23 MAY 2016

Both sides should stop treating the public as fools in this ugly referendum campaign

With a month to go until the EU referendum, the public deserve better from this campaign. I came into politics urging for better use of data and, like so many who are grappling with the questions at the heart of the debate, I'm dismayed by the disingenuous and at times downright misleading claims from both official campaigns.

We have seen a spiral in recent days, with both sides making ever more outlandish claims. Most recently Vote Leave has blamed EU migration for NHS pressures, brazenly hijacked their branding and continued to make the absurd claim that Brexit could divert £350million extra per week to the NHS.

There are many reasons for the pressures on the NHS, but largely because we are living longer and with multiple and complex conditions. As many have commented; if you meet a migrant in the NHS they are more likely to be caring for you than ahead of you in the queue. The NHS Chief Executive, Simon Stevens, set out the stark dependence of the service, on overseas staff during his interview on the Marr Show and, whilst many health and care workers come from outside the EU, a vote to leave would have consequences if those from the EU were made to feel unwelcome. He also highlighted the dependence of the NHS on a strong economy and the knock on consequences for any uplift in funding of financial turbulence. In my view, it is an increase in the percentage of our national income that we spend on health and care that will save the NHS, not Brexit. After the rebate and funds already committed to support farmers, exporters, regional development projects and science, the leave campaign clearly does not have an extra £350m per week to promise the NHS and they should stop treating the public as fools.

There are legitimate concerns about pressures of population growth on housing, schools and certain areas of health provision but the current pre-occupation exploiting the NHS, and its protected branding, to support the leave campaign's argument on the EU is a cynical distortion which undermines the credibility of their other arguments. I will not hand out Vote Leave's deliberately misleading leaflets about the NHS.

The issues around this referendum are complex. People are sick of the deluge of misinformation and don't know who to trust. We cannot point to either official campaign as a trusted source. I'm suggesting people look at websites like Full Fact or the detailed research published by the House of Commons library.

I remain very torn about this referendum. I had never imagined that I would vote to leave the EU and welcomed the renegotiations as an opportunity for the institution to take account of the serious concerns not just from Britain but from across the continent. I wanted to stay in a reformed EU and yet the renegotiation only served to highlight that the EU appears neither interested nor capable of genuine reform. The democratic deficit at the heart of the institution and our own detachment from it are deeply troubling.

We tend to think of the EU as benign and remote but what if a federal and ever more centralising Europe moves against our national interest? We will be powerless to effect meaningful change just as we are already unable to vote its leaders from power. The situation in Austria should act as a wake up call to those who feel that the direction of the EU could not change. My fundamental concern is that in our own mature democracy we must retain the ability to remove from power those who make the decisions which govern our lives.

I am concerned about the increasingly ugly tone of the Leave campaign but I'm also sceptical about the wild claims of a descent into chaos, war and the collapse of security from the Remain camp. In the event of Brexit wise heads would surely prevail to ensure essential cross border cooperation.

Project fear however, appears to be working. I meet many people who are switching to Remain because they have been spooked by the relentless messaging on security and the economy. They will be holding their noses to vote for remain, not endorsing the status quo. There is still a powerful feeling that people want a relationship based on trade rather than tied to the rim of an ever more centralised and powerful federal Europe.

If the majority vote to stay - which I think is likely – we must fundamentally rethink how we engage with the EU and develop a meaningful relationship between people and the currently remote bodies which make up this institution.

The remain campaign is anxious, and as a result – they and the government are overhyping both the risks of leaving and the benefits of remaining rather than leading a nuanced and honest debate. The danger of that approach is that the result will be interpreted by the EU as a ringing endorsement of business as usual.

13 comments

I think it is a great shame that leaders of both campaigns are resorting to sniping, when they could be laying out the facts. Regrettably, this could be our only chance to leave an increasingly federal Europe, and we need our sovereignty back. The UK's influence in Europe is diminished, and membership is inhibiting our ability to negotiate elsewhere in the world. Of course we will have pain if we leave, but it will be much less now than in the future, when we can no longer bear the EU's stranglehold, and quest to subsume us completely.
- Jacky Davis

I agree totally with your views however do believe the cost to the UK economy if we leave will be too high a price to pay. The Brexit campaign has been abysmal and Boris has been totally unconvincing. The statistical and analytical arguments to stay are far greater, but I agree the campaign has at times been foolish and far less effective than it should have been. Trade with with the EU is vital to our economy. We cannot afford to lose circ. 45% of our exports. Some may argue the EU needs us as much as we need them but if we leave they will set an example of us the same way Russia stopped imports that harmed them more than their suppliers. Brussels will have the stronger hand in any future trade negotiations which will no doubt result in onerous terms, probably including a free movement of EU citizens such as the agreement with Norway. We will be over a barrel. Leaving the EU therefore may not resolve our immigration issues and with less influence to determine EU policy we could have less control than we have now. The answer has to be staying in Europe but getting tough, using our influence and using our veto. There will be other member Countries that share our concerns and who want to retain sovereignty and move further away from being a Federal state. We have as much right as any other EU member Country to determine the future of the EU and it is time we made our voice heard. We should oppose any more member Countries unless we get agreement on tighter controls on freedom of movement.
- Mike Allen

What is wrong these days with the word traitor. Those that are prepared to throw our sovereignty away,allow our legal system to fall pray to a foreign legal system are nothing less.
- Loris Goring

I very much respect your position on this Sarah, and as ever your tone is measured. There are clearly faults on both sides of this debate. Leave have run a poor campaign and seem destined to lose. I really don't think the campaign is helping the party or the country. I started off as a soft leaver (probably similar to yourself) and have become more convinced of Leave as the campaign has gone on. The issue is one of long-term economic prosperity and democracy. The PM's renegotiation in some ways only served to confirm for me that this organisation is incapable of the serious reform needed. As you suggest, it looks like Remain is winning. Since the campaign has been largely about the economy (the worst kind of short-termism, empty speculation about the value of the sterling in the weeks after a referendum and so on), and the general public largely doesn't understand these issues, it is reasonable to assume that many people will be swayed by the volume of information when their prosperity is threatened. This is a shame, because the economic record of the EU is hardly unblemished. The EU seems to have no idea how to resolve long-term structural weakness and achieve growth. The Prime Minister has led poorly on this, and has damaged the party. He has compromised the hard won reputation of independence in the Civil Service, Bank of England and the NHS (Mark Carney and Simon Stevens had no need to get involved in such a partisan way). The Treasury has left itself open to ridicule with its claims. I resent Mr Osborne calling Leave campaigners "economically illiterate" (many Leave supporters are clearly not such a thing), when it is many of these people who have supported him over the past six years (often against many of his new found friends), even when he has missed a succession of economic targets The spending of £9 million on a leaflet promoting the Remain view was equally embarrassing, and a breach of basic fair play that does the Party little good. Having voted for the Party and been a loyal supporter, I am angry beyond words at his claims that Brexit is unpatriotic and immoral, and that "Al Baghdadi will be smiling". The PM should remember that a great number of the people on the Leave side are (or at least were) his supporters. I am grateful for the opportunity of this referendum...it was one of the main reasons to vote Tory in 2015...and I respect his right to disagree...but his conduct during this campaign has been disgraceful. He may argue with good reason about the conduct of some on the Leave campaign...but he is the party leader, his responsibilities were clear and his conduct has been appalling. Clearly the PM believes that the end justifies the means. I disagree. Such a campaign means that the vexed issue of Europe will not be settled, and will surely be the dominant theme in the coming leadership election (which it shouldn't have). The Parliamentary group and the wider party have been ignored and insulted on this issue. I have always supported Tory candidates in all elections, but I will not be able to continue this unless Mr Cameron names a date for his departure. After 24 June the PM will be reliant on MPs who he has insulted...he cannot surely believe that he can breeze back into the 1922 Committee and say "good game chap, let's get on with governments" after that performance. There may be no Brexit (and I am scared enough about that prospect), but change is coming nonetheless.
- George, Paignton

I am heartened by this thoughtful post. I don't agree that the distortion of data falls equally on both sides of the Leave/Remain campaigns, especially when it comes to data concerning the NHS. But it is good to see a recognition that the misuse of the NHS brand in the Leave campaign is not something that goes unremarked, or without consequence, as you imply by your refusal to use material which does this. I hope that we can encourage a discussion about the EU and its decision-making processes that both recognises that our own constitutional arrangements are far from perfect, and that accepts that "the EU" isn't "them" - it is often "us" - look, for instance at the European Medicines Agency, located in London, or the many partnership arrangements between regional bodies and EU institutions for capacity-building and infrastructure investment. The EU hasn't remained the same since it was established, so we can confidently expect there will continue to be opportunities to change it for the better. (T.hervey@sheffield.ac.uk)
- Tamara Hervey

Dear Dr Sarah, I would like to say that your post is one of the most inspiring I have ever read from a politician and I respect your reason for voting to leave...if only more UK politicians could be so clear about the debate...before I comment on/repeat anything I hear, I always do my own research to get to the real truth behind the claim..my biggest concern is that our successive governments and oppositions continually put party politics before the best interests of the UK, the EU and the world...people are genuinely tired and frustrated of what's happening in the UK Parliament...I have come to the sad conclusion that it's better to trust the collective views of MEPs from 28 democratic countries rather than my own Parliament and that is the main reason I will be voting to remain in the EU...Kind Regards, David
- David Coole, Andover

What a breath of fresh air amid the incessant wind tunnel of bogus claims, lies and polarised opinions!
- Daniel Sainty

Hear! Hear! 👏🏼👏🏼👏🏼 Although I am for IN, I think your article is a good well thought out argument and I, along with many others, are sick of BOTH sides going to extremes to support their case!
- Dr Stanley Ooi

I would just like to quote from a speech made by Winston Churchill in 1946 regarding the avoidance of another catastrophe in Europe (and hope not to be called traitor by Loris Goring) : "Yet all the while there is a remedy which, if it were generally and spontaneously adopted, would as if by a miracle transform the whole scene, and would in a few years make all Europe, or the greater part of it, as free and as happy as Switzerland is today. What is this sovereign remedy? It is to re-create the European Family, or as much of it as we can, and provide it with a structure under which it can dwell in peace, in safety and in freedom. We must build a kind of United States of Europe." People of reason realise that some compromise is necessary in any democratic agreements between groups of countries. Consider the state of the British economy when we joined the EU in 1973; surely nobody will claim that the EU has prevented our economic development since then.
- Keith Best

Well, good to see a well balance article, well constructed, which even i am a remain voter, it good to see a outer, who is agreeing with my point of view, on this subject,while we can disagree on other points with the outers, this is a breath of fresh air, well said and done
- Geordie best

"Consider the state of the British economy when we joined the EU in 1973; surely nobody will claim that the EU has prevented our economic development since then". Our prosperity has an awful lot more to do with Thatcher's supply side reforms in the 1980s than the anti-trade EU. With so many EU economies on their knees, how on earth is membership of this crumbling relic an economic necessity for the world's fifth largest economy?!
- George, Paignton

Your article represents a sneaky attempt at damping down the patriotic effort to gain freedom from this monster called the EU. Lecturing to the "fools" about not treating us like "fools" is perverse. All this psychobabble double talk has evolved into a political double speak, originating from the old Tony Blair school of PR chicanery.
- Jack Hough

Sarah Your integrity is an example to us all. But I think you misinterpret the threat to democracy in Europe. The big threats to democracy in Europe are not coming from some vague top down institution "the EU" but from individual countries. As they react to the triple of challenges of immigration, terrorism and slow growth, far-right movements ride a wave of populism (as in Austria) and when in power erode democratic fundamentals (as in Hungary and Poland). The question is how best to respond to this. Do we isolate ourselves - content with the assumption that we can always vote out our national government if we don't like it - or work with and improve the EU to maintain and promote a set of democratic values and human rights that can challenge undemocratic member governments. The isolation option seems to me badly mistaken. We would be rash to assume that just because our government has been democratic and moderate in the past that we are immune to these same forces that affect currently affect Poland and Hungary. We already see some fundamental rights being challenged and our popular press, while far from being under government control, is rabidly right-wing, xenophobic, and appears to have even less interest in the truth than the politicians. But even if we maintain our democracy - we would be an individual state in a Europe of many individual states some of which are developing in very unpleasant ways. David Cameron never implied that Brexit would lead to WWIII - that was Boris's fertile imagination - but we have been there before and this scenario is ripe for conflict of some kind - perhaps in the East with an expansionist Russia keen to take advantage. The stay and improve option is not easy either. The EU is very far from bridging the democratic deficit but it is slowly moving in the right direction (e.g. the parliament has moved from being essentially advisory to having a veto), has some impressive achievements in promoting democracy in Europe (e.g. the incorporation of the ex-totalitarian countries of Eastern Europe), is more democratic them many realise (e.g. elected MEPs that are prepared to contribute, can and do sit on committees and participate in policy-making just as MPs do in the UK) , and if the EU should no longer be benign we can withdraw - an option that is not available to the people if we should get an undemocratic national government.
- Mark Frank

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17 APR 2016

Community Hospitals; a precious community resource

Our community hospitals are immensely valued and so any changes, especially those that could lead to bed closures are a serious concern. Community hospitals are about far more than their bricks and mortar, they are at the heart of delivering a service to local communities that allows people to be cared for closer to home, sometimes to be able to be cared for near loved ones at the end of their lives or to avoid having to be admitted to a larger hospital too far away for friends and family to be able to visit. Community hospitals provide personal, high quality and supportive care and are extraordinarily important to all the communities and individuals they serve.

To be clear, I do not want Paignton or Dartmouth hospitals to close. But our ageing population and the rising demand for services especially as a result of the growing number of people living with long term conditions mean that those planning services have to look at how we can care for as many people as possible close to home within the resources available. That means looking at the whole system of primary care, community nursing, social care, mental health services and voluntary services alongside community hospitals and Torbay hospital. We cannot look at them in isolation.

Across South Devon our primary care and community services are under great pressure with difficulty recruiting staff and in some cases working from totally inadequate premises. The closure of the minor injuries service at Dartmouth happened because they could not recruit or retain the highly skilled staff to maintain a safe level of service. Local health and social care is also under great financial pressure and our Clinical Commissioning Group is on course for a £15million shortfall in 2016/17.

Torbay and South Devon Foundation Trust and the CCG will be publishing their final plans on April 22nd but it is worth looking now at the links from the CCG website for Paignton and Brixham as well as Moor to Sea. These set out the challenges around age, deprivation and health inequality as well as the financial pressures facing our local area alongside the draft proposals.

If the plans just involve cuts to services and beds I will not support them. If a strong case can be presented for how money would be invested in genuinely improving services for patients then I think there must be a clear promise about how that will be guaranteed and greater detail on what it will look like.

The beds that are so valued by communities, close to home, can sometimes be provided as beds with extra support within a nursing home or residential care but there must be complete honesty about what the money saved, estimated at £3.9m would be invested in to make the overall service better at allowing people to be supported in their own homes without needing hospital admission in the first place.

Our community hospitals were gifted to local communities and supported over many years by generous donations and bequests. If any are sold, and it remains a big if, that resource must stay for the benefit of the local communities to which they were gifted and be used to build primary and community care facilities that are fit for the needs of today's patients. Those changes must have the support of communities and that will only come if the case can be clearly made for why the service could be better if provided in a different way. We know for example that NHS community bridge workers working alongside voluntary services can make a great difference in supporting people as they leave hospital and in reducing the risk of unnecessary admission. Community teams can include physiotherapists, occupational therapists and community mental health professionals as well as community nursing and social care but they need a base. Multidisciplinary teams can work even better if located alongside primary care so the consultation needs to set out a vision for the whole service and clear evidence for why that would be better than our highly valued local network of existing community hospitals. There is a strong case for community hospitals to do more, not less but that may mean using them in a different way focusing on prevention and care for people living with long term conditions.

