The Leng Review became a deep disappointment after it was first published in summer 2025.1 Instead of being the moment when physician and anaesthesia assistant roles were reined in and refocused on supporting members of healthcare teams, it simply became another example of delaying tough decisions.As the BMA said at the time, it was an inadequate response to a patient safety scandal, particularly in its lack of support for a national scope of practice for physician assistants (PAs), and its failure to clearly reject PAs seeing undifferentiated patients.It was the latter that was most ominous—we have seen far too many examples of patient harm resulting from PAs being put in the position of being the only staff member that saw gravely ill patients when it could make a difference. The case of Emily Chesterton was only the most prominent of these.2Although the prescription fell well short, Leng’s diagnosis was accurate....

Health officials are warning of “ominous” signs of winter pressure already building in hospitals in England, as new data show flu levels soaring for this time of year.The UK Health Security Agency (UKHSA) said that flu levels were currently higher than the previous four years at the start of the agency’s winter reporting season.The UKHSA’s first weekly winter respiratory virus surveillance report1 shows that, while still at very low levels, flu has been rising since August, suggesting a potential early influenza season.The weekly reports are based on a range of indicators provided by GPs, hospitals, laboratories, and the wider community. This first report recorded that flu positivity—based on a percentage of people who test positive for the virus in hospital—was 6.5% in the week ending 4 October, up from 5% the week prior. In comparison, the previous four years have seen figures of about 1-3% at this time of year.Overall,...

Has the flu season started early?For the second year in a row, it looks like the influenza season has started early in England.“It is very early in the season, but the number of hospital admissions for flu are the highest that I can remember seeing at this time of year,” says Frankie Swords, national medical director at NHS England, speaking at a briefing on winter viruses on 8 October.The latest surveillance report from the UK Health Security Agency (UKHSA)—covering 28 September to 4 October 2026—shows that influenza activity is increasing, with a flu test positivity rate of 6.5%, up from 5% the previous week.1Meanwhile, hospital admissions for flu are at 1.97 per 100 000. As this is the first week of reporting on this figure, there is no comparison.The agency says that, although levels are still low, “flu trends have been rising since August, and there are possible signs that...

ADHD and autism diagnosis in England needs a “fundamental shift,” say the authors of a major government backed review.The Fonagy review1 was tasked with investigating rising demand for mental health, attention deficit/hyperactivity disorder (ADHD), and autism services in England and the factors driving this.Chaired by the clinical psychologist Peter Fonagy, the review was commissioned by then health and social care secretary Wes Streeting, against a backdrop of surging demand for NHS services in these areas. It found that more than 254 000 people were on the autism assessment waiting list in December 2025, while 560 000 were waiting for an assessment for ADHD.The report adds that estimates using NHS data suggest that autism has increased among 6-11 year olds more than 20-fold and among 12-17 year olds more than 40-fold.Published today, the almost 600 page report warns that “continuing as we are is not sustainable.” It advises, “The current system...

Dozens of people claiming to have sustained eye damage from using GLP-1 medications are suing Eli Lilly and Novo Nordisk, the makers of the blockbuster drugs.1Semaglutide and tirzepatide are now among the most widely used drugs to treat type 2 diabetes and promote weight loss.Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist marketed by Novo Nordisk under the brand names Ozempic, Wegovy, and Rybelsus. Tirzepatide, which acts on GLP-1 and glucose dependent insulinotropic polypeptide (GIP) receptors, is produced by Eli Lilly and available under the brand names Mounjaro and Zepbound.The condition at the centre of the lawsuits is non-arteritic anterior ischaemic optic neuropathy (NAION). It is sometimes described as a “stroke” of the optic nerve and is the most common acute optic neuropathy in people over 50.2Kevin Gendreau, an obesity medicine physician at the Weight & Wellness Center at Signature Healthcare in Brockton, Massachusetts, said of NAION: “Blood flow to...

