11 JAN 2018

Political courage is required and determination to properly fund the NHS and Social Care

Below is an article I wrote for the Financial Times

There is nothing new about winter pressures in the NHS. What has changed is that those pressures have become relentless, extending year round into traditionally quieter months but deepening in intensity over the winter. The current crisis is not simply caused by the number of people turning up to A&E but because those who do are far more unwell and many more need admission. With hospital bed occupancy already running at unsustainably high levels and a growing shortfall in community beds and workforce, the health and care system can rapidly become overwhelmed. An upswing in norovirus and flu over the past fortnight seems to have been the final straw. NHS England had little choice but to implement its emergency plan to ease the acute pressure by cancelling routine surgery until the end of January. Unless we address the underlying issues across both health and social care this will however become the norm for every winter. Beyond that the unsustainable pressures will result in a collapse in routine waiting time standards.

Increasing life expectancy is one of the greatest successes of our age, but as we live longer and with more complex conditions, health funding has lagged behind. There has been an abject failure on the part of successive governments to plan for the sheer scale of the long term demand and costs associated with demographic change and for the change required to integrate of health and social care,

The House of Lords Select Committee set up to examine the long term sustainability of the NHS rapidly concluded that it could not do so without including social care. The government needs to take note before repeating the mistakes of the past. A green paper that looks solely at long term funding for social care will miss the point that these two systems cannot be considered in isolation from each other. Neither should anyone underestimate the challenge of delivering policy change in a hung Parliament or under a government whose energy is so consumed by Brexit.

There is a way forward but it will take political courage from both front benches and genuine willingness to put the public interest first. Before Christmas, 90 backbenchers from across both sides of the House of Commons, wrote to the Prime Minister urging a cross Party whole-system approach to the challenges and funding of the NHS, social care and public health. Select Committees could also play a role to help to build on existing work and set out the options for the public. Theresa May's former Chief of Staff has advocated a Royal Commission but we do not have the luxury of time to kick this important issue into such long grass.

Many of the options have already been described, for example by the Barker Commission and recent House of Lords inquiry. The reality is that we will all need to be prepared to contribute more if we want the NHS to remain a universal service, free at the point of delivery and meeting our needs both now as well as in the future. This cannot in my view fall entirely on working age employed adults but also needs to consider inter-generational fairness, wealth and contributions from those who are self employed. As graduates struggle with student loans it would be unfair to expect them also to shoulder the increasing costs of health and care for those in retirement irrespective of their wealth. We could look at ideas for a hypothecated health and care tax for example paid by those over forty and with income from any source above a set threshold. Some advocate introducing charging and top ups but these bring higher transaction costs and widen health inequality. The point is that all these options should be clearly set out alongside the consequences of a failure to invest more in the NHS, care, public health and prevention.

Since 2010, total health spending has risen by an average of just over 1% per year. This is far lower than the long term average increase of around 4% and comes at a time of extraordinary rise in demand and the costs of drugs and technologies. Real terms cuts to social care have added to the strains.

It is time to stop viewing health as a bottomless pit but rather as one of our greatest successes and make increasing investment a source of national pride. I cannot think of a better way for Theresa May to celebrate the 70th anniversary of the NHS than by helping to make sure that it has a sustainable long term future.

5 comments

Not being a supporter of your government and a reader of many of your posts I have come to the conclusion you are in the wrong political party. Why, you yourself must realise the Tory party will never promote a system which benefits the many and not the few. Perhaps if your government went after the multi nationals that avoid paying tax in the U.K. We would have a fully funded NHS. Cheers.
- Peter Gunn

You're an excellent advocate for health and social care, and have long recognised that matters cannot remain as they are. I wish you were Secretary of State for Health, even though I wish the Conservatives were not in government. Political parties have studiously avoided the discussion and debate which is now so pressing and necessary. Surely, the UK should benchmark its standards and funding against the best providers in Europe and elsewhere, determine the standards that it should deliver, and develop the best funding model. You are so right about another Commission - that simply kicks the can down the road. As the Barker Commission commented, hard choices need to be made about tax and public funding. A political agenda to shrink the state to unsustainable levels runs contrary to the vital needs of health and social care, and the viability of public services. As a fortunate pensioner, I recognise that my generation should be contributing more, not least because we can afford it, so I support the idea of a health and social tax on the over 40s. More generally, regardless of the arguments against hypothecation, the concept will have public support because people are prepared to pay more if they believe the funds will be ring-fenced to support health and social care. I worry that Brexit can only make matters worse, in all the obvious ways, but also in the emerging decline of tolerance and compassion. You can make a real difference, and you are doing so. We need long term sustainable funding supporting a long term plan, and to the maximum extent practicable, a de-politicisation of these vital services. History is littered with the errors of successive governments in this arena, not least with constant restrucuring and the disastrous PFI initiative. There are many tough questions around funding, taxation, what should be free at the point of deilvery, and all kinds of bioethical dilemmas. But the nation cannot sit on its hands for any longer. The threat to your party is that the NHS/social care may bring down the government while it obsesses about fantastical solutions for Brexit, when it could have elected to remain in single market within the EEA. You're doing a great job, Sarah: please stay on the case, and let the public know what we can do to support you.
- Adrian Baskerville

I agree with the comment above in that we should chase multi nationals and other tax avoiders.We should also greatly increase fuel duty as many health problems exist or are exasperated by pollution expecially pollution from diesel vehicles. Of course people do not help themselves in this respect as they can often be seen driving round and round in circles in Kingsbridge because they are too tight to pay for parking.They would also improve their health if they were to walk more often. The point being that people often do not take responsibility for their own health and therefore I do not think they should be entitled to free health care and should pay for use which would encourage many to take better care of themselves and avoid drinking like fish and smoking like chimneys. There are also many procedures available on the NHS which should not be as this was not the intentions when this institute was first founded. Finally just to calm the doomsayers, Brexit will not make any difference to the NHS or any other aspects of living in UK and will only improve matters. Oh also Sarah Wollaston's comment suggesting that living longer is something positive is subject to one's perspective and not something I would agree with.
- Derek

I believe the NHS is struggling because it undertakes procedures that should not be freely available and the sooner everybody and the government accepts this the better. There could then be more money available for procedures and treatments that truly related to one's immediate health. I do however believe the time has come to consider charging patients for their treatment. This would enthuse people to take better care of themselves as we are all aware of the need for improvement in our diets and the need to abstain from intoxicating liquor. It has recently been reported that the British eat the most processed foods and salty snacks of anywhere in Europe. Terrible diets. Cutting back on pollution from too many vehicles would also help by improving health and therefore reducing the burden upon the NHS. I do also have difficulties in regard to people suing the NHS. This gives me many sleepless nights as I cannot feel comfortable with someone suing a service that is essentially free and by suing only creates a greater burden upon the NHS. I myself have had a couple of procedures done under the NHS which have not been altogether successful, far from it,but to sue the NHS for this poor treatment I received, well I couldn't.
- Derek

With you on this one Sarah. Keep up the good work. This issue is of much greater importance to we Baby Boomers than Brexit, so please remind Mrs May of this fact. Do you have Jeremy Corbyn's phone number by any chance..?
- Roger Westlake

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07 JAN 2018

NHS Funding

Below is an article that I wrote for the Sunday Express

There is nothing new about winter pressures in the NHS. What has changed is that those pressures are now year round but in winter the crisis is far deeper.

NHS England has put in place a plan to deal with this by cancelling routine surgery, but this will not feel 'routine' for those in pain awaiting a hip replacement for example. I understand the need to focus here and now on emergencies but we should not have to accept that cancelling this kind of life-changing surgery becomes the accepted annual response to winter.

The causes of these pressures are well known. It is of course great news we are living longer but as we do so we are living with far more complex long term conditions and the cost of treatment and technologies continues to rise faster than increases to the NHS budget. NHS staff have done an heroic job but they and the whole health and care system are stretched to the limit as they cope with far more people who are seriously unwell.

We cannot continue to provide the service we all expect on current finances, staffing and infrastructure. It is time for an urgent review to find the funding that both the NHS and social care need in order to make it happen.