There is not enough detail in the draft proposals on how the new arrangements would improve or work alongside GP services and far more detail is needed about where nursing home or residential 'intermediate care' beds would be provided if not at the local community hospital. The proposed closure of 28 beds at Paignton and 16 at Dartmouth would be a great loss and local people will need a clear explanation of how the money saved from closures would be invested both to improve services for local people and allow care to provided more efficiently rather than it just being sucked into plugging a financial gap.Whilst some admissions can be avoided with better community care, that is not always going to be the case. Torbay hospital is already under pressure and, without a clear plan for community beds, there is a danger that we could see people being admitted to even more costly hospital beds further from home as well as greater difficulty discharging patients at the end of their stay, one of the main causes of delays in casualty departments. It is very important that the beds from St Kildas are also taken into account.

The proposed closure of minor injuries units also means more people turning up in A&E from where they are more likely to be admitted unless there are really effective measures in place to avoid this. Anyone who has tried getting from Brixham to Torbay at peak times in the summer will know how difficult this can be and a Brixham hub should include access to a MIU in my view.

Amongst the many principles set out for the proposed reorganisation, there is a specific reference to improving life expectancy especially in the most deprived areas. There is a serious question therefore about the impact of closures on our most deprived communities in Townstal and Paignton and what services would be put in their place to reduce inequality and improve health and wellbeing.

I will be closely studying the final plans once these are published and attending as many of the community consultation meetings as possible. As Paignton hospital is in the Torbay Parliamentary constituency, Kevin Foster MP will be leading the discussions on the proposals there whilst I will be doing so for Brixham and Dartmouth hospitals. We will be working together as people from across the Bay use and value all our community hospitals.

6 comments

Dartmouth Hospital is seen as prime real estate. It'll be sold to the highest bidder and turned into luxury waterside penthouses.
- Anon

as both Sarah and Kevin Know that in truth the deal has already been done all this rubbish about public consultation is a smoke screen the true Conservative policy is to CUT and promise to invest in better alternatives ,which will not happen this is yet another move to eventually have the N H S dismantled and private profiteer organizations to take over I fear for the younger generations that will be at the total mercy of corporations profit margins
- victor freeman

The problems with staffing have a lot to do with the gross lack of affordable housing. The problem with housing is that too many houses are being built to be sold on the open market to the highest bidders. The solution to the housing problem could well be the solution to the staffing problem - build more decent affordable housing.
- Victoria Trow

If there is closure of some community hospitals it is my understanding that staff that work in these hospitals are expected to offer an intermediate care service that would prevent hospital addmisions and allow people to remain in their own homes. Whilst this is a good idea and no doubt many people would prefer to remain and be nursed at home ,it would prove extremely difficult in practice. Many staff do not have their own transport and rely on public transport or lifts to work. How are these staff going to deliver a service in an area that has many rural and outlying villages . Its a logistical nightmare and if two staff are required to attend a patient that may have mobility problems and need the assistance'of two staff ,then the problem becomes even greater. Has anyone actually worked out how much more time and effort in delivering this service is likely to cost?
- valerie Husband

The loss of the MIU at Dartmouth is a very regrettable event. With the population of Dartmouth and Kingswear, as well as Kingsbridge/Salcombe and surrounding holiday sites swelling to capacity in the summer months, it puts lives at risk--especially children's--during these periods. If people are meant to travel to Totnes or Torbay for help it could mean people fail to get needed attention. A minor injury (if not addressed in a timely way) can become more serious and perhaps disfiguring if help is not prompt and effective. Dartmouth hospital needs to be saved not only because of the community element of care to local people, but also to reinstate, as soon as is practical, the MIU. The lifeblood of the area is tourism, and if the South Hams cannot take care of its own communities, it won't be able to care for visitors either. One would think that with all the private money pumped into the area for real estate and tourism, that a decent emergency and urgent care facility would be a basic priority of the local commissioning groups and councils.
- Prana Simon

I really do not want any small hospital to close. As we do not have Convalescence homes any more we need feeder hospitals to allow beds to become free in the main hospitals. . It also allows patients with less serious complaints to be nursed nearer home even though nursing patients in their home can be valuable at times. The cost of care homes is extortionate. For example, my mother needs an urgent cardiac procedure. The waiting time for an urgent procedure is 6-8 weeks. My mother is desperate for a replacement hip and at present is immobile. On her surprise on the time the Consultant commented that he had to cancel all his operations that day as there were no beds and that the NHS was "falling to pieces" . We need more beds, consultants, nurses etc and more local facilities. Travelling from Bude to Plymouth each day for a visit? Just think of that toll on families.
- Anon

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04 APR 2016

In this junior doctors row, both sides have lost sight of the patient

I wrote the following article for the Guardian

I have great respect for junior doctors; it has always been a demanding role. Alongside my clinical practice, I spent over a decade teaching them before changing my initials from GP to MP. I should also declare a personal interest as my daughter is one of them, albeit currently working in Australia.

There is a long tradition of juniors spending a year or two abroad early in their careers before settling down to specialist training back in the UK, but now there is a genuine concern about the balance between leavers and returners. Many of my daughter's colleagues are not planning to join her on the journey home next year and there has been a marked increase in the numbers applying for certificates to work overseas.

The toxic dispute between the government and our core medical workforce risks driving an exodus of skills that we cannot afford to lose.

The contract sits like a festering boil with neither side ready to agree a way forward, and the dispute looks set to erupt into a dangerous full walkout by junior doctors. The British Medical Association (BMA) claims that the contract will harm patients by stretching doctors too thinly across seven days while reducing their take-home pay. The government insists that patients are being put at risk by understaffing at the weekends and that the contract reduces doctors' maximum hours and consecutive shifts while increasing basic pay by 13.5%.

The Department of Health and the BMA have spent so long shouting at cross purposes that they have forgotten their common purpose. In using them as pawns, both sides have lost sight of patients, the very people both claim to want to protect.

It was perfectly reasonable for the government to try to tackle the higher mortality at 30 days for those admitted to hospital at weekends, but entirely unreasonable to blunder on asserting that the new contract is the answer. Ministers are undermining their case and inflaming tensions by misquoting the evidence, which points more to the need to improve senior decision-making, nursing cover and rapid access to investigations at the weekends than to increase junior doctor cover. If the objective is to tackle excess weekend mortality at 30 days, the government should have followed the evidence and focused elsewhere.

It seems to me that the contract is more about the manifesto commitment to a seven-day NHS and the perceived barrier of premium Saturday pay rates. There needs to be a far clearer and more consistent definition of what the government means by a seven-day NHS and how it will be staffed and funded. Is it about convenient seven-day access to routine services and surgery, or about making sure that urgent and emergency care is available to the same standard every day of the week?

The Department of Health should have been more robust with No 10 that a routine seven-day NHS is unachievable within the current workforce and financial pressures and refused to accept underfunded new commitments.

Mine was the last generation of doctors to endure crushingly unsafe 120-hour working weeks and I have no romantic nostalgia for the 72-hour shifts commonplace in the late 1980s. Tired doctors can be dangerous doctors. What struck me, however, from the juniors I taught before coming to parliament, was that they felt every bit as exhausted and demoralised, not through lack of sleep but because while on duty they too often felt stretched to the limit. Medicine has also lost the supportive team structures and flexibility to work near partners and accommodation that once compensated for the stresses of the job. Today's juniors, feeling powerless and undervalued, are now prepared to walk out on their patients – but that will have lasting consequences.

A failure to recognise this until too late in the negotiations, alongside a disastrously timed and clumsy announcement, risks scuppering an important opportunity for change. The appointment of Professor Sue Bailey, chair of the Academy of Medical Royal Colleges, to examine how to improve juniors' working lives, should have been unequivocally welcomed by the BMA. Anyone who knows her will know that Prof Bailey is no mouthpiece for government and would be a powerful advocate for change.

Pressing ahead with a full walkout however, will serve only to harden attitudes and solves nothing. Most importantly, it will be disastrous for patients. The BMA has no doubt calculated that people will blame the government, but a strike that leaves patients without junior cover even for emergencies puts lives at risk. It cannot justify such drastic action by claiming to protect patients.

Given the agreement to pay the premium rate all day to any doctor working one Saturday or more every month, how can it be argued that patients will be safer only if all Saturdays are paid at the premium rate, however infrequently worked? Given the scale of concessions and protections on maximum hours and consecutive shifts, the BMA could have declared victory and moved on to focus on the deeper and longstanding causes of discontent.

Junior doctors are understandably concerned about being pressured into working unsafe hours despite the proposed safeguards, but this was all the more reason to work with Prof Bailey and new provisions in the contract to make sure that whistle-blowers are confident to come forward and fully protected when they do.

Both sides now need to put patients first and step back from this dispute. The government should do as it promised under the Health and Social Care Act and to stop trying to micromanage the NHS. If there was a clearer definition of their purpose behind a seven-day NHS, the service could better design the solutions and set out the costs.

It would also help for the government to make a clear statement of the obvious: that come August, junior doctors will see little change to their shift patterns. The simple reason is that there are not yet enough of them to achieve a truly seven-day service. That ambition requires a change in the workforce and a commitment to supporting and working alongside it rather than in an atmosphere of conflict.

NHS England, Health Education England and the BMA should work with Prof Bailey to undertake a fundamental review of junior doctors' training programmes, responsibilities and working lives, including facilitating them to coordinate placements with partners. Many more of their duties could be shared with others such as pharmacists, physician associates and admin staff. Patients are already benefiting from the greater use of the professional skills of specialist nurses and far more could be achieved.

In some hospitals, such as Salford Royal in Manchester, electronic patient records are finally reducing the scandalous waste of time and resources that come with duplication and paper trails. More could be done to make sure that best practice benefits patients everywhere.

A constructive relationship between doctors and government will take time to rebuild; it cannot be imposed and it will not happen unless both sides put patients first and start listening. Saving lives must take priority over saving face.

4 comments

I agree fully with you when you say: "The Department of Health should have been more robust with No 10 that a routine seven-day NHS is unachievable within the current workforce and financial pressures and refused to accept underfunded new commitments." The problem is that government has pressed ahead with the plan without the additional funding required. This is the crux of the dispute - although the genuine concerns of doctors have since been magnified ten-fold into utter anger and frustration by the way in which Jeremy Hunt has treated them. The BMA have asked for talks to resume - but received the response that 'the matter is closed'. The most important thing now is for the threat of imposition to be removed so talking can start again. Without talks nothing can move forward and the situation can only worsen.
- Jonathan

What a shame that you are not our Health Minister. Our daughter is a new GP. Having seen her experience in training and now as a salaried GP I can only say that there is a significant void in the planning and delivery of the NHS' staffing requirements and a profoundly callous approach to the employment and development of valuable and dedicated young professionals. We desperately need a Health Minister who understands the issues and who commands the respect of staff and patients alike, able to go beyond sloganeering into long-term planning.
- David H

Took the liberty of writing you in as my choice for Leader in the latest Con Home survey. Cons need to be seen to be safe with public services. I greatly valued this article, but I'm still not clear about the money. How much is the "premium rate", and how much might be lost with the new contract please?
- John Bald

Dear Dr Wollaston, I read your "in a personal capacity" article in the Guardian pointing out that available evidence suggests that increased weekend-admission-mortality is due, not to the lack of junior doctors on duty but to poor senior decision-making, inadequate nursing cover and insufficiently rapid access to investigations at the weekend. As a Conservative MP, a doctor and the Chair of the health select comittee, are you not able/allowed to convey this simple piece of information to Mr Hunt and Mr Cameron? Is it that you are ignored? Your puzzled colleague, Miriam Wohl, MB ChB, JCCCCert, MSTAT
- Dr M Wohl

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18 MAR 2016

Taxing sugary drinks companies helps to boost funding for children's sport

George Osborne's announcement in the Budget that he wants to help fight childhood obesity through a tax on sugary drinks has provoked the usual grumbles. But this is not a 'pious, regressive absurdity', as some claim. It is practical action that will help to tackle an avoidable health disaster for the nation's children, a quarter of whom from the most disadvantaged families are leaving primary school not just overweight but obese. This is double the rate for the most advantaged children and the inequality gap is rising every year. If that had no consequences for them, there would be no case for action, but obesity blights their future health and life chances. It also adds to the rising and unsustainable bill for the NHS of at least £5bn per year.

Finally, the manufacturers and importers of sugary drinks have an incentive to reduce the sugar content of their products so that they are below the 5 or 8g/100ml thresholds if they are to avoid paying increasing levels of levy.

'Why pick on sugary drinks?' bleat some of the manufacturers. Of course they are not the only cause, and this measure wouldn't work in isolation, but sugary drinks are the single biggest source of sugar intake in older children and teenagers' diets, making up around 29% of the total. These are wasted calories with no nutritional value whatsoever. Sugary drinks are also rotting children's teeth and, at a time when admission for dental extraction is also the leading cause for hospital admission for young children, isn't it time that manufacturers took some responsibility?

I hope they were listening to the Chancellor as he pointed out that passing the levy on in the form of a price differential at point of sale would have a further impact on consumption. In Mexico, there was a 17% fall in sales of sugary drinks amongst the heaviest users one year after a modest differential in the form of a sugary drinks tax. It is childhood obesity that is regressive, not a levy that will make a positive difference, especially because it will most benefit disadvantaged children through doubling the school sports premium and funding for breakfast clubs.

Manufacturers may choose to swallow the costs themselves, but the tax could still push them to get on with cutting down on the amount of sugar in their products, in the same way as we have successfully cut back on salt in food.

This is a victory for children's health and manufacturers and retailers should now step up to the plate, show that they understand the scale of the problem, embrace the change and prioritise the health of their customers.

3 comments

Do you think there is a risk of diet drinks, with their proven to be carcinogenic sweeteners (eg aspartame) becoming even more prevalent, and there being significant unintended consequences in the long run?
- tim

Well done Sarah in supporting a sugar tax that is blighting disadvantaged families and the NHS with an obesity crisis. As you mention it does appear to be working in Mexico but Tim makes a very valid point in that any substitute should be safe and not lead to long term side effects of a different nature.I believe Sucralose has been deemed to be a safe alternative.
- John Roadknight

It is not safe at all John!, reinforcing Tim's and my own very valid point. We need to look very long term, fail safe, in fact! David
- David Cassell

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21 FEB 2016

Britain Will Be Stronger Out of a Federal EU

The European Union has missed an important opportunity for reforms that could have benefited all its member states and their citizens.

As a result, the prime minister has returned with a threadbare deal that has highlighted our powerlessness to effect institutional change. If this is the very best that can be grudgingly conceded when EU leaders express concern at the prospect of a British exit, what hope is there of any meaningful reform in the future?

Come the referendum in June, the deal will be a distant memory and unlikely to influence decision-making so much as gut reaction and weighing the balance of individual and national interest. I expect that those campaigning for us to remain in the EU will win the day if they can persuade people that doing so is the only way to guarantee security and prosperity. They will not win because people have any love for the institution itself.

Referendums have a tendency to deliver the status quo. The point needs to be made, however, that neither choice delivers the status quo because, like it or not, within a decade our relationship with the EU will look radically different, whatever the outcome. Last week's deal has underlined the reality that our Eurozone partners are continuing their separate journey towards full political and monetary union. We will inevitably be bound by and disadvantaged by the decisions they make in their own interest.

The time has come for us to frame a new independent relationship as good neighbours rather than remain a discontented junior partner picking up the bills but with no power to influence the rules of the club.

The costs go far beyond our considerable net financial contribution, annually variable but between £8.5bn and £10.5bn over the past three years. The Common Fisheries Policy has been disastrous both for fish stocks and for our once thriving industry. Nearly a quarter of our quota is now landed overseas by a single Dutch trawler and policy has been mishandled for decades with no accountability to parliament. There is a tendency to think of EU regulations and the European Court of Justice as benign, but interference with decisions like minimum unit pricing in Scotland show the power of big business interests to win out over important public health protections.

