The BMA is asking members to sign a petition asking Government to repeal the Health and Social Care Act 2012. The leadership’s rationale is that the Act requires providers to compete, while the BMA believes that “collaboration and not competition is more likely to allow a greater integration of community and hospital services”.

I could not agree more: collaboration is more clearly in the interests of individual patients than competition, and collaboration seems at odds with competition. Yet I don’t think the BMA’s position should be to call solely for repeal of the Act: after all, the Act is not solely about competition. The legislation brought about many changes, some of which are working well.

For example, we are beginning to see the value of a new local authority perspective on influencing the wider determinants of health, as shown by the exemplary nominees for NICE’s local government public health award. This sort of progress can be found in many Local Authorities across England. To campaign for repeal of the Act is to surround this progress with a fog of uncertainty: repeal would reject this progress outright and move staff back into PCTs.

The Act limits the Secretary of State’s powers to intervene in the day-to-day running of the NHS. While the success of this has been questionable at best, we are beginning to see push-back against Government diktat. No one, except perhaps Lansley and Hunt, would argue that the NHS benefits from the Health Secretary holding operational control; yet repeal would reintroduce this.

The Act confers new responsibilities on NICE to support evidence-based social care. The Act provides the first (baby) steps towards regulation of healthcare support workers. The Act gives an unprecedented level of legislative support to research in the NHS. These may be small considerations in comparison to the problems of the Act, but outright repeal would (if I may mix metaphors) cast the baby and the bathwater both into uncertain territory.

How quickly the BMA seems to have forgotten the pain inflicted on our profession through restructure, job uncertainty, and redundancy. Excellent professionals left medicine — and especially public health — to pursue other careers, while others lived for years with the stress of the uncertainty of their positions. For the profession’s trade union to argue for yet another overnight reorganisation “so big, it can be seen from space” seems utterly perverse. Perhaps this is why, despite the BMA’s repeated urging, fewer than 4,000 people have signed the petition. Even if every signatory were a BMA member, this would represent less than 3% of the membership.

Repeal represents only a return to the past. It behoves professionals to put forward an alternative vision. For example, politicians refuse to discuss the threat to universal healthcare of having fewer taxpayers per patient as a result of an ageing population; yet the BMA is uniquely placed to devise a considered, collective, professional vision of the future of the NHS. To campaign only for repeal of what exists, and allow the next government propose and introduce yet another short-term model, seems to me to be a sure route to unhappiness.

The BMA should not call for repeal of the Act: this is opposition without a position. The BMA should identify the most insidious parts of the Act, and work tirelessly to scrap or rework them. But, more importantly, the BMA should thoughtfully advocate for the future health of the nation, not for a return to the systems of the past.

Earlier in the year, Richard Sambrook (the former director of BBC News) wrote an article for The Guardian in which he argued that 24-hour news channels were no longer relevant in the modern world. This week, with news reaching The Independent that his thoughts are being taken seriously inside the BBC, I feel like it's time to put across an alternate point of view.

Here are six reasons I believe Sambrook is wrong.

1. News channels don't need to break news first

Cable news established the 24-hour news habit, but today social media and mobile phones fulfill the instant news needs of consumers better than any TV channel can. Twitter – and increasingly live blogs of breaking news events – consistently beat 24-hour TV channels. Being first – the primary criterion for 24-hour news channels – is increasingly the least interesting and effective value they offer.

Sambrook is right to say that the ability of television channels to deliver lines of breaking news at high speed is limited in comparison to online sources, whether accessed through mobile phones or social media. But most online and social media outlets are poor at putting those lines of breaking news into context. Indeed, at present, news channels are equally poor at this.

In my vision of a news channel, a line of breaking news would appear on screen, in much the same way as it appears online. Perhaps, "Valco supermarket chain in administration". I don't need the channel to break away from whatever it is reporting to bring me this news – it can simply appear on screen. That is the benefit of the visual medium.

Then, within a short period (say within fifteen minutes or half an hour), the BBC can put one of its expert business correspondents on the air to discuss that news in context. They can tell me the relevance of this to the City, to individuals, and perhaps even bring a degree of response from their journalistic contacts.

There is no need to discuss the news immediately and constantly repeat a single line accompanied with endless speculation. Instead, the channel should wait until there is something to report, and report it in a detailed and intelligent way.

