Druin Burch

This April, we agreed another deal with France to stop migrants coming across the Channel. The Home Office has explained it is ‘bearing down’ on small boat crossings, and that this latest £662 million deal would ensure ‘enforcement action on beaches and put people smugglers behind bars.’ Over the last Bank Holiday weekend, almost a thousand migrants were recorded as coming across the English Channel. This is regrettable, but there is no alternative. Small boat crossings began at scale in 2018. Since then, the total number of recorded arrivals comes to about 200,000. We have to accept that they are now a fact of life.

“Leaders take responsibility,” Wes Streeting wrote, in what has already been called his Wesignation letter. The charge against Keir Starmer was that he hadn't; the boast, gift-wrapped in NHS statistics, was that the outgoing Health Secretary had. “The only question that matters in government is whether we leave our successors a better situation than we inherited.” As he angles for the top job after almost two years running the NHS, what does his record amount to? Streeting’s no wild success, but no abject failure Streeting’s letter is heavy with figures. Ambulance response times for heart attacks and strokes have improved, A&E waiting times too, and GP recruitment is up.

Florence Nightingale, born in Florence on this day in 1820, made her world measurably better. She counted the dead until the living had to listen. Her contemporary in Crimea, Mary Seacole, is now zealously celebrated alongside her – and for the wrong reasons. Nightingale acted from duty, Seacole from entrepreneurial ambition Seacole, Jamaican and mixed-race, improved her world because she was a successful small-scale capitalist: brave, exuberant, and possessed of a chutzpah that tended toward creative fiction. Nightingale was part of the Whig advance of history. Her work in data science and sanitation underlies the health improvements we enjoy today.

‘The King and Queen got me to do something that nobody else was able to do, without hardly even asking!’ Donald Trump announced on Thursday. In their honour, after their White House visit, he is removing tariffs on Scotch whiskey and bourbon, ‘two very important industries within Scotland and Kentucky’. A few more visits from His Majesty, and who knows what might follow. The obvious next gifts would be Virginia and the Carolinas. In the meantime the US is open for business, and our whiskey no longer faces tariff headwinds. Trump’s announcement pleased me more than my own drinking tastes justify. Like many another Englishman, I did not take naturally to whiskey. Despite the best efforts of a wine-loving stepfather, I went the traditional route.

Kemi Badenoch has said she will ban doctors from striking. Yesterday, asked if he would do the same, Health Secretary Wes Streeting refused to rule it out. The police aren’t allowed to strike and nor is the military. Why should doctors be different?  The junior doctors are now on day four of their six-day strike; I have lost track of which number strike this is. Since I’m doing 13-hour days covering for them and have worked through Easter, I’ve also lost track of what day it is and fervently wish the legislation to ban the strikes was already in place. I’m being paid well above my normal rates, and my part of the hospital is running smoothly. I deal only with emergencies, so am one step removed from the costs of cancelled clinics and operations.

Immediately after the Easter weekend, junior doctors are planning a six-day strike. Unless they call it off, Starmer has said today, they’ll be punished. They have been offered a deal. On the table is an above-inflation pay rise, along with government funding for postgraduate exams that doctors have historically paid for themselves, and an offer of 4,500 additional specialty training places. ‘There are still 48 hours left to choose a better path,’ said Starmer. After that, the offer disappears. The strikes are being driven by those who are most radical in support of state healthcare in its current model.

What is it that doctors actually do? The answer is not obvious and I say that as a physician who has spent the past 30 years in hospitals. But the question matters. Which tasks can be done better or more cheaply by nurses, paramedics or AI depends upon it. So, too, does the government’s push to create NHS Online. Trailed last September in Sir Keir Starmer’s speech at the Labour conference, the service is due to open in 2027. 'The NHS’s new online hospital will see a huge shift in the way we deliver care,' said Stella Vig, clinical director for elective care at NHS England. What she doesn’t say – what nobody says – is how anyone could know such a shift will be an improvement. NHS Online will provide 8.

Two people have died of meningitis in Kent: an eighteen year old year 13 student named as Juliette, and an unnamed 21-year-old. The outbreak has centred on a nightclub, Club Chemistry, and on a private party. Since news of the outbreak broke, the newspapers and television have been full of images of students queuing patiently for prophylactic antibiotics. Concerns have been raised that the UK Health Security Agency could have raised the alarm hours, or perhaps a day, earlier. Some of the cases have been confirmed as meningitis B, a strain for which adolescents are not vaccinated. Infants are offered the vaccine at eight and 12 weeks and at one year, but protection wanes after about five years.

Health Secretary Wes Streeting has tried using the NHS for social engineering before. Previously, he’s suggested that weight-loss jabs could get people back to work. This week he’s gone further. Yesterday, Streeting said that ‘for the first time’ he would be ‘making the NHS accountable for patients’ employment outcomes’.  Streeting is right that ill health is contributing to unemployment. Economic inactivity due to long term illness runs at a record level. The rise has been steep post-Covid, with assessments shifting from face-to-face to virtual. And what’s most striking is that the surge has particularly affected those between 16 and 34.  There are 1.9 million people unemployed, and another 2.

New research reveals a startling truth about the people paying thousands for weight-loss drugs: they're mostly middle-aged, wealthy women. In other news, February is cold and the snowdrops are here. The Health Foundation, a British health charity backed by a billion-pound endowment, confirmed today what most people would have guessed: those paying thousands of pounds a year for these drugs are not the poorest and most deprived, nor the fattest, nor the most in need: People living in deprived areas already face poorer health outcomes than those in more affluent areas, and men experience worse health outcomes than women. Yet these are the groups that have the lowest uptake of GLP-1 treatments. GLP-1 agonists are in the news so much because they work.