The concern about the level of migration is genuine and could have been addressed but the EU has failed to take the opportunity for measured and sensible reforms to benefits. The emergency brake is cosmetic, merely adding rafts of bureaucratic complexity with no meaningful impact on migration.

For all the dire warnings from Project Fear, I simply do not believe that co-operation on issues as important as trade, security, defence and science would collapse in the event of a vote to leave. No possible good would come for either the EU or Britain in an acrimonious separation.

We would set out on a new path as the world's fifth largest economy, confident, outward looking, keen to maintain close co-operation with our European allies and open for business. We would regain control over our own laws and borders and be free to negotiate our own trade deals with emerging markets.

There would undoubtedly be turbulence in the short term but we should balance that against the long-term risks of remaining bound to an institution that we will never learn to love.

I am always struck by the scale of our disengagement from the EU. When I ask at public meetings, few people can name a single one of the MEPs; fewer still have ever contacted one. It is hard to see why they would bother, given the democratic deficit at the heart of the institution.

In June, we face tying ourselves in for the long term to be increasingly governed by a body that few understand or trust and whose powerful commissioners we cannot vote from office. For anyone concerned about issues such as TTIP or the "tampon tax", the reality is that these are the domain of the unelected and unaccountable in Brussels and the list will only get longer.

In the run-up to the referendum, the most compelling request I hear is for more information and the opportunity to debate the issues without the shouting or sneering. People want clear, unbiased information from trusted independent sources.

Commentators should also set out their own voting intention so that their messages can be judged accordingly. We should not shy away from any aspect of this debate but the public do not want a campaign that is dominated either by immigration or by Project Fear.

My vote will count for no more than anyone else's but, for what it's worth, I am optimistic for our future, I believe the balance of our national interest now lies outside the EU and I will be voting to leave

24 comments

Sorry Sarah, but this a sad read. Descending level of argument and persuasion, lowest common denominators, isolationist. 'Tampon tax', 'project fear' - who is shouting and sneering? Predominantly negative. Bleak. Scary. Unpersuasive, weakening position that seems increasingly shallow intellectually. Will have to consider Health Select committee work with a much more careful and critical eye I think. Really disappointed. Bad bad call.
- Richard Stanley

Great Post - let's hope common sense prevails and the electorate of the UK stops our money being spent on the EU gravy train! PS Have the European Commiissions accounts ever been signed off by Audit, yet?
- David D

Sorry Richard Stanley but I think its a great post. Clearly "out" with a positive view ahead but still wanting the arguments aired by as many independents as possible. What's not to like..?!
- Tim Page

As a Uk taxpayer for over 50 years I take exception to the millions being wasted on the EU which could be better spent at home. The UK is an island and not part of the European continent and our laws should not be overruled by Brussells. Well done Dr Woollaston for making your postion clear by wanting out.
- Peter Clinton

Mr Cameron has returned from negotiations with little more than a bag of smoke and a few mirrors. The so-called "deal" that he has secured is worthless. So an "in" vote means nothing changes, while an "out" vote means we might have some chance to regain power over our own destiny, rather than be dictated to by an unelected crowd of trough-snufflers in Brussels. I can't help but wonder what ripples a Brexit might cause in the rest of Europe. Anyway, well said Dr W!
- Mike

It is certainly causing quite a few ripples in Scotland if you heard Nicola Sturgeon on the Andew Marr show last Sunday! The only divorce that is likely to occur on Brexit is the disintegration of the UK when Scotland leaves and reapplies to rejoin the EU! If I were one of the Footsie 100 CEOs' signing the letter in the "Times" today I would already be looking to relocate my headquarters north of the border. If I were one of the hundreds of thousands of UK pensioners happily living in Spain, France,Portugal and Cyprus, I would be extremely concerned at the plummeting pound caused by the current uncertainty and whether, on our exit, our reliance on the European Health Insurance Card Scheme would be affected. The citizens of Gibraltar must also be very alarmed if we Brexit and their land border with Spain is once again sealed. The EU will be weakened by our exit but will survive and we will no longer be able to rely on 500 million people and the world's largest trading bloc to shelter us from heavily, state subsidised goods coming from authoritarian countries like China and Russia. Yes, Peter we are an Island but no longer an empire and I am all too aware of that fact when there is a dispute in Calais and the M20 is grid locked and hundreds of lorries are stacked up hindering our 43% trade with our nearest neighbours that 3 million UK jobs are dependent upon! When it comes to bureaucracy Sarah, huge advances have been made in Fisheries with Hugh Fearnley Whittingstall playing a prominent role in abolishing discards and the UK FINALLY setting up Marine Conservation Sites! Instead of continually, complaining about EU bureaucracy it may be an idea to look closer to home! Stuart Goodall, the chief executive of the Confederation of Forest Industries is extremely frustrated at the "too bureaucratic" Government woodland creation grant scheme. Only 10% of land in England is wooded against an EU average of 38%! I thought wooded areas reduced the risk of flooding that many households have suffered this year.
- John Roadknight

With regard to the EU Accounts, I was under the impression that the only reason why the European Court of Auditors was unable to sign off the accounts for regional and social funds for 10 years was because the treaties did not give them the power to force national governments to disclose how the money had been spent. This was not the case for farm and fishing grants that were signed off. I understand that the above problem was resolved 6 or 7 years ago and the accounts have been signed off every year since.
- John Roadknight

I agree we should rid ourselves of the unnecessary bureaucracy of Brussels and we should be free to create trade treaties that suit our needs. However, we should stay in the EU, the benefits considerably outweigh the negatives. Norway and Switzerland sit ostensibly outside the EU and continue to contribute to the EU but have next to no say in how it the EU is run and suffer even more than we currently do (with the exception of the banking sector) from the volatility of exchange rates, oil prices and raw material price changes that can make a regional manufacturing unit and jobs redundant over night. A huge amount of our GDP depends on trade with the EU, harmonisation has created secure revenues that allow businesses to plan for the future and create jobs.In the future it will be our tech savvy children working with companies all over the EU that will in part create the wealth and tax flows that will support us our communities. We should be making it easier for them to compete not harder.
- Ged Yardy

Sorry Sarah; you have got this one wrong. Wrong strategically and wrong in relation to loyalty to the Conservative party.
- Malcolm Mackley

Dr Wollston is wise to carefully consider the implications of the federalization of the EU. We did not sign up for this in the EEC and neither did we imagine that it would become a club of 28 disparate nations dominated by the stifling maw of a massive bureaucratic administrative machine that hides its calamitous spending behind poorly drafted policies on auditing in earlier treaties. The economy. In my business I traded for over 30 years with companies in most of the present Member States and beyond. We gave our customers the products they needed, of the right quality and price and also delivered on time – result, a growing repeat order business. Our success owed absolutely nothing to the UK being a Member of the EEC nor the EU. The UK imports more from Member States than it exports to them, not simply because those suppliers are EU Members but because we get the goods and services we prefer, against offers from other sources. So people who scaremonger about the potential damage to our economy have little confidence in themselves, their companies nor the grit and determination of the people in our Nation. Laws Taxes and Sovereignty As a nation we need to demand the right to live under the laws and regulations agreed by our Parliament of MPs who can only remain in power by the will of the people they govern. The Federated EU will reduce our ability to do so, to an infinitesimal shadow of that right. Security The Politico/Administrative fiasco of the handling of the present immigrant Diaspora illustrates to me the abject failure of security offered by the politicians and administration of a combined 28 Member State organization (the EU). Scotland During the run up to the Referendum on Scotland “In or Out” of the UK, Nicola Sturgeon made much of demanding Scotland must have much more autonomy. Our Government listened and understood this demand and acted to give Scotland a great deal more “home control”. Now, Nicola Sturgeon is saying that if UK leaves the EU, she would fight to get Scotland in to the EU – what an extra ordinary volte-face in wanting to plunge the people of Scotland into a much much less responsive quagmire !!! In my travels, I have talked to hundreds of ordinary folk across Scandinavia, Germany, The Netherlands, Belgium, France, Italy, Spain and recently Portugal. I can honestly say that I met some “on the fence ditherers” but the vast majority of ordinary folk I talked to right across the heartland of Europe are fed up with and distrustful of the present EU machine as it is now constituted and run. MEPs and Administrators beware the turning worm !!
- Bob Hattersley

I agree with your statement about the reasons for brexit. Those who want to stay in Europe do not explain the lack of democracy at the top of the EU. It has been an eye opener as to how long it has taken David Cameron to gain any kind of reform. If the prime minister himself believes further reform is needed - how does he think that can be achieved?
- Roger Whitehead

I think that the only quagmire that will result from a Brexit is an isolationist "Little England" that will be much diminished both economically and politically. When Scotland exits and the UK fractures will we still hold onto our seat as a permanent member in the UN Security Council? With English being the world's international language and many foreign CEOs being able to speak it,many overseas companies such as Nissan, Honda and Jaguar Landrover choose to set up their subsidiaries over here in order to access the world's largest single market. I certainly do not want to endanger our next generation's economy and security by a leap into the dark that no-one can determine.
- John Roadknight

I am afraid that I have much more confidence in our Prime Minister and Chancellor and the G20 finance ministers than I do with the Brexit campaigners who wish to play Russian Roulette with our economy and security and cannot guarantee a safe,prosperous, secure outcome to their gambling.The status quo may not be perfect but at least we know where we stand and David Cameron has fought very hard to win concessions and safeguards. Below is a recent BBC statement from our Chancellor. I note that he states "Britain" as opposed to "Great Britain" comprising all the countries that make up the UK. Presumably he has taken account of Scotland's exit from the UK! What will we call our fragmented nation after Scotland leaves? The chancellor told the BBC: "The financial leaders of the world's biggest countries have given their unanimous verdict and they say that a British exit from the EU would be a shock to the world economy - and if it's a shock to the world economy imagine what it would do to Britain." He added: "This isn't some adventurous journey into the unknown, with all the humour attached to it, this is deadly serious."
- John Roadknight

Pull up the drawbridge, put up a wall, it is an unfortunate and dangerous trend. It is damaging to the economy, national security and the future for our next generation. Better fix the shortcomings from within than no doubt be exposed to them outside.
- Paul Churcb

Sarah, if, as Ian Duncan Smith told Andrew Marr this morning the Le Touquet Agreement is such a "benefit" to the French, can you tell me why, when the Eurostar Terminal in Calais was being breached by migrants last year, the UK Government poured millions of pounds of taxpayers money into shoring up its defences? If it is such a "benefit" to the French to police and secure the "Calais Jungle" on their territory and prevent thousands of mainly English speaking migrants from being processed in Dover and Folkestone why were they not prepared to pay the cost in full? Could it be that David Cameron and Theresa May knew full well from speaking to Sir Peter Ricketts, until recently our French Ambassador, how fragile the agreement is and did not want a "Dover and Folkestone Jungle" whereby it would be up to UK Border Agency staff located in the UK to process thousands of migrant applications many of whom had destroyed their identities? As well as Ian Duncan Smith's pie in the sky belief that we would be able to secure a better deal than Norway and Switzerland (Most divorces to not end amicably!) he obviously did not hear his fellow Scot, Nicola Sturgeon on the same programme last Sunday say that if Scotland was forced against its will to leave the EU it would spark another referendum that would likely lead to the disintegration of the UK.
- John Roadknight

We both had a long, hard think about all the "for and against" arguments and reflected back on our vote to stay in the Common Market last time. My wife and I decided without any doubts that we want OUT. Having just heard that our MP is voting the same, I came to look at her arguments in this Blog. We couldn't have put it better! Just get the "Outs" together with a good strong leader and show the UK the way. Well done Sarah!
- Gordon

Out to what Gordon? That is the problem! No-one in the "out" campaign can DEFINITELY tell us what our future will be! It will pretty certainly be without Scotland!
- John Roadknight

So now we have the UK French Ambassador on this evening's Channel 4 news as well as our previous British French Ambassador telling us that on Brexit they have no idea whether the Le Touquet Agreement will be maintained that could well lead to thousands of English speaking migrants without identities in France being processed in the UK (probably minus Scotland!) as opposed to Calais. If I were a UK citizen living in Dover or Folkestone I personally would want to learn from Sarah and her Brexit followers what contingency plans she has in place to deal with the influx but unfortunately all we get when we ask pertinent questions is that we are contributing to "Project Fear"! If I were one of Sarah's constituents with family or friends living in Spain, Cyprus,France or Portugal and heard Matthew Hancock report that he did not know what the status of The European Health Insurance Card, that so many of us rely on when we holiday in the EU, would be if we Brexit I feel that I would have every right to be concerned. There are hundreds of thousands of UK citizens,many elderly,living out there that rely on this EU insurance and many would be forced back to the UK because they would either be denied private health cover or could not afford it. Is this "Project Fear"? Those of us who like the protection of the EU in connection with health care or protecting us against unfair competition from China and Russia are just asking questions Sarah and unfortunately all we get from you is "Project Fear" and no answers or contingency plans.
- John Roadknight

You don't always get what you want! Even Norway's Prime Minister would like to be part of the EU! Speaking to the BBC, Norway's prime minister, Erna Solberg, said she would like her country to be part of the EU because it lacked influence over important decision making and had "basically... left part of our democracy to Europe". Asked if she thought Britain could retain access to the single market without being subject to free movement of people, she said: "To believe you'll get everything you want without giving something back does not happen in any political body."
- John Roadknight

John R, whose blog is this? You've already written more than the MP, far less coherently, and most of it other people's opinion. You appear to have an excessive respect for those you consider "experts" (the chancellor, the Norwegian prime minister, FTSE 100 companies) and you are unable to assess their potential for conflict of interest, or for being just plain fallible in their predictions. For one thing, a person's position or seniority does not make their argument right, and for another, there are plenty of eminences, ex chancellors, business-people etc on the other side. To address but one of your arguments, no-one is saying we will get exactly what we want by leaving - but we are clearly not getting what we want by staying either. Leavers have made a judgement that by continuing as 1/28th of the current unwieldy, unresponsive, undemocratic hegemony we have little or no influence over anything in Europe. On leaving, we might get some influence, as well as the obvious benefit of sovereignty. This argument was beautifully illustrated when Cameron used his veto back around 2011; the Liberals wailed that this was "just not done", and that to be so rude would remove all influence we could have. So, by their logic and that of the remainers, we should go along with something we completely disagree with - not attempting to exert any influence - in order to retain influence! Also, don't insult our intelligence by talking about draw bridges, little England (neither is proposed by any serious leave campaigner), or the idea that the EU invented free trade or peace. We have had and can have both without the EU, nor does the EU look like having any positive impact on disasters like Putin, Middle East instability or the rise of extremists of all colours. Quite the opposite in fact. No doubt we need Europe-wide and world-wide cooperation; but let's dare to think a better structure than the EU could exist, and help bring it about. The EU is the FIFA of world politics.
- Tom Ball

Tom,as Sarah I am sure will endorse, I raised my concerns over our exit from the EU 5 years ago soon after she was elected. They were similar, apart from the very possible influx of English speaking migrants into this country, to all the ones I have raised on her two blogs so I am afraid it is a little demeaning of you to suggest that I am just taking "other people's opinion"! In relation to" unwieldy,unresponsive,undemocratic, hegemony perhaps it would be sensible to look a little closer to home before we once again start blaming all our woes on the EU! If you watched "Spotlight" last night you will have seen a scathing attack by our farmers on late subsidy payments due to Whitehall, DEFRA bureaucracy. There was then the case of patient medical notes being filed in a laundry bag so whenever we cast aspersions at our EU neighbours it would be a good idea to reflect on our own bureaucratic, inefficiencies.Philip Hammond very clearly set out the alternatives to our continuing EU membership yesterday and none of them remotely compares to the one negotiated by David Cameron recently that maintains our economic and political status in the world. I am afraid that all your arguments are drawn on hypotheses because you just do not know and have to rely on "project fear" and "dodgy dossiers" when you are presented with facts! I am sorry that you have little or no regard for CEOs of FTSE companies that employ millions of people and on which many of us depend upon for our pensions. I would much prefer to rely on their judgement as well as our Prime Minister and Chancellor than people promising us a land of milk and honey without any certainty as to how it will be achieved.I have not actually raised, as you pertain, the case of the EU and peace but being a post war child I remember how pleased my father and his close sailing friends were when we joined the EU. They all served and included Stanford Tuck, a Battle of Britain hero, my godfather with an MC from the desert campaign and Bill Dean a GP who volunteered to stay behind at Dunkirk,escaped 3 times and came back a skeleton after being put in solitary confinement after his third escape. My father several times took me back to his Oxford college to show me the memorial plaque with so many of his close friends on. The EU has a tremendous role to play in maintaining peace on our continent and that should never be forgotten. What will you do next time Spain seals its land border with Gibraltar and cannot rely on the EU for protection?
- John Roadknight

