BMJ - British Medical Journal

In the UK, 2.8 million people are economically inactive and in receipt of health related welfare benefits.1 Almost a million young people aged 18-24 years are not in education, employment, or training, and one in five of those receives health related benefits, largely for mental health conditions.2 Following a decade of austerity, and exacerbated by the covid-19 pandemic, ill health and health inequalities have worsened in the UK such that it is the “sick (wo)man of Europe.”3The UK has far higher rates of health related worklessness than most other comparable economies (including Germany, Sweden, and France).4 It faces a serious economic challenge because of stagnating growth and widening inequalities in productivity, which contribute to rising rates of poverty and further inequalities in health.5Health related worklessness became a problem for the UK in the 1980s when rapid deindustrialisation led to mass unemployment, particularly in the north of England, Scotland, and Wales.1...

A nurse forced to change an incontinent patient with dementia beside a vending machine and a patient dying from a cardiac arrest who couldn’t be given adequate cardiopulmonary resuscitation (CPR) because of overcrowding in the corridor are just two examples from a stark new report from the Royal College of Nursing.1The report is based on a survey of 5408 UK nursing staff carried out from 18 December to 11 January 2025, in which more than two thirds (66.8%) said they had on a daily basis treated patients in inappropriate settings such as a corridor, bathroom, cloakroom, bereavement room, or converted cupboard. More than nine in 10 of those surveyed believed that patients’ safety was being compromised. Nurses reported caring for up to 40 patients in a corridor but unable to access oxygen, cardiac monitors, and other vital equipment.The report also highlights serious concerns about infection prevention and control. One nurse...

bmj;388/jan16_7/r92/FAF1faWhile he was a senior house officer in Ashington, Northumberland, Mike Snow developed open tuberculosis. He had a considerable amount of time off work, including 100 days of intramuscular injections of streptomycin.This experience may have coloured his choice of career. Despite infectious diseases being prevalent in the 1970s the specialty was in its infancy and most patients, apart from the most serious cases, were treated by general physicians.In 1978 Snow was appointed to a new post at Newcastle General Hospital, where most of the serious infectious diseases were treated. There was a small isolation unit to which any consultant in Newcastle could refer patients for nursing care, while their medical care would be delivered by the referring consultant. Snow took a strong interest in developing the unit.He completed his training as a physician and then spent six months in Birmingham with Alastair Geddes, a specialist in infectious diseases. HIV and...

Next week the US president elect, Donald Trump, will take office with a mandate to make radical changes to the government’s approach to medicine and public health.Health insurance coverage in particular faces massive, potentially harmful, reform (doi:10.1136/bmj.q2801).1 Republicans in Washington plan to shrink Medicaid, the programme for people on low incomes, potentially leaving millions of Americans uninsured. Traditional Medicare (for people over 65 and those with disabilities) could also reduce to the point that it covers only a small fraction of the current Medicare population.In the meantime, public frustration with insurers has been evident after the murder of Brian Thompson, chief executive of UnitedHealthcare (UHC) (doi:10.1136/bmj.q2879).2 It has exposed the healthcare giant’s high rate of insurance coverage denial and the misery this has caused. The fact that Luigi Mangione, who is accused of the murder, left a note accusing the US healthcare system of corruption and greed has been widely...

Shhhh. Stop eating so loudlyWe’re not talking about crisp crunching in the cinema. “Food noise” refers to the constant and obsessive thoughts some people report having about food.Noise cancelling?In effect, yes. The term is currently being discussed in relation to glucagon-like peptide-1 receptor agonist (GLP-1RA) weight loss drugs, such as semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro), with people reporting that these drugs have silenced their internal food chatter. Videos on the subject have gained millions of views on platforms like TikTok,1 and major outlets such as the New York Times have covered the concept.2Where did it come from?The origins of the term aren’t clear, but a Google search shows that the term “food noise” has been around for at least a decade, being used in nutrition blogs3 and by celebrities promoting their brands.4 The meaning of the term seems to have evolved in recent years, however, from the...