We also need to end the culture of short termism and look not just at the here and now, but plan properly for the future and look at health, social care and public health together.

The public are being let down by a political failure over past decades to plan ahead, to be honest about the scale of the challenge and to work across Party lines to find a fair solution.

Before Christmas 90 back bench MPs from across political parties tried to change this, we wrote to the Prime Minister calling for this approach. Likewise in my role chairing the committee that calls the PM to give evidence, I told Theresa May that Select Committees (which work across Party political lines), stood ready to help. The fact is that no Party has a monopoly on good ideas on how this funding could be achieved and in a hung Parliament it needs cross Party working to get change such as this across the line.

No one wants to have to fork out but the truth is that we need to be prepared to pay more to support health and care services or services will decline. There are serious questions about whether it is fair for this to fall entirely on those of working age through taxes. My personal view is that it is not and that we should look at how it could be shared fairly across generations.

I know many people argue it is time to introduce charges to the NHS but this risks widening inequalities and also introduces costs and bureaucracy associated with collecting these relatively small payments. I know, as a former GP, that many of my sickest patients struggling on low incomes would have delayed coming to see me had there been a charge. This can end up not only with worse consequences for health but costing the NHS more in the long run. I also feel strongly that charging for appointments would go against one of the great founding principles of our NHS, that it is free at the point of need. It's what makes our system the fairest in the world and we should beware undermining that.

I believe the best way forward is stick with our tax and National Insurance based system as the core funding but look again at how National Insurance is collected and from whom so it can became dedicated to funding the NHS and social care.

It is time for an NHS and care convention to explore all the funding options and explain these clearly to the public and to look again at the options for sharing the costs of social care so that we no longer have the awful care costs lottery of one in ten people over 65 facing catastrophic costs.

A convention should not ignore the ongoing need to reduce waste in our NHS and I hear many examples of this in my work as chair of the Health Select Committee. Making sure that all areas learn from the best performing Trusts for example. Progress is being made in many areas already, for example driving down the huge variation in the amount the NHS pays for identical products. We also have to go further on prevention. Anyone who has spent time in an emergency department on a Friday or Saturday night will know how much drunkenness adds to the workload and avoidably ramps up waiting times.

It's easy to focus on the negative stories but the fact remains that our NHS and is doing a remarkable job and in its 70th year we should should celebrate it's successes and grasp the opportunity to make sure that it can not just survive but thrive. Rather than seeing health and care spending as a 'bottomless pit' we should view funding these properly as a source of national pride. These discussions have now become a national emergency and its time to ditch the Party politicical bickering and make it happen for the whole system our NHS, social care and public health.

2 comments

We need to end internal markets between primary & secondary health, between Community
- Debra Woodhall-James

You can have a good cheap job but it will be slow You can have a fast cheap job but it will be poor quality You can have a good fast job but it will be expensive Whichever way you slice it, this is the reality of life. If we want a good NHS which delivers promptly we will need to pay for it.
- Bob Bowling

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14 DEC 2017

Why Parliament Voted to Take Back Control

This week I voted for an amendment to the European Union Withdrawal Bill because it was necessary to guarantee that there can be Parliamentary scrutiny and sovereignty as we return control of our laws from Brussels. There have been strong opinions on both sides of the argument about this, and even suggestions that by backing this amendment I have somehow blocked Brexit, or increased the likelihood of another election. This is not true. I respect the referendum result and voted to trigger Article 50. We are leaving the European Union but need to do so in a way that leads to as few unintended consequences as possible.

In returning powers from Brussels we must not exchange one system with poor democratic oversight for another. As we take back control of our laws, Parliament has an important role to play in scrutinising the government's work. Both in my role as Chair of the Health Committee and as a Constituency MP it is my duty to be look closely at both the pitfalls and opportunities of the various options for the type of Brexit ahead.

Clause 9, which I and colleagues voted to amend, had such far reaching consequences that I have copied it verbatim below:

A Minister of the Crown may by regulations make such provision as the Minister considers appropriate for the purposes of implementing the withdrawal agreement if the Minister considers that such provision should be in force on or before exit day.

If left unamended, this clause would have been incompatible with the Prime Minister's pledge to give Parliament a 'meaningful vote' on the deal. In effect, it allowed Ministers to make changes to laws with no democratic check by Parliament. Its breadth even concerned Brexiteers like Jacob Rees-Mogg, who said during the debate, "clause 9 gives some powers that trouble even Eurosceptics. I have never felt comfortable with the self-amending part of the Bill."

I and my colleagues had made our concerns clear to government for many weeks ahead of the vote and we feel that this vote was entirely avoidable. The clause should have been removed and the government could easily have done so. This would have avoided the need for an amendment.

Far from obstructing Brexit, this vote strengthened its democratic underpinnings, preventing major constitutional change from potentially being pushed through purely by ministerial decree.

I have been dismayed with how irresponsibly my vote has been misrepresented in some parts of the press. I welcome robust debate and I am always willing to listen and to defend what I believe. Labelling MPs 'traitors' for defending a fundamental democratic principle or judges 'enemies of the people' for upholding the law, just fuels a hateful division. It also entirely misrepresents why I voted as I did and why I felt it was necessary.

As we build an independent Britain – we will need to work constructively with our European neighbours. The more I hear, during Select committee hearings, about the consequences that would arise from a disruptive and chaotic Brexit, the more I feel that we must try to achieve a soft landing. The consequences of no deal and no transition would be very serious indeed.

39 comments

Thank you for having the courage and conviction to vote for this amendment. The brexiteers become more extreme in their views and actions and any who disagree are portrayed as disloyal or treacherous. They must be countered by sound, logical argument by people like you to ensure that when we leave the EU, we do so on a sound and reasonable basis and do not just crash out. Thank you.
- Kevin Gleeson

" The consequences of no deal and no transition would be very serious indeed." IN YOUR OPINION
- mike

What rubbish - thoroughly disenchanted with our elected 'Representative'. Again.
- Hugh Welbourn

It’s about getting us ‘out of the eu’ but actually sliding back in by the backdoor. Which is actually worse than leaving in the first place. Still in the customs union, still in the single market, still got free movement with no say. I’m afraid our representative and the majority of parliament think we’re all a bit thick and not capable of making the right choice. They hold us in contempt. It’s not just here, the political elite in Europe hold their citizens with contempt also, hence the rise of far right parties in Europe. I’m sure the vast majority wouldn’t vote this way, but hey!! If they won’t listen. What an awful choice we’re left with
- John

Thank you for supporting the amendment to the Withdrawal Bill. The British public voted for powers to be 'returned to Parliament' not tranferred to individual Ministers enabling them to pass laws without scrutiny
- Steph Crutchley

You are put in Parliament by the people to represent OUR views NOT yours. Nothing in the above shows any sign of listening to US the people you are meant to represent . You are ONLY there because WE elect you. You are also part of a party and should also remember that . What you have done is a possible back door into a Marxist government that would destroy this country possibly forever and you should have the intelligence to realise this . The people voted for Brexit and just want to get on with it . Businesses need to see clear water ahead , what you have done and your arrogant lot is set this back. We the people who you claim to represent have had enough.
- Anne Swabey

Parliament gave the people the right to decide on brexit. We did and with a larger % turnout than for the recent election, so which is therefore more democratic? If you support democracy then the people must be obeyed not some false idea of the less democratic members of parliament!
- adrian lewis

Directed here by my email to you where I spoke of understanding your concerns re Clause 9, I now fear, having read your explanation, my sympathy was misplaced. The people of the UK, who you (the collective you) represent, voted to leave... that has to be at the forefront as to what type of Brexit you feel is best going forward. In an age when the population have never been better informed through MSM and social media, I still find it gulling how politicians continue to act as if they know best. And simply quoting Jacob Rees-Mogg as being concerned, yet not adding why he still felt inclined to support the Bill is disingenuous to say the least.
- Stuart Price

