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 breaks' 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.

42 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

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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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28 OCT 2015

Tampon Tax

Many people have contacted me about VAT on sanitary products. Of course I am opposed to VAT being placed on these essential items but I did not support Paula Sherriff MP's amendment on this topic to the Finance Bill as this matter is entirely devolved to the EU and it would have been entirely misleading to pretend otherwise.

Unfortunately, we are in this situation as VAT replaced the UK scheme when we joined the then European Economic Community. Anything we already had as zero rated tax was allowed to remain that way but the EU have not allowed the UK to add new categories for zero rating since then. I am pleased that the European Commission has now stated that a review of VAT rules will take place next year, which is the realistic opportunity we have to tackle this issue and I would urge those who have concerns to contact our MEPs to ask them to lobby for sanitary products to be zero rated for VAT and you can do so via the following link.

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Stop blaming the EU for this non issue! The fact of the matter is that VAT on tampons is only 5%. It's 20% on toothpaste, razors, pain killers and glasses (and of course many other products). I can't function without my prescription lenses so why should I have to pay VAT on them?
- Marc Cornelius

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16 OCT 2015

Half-Baked and Reheated; the Medical Anecdote Bill Returns to the Commons Today

This article appeared first on Huffington Post

We all want to be able to access effective treatments as quickly and safely as possible. Why then do the overwhelming majority of research and medical bodies alongside the Patients Association and Action against Medical Accidents so firmly oppose the Access to Medical Treatments (Innovation) Bill?

In a nutshell because it will do nothing for genuine innovation or to improve access to treatments but it will confuse the legislation, remove important protections for patients from reckless practitioners and undermine research.

This bill is a reheated version of the half-baked Medical Innovation Bill which was thrown out in the last Parliament. If it was a turkey pie, you wouldn't touch it.

It starts from the false premise that fear of litigation is the key impediment to innovation. The Academy of Medical Royal Colleges, The Academy of Medical Sciences, Cancer Research UK, The Wellcome Trust and a very long list of other research charities have all made it clear that they disagree...that they do not see the need for this legislation and that they do not believe the bill will achieve it stated aims. They all speak of the unintended consequences for patients and for medical research alike.

It is hard to see why the government is not firmly opposing this bill.

Existing legal and professional ethics arrangements already allow responsible innovation. Action against Medical Accidents set out the risk of creating a 'Heaton Harris' legal defence which would make it easier for rogue doctors to carry out risky but 'innovative' procedures or 'have a go' treatments. Under the proposals, these doctors would only be required to obtain the views of at least one other doctor with experience of patients with the condition in question. There is nothing to protect patients from doctors who selectively seek the views of peers who are themselves profiting from newly permissive experimentation.

Faced with a dreadful diagnosis, people are at their most vulnerable to the siren call of innovation. Why take part in a clinical trial if seeing a private clinic would guarantee something innovative? The problem of course is that innovative treatments may turn out to be more harmful than existing treatment or none but a series of anecdotal treatments means that neither we nor patients will ever know.

The bill seeks to address this by tagging on powers for the government to set up a database of these anecdotal treatments. If publicly searchable it would make for wonderful free advertising for private clinics but a vast sprawling register of treatments is no substitute for a proper evaluation of evidence and simply fails to understand the science.

There is no need for legislation to create a database that would be of genuine value to patients and the research community alike, it does however, require funding.

Clinical trials already struggle to find enough participants without this undermining legislation; far better for government to build on improving access and information about clinical trials for those who would like to take part and to focus on their 'Accelerated Access Review' which is examining how to speed up access to new drugs, devices and diagnostics for NHS patients.

When I worked on a children's ward as a junior doctor in the late 1980s, the outlook for childhood leukaemia was grim. That so many of those diagnosed with the same conditions today will survive and thrive is not thanks to a series of anecdotal treatments but because of the meticulous research which allowed us to discover the best treatments. Patients today benefit thanks to the thousands who took part in clinical trials before them and very many go on themselves to take part in the studies that will help others in the future.