John you have successfully defeated a series of straw man arguments, none of which I made! I did not mention bureaucracy (this is a nebulous concept, hard to argue for or against, and by no means the preserve of the EU). Sure, let's improve DEFRA. I accept your point 100%. The fact that someone's medical notes got lost once is deplorable but entirely irrelevant to our discussion; I am sure you wouldn't use a one off UK-based mistake to argue for a Brussels take-over: I thought that sort of non sequitur was supposed to belong to the more irrational, anecdote-based out-ers. The other non sequitur is to say that only remainers know the future; you and the FTSE chaps (not all of them by the way) don't know what will happen for sure any more than I will, so to call their grim predictions "facts" is a misrepresentation - they are well informed opinion, educated guesses; I am sure in the short term there would indeed be some instability, but I trust and hope for medium and long term gains, but surely you can see that the CEOs' interest is themselves, not their employees or your pension. Leaving might create some administrative headaches for multi-nationals; I can live with that, and I am not sure that companies larger than many countries' GDP are an unmitigated good anyway. The remainers are gradually being forced to admit that trade would not halt overnight, they can't afford to make us a pariah, nor would 3 million jobs evaporate, a figure Nick Clegg used to bandy about. Threatening 3 million job losses is scare mongering, no other way to name it. Hundreds of small business owners wrote to the Telegraph this week advocating leaving - is their voice not important? I admire the 5 year longevity of your concerns - I myself am rarely so sure, and constantly question and reassess my opinions - but as with the appeal to arbitrary authority, the longevity of an opinion does not equate to infallibility - in fact it is more a marker that someone is not responding the the ever changing evidence. People thought the Earth was flat for centuries, they were still wrong. I am moved by your family's connection to WW2; they were truly heroes. But I humbly submit that the story doesn't support the conclusion you draw. The alternative to EU membership is not WW3. Don't allow the fear of a WW3 to justify all the wrongs of the EU. The EU did not bring about peace, nor can it claim to have preserved it, and were it to do so, it would be remarkably (but characteristically) arrogant. After WW2 it was the USA / UK / France (or more accurately the well-balanced antagonism between USA and USSR) which kept the "peace" of sorts, succeeded by NATO. The EU had nothing to do with it. It had the luxury of a largely pacifist outlook through the cold war, with very few arms, only because America protected it via its European bases.The EU then sat by while the Balkans reignited, and it was Clinton et al who finally ended that war; some say Germany helped start it by recognising Croatia but I wouldn't go so far myself. I am slightly contradicting myself here because as I say, the EU, despite its aspirations, is largely irrelevant when it comes to world peace. Its response to Putin over Georgia and Ukraine was pathetic, and merely emphasised the West's weakness (a wider issue, I'll admit). Or, more sympathetically to Russia, the EU provoked Putin by its aggressive economic imperialism in the old USSR, without then backing it up militarily; either way, an incompetent intervention which the UK and probably most other Euopean governments would never have countenanced. It wants political union between peoples who are so different in outlook and needs that they couldn't possibly want union. The only gain from political union is more power to a few unelected people. It is unresponsive in that we have no say in who governs it (unlike our own admittedly imperfect democracy) - even our PM couldn't influence appointments to the Commission - and when Ireland said "no" to the Lisbon treaty the EU merely threatened her and repeated the vote in order to get a different answer. Its monumental failure of Greece, Spain etc through the financial crisis - who would have been far better off outside the Euro - and its failure to recognise the mistakes made, is a sure sign that it is past its sell-by date. Its lunatic Schengen agreement, coupled with poor policing of borders, is another example. Of course we need peace, trade, treaties, migration etc but let's tear up the Brussels-based oligarchy and start again. It clearly has no desire or ability to change. Fair point about Spain and Gibraltar, but I am not sure the EU prevented that or dealt with it brilliantly; there is still clear enmity and non-cooperation, despite our apparent alliance, as there is with our French friends and their threats this week over Calais; I suppose one would have to appeal to international law or other conventions, which the Spanish were anyway breaking, alliance or not. Many conflicts have, after all, been resolved outside the EU paradigm. As for our political and economic status in the world, the former is largely historical and waning, but is partially maintained by our occasional clear leadership (Sierra Leone) or misguided first-in mentality (Libya), our still-active military, our UN-based diplomacy, and Trident; and our economic status is due to, er, our being the 5th largest world economy, not our EU membership. The more economically literate leavers point out that the EU in fact hampers our ability to trade with countries like China, India, Canada, Brazil... pie in the sky maybe, nostalgia, or just a longer memory for the centuries when we thrived as an independent nation... but there's only one way to find out. Respectfully,
- Tom Ball

Tom, you are quite right that the remainers do not know the future but we do know the status quo in that the UK is the 5th largest economy in the world, a member of the largest single market in the world with 500 million people on which 3 million jobs and 42% of our trade relies upon, is a NATO member,has a permanent seat on the UN Security Council and Scotland is still part of the UK. I am also still old enough to remember when the UK was the "sick" man of Europe with our economy lagging behind Italy and our plumbers,electricians and carpenters going over to Germany to find work on which the series "Auf Wiedersehen Pet" was based on. It is this scenario that I do not want to be repeated on a speculative leap into the dark.Instead of trying to refute Philip Hammond's analysis of the alternatives point by point I am afraid all that you can do is come up with "Prospect Fear" and "Dodgy Dossiers" because the reality is that as opposed to the status quo you just do not know what will come about on Brexit with most analysts believing it will be no better than Norway's, whose Prime Minister would like to join the EU! In relation to hundreds of small business owners writing to the "Telegraph" I would question why they are not trying harder to export their goods to our neighbours across the Channel. I believe that 45% of German small and medium sized businesses export their products as opposed to 19% of ours. This is probably due to our appalling linguistic skills. It can be quite disconcerting negotiating contracts when the other party suddenly reverts back to their native language with their colleagues and you cannot understand a word!Many of the countries you list like China, India,Canada and Brazil would like us to remain within the EU in order to access the world's largest single market as does the US both economically and strategically. I hugely value the number of foreign companies outside the EU who have set up their subsidiaries here in order to access the EU, and would hate to see companies like Nissan,Honda and Jaguar Rover possibly curtail their operations here and set up plants across the Channel. German companies like Siemens with their hospital scanner and wind turbine factories and BMW are also extremely concerned at the prospect of our exit.It makes perfect economic and business sense to first of all concentrate on the world's largest single market that is, at the most, a few hours or a couple of days away as opposed to weeks or months away or alternatively a costly and environmentally damaging flight away. I would also prefer to trade with a market that we hold so much more in common with such as freedom and culture rather than China who is able to restrict the movements of the Dalai Lama through their economic clout and has an abysmal human rights record. The Balkans was a terrible conflict as Paddy Ashdown knows all too well but all the countries there are, or want to be, part of the EU. On Ukraine I believe that most world leaders think that it would have generated into a much worse conflict without Angela Merkel's intervention.In respect to your comments regarding"bureaucracy" I did feel that bureaucracy was somewhere hidden in your "unwieldy,unresponsive,undemocratic hegemony" and felt that we should also sometimes look closer to home! I certainly do not want to gamble our future generations' prosperity and security with a huge, hypothetical leap into the dark and I am pleased that our Prime Minister and Chancellor, as well as most of his cabinet colleagues, are doing everything to prevent this from happening.
- John Roadknight

Does anyone in their right mind think that the UK will be able to negotiate a better trading deal with Europe then it has now, if the UK chooses to leave? If this was the case then every EU member would leave. The EU would not allow this to happen. As the German finance minister said on the Andrew Mar show, if the UK wanted access to the single market, it would have to accept free movement of people and pay into the pot but would not be able to shape rules or policy, so what is the benefit here? Finally, when negotiating these incredible free trade agreements with India and China that the BREXIT politicians say we will be free to do on leaving, who will get the better free trade deal, the UK or a massive trading block like the EU? India and China don't need the UK (hence weak negotiating position) but they do need the EU, the world's largest free trading block (very strong negotiating position).
- P. Morley

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09 FEB 2016

Why, as a Europhile, I'm heading towards the Brexit Door

I have always been a Europhile and before becoming an MP would not have imagined voting to leave the European Union. So why am I heading towards the door? I am in love with the possibilities of the EU but can no longer ignore the grinding reality of the institution.

The Prime Minister has set out the terms of his provisional deal with the leaders of our EU partners and it is a threadbare offering. What use are 'emergency brakes' when the driver has no control or 'red cards' that have no credible chance of being deployed? Apart from a small concession on sham marriages, the truth is that the proposals will have no significant impact on our ability to limit inward migration from the EU. They will however, usher in rafts of bureaucratic cost and complexity with sliding scales for length of residency and nationality for child benefit.

David Cameron was right that the EU will need further reform but if this is the best that can be grudgingly conceded when there is a serious risk of a British exit, what chance of any meaningful further reform if and when we are tied-in long term by the referendum? The proposed red card system to halt unwanted EU diktats will need a majority of other leaders in support...so it is vanishingly unlikely to be of use if future policies are imposed against our national interest.

I am glad there has been recognition that we will never join the Euro and that non-Eurozone countries are on a different course rather than ever closer union but the safeguards remain too weak. It is inevitable that the Eurozone bloc will make decisions in their best interests. We have in effect already opted for life on an outside track, tolerated largely for our considerable net financial contribution but the renegotiation has made clear that we are powerless to change the rules of the club.

Those who wish for us to remain in the EU, are ramping up the rhetoric, warning about a risk to our national security in the event of Brexit due to a collapse in cooperation. It will clearly be in everyone's best interests for such cooperation to continue and to foster positive relationships on both security and trade. We are warned that we will become like Norway, subject to all the rules and fees but with no hand on the levers of power but arguably that sounds pretty much like the current situation, except of course that Norway control their own fishing grounds. In the event of Brexit there would be every incentive for Norway and others to join Britain in a different and more positive relationship with the EU based on trade and cooperation.

The case is often made that we should vote to remain in order to prevent internal conflict in Europe, but the anti-democratic nature of the EU is already fomenting the rise of extremism across the continent. When it comes to external threats, our national security has long depended on our membership of NATO rather than the EU.

When I ask at public meetings, few can name a single one of their six MEPs, fewer still have ever contacted one. Why would they bother when their representatives are powerless in comparison to the elite corps of unelected, remote and unaccountable commissioners?

Referendums have a habit of delivering the status quo, especially as project fear gets into gear. If they are to have any hope of persuading the undecideds, the leave campaigns must settle their differences and inspire. We need a clear blueprint for Britain working alongside the EU in a constructive new partnership. We would join as the world's fifth largest economy, not isolated but confident, outward looking and open for business.

71 comments

A very defeatist and sad post utterly introspective and frankly ignorant. I could ask you a hundred questions which would reveal the poverty of your arguments. But I'll confine myself to just one. Why are 27 members of the European Union content to work with each other to further both Europe and themselves? And why should we be the odd man out picking up our ball and running away? Running away to God knows where and ensuring isolation not just from our erstwhile partners but from credibility and respect. Grotesque.
- Paddy Briggs

This is a catastrophic failure of judgement by a very intelligent person who I much respect. I am incredulous that you arrived at this conclusion.
- Stephen Perry

I am pleased to see you are leaning towards supporting Brexit, but rather disappointed by the apparently superficial nature of your understanding of Norway's influence. In addition to owning their fishing grounds, they are also solely responsible for their own trade policy and can form trade agreements on mutually acceptable terms. The UK does not have this power. The EU tells us what agreements we must honour and the tariffs and non tariff barriers we must implement. Norway also has its own seat on the global bodies where regulations and standards are shaped before being handed down to implement. Norway helps shape the rules, while not one EU member state can directly influence them. If the UK leaves the EU, the safest course of action would be to rejoin the EEA, aided by membership of EFTA. In that, we would be joining Norway, rather than Norway joining us. If you haven't already, I recommend you read 'Flexcit' which is the only Brexit plan in existence and is backed by Helena Morrissey as the best work in this area. We can have a bright future outside the EU, cooperating with its member states in areas of common interest, but without having our laws determined by unelected and unaccountable people from 27 other countries, and without being subject to the decisions of the European Court of Justice. Brexit will be a big step towards a more democratic UK.
- Mr Brexit

One point about the perceived lack of democracy in the EU structures. I believe it is that way because the nation states (not least the UK) would not allow a more powerful directly elected pan-EU leader or parliament precisely because it would diminish the status of the elected leaders and parliaments in the member states.
- James

Full credit...
- tom

Because, Paddy Briggs, we ARE the "odd man out". That's why so many Britons are profoundly uncomfortable with "ever closer union" and it's why Euroscepticism is much more common here. We are an island with a completely different political and legal heritage from our Continental neighbours. We, unlike them, are also not in retreat from a horrendous 20th-century experience scarred in almost all cases by exposure to totalitarian regimes, either imposed by invasion or cooked up domestically. Being dictated to by a bunch of jumped-up bureaucrats in Brussels or Berlin is understandably better in those people's eyes than what they've previously suffered. But that isn't the case for the UK, which has enjoyed freedom from foreign occupation and a representative system of government for many centuries. Frankly if you're so ignorant that you don't know any of this about Britain's and Europe's very different histories and about the obvious reasons why many of them favour trying to create a powerful Europe-wide statehood to replace national decision-making and we overwhelmingly do not, then you really shouldn't be daring to criticise Dr Wollaston's understanding of this topic.
- John Jones

Very sad to say I am afraid that I am inclined to agree with you. I was so excited when Ted Heath took us into the common market. But it has got worse and worse.
- Robert

Great post and great to have you on board Sarah. Sounds like sour grapes from Paddy Briggs. Out of the hundred questions he claims to have, I can't understand why he chose such a silly one, exposing his own ignorance. The U.K. Will be "content" to work with EU member states post Brexit but the EU are doing nothing to "further Europe". Unless of course you're referring to expansionism?
- Lee

If the UK has the good sense to leave I think others would be inclined to take our lead and follow. Paddy, there are none so blind as those that can't see.
- Peter

Wonderful to see that Sarah, a respected and decent MP, has seen the reality of the sham negotiation and the awful prospect of staying on the EU juggernaut. As for Paddy Briggs, there are so many answers as to why the 27 wish to remain members (at least for now), the most obvious being that in most years 25 or 26 of those members are net recipients of EU largesse, often with only Germany and the UK being net contributors. P.S. Sarah, you have a typo: 'breaks' should be 'brakes', though both work in different contexts :-)
- Andrew

A lot of people agree with what you say. In your position as an MP, please envision the alternative and propose it clearly. Without a good understanding of that, people will likely vote for the status quo and we will miss the opportunity to re-position ourselves, for the better, for the next 50 years. This matters.
- VB