2nd paragraph of your "Blog" quote "as a Constituency MP it is my duty to look at both the pitfalls and various options for the type of Bexit ahead" Surely therefore it was your duty to "look at pitfalls,facts options etc etc etc" before becoming a Leaver, and then changing to Remainer, why the change? People of the UK voted to leave in a Democratically held Referendum , including 54% of your constituents, we entrusted the Conservative Party to honour that and get on with it, Teresa May is doing just that ,despite various factions holding her to ransom at every turn, this will only get worse coming back to Parliament with the opposition, SNP DUP various gangs of 12 who really can't accept Democracy. Your action has only strengthened Corbyn and his Marxist party, Teresa May deserves better, I feel totally let down, by your actions.
- Peter Mulloy

However well intended, a very poor decision and one which will risk further undermining our negotiating position at potentially great cost to our country. The opposition will doubtless be pleased with your conduct but I am very disappointed although, regrettably, not surprised.
- Brian Kelly

Absolutely shocked and disgusted that our local MP should be so treacherous towards the Prime Minister and to the majority of her constituents. I believe that she should be de-selected and an honourable replacement be put forward. I personally will not support her in any shape or form in the future.
- Mary Bell

Cannot but help agreeing with the post above from Mary Bell.
- bryan boswall

Those Conservative MPs who voted against the government cannot duck the self indulgent disloyalty they have demonstrated. Disloyalty to the PM, their Party and the majority of the electorate who voted to leave. Even the leaders of the EU acknowledge that this defeat weakens the government's negotiating position and increase the chance of a "no deal" exit. This, coupled with the gift handed to those who seek a Marxist government, does not bode well for the future. What is done is done but let us all hope that this mistake will not be repeated in the coming weeks and months.
- Anthony Croke

Well done, it takes courage. Go and get yourself a glass of white wine!!
- David Lavender

my comments re the same as Mary Bell de-selected or better resignation after letting us down
- jim davis

You were a Leaver first and changed - not good, you can't be trusted with our vote. I agree with the above people, let PM get on with her job with help from her party. This is not good for other countries looking in on us. This is not a well done to you but maybe 'sheep' is more like it!!
- Penny Davis

David Lavender how flippant, and pathetic are your comments. It therefore means that except for 12 Conservative MPs, the rest of her colleagues have no courage, and according to Sarah's blog they are the only ones who see the real dangers, they cannot trust the Prime Minister, her Ministers and elected Conservative MP's to get the best deal possible for leaving the EU, how insulting to those people. Arrogance at its peak, maybe the medical term could be the Anna Soubry Complex.
- peter mulloy

Steph Crutchley's post shows that she and Sarah Woolaston doesn't see the simplicity of how a Gov should work. The electorate elect , this is a show our trust, if that trust is broken then we elect some other party . By removing powers from the Cabinet the Rebels are frustrating the will of the people. I am surprised at Moog's comments quoted, Govs need to be able to get stuff done with out too much fuss. The EU now are saying that the the Article 50 period of 2 years can be extended I am afraid that if this goes on into a Labour Gov's term then Brexit will not get done which would be a disaster . The 12 Rebels have no business experience or Trade understanding . Not one of them was seen in the Pre referendum Trade select committee meeting with Professor Mindford that you can watch on Youtube. Nadhim Zahawi was there , he was at that time a remainer after that meeting he changed to a Leaver. There are very few excellent MPs that serve as they should as a conduit for the peoples will. Remainers should respect the 1st past the post system we have , they may also like to study this site , we should never have been considered part of the EU ! http://www.vernoncoleman ( dot com ) /euillegally.html
- Bill Davies

Sorry but I totally agree with Bill Davies comments, the thorn in the side of the Tories, of which I an one, will rumble on forever until it is totally removed.
- David Jennings

You say you are proud to have voted the way you did. What have you got to be proud off, causing more division in the country than there alredy is humiliating us as a country and your leader. Proud is not a proper way to justify what you did. You are a flip flopper anyway and should apologise or even better resign for your inconsistent views. How are we supposed to vote for you when you change your mind regularly. we vote for what you tell us you stand for, not for you to change you views.I'm not proud to have you as my MP when you embarres us on a world stage and belittle our standing in the world. Shame on you and your hypocracy..
- John shields

My husband and I agree with the majority of the above. My husband is of Italian origin and his relatives in Italy are on a three day week with a crippled economy caused by membership of the EU. They would also like to leave the broken EU. Your post contains I think I feel - you are in Parliament only by the will of the people to carry out the will of the people. You have failed in your duty and you have failed Theresa May. We will not support you by voting for you in this constituency again.
- Sharon Carrino

"Et tu, Brute....Knifed in the back, by one who I thought I could trust. I feel your actions and those of your fellow rebels have put OUR Prime Minister in a very difficult position to be able to negotiate a fair Brexit. Do you realise that you have jeopardised the entire future of The United Kingdom, on what terms it leaves the EU and where it will stand in the world, in the future? You really should be ashamed of yourself. Robert Summers Chairman of Wellswood Conservatives Torbay
- Robert Summers

So you have humiliated your PM,weakened the UK’s negotiating position,given encouragement to Juncker and Barnier,made the prospect of a Brexit deal even more difficult ,emboldened the Marxists and betrayed the electorate.Yet you claim on Twitter that you are proud of your achievement.If you are,then you are occupying a seat on the wrong benches in the Commons.
- MichaelR

I would urge those commenting above to take the time to read the text of the EU withdrawal Bill as proposed by the government. We are all agreed that we will leave the EU, but the Bill gives the government powers to amend any current UK legislation which originates from the EU in any way it sees fit - without having to seek parliament's approval first. This could have far reaching consequences for our personal lives and businesses - it includes legislation that covers maternity rights, our rights to keep our personal information confidential, environmental regulations.... Normally the government has to seek parliament's approval to fundamental changes to UK legislation. Why should changes to our statutes as a result of Brexit be treated any differently? Thank you, Sarah for voting for proper parliamentary scrutiny. Had the government dealt with these issues properly in the first draft of the Bill, the Brexit process would not have been held up.
- Sara Chisholm

Most of the people here who attack you do not understand the function either of our representative democracy or of the European Union. I support your action, and hope that you will continue to follow your conscience in voting for the good of your country. Thank you!
- Dr Robert Lawson-Peebles

Despite your excuses, you are a remainer as are all the other so called rebels and you clearly do not trust our Prime Minister, your leader who promised you all a vote. we need to look for another candidate to represent us, someone who knows what they feel on these issues not a last minute mind changer or turncoat.
- John Butler

It means taking our powers back when we get out of europe, then out parliament can bring in any laws they wish. You ae educated but have no sense or understanding of the matter. Watch question time from last Thursday where a man in the audience told you remainers the truth. The referendum was of the whole UK not constituency. You should be ashamed and as for courage, that does not come into it The country voted OUT so lets get out. You are a traitor
- Ken Lakin

What nonsense people write in relation to the nature of this very sensible amendment. I applaud Sarah for backing the amendment and also for making the very good point she does over clause 9. It could easily have been taken out, had the Government done so, there would not have been the degree of unrest over the potential consequences. It is ridiculous how these amendments have been taken out of context, they are not a 'sabotage Brexit' mechanism, merely an entirely sensible airing of concerns from many sides aimed at ensuring the legislation is properly scrutinized, why on earth wouldn't we want this on something as important as the Brexit deal? The government created a great deal of suspicion by virtue of its refusal to take out clause 9. People voted for Brexit and 'taking back control'. That's still what you end up with, law in this Country is subject to Parliamentary approval and scrutiny, that is how our system operates; Brexit changes nothing as to how we implement our own laws. Clause 9 however allows a 'Minister of the Crown' to draw up regulations, that would mean no scrutiny whatsoever; that can never be right in the way we legislate. Regulations are not the same as an enactment, clause 9 allows a single minister to implement secondary non debated legislation; that can never be right for something as important as this. "A Minister of the Crown may by regulations make such provision as the Minister considers appropriate for the purposes of implementing the withdrawal agreement if the Minister considers that such provision should be in force on or before exit day. " Like it or not, Theresa May does not have a strong negotiating hand, she lost her majority at the last election; this places an even greater duty upon Parliament to scrutinize the laws she she is proposing. This was an entirely sensible call by a responsible constituent MP acting in the interests of those in her locality, that includes those who voted for leave or remain.
- Nick Dilworth

