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...

kabbasi@bmj.comSocial care has had its NHS moment. Andy Burnham’s announcement of a national care service may become historic if he is able to deliver it. His vision will be met with resistance, just as Aneurin Bevan’s announcement of the NHS was received in 1945. The importance of national reconstruction, agreed during the second world war, led to the Beveridge report, which identified “five giants” that needed to be tackled for Britain to succeed economically and socially: “want, disease, ignorance, squalor, and idleness.”1 The five giants have been forced back at various times but they seem to be back on the march.Some commentators observe that the covid-19 pandemic was the other great national emergency of the past 100 years, alongside the second world war.2 The need to build back better and fairer remains (doi:10.1136/bmj.n1677).3 Economist John Maynard Keynes, subject of a new West End play,4 deemed the plans in Beveridge’s report...

kabbasi@bmj.comSocial care has had its NHS moment. Andy Burnham’s announcement of a national care service may become historic if he is able to deliver it. His vision will be met with resistance, just as Aneurin Bevan’s announcement of the NHS was received in 1945. The importance of national reconstruction, agreed during the second world war, led to the Beveridge report, which identified “five giants” that needed to be tackled for Britain to succeed economically and socially: “want, disease, ignorance, squalor, and idleness.”1 The five giants have been forced back at various times but they seem to be back on the march.Some commentators observe that the covid-19 pandemic was the other great national emergency of the past 100 years, alongside the second world war.2 The need to build back better and fairer remains (doi:10.1136/bmj.n1677).3 Economist John Maynard Keynes, subject of a new West End play,4 deemed the plans in Beveridge’s report...

kabbasi@bmj.comSocial care has had its NHS moment. Andy Burnham’s announcement of a national care service may become historic if he is able to deliver it. His vision will be met with resistance, just as Aneurin Bevan’s announcement of the NHS was received in 1945. The importance of national reconstruction, agreed during the second world war, led to the Beveridge report, which identified “five giants” that needed to be tackled for Britain to succeed economically and socially: “want, disease, ignorance, squalor, and idleness.”1 The five giants have been forced back at various times but they seem to be back on the march.Some commentators observe that the covid-19 pandemic was the other great national emergency of the past 100 years, alongside the second world war.2 The need to build back better and fairer remains (doi:10.1136/bmj.n1677).3 Economist John Maynard Keynes, subject of a new West End play,4 deemed the plans in Beveridge’s report...

AI “has the capacity to dominate us to free us from medical tyranny” US health secretary Robert F Kennedy Jr has claimed.1“It can give you a second opinion that is much better informed than any doctor in the country,” Kennedy told a Make America Healthy Again summit earlier this week.2Kennedy quoted Sam Altman, OpenAI’s chief executive, who reportedly told him in a private meeting days before that it would be “malpractice for a doctor to make a diagnosis or to make a prescription without at least checking AI.”“One of the things that is going to change is that we’re never ever again gonna be dominated by public officials who tell us ‘trust the experts,’” Kennedy said.“If somebody tells you, ‘Masks work, trust the experts,’ AI may tell you otherwise. If somebody tells you, ‘Social distancing works, trust the experts,’ AI may correct that. And if somebody tells you that a...

In 1788, the Birmingham physician William Withering was consulted by an apothecary in Wellington, Shropshire, about the case of a woman, Mrs Houlston, whom Erasmus Darwin’s son, Robert Darwin, a medical practitioner in Shrewsbury, had attended the day before. Withering thought that Darwin’s prescription had been inappropriate and changed it. Robert reacted angrily, and a vituperative correspondence followed. Erasmus, Robert’s father, also medically qualified, may have been involved in the affair, by urging his son to attack Withering and by helping him to write his letters. Erasmus may have had good reason for wanting to damage Withering’s reputation. Although all three of them were alumni of the Edinburgh Medical School in the latter half of the 18th century, albeit at different times, and although Erasmus had recommended Withering to both a post in Birmingham and membership of the Lunar Society, he may have become jealous of Withering’s success as a physician and botanist. The enmity between them had culminated in a dispute over the treatment of a patient in Staffordshire, whom Withering was asked to see after Erasmus had attended her, with little therapeutic success. Withering recommended digitalis, which seemed to have saved her life. Darwin reported the case in 1780, anonymously including it in a posthumous publication credited to another medical son, Charles, and without crediting Withering. In turn, Withering responded by criticising Darwin in his 1785 monograph An Account of the Foxglove. The rift between the two seems to have been irreparable.

Any NHS staff member suspected of improperly and unlawfully accessing patients’ medical records will be immediately suspended, NHS England has announced.Staff under suspicion will also have their access to NHS computer systems cut off, under a “zero tolerance crackdown on snooping staff,” NHS England said.Jim Mackey, NHS England chief executive, has written to every NHS trust demanding they immediately implement the new approach.Staff suspected of accessing patient records without proper justification will be suspended pending investigation and have their access to NHS systems paused.It comes after several cases of staff being caught accessing patient records when they should not have.In May, Nottingham University Hospitals NHS Trust fired 11 staff members and issued warnings to 14 others for inappropriately accessing the medical records of three people killed by Valdo Calocane.1NHS systems keep records on who has accessed patient information, and suspicious activity can be identified through routine monitoring and audits.When inappropriate...