New NHS chief executive needed

Nigel Hawkes understands the current situation in the NHS. Would Neil McKay do a better job than David Nicholson? McKay was Deputy Chief Executive for the NHS Executive. Following Nigel Crisp's appointment as Chief Executive/Permanent Secretary in November 2000, Neil McKay became Chief Operating Officer for the Department of Health and Chaired the NHS Operational Board. He became Chief Executive of the Leeds Teaching Hospitals NHS Trust in April 2002. He's now at the Strategic Health Authority in the East of England.

Why's David Cameron got a mortgage?

There's nothing to lose by taking out a mortgage if the interest payments get paid. Still, the focus has been on David Cameron repaying £680 for repairs on his Oxfordshire cottage, which included clearing wisteria and vines from a chimney.

No-win situation in child protection

On the day that the Badman review of Baby Peter was published, with Badman saying that social workers were not interventionist enough, a High Court judge refused to overturn a decision by the GMC to strike David Southall off the medical register for being too interventionist. True, the judge said that Southall was "speculating on non-medical matters in an offensive manner". I do not know the full circumstances to say whether Southall was offensive. I understand there was a social worker in the room at the time. Southall admitted that the mother may have perceived his questionning as aggressive and hostile, but he denied he had accused her of murdering her son. There are plenty of doctors who can be offensive, who don't get struck off.

The judge found the mother a credible witness. I am not saying she wasn't credible. To lose a son through him hanging himself is a tragedy. However, I don't understand why child protection is not a medical matter. Maybe the judge finds it difficult to appreciate what people can do to their children. Isn't this what the shock about baby Peter case is all about?

The danger is the polarisation in the debate. There needs to be open discussion about the issues. Our best hope is the Social Work taskforce. However, the position of Ed Balls, as secretary of state for children, schools and families, is compromised by his legal battle with Sharon Shoesmith, ex-head of Haringey's children's services. Hopefully, Balls will get moved in the cabinet reshuffle, but he can't go to chancellor yet, as he would like, I'm sure, if only because of his involvement in the MPs' expenses fiasco.

Predicting the market for polypill

Malcolm Law, Professor of Epidemiology and Sir Nicholas Wald, Professor of Environmental and Preventive Medicine, at the Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, hold patents (granted and pending) on the formulation of a combined pill (polypill) to simultaneously reduce four cardiovascular risk factors - low density lipoprotein cholesterol, blood pressure, serum homocysteine, and platelet function.

They argue that the motivation for the patent for the Polypill is to help ensure its development and to fund the necessary clinical trials, which are costly. According to the Independent, they have had talks with the Government's Heart Czar, Roger Boyle, and the Medicines and Healthcare products Regulatory Agency (MHRA) about obtaining a licence. Progress has been held up by a lack of funding and charitable foundations are being approached for support. I think the argument will have been that the NHS should pay for the necessary trials.

Keep up to date with the Polypill news blogspot. The blogger, Shaun Holt, is an enthusiast for the pill, not least because he's launched the polypack, which packages the polypill medicines into daily sachets. "The benefits are massive," Holt argues. He admits the polypill is several years away if it is going to produce data on mortality and morbidity, as the estimates of reduction in cardiovascular risk are predictions and projections. There's probably no money in it for drug companies as the drugs are off patent.

Other people are also enthusiasts, such as Richard Smith, the ex-editor of the BMJ, who takes the 5 pills every night. The BMJ has this week published an article by Law and Wald said to be providing evidence that everyone over 55 should take medication to reduce blood pressure. They should get their money out of the patent eventually.

Who were the first MPs to show contrition about expenses fiasco?

Who were the first MPs to start the my shirt's hairier than yours competition? I think it was Andy Burnham and Ed Miliband.

I'd bet on them to do well out of the cabinet resuffle. They must also be positioning themselves for the labour leadership.

System of pursuing allegations against doctors is failing

The Guardian reports that GMC statistics obtained by the Liberal Democrats show that the number of all doctors suspended in the UK has risen from 216 in 2004 to 388 last year. This is despite guidelines being introduced in 2003 called Maintaining Higher Professional Standards in the Modern NHS (MHPS), which made it more difficult for doctors to be suspended. So it looks as though the momentum to suspend and discipline doctors has not been curbed by MHPS. But without it, numbers of suspensions are likely to have been even higher.

I am someone who has been suspended twice - it's actually now called exclusion. Not many doctors get back from one suspension. According to a report from the National Audit Office in 2003, only 40% get back to work. They found the average length of suspension to be 47 weeks. This average figure is likely to have come down with MHPS - which would suggest the number of suspensions has increased.

I have gone public about my first suspension eg. BMJ letter and Times Higher Education Supplement article. I am not yet in a position to go public about my second exclusion.

What I can say is that MHPS does not place enough emphasis on informal resolution. Almost certainly the number of formal investigations is too many. This could be prevented by people talking about whatever the problem is and solving it. It may not be a disciplinary problem at all.

There is inevitably conflict between management and clinicians, but they should work together. Management should not misuse its disciplinary power to deal with what it doesn't want to hear from clinicians. As a letter in this week's BMJ says, leadership is not management.