Sarah is one of the few MPs who shows she reads her brief. What is forgotten is the referendum in 2016 was advisory but to see the reaction of politicians afterward they had clearly forgotten this. Parliament needed to formally vote to accept the result and then put in place withdrawal. That would have been sensible and surely within the Ken of our representatives. But what we have seen for the last eighteen months is incoherent lurching through one badly-drafted proposal to another. This is government by the seat of the pants and it isn't working. So when one of our representatives actually reads her brief to understand it she should be applauded. Not condemned and threatened with deselection. There is too much at stake for ill tempered lobs across the barricades. Leave that to the press.
- Helen Darch

She is a Remainer and a Traitor, 1 of the other 11 Heidi Allen has been hauled to a party meeting in South Cambs to face a de-selection battle this should be happening in Torbay. I will not vote for Sarah Woolaston again if she is still standing at the next election. Come on Sarah be honest about your intentions, instead of all these excuses
- Pat Brodie

What a lot of nonsense posted here. The passing of this amendment has placed the power to decide whether the brexit deal is acceptable or not firmly where it belongs. Parliament is the sovereign body, not the cabinet, the government or a handful of ministers. One of the planks of the leave campaign was to return power to parliament. To talk of treachery or deselection is just ridiculous.
- Bob Bowling

I agree entirely with Bob Bowling. Sarah Wollaston has acted perfectly correctly, according to her conscience, and posters like Pat Brodie who use such inflammatory language as "Traitor" should remember where such language leads.
- Dr Robert Lawson-Peebles

Many of the people on this message board are not from Totnes and don't seem to understand our constituency, Sarah is our representative and has always voted on issues for what she thinks is right rather than always follow the party line. As she achieved more than half the entire vote for Totnes and has been re-elected twice with a larger vote each time I'd say she's pretty popular. So please stop all this name calling and let our representative represent us in the way she has always done. This is a democracy and if you don't like it then simply vote her out when the next election comes. Intimidation has no place in anything other than a dictatorship.
- Jon Merriott

…sorry but I’m struggling to follow the logic here. These sanctimonious rebel MP’s (who all voted to remain in the EU) are now talking in dewy eyed terms about the sanctity of the UK parliament and democratic process, yet they were only too happy at the referendum to undermine our parliament in favour of the much more undemocratic EU. It seems that they only see the benefits of our democracy when it suits their objectives which seems to be either to stop, frustrate or soften BREXIT
- Mark A

Clause 9 is badly phrased, as it implies that a single Minister may change whatever he/she wishes without reference to Parliament. But we all know that this is nonsense, and Parliament could force a debate, and hence refusal, or amendment to the Minister's wishes. What I am dismayed about the most is that many people refuse to accept the referendum result; they should stop moaning, and set out to achieve a successful Brexit. The greatest danger by 'the rebels' is that they are encouraging Corbyn and Co to believe that they will form the next Government. Heaven help us, should that be the case!
- Barry Day

I don't just disagree with our MP on this. I am amazed by her lack of judgement and wit. The highlight above was where she acknowledge that the EU membership she urged us to vote for "lacked democratic oversight". She refers to "building an independent Britain". Surely any Tory MP urging Remain as she did (eventually) would have argued that we were ALREADY independent. Otherwise wasn't she therefore arguing for the British people to vote against their own independence? She sits in Parliament with that group of the most ardent Europhiliacs, federalists and remainers. When she railed on Twitter for months against Juncker, Brussels and the whole EU kleptocracy. Really? Judgement? I am sure Sarah is a very good doctor, and in many ways an intelligent person. But politics and political argument just isn't her thing is it? The bottom line is that Sarah is simply out of her depth in Parliament. Her lack of judgement shown in the Referendum, her bizarre behaviour since, and her completely incoherent articulation of her reasons for voting for this amendment are proof that she simply does not belong in Parliament. She is the best argument against open primary selection of Tory candidates that I can think of. Everyone in the area should mobilise to remove Mrs Wollaston (as much for her own good as our's). I think a Conservative who could honour the manifesto upon which they stood would be a start. A MP who could frame a coherent argument would be an added bonus.
- George, Paignton

Thank you Sarah for supporting the sovereignty of Parliament and safeguarding our parliamentary democracy. Please continue to do so .
- LizK

The people are sovereign in a democracy and they delegate their sovereignty to Parliament by election of representatives. In the case of Brexit Parliament voted for a referendum to make a stay or leave the EU decision. SW is a remainer trying to frustrate the will of the people. She has lost my vote.
- David, Brixham

Instead of all the arguing and bickering that goes on in parliament there should be far more intelligent and positive decisions made and made promptly with regard to the electorate. The facts are we should never have joined the common market in the first place. Now we need to leave as soon as possible and whether there is a deal or not is of no consequence as no one in any walk of life is able to conclusively forecast the proster and cons of leaving the EU. I suspect that the general populace will hardly notice the difference. It will however be good to leave the EU as they have lost direction especially over the last twenty years.
- Derek

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28 JUL 2017

Ambulance Services in South Devon

Following concerns about long waits for ambulances and the withdrawal of local Rapid Response Vehicles, I invited South Western Ambulance Service NHS Foundation Trust, SWASFT, to an open meeting at Kingsbridge Community College. Chief Executive, Ken Wenman and the team leading operations in South Devon came to set out why services are changing and to answer questions. Many volunteer Community First Responders also joined the audience to share their experiences.

The Ambulance Service has undergone huge changes from one which primarily transported people to hospital to one staffed by highly trained paramedics with specialist equipment also capable of delivering treatment at home, backed up by a network of community first responders and co-responders from other emergency services.

The key challenge has been the rise in demand for their services. Over the past five years the number of calls has risen by 19.2% in the Totnes area, 29% in Plymouth and 23.7% in Torbay. One effect of this has been that once ambulances based in the rural South Hams have taken a patient to hospital in Torbay or Plymouth, they often get diverted to other calls in those urban areas rather than returning to base. The way that targets have been set in the past can mask poorer services in rural areas. Until now, those response targets only covered the most urgent calls with a requirement that a vehicle arrived on scene within 8 minutes in 75% of cases. Overall SWASFT met that target for the South Devon and Torbay CCG area at 75.65% of calls over the past year. But the figures I obtained for the Totnes constituency, which is more rural, tell a different story, with ambulances reaching just 61.1% of those calls in 8 minutes over the past three months. Targets need to be set in a way that doesn't lead to unintended consequences such as focusing on urban areas where they are easier to reach or allowing the arrival of an inappropriate ambulance vehicle to 'stop the clock' when measuring response times.

Now that many more treatments are available in specialist centres to help people who have suffered conditions like acute stroke and heart attack, it is more important than ever that the right vehicle attends a call. Ambulance cars, known as Rapid Response Vehicles, cannot take people to specialist centres but can distort the figures for waiting times. These vehicles are being removed but the meeting was told by SWASFT that overall ambulance hours cover would increase for the South Hams through a double crewed ambulance based at Totnes and use of a 'dynamic coverage tool', otherwise known as getting vehicles back out from urban centres to be closer to respond to emergencies across rural areas like the South Hams. Changes to targets will mean that all calls will count, and using mean average response times as well as the time taken to reach 9 in 10 calls will help to keep a focus on reducing long waits especially in rural areas. I will be following this carefully to make sure that the changes do lead to improvements in the service. These are being put it in place following the national Ambulance Response Programme trial and the following links give further background to this and to the changes:

https://www.england.nhs.uk/wp-content/uploads/2017/07/ambulance-response-programme-letter.pdf

https://www.england.nhs.uk/2017/07/new-ambulance-service-standards-announced/

At the meeting, volunteer community first responders spoke of their concern about not being able to deliver pain relief whilst waiting for an ambulance to arrive. Ken Wenman confirmed the good news that they will now be able to receive training in the use of pain relieving gas and air.