It was refreshing to read your well argued piece which made the key points with clarity and commonsense. You will be rewarded for your courage in speaking out rather than being silenced by Whips. We need more MP's like yourself who have built a successful career outside Politics before being elected which gives you the self-confidence to speak up. The UK has a large (and growing) trade deficit with the EU which means that the EU needs to trade with us more than we need to trade with them. This means that it's in the EU's self-interest to give us an advantageous trade deal after Brexit. The bungled EU policies of the single currency, Schengen and CAP, etc, have created misery and economic hardship for many millions of European citizens. The EU is a failing declining political entity dragging us further behind the US and Asia in relative prosperity. We can either decide to exit now on our own terms or be stuck in the inside when the EU finally breaks under the weight of its own failed and inefficient policies. Everyone thanks you for your bold stand in putting the long-term prosperity of the British people first and making the argument to help persuade the undecided's that Brexit is the best way to secure the UK's future freedom and prosperity.
- Richard

"If they are to have any hope of persuading the undecideds, the leave campaigns must settle their differences and inspire." I don't think they need to. The lack of a united Leave campaign with a single leader means that the Remain campaign must attack the ball rather than the man. They must win the political, economic and social arguments rather than running a smear campaign against a particular personality. After all, what better postion could the Leave campaign be in other than to have a bunch of widely-distrusted politicians and corporate leaders telling us that remaining within the EU is a Good Idea.
- Steve

It's clear that Paddy & Stephen need to re-read what Sarah wrote and spend a while thinking it through to be sure they've understood it accurately. It's interesting that neither Paddy nor Stephen put forward any arguments in favour of being in the European Union. Paddy asked two questions: 'Why are 27 members of the European Union content to work with each other to further both Europe and themselves?' 'work with each other' is one thing, subordinate themselves to a supranational government and eradicate themselves as Nation States is something else. Sarah outlined a future in which the UK would always work together with its allies not just on the continent of Europe but in the whole world. That's what the UK has always done. What sort of weird ideas are in your head that cause you to think that anyone is advocating stopping that inter-national cooperation?? Please do try to think clearly and stop accusing other people of advocating things they haven't advocated. Secondly, in every country in the EU you will find people who aren't happy about being in the EU. Why would you hold such a strange idea that the UK is the only country containing people who aren't happy about it??? Bizarre. Thirdly, you're getting mixed up about Europe and the EU. They're two completely different things. We work with European countries that aren't in the EU. We work with non-European countries that aren't in the EU. We work with countries that are in the EU and in Europe. We always have. We always will. 'And why should we be the odd man out picking up our ball and running away?' That's a straw man argument, Paddy. See above.
- Jim

Excellent blog. You are a brave lady. I admire you.
- Onnalee Cubitt

I congratulate sarah on a well argued and thought out position. It is one i have much sympathy with. I am not a reflexive Outer, and genuinely felt there was a real chance at this point that Cameron could come back with a real change and progressively redefined way for states (not just the UK) to relate to the EU. It was a golden opportunity to reconfigure the EU into an organisation fit for the 21st century and not just a 1950's statist answer to 1930's questions about nationalism (questions which, in any case, have far less relevance to the UK). But it was;t to be - and as Sarah points out, if such derisory concessions are made with the looming possibility of Brexit then that just goes to show how little actually influence we have with the EU.
- Patrick

This gives me some faith in our elected MPs. Ms Wollaston has reviewed the extensive evidence that membership of the EU is not in our national interest; Cameron's "deal" is worthless and the EU will not implement the major reforms it so badly needs. On the basis of the evidence - not the scaremongering being issued by the Remain campaign - she has changed her mind. Co-operation with our continental neighbours doesn't need us to be under their political control. Trade with other countries doesn't require an anti-democratic political union. Our security will be enhanced when we can control our own borders. Our economy will be strengthened when we are not transferring £350 million a week to Brussels. I hope Ms Wollaston will join the cross-party Grassroots Out campaign.
- Donna

Well done Sarah, for having courage and conviction to speak out from under the Cameron ban on his party to speak against support of Brexit. A measured and non emotive account of your position. Alongside the excellent speech from David Davis, we are seeing facts based arguments that provide the public with a balanced view without the scaremongering and rhetoric from both sides of the argument
- IMcW

The rest of the EU has different ways of doing things from us based on their individual national histories. Our history is over a thousand years old, the foundation of our legal system, Common Law, was established in the villages of England in Saxon times, before the Norman invasion. The principle of Habeas Corpus was set down in Magna Carta in 1215 and all Britons are free under the law. None of these apply in the rest of the EU. We can trade perfectly well with any other country we don't have to be ruled by them. People need to seperate trade and co-operation from political union. Lord Tebbit sets out the case for leaving the EU very well. http://getbritainout.org/lord-tebbit-britain-must-rescued-eu/
- Roger

Congratulations to Dr Wollaston on reaching her conclusions. To Paddy Briggs: I would suggest that most of the other 27 EU members are happy in their membership of the EU because they get out of it a lot more than they pay into it. And that's not just in terms of money, just think what a boon it is to countries like Romania, Bulgaria and Poland to send most of their unemployed to richer countries like the UK and benefit from salaries and much higher child benefit being sent back to those countries. Why would your average Pole want to leave such a beneficial arrangement?
- Ian G

Bravo Dr W! And a brave Sarah you are, standing up for evidence based policy rather than fear based policy. I too am surprised to find myself supporting Brexit, having been a Europhile all my life. Ever since the 'expansion' of the EU decided largely by German interests seeking cheap well educated workers sitting just across the border....the place have become ungovernable. The shenanigans of the Greek debt crisis culminating in uncontrolling flows of refugees is proof enough that current structures do govern, they do no manage and they do not deserve support.
- Penny

One of the reasons why the rest of Europe joined the Euro, and the European Union is because they were; in the the majority of cases, all poorer countries. They all benefited from; in some cases massive financial boosts. We were never in that situation, and by staying part of the European would loose more than we gain. Migrants coming to this country are doing it for that very reason, otherwise; why come here. There are not many Brits that would consider going to the poorer parts of Europe to start new jobs, because the money simply isn't there, and there are no benefits to back up the lack of wages, so it's an unfair system. And why on earth would a country put itself up to be dictated to by an unelected regime, and have to ask permission if it can do certain things. What is the point in having an elected government! You may as well just elect a head boy/girl to run to the headmaster, and save a fortune on running a government.
- Sean

Very well argued piece. Quite annoyed by the scaremongering and the fact that the so-called pro-European politicians have not, as far I can see, laid out how staying within the EU benefits British citizens in the UK. The EU arguments on human rights are decent, but on the flipside I think it's inappropriate that the EU dictates to the UK on some areas of its legislation.
- Sandy

Unfortunately we will see many posts across the web similar to those of Paddy and Stephen. Whether one agrees with it or not you make and substantiate your case Sarah, life; and it's been longer than most; has taught me that such responses are invariably used by those who do not have a tangible, coherent counter argument. Like you I probably agree with the concept of a cooperative Europe however as I see the for and against arguments and place them into a lifetimes context I'll be looking to leave 'the project'.
- Kevin

A good decision and a well argued rationale, the EU no longer works for the people of Europe but for the Corporate masters and well provided for unelected minions.
- Roy

We hear so much of the failed rhetoric regarding safety within the EU and how THEY the EU have maintained the peace for over 70 years...Poppycock...it was NATO of which I've served many times as a soldier....I have been uplifted that a convinced europhile can see a failure of this elitist club for what it is. Well done Miss Sarah Here’s a brilliant quote from the book about the EU: Written Dr David Owen in the 80s.....GET's RIGHT TO THE NUB OF THE EU.......30 YEARS AGO....AND VERY TRUE TO THIS DAY........ “It is the weak nerve centre of a flabby semi-state, with almost defenceless frontiers, where humanitarian rhetoric masks spinelessness.”....For me it say all that is required....before this disgraceful project we were self reliant and most surely self-assured..
- Bill L

Well done Sarah. Eloquently put. The logic of Brexit is unarguable. David Cameron's pathetic attempts to gain the concessions he thinks he needs to persuade us to remain in the EU emphasises just how little influence we have in this undemocratic monster. None. The EU is trying to build a single country to rival the USA and it simply isn't going to work in the same way. There is no way Britain will ever stop cooperating with other nations politically and economically outside the EU. But it will be by choice and not because it we are forced to against our will. And that huge financial burden running at £55 million/day will be lifted. We really will be better off out.
- Alan

Britain never signed up to cede sovereignty and it is to me neither morally right nor in our gift, considering those who'll come after, to allow this country to be governed from abroad. That's the way the EU is goiong and it's part-way there. To say sovereignty is 'pooled' as was once said fails to recognise the inevitable reality of this arrangement. The cannot work for the UK either politically or economically, not least because it's an anti-democratic construct. It's impolitic to say so but people fight and die every day and since time immemorial for national independence. I am an Australian, with a British family, who runs a small business and has lived more than half my life here, all of which I feel qualifies me to say - the British have the best legal system, the best mode of government, some of the best institutions and arguably the best, most secure national culture of any nation. Vote to keep these priceless things or you're bound to lose them.
- peter

Would like to have heard more about what happens to our economy while the years of negotiations take place with the EU and others. We can be certain the the UK will not get all it wants. EU without UK will also probably become more protectionist. We also need to be prepared for a UK without Scotland. Agreed though that the EU is not working as it is.
- Martin

Brilliant article. Sums up the need for Brexit. As Alan above says you can't argue against the logic for Brexit. I expect the result will be 60:40 in favour of Brexit as the more people know about the EU the ore they will vote to leave. What I want to know is, why so many MPs are campaigning for in?
- Bob A

I think you call out the limited effect of Cameron's renegotiations very well. And I think you were right to call out Cameron for his overegging security. But you've fallen into the political trap that Cameron dug for himself- ie he's made the Referendum about his renegotiations rather than membership in broader sense. The UK's actually been very influential in creating the Single Market, and if influence has waned that's down to Cameron being hopeless. If you don't think that the EU could make things very awkward for Britain when it left, you are being very naive. See how the EU is strangling Swiss banking, and ask yourself if you want it doing the same to the City. I urge you to reconsider.
- Tubby Isaacs

If Sarah's view prevails it will trigger a second Scottish referendum and the break up of the United Kingdom Then Scotland will close the Faslane Trident submarine base which will be transferred probably to Falmouth at the cost of many billions And the army and RAF bases in Scotland will close too Devon farmers will lose their EU subsidies and the NFU will expect the UK government to pick up the tab And manufacturers like Nissan will close their UK factories and move them into Europe The immigration camp in Calais will close and all those migrants will end up in Dover for screening There are up and down sides to staying in or exiting Europe and since this will affect the lives of the next generation, young people must be given a vote on this Brian
- brian

One more point, Sarah. There's already an alternative body to the EU- EFTA. Why do you think this is better than being in the EU? Why do you think Norway, Iceland and Switzerland (which is outside EFTA) will want to reshape the way they relate to the EU to fit in with Britain? In every case, it's the relationship with the EU that matters for them, not the one with the UK. I think it's hard to make any case that Britain will have a better trading arrangement than now.
- Tubby Isaacs

Welcome aboard Sarah! Great to see momentum (and i don't mean the labour group) building for Brexit. Democracy is the key point for me. I liken the current UK situation to that of a dementia patient who has signed over their decision making powers to a friend. The problem is in the UK's case, Brussels is not our friend. Lets get our democracy back!
- Tim Jenkins

It is certainly high time that we had a "clear blueprint" from the Brexit side, whose rhetoric thus far (yes there is rhetoric on both sides -- see above for some examples) boils down to the claim that we will be able to magically keep all the good bits of EU membership and slough off the bad bits. A similar approach was, incidentally, used by the Independence campaign in Scotland. We now need to address specifics. A couple of examples: - It seems pretty much certain that from the EU side, post Brexit, one of the main conditions of a trade deal would be the retention of the free movement of people (as is the case for the deal with Norway and Switzerland). Do you think we could get a satisfactory deal without this? Would we want to continue to allow the free movement of people? If not, what arrangements will be made for the British citizens currently living in the EU? - When it comes to sovereignty, and "being dictated to by Europe", which laws would you change and what would you replace them with? Frankly, I worry far less about where laws are made and more about whether they are good laws or not. British governments (of all political stripes) have shown themselves to be perfectly capable of enacting bad laws, and stubborn in their refusal to remove or improve them once they are in place. It is no longer enough to claim, blithely, that Brexit will remove all ills and produce nothing but good. The case is not unarguable, as has been claimed above. As Sarah's original post recognises, it relies on a judgement of the balance of benefits and harms of staying in or leaving. To make that judgement, we need a far clearer picture of how a post-Brexit future would look. Lastly, I would welcome a commtiment from Sarah, as my MP, that should the referendum turn out to support our continued membership she will support the will of the people and back a policy of constructive engagement with the EU. A substantial part of the difficulties in Britain's relationship with Europe has been self-inflicted by a wilful "semi-detached" approach, motivated most often by the decades-old schism in the Conservative party. If the British people vote to stay in then this government, and its successors of whatever party, should reflect that in a new, more constructive and cooperative approach to membership.
- Simon

So you too wanted a European Community but have been disappioned to have been foisted with a European Union. The difference is that I realised this in 1973.
- John S Churchill

Good for you Sarah ,I have yet to see one truthful,intelligent and worthwhile comment for staying in.Too many people are scaremongering,saying we cannot be on our own and the rest of Europe will not trade with us if we leave but I am sure our country will be fine and it will be the rest of Europe who will be the losers.
- Grahame Powell

As a member of the LABOUR PARTY I am glad & proud to be at one with you on this issue. Great post. Democracy transcends party boundaries every day for me. If the British public think there is a Westminster bubble and its out of touch then they have not seen anything yet when it comes to the undemocratic and out of touch Eurocrats. To stay gives them a green light. Yes, we are tolerated for the net £8-10B they get from us each year. There really is a better world wide view. Just got to convince the rest of my party now....
- Tim Page

I was just about old enough to vote in the 1975 referendum and voted to come out of the common market, as it was then called. I have seen nothing since then to change my mind that we would be better off out of the EU. We simply do not get value for money from an outrageously bureaucratic and non democratic organisation. Well done Sarah.
- Steve Tucker

Great post. Good to see that politicians can think through the pros and cons, and come to a reasoned conclusion that's not borne out of panic or blindly following party-line.
- Jacqueline

So sorry that our fine MP has chosen the Brexit route whose only near certain outcome will be the break up of the UK after Scotland holds another referendum, quite possibly followed by Wales and Northern Ireland after they feel the impact of our economic downturn. The UK is a magnet for Far Eastern and other national companies to set up subsidiaries in order to trade with the largest single market in the world..Look at Nissan, Honda and Jaguar Landrover. Because of our colonial past and more recently U.S. influence and UK/US cultural popularity, especially in music, English is most peoples' second language. It must be far easier for English speaking foreign CEO's to communicate with their work forces here without the need for interpreters. Do we want many of these to relocate north of the boarder? On migration, Sarah would do well to listen to Sir Peter Ricketts, until recently our French Ambassador and David Cameron's national security adviser who has warned us, and should know more than anyone else,of the fragility of the Le Touquet agreement where UK immigration checks are carried out in Calais. What possible advantage would it be to the French to continue to police the Calais"Jungle" on our exit? It would be far easier for EU countries to play pass the parcel with their migration problems and send them to our island to be processed where they have nowhere else to move on to. Heaven help our Boarder Agency staff processing thousands of applicants who have destroyed their identities! Many migrants quite naturally want to settle here because many speak a smattering of English as their second language,essential for getting a job, and we do not have identity cards. Being part of the EU gives us much more influence politically and economically and the US certainly wants us to remain a partner. Where does our Foreign Secretary go when there is a problem? Brussels to garner EU support. At present Germany, France and the UK are drawing up plans to impose a tariff on China and Russia dumping heavily subsidised steel on our shores as the EU did with heavily subsidised Chinese solar panels. We are far stronger negotiating as a member of 500 million people as opposed to 60,less after Scotland leaves the UK! Do we really want to be subservient to larger economies like China who use their power to control the movements of the Dalai Lama? What will be the status of the 2 million UK citizens happily living in the EU? Will they, as well as us, continue to enjoy our European Health Insurance cards? Could many elderly residents unable to afford private medical insurance be forced back to the UK.? How about the residents of Gibraltar who have sheltered behind EU protection for many years against Spanish hostility? The EU, like many of the UK Government policies is not perfect but I feel that David Cameron deserves the support of his MPs' in his negotiations. I really dread the prospect of an isolationist little England that many Brexit supporters feel is still an empire. We are far stronger in than out.
- John Roadknight