2. News channels needn’t conform to expensive norms

The infrastructure behind a 24-hour news channel is impressive – and formidably expensive. The biggest cost comes from having created a machine that has to be fed. Every 15 minutes we go back to our reporter in the field for an update on what's happened since the last time we visited them. Most of the time the answer is "nothing".

Going back to a reporter in the field every fifteen minutes is not only expensively, it's also irritating. There is no need to do this. There are two reasons news channels do this: to fill time, and to follow the structure of a conventional network news bulletin every half hour.

We'll return to the former, but the latter is simply farcical. There is no reason (beyond "it's what we've always done") for 24-hour news channels to follow the structure of a conventional news bulletin. There is no reason why we have to return to the same correspondent to repeat the same news every hour. This is a problem of the format, not of the medium. A much more open-ended structure is possible.

3. News channels needn’t carry everything live

Newsgathering becomes a sausage machine, dedicated to filling airtime. Hours a day are spent on live feeds waiting for something, anything, to happen. The editor can't risk broadcasting a different report or going live somewhere else in case he misses the start and a rival channel can claim to be "first".

Of course, there is no reason to do this other than it being what rivals do. Every Wednesday, I cringe as presenters on television and radio fill in anticipation of Prime Minister's Questions, which starts a variable number of minutes after midday. Every Wednesday, I wonder why no broadcaster has had the bright idea of scheduling a five-minute discussion previewing the content, and then starting the coverage, cleanly and professionally at 12.05, through the simple use of a few minutes' delay.

The number of people who are insistent on watching Prime Ministers' Questions absolutely live is probably tiny. I know that I, for one, would prefer to watch a slick production with informed commentary and analysis rather than an unedifying scramble every week.

4. News channels needn’t uselessly fill time

The need to fill airtime – and particularly the need to be seen to be live – means that in the heat of the moment questionable editorial judgments can be made. Everything seems to be "breaking news". In the last 12 months we've seen the BBC showing live pictures of an empty courtroom in the US, eagerly anticipating the sentencing of already convicted kidnapper Ariel Castro – a story of interest to few if any in the UK.

There is a need to fill airtime. There is not a need to fill airtime with live content. With 24-hours at their disposal, and with less of an emphasis on a presenter reading a single headline every time news breaks, there is much greater scope for in-depth reporting and interviews with newsmakers. Watch an hour of any 24-hour news channel, and you'll almost certainly see an interview cut short, often for no good reason. Allow these to be much more open ended, and repeat them (in edited form, with expert analysis) and much of the airtime will be filled. As with Prime Minister's Questions, make much more extensive use of live delays and on-the-fly editing to increase the standard of presentation, and to allow the programme to naturally flow.

Similarly, I can see no reason why these channels don't make the most of the available air time to show more "explainers". I think an occasional airing of an updated 15 minute background package on what's actually happening in Ukraine would be a valuable service a news channel could offer. And it would fill time at low cost.

5. News channels can show pre-recorded packages

The number of stories that are conveyed by live "as it happens" pictures is vanishingly small. Many stories – the economy, climate change – aren't best served by pictures; others (inside Syria, Iraq, Afghanistan or Zimbabwe) often don't have pictures available until days after the event; many more work better with a well crafted, tightly edited package rather than a live feed.

There is no reason for 24-hour news channels to be so focused on live pictures. Well-crafted, tightly-edited packages would be welcomed by viewers over somebody standing in the rain reporting nothing.

6. Sambrook's vision doesn't fulfill the BBC’s purpose

What might a reconfigured on-demand news service look like?

Sambrook's suggested on-demand news service (I haven't quoted his whole plan, for it is far too long) involves people actively participating in creating their own bulletin. This is precisely the opposite of what I believe the BBC should be doing.

We, the people, have terrible news values. The more the BBC tries to align itself with our values, the more it degrades its worth. We need to be told what we need to be told. We need experts to fight for coverage of their areas. We need to know what matters, not what we want to know. And we place our trust in the BBC to make those decisions for us.

If the BBC won't make those decisions, but will defer to us, then there is no point in the BBC existing. I can ferret out news that interests me from a wide variety of sources without the Beeb's help. And in the areas in which I have a particular interest, that's exactly what I do.