None of us will benefit from undermining clinical research with unwanted and ill-judged legislation. MPs should send it to the sluice.

2 comments

Having some past knowledge of the "alternative" health market and having been somewhat naive in their anecdotal testimonials, any legislation should only aim to encourage the efficacy and funding of clinically based trials. As someone with cancer I appreciate all the research that has and continues to take place and which is helping me to improve my treatment outcomes. I was unaware of this legislation and will call upon my MP to vote against it. Oh but I suspect he won't because he is a colleague of yours who blindly toes your party's line. You have my greatest respect for attempting to educate your colleagues on this and other health matters.
- David Westwood

The expression, "Don't confuse me with facts [and logic]", comes to mind! Sadly, successive governments have demonstrated the ability to ignore expert advice for the sake of perceived political advantage. But don't be discouraged, you put the case so well. Keep up the excellent work. Good luck...
- Chris Bulleid

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12 OCT 2015

Sugar Tax Report

I wrote the following article for the Telegraph that appeared this morning.

Sitting on the desk of Jeremy Hunt is a detailed and impartial review of the international evidence on measures which could reduce our consumption of sugar.

But the Secretary of State for Health is refusing to publish this study - compiled by Public Health England (PHE) - despite repeated requests to make it available to the public.

This matters because the public health community and campaign groups need to be able to access unbiased evidence to fully contribute to the Government's forthcoming childhood obesity strategy before the ink is dry on the paper.

It also matters because an important principle is at stake around the transparency of evidence and data.

The Secretary of State regularly speaks of the need for timely publication of data by NHS staff, even if that is inconvenient or embarrassing for the organisations concerned - and we rightly no longer accept that pharmaceutical firms delay or conceal evidence from their clinical trials.

Leadership on transparency however, has to come from the top.

It sends a dangerous message when NHS staff see delayed publication of data on NHS finances and now an unreasonable refusal to share key evidence on reducing sugar.

This week the Commons health committee begins its inquiry into what should be included in the childhood obesity strategy. This will also be Parliament's response to the e-petition signed by 147,000 people, initiated by Jamie Oliver and Sustain, which calls for a tax on sugar sweetened drinks.

Why should campaigners be denied access to an important evidence base paid for by the public purse for the benefit of the nation's children? Given the refusal of Mr Hunt to publish, the health committee has formally requested Duncan Selbie, the chief executive of PHE, to use his powers to do so. At the time PHE was set up as an executive agency of government, there were concerns about the possibility that ministers might lean on officials.

For this reason it was made explicit that its credibility would be based on its "expertise, underpinned by its freedom to set out the evidence, science, and professional public health advice it presents without fear or favour".

Mr Selbie has, however, agreed with Mr Hunt it is inappropriate to publish in advance of the obesity strategy.

He should re-read the framework agreement which sets out PHE's operational autonomy and which requires him to operate "transparently and proactively and provide government, the NHS, Parliament, public health professionals and the public with expert, evidence-based information and advice".

The wider public health community will not understand a refusal to use his powers to publish this evidence.

Mr Hunt must practise what he preaches on timely transparency of data and evidence.

If he will not do so, the chief executive of PHE needs to act in the public interest and do so in his place.

4 comments

Whilst i live in Bingley, West Yorkshire, i fully support your campaign, it is crazy to keep the costs low for such a harmful product to peoples health. As a prominent MP on health issues will you support the continued provision of free school lunches for primary school children. This may increasingly become the main meal of the day for children from low income house holds.
- John Burns

Thank you for taking such a firm position. It is scandalous that this report is so delayed. It seems that the leadership of the Conservative Party are in thrall to the global companies that pedal sugar to children.
- Andy Christian

Keep up the good work Sarah. I can't believe that Mr Hunt and the Prime Minister refuse to support you and the committee on introducing a sugar tax. It's like a repeat of the failed attempt for many years to ban smoking by sweeping the bad news under the carpet. The voices of the sugar lobby are bordering on the immoral. Please continue your sane battle for the health of the nation and especially our youngsters.
- David Westwood