In September 2024 NHS England published Principles for providing safe and good quality care in temporary escalation spaces1—in short, a guide to the ethics of corridor care. There wasn’t much fanfare on publication. It wasn’t shouted from the rooftops. Reading the document it is obvious why: this is a protocol issued from a system in serious trouble.It cannot have been easy to draft. The title is a contradiction. Its basic premises are at loggerheads. Safe and good quality care cannot co-exist with treatment in corridors. “Our aim,” says NHS England, “is always to deliver high standards of care for patients in the right place and at the right time.” From the beginning, therefore, it announces its failure. No patient ill enough to be in hospital can be properly cared for in a corridor—or car park, storeroom, or waiting area. Yes, they can be cared for. Yes, it may be better...

I’ve only been working as a foundation year 2 doctor in an emergency department for six weeks and already I’m physically and mentally exhausted. Our department has far too few staff to match the ever increasing demand—a familiar story that is playing out across the country.1Every day I see colleagues working tirelessly to offer the best care they can for their patients, but the current provision doesn’t let us deliver the gold standard care I was taught to give and aspire to provide. As doctors, we’ve had years of practice interacting with patients under our care to hone our empathy. In this dystopian system, however, it’s not only doctors empathising with patients but also patients empathising with doctors. I’ve had patients commiserate with me over the relentless conditions in the emergency department. They can see the environment that my colleagues and I are working in and are often very understanding,...

A former paediatric surgeon has been jailed for five years and seven months for offences committed while operating an unsafe and unsanitary mobile child circumcision service.Mohammad Siddiqui, 58, was sentenced at Inner London Crown Court after pleading guilty in October at Southwark Crown Court to 12 counts of assault occasioning actual bodily harm, five counts of child cruelty, and eight counts of administering a prescription only drug to young and vulnerable patients while ignoring basic hygiene rules.He operated the private home service between June 2012 and November 2013 while working for the NHS as a clinical fellow in paediatric surgery at University Hospital Southampton NHS Foundation Trust. In this role he was able to source the local anaesthetic bupivacaine hydrochloride, a prescription only drug.In 2015 he was struck off the medical register for various failures in performing circumcisions in the homes of four babies. In one case a baby was...

Alcohol is widely available and drunk by around 80% of adults in the UK. No safe level of alcohol consumption has been established,1 and the physical and mental health harms increase (at different rates) with the amount consumed.2 Alcohol is well recognised as a leading preventable cause of cancer.3The health and social harms of alcohol are higher in socially disadvantaged groups4 despite lower rates of use than in more advantaged groups. This “alcohol harm paradox” means that alcohol consumption has the greatest detrimental effect on the most vulnerable in society and is a significant contributor to health inequalities and premature death.567The challenges faced during the covid-19 pandemic89 resulted in an increase in the number of people drinking alcohol at increased and higher risk levels.1011 Deaths from alcohol specific causes in England also rose by 42.2% between 2019 and 2023, the highest number on record, most of them from alcohol related...

Every year, as the weather turns colder, we can’t go far without hearing someone cough or sniffle. The “cold and flu” season is nothing new, but we need to do more to tackle winter illness.The end of 2024 saw a “quademic,” with high incidence of influenza, respiratory syncytial virus (RSV), covid-19, and the winter vomiting bug (norovirus) all putting pressure on the NHS. The number of hospital admissions with influenza rose from 1190 to 5074—more than 300%—from the end of November to the end of December.1 This was triple the number of admissions recorded at the same point last year.As hospitals throughout the UK declare critical incidents, we shouldn’t be surprised by the demand on healthcare services during winter. High rates of hospital admissions with flu aren’t unprecedented: we saw a similar peak in the 2022-23 winter season.2But we should be doing more to tackle the winter viruses that in...

The BMJ widely discussed the assisted dying bill that is currently at the committee stage in the UK parliament.1Having worked for many years now for a health system that gives people more agency and dignity, I thought I had already come across all the arguments of medical paternalism. But I was wrong.What I wasn’t prepared for in the discussion about the assisted dying bill was that the current state of palliative care would be used as an argument for why we shouldn’t have agency. According to some politicians and leaders of the medical profession, it should be palliative care that is fixed, rather than giving choices to patients.2 As if we couldn’t have both.For now, no mainstream politician in the UK is proposing to turn back the tide on women’s right to choose just because maternity services are far too often unsafe.3 No one is saying that women cannot safely...

