In the UK, the prime minister has announced the disbanding of NHS England, Nigel Crisp - former chief executive of the NHS, explains why he thinks that it’s important the health service is closer to the political decision makers, and why this could be the time to really acknowledge the healthcare emergency.

On the international stage, the Trump administration's withdrawal from the WHO is throwing global health into disarray - Illona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, joins us to explain which new alliances are emerging, why the funding that has disappeared may never be replaced, and how tech will surpass pharma when it comes to industry influence.

Finally, there is a triple burden of malnutrition for adolescent girls in south Asia - which creates a cycle of ill health that is hard to break. However, Zulfiqar Bhutta, chair in global child health at the Hospital for Sick Children in Toronto, thinks the region can come together to change both government and society to champion young women’s health.

Abolishing NHS England: risks and opportunities

https://www.bmj.com/nhs-commission

https://www.bmj.com/collections/nourishing-south-asia

We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found.

Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride. 

Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother".

Our panel;

Katie Bramall-Stainer, chair of the General Practice Committee of the BMA

Reading list

Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research

Together we can challenge the racism that persists in healthcare

From pay restoration, to making sure there are enough training posts for resident doctors, the BMA has been busy.

In this podcast, Kamran Abbasi, the editor in chief of The BMJ, spoke to Phil Banfield, chair of the BMA’s council.

They talk about the ongoing pay discussions, how the BMA is working with the new government - touching on both speciality training places, and the role of physician assistants.

The conversation also covers the BMA's changing strategy, which aims to empower local members to take on the fights they care about, and how the organisation is linking both their trade union and professional activities.

Providing quality healthcare is demanding, often stressful, and requires sustained effort. When resources are stretched and pressure mounts, compassion can slip - but compassion is an essential tool for leaders, who need to support their teams to continue delivering the best possible care.

In this final episode of The BMJ’s podcast series on quality of care, Rachael Hinton, BMJ Editor, speaks to three healthcare leaders. They discuss how fostering kind and compassionate leadership and care can improve morale, combat burnout, and contribute to better patient outcomes.

01:48 Lydia Okutoyi talks compassionate leadership in Kenya

08:39 Pedro Delgado talks refocusing on the human factor and tools for kind leadership

15:02 Alexander Ansah Manu talks reaping quality of care benefits in Ghana

This podcast was produced as part of the BMJ Collection on Quality of Care, developed in partnership with the World Health Organisation and the World Bank. Visit bmj.com/qualityofcare to view the full Collection. The BMJ commissioned, edited, and published this podcast. This episode edited by Brian Kennedy.

This week Rebecca Coombes is back with another big-food investigation, this time about fast-food giant MacDonalds subverting attempts to stop it opening stores near schools.

Sticking with industry behaving badly, May van Schalkwyk, from the University of Edinburgh, wonders why we haven't learn lessons from the attempts to control big tobacco companies, when it comes to other industries that harm health.

And finally, AI in healthcare - Karim Lekadir, from the University of Barcelona, explains new guidelines which can help evaluate which AI applications are trustworthy.

Reading list

McDonald’s triumphs over councils’ rejections of new branches

FUTURE-AI: international consensus guideline for trustworthy and deployable artificial intelligence in healthcare

Exercise and a better diet, prior to surgery, can improve outcomes. Daniel McIsaac, a professor of anaesthesiology from the University of Ottowa and lead author of that research, joins us to talk about getting those results into practice.

Julia Sinclair, professor of addiction psychiatry at the University of Southampton, explains how the NHS has lost sight of the impact alcohol consumption has on clinical care, and why we need a strategy to tackle it.

Finally, Matt Morgan, consultant in intensive care and BMJ columnist, has written another book - this time about patients who are revived after cardiac arrest, and the profound effect it can have on their outlook in life. 

Reading list:

Relative efficacy of prehabilitation interventions and their components

UK needs national strategy to tackle alcohol related harms

A Second Act

US President Donald Trump has signed an executive order to withdraw the US out of the WHO. This would cut funding for the UN’s medical agency by one-fifth.

Will they really exit, or can a deal be made? Lawrence Gostin hopes so, and as a professor of law at Georgetown, and director of the World Health Organisation Collaborating Center on National and Global Health Law, he is working with senior US and WHO officials to try and understand what reforms could be made to WHO what would allow a such a deal to be be struck.

Gostin also believes that the president cannot withdraw from the WHO with an executive order, but instead requires congressional approval - and is exploring the options for legal challenge to the move.

00:00 Intro

01:01 US history with the WHO

03:31 Executive order

06:35 WHO’s relationship with China

11:14 Funding

12:47 Benefits to US from the WHO

18:05 H5N1 threat

19:43 World benefits from US involvement

21:57 A deal to be made?

24:55 Legal action?

26:37 Administration responses

Read Professor Larry Gostin’s co-written opinion piece on the dangers of a US withdrawal from the WHO here: https://www.bmj.com/content/388/bmj.r116

In the last podcast of 2024, Richard Smith, former editor of The BMJ and head of UKHACC will be making the case for being more convivial. Tina Korownyk, professor of family medicine at the University of Alberta is the ghost of Christmas past for TV doctors.

Tim Feeny and Navjoyt Ladher take us through this year's Christmas research papers.

And finally, Mari Martensen, a paramedic, explains what makes being a medic in Svalbard bear-able.

Reading list.

Conflicts of interest harm health, and a new investigation uncovers the infiltration of big food manufacturers into UK schools. Emma Wilkinson reports on that investigation. Kamran and  Rebecca Coombes, head of journalism, discuss moves to reduce industry's impact on food policy in the UK.

A new research paper has identified a link between eating chocolate and lower rates of diabetes. Binkai Liu, doctoral student and Qi Sun, associate professor, at the Harvard T.H. Chan School of Public Health explain what they found.

Finally, Sam Hutt is a doctor in the NHS, but is better known by his stage persona “Hank Wangford”. Hank performed a celebration of the NHS at Glastonbury this year, and has now released that song. He joins us to talk about what inspired him.

Reading list

Hank Wangford