Hi Sarah, Well done and thank you for all that you are doing to promote this issue, despite getting no support at all it seems from the rest of your party. I am so angry about the delay in making public , and now the negative response from the Government to the sugar tax report. I have sent the link to Jamie Oliver's petition to everyone I know. I work in the level 3 Obesity team for TSDFT. is there anything more that we can do to support you keep up the good work , and best wishes from Emma Stubbs
- Emma Stubbs

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04 SEP 2015

We can and should do more to help the humanitarian disaster at our door

Aylan Kurdi is not the first child to drown in the Mediterranean Sea or to suffocate in an airless lorry at the hands of people traffickers but his image burns into our humanity. As we witness the scenes of refugees desperate to reach the sanctuary of our shores the question is whether Britain could and should do more to help and if so in what way?

A mass movement of people is underway, not only of those fleeing conflict in the Middle East and North Africa but of others trying to escape from conditions of grinding poverty. Children just like Aylan die every day from malnutrition and disease but we cannot provide a home for everyone.

In the year ending March 2015 we received 25,020 applications for asylum but just 2,222 of these were from Syrian nationals. Those accepted make up a tiny fraction of the 330,000 annual net migration into the UK and yet, in a democratic country, there is a need to listen to the expressly articulated concern about our ability to cope with the scale and pace of change. I do not believe there is support for us to match the 800,000 refugees welcomed by Germany in addition to our existing migration from other sources and we simply could not provide housing on that scale. Neither is there support for delegating compulsory decisions about quotas to the EU without the leadership to look at all the options. At a time of such humanitarian disaster however, we can and I believe that we should accept more refugees There is also a case for the EU suspending the rules on free movement to seek work to allow greater flexibility to offer those opportunities instead to refugees in desperate need.

International leadership is paralysed despite the scale of the unfolding disaster and there are so many factors beyond our control. Britain cannot force an end to the vicious regional religious sectarian struggles; that will take their own religious and political leaders to actually show true leadership. In the meantime Russia's shameful ongoing support for Assad blocks a negotiated transition of power in Syria. The UN has been entirely impotent in effecting an international military response to the situation and the hard reality is that ground intervention by Western nations acting alone would become a recruiting sergeant for the likes of ISIS and Al-Qaeda. In short, the exodus of desperate refugees is set to continue.

There are clear dangers if a perilous journey with traffickers becomes the surest way for those escaping the conflict to gain asylum and, even if they cannot agree a means to end the war, it is time for the international community to review the way that we assist and prioritise help for the civilian victims. Recognised refugee assessment centres in countries jointly funded to host them should be established in addition to the existing mechanism from refugee camps as the only routes to gaining asylum from conflict zones but that would take a change in international law. If nothing changes then we will continue to play into the hands of the criminal gangs profiting from their trade in human misery. There is also a question about who is in greatest need, the (mostly) young men trying to break through the fences at Calais or the unaccompanied children out of sight in refugee camps? We should in my view prioritise those in the refugee camps.

Unless there is a clear message that arriving by sea will not result in direct entry to the EU, we will simply condemn more people to attempt these treacherous journeys. Fast track assessment centres would also need powers to repatriate those who are are not granted asylum. The current situation is placing intolerable and growing pressure on countries at the front line and countries like Greece cannot possibly cope especially in the midst of their own financial crisis.

We can all be proud that Britain is one of the few countries to commit 0.7% of our income to international development and that we are the second highest financial contributor to the relief effort for Syrian refugees. Yet there are loud and growing calls for overseas aid to be slashed in favour of spending at home. In a democracy consent matters and my sense is that there would be greater support for our aid if the rules for spending the budget could allow it to include humanitarian relief and operations like Mare Nostrum by our armed forces. There is also a case for it to fund onward support in their countries of origin for those denied asylum alongside continuing efforts to prevent the need to leave in the first place.