A wonderfully absurdist NHS fantasy has been doing the rounds on social media. It stemmed from a case vignette in a government document, Reforming Elective Care for Patients,1 in a text box illustrating how patients can be empowered by accessing their results on the NHS App. I’m a great fan of patient empowerment and have nothing against the NHS App. But the illustrative story (which has since been removed) was so hilarious that it deserves to be widely shared.The heroine of the story is Sarah, a patient with sinus pain and hearing loss who goes to her GP surgery and sees a nurse practitioner. You’d reasonably expect that the nurse might recommend steam inhalations or possibly follow NICE guidelines by prescribing a decongestant nasal spray.2 But alas, she seems to be a devotee of expensive, privately financed high tech, so she refers the patient immediately to the local community diagnostic...

The UK government has announced its approach for social care—establishing yet another commission.1 In its 2024 election manifesto Labour pledged to create a “national care service” (without explaining what this means), tackle low pay for care workers, and “build consensus for the longer term reform needed.”2Meanwhile, social care is in crisis. Analysis suggests that age adjusted spending per person will be at least 5% lower in 2024-25 than in 2009-10, and that an additional £8.3bn a year could be needed by 2032-33 to keep up with rising demand.3 Age UK estimates that two million people aged ≥65 have unmet needs for care and support,4 and analysis by Healthwatch suggests that up to 1.5 million disabled adults of working age could be eligible for social care support but are not receiving it.5 There are 131 000 staff vacancies,6 and some 81% of councils are due to overspend their adult social care...

AbstractObjectiveTo report on complications of conisation and its effects on fertility and stenosis.DesignRegister based nationwide cohort study on routinely collected data using several linked databases.SettingPrimary and secondary care in Denmark, 2006-18.PopulationThe conisation cohort comprised 48 048 conisations on women aged 23-65 who had undergone conisation within 120 days of a cervical biopsy. The biopsy cohort comprised 48 048 biopsies on women who had undergone a cervical biopsy but not conisation who were matched by age and time of procedure. Women were excluded from the conisation cohort before long term outcome analyses if they had undergone hysterectomy, resection of the uterus, or had cervical cancer or any long term outcomes within the 10 years before their conisation.Main outcome measuresBleeding, infection, and gynaecological operations within 30 days of conisation (stratified by age, year of conisation, and number of previous conisations) and long term risk of fertility treatment, fertility consultation, stenosis, cervical dilatation, infertility diagnoses, and death at any point after conisation. Long term outcomes were followed up until death, emigration, diagnosis of cervical cancer, hysterectomy or resection of uterus, or the end of 2018. Long term outcomes were analysed with incidence rate ratios from Cox regression models.ResultsBleeding, infection, and gynaecological operations were registered for 2.81% (n=1351), 0.48% (n=231), and 3.95% (n=1897) of all conisations within 30 days of the procedure, respectively. Women in the conisation cohort had increased risk of stenosis (incidence rate ratio 14.81, 95% confidence interval 7.55 to 29.05, 0.41% v 0.03% (n=176 v 12)) and cervical dilatation (2.68, 2.41 to 2.97, 4.01% v 1.58% (n=1735 v 668)) compared with women in the biopsy cohort. No significant differences were observed for the other outcomes when adjusting for baseline covariates (such as age and region of residence). Cervical suturing after bleeding was associated with a substantial increase in the risk of stenosis and cervical dilatation.ConclusionThis study found higher rates of complications within 30 days of conisation than previous studies with comparable outcome definitions, and a substantially increased risk of stenosis and cervical dilatation for women who had cervical suturing to treat bleeding after conisation. However, these results were based on few events in a small subgroup, and are therefore associated with major uncertainty. This study supports previous findings that conisation does not generally increase rates of infertility treatment or infertility diagnoses.

Private equity’s ownership of US hospitals has led to patient suffering, understaffing, reduced care quality, and health and safety violations, while investors have earned millions, a year long Senate Budget Committee investigation has found.1The bipartisan committee looked at more than a million pages of documents, including emails, board meeting minutes, financial reports, spreadsheets, and loan agreements, relating to two major private equity firms, Apollo Global Management and Leonard Green & Partners.Through studying these documents the committee “uncovered troubling patterns of prioritising profits over patients and of unfulfilled promises.” It identified “systemic issues” such as underinvestment in critical hospital infrastructure and the “pursuit of financial gains through leveraged buyouts and dividend extractions—often to the detriment of patients and hospital operations.”Apollo owns around 220 hospitals through the rural hospital operator Lifepoint Health and a second operator ScionHealth, and Leonard Green & Partners held a majority stake in Prospect Medical Holdings from 2010...