A lack of equity, diversity, inclusion, and accessibility (EDIA) considerations is a well described challenge that threatens the scientific and ethical integrity of healthcare research.1 Underrepresentation is costly, unjust, and harms patients.1 Unintentional exclusion of patients who may most benefit from trial evidence is a central focus of many efforts to improve EDIA considerations in research, with the exclusion of black participants from cancer trials being an important example.1 Intentional exclusion of pregnant23 or cognitively impaired45 participants from trials that may most benefit these populations is an emerging area of concern. Further, a lack of understanding of structural discrimination relevant to the trial discipline can lead to erroneous conclusions. An important example is attributing findings from observational studies showing worse outcomes from covid-19 infection in black populations6 to biological mechanisms7 without considering how systemic overestimation of blood oxygen by pulse oximetry used on skin of colour8 influences access to treatments...

Oliver makes a valid point about the false binary of the “home good, hospital bad” credo.1 He rightly points out that the UK has the fewest beds per 1000 population of all developed countries and that community services for facilitating early discharge are sadly lacking. In addition to these points, most home discharges of patients who are “medically stable” but still requiring rehabilitation are heavily dependent on the presence of a fit and willing carer at home. In an increasingly ageing population, this frequently means an elderly spouse, often with their own medical needs.There is an alternative to direct discharge to home: community hospital rehabilitation care. There are still hundreds of community hospitals in the UK, providing skilled multidisciplinary inpatient rehabilitation.2 The UK government ignored the contribution of these hospitals during the covid-19 pandemic and continues to display astonishing ignorance of how many hospitals still exist and what potential they...

Last month the final report of the Thirlwall inquiry was published.1 The inquiry investigated the events at the Countess of Chester Hospital that surrounded the arrest and subsequent conviction of paediatric nurse Lucy Letby for the murder and attempted murder of several neonatal patients from 2015-16.I took an especially keen personal interest in the findings as I had been asked to give detailed written evidence to the inquiry on a range of issues around governance, safety culture, and regulation, all of which is online.2Among her observations and conclusions, Kathryn Thirlwall highlighted the role and attitude of senior managers at the trust.3 Doctors on the neonatal unit had repeatedly raised concerns about the possible role of Letby in unexplained patient harms and unexpected deaths. Yet these doctors had been ignored (p 14)4 and silenced (p 6),4 their concerns dismissed (p 58),3 and they had even been threatened with referral to the...

A woman in her 30s was referred to rheumatology by ophthalmology after six months of recurrent right ocular redness, pain, and photophobia, without fever or impaired vision. At initial assessment by ophthalmology, examination showed conjunctival injection and scleral vessel dilation (fig 1). Slit lamp examination showed localised violaceous conjunctival injection in the inferotemporal quadrant of the right eye. Anterior segment optical coherence tomography showed scleral thickening in the same area. The patient was diagnosed with scleritis.bmj;395/oct07_10/e100622/F1F1f1Fig 1Right eye showing conjunctival injection and scleral vessel dilationOcular symptoms persisted despite treatment with topical non-steroidal anti-inflammatory drugs, antibiotics, glucocorticoids, and cyclosporine eye drops.Four months after the onset of the ocular symptoms, the patient began experiencing pain in multiple proximal interphalangeal joints without swelling or morning stiffness, fatigue, or fever. Two months later, she was referred to rheumatology.Examination in the rheumatology clinic revealed tenderness in 16 joints, including the metacarpophalangeal and proximal interphalangeal joints...

Spain’s framework governing maximum working hours for healthcare professionals, called Estatuto Marco, hasn’t changed since 2003. However, the government is now trying to update the framework, reducing on-call shifts from 24 hours to 17, capping weekly hours at 45, and banning standard shifts directly after on-call shifts.1The reform bill was sent to Congress at the start of September and is now working its way through the parliamentary system.Although most unions, including the nurses’ union, now support the updated framework, after months of negotiations, seven unions representing doctors have rejected it. They are arguing for a separate framework specifically for doctors that reflects the “unique aspects arising from their training and responsibility.”2Spanish health secretary Javier Padilla Bernáldez says that, if passed into law, these working hour reforms “would be the biggest advance in labour rights for healthcare professionals in the last two decades.”After strike action earlier this year in protest at...