Britain has a long tradition of welcoming people fleeing persecution. Our anxiety about net migration and especially about EU economic migration has hardened attitudes but this is hitting the most vulnerable. We cannot help every child in need but we could play our part by accepting an increase to 10,000 refugees. In particular I hope that David Cameron will consider the call for a modern day equivalent of the Kindertransport, which was a beacon of hope in Europe's darkest hour.

6 comments

I have not voted for you .. Please do not speak for me ... From a very old Brixham family. Thank you ..
- G.Bedford..


- One of the best blogs I have read on he issue. Agree entirely that help for women and children should be the priority not young able bodied men and that setting up safe havens in contiguous countries is safest, most sensible answer. However, I am not sure you are right about Putin. Much as I disl

I agree with these views. We need to help not only the refugees but also those countries that border Syria and are struggling to cope with the influx of refugees. Greeks, suffering from severe austerity, have shown more compassion than we have. They have sheltered those flooding into their country and of course they encourage them to move elsewhere - how could they cope it all the refugees stayed? To stop the refugees drowning in the Med we need to help improve conditions in the camps near Syria and take refugees direct from those camps. This is not only a moral obligation but also a political one - we need to aid the neighbouring countries, help them remain stable and reduce the pressure on their own infrastructure.
- J Sanders

You cannot separate the massive net immigration numbers from the debate about asylum seekers. All MP's are responsible for the failure to provide leadership and to vote on sensible controls to limit the numbers to ease the social and financial pressures we now face. The health and social services face pressures, yet the proposal by Dr Wollaston is for even higher numbers of refugees. If we did not have the mistakes made by successive governments the situation may be different. No, it is time for other countries to play their part now.
- Phil

This is worrying. I've never voted Tory and probably never will, but I find that Dr Sarah seems sensible, well-informed and intelligent on a range of topics and I find myself agreeing, even modifying my views.. I agree with most of this blog although I am a bit worried about our government's role in the disintegration of Syria. I'd like to ask the refugees how their current situation compares with how things were 5 years ago before the Arab spring, and our ill-thought out response to it.
- TW

I agree with these views, but feel that we are not doing enough and cannot turn our backs on these people when we contributed to the problems in the region. I am part of a CUK initiative to help Syran Refugees who are coming to this country following David Cameron 's pledge to take 1000 before Christmas. Anyone interested in helping the Syrian Refugees or finding out about what is going on in the South Hams should look at the Beyond Borders website which is a hub for various initiatives taking place. Furthermore, in mid December there will be a register of interest for private sponsors featured in the Sunday Times, this ill involve a number of high profile, faith, civil society and celebrity figures. Will you Sarah Wollaston be one of the 50 -100 MP's to add your name to the Refugee Commitment ( RC) ? Items being considered for the RC: Private sponsorship creating safe migratory routes , letting in up to 50,000 vulnerable refugees humanitarian visas Cathy Koo
- Cathy koo

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03 AUG 2015

Care Cost Lottery

For anyone hit with a debilitating illness, it comes as a huge shock to find that there is no entitlement whatever to receive help with the costs of social care if their assets are worth more than £23,250.

Through no fault of their own, around one in 10 people aged over 65, many of whom have saved all their lives, face catastrophic costs especially if they need long-term residential care. This was not an issue at the general election in May because, during the last Parliament, the Government responded to the Dilnot Commission and passed ground-breaking legislation through the Care Act to place a cap on the total amount that anyone would have to pay, alongside a major increase in the asset threshold.

The Government has now kicked that promise into the long grass. The announcement was silently delivered via a written statement, snuck out in the Lords on a Friday afternoon, two working days before the Commons went into its long summer recess. Despite affecting thousands of families, the timing effectively prevented this major shift in policy being properly debated in Parliament.

There were many unanswered questions, and the Health Committee, which I chair – wrote to Jeremy Hunt, the Health Secretary, to ask them.