The service has been under increasing pressure due to rising demand and this has meant that it has been coping with 2.46% less funding per call over a three year period. SWASFT's operations director Neil Chevalier, told the meeting that they had received a £3.6m uplift in funding to implement the changes from the Ambulance Response Programme trial and, in response to questions about pay, said that paramedic staff had been put onto band 6 of the NHS pay scale up from band 5.

SWASFT representatives heard direct from volunteer community first responders and local residents about the pressure on services including examples of long waits and these were all examples of why the service needs to provide a better response to rural areas. I will be following this closely.

The message that came over loud and clear was the value that we all place on our ambulance service. Thank you to all our paramedics, support staff and volunteers.

5 comments

Very useful update. Can I encourage St John's ambulance to train its community volunteers in emergency IM hydrocortisone for relief of adrenal crisis? This authorised under Schedule 19 of the Human Medicines Regulations. Our charity's experience has been that this is straightforward to master, and saves lives. We have a first hand report from an untrained office first aider who successfully gave IM hydrocortisone earlier this year for adrenal crisis prevention: he watched our How To training video on his phone. http://www.addisons.org.uk/forum/index.php?/videos/category-2-emergency-injection-videos/ See www.addisons,.org.uk for more information and case studies about this life-saving technique.
- Katherine White

I'm pleased that attention is being given to the response times in rural areas after waiting three and a half hours in my next-door neighbour's house after he fell in his kitchen and broke his hip. He was not classified as life-threatening, though he died a few days later. Even the 999 system did not work as it should have. Everything under great stress. There is line in the sand, which when crossed in the quest to deliver greater efficiencies and particular Ministerial targets get in the way of caring for the customer. Delivery of patients to A&E and Ambulance crews having to wait crazy times in order to hand over patients (queueing in corridors) is another pinch point for availability of manned Ambulances. We need a good shake of the money tree for the NHS in particular.
- mike north

So the response to the ARP trial has been to reduce ambulance cover in S. Hams by removing all the RRVs. The ambulances spend most of their time in the urban areas leaving the residents of S.Hams with less medical help than before, a paramedic in a car can still give life saving treatment as Katherine Whites's post shows. Hypoglycaemic patients are another group of patients as are those with major blood loss etc etc. If the number of 999 calls has gone up so much the question is are all these calls appropriate? J. Hunt was pushing the idea that the NHS should be a 24/7 organisation, has that contributed to people calling 999? Perhaps the Government could help by not listening to lobbyists from the tobacco and food industry but to the health service instead. Educate the public on when and how to access the health service. Encourage people to take responsibility for their own health and not expect the health service to fix the problems arising from smoking, overeating and being lazy.
- S. Hams resident

When can local Conservatives have an MP who votes for their interests, who shows some loyalty to the government and respects the vote of 23 June 2016? It ain't Sarah Wollaston that's for sure.
- George, Paignton

Well done for defeating the government ! We need a second referendum and this time the people of Britian will give the right answer . With the humiliating defeat of Mrs May we are thankfully closer to a Labour or Lib Labour goverment which will end the folly of Brexit and bring the UK back to where it belongs ; an integral and vital part of the European Union. Thankyou so much.
- Peter Thompson

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29 JUN 2017

Public Sector Pay and the NHS

Public sector pay increases, including for NHS staff, have been capped at 1% since 2013–14 and for two years prior to that subject to a pay freeze affecting the majority. NHS employees' pay fell by 10 per cent in real terms between 2009/10 and 2014/15 and continues to fall.

It is time in my view for pay restraint to be loosened but that cannot be done without a clear plan for how it will be funded.

In 2015–16, the Department of Health spent £48.7 billion on NHS provider staffing costs. The IFS estimates that each 1% increase in staff pay would add approximately £0.5 billion to the pay bill, just for the NHS. This means either additional funding for the service or painful reductions in other areas of the NHS or DH budget.

I agree with the pay review body that there are also costs in ignoring the need to increase pay. As the gap between NHS pay and jobs outside the public sector widens, this is hitting the recruitment and retention of key staff, especially when there is fierce international competition for skilled healthcare professionals. The fall in real incomes is also affecting morale, especially where staff are having to work under greater pressure to compensate for unfilled posts. Vacancies and staff shortages can also affect patient safety as well as lead to higher agency costs. Pay restraint is becoming a false economy.

For all these reasons I believe it is time for a rethink but it will require a clear plan from the Treasury as to how it will be paid for. Ending the pay cap won't happen through a simple amendment to the Queen's speech.

It is essential for all Political Parties to face up to the scale of the funding challenge across the NHS and social care and to work together to find a way forward. The reality is that the wider challenge in funding these vital services, in the face of an extraordinary increase in demand and costs, will be there for which ever Party is in Government after the next election. It is in everyone's interests for MPs to work constructively together across Party lines in the national interest. We have a responsibility to level with the public and with each other because the reality is that we are all going to have to pay more to put the NHS, social care and our other valued public services on a sustainable long term footing.

Much of the ground work has already been carried out and we should look again at the full range of proposals from the Barker Commission and the House of Lords inquiry into the sustainable long term funding of the NHS and social care.

25 comments

I admired your stance on public sector pay in parliament yesterday, you told us how the folks we regard as heroes could take no more. Then you voted against them. I require my MP to be driven by conscience, not by a desperate need to cling to power.
- Christopher Mockridge

Brexit u-turner mid campaign. Now this slap in the face. Find a way to fund it? It took your leader five minutes to find a billion to prop your party up. Sickening. I don't believe you understand the anger at this vote; this cheering that went on. It's a game once you get into the Common, where you can forget about the salt of the earth. Like that policeman that died right there at the mother of parliaments - laid down his life for a hardened political class.
- Rosalind Salter

In my 62 years I have never been so disgusted with a party as I currently am with the current Conservative party. To see the cheering following yesterday's vote denying essential public sector workers a raise after 7 years of falling wages sickened me. Your sheer hypocrisy, claiming on your blog and twitter feed to support a loosening of the pay cap whilst voting for the opposite shows that you have no morals or integrity and are clearly in politics for the benefit of your party, not for the good of the British people. Utterly shameful.
- Ian Scott

So, why not grow a backbone and vote with the opposition last night? Austerity is a political choice, not an economic necessity. And your leader proved it by finding £1.5 billion down the back of the sofa for her bigoted DUP friends in 5 minutes. Nurses having to use food banks, policeman & fireman driven to suicide because of the pressure cuts have put them under. You and your party should be ashamed. I really don't know how any Tory MP sleeps at night. At last, the country is awakening to Tory fraud. The quicker there is another GE, the better.
- Mark Jones

You write all that and then troop through the lobies opposing any increase.It is this sort of behaviour that gets politicians a bad name.This is why Jeremy Corbyn is different.During the last Labour government,if there was a policy he disagreed with he voted against it.I hope you were not one of the hooligans who cheered when the amendment was defeated.If the amendment had been passed It would have forced the treasury to look at ways of finding the money.I am 86 and owe my life to doctors and nurses in the NHS and it's time they were adequately rewarded.The firefighters and police who risked their own lives in recent events are praised by Mrs May,but are still seeing their wages fall behind and yet a billion pounds is found to keep your party in power by bribing a party that were hardly going to oppose the government.It stinks.
- Alan Bailey

Blah blah blah. "It is in everyone's interests for MPs to work constructively together across Party lines in the national interest." You had your chance yesterday.
- Figrat

I can only agree with other posters above. Funding public serve is is a choice. Finding the money reflects choices made elsewhere. Austerity has been, and continues to be, a brake on the growth of the economy, never mind the suffering it continues to cause. Choosing to spend a billion on shoring up the outcome of a pitifully poor performance around the general election (which cost another, what, £130 million of taxpayers' money and was entirely unnecessary?) is also a choice, isn't it. The public do not want this. Our elected representatives are presumably there to serve the wishes and needs of the public, for the good of our society. We are being very very badly let down, and this public hand-wringing while continuing to support these poor decisions is hypocritical in the extreme. Cross the floor, Sarah. Please.
- Veronica Conboy