But the BBC, and its news channel, should be about expert contextualisation. It should be the outlet which says "actually, this isn't an important story, so we're not covering it in depth" more often that it says "sit up and pay attention, this is boring but important".

It should make the most of genuine experts in their field – including fields it currently covers with a laughable level of credibility, like science and technology. The BBC news channel should be the "news channel of record". It should cover things in depth and intelligently. It should not chase ratings, and it should not be in a race to read out lines of news with no context. It should not be obsessed with live coverage. It should edit, curate, and analyse.

In his analysis, Sambrook conflates the current output of news channels with the medium of news channels itself. He uses the argument that current output is poor to suggest that there should be no output. I disagree.

I think that news channels can be done better – particularly the BBC News channel, which doesn't have to answer to shareholders, and doesn't have to chase ratings. It should be held to a higher standard, and should drive the quality of 24-hour news up. The BBC should not abandon it altogether.

I am implacably opposed to capital punishment. There are few issues on which I'm so certain. The state should not kill people. As I've said before, humanity is better than that.

It was only a few weeks ago that I learned that the European Union forbids the export of drugs used for killing prisoners in the USA through lethal injection. For perhaps the first time, I felt a real swell of pride at what seemed a surprisingly strong and principled stand. It is rare to see ethics translated to action on this scale.

But today, Owen Dyer's article in the BMJ (paywalled) has given me pause for thought. This excellently-written article discusses, in some detail, the difficulties drug shortages have caused for the lethal injection programme in several states.

Dyer's article talks through a number of horrendous botched executions, as well as the methods (some illegal) by which states have attempted to procure drugs for lethal injections. I found it a deeply thought-provoking piece. Towards the end, Dyer comes to this point:

Arkansas’ attorney general last year called the state’s capital punishment system “completely broken … it’s either abolish the death penalty or change the method of execution.”

Initiatives are now cropping up in state houses to return to more violent methods. These methods are not so far behind us as some imagine. The last execution by firing squad was in 2010, the last by gas chamber was in 1999, and the last hanging occurred in 1996. The last use of the electric chair was in 2013 in Virginia.

Is it better to bend our principles to supply drugs and assure a more humane death, or to withhold them and ensure a violent death?

The dilemma is complicated by the knowledge that violent methods have less public support, so may – or may not – bring about the end of capital punishment in the USA sooner than non-violent methods.

I tentatively lean in the direction of the greater good, and suggest that drugs are withheld. But it is certainly a complicated issue.

On the 25th March – approximately a lifetime ago in internet terms – the GMC published guidelines for doctors’ use of social media. The guidelines come into effect later this month.

Publication of the guidelines caused something of a social media uproar, particularly around the anonymity clause. The brilliant Anne Marie Cunningham, who has written and spoken a lot about social media in medicine, has hosted a particularly fascinating conversation about this on her blog, with well made points on both sides.

With all the high-quality discussion and carefully thought-through points flying back and forth, I’ve taken a back seat on this one. I’m not sure that I have all that much that’s new to add, and I don’t blog all that much about medical matters any more. But a nagging feeling in the back of my head says that this is exactly the sort of debate I would once have jumped into with both feet, and the focus hasn’t been on the part of the guidelines to which I most object. So here goes.

In all guidelines, I’ve always been lead to believe that definitions are crucial. For a guideline to be effective, let alone for it to be enforced, it must be clear what it covers. And yet, the GMC’s definition of social media is absurdly wide:

Social media describes web-based applications that allow people to create and exchange content.

Later in the guidelines, it is clarified that this definition includes non-public, professional social networks too. As I’ve discussed this issue with tech friends and colleagues over the last couple of weeks, this definition has caused several to – literally – laugh out loud.

It, of course, includes all manner of things that are not social media, and essentially describes any form of cloud-based application. If we interpret this guidance as written, then from 22nd April patient-identifiable information can no longer be uploaded to web-based GP note systems, or to HPZone used by Public Health England to track outbreaks, or indeed transferred via NHSMail, the restricted-level security email system designed exactly for that purpose. Use of Choose and Book will be against the GMC’s rules. All of these are online applications which allow people to create and share content. All are clearly not supposed to be covered by this guidance.

