Druin Burch

On Monday, Jeffrey Goldberg, the editor of the Atlantic, told the entertaining story of being added, alongside Pete Hegseth and J. D. Vance, to America’s group-chat plans to bomb Yemen. Not the most obvious stuff of comedy, perhaps. Yet the affairs of men turn farcical precisely when they’re trying to be most serious. The cast here included the US National Security Advisor, the Secretary of Defence, the Vice President, the White House Chief of Staff, the Director of the CIA, and a handful of others holding Importantly Capitalised roles. Much is already being made of the fact that those involved have previously frothed at the mouth about their opponents’ sloppiness with classified information, but the greater point is not about Republican hypocrisy.

The NHS is swallowing more money than ever, yet delivering worse results. Now its failings are not only hurting patients, but also weighing down the economy. Employment in healthcare, said the Bank of England in last week’s Monetary Policy Report, has surged since 2019, while productivity has dropped. The Bank downgraded its 2025 growth forecast for the country from 1.5 per cent to 0.75 per cent, blaming the public sector – which has ballooned in size and shrunk in effectiveness – and healthcare in particular. After thirty years working in medicine, I’m not surprised. I have seen a few genuine improvements, but I have also seen the NHS become far more bloated and less efficient. In hospitals, more doctors – and, in particular, more senior ones – look after fewer patients.

Doctor Who, which started back in 1963, is often spoken about with a curious reverence as though it were something other than trash TV of varying quality. Unhealthy infatuation is not confined to the show’s viewers, as is obvious from the BBC’s recent announcement about the show’s new writers. Pulp television can be joyful, unless it starts believing it’s art “Scripting the best TV show of all time is truly a dream come true,” says Juno Dawson, who has just been announced as one of them. “I started watching when I was ten in Nigeria,” explains Inua Ellams, another new recruit; “The show invited me to dream, to live beyond my reality. Getting to write for the show felt like touching God,” he adds.

Not a winter goes past without hospitals overflowing; the situation is so predictable it deserves a better word than 'crisis'. Yet for patients and staff the sense of crisis is real, and connoisseurs of this annual event say that this year’s is especially dire.  Health Secretary Wes Streeting has spoken of his distress and shame, saying the state of A&Es breaks his heart. Hospital and ambulance trusts have been declaring critical incidents – as they do every winter. The real problem is not that this year is merely worse than the last, it’s the trajectory. Something is rotten in the state of our healthcare. The mantra of 'care in the community' has translated into care in the corridor Back in early 2014, 150 people waited more than twelve hours in A&E for a bed.

Most people shudder at the thought of working on Christmas Day. Not me. I've worked as a hospital doctor since 2000 and, most years, come 25 December, I'll be doing the ward round. As a junior doctor, I didn't have much choice about doing the Christmas Day shift. But since becoming a consultant, I have usually volunteered for Christmas, and am used to working when others are tucking into their turkey and opening their presents. How lonely must those souls be to regard staying on the wards as festive? I recall being bad tempered one early start, knowing I was missing my two young kids’ excitement, but otherwise the pattern has been a joy. For all its failings, the NHS has a capacity for camaraderie.

Most of those commenting on the guilt or innocence of Lucy Letby – the nurse who is serving 15 whole-life jail terms for murdering seven babies and attempting to murder seven others – don't know what it's like to work alongside a killer nurse. I do. Benjamin Geen, whom I worked with at Horton General Hospital in Banbury, Oxfordshire, took the lives of at least two patients during his time there. Something in the nature of our interest in murderers has a habit of making us forget logic Geen's case has, like Letby's, become popular with conspiracy theorists. Public fascination has been far greater with Letby. But the two cases share an attraction for those convinced that they have hit upon the 'truth'.

I have spent a quarter of a century caring for people dying from smoking. Deaths of this sort are not only premature but often horrible. My mother’s death from lung cancer was both. The puritan nature of my medical heart should, therefore, leap up at the new restrictions of the Tobacco and Vapes Bill, introduced to parliament today. Smoking, Labour have declared, should be banned outside schools and hospitals. How they intend to police the ban, they haven't said. Self-righteous pleasure at seeing other people’s freedoms being reduced – unhealthy freedoms one disapproves of – should come naturally to a practising doctor. Instead, I’m struggling to feel even a frisson of morally superior joy. Something is amiss.

Over my quarter-of-a-century of being a doctor, I have overseen thousands of deaths. For a busy hospital physician, this is not an unusual number. Helping people die is a core part of our job. In the Commons today, the Assisted Dying Bill gets its first reading. But the debate about this bill is missing a crucial detail: assisted dying is already something of a reality. For those in unsalvageable agony, I like to think it happens almost automatically. Neither people, nor the NHS, being perfect, there will be errors and omissions. But I’m confident that assisted dying, in a sense, happens often already, and I speak from experience.  As junior doctors we were taught that we had the power to kill Hospital is the most common place of death.

Kemi Badenoch kicked up an almighty stink when she argued at the weekend that not all cultures are ‘equally valid’ when it comes to immigration. The Tory leadership contender was forced to clarify her comments, made in the Sunday Telegraph. ‘I actually think it extraordinary to think that's an unusual or controversial thing to say,’ she told the BBC’s Laura Kuenssberg. The truth is, Badenoch is right – and to pretend otherwise is a mistake. There can be no better reminder that the different qualities of culture matter very much indeed I’m a doctor and the idea that all cultures are equal, at least in the way they practice medicine, is absurd. Some years ago, the historian David Wootton wrote a slim and beautifully argued book called Bad Medicine.

'The wise bustle and laugh as they walk, but fools bustle and are important,' wrote F.L. Lucas a century ago. 'And this, probably is all the difference between them.' The government and the British Medical Association, who yesterday announced that henceforth junior doctors will be called 'resident doctors', are bustling and self-important fools. I was 37 when I ceased being a junior doctor and became a consultant. Not quite the glittering early success of Pitt the Younger, but I had the common comfort of being ordinary and surrounded by peers roughly my age. I search my memory for the awful horrors caused by carrying around the name ‘junior’ all those years, but I search in vain. No mental scars seem apparent.