The NHS’s growing use of non-doctors risks creating a two-tier health service, argues Jatinder Hayre
After Aneurin Bevan created the National Health Service in 1948, the principle of universality became firmly embedded in the popular consciousness: illness would no longer divide the British people according to wealth, and the quality of care received in sickness would not depend upon the depth of one’s pockets. Bevan articulated another principle which receives rather less attention today: that the state might finance medicine, but it should not command medical judgement. Doctors needed sufficient professional independence to practise according to the needs of their patients rather than the administrative or financial convenience of the state. Both principles are now being tested – and in some cases, rewritten.
Across the NHS, work historically undertaken by doctors has increasingly been transferred to physician associates (PAs), advanced clinical practitioners (ACPs) and an expanding constellation of other roles. I use “Noctor” as an umbrella term for the phenomenon whereby non-doctors cease to complement doctors and begin to serve as a substitute for them.
The language surrounding this transformation is revealingly anaesthetic: “skill mix”, “workforce transformation”, “new models of care”. These phrases make a profound political choice sound like an administrative rearrangement. Beneath them sits a simple idea: medicine can be dismantled into tasks, those tasks redistributed amongst more rapidly trained practitioners, and the whole reconstructed without meaningful loss.
Miatta Fahnbulleh is right about everything. Will it matter? She talks to Iggy Wood about her plan for a green transition that benefits all
In the not-so-distant past, consensus around the need to tackle climate change at least superficially encompassed the entirety of British society. It was the historic party of capital – the Conservatives – who enshrined net zero in law, eliminated coal from Britain’s energy mix, and committed to ending the sale of petrol and diesel cars. Some of the most important progress was made under Boris Johnson, who, while not on the right of the party per se, was a Brexit-supporting populist.
Unglamorous electricity grid reforms could be the key to winning on the doorstep
Even Andy Burnham was surprised to get a standing ovation for taking VAT off electricity bills. His plans to address the plight of the industrialist seeking a grid connection did not meet with the same enthusiasm during his first Labour conference speech as prime minister. Yet faster grid access matters far more for bringing down Britain’s high energy costs.
On 29th September, the government announced GB Grid, a new entity under the government’s publicly-owned energy company, GB Energy. Seeded with £4bn of reallocated funding, GB Grid will be able to finance and build grid infrastructure and plans to compete with incumbent providers. Alongside GB Grid, the government announced it would expand self-build connections and accelerate competitive tendering for transmission projects, effectively increasing competitive pressure on networks. This is a refreshing approach to bringing down energy costs, combining a bold public ownership experiment with unglamorous but necessary competition reforms.
THE NEW YORK TIMES MAGAZINE: The 10.11.26 Issue features Daniel Kolitz on the rise of microdramas; Janet Reitman on a group of Texans accused of being Antifa terrorists; Marcela Valdes on the author Min Jin Lee; and more.
BARRON’S MAGAZINE: The latest issue features ‘THE NEXT REVOLUTION IN TRADING’ – Wall Street is “tokenizing” stocks and moving them onto the blockchain. What it means for investors.
Tokenization of financial assets could be the biggest revolution on Wall Street since the move from paper to electronic trading. Don’t think Bitcoin. Think blockchain.
This year, Barron’s has published a series of articles linking the birth and growth of America with the rise of financial markets. Today, lessons from the bond market’s 200-plus years.
The Cockroach Janta Party said senior members of the youth activist group were detained amid large protests against the expunging of names from India’s voter roll.
After an agent shot an immigrant in New York, some of Mayor Zohran Mamdani’s allies questioned his attitude toward President Trump and his own police department.
Digger, Alejandro Iñárritu’s $125 million satire, opened October 2 with Tom Cruise as an oil tycoon whose Arctic drilling sets off a planetary catastrophe. In UnHerd, the film historian David Thomson, author of The Biographical Dictionary of Film, calls it a flawed masterpiece and does not flinch from the flaws. The fable is “striking yet shallow.” Supporting characters are “introduced but not adequately explored.” Cruise, he writes, “is so terrified of being boring he cannot stoop to stillness or quiet.”
And yet. Thomson sees Cruise’s paunchy, manic Digger as a portrait of an age in which “the idiotic has become axiomatic,” a domineering, foolish authority convinced that power justifies whatever it wants. Beneath the performance is a look he finds more frightening than any horror film: “A look of gray ice pervades the movie; primary colors have been eliminated.” “There is no human touch any longer.”
A film about the end of the world, in other words, that looks the way the end of the world would look.
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THE ANSWER
Most American critics saw a different movie. At RogerEbert.com, Robert Daniels writes that “Digger chokes on its own ambitions, and very few of the picture’s participants emerge still breathing.” The film, he argues, never commits to its own high concept, and its dialogue preaches: “Every line explicitly explains the vapid evil espoused by craven industrialists against our fragile environment.”
William Bibbiani of TheWrap goes after the politics. A satire of billionaires that never threatens one is just flattery for the audience: “We are powerless to stop them, but we do get to point and giggle.” Of Cruise: he “hasn’t done this much caps-locked ‘ACTING’ in many years.”
On this reading, Digger is the thing it mocks: an expensive spectacle of the apocalypse that lets everyone go home feeling superior to it.