Alongside her very pertinent points on the matter of providing appropriate food to NHS staff at the time it is needed, Hubbard also hints at the issue of people eating together.1Opportunities for informal communication must be fostered. They enable discussion of medicine in general and individual cases in particular. They foster cross specialty learning. They encourage development of friendship and a sense of community in the hospital.

If 2025 was the year in which the international order fractured, forcing drastic change on the global health system,1 then 2026 has responded by generating an industry to reform, reset, and rebuild it. No fewer than 38 publications, 11 major initiatives, and 405 recommendations on the global health architecture have emerged in the first eight months of 2026.23Most prominent are the World Health Organization’s mapping of six initiatives for its Task Force on the Reform of the Global Health Architecture4 and the Accra Reset of Global Health Architecture and Governance initiated by African nations to drive their move away from aid dependency.5 The surrounding commentary shows an emerging consensus on the need for greater country ownership of budgets and governance, health systems strengthening rather than disease specific programmes, and regional authority replacing that traditionally held by global institutions. Together these debates set the scene for a highly consequential election of...

There are many models for neighbourhood health, including different approaches taken in Fleetwood, Lancashire, and international models in Singapore, Brazil, and New Zealand.12 Brazil’s Family Health Strategy and Healthy Families New Zealand were shaped by distinct histories and system structures and operate in different ways. What stands out is that their relative success depends not on the model itself, but on the conditions that allowed their approaches to take root and endure. We can learn from them about whether England’s approach to implementing neighbourhood health has the potential to create the necessary conditions for transformation.New Zealand and Brazil had clearly defined, long term ambitions and purpose. Brazil’s aim was to make proactive, neighbourhood based care the default model for the whole population. New Zealand focused on driving community led change to reduce health inequalities. Their goals differed, but in each case those goals were explicit—and that clarity mattered.I worry that...

There are many models for neighbourhood health, including different approaches taken in Fleetwood, Lancashire, and international models in Singapore, Brazil, and New Zealand.12 Brazil’s Family Health Strategy and Healthy Families New Zealand were shaped by distinct histories and system structures and operate in different ways. What stands out is that their relative success depends not on the model itself, but on the conditions that allowed their approaches to take root and endure. We can learn from them about whether England’s approach to implementing neighbourhood health has the potential to create the necessary conditions for transformation.New Zealand and Brazil had clearly defined, long term ambitions and purpose. Brazil’s aim was to make proactive, neighbourhood based care the default model for the whole population. New Zealand focused on driving community led change to reduce health inequalities. Their goals differed, but in each case those goals were explicit—and that clarity mattered.I worry that...

Pay for resident doctors remains significantly behind where it should be despite this year’s settlement, and the pay review body should be “on notice” ahead of its next recommendation, the departing chair of the BMA’s Resident Doctors Committee (RDC) says.Speaking to The BMJ, Jack Fletcher warned that the agreement accepted by members in June would not end the union’s efforts to improve pay, training opportunities, and working conditions.The government’s June 2026 deal, now accepted by the BMA, gave resident doctors in England an average pay rise of 6.5% and 4500 extra specialty training posts over the next three years, alongside more secure employment and nationally aligned contracts for locally employed doctors.1But Fletcher, an acute medicine doctor in North East England who became RDC chair in September 2025, said this was only progress on pay, not a conclusion.“This is not an endpoint,” he said. “Residents are still behind on their pay...

