“The cuts”
==============

* Jane Smith

There’s an irony embedded in this week’s *BMJ*. Our cover story highlights the Safety Alert article on administering insulin safely (doi:[10.1136/bmj.c5269](http://www.bmj.com/lookup/doi/10.1136/bmj.c5269)), which recommends using insulin syringes and not using abbreviations for units or international units. As our cover image shows, a badly written “U” can be easily misread as “0”, prompting a potentially lethal dose 10 times that intended. In their article Tara Lamont and colleagues point out that errors in giving insulin are common—a recent audit showed prescribing errors for 19.5% of inpatients with diabetes—and often lead to harm. 

The irony is that last week the UK government confirmed that the National Patient Safety Agency, the body that produces these safety alerts, is one of the health quangos that will be abolished (doi:[10.1136/bmj.c5819](http://www.bmj.com/lookup/doi/10.1136/bmj.c5819)). Altogether 15 health related government funded but independent bodies will be abolished and 19 will be absorbed into other organisations or government departments. Our News story points out that it is not clear how much money will be saved from this cull, and the government is now emphasising increased accountability rather than savings. The other high profile victims are the Human Fertilisation and Embryology Authority, the Health Protection Agency, and the Human Tissue Authority; the NHS Litigation Authority stays. Most of the National Patient Safety Agency’s work will go to the new NHS Commissioning Board, but NPSA staff fear that the in depth multidisciplinary analysis—qualitative as well as quantitative—of the incident reports that goes into producing safety alerts will get lost in the wash.

But they don’t really know yet, and neither do we. Iona Heath’s column this week reflects the frustrations of that uncertainty (doi:[10.1136/bmj.c5541](http://www.bmj.com/lookup/doi/10.1136/bmj.c5541)). She welcomes the health white paper’s emphasis on listening to clinicians and placing decision making in the hands of front line staff. But she doesn’t like the continuing emphasis on competition rather than collaboration. She worries about taking GPs away from the job they were trained for to undertake the “immensely complex task of commissioning services.” 

That task may have just got more complex. In their editorial on a recent European Court of Justice ruling about the rights of EU citizens to seek healthcare outside their own country (which usefully summarises the state of the law in this complex area) Helena Legido-Quigley and Martin McKee point out that, even though cases may be few, the new GP commissioning groups will have to set up mechanisms to determine whether to authorise payment for care sought abroad (doi:[10.1136/bmj.c 5769](http://www.bmj.com/lookup/doi/10.1136/bmj.c)).

Meanwhile, as Britain waits to hear the definitive word on where its spending cuts will fall, Sir Michael Marmot, chair of WHO’s commission on the social determinants of health and author of a recent review of health inequalities in Britain, has berated the government for claiming that its proposals will create a “fairer” society (doi:[10.1136/bmj.c5862](http://www.bmj.com/lookup/doi/10.1136/bmj.c5862)). He wants to see an increased minimum wage and a minimum income standard, and argues for not concentrating only on the poorest people: “We can’t just focus on the very bottom…we have to address the social gradient.”

A more positive response to government proposals comes from Ed Peile’s Editorial on proposed changes in university funding (doi:[10.1136/bmj.c5781](http://www.bmj.com/lookup/doi/10.1136/bmj.c5781)). Lord Browne’s report, published last week, recommended that universities should be able to charge larger fees, with the government paying the fees initially and reclaiming the money from graduates when they can afford to pay (doi:[10.1136/bmj.c5723](http://www.bmj.com/lookup/doi/10.1136/bmj.c5723)). Most comment has been about the levels of debt students will incur, but Peile is also interested in the opportunities to improve teaching and the implications of student choice. Richard Smith agrees that students will become more discerning customers and in his blog he speculates that as a result some medical schools might fail ([http://bit.ly/azspC0](http://bit.ly/azspC0)). He also predicts fewer doctors and medical unemployment.

## Notes

**Cite this as:** *BMJ* 2010;341:c5895

## Footnotes

*   Follow *BMJ* Editor Fiona Godlee on Twitter at [twitter.com/fgodlee](http://twitter.com/fgodlee) and the *BMJ* at [twitter.com/bmj_latest](http://twitter.com/bmj_latest)