The theme of the BMJ this week is, ‘where are we in the rationing debate?’ and features contributions from US academics and policy makers, English economists and Norwegian doctors. The real theme is that it is critical to involve the public in rationing decisions and the central question, can it be done?

LESSONS FROM OREGON

It is 20 years since the Oregon Health Plan first attempted to involve citizens in setting priorities. Vidhya Alakeson, a policy adviser at the Department of Health and Human Services in the US, looks back at the plan in this week's BMJ.

The big news today is that the Government plans to come out spending as it employs the economic thinking of John Maynard Keynes to counter the contracting tendencies of the banking crisis. Today’s FT says ‘the chancellor is to call on departments to bring forward billions of pounds of capital expenditure to reinvigorate the economy ahead of an expected recession’. The NHS is a potential beneficiary, as the construction sector could be given the task of building new primary care facilities.

DARLING TO ANNOUNCE NEW MONEY FOR POLYCLINICS?

Whether or not they are commensurate with increased levels of funding, there have been improvements in the NHS in recent years. But one area in which the NHS has gone backwards is in engaging patients.

There are pockets of excellence, but being responsive to patients’ complaints, for example, has become less of a real priority across the service over the last ten years. In response to these continued failings, new ways are emerging for patients to express their views on services

WILL NEW WAYS EMERGE FOR PATIENTS TO FEEDBACK ON SERVICES?

The economic crisis has stifled health policy debate for a week or two – including the regular updating of this summary – but with the worst of the emergency seemingly now over, we can look ahead to a more steady tumble into recession.

We are not going back to normal times, but instead entering a new period, what the BBC’s political editor Nick Robinson calls the politics of recession. After a fortnight we will never forget, where are we with health policy?

THE NEW POLITICAL SETTLEMENT IS STILL TAKING SHAPE

In 27 days time, voters in the US will decide between Barack Obama and John McCain in an election that will have ramifications for the rest of the world. Drawing on recent analysis in the BMJ and this week’s Economist, this issue looks at the two candidates’ positions on healthcare, an issue that 44% of US voters place among their top three concerns.

In a recent HSJ poll, NHS managers suggested they are more comfortable with what they know, when asked their preferred secretary of state. With the government behind in the polls and change looming, it has not been a great conference season for senior local authority or PCT managers listening to the opposition set out their plans.

A new report from Which? is based on an ‘undercover investigation’ into advice dispensed from pharmacies . Which? researchers posing as patients asked questions about emergency contraception, migraines and traveler’s diarrhoea.

They received ‘unsatisfactory advice in 48% of independent pharmacies, 28% of national and regional changes and in 26% of the biggest supermarkets. The results do not bode well for plans to pass more clinical work to pharmacies from GPs.

Reports that Gordon Brown’s speech saved the day are wide of the mark. It was not brilliant rhetoric or piercing analysis that has staved off a challenge to his premiership, but the shift in global economics giving him the opportunity to take a political lead in uncertain times. Having pleased everyone from the Mail to the Mirror , Brown must now set out the substance of the tough choices he talked about - by elucidating what these are.

TALKING THE WALK ON TOUGH CHOICES

In recent weeks and months, much of the media has formed a conclusion that Gordon Brown is unsuited to modern politics. Last week’s economic events may mean, however, that in the last week politics has changed to suit Gordon Brown.

THE ECONOMIC TIDE CHANGES, AND GORDON BROWN FINDS HIMSELF ON MORE FAMILIAR SHORES

The Labour Party want to devolve power in the health service to those best placed to make decisions. The Conservatives criticise the centralizing tendencies of the government and favour greater localism. The Liberal Democrats remain strong advocates of local accountability and decisions made locally.

Today’s HPT wonders, what are we all arguing about? All united in a common desire to empower local people, it should be straightforward to achieve. No? Just what do the parties mean by achieving greater local accountability and is it the same thing?