Well put, Dr W. I love Europe but detest the EU. I will vote OUT. Project Fear is dark. If we shine light upon it by rational analysis, it will disappear.
- Stewart Brown

Dr Wollaston like you I was a Europhile who supported the ideal of a Europe at peace with itself. However the European Community has morphed into a European (political) Union ruled undemocratically from Brussels by unelected bureaucrats who disregard the sovereignty and the elected parliaments of its member states. Cameron's negotiations with the EU are a disaster. He has failed to gain even a fig leaf from the EU to cover his own embarrassment. And most significantly he has failed to get protection for the City of London from the predations of the EU to vest financial services from the City. Cameron's Brexit scaremongering is very likely to backfire on him. Winston Churchill rallied the British people and stirred up their spirit of defiance and determination to see off the threat from Europe. A British vote for exit from the EU would be the signal for the beginning of the end for the EU and would soon cause the whole of the EU to implode economically, socially and financially. A financial crisis is looming in the global economy. This is a crisis that is very likely to blow the European Union away.
- John Collins

One can feel only a sense of betrayal now that Sarah Wollaston, my M.P., has made her statement on Europe. Clearly, she was flying under false colours when she made her pre election statements to get approval in South Hams. Her reasons are quite paltry for joining the Leave group. I thought it was rather shabby that the first thing we heard was through the Sun newspaper quoting her stating that "Tory MP Sarah Wollaston also weighed into the tow saying Mr Cameron's claim was "simply not credible" and complained pro-EU campaigners were taking voters "for fools". The Sun, that progressive and pro equality newspaper. Much better informed sources, such as Sir Peter Ricketts, the British Ambassador in Paris stated that same day that there was every possibility that France would indeed end the British border in Calais if we vote to leave. Folkestone folk will no doubt be pleased with Sarah Wollaston if they get the Calais Jungle in their midst, but Sarah Wollaston will be safe in South Hams, where it is indeed rare to see anything other than a white face. Not much of a threat here of a diverse society, Mrs Wollaston? The statement which was broadcast on the TV this evening which showed an interview with Mrs Wollaston was insulting to my intelligence and was "simply not credible". According to Mrs Wollaston, she will vote to leave as the other EU countries have not offered enough to David Cameron given that we have threatened to leave the EU. So Mrs Wollaston favours the blackmail approach. If you don't give us what we want, we shall walk out. There's principle for you and a person of integrity. No substantive reasons given, no reference to the three million jobs that will be lost, the massive farm subsidies that will go at a stroke, the huge development money that has poured into Cornwall for the last 10 years of more (over one billion pounds), no mention of the estimated £3000 a year benefit to every household in the UK, no mention of the fact that the EU accounts for half of our trade and is the biggest market in the world, no mention of the fact that if we leave we shall have to pay into the EU but have no say in its decision making, no mention of the estimated £66 million a day that EU countries invest in the UK, no mention of the employee and work benefits that the EU has brought to British workers, a stark contrast to the Conservatives' plans to further decimate workers' trade union rights...finally, no mention of the progressive force that the EU represents for all the peoples of Europe and indeed in the world. Sarah Wollaston has retreated in a world of Little Englanders, xenophobes and people like Liam Fox who are embittered Tories.She is welcome to them and will never receive my vote. This country is founded on a huge mixture of races and cultures. What percentage of non whites do we have in your constituency, Mrs Wollaston? Most of the immigrants are from the Midlands and the North West. I am one of them. Another politician whose manifesto promises have evaporated once elected. A shameful performance by someone who once showed signs of a positive vision for British people.
- Tom Jolliffe

To the scaremongers who say that leaving the EU will lead to the break up of the UK, don't worry, it won't. Britain leaving the EU will not change how the majority of people in Scotland feel about being British, which was clearly demonstrated in the recent referendum with a 90% turnout. The SNP would have another referendum tomorrow if they thought they could win it, but they wouldn't, so they won't. Their la-la-land economic policy didn't fly in 2014 with oil over $100 per barrel and it certainly won't fly now at $30-$40.
- Andrew

For those scaremongers who claim that leaving the EU will lead to the 5,000 migrants (economic migrants, as they are already in a safe country, France) and those who follow after them being waved through France to turn up at Dover and claim asylum, don't worry, they won't. Even IF the French were to resile on the existing Le Toquet agreement, return the UK border to Dover and wave through their unwanted guests, our government would simply impose more stringent obligations on the ferry companies and the tunnel operators - just as we already do with airlines and their passengers, which is why we don't have Calais style camps around Heathrow (which we would if Cameron and other scaremonger claims about Calais were true!).
- Andrew

I don't believe our 19 or so frigates with engine breakdowns are going to be much of a solution to policing the channel! Have you not observed the chaos that ensues when there is a dispute in Calais? Nearly 50% of our trade and over 3 million jobs is dependent on our EU membership. You would do well to listen to Sir Peter Ricketts our previous French Ambassador who knows more than anyone else how fragile our border is.
- John Roadknight

Scotland has very close historical links with France and is far more pro EU than Little England. The last thing this proud nation will want is to be dictated by Little England as to their relations with the EU.
- John Roadknight

I am sad to see that you have joined the exit camp. It seems shortsighted in the long term. Russia is breathing down our necks on the border of Europe - how will we respond as an island race? The days of empire are long gone - yet many in the Tory party still vote and operate from that perspective. I want a Conservative party rooted in the 21st century with politicians who can see beyond their own limited career objectives and take this country forward not backwards. So David Cameron did not manage to force the EU to change, it doesn't matter - what matters is that we continue with what we started when we joined the Common market back in the 1970's. We fought two world wars to bring peace and stability to Europe. It is time for us to unite get behind the EU and make it work for us. Turning back now will be catastrophic in every way.
- Cathy Koo

Sarah, it's important to distinguish between (dis)approval for the Tories, David Cameron, the renegotiation terms and the EU itself. You are giving too much emphasis to the new terms, rather that the benefits of continued membership. You say you've always been a Europhile - think again about why. You are in favour of evidence-based medicine; how about some evidence-based policy making on this subject? Colin P
- Colin P

I am old enough both to remember post war austerity and the vote to join the EEC. At that time we were lied to by the politicians as history has now proven. The EU is intent on forming a European State, it has been stated by many European leaders over the years, part of which we will be a minor player if we allow that to play out. We are being lied to now by the IN politicians and scaremongering is not the way to conduct an adult reasoned debate bout the merits of staying or leaving. The EU has shown its true colours on many many occasions but to describe a Brexit as like a game that we don't like so are taking our ball home, is idiotic and childish in the extreme. This is a serious issue and requires a serious debate, not petty point scoring. Our relationship with the EU is a business that has a contract with benefits and defecits on both sides. The British people, through their MP's, have indicated our contract needs re-negotiating. In business, if either party fails to agree terms that is in their interests, then they go their separate ways. If the EU is not prepared to change or meet the terms that the UK requires to continue its partnership, then that speaks volumes of what the EU thinks of the U.K., so it is time to go our separate ways. Before the EU we managed quite well, but the politicians KNEW back then that the EEC would morph into the EU and that political union was the ultimate goal. Had they told the truth at the time then the result of the vote back then may have been very different. In my view the result was illegitimate. As a result of their deceipt I believe we are being lied to now by politicians who have been proven to be dishonest and will NOT tell the truth. Dr. Wollaston has put forward a cogent argument and I for one believe she is being honest in her change of mind. It would be so easy for her to 'go along with' party lines, but this issue is more important than party politics but is an issue of conscience. I admire her courage and I hope she remains true to herself, whatever way she chooses to vote in the end.
- Gary

Heading for BREXIT? I feel the same pain. Having worked more than 4 decades to achieve realistic and sensible requirements in a highly regulated industry both at EU and ECE in an industry that cannot afford the R&D needed just for the UK market, this decision we soon face is highly concerning, whichever conclusion we as a nation come to. Even if a majority of those voting south of a line slightly north of Hadrian’s Wall want to remain in, our friends, colleagues, relatives north of that line might be sufficient in numbers to vote the UK OUT, so that they can then take a vote to stay IN as an independent nation – provided of course Spain will accept that, risking Catalonia and Basque applying for independence as well! However we are where we are, mostly because Member States such as ourselves allowed EU too much power in past EU treaty changes, that we could have vetoed. Having shown we were OK with those decisions, was the EU so wrong to think the UK Government wanted closer integration? We should have stood our ground more firmly then! Much of where we are is due to unprofessional 5 second sound bite politics that we have in the UK and a lowering of the professionalism of the political and official decisions of state. One example - The UK Ministry of Transport having sought a change in EU regulations which was agreed and enacted in 2012, have in 2016 still not yet implemented that change in UK national regulations, resulting in a nonsense of anal administrative burden to continue, costing consumers more for absolutely no safety of environmental benefit whatsoever. Should BREXIT occur, national regulations will need a total overhaul to bring them up to date to the standards that society has today with the EU requirements. On the basis that the DfT does not have enough manpower now, that is the reason given for 4 years of delay above, will it be able to cope in the event of BREXIT? The civil service will certainly need more staff to match the very few knowledgeable ones that are there now who still have enough skill and experience to provide a professional service for society as a whole that can be delivered in a timely sustainable manner. Unfortunately we are only most likely to get even more 5 second sound bite political decisions which will need reviewing almost as soon as they are passed to clear up the mistakes made. The EU did at least look at a longer term perspective rather than the max 5 year – often 6 month between budget statements – policy positions we lurch from in UK politics today. Industry and service sectors cannot work with such short lead-times and even the financial services sector has shown that it cannot deliver what society needs – only looking to satisfy its own greed.
- Ray

A well presented view. We can only gain by leaving the decrepit and corrupt EU. The Mafia would be proud of the EU.
- J Karna

In complete agreement. My impressions from campaigning in The general election last year is that 90% of Brixham would vote for a Brexit and 70% in the remainder of the South Hams. Sarah can rest assured that these views would be overwhelmingly supported in her own constituency.
- Dr Katy Bowen

I agree with Paddy Briggs. With politicians having such a poor understanding of major policy issues and/or engaging in populism, it is no wonder why citizens do not trust them. The leavers are the real EU scaremongers. We pay only 1% of our tax money on the EU (which returns 9 times as much to us in terms of jobs and foreign investment). The EU is directly accountable to UK citizens through the participation of our elected Ministers who make decisions in the European Council and our directly elected European Parliamentarians. The problem is less to do with Europe and more to do with Westminster.
- Nick Hopkinson

having voted originally to go into the EEC I am now totally against the whole current EU stet up. Why have I changed my mind? 15 YEARS BEING IN BUSINESS IN FRANCE
- simon

Well done Sarah. One of the few politicians who has had a proper job in the real world and has realised the billions of pounds we pay into corrupt European bureaucrats can be better spent for the benefit of the people of this country. Roads repaired, a better health service, protection of our own boarders, better schools and the ability to reject the immigrant scroungers taking advantage of crass EU laws and gaining access to our housing and welfare benefits. Charity begins at home.
- Graham

Sarah when were you a Europhile? Remember having conversations with you on the EU soon after you were elected and you were a complete Europhobe then with nothing complimentary to say about our important relationship with the EU and the largest single market in the world that gives us so much more influence politically and economically in the world when negotiating with countries like China and Russia. May soon be the case of "Little England", after the fragmentation of the UK on Scotland's exit and quite possibly the remainder of the UK apart from England, negotiating how many Burberry coats equate to us accepting 1000 tons of their heavily subsidised steel! Heaven knows how many years it will take "Little England" to negotiate, at a much lower advantage, the number of trade deals that are currently in existence with us being a member of the EU?If you get your way you could be one of the last UK members of Parliament and David Cameron,against his will, our last UK Prime Minister! After Scotland's exit from the UK we will certainly not be able to call ourselves a "United" Kingdom! Will we, in our diminished status, still have a seat as a permanent member on the UN Security Council?
- John Roadknight

Do not forget The European Free Trade Association
- simon

I have the utmost admiration for Sarah and am delighted that she has decided on BREXIT. When I read through some of the comments about her post, I can't help but feel that the honest way for this debate to be framed is between joining a federalist club and rescuing our democracy by reclaiming our independence. Ultimately it is as simple as that and people should remember that the only way we are able to contemplate BREXIT is because we wisely avoided being sucked into the Euro. The relentless drive towards centralisation by countries that are not at all homogeneous has busted Europe's flush and exposed that members like Germany and Greece have about as much in common as a fish and a dog. The sooner we reverse ourselves out of this dead end the better. BREXIT now, you know it makes sense!
- David Craggs

Reverse us where? No one knows! George Osborne has been cosying up to China whose economy is plummeting and who executes more criminals than the whole of the rest of the world put together. It also has an extremely corrupt judicial system and is currently using its power to expand its military presence in the South China Sea. Economically and politically we are FAR stronger negotiating with China and Russia as part of the EU and not as a "Little England". I believe the vast majority of the UK share the same values,culture and liberties as our EU neighbours and do not want to be dominated by authoritarian regimes.The only near certain outcome of a Brexit is the disintegration of the UK. I am sure Nicola Sturgeon is licking her lips at the prospect!
- John Roadknight

I do wonder what level of real understanding people, like you Sarah, have of the day to day workings of trade within and between EU countries? I have worked as a Senior Executive in a FTSE 100 company on some of the biggest, and most profitable, multi-national projects, with partners from other EU member states. These projects have brought many billions of pounds into the UK. One of the reasons why these projects were, and continue to be, successful is because of political will and the ease of trade between EU member states. Frankly, whilst I appreciate your loyalty, David Cameron has failed to set out clearly, the pros and cons of the various arguments in commercial terms. If, and this has not been made clear, the cost of trading with EU member states rises post Brexit, then UK Plc will be seriously damaged, possibly fatally. Neither you Sarah, or anyone in government has addressed this in clear, commercial terms. From what I have read thus far, Cameron's position is founded upon immigrant access to the Welfare State. I am not condoning this. However, this would amount to an estimated saving of some £30 million pounds. That is small fry compared to the potential long-term loss of billions. Finally, can I say that many of the arguments above are, with respect, akin to closing the stable door after the horse has bolted. Most former British companies are now owned by other EU companies. We no longer have any control over them. Today, in 2016, the profits go out of this country. That was clearly not the case when Britain joined the, then, EEC. We no longer have a British owned industry, coal industry, steel industry or electronics industry. Regardless of who is to blame, Britain has record levels of debt and is a poor collector of corporate taxes. If Britain is left to paddle its own canoe, people might care to ponder upon what I have said before taking a potentially irreversible decision. Like it or not, commerce has changed. If Britain leaves, it cannot flip the calendar back to the 1970s and pretend that global integration hasn't happened.
- Gary

Leave one, leave all. Germany will be left alone to welcome the Turks.
- Brexit

Bet you feel more comfortable now George Galloways on board! Can't believe you"re really in the same boat as him and Farage? Don't think that will go down too well with your supporters who voted for you.
- Peter

We have one chance to get out of this increasingly undemocratic failure known as the EU. We can again be a world leader in the new technologies if we regain control. My vote was never in as we never got a vote. It is definitely out now we have one.
- Sam Seal