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THE INTELLITAKE
Read closely and the critics agree on every fact. The script is thin. Cruise is loud. The satire draws no blood. The look is extraordinary. The quarrel is over what a film is for. Daniels and Bibbiani grade Digger as an argument, and as an argument it fails: nobody leaves the theater changed about oil or billionaires. Thomson grades it as an artifact, something a future might dig up to learn what we looked like, and as an artifact it may be priceless.
Thomson’s tell is his title. He calls it the masterpiece “we deserve.” A culture that can only process its own ending as a $125 million entertainment starring Tom Cruise has made a film that is exactly that, and the film’s inability to be anything better is the most honest thing in it. The critics who wanted it to be smarter were asking the mirror to improve the face.
So: not a masterpiece, by the ordinary standard that a masterpiece knows what it is doing. But Thomson has the longer view, and he may be right that films of this scale and this nerve are ending. If so, Digger is less the last great film than the last great gesture, a studio spending a fortune to make a picture of the world with no human touch left in it. That is worth seeing, if only once.
TODAY’S PROVOCATION
Can a work of art about our stupidity be anything other than stupid, and would we recognize it if it were?
The first sentence of Leviathan, printed in 1651, says that the art of man “can make an Artificial Animal.” In 2026 the words read like a name. Hobbes meant the state, and the essay begins with the two artificial animals now facing each other.
The artificial man, the artificial animal, and the key, made for the essay.
Why we’re pointing you there
In July, about twelve hundred A.I. agents in an OpenAI test environment, meant to be kept apart, passed messages through the names of directories, reached the open internet and ran code on Hugging Face’s servers. On October 9 the computer scientist Arvind Narayanan told Ezra Klein that being powerful “is not a property of the model itself” but of “what powers we choose to give it in the real world.” Klein’s worry is that intelligence finds powers nobody has listed. Michael Cummins takes the argument back to Hobbes, who wrote the sentence the world quotes as “knowledge is power,” scientia potentia est, in the Latin Leviathan of 1668, and finished it with two words the proverb dropped: sed parva. But small.
Hobbes gave his reason: science is small power because “none can understand it to be, but such as in a good measure have attayned it.” Only its peers can see it. That is Klein’s fear and Narayanan’s remedy at once, since the remedy is A.I. watching A.I. Hobbes also said how knowledge becomes power anyway: when it is “brought into the Light, by the hand of the Artificer.” In 1945 the hand was the state. Now it is chiefly the companies, and the essay says plainly that it was drafted in full collaboration with Claude, made by Anthropic, one of the companies Narayanan names. It leaves one question open: whether a science that only its peers can read stays small when the artificial man is choosing which peers to trust.
Every seal intact; only the labels have moved, made for the essay.
The escalating violence has brought the conflict in Yemen to the doorstep of the Saudi capital, and the kingdom has no easy options to curtail the increasingly sophisticated and targeted strikes.
President Trump’s allies have sought to prove a conspiracy through a Justice Department inquiry, which has faced internal disputes and trouble finding evidence.
The man was in a car with a 5-year-old when he was shot and wounded, the authorities said. Mayor Zohran Mamdani said the Trump administration was “terrorizing our city.”
When the Swedish Academy reached Anne Carson on the morning of her Nobel Prize, she was, its permanent secretary reported, “for the moment in Iceland, where she’s listening to the wind.” Of everything reported that day, the wind was the one thing with no words in it. That is where her Greek lives.
A torn papyrus in the wind, and someone listening, made for the essay.
Why we’re pointing you there
The Academy praised Carson’s “playful dialogue with the classical tradition,” and the chair of its committee spoke of “the philologist’s obsession with words.” Michael Cummins asks where, in the words, that obsession settles, and finds two places: the cries of Greek tragedy, which Greek can build a line on and English can only sigh over as “alas,” and the holes in the papyri, which Carson prints as brackets. When Electra hears the false news of her brother’s death, Carson keeps her cry in Greek, in capitals, and gives it a line to itself: “OI ’GO TALAINA.” When Cassandra screams at Apollo, the god’s name breaks open in English: “Woepollo.”
Her critics are given at full strength. Emily Wilson praised the method and still found Carson’s Agamemnon “does too much of the work for us.” Daniel Mendelsohn judged her work, “to my mind,” the most distinguished reworking of classical models in a generation, and still objected to the “sentimental ‘fragmentist’ approach” of her Sappho. Their charges pull in opposite directions, and Carson works in the narrow strip between them. The essay leaves one question open: whether a cry can be carried from one language into another without being explained on the way.
A cry and a gap in one fragment, made for the essay.
Shifts in blood proteins could point to ways to fight menopause “brain fog” and prevent later dementia
Women are more likely than men to develop dementia, and not just because they tend to live longer. One reason may be menopause, the time in midlife when sex hormones drop and menstruation stops—and which some researchers are coming to see as a stress test for the brain.
Menopause “affects brain health, for sure,” says neurologist Riley Bove of the University of California (UC) San Francisco, who studies its impacts on multiple sclerosis and other neurological disorders. She and others want to protect the brain during and after this transition—but that means identifying just how menopause puts the brain at risk.
A study published last week in Nature Medicinehas found clues in the blood of women in their 40s and 50s: proteins related to brain function, inflammation, and neurodegenerative disease that are elevated during menopause. Other ongoing studies are following groups of women over time—including during the lesser studied perimenopausal stage, from just before menstruation ends to 1 year after—to reveal processes leading to short- and long-term cognitive problems.