It can be argued that even if the definition as written is unclear, it is perfectly clear to most people what it is supposed to refer to. I don’t buy that, for two reasons. Firstly, what’s the point in publishing the guidance at all if we aren’t to interpret it as written? Some might say that the definition has to be broad in a fast-moving environment, and that the guidance would quickly be outdated if it were too pinned down.

Which brings me to my second problem: you may understand it, but I don’t. I actually don’t know whether this guidance applies in edge cases. Office 365 and Google Drive are both web-based applications which allow the creation and exchange of content. Applications like these are almost certain to replace locally hosted applications like the Word and Excel of today within this decade. Indeed, some organisations have already made the switch.

Is use of these outlawed by the guidance? I can see arguments why it, perhaps, should be. There are inherent risks about patient confidentiality in these systems. But to ban their use for patient identifiable information is a big statement, and I suspect that they didn’t actually mean it. But I’m far from certain.

To me, the nub of the problem here is that this is guidance on using a particular medium – and one that is ill-defined, at that. Publication might feel relevant now, and everyone from the BMA to the RCGP is helping people to understand how to use this medium safely. But I don’t think this is the place of a regulator. I’m acutely aware that others will strongly disagree with this position.

By and large, I think the GMC should stick to outlining principles. I no more expect to see supplementary guidelines on social media use than I would on letter writing or telephone conversations. Although, if – like many hospitals – you’re using a VOIP system, it could be argued that these guidelines apply. Just like the GMC does with those two media, I think case studies would have been a better way to illustrate the application of principles, rather than a list of inflexible “rules”. I don’t think it’s sensible or advisable to try and give over-arching “explanatory guidance” about an area of life which is changing so rapidly.

After all, these are only supposed to be explanatory. They are not intended to introduce new regulation. Though, to my reading, their poor formulation does lead to new regulatory burdens being placed on doctors.

When the last Good Medical Practice was published, Twitter had barely been conceived, and Facebook had yet to open to the general public. These guidelines aren’t clear now, so goodness knows what we’ll think of them in seven years’ time. I think they should be withdrawn.

A little over twelve months ago, I was asked on a discussion forum to make predictions about the retail sector in 2012. I’d forgotten all about this until today, when somebody pointed out my prescience!

On 30th December 2011, I posted the following (forgive the reformatting!):

M&S is going to have a bad year: They seem to be doing everything humanly possible to disassemble the formula that brought them back from the brink a few years ago. On the other hand, WHSmith’s profits are up, even if their sales are down – I reckon they can ride out the storm for a while. My predictions for chains that will collapse are JJB (frankly surprised they’re still around); Past Times (feels like it’s had its day, so to speak); and Mothercare / ELC (already pulling out of town centres, doesn’t bode well).

And, indeed, M&S had a bad year, WHSmith did reasonably well, Past Times closed, JJB closed, and Mothercare is on the brink.

You might think I’d feel proud of my amazing predictive abilities, but in fact, I feel mainly freaked out – especially since my history with predictions isn’t great. It’s also weird to think that I correctly predicted thousands of job losses – it gives me a creepy sort of guilt, as though I’m somehow responsible.

So given the discomfort I’ve inadvertently caused myself, the only prediction I’ll make for this year is that the economy will fully recover with no more companies folding, and unemployment will hit record low levels. Though if that turns out to be true as well, I might displace Mr Soult as the media’s favourite north east retail analyst!

You might have read that today M&S reported a £297m drop in profits for the first half of this financial year, with non-food sales particularly suffering (though admittedly improving somewhat towards the end of the period).

Mark Bolland is working on supply logistics, merchandise design and technology (including thousands of iPads) as the solution to these problems. There’s also, of course, the oft-cited problem of the M&S bust of the 1990s – over-diversification, especially of brands – which Mark Bolland is ploughing an awful lot of time and effort into repeating for reasons that frankly baffle me.

But I think there’s a slightly under-discussed problem: the state of the estate. Despite Sir Stuart Rose investing some £2bn in the estate only a handful of years ago, the estate is a mess. Here’s some pictures I took last weekend in the Newcastle flagship store:

The store has broken signs, patched up floors and fitments, the whole works. Note that these are not front-line problems – these are problems caused by poor quality, poorly designed store fittings. This despite going through Mark Bolland’s slightly half-hearted £600m store re-invigoration programme.