Really very sad to see such a big mistake from a usually clear thinking, thoughtful fellow GP, who has often commanded my respect. Sarah, I urge you to carefully reflect on your position. Consider its basis on short term, small-picture analysis. Consider your focus, almost entirely on our differences, ignoring the far greater scope of our shared problems and shared interests. Consider the huge potential for leadership the UK has to offer as the EU evolves. If only we were to engage without reluctance, on these new terms, particularly with this significant shift in emphasis in accommodating diversity, which is very likely to strengthen. We are a far stronger country now than when we entered the EC, in no small part because of it. Has it really, in totality, served us so badly? Who knows their MEP, indeed. But how many more people actually know their MP? Their county counsellor? Their district counsellor? Their Police Commissioner? Yes, we do have a big problem with broken democracy. This is a big worry at local and national level, but your focus is solely on this problem at a European level, ignoring the rest. Again. Your position on European democracy follows through that we either abolish or withdraw from local and parliamentary democracy as the answer... non sequitur, surely. Your position runs high risk of breaking up the UK, resulting in increasing division at many levels, and greatly diminishing our influence at every level. Far better to remain a United Kingdom, being British and European, and maintain our position in the world on the back of the strength of all these partnerships, surely? Your choice appears bleak and defeatist - misplaced nationalism leading to a much diminished, very little England. My choice is Great Britain, showing leadership and sharing ties amongst friends in a diverse Europe. Give it some thought - seriously. With best wishes.
- Richard Stanley

Get out to what? No-one knows! Into a fictitious land of "milk and honey" as David Cameron put it? Scotland looks very likely to leave so it will be goodbye to the UK as we will no longer be United.You would do well to read Gary's excellent resume above who knows much more than me about the dangers that lie ahead in the event of Brexit. Are we going to send gun boats to Gibraltar next time Spain seals its land links after we exit?We have much more power and influence staying a member in the largest single market in the world.
- John Roadknight

Richard Stanley: I think you will find we all need counselling if we stay in the EU superstate. And thanks - I do know my councillors and MEP.
- Boris the Blonde

What will happen to UK farmers if we leave EU? I can immediately see EU farmers, ie French, immediately saying UK farm produce should have tariffs imposed, to protect the EU farmers. The French farmers could see this as a great opportunity for themselves at great cost to UK farmers. Currently London is the financial capital of Europe much to the German's -in particular Frankfurt's- annoyance. If the UK leaves EU, then a lot of city institutions will relocate to Frankfurt.This might seem irrelevant to us in South Devon, but the fact is, the City of London subsidises much of the UK. The BREXIT politicians constantly state, that is is in everyone's best interest for the UK and the EU to continue to trade freely and, therefore, this is what will obviously happen. But since when, have governments and politicians ever taken the sensible path? There is no guarantee that the EU and the UK will come to a mutually beneficial agreement. The EU governments will have to answer to their populace, which can easily be swayed by populist politicians. The end result may be very self destructive to both parties. The UK will soon become the largest economy in the EU, overtaking Germany. The UK's interests are best served by being the big fish in a big pond and using its might to make the EU more democratic and accountable.
- P. Morley

What a short sighted position, we should be leading Europe and not abandoning it. No-one knows what life outside the EU will look like and the leave campaign will not, or cannot, give any details about whether we will be better off materially or socially. This makes me think that things are going to be difficult and painful for the majority of people as we adjust to this new order which includes a large swathe of Sarah's constituents whom she is supposed to represent. Whilst the independently wealthy, retired or well employed can afford to insulate themselves from this turmoil the rest of us will suffer so that they can wallow in their ideological mire. Hardly the 'One Nation Conservatism' we were sold.
- Nick

Excellent post, Sarah. I am a Europhile too, and want a free trade area BUT not at the price of the loss of democracy. The EU was powerless to act decisively on Bosnia or the Greek, migrant and banking crises. Loss of democracy is too high a price to pay for its membership. 'Ordinary' people that their vote no longer matters.Ultimately European instability and the rise of extremism will be the consequence. This may not do your political career much good in the short term but it is better to stand on the side of what is right. so thank you for having the courage to stand by your beliefs.
- Maureen

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21 JAN 2016

It's time for a bold and brave strategy on childhood obesity

I wrote the following article for PoliticsHome

On the morning of the 2012 track cycling Olympics, the architect of Team GB's victory, Sir David Brailsford, attributed their success to the relentless pursuit of 'marginal gains'. He looked at absolutely everything that goes into riding a bike, from the rider and their bike to the environment around them. It was by improving every aspect, even if that was by a small margin, that the sum total struck gold.

There is no single easy solution to the crisis of obesity which is blighting the lives of our nation's children and I hope that David Cameron will look at the success of team GB and apply the same principle of marginal gains.

Some firmly believe that tackling obesity is all about education and information, others that exercise is the answer. Some will focus on the role of marketing and promotions, tackling super-sizing and reducing the levels of sugar in food or the role of taxation.

The fact is that we need all of the above, and far more. We need a bold and brave obesity strategy because of the sheer scale of the problem and the implications both for individual children, their families and wider society.

A third of children are now moving on to secondary education obese or overweight. Independent data also highlights the stark and widening health inequality associated with obesity. A quarter of children from the most disadvantaged families are leaving primary school obese, more than twice the rate for children from the most advantaged families.

The consequences for the physical and mental health of the individual children who are falling down that gap are serious: they face a significantly increased risk of type two diabetes, heart disease and cancer and they are more prone to bullying and marginalisation.

There are costs too to wider society and the NHS because of our failure to take effective action - diabetes care already consumes around 9% of the NHS budget and the total cost of obesity is estimated to exceed £5bn per year.

It makes sense to prioritise the measures that will produce the greatest gains and especially where they can produce those changes quickly.

The greatest gains lie in tackling our food environment because, whilst exercise is important whatever a child's weight, no strategy can succeed without tackling the prime culprit; too many calories. That is why we must tackle promotions, advertising and marketing, portion sizes and reformulation. The government must also take into account the potential of a sugary drinks tax.

Price helps to determine choices and relatively small changes can have an enormous impact.

The 5p plastic bag levy has driven a 78% reduction in the use of plastic bags at Tesco. It changed behaviour in part because most of us just needed that final nudge to change the way we shop and its acceptability was increased because all the money raised goes to good causes. One paper suggested that apparently outraged customers could defy the imposition of the tax... by taking their own bag... which was of course the whole point of it in the first place.

The same applies to a sugary drinks tax. No one would need to pay it at all because its primary purpose is to nudge consumers to low calorie alternatives. It should be included because we know that it works and that it works quickly. It particularly helps the heaviest consumers as demonstrated by the 17% fall within this group in Mexico one year after the introduction of a 10% levy on sugary drinks. If every penny raised went to funding programmes to benefit children and young people, it could provide financial backing for additional school sports, education and to teach cooking and nutrition skills.

The Prime Minister is right to focus on a childhood obesity strategy and his action list will need to be far longer than space in this article allows, including clearer information for consumers and giving local authorities and schools greater powers to tackle obesity. My plea would be to follow the lead of British Cycling on marginal gains and make a lasting and positive difference to our children's future.

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30 NOV 2015

It is time for bold and brave action to tackle childhood obesity

There is a single fact which demonstrates the compelling case for bold and brave action on childhood obesity. A quarter of the most disadvantaged children in England are now obese by the time they leave primary school. This is double the rate among the most advantaged children, setting out in stark terms the scale of the health inequality from obesity – and that has profound implications for children's health and wellbeing both now and in the future.

Obese children are at greater risk of bullying and of developing heart disease, diabetes, cancer and joint problems later in life. The cost to the NHS of obesity is estimated to be £5.1bn annually, and treating diabetes accounts for about 10% of its entire budget. Prevention is a central theme of the NHS's own long-term plan, yet there has been a further cut in the resources for public health under the November spending review. This places an even greater responsibility on the prime minister to make sure the policies in his obesity strategy can make a lasting difference to children's wellbeing and life chances. This cannot be stuck in the "too difficult" box just because effective action requires politically difficult decisions.

There is no individual course of action that will solve this epidemic; the scale and consequences of childhood obesity demand bold and brave action in as many areas as possible.

In our report published today, the Common's health committee urges David Cameron to include a 20% tax on sugary drinks. We do not believe that this is an attack on low-income families as industry lobbyists will no doubt claim, but rather an essential part of trying to reverse the harm caused by these products. That harm is not confined to obesity; we know for example that dental decay is the commonest reason for hospital admission in children between the ages of five and nine.

While not the only source of dietary sugar, sugar-sweetened drinks account for around a third of intake in four to 18 year olds. A levy on these products need not hit the pockets of low-income families as there would always be an alternative, untaxed and cheaper equivalent. One of the main purposes of a sugary drinks tax would be to encourage healthier choices, and that has clearly been the effect in countries such as Mexico.

There is also a compelling case for any revenue raised to be used entirely to support children's health, and to be especially directed to the most disadvantaged schools and communities. A sugary drinks tax would also have the advantage that it could be introduced quickly – and given the scale of the problem, there is no time to lose.

A successful strategy must include education and increasing physical activity but it would be a huge mistake to imagine that obesity can be tackled wholly by this approach. There needs to be an unequivocal message that exercise is enormously beneficial for children and adults alike, whatever their weight. When it comes to preventing obesity, however, no policy will be effective without tackling our food environment.

To be effective, the strategy has to get to grips with the saturation marketing and promotion of junk food and drink. Price promotions have reached record level, with some 40% of our spending on products consumed at home now coming from these apparent deals. The evidence is that they do not save us money, just encourage us to spend more on unhealthy food and drink, where the bulk of promotions are targeted. Who benefits from junk food promotions at the point of sale alongside non-food items or the chicanes of junk alongside checkout queues?

Reformulation has reduced the amount of salt in processed foods, and its time to ask industry to do the same for sugar – and to go further in "downsizing" rather than "supersizing" standard portions. While voluntary agreements have some advantages, industry will need a level playing field with regulation if that does not succeed.

Education messages are dwarfed by the power and persuasion of junk food and drink advertising. Our children are not protected by regulations as they stand, and these must be extended to include internet advertising, especially through so-called "advergames". It is also time to end the TV advertising of unhealthy food and drink before the 9pmwatershed and the use of celebrities and cartoon characters to peddle junk food.

No one would add 14 teaspoons of sugar to a cup of tea, so why not make it clear when that is what is hidden in a small bottle of sweetened drink? Information is powerful when it comes to making choices. Finally, our report recommends giving our local authorities the power to put health at the heart of their planning decisions, be that the design of active communities and safer travel, or the density of fast food outlets near schools. Its time too for a consistent policy for the latter with food standards applying wherever our children are educated.

There are no single or simple answers, but an obesity strategy that is thin on action will condemn another generation of children to a lifetime of obesity.

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27 NOV 2015

I opposed Syria bombing in 2013, but now David Cameron has my support

I wrote this article that appeared in the Telegraph today

Two years ago, I voted to oppose military action against the Assad regime in Syria. If David Cameron returns to the Commons next week, I will be voting to stand with our allies in extending air strikes against Isil, wherever they hide. It has not been an easy decision because, whatever the accuracy of our weaponry, the innocent are likely to be among the victims of future bombing. Right now, however, countless thousands across Syria and the wider region living under Isil barbarity are subject to systematic enslavement, rape, torture, murder and genocide. Isil cannot be reasoned with and it shows no shred of humanity or mercy to those under its barbarous control.

The first duty of any government is to protect its people and, unlike Assad, Isil also poses a direct threat to all of us here in the UK. Far from making it more likely, the threat of mass casualty attacks remains irrespective of any decision to extend our operations. Seven terrorist plots against the UK have been disrupted in just 12 months and 30 of our citizens were murdered on the beaches of Tunisia. The same carnage we witnessed on the streets of Paris is being actively planned against us here at home. We need to do everything we can to disrupt Isil at the nerve centres of their operations in Syria as well as Iraq.

There are those who claim that our action will be meaningless tokenism. I do not agree. We have an important contribution to make through our precision Brimstone missile systems and the capabilities of our Tornado aircraft. Our Reaper drones are providing a significant amount of intelligence from the skies above Syria but cannot currently deploy their missiles against targets which have been identified. Our action in Iraq has already helped to prevent ISIL taking control of a far wider territory and pushed them back from key strongholds. We have learned the lesson that Western forces should not intervene on the ground but we can play a crucial role in supporting local forces from the air.

The cloud of the Iraq war has long hung over decision-making but at long last the UN has woken up to the horror of the humanitarian crisis. Resolution 2249 states unequivocally that "Isil constitutes a global and unprecedented threat to our international peace and security" and it calls on all member States to take "all necessary measures" to prevent and suppress their terrorism and to "eradicate the safe haven they have established over significant parts of Iraq and Syria."

Military force alone cannot defeat Isil and we have to step up international efforts to disrupt the flow of Isil's finances and their internet poisoning of young people. There is also a pressing need for regional States and religious leaders to acknowledge and address the vicious sectarian divide and bigotry which ultimately fuels the bloodshed.

International efforts must be redoubled to work towards a just peace if the millions of refugees are ever to be able to safely return to their homeland. But however desirable it would be to see a change of Assad's leadership in Syria, we cannot wait for that to happen before we act because Isil is too great and present a threat to us here, right now, in the UK.

It is time in my view to stand with our allies and the countless thousands living in fear, and to play our full part in a just war against an unspeakable evil.

14 comments

Hi Sarah I strongly disagree with your stance on military action in Syria and I urge you to vote against David Cameron on this issue. Recent military intervention in Iraq and Libya has demonstrated that similar action has not discouraged terrorism or civil war. I believe that military intervention by western countries in this case will not solve the civil war in Syria and will make the refugee crisis worse. I also believe that ISIL will not be deterred. I believe instead we should be concentrating on home security to protect ourselves from terrorism and that we should be working with the UN on non military means to tackle Syria
- Celia Minoughan

Dear Sarah, UK AIR STRIKES IN SYRIA Whilst I agree with your assessment of the nature and severity of the threat posed by ISIL, and that negotiation with genocidal fanatics is not an option, I am not convinced that the solution proposed by the UK Government is effective or appropriate. An effective and appropriate solution would need to target ISIL militants without causing mass civilian casualties, it would need to improve the long-term prospects for residents, the remedy must not be worse than the problem being treated and there needs to be a clear exit strategy. Our intervention in Iraq and Afghanistan and Libya has failed on most or all of these points and I see no evidence in the latest proposals that we have learned from our mistakes. The biggest unlearned lesson is that is counter-productive for intervention in the Middle East to be “western led”. America and Britain, in particular, seem incapable of learning this lesson. Whilst most people in the Middle East are wary of Islamist fundamentalists, they are also generally hostile to western intervention in Moslem nations without their consent – a view that can be traced back past the Iraq war to colonial times and even to the time of the Crusades. If every ISIL militant killed by western forces results in the radicalisation of two moderate Moslems, which appears to be the situation, then western-led intervention can only exacerbate the problem. Tactless and arrogant intervention doesn’t just radicalise more people in the Middle East, it can also radicalise people in the minority communities in the UK. If western forces are involved they must, in the interests of diplomacy, be seen to be clearly acting under the command of a coalition of Middle Eastern nations such as Jordan, Turkey, Egypt, Kuwait or the UAE – which at present they are not. Western forces dropping bombs from the air have failed to prevent the spread of Islamist militancy in any nation where they have intervened. ISIL, the Taliban, Boko Haram and other Islamist forces have only ever been defeated by local troops on the ground. One of the unforeseen consequences of removing Saddam and Gadaffi and Assad and Mubarak from power, though our Ambassadors to the Middle East did repeatedly warn us, was that it was Islamists rather than democrats that took advantage of the resultant power vacuum. Those dictators, when they were in power, were infinitely more effective at preventing the spread of religious fundamentalism than any western air force. The proposed air strikes would not be carried out in partnership with any organised army on the ground – unlike the air strikes currently being carried out by Russia. Russia, like the West and most Middle East nations, wants stability in the area and a defeat of Islamist forces. The failure to find common ground with this obvious potential partner, and the resultant dangers of escalating conflict between Russia and the West, should increase our caution. Finally, it is the lack of a coherent exit strategy that remains my most serious concern. If we have no idea what type of government should replace Assad or how it could be established then should we really be getting involved at all? Assad is undoubtedly a brutal dictator, but if he has the ground forces to defeat ISIL, which we don’t have, then – having already seen what happened following our intervention in Iraq and Libya – should we be acting to destabilise his government when we have no coherent strategy of our own? Whilst the people of Syria desperately need our help, this is not the way to help them. Kind regards, Robert.
- Cllr Robert Vint