A controversial scheme in which midwives paid by a leading formula milk company have been providing infant feeding advice to new parents has been axed after an outcry.The initiative, hosted by the supermarket giant Tesco and revealed by The BMJ last week,1 drew criticism for its parallels to disgraced activities by formula milk companies that took place many decades ago.Midwives hired by Danone, which owns the UK’s leading formula brand, were being paid nearly double NHS rates to work at Tesco offering infant feeding advice. The service breached the International Code of Marketing of Breast-Milk Substitutes, established by WHO and Unicef, which clearly advises against marketing personnel seeking direct or indirect contact with pregnant women or mothers. As the midwives were working for Danone they are seen as marketing personnel.Tesco originally said it intended to continue the pilot in its flagship Hertfordshire store and roll out the service to two...

In recent years, the NHS has faced numerous drug shortages, with serious consequences for both patients and healthcare professionals.12 These ongoing shortages have affected a wide range of drugs, including antibiotics, diabetes medicines, ADHD medications and hormone replacement therapy.34 As the NHS grapples with drug scarcity, it is necessary to understand the causes and prioritise solutions to tackle this recurrent problem.Medicine shortages doubled between 2022 and 2024, with 101 drug supply disruption notifications in February 2024 compared to 52 in the same month in 2022.567 In 2023, healthcare providers received an average of 137 monthly notifications about supply disruptions, signalling a worsening crisis which is affecting patient care.7The current drug shortages in the UK arise from global and local factors.2 Disruptions in worldwide supply chains—triggered by events such as the covid-19 pandemic, the Ukraine war and increased energy costs—have impacted the manufacturing and transport of essential pharmaceutical ingredients.8 Manufacturing problems...

A 44 year old man with epilepsy who died following a fall had been left without his anti-epileptic medication carbamazepine (Tegretol) after his pharmacy could not supply the drug, a prevention of future deaths report has said.1The coroner’s report was addressed to both the Midway Pharmacy, Pudsey, and the General Pharmaceutical Council (GPC). It said that David Joseph Crompton had not received his medication twice last year, first for 10 days in April and then again in December, when his pharmacy left him an “IOU” for Tegretol when delivering his other medications to his home.According to the report, Crompton and his family were then left to “contact other pharmacies to see if they could obtain it.”The coroner said, “Without his medication his epileptic condition was likely to destabilise and give rise to fits. His falls both in April and December 2024 occurred when he was left without his essential medication....

New roles in healthcare provision, such as physician associates (PAs), have been introduced too quickly and without proper preparation, a review has found.The review of new staff roles in the NHS in England,1 carried out by the health think tank the Nuffield Trust, found that too often they had been introduced before agreement on issues such as regulation, training, supervision, and communication.The study, commissioned by NHS Employers, looked at the history of how different roles have been introduced, how the mix of staff skills in the NHS compares with other countries, and what needs to be tackled if the government’s plans to expand the workforce and invest in new roles are to succeed.The NHS has a long history of introducing new roles, said the authors—recently including PAs, nursing associates, and advanced nurse practitioners to tackle staff shortages, financial constraints, and changing health needs.The report drew on published data throughout England...

An employment tribunal has ordered an NHS trust to pay just over £100 000 to a trauma surgeon with post-traumatic stress disorder (PTSD) after deciding that he was unfairly dismissed.1The Cambridge tribunal found a “wholesale failure” by East and North Hertfordshire NHS Trust to follow its own illness policy when it decided to dismiss Vladimir Filipovich, who worked at the Lister Hospital in Stevenage, at the age of 60.Filipovich, who represented himself at the tribunal, had worked for the trust for nearly 20 years when he was sacked in July 2019. He had conducted over 25 000 operations without any deaths. Before coming to the UK he had been a trauma surgeon in the Bosnian war, exposed to severely injured and dying patients.He experienced an inability to concentrate, memory loss, exhaustion, and flashbacks. In November 2016 a psychiatrist made a preliminary diagnosis of PTSD.In January 2017 Filipovich turned up for...