Could you please explain to us WHY you voted to keep the cap Sara? Speaking in favour of lifting the freeze and then voting to keep it is pure hypocrisy! Especially since MP's have been given a pay increase and they are public sector workers, and they are also able to claim extortionate expenses. Its a slap in the face! I work in the NHS as a Emergency ambulance crew, many of my colleagues in London and the country don't want to be hailed as hero's, we just want a right to earn a decent wage.
- Noelle

The Barker Report is wide ranging but has a very important conclusion: "With a view to raising additional revenue, we recommend a comprehensive review of wealth taxation". If you also agree with this maybe it is time to cross the house or at least vote in line with your beliefs.
- Ken Pickering

Agree with all the other comments on here, SHAME ON YOU ALL!! Unbelievable scenes yesterday, cheering the decision! I had to explain to my 6 year old why all the people of TV were so happy ! Disgraceful behaviour!! VOTE for what you believe in and stop being a May Puppet. Oh and reply to your constituents and enjoy your pay rise!
- Jack

I wish I could say I was shocked by the two faced, cowardly and selfish approach shown by yourself and other members of your party. There is no point in anyone saying shame on you, for you all lack integrity and any moral standing. Of all the people to cower to, a leader who is scared, has sold members of her own party, who saved her skin,down the river and won't stop short of buying her way out with public money. You are a representative of the people yet all you do is take for yourselves, you are pathetic and immoral, all of you. Sadly you all think this is acceptable.
- Dave Hennig

As a new constituent I was at least reassured by your public pronouncements and apparently principled response to the Leave campaign's complex relationship with the truth. However I can only agree with the other posters here: You have really let yourself, and us the people you represent, down.
- Nick Quine

Many of us in the Southwest had high hopes following your election that at last there was a person who came from and really understood the health service, its needs, pressures, and the welfare of its staff and patients. So very disappointed that after all the rhetoric, in which you appeared to understand the impact that the pay freeze has had on morale aand recruitment, and therefore patient safety, that you voted against the words you had spoken. Thank goodness most of us in the NHS are advocates for our patients and not afraid to speak out, and refuse to simply toe the line if we feel something is wrong. Let's now look forward to spending even more money on agency and locum staff, and see services wither, such as dermatology at Taunton which another Conservative lady wrongly stated that she had saved.....
- Teresa

You are a disgusting person, a disgrace to your profession and your country.
- Birte Evenden

I have always been a fan of your political stances as you always seem To represent fairness and stand up for the principles You hold dear., however I was very disappointed to see you vote against the pay rise for Nhs staff despite your entry, statements and blogs to the contrary. This would seem hypocritical and you certainly have lost a lot of this integrity in my opinion with this vote. It is also maddening when politicians have a 10%pay increase that you can credibly take this stance.
- Ed Schwallins

I think your blog and the work you do is excellent. Unfortunately, your excellent work in the commons health committee failed to hold the sec of state for health to account for misleading the house regarding "increased spending"; by changing indexing, adding a year to the period and including monies already promised. As you point out retention is disasterous, and for nursing means 1 in 5 posts vacant, and applications to nursing dropped significantly since the bursary was removed. This means more "bank/locum" work with increased costs. The SOS for health plans to privatise the body which has saved money in providing locum/bank staff. Really? When you state "an amendment in the queens speech isn't the way to address this" you are being politic. The DUP deal cost £1.5 billion. That was also being politic. Honesty is required. The govt states the NHS is "safe in our hands". It is not. We need 8% of GDP (or more) to fund the NHS. The suggested cuts have been criticised by practically every body that has commented that it is not possible. The govt should be honest that the plan is for privatisation of the NHS. Why aren't you? It's called being politic; you know anyone stating this would not get into power. So you made a choice to be politic. That's your choice. But please accept that's what it is. The cheer when the ammendmemt failed was an insult to all of us working in the emergency services (including you of course as a Doctor), and was disgusting.. I was in Washington DC last week and saw live at Capital Hill the speeches made to fight against the repeal of Obama Care which would mean 22 million people not having access to health care in the U.S. if repealed. This govt seems to be demonstrating privatisation through stealth, as per the motion passed at the BMA ARM. I ask you to consider your role in that, as I have really admired you taking SOS to task; however it seems misleading the house is just accepted these days...
- Dr Peter Taysum MBBS MPhil MSc MA (home)

I always thought you were one of the good Tory MPs. I feel sickened to see that you voted for keeping the pay cap in Parliament. You are a wicked person.
- Dimer Caprol

And despite Labour having a clear unambiguous plan on how to fund the long over due pay rises you flatly refuse to accept it as it doesnt fit in with your ideology. Meanwhile you continue supporting a failing system that has seen unfettered growth for one part of society whilst at the same time sending public servants along to food banks, leaving in huge numbers and retiring as early as they possibly can to escape the unfair pressures that your 'Austerity ' plans have created. Even Marie Antoinette offered cake. All the Tories do is offer platitudes. Ive yet to see one cooked and served up on a plate that will fill the belly of anyone. Your blog on the public sector pay cap is apropos of nothing. Nothing by way of a solution offered except bread tomorrow, if you live that long. As usual in all areas where money has to be spent its 'Lets set up a review panel and procrastinate a little longer' But it just aint good enough, Sarah . And deep down you know it. Trouble is you are stuck in the middle of this Tory quagmire and dont really know how to extricate yourself without losing a lot of your friends and being rescued by getting to the Socialist side of the mire, where I think your heart as a doctor would love to take you. The Tory patient is terminally ill no chopping off of the parts of the poor to use as transplants can save it as the one ingredient medicine cannot provide is spirit and its long gone from the tory body.
- steve howard

It seems to me, you took the Hypoctritic oath. Shame on you.
- Derek Robinson

you, your party..sicken me..You are lacking in everything that I regard as decent.Ashamed that my beautiful home Town ever considered you as someone that could represent them.
- Virginia Keyes

There is no excuse for Theresa May and your so-called government to find a huge sum of money when it suits them to prop up an unworkable majority by stitching up a deal with a bunch of ulta-right thugs. We all know it. You know it. Droning on about how to help the NHS is a little thin in the circumstance - especially as everybody knows that the Tories want to privatise it bit by bit. Your party is morally bereft, ethically corrupt and has sacrificed what little respect it might have expected.
- Sam Richards

Well said all of the above. Take heed Dr Wollaston. Your constituents are watching & they are not happy.
- Jane Begley

Absolutely disgusting behaviour in the commons the other day. You had your chance Sarah but you blew it. You just join a long list of MP's we can't trust.
- Alex Clough

Where is the fair society Theresa May promised before the election ? 1. BBC presenters vastly overpaid (at license payer expense and we have no option but to pay it) whilst public sector workers get a pay freeze. 2. Even public sector workers are much better off than those who are unable to work and only get Employment Support Allowance which is less than £6,000/PA and has also been frozen since 2104 ? Theses people need help more and long term poor health can happen to anyone. There is a lot that could be done to help theses people such as unfreezing the benefit, bringing in a council tax exemption and more.
- Stuart

I am of the opinion that the NHS is badly managed, and huge savings could be made by looking carefully at the management structure, and the way it operates. Why are there so many layers of management? I am now retired, but on one project I was involved on with the NHS, meant going to a meeting to discuss the revision to one of the hospital wards, along with the other design consultants. But, as the location of the toilets had not been decided upon, the meeting was aborted, at a cost to the NHS. This was just one small example, and no doubt is repeated many times over in many hospitals of the waste. Also I have read of many inefficiencies in the NHS with regards to purchasing such simple items as rubber gloves; it makes one wonder about the purchase of more expensive equipment. In summary, the NHS should put its own house in order before asking for more cash
- Barry Day

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19 MAY 2017

Social Care is at a tipping point but increasing funding needed intergenerational fairness

This is the original article I wrote that appeared in the Times today.