Dear Dr. Wollaston, I am disappointed to read your post and to see that in spite of your courageous, and very right, stance in 2013 you are backtracking and supporting air strikes this time round. Of course ISIS/daesh poses a threat. But will air strikes really lessen this threat and make us (in Europe) any safer? The 2003 war in Iraq, opposed by a majority of UK citizens whose views were blatantly ignored by politicians who thought they knew better, has not made us any safer. Quite the contrary. There is nothing to suggest bombinf ISIS will make us any safer either. The most shocking, in my opinion, of your comments is your acknowlegement that innocent people will die in these airstrikes - in order to protect innocent people in Europe from dying! How can that be right? are you saying a life in the UK is worth more than one in Syria? It is a sad state of affairs if those are the values of our society. I agree with the comments posted above too, and urge you to change your mind and VOTE AGAINST airstrikes.
- Philippa Candler

I also feel that I have to state my disagreement. As someone who has just turned 18 and therefore hasn't yet had the chance to vote it can often feel like I have very little power with regard to politics in my country and a part of that extends to an idea that there are very rarely things in politics that I feel this strongly about. I feel that this decision would be a huge mistake, not only for the innocent victims in the areas directly affected by the attacks but also for the victims of senseless racism that may be caused by this in the UK. The decision to agree with the attacks may have huge repercussions to both civilians in Syria and Europe. This becomes an attack on the general Muslim population and extends much further than defending our country. Your acknowledgement of the innocent civilians who will be affected by these attacks shocks me but also suggests that there may be a hope in you deciding to vote against this decision. Please, please don't make this decision in the name of our town. If it is decided to be carried forward it will be the end of any chance of me voting for your party in the future and I am aware of many, many other young people who also strongly disagree.
- Ella Watkins

I do not believe that David Cameron has made a compelling case to bomb Syria. I do not believe the way to support "countless thousands across Syria and the wider region living under ISIL barbarity ... subject to systematic enslavement, rape, torture, murder and genocide" is to drop bombs on those very people. You said yourself that those people are being used like human shields and there will be 'collateral damage'. I'm deeply disturbed by the images of French and American bombing campaigns, children being lifted from rubble. If this doesn't prove to ISIL that the West does not care about the people of Syria, I don't know what does. See this article from the Guardian 'Voices from Raqqa, We can't hide from your bombs, tell your MPs to say no'. http://www.theguardian.com/world/2015/nov/29/raqqa-exiles-bashar-al-assad-isis-bombing Two years ago David Cameron asked for a vote to support a bombing campaign AGAINST Assad. Now the French and Americans have asked for support in bombing Assads enemies... this is a multi-sided war that western nations have intervened in enough already; western nations funding different factions depending on their political interests. It is extraordinary that David Cameron wishes to go to war when we don't know who are allies are. Indeed the western nations currently bombing Syria aren't in agreement as to the extent of regime change required. So, what happens next.. when we've bombed the life out of Raqqa, maybe defeating a few targets underneath the remains of those human shields? The failures of the American Government and Islamist rebels to topple authoritarian regimes—in Iraq, Libya, and now Syria—created power vacuums that will be filled with extremists without persistent local forces to suppress them. (ref http://www.theatlantic.com/international/archive/2015/10/how-isis-started-syria-iraq/412042/) I am unconvinced that there are 70,000 moderate fighters in Syria to do this. Julian Lewis, chairman of the Defence Committee was surprised at this 'revelation': "Where are these magical 70,000 people and if they are there fighting, how come they haven't been able to roll back Isil/Daesh? Is it that they're in the wrong place? Is it that they're fighting each other? Or is it that in reality they're not all that moderate and that there are a lot of jihadists among them?" as quoted from Sky News. The UK may be at risk of terrorist threats. I am grateful to our Intelligence Forces in protecting us from those recent threats in the UK, identified and thwarted.... but I feel compelled to tell you as my representative in Westminster that I refuse to allow your party to use 'fear' as the evidence to create untold suffering and fear in another land. This is simple to my 7 year old daughter, to looked at me wide eyed when I asked her whether the British should bomb another country and she said 'of course not! Why would we do that to them when we wouldn't want them to do it to us? They tell us about that kind of thing in school every day.' I hope that your invitation to respond to your letter is taken up by the people of the Totnes constituency and that you get a clear mandate for your vote from your constituency as I do not see my voice nor the voice of anyone I know represented in the media to date. I hope that you get sufficient responses to change your vote to 'no'.
- Cat Radford

Dr. Sarah, I can understand that this has been a difficult decision, but as a constituent you have my support in taking it. ISIS represents a truly barbaric medieval force that stands against everything that the liberal-minded folk of Totnes stand for. Politics often comes down to 51-49 decisions, but in this case if we cannot take action against this vile cancer, it is pretty damned hard to envision when we would ever use our armed forces.
- Mark Marshall

Dear Dr Wollaston, Lest we forget I saw you at Brixham War Memorial on Memorial Day so I was surprised that you support the bombing of targets in Syria in order to combat terrorism in the UK “even though the innocent are likely to be among the victims of future bombing.” Here are some points that should be considered 1. In your lifetime the majority of terrorist atrocities in the UK were committed by the IRA. In the 40 odd years since the 1971 bombing of the Post Office Tower over 3500 people have been killed. Even last year Europol recorded 109 shooting and bombing incidents in Northern Ireland. Would you have supported bombing the IRA homelands of the Falls Road and Bogside? Would that have made the UK a safer place? The Bloody Sunday massacre didn’t . 2. DAESH is only one group amongst many such as Al Quaeda, Al Shabaab, and Boko Haram that have a similar ideology. Bombing Raqqa will be like beheading the Lernaean Hydra which caused the monster to grow two more. There are already reports that DAESH is establishing another headquarters in Sirte in Libya to control the oil and gas trade with Europe. How will we know when to stop the bombing? 3. Given that the crusades instigated by Pope Urban II in 1096 led to 200 years of Holy War by Roman Catholic Europeans on Muslims, other Christians, Jews and Pagans throughout the Middle East and Europe, there is a strong possibility that we will run out of money before we bomb DAESH and its affiliates into oblivion. How long do you think we can last financially in a war situation? 4. The 13th century Franciscan friar Roger Bacon said of the crusades "Those who survive, together with their children, are more and more embittered against the Christian faith". Do you think that is not happening already? My experience of muslim friends and colleagues in the UK, Saudi and Indonesia is that many assume that a European is, de facto Christian. 5. In about 2006 King Abdullah of Saudi Arabia visited China starting the “Look East Policy” in which there will be financial and technical cooperation in oil extraction and refining. I have seen a construction crane with Chinese writing along its boom in Saudi Arabia. The Chinese navy have built or are pursuing agreements to build ports at Darwin in Australia, Hambantota in Sri Lanka and Djibuoti in Africa. This will give them bunkering facilities for their warships to protect their trade from the Gulf to China. In April this year a Chinese naval frigate evacuated 225 foreign citizens from strife-torn Yemen. The Chinese are not judgemental in their dealings with foreigners and have no colonial baggage. Do you think that bombing Sunni Muslims will help the security of the oil supplies that our society is based on? I wish you well in coming to the best decision for us all. Edward Stone
- Edward Stone

Dr Dr Wollaston You state a good case but like all but one of the comments above I can't see the point in more British military action over Syria. Serious sanctions need to be put in place against those that fund these groups. We can't just pretend we are going to destroy them from the air. They will just move further into Libya and the other areas laid lawless by decades of Civil war and corrupt governance to which, in some cases, the West has turned a blind eye. As your constituent I beg you to desist on voting for Military action in Syria and urge you to consider bringing all our troops in the region home. Alastair Prichard
- Alastair Prichard

Dear Dr Wollaston. I am most concerned that we are likely to use air strikes in Syria. First we need to consider the people of Syria and then look at our involvement in Iraq, Afghanistan and Libya, these countries are not considered safe since our military action, Please no air strikes, this is extremely complicated and we need to act with great care. June Wood
- June Wood

Will we never learn! Having created and trained ISIL in order to help overthrow Assad because he wouldn't allow the gas pipeline we wanted built across Syria what we actually created was an inhumane mess. This is an extraordinary and dangerous situation. The Russians are backing Assad because of course they do not want an alternative supply of gas to theirs in Europe whilst the USA want the pipeline to reduce Russian influence Neither Russia nor NATO wish the pipeline that Assad is backing built by Iran so increasing Iranian power and influence. Is it any wonder that the Wests cavalier attitude to the lives of people in the Middle East has resulted in the increase in terrorism? This is a war of smoke and mirrors. Have you really been given intelligence from David Cameron which makes you as a doctor believe that our killing more civilians in the Middle East is actually going to have a positive affect? Surely there are still too many lies and deceptions to make the decision to increase bombing.
- Timothy Kendall

Dear Dr. Wollaston, I cannot equal the excellent and eloquent arguments posted here in opposition to bombing, but alike, and for all those informed reasons, I urge you to use your conscience and agency to vote against the barbarous and presumptive act of bombing a people based on the rationale you have listed in your argument. It can only be disastrous to add to the present chaos. I sympathize with the difficulty of your position, but I hear unmistakably in your and the Party's statements the monotone of rhetoric that allows us to slide words over the possible death of civilians as implicitly justified under the guise of protecting our own. In the smallest matters of life, and all the more at this scale, the deepest wisdom at times is inaction, waiting, and listening, until we know what is the right thing to do, to have the ethical courage of non-action until we know what part to play, rather than forge ahead with the bombast of our collective ego. Is this not the ultimate opportunity for all politicians trapped within their party identities to test their own truths, act on them, and change the foundations on which we govern? Please consider carefully the concerns that your constituents and many members of the public are expressing, Regards, Vaughn Barclay
- Vaughn Barclay

This article for the Telegraph is merely a propaganda puff for which Dr Wollaston will I am sure be amply rewarded by Mr Cameron in the future. ( gong or peerage ? ) Most of the funds for ISIL comes from Qatar and Saudi and ISIL taking root in Syria and Iraq is a consequence of the US policy of regime change. As for the Paris bombers , most of them lived in Brussels not in Raqqa and has more to do with modern France's attempt to absorb and integrate millions of its former colonial subjects from north Africa. Today we see the first bombs falling on Syria from the RAF which are not " precision " British Brimstone missiles but in fact Paveway bombs manufactured in the United States. End result ; more money for arms manufacturers at the same time as increasing refugee flows in Syria and adding to the toxic mix in the Middle East.
- Peter Thompson

What eloquent letters above. I cannot attempt to match with understanding and knowledge of the complexity of the matter but I liked the phrase by the last writer; 'propoganda puff'...... One evening I watched ITV, BBC and C4 news one after the other. Each carried exactly the same news reports and video clips. Surely there is more than 4 news stories on the immense beautiful and diverse planet that we live on. (Yet we don't hear much about corporate pollution, the struggles of the amazon rainforest people, the fires in Indonesia etc. etc.) Years ago, when my sister lived in South Africa we were really concerned about the riots we heard about on the news over there, so called her. She barely knew of what we were talking about. Then she called us when she heard on her news about riots over here: Again, life was carrying on as normal to us. I read George Monbiot's bio. a little while ago (he writes for the Guardian) and he said he had been so excited about working for the BBC but when Thatcher became prime minister she got rid of the chairman in the 80's and the new ruling was 'no more investigative journalism'!! Replaced by propaganda puff? (So, after all this austerity by the Conservatives, suddenly there is millions and billions for killing people again.) Where DID Cameron get his emotive speel from? (Same place as Blair?) Can we believe what we hear on the news? Is it only countries 'we don't like' that have propaganda? Do politicians really question what is going on? Who is behind everything? What are the motives? Who will benefit....... Follow the money. I was struck watching the film 'Amazing Grace' that the slave trade continued for 500 years. Not least because politicians were making money out of it. 100 years ago over a million men were killed and traumatised in the trenches fighting over a metre of mud. Why? What lies were they told? (Apart from the shaming if they didn't do it) Oh where are the wise elders that make decisions led by their heart, not media, propaganda and profit?
- Karen Evans

Disappointed. If a foreign government ordered the bombing of Totnes due to a possible radical/ terrorist cell would you let that happen? D
- DAVID ROPER

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25 NOV 2015

Social Care and Public Health are Essential for Individuals and the Future of our NHS

I wrote this article which appears in today's Telegraph

Britain spends 8.5% of GDP on health care, just below average among the OECD group of rich nations. But while our spending on health has been virtually static in real terms since 2009, the same is not true of demand, which has risen inexorably. Anyone listening to those on front line will hear the unequivocal message that our NHS is under unprecedented strain from the increase in the number of patients with complex long-term conditions, and the shortage in staff and funding to cope. Hospital trusts are heading for a record end of year deficit of around £2bn.

George Osborne faces enormous pressures as he tries to balance the books but he is right to commit an additional £3.8bn to the NHS next year, bringing forward a significant down payment on the £8bn promised by 2020. No one should be under any illusion, however, that this £3.8bn will solve the financial challenges facing our health service.

The fate of the NHS will also depend on the settlement for social care funding outlined in today's spending review. Any Accident & Emergency department will tell the Chancellor that winter pressures are mainly the result of so-called "exit block". Staff time is taken up caring for patients with complex problems who cannot be admitted to wards because those already in beds cannot be discharged due to the lack of social care packages. Social care cannot be divorced from health care and if you combine budgets for both, overall heath and social care spending has seen a worrying decline.

The widening gap in social care funding is set to become wider still as councils fund the living wage. Any further squeeze on their already thin payments to care providers risks prompting a mass exit from the sector. The NHS would then, even more regularly, become the default backup, incurring wasteful and disproportionate costs when people would far rather be at home.

Can more money be set aside for social care provision? There are suggestions that the Chancellor may allow councils flexibility to raise revenue themselves to do just that. But doing so will be most challenging in the very areas with greatest deprivation and need.

Without the ability to manage these extra costs, hospitals will have to make tough choices about priorities.

This is not the time to push for routine seven-day NHS services without the realistic funds to match. The extra costs of routine services on a Sunday were not included in the NHS's own long term plan, the "Five Year Forward View". So any promise that the service can operate at the same level of convenience on a Sunday as on a Tuesday is simply unrealistic. We must prioritise safety and follow the evidence about the measures which will genuinely make a difference. With staffing stretched, there is a danger of unintended consequences and we have to make sure that improving weekend services does not simply result in worse outcomes for patients treated on a weekday.

Today we will see the small print of the spending review. Boosting funding for NHSEngland should be transparently achieved with "new money", not at the expense of bodies like Public Health England or Health Education England, which is responsible for workforce training.

Public Health is the front line of the NHS. Further cuts would hit already stretched services like mental health, drug and alcohol addiction services and sexual health. Action on prevention and early intervention was central to achieving the savings set out in the "5 Year Forward View" as these are key to stemming the rise in demand from preventable disease. Obesity, for example, is estimated to cost the NHS over £5bn per year and the wider economy £27bn, yet we spend a tiny fraction of that on prevention.

Public Health England is not some dry outpost of the NHS, it is both core clinical business and crucial to future savings. Driving it onto the rocks could sink the ship.

Meanwhile it hardly needs saying that it would be unwise to scupper our ability to train the future workforce by cuts to Health Education England.

I really welcome the Chancellor's boost to NHS funding but the time has come to look at how much more we could do to reduce the future costs to individuals and society through preventing illness. We must also follow the evidence when it comes to getting the best out of a tight budget and that requires a serious plan for social care and a review of the key priorities for a seven day NHS.

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