In his response, Mr Hunt noted that it was important to announce the decision as soon as possible after it was taken. This was, he explained, because many organisations were continuing to work to deliver the reforms to the original timetable.

I believe these organisations, and all of us, deserve to know when and by whom these decisions were taken.

The Local Government Association (LGA) requested the delay – but this was because of the financial reality of implementing the policy, rather than an argument against the principle of protecting people against overwhelming care costs.

The resulting delay is unacceptable, but it is not the fault of local government. Throughout the passage of the Care Bill, the need to fully fund the proposals, which would have greatly increased the number of people entitled to free care, could not have been made clearer. Reassurances were given at the time that the government understood and had allowed for those costs. Since then, however, the LGA received no indication that new funding would cover both mainstream adult social care and the cap reforms. In the absence of funding for both, they therefore made it clear that existing care, which is already at breaking point, must be the priority.

The LGA estimate that the already yawning funding gap for social care is growing by a minimum of £700 million a year, chiefly as a result of rising demand. Implementing the National Living Wage may add an extra £1 billion to their costs by 2020 to pay the wages for residential and homecare staff. This may have been the straw that broke the camel's back.

Thousands of eldery men and women could still be forced to sell their homes

In a further blow, Mr Hunt's response to the Health Committee confirms that the asset threshold limits will remain at their current levels of £23,250 for the upper limit and £14,250 for the lower limit. This has long been a bitter pill for anyone who has done the right thing and saved for retirement, only to face what amounts to unlimited care costs.

The care costs lottery looks set to continue until at least 2020 but there can be no excuse for any delay in clamping down on the absolute disgrace of cross subsidies. Those who fund their own residential care are too often being charged extra to top up shamefully unrealistic fees paid by local authorities for those who do not. In his response on that point, Mr Hunt maintains that there may be "good reasons why councils can often pay less than self-funders for care: they often buy in bulk and have responsibilities to drive the best deal possible to ensure value for taxpayers' money." This grossly underplays the appalling scale of the practice.

There is now statutory guidance setting out how local authorities must consider the actual costs of care and support when negotiating fee levels. The Health Secretary says he will be taking action in partnership with local authorities and providers to make sure this happens. I hope that care homes and affected individuals alike will send him the evidence, wherever and whenever that continues not to be the case.

The government promised fairness for those who have saved for decades only to see their assets decimated because they need to rely on social care. The delay may have been a reflection of the financial reality that councils would have been bankrupted by the costs of the National Living Wage alongside the bill for fully implementing the Care Act. The government claims that the delay is in response to a direct plea from the LGA. A better answer would have been to address the gross underfunding of social care. Instead they have used the LGA's request as covering fire to ditch a cornerstone of legislation and a clear promise to older people and their families.

The Care Act should not have been shelved and certainly not in this manner.

My article first appeared in the Telegraph today.

1 comment

Thank you for taking up this cause. I do not own a home and have little savings having spent my money on eye operations to save my sight. Sick of the run around of clinics and long journeys. I am 76 and more disabled as my years of heavy lifting have taken their toll. We are told we are living too long and the health service can't cope. Care homes are mostly in private hands with wealthy owners who pay their staff a pittance, or employ foreigners who do not speak proper English the elderly cannot understand.--The reason the home in Chillington was closed. I dread old age as do my friends. In their late 70s and 80s. One is 95 and luckily quite wealthy but terrified of going in a care home. We have worked all our lives and feel we are being used as a scapegoat, using scarce recorces, whilst foreign aid seems to have been guaranteed to every tin pot dictator, as funding to Zimbabwe to help to bring about democracy!! I lived there and assisted my friend to run a hospital and clinics. At the sharp end. Anybody can come here and get free medical treatment. I know from experience. Our people are being short changed while money is scattered like confetti to all and sundry. We have to care for our own first! Part of the N.H.S. cradle to grave. Thank you.
- Margaret Newton.

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