BMA News today carries a plea from a junior doctor to the Health Secretary for the government to be more open with NHS staff about its plans. When she confronted him at the Labour Party conference his response was that she should stick with the NHS ‘because it is the right way forward for our country’ and that staff commitment was needed to enable progress. She hopes to work with offenders with learning disabilities when she becomes a consultant next year – an area traditionally underfunded and where the private sector is now playing a larger role. Uncertainty about the government’s intentions for developing the health service and the extent of private sector involvement, is affecting morale and creating a dilemma in developing careers.The uncertainty has been compounded by a review of the NHS set up by the Treasury. The terms of reference make it clear that the policy of treatment according to need rather than ability to pay will be maintained, but the emergence of the review reveals concern about funding. Costs are set to go on rising to provide better pay to recruit and retain staff, to fund new higher cost treatments and to cope with the increasing numbers of elderly people.