One of the the most striking figures set out by the Chief Executive of NHS England, Simon Stevens, in his recent update to the NHS Forward View was that life expectancy is increasing by five hours a day. This extraordinary success has also driven an unprecedented rise in demand for health and social care to levels which can no longer be met from current spending. The Care Quality Commission is not alone in describing social care as being at a tipping point. In her manifesto, Theresa May has acknowledged that the elastic can stretch no further and promised to increase funding for social care as well as per capita spending on the NHS. The manifesto also includes a much needed boost for capital projects described as 'the most ambitious programme of investment in buildings and technology that the NHS has ever seen'. Funding promises have to be realistic and fair. The Prime Minister is right not to duck the issue of intergenerational fairness in meeting the challenge of funding social care and it would not be fair for the increasing costs of both the NHS and social care to fall entirely on the working age population. The options were never going to be easy but failure to increase spending risked the collapse of social care provision and a downward spiral of NHS performance. Hard choices on the means testing of winter fuel payments and downgrading a triple lock to a double lock on pensions after 2020 are fair if the money raised rescues social care from the brink for those who will need it the most.

It still takes many people by surprise that if they have assets over £23,250, they are liable to meet the full costs of their residential care and raising that threshold to £100,000 will be welcomed but the long awaited cap on the total that families will have to spend meeting the cost of care has been dropped. The greatest change however, is that many more people will be liable for care costs because the value of their family home will no longer be exempt if they need care in their own home. Any policy must avoid unintended consequences and ministers will need to clarify what period of grace will be applied for those who may only need short periods of care. Currently this so-called 'disregard' is set at 12 weeks for those needing residential care and it is essential that this also applies to home care. If not, it will exacerbate rather than reduce delays to hospital discharges.

The dropping of the care cap sadly leaves social care uninsurable, leaving in place the miserable lottery of care costs. A future government should at least look again at supporting state backed insurance for those who have not yet reached retirement age, so that they can begin to protect against this.

0 comments

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27 FEB 2017

The 2017 Budget Needs to Provide a Lifeline for Social Care and a Plan for the Future

This is an article that I wrote for the Times.

As the Chancellor finalises his 2017 Budget he can no longer afford to ignore the stark warnings about the impact on individuals and the NHS from the crisis in adult social care. Last year the Care Quality Commission described the fragility of the system as approaching a 'tipping point'. The situation looks set to worsen without an immediate lifeline and one that goes beyond the uneven and inadequate sticking plaster of a 3% increase in council tax precepts. To put this in context, last year's uplift in the precept raised £382m but this was entirely swallowed by the £612m increase in costs from the National Living Wage. Precepts also entrench inequality as those areas least able to raise money also have a greater proportion of residents who are fully dependent on their local authority to fund their social care. The 2017 Budget needs to bring forward the so-called Better Care Fund already planned for later in the spending review and it needs to be 'new' money, not a smoke and mirrors device to transfer funding from an already overstretched NHS.

Over the last review period 09/10 to 14/15, local authority spending on adult social care fell by 10% at a time of profound and ongoing demographic change. Despite rising demand for services, more than a million people are estimated to be going without the care they need. It is a false economy because they are increasingly ending up in A&E or stuck in hospital when they could and should have been discharged. The knock on effect on NHS services has been the marked rise in waiting times, 'trolley waits', and cancelled appointments and admissions. What is surprising and unacceptable is that no government has assessed the full impact and cost of the shortfall in social care on the NHS.

The number of people with care needs is expected to rise by more than 60% over the next 20 years whilst the proportion of individuals of working age will continue to shrink in relation to those living in retirement.

It's time to stop presenting longevity as if it were a negative. It is amongst the greatest achievements of our age and government needs to highlight and support the extraordinary value that older people add to our communities. It also needs to set out how we will fund social care for the rising numbers of people who will need help to live with dignity in older age. There has been an abject failure of successive governments to plan for the future. Councils also need certainty about the Care Act provisions, delayed to 2020, which bring in a cap on care costs and change the financial threshold for entitlement.

The Prime Minister has already confirmed that she is looking at social care but it is worrying that her review currently excludes the NHS. The two systems are inextricably linked.

In his 2017 Budget, the Chancellor must show that he has grasped the seriousness of the situation and announce an immediate cash injection for social care. He should also set out plans to tackle the greatest domestic challenge of all; how to bring forward a fair and sustainable long term settlement for both the NHS and social care.

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30 JAN 2017

Trump Trading on Prejudice

This is an article that I wrote for The Guardian

Donald Trump made no secret of his deeply divisive instincts during his long campaign for the White House. Vile racial and religious stereotyping, misogyny, his support for torture, even parodying those with disabilities. All his prejudices were worn as a badge of honour, displayed from campaign platforms and television studios for months on end.

Locker room talk, we were told, of his boasts of 'grabbing women by the pussy' as voters were assured that the office of Presidency would surround him with wise counsel and bring out the statesman in him. Less than a month since his inauguration, the stark reality must be dawning on Americans, that their choice of President isn't 'draining the swamp' but dragging them into one of his own making. We don't have to join them.

It would be a mistake to dismiss Donald Trump as some oafish 'man baby' impulsively blurting whatever comes into his mind. His actions seem calculated to offend, bully and control.

Some touted the hand holding with Theresa May as the seal of a special relationship and a gentlemanly gesture. To me it smacked of the unwelcome infantilising of a strong female leader, more than capable of negotiating the White House steps on her own.

In the rush to forge a trade deal Mrs May should remember that Trump's executive orders since assuming office don't just affect millions of Americans but our own citizens. Nadhim Zahawi MP, is just one of many thousands of our fellow Britons who are now barred from the USA for no reason other than the nation of their birth. All those countries on his banned list are predominantly Muslim countries apart from, as Andrew Neil points out, 'those where Trump Org has business interests'.

A shameful curtain of prejudice and discrimination is drawing across the Land of the Free and, if we are truly in a special relationship, true friends should be frank in saying so. By his actions as well as his words Trump is also turning back the clock on women's rights across the world. His executive order bringing in the so called 'global gag' will restrict access to safe contraception and healthcare as well as to safe termination of pregnancy for the world's most disadvantaged women.

The State Visit looks set to go ahead but symbols matter. Westminster Hall has long been reserved for those Statesmen and Stateswomen who have made a lasting and positive difference in the world. That does not include Mr Trump. No doubt there will be those who wish to fawn over him, but that must not be from the steps of our nation's greatest hall.

13 comments

Thank you, Sarah, for your brave and principled article in the Guardian. Bob
- Dr Robert Lawson-Peebles

Donald Trump's first week should be a warning to the UK to tread carefully. We should not appease him just as Chamberlain should not have appeased Hitler. We should not turn a blind eye to his brand of evil in case it hurts our wallets. There are those, like the Sun, who have a go at you for your stance, Sarah but they are plain wrong. Please carry on with your efforts to debar him from Westminster Hall. He has no place there, and if he finds one our democracy is diminished. Those who say we should accept him as the USA's democratically elected president and leader of the free world should remember that Hitler was democratically elected too, and in a very similar way in the first year made a grab for power that left him unassailable. Let us not make the same mistake with this 'sickening piece of work'.
- Peter Scott

Peter Scott seems to go for Godwin's law at the outset. ! The US is the largest most powerful country in the world and has elected a President who will put the interests of the American people first. We as a nation need to work with the US if we are to make Brexit ( opposed by Ms Wollaston ) a success. Most of Ms Wollastons article it is a mixture of half truths and MSM propaganda.
- Peter Thompson

Excellent article. Thank you. I am very opposed to honouring him with a state visit or the opportunity for him to talk in Parliament. Teresa May has jumped the gun in inviting him. Please pass on my thumbs down to her.
- Tracy Harris

How about adding to the rapidly growing number of Britons who are fed up with people undermining the strategy of our courageous Theresa May and sign the 'other' government petition at: https://petition.parliament.uk/petitions/178844 and trust the Queen and our PM when they invite President Trump to visit and see what we can do.
- David

Thank you for making such a principled stand.
- Andy Christian

Just the guy to take on Putin!
- Sam Seal

I really cannot work out why Sarah continues to sit with the Tories in the Commons. She has scarcely a Conservative bone in her body and hardly a positive thing to say Brexit or Theresa May. Joining in the hyperbole about Trump is about the level I expect these days. Why not just resign, and let the Tores stand a candidate in the constituency more in tune with their values?
- George, Paignton