Pay for resident doctors remains significantly behind where it should be despite this year’s settlement, and the pay review body should be “on notice” ahead of its next recommendation, the departing chair of the BMA’s Resident Doctors Committee (RDC) says.Speaking to The BMJ, Jack Fletcher warned that the agreement accepted by members in June would not end the union’s efforts to improve pay, training opportunities, and working conditions.The government’s June 2026 deal, now accepted by the BMA, gave resident doctors in England an average pay rise of 6.5% and 4500 extra specialty training posts over the next three years, alongside more secure employment and nationally aligned contracts for locally employed doctors.1But Fletcher, an acute medicine doctor in North East England who became RDC chair in September 2025, said this was only progress on pay, not a conclusion.“This is not an endpoint,” he said. “Residents are still behind on their pay...

On 23 September 2026, the Australian prime minister, Anthony Albanese, disclosed that on 18 June 2026 an OpenAI agent gained unauthorised access to the Medicare Statistics Reporting Service, a public facing portal hosted by Services Australia that publishes aggregate data on Medicare billing, vaccination uptake, use of the Pharmaceutical Benefits scheme, and organ donor registrations.12 This has been widely reported as the first known “AI hack of a government website.”Both Albanese and OpenAI have stressed that no personal data were accessed. However, the agent did run commands; retrieve internal files, credentials, and aggregate statistics; and write files. It also accessed the websites of the Victorian Department of Health, the Australian Institute of Health and Welfare, and the NSW Bureau of Crime Statistics and Research.3The Australian government has launched a taskforce to investigate the incident and chastised OpenAI for taking too long to notify it of the agent’s actions; and for...

On 23 September 2026, the Australian prime minister, Anthony Albanese, disclosed that on 18 June 2026 an OpenAI agent gained unauthorised access to the Medicare Statistics Reporting Service, a public facing portal hosted by Services Australia that publishes aggregate data on Medicare billing, vaccination uptake, use of the Pharmaceutical Benefits scheme, and organ donor registrations.12 This has been widely reported as the first known “AI hack of a government website.”Both Albanese and OpenAI have stressed that no personal data were accessed. However, the agent did run commands; retrieve internal files, credentials, and aggregate statistics; and write files. It also accessed the websites of the Victorian Department of Health, the Australian Institute of Health and Welfare, and the NSW Bureau of Crime Statistics and Research.3The Australian government has launched a taskforce to investigate the incident and chastised OpenAI for taking too long to notify it of the agent’s actions; and for...

A botched execution attempt of a woman on death row in Tennessee has reignited the debate over use of the lethal drug phenobarbital.Christa Pike, 50, was taken to hospital after two syringes of pentobarbital were administered at a prison in Nashville. According to her legal team, these failed to stop her heartbeat and she could be heard snoring.Pike’s lawyers filed an emergency motion seeking to immediately halt the execution, saying she was in unnecessary agony and it was violating her right to be executed free of cruel and unusual punishment.Pentobarbital is a short acting barbiturate that slows down the central nervous system. In the UK it is used almost exclusively for veterinary euthanasia (box). David Nicholl, a UK doctor who submitted a petition to the Florida Supreme Court to stop an execution using pentobarbital in 2011, said the Pike case highlighted why it should not be used in lethal injections.“The...

A botched execution attempt of a woman on death row in Tennessee has reignited the debate over use of the lethal drug phenobarbital.Christa Pike, 50, was taken to hospital after two syringes of pentobarbital were administered at a prison in Nashville. According to her legal team, these failed to stop her heartbeat and she could be heard snoring.Pike’s lawyers filed an emergency motion seeking to immediately halt the execution, saying she was in unnecessary agony and it was violating her right to be executed free of cruel and unusual punishment.Pentobarbital is a short acting barbiturate that slows down the central nervous system. In the UK it is used almost exclusively for veterinary euthanasia (box). David Nicholl, a UK doctor who submitted a petition to the Florida Supreme Court to stop an execution using pentobarbital in 2011, said the Pike case highlighted why it should not be used in lethal injections.“The...