos Gomez Marcial, emergency medical director …

The prime minister has announced plans to change the law on organ donation in England to presume consent unless people opt out. The move, aimed at increasing the number of organ donations, was announced by Theresa May in her keynote speech to the Conservative Party conference in Manchester on Wednesday 4 October and will be subject to consultation. The Labour Party made the same commitment at its annual conference in Brighton last week. The announcement means that England is set to follow Wales in moving to an opt-out system of organ donation. Scotland is also consulting on whether to move to this system.1 May said, “Our ability to help people who need transplants is limited by …

Managers have secured a temporary agreement with a neighbouring ambulance trust following the collapse of a private ambulance service that was contracted to provide services for the NHS. Private Ambulance Service Ltd, based in Essex, was issued with a winding-up notice by the Inland Revenue on 27 September. It will cease trading from 9 October. Earlier this year, the company was awarded a contract by Bedfordshire, Luton, East and North Hertfordshire, and Herts Valley clinical commissioning groups (CCGs) to provide non-urgent patient transport services in their areas after the previous provider, Medical Services Limited, served notice to quit its contract early. Since then, concerns have been raised by patients, the trade union UNISON, and some of the firm’s …

Healthcare staff in England will be offered first refusal to buy affordable housing built on surplus NHS land that is sold off, the health secretary has announced. In his speech to the Conservative Party conference in Manchester on 3 October Jeremy Hunt also announced plans to offer NHS staff new flexible working hours arrangements to boost recruitment and retention. Hunt said that the approach, which would use a new app, would be piloted in 12 trusts from next year. Alongside this, Hunt set out an ambitious …

Our increasing inability to meet the four hour target for emergency departments has been used as a surrogate for all the NHS’s ills. Stories of overcrowding, long waits on trolleys, and ambulances stacking up outside make the headlines week after week. But there have been lamentably few informed discussions in the media of the complex underlying systemic causes behind the pressures at the hospital front door. Last week a Department of Health spokesperson said that “we have robust plans for winter,”1 in response to the Labour Party’s call for an urgent £500m cash injection.2 We can all keep calm and carry on, then? Dangerously full hospitals, struggling to cope with demand they can’t control, are no longer just for winter but a year round phenomenon.34 But fears of …

Doctors warn that hospitals are “reaching breaking point” in response to a report that seeks to provide a better understanding of NHS bed capacity in England, writes Jennifer Richardson

The Labour party has called on the government to commit to a £500m (€565m; $675m) bailout fund for the NHS this winter to reduce waiting lists for treatment. In a keynote speech to the Labour Party’s annual conference in Brighton on Tuesday 26 September, the shadow health secretary, Jonathan Ashworth, emphasised that ministers must not repeat the mistakes of last year that led to lengthening waiting lists during Theresa May’s first winter as prime minister. A Labour analysis of official NHS figures1 shows that if the NHS suffered a similar collapse in performance this winter an additional 10 000 people would be waiting more than four hours for emergency treatment each day, with hundreds of operations cancelled and waiting lists growing. The party wants …

Neville Martin Bailey served as house surgeon at Withington Hospital and then as house obstetrician at Saint Mary’s Hospital Manchester. National service was still obligatory, so he joined the Royal Air Force and served in fighter command as senior medical officer at RAF Odiham from 1 January 1956 to 31 December 1958. During this time the station was testing new aircraft, often flying round the clock, and Neville had to be available on call for very long periods. He decided to use the time to study for an external degree in zoology at London University and travelled to the University of Reading on an occasional free Saturday, where the professor of zoology allowed him to use the laboratory and kept back specimens for his practical work. In 1958 he was awarded a BSc (Hons) from the University of London. At this time, he was invited to join the Royal Air Force on a permanent commission, but progression would inevitably have meant working in London, and he was a countryman who disliked city life. By this time, we had three children, and with a fourth due imminently, he decided to become a general practitioner—ideally in a country practice. But when a singlehanded retirement practice vacancy came up in Peterborough, he applied and was offered the appointment in mid-December 1958, but only on the condition that he could provide premises and a commitment to offer a service to the existing patients of the practice—24 hours a day, seven days a week, 365 days a year—from 1 January 1959. The RAF had provided a gratuity of £600, and Neville’s father lent us a deposit to enable us to buy a house. The house we bought in such a hurry soon proved to be in the wrong place and had no access to a …

Doctors’ way of working would not be accepted by businesses making decisions with far less impact