Well done on your opposition to Trump speaking in Westminster Hall. This week you also expressed your opposition to 3000 child refugees being allowed to come to Britain. Could you please explain your thinking behind that?
- Chris Davison

Thank you for your principled stand - I am deeply worried about turning our backs on our biggest trading partner and allying ourselves with Trump. I believe tats a lot of people are now wondering how safe our country is economically following Brexit and Trump's nomination. By the way Chris Davison Sarah did not express opposition this week against the child refugees. Sarah remainsin favour of resettling child refugees. The decision was made by the Home Office.
- Alison Williams

We spoke to several Americans, including students, while on holiday in Florence recently. I said we felt that there must have been something seriously wrong in America for people to vote for him. They said that the alternative was worse and Hilary Clinton was not popular. The students said that they would wait and see.
- Irene Allum

I agree with George. Most of what Sarah stands for flies in the face of what the conservative government is actually doing from social cuts, women's rights Trump and environmental issues Sarah is clearly at odds with her government and its leader. Please get off the fence and fight for a opposing political that can and will make a difference.
- Rupert Eden

I think Trump is wonderful and many of his policies are well thought out and carefully considered. I would enjoy Trump dealing with the EU on behalf of United Kingdom as he would soon dismiss the idiotic notions that the EU hold and guide us to a pleasanter realm.
- Derek

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26 JAN 2017

The global gag will hit the world's poorest women

A few days into his Presidency, Donald Trump has signed an executive order dubbed the "global gag rule". It will have the effect of cutting off funding for overseas NGOs whose work is associated in any way with abortion services. This means that many international health workers and organisations, even those who receive part of their funding from other private sources for work or advice linked to abortion services, will have to decide whether or not to continue. These services risk losing crucial funding – meaning cuts to choice based contraception and other health services for the most disadvantaged women worldwide. Because the US is the largest health donor this will have an impact on unwanted pregnancies and could have a knock on effect on other areas of women's health care like screening programmes, prenatal check-ups and support for HIV sufferers.

President Trump's policy is also counterproductive – fewer abortion services does not necessarily mean fewer abortions but more unsafe 'backstreet' abortions and maternal deaths. It turns back the clock on women's rights to exercise control over their own bodies.

While organisations are being coerced by the new rules into reconsidering their future programmes, it is a relief to hear that the Netherlands have already announced plans to try to compensate for the new administration's draconian policy, by considering an international fund to help provide these services.

Britain should join with the Netherlands to help protect women's right to access safe contraception and termination of pregnancy alongside the other health services that will be hit by the global gag.

7 comments

You really are something aren't you . You pontificate from the lofty heights of Totnes on the policies of the elected leader of the United States. Your only contact with Islam is when you pop into the Indian take away . It was a disappointment for you when the " plebs " voted for Brexit and devastating when the Yanks voted for Trump. Instead of getting in your pulpit why don't you try and understand what is going on and the reasons for it. get out of your politically correct bubble.
- Peter Thompson

It would be excellent if Mr Thompson would explain the relevence of Brexit and Islam to a policy that will cut health aid being delivered in countries across the world. Thank you Dr Wollaston for pointing out that this policy is not about abortion at all, but about cutting sexual health services. There is nothing pro-life about limiting HIV prevention and treatment, or leaving desperate people with no legal options.
- R Edwards

Sarah Wollaston's article is well thought out and something I agree with. Peter Thompson's abusive comment is a pathetic rant with no content whatsoever. Would you say it if you were face to face with her, or do you only get abusive from behind the veil of a computer screen? Next time string two thoughts together into a coherent sentence and perhaps we might listen to you.
- Peter Scott

To R Edwards, given the stated criterion "whose work is associated in any way with abortion services" it very clearly IS about abortion. The other services are collateral damage. Those organisations can, presumably, get access to the funding again by stopping abortion work. However, this may not be of interest. As has been demonstrated on occasion, too often "woman's health" is used as a fig-leaf of attempted respectability to distract attention from the headline act - abortion.
- Dave R

Thanks Mr Scott but I think my comment was on the nail. As for abusive rant I would think Ms Wolastons comment " Trump really is a sickening piece of work. That's the story " rather fits the bill .
- Peter Thompson

Well done, Peter Scott, for highlighting the vacuous and abusive nature of Peter Thompson's post. All he can do is repeat his point, not engage in debate. Hasn't it occurred to him that political correctness may at time be - er - correct?
- Dr Robert Lawson-Peebles

I think Sarah Wollaston's stand is principled and impressive. Peter Thompson's wild assertions and obnoxious tone make it rather hard to see whether he has any logical point of view. I am sorry her convictions have upset him but I would wager he is a man who is easy to upset if you don't fall into line with him. I am not a Conservative but I am pleased to have an independent, intelligent, well informed and progressive woman representing us.
- Andy Christian

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22 JAN 2017

My response to the consultation on re-shaping community services

Following their recent consultation, the South Devon and Torbay Clinical Commissioning Group has now published its recommendations . These will be put to their governing board when it meets in public on 26.1.17.

The most controversial aspect is that the CCG continues to recommend that several local community hospitals will close as part of their plan to introduce a new model of care. In my constituency that would mean the closure of Dartmouth hospital. Many Paignton residents will also be affected by the closure of their community hospital in the neighbouring Torbay Constituency.

Reading the document I am deeply concerned at the statements on page 24 which imply a lack of support for Dartmouth hospital from local residents and their representatives. This is simply not the case. There is huge support for our local community hospital and gratitude for the dedicated work of the staff. There was however pragmatism that the consultation was likely to result in the closure of the hospital, if nothing else by further undermining the ability of the trust to recruit staff, and therefore a determination to work to make sure that we have a commitment to an effective alternative.

Dartmouth would benefit from modern primary care facilities on the same site as Dartmouth Caring, community clinics and an enhanced primary care minor injuries service. The new service must also include commissioned beds in River View for local people who need extra care and re-ablement as a step between hospital and home, or to support them close to home at the end of life. A new combined facility could also allow us to provide better training and development for our local workforce. We know that there is a serious shortage of staff across community teams which is increasing the risk of unnecessary hospital admissions. But the support for this approach will depend on a clear commitment to put this in place and have the new facilities up and running before any closure goes ahead of our much loved community hospital. Clumsy language implying a lack of support for Dartmouth hospital should be withdrawn.

On the issue of Paignton hospital, I will be supporting Kevin Foster MP and again point out the need to have high quality alternative facilities in place before any closure goes ahead. It is also vital that the community are reassured about the quality of provision of social care following the damning CQC report on Mears.

I remain deeply concerned about the financial pressures across health and social care and will continue to press at national level in my role as chair of the Health Select Committee for an urgent review of and increase in the short and long term settlements. The pressures are not just financial but also as a result of a very serious workforce shortfall across health and social care and I would like to see greater emphasis on maximising training opportunities in the final CCG document.

I also remain deeply disappointed that there will not be a minor injuries unit with X-ray support at Brixham hospital. Concentrating services and facilities at Torbay hospital not only risks driving more people to A&E and increasing the risk of avoidable admission but also far longer travel times for Brixham residents.

I will be attending the public meeting this week to put these points to the board.

On a separate note, I have also been speaking in Parliament and directly to NHS leaders about the recent threats to Torbay's nationally and internationally respected model of integrated care. Whilst I have every confidence that Torbay council and the local NHS will continue to work closely together within the Integrated Care Organisation, ICO, it makes no sense to see their work undermined by outside threats to stop them pooling their resources to work in the best interests of patients.

1 comment

Ho ho Sarah,this was a done deal,focus on community,that’s a joke,recently,Torbay miu closed,sending casualties to newton or totnes?out of brixham?and surely in the summer influx,massive in holiday camps alone,for Paignton,brixham,what idiots in your clinical commissioning decided this was the way forward,despite meetings,no one actually spoke to front line staff..brixhamhospital,now a ghost of its former self,in my opinion,wellness,well a nice idea,but not before sacrificing acute services,because as you will be aware,dr Wollaston,our aging population need the former,not the latter,feel the gov have set the wrong target,and so will fail..
- Ronald

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