At heart, M&S is a premium retailer charging premium prices, which needs a premium retail environment – not shoddy broken fitments and badly scratched floors.

Clearly, the estate isn’t M&S’s biggest problem, but I think it needs further consideration. But then, when you’ve spent £2.6bn on refurbishing the estate in just eight years – the better part of £1m per day – how can anyone possibly convince shareholders that further investment is warranted? Does it start to look like serious mishandling of the original investment?

I don’t have the answers – and, frankly, I’m not convinced Mark Bolland does either. I’m obviously not party to the details, but I don’t think integrated multichannel retailing should be a massive priority – multichannel sales are increasing, but almost half of online orders are collected in store. In fact, if I were Mark Bolland, I would be trying desperately to retain in-store sales where service – M&S’s primary point of difference – is maximised. I’d be worried that one in five sales of men’s suits is online, not celebrating, as it puts customers a click away from, say, Brook Tavener, who compete strongly on price and quality, but without a bricks-and-mortar presence can’t hope to compete on service.

Why isn’t M&S pushing it’s service? If it wants to embrace multichannel, why not do it in a novel way that makes the most of bricks, mortar and service? ASOS famously advertises it’s free returns service, inviting customers to order clothes in a number of sizes and return the ones that don’t fit. Why doesn’t M&S push a similar order-a-range-of-sizes-to-store service, which could be a strong competitor, losing the complexity for the customer of organising parcel drop-offs and pick-ups? It’s a service which is pretty much already available under the current system, but isn’t pushed at all online.

Anyway, this is getting remarkably ranty for photo-a-day. I do hope you’ll forgive me! I’ll be back to normal service tomorrow, I’m sure!

I am not an MP for any reason other than because God wants me to be. I constantly try to do what Jesus would do.

So said Nadine Dorries in 2007. Obviously, Jesus has now recommended that Dorries abandons her constituents and takes a month off her regular job (while retaining a full £65,738 salary) to earn about £40,000 appearing on a tacky reality television show. God certainly works in mysterious ways!

Rail fares are going up again. Every time this happens, talking heads on the news suggest that a re-nationalised railway would be cheaper. Is this true?

That is, of course, an impossible question to answer. It is undeniable that private companies now take profits that would otherwise have been returned to the Treasury under a nationalised system. But there is some data to crunch – There’s some data I’ve located with the help of @jrothwell (he blogs here) and @welsh_lisa2 in the House of Commons library.

This sets out rail fare increases in real terms since the late 80s, using the contribution of rail fares to RPI. I don’t think it’s too erroneous to assume that this is an okay proxy for an inflation-corrected comparison of the average change in rail fares. Because it’s based on a comparison of contribution to RPI with a 1987 baseline, the data isn’t in intelligible units – it’s all comparative.

This data shows a 42% increase in the real cost of rail fares from 1987 to 2011: this seems like a bad thing. This graph shows how rail fares increased over time. It shows the percentage increase on the 1987 fare for each year (including the 42% increase over 1987 fares in 2011).

That looks fairly damning! But is it down to privatisation? Privatisation got underway in 1994. The average year-on-year increase in fares between 1987 and 1994 was 2.34%. If we assume that this level of increase would have continued had privatisation not happened, we can plot the new course of history (red) versus the old one (blue):

As the new red line shows, had fare increases continued at the pre-nationalisation level, they would’ve ended up higher: they would be 73% higher than the 1987 equivalent.

However, some people claim that between 1992, when the Conservatives were re-elected with a mandate to privatise the railways, and 1994, when this actually happened, fares were artificially inflated to make the franchises seem more desirable. So, perhaps it’s unfair to include 1993 and 1994 in our calculation of the pre-nationalisation average increase. If we exclude them, the average year-on-year increase drops to 1.73%. The graph then looks like this:

That is, fares still end up higher in real terms than they actually did: in this scenario, the 2011 fare is 53% higher than the 1987 equivalent.

It would be great to have some pre-1987 data to see if that suspicious looking flick up in 1991 is really unusual, or just part of the pattern of the background picture: certainly if the 1987-1990 trend had continued, fares would hardly have increased. Combined with the above data, this answer in Hansard from Norman Baker suggests that the change from 1980 to 1986 was of the order of 6%. If we assume a 1% year-on-year increase, as that figure suggests, then the predicated and actual fare increase from 1987 to 2011 are pretty much equal.

Bearing in mind all of the above, I’m not sure it’s fair to say that privatisation has driven up passenger fares, even if some of the revenue is now siphoned off to private profit rather than being invested in public services.

Add this decrease in the rate of increase of fares to the indisputable data showing that passenger numbers have risen, passengers satisfaction ratings with both trains and stations have risen, and delays have decreased considerably, and suddenly privatisation seems like it might not have been the disaster we’re often lead to believe it was.

Of course, this is an extremely simplified view of things. I’m ignoring the complexities of the timing of various changes, I’m ignoring the government subsidies that have happened even under the privatised system, I’m ignoring the added jeopardy of train operating companies handing back franchises and leaving the government to pick up the pieces, and I’m ignoring the potentially dubious morality of selling off national infrastructure.

I’m not left with an overwhelming sense that privatisation is the best thing since sliced bread – or even that it was the right move – but I think that perhaps the waters are a little muddier than some would have us believe. And I’m going to stop being geeky now, and resume normal service…!

Every now and again, I find myself moaning to Sky News about some report or other they’re running, usually on a medical topic. This might put me in the same box as the green-ink angry brigade of old, but I kind of hope it doesn’t.

Sky News is normally the outlet on the receiving end of my moans because Wendy likes to watch Sunrise in the mornings, so they tend to be the ones to irk me when I’m sleepy-eyed and vulnerable. Usually, they’ve misunderstood the findings of some piece of research, or are giving advice that needs a little more nuance. Generally, I fire off an email to them, and they correct either their script or package pretty quickly, or else get back to me to explain why they won’t. I actually think I have a pretty good relationship with them.

A few years ago when the whole MTAS debacle was kicking off in the medical world, I helped Channel 4 News with some of their reporting, and also found them really helpful, willing to listen to my explanations, and good at accurate reportage.

Until a couple of weeks ago, I don’t think I’ve ever complained about a BBC News report. But then, the BBC News website published this article about the Queen’s faith role. This couldn’t be further from the stuff I’d usually moan about, but the report was based on a COMRES poll, and originally opened with the claim that 80% of the population supported the Queen’s faith role. I didn’t believe this, and so checked out the original data on the COMRES website, which revealed that 80% responded positively to a question about whether the Queen has a faith role. This is, of course, different from giving support – it’s a question of fact, and, as the Queen is the head of the Church of England, it seems pretty undeniable that she has a faith role, whether or not it’s supported.

So I fired off an email. And, within hours, the article was changed to the current version, which reports the actual survey findings more accurately. What I hadn’t anticipated, and hadn’t had from any other outlet, was that the Religion Editor gave me a call. We had a great chat in which he explained how the article had come about, how the mistake had been made, and also a general talk about the complex rules that the BBC has around commissioning surveys. This was fantastic.

So what’s my point? Essentially, any time I personally have moaned to a media outlet about a factual reporting error, I’ve received a positive response. Granted, it would be better that the mistakes weren’t there in the first place, and it’s probably true that not all sections of the media are as responsible as those I’ve been involved with.

But journalists are humans too. They make mistakes, and many of them seem happy to have these corrected. Leveson might give the impression that all journalists are unethical idiots, and Blair might think they’re feral beasts, but some journalists are just doing a bloody hard job as well as they can, with the utmost professionalism.

I know it’s not a popular view at the moment, but maybe we can consider giving journalists a break sometimes? Just a thought.

BBC One should reflect the whole of the UK in its output.

That’s a key part of BBC One’s remit. I get that the ratings are better on the CBBC channel, and I sympathise with that position; but I simply don’t see how BBC One can meet it’s remit without kid’s programmes. BBC Two hasn’t got over the existential crisis it had because of BBC Three and Four, yet they’re inviting the question: “What’s BBC One for?”

It also invites criticism, means that they have to find (and pay for) something to plug the gaps in the schedule, and reduces awareness of kid’s TV amongst the people who actually pay for it. As strategies go, it seems like madness.