Over the past couple of days I have supported a series of amendments to try to reduce the risk of the U.K. crashing out of the EU on March 29th with No Deal. The Government must stop introducing deliberate delays and instead make serious plans for what happens if the Prime Minister's Deal is rejected. As there have been no changes to the legal text of the Withdrawal Agreement, rejection looks to be near certain and we do not have the luxury of time on our side with just 79 days to go until Brexit.
Yesterday I voted for an amendment that will prevent the Government implementing the "no deal" provisions of The Withdrawal Act without the explicit consent of Parliament.
In essence, this was about Parliament making it clear to Government that there is no majority for No Deal. That message was highlighted further during a cross Party meeting between the Prime Minister and over 200 MPs after we had written to set out our deep concerns about the damaging effect of No Deal on individuals, businesses and communities.
Today I supported a further amendment in order to reduce the timeframe for Government to return with its proposals about what should happen next if the Deal is voted down next week. The Government will now have 3 days rather than 21 days to respond.
This matters because of the very serious consequences that would follow if we left the EU in a chaotic manner and the increasing risk of that happening as a result of running out of time for any alternatives.
A majority of MPs won't support No Deal because of both the immediate and longer term damage this would inflict on our economy. The government's own forecasts predict that growth over the next 15 years without a deal would be 9.3% lower than it would otherwise have been on current terms.
WTO rules are not the panacea that some claim, British exports to the EU would be hit by tariffs of around £6bn. The cost of Imports would also be affected, increasing the cost of living in the UK.
There would be serious disruption to complex supply chains hitting many of our key manufacturers and also creating delays to the supplies many products including diagnostic supplies and medicines which are crucial to patients who rely on NHS care. Stockpiling and other No Deal planning costs are already running into billions and the Government could and should prevent this waste by ruling out No Deal.
But the avoidable problems created by No Deal extend beyond this to the major disruption to networks of cooperation in vital areas such as policing, security, research and travel.
We would all be affected and whatever the rhetoric from those who argue for No Deal, Britain would be far poorer, weaker and more isolated. No responsible Government or MP could vote to knowingly and deliberately inflict this on the people they represent. I and many of my colleagues would resign the Conservative whip if it became the Party's stated policy objective.
It is also time for Government to stop presenting this as a simple binary choice between the Prime Minister's deal and No Deal. Parliament has shown and will continue to demonstrate that it is not prepared to accept that.
I welcome the NHS Long Term Plan, which is wide ranging and ambitious. It rightly celebrates the successes of the NHS but is realistic about the scale of the challenge to meet relentlessly rising demand and to improve services. It acknowledges the pressure on staff as a result of the workforce shortfall and the urgent need to upgrade facilities including digital resources.
It is one of the greatest triumphs of our age that we are living longer but more of us are living with complex and long term conditions and there are widening inequalities in the degree to which both young and old are living in poorer health. There also remains an unacceptable variation in outcomes and experiences for patients from one area to the next even where that cannot be accounted for by resources or local challenges.
The Plan sets a number of priorities such as making sure that a greater share of NHS resource goes to mental health, especially for children and young people as well as to GP and wider community services. It lays out a number of proposed improvements to major areas such as cancer, cardiovascular disease, diabetes and respiratory disease as well as a welcome focus on children and young people.
I'm glad to see the Plan accept the recommendations of the Health and Social Care Committee on closer joined up working across the NHS. Not only to bring truly integrated services with social care but to break down unnecessary barriers between GPs and hospitals, and between mental and physical health. Some of these artificial barriers could be better cleared if there were changes to legislation, including to help reduce wasteful and bureaucratic competitive procurement rounds and to allow a greater priority for joint cooperative working rather than competition. The HSCC recommended that any legislative proposals should be designed by and come from those working in and alongside the NHS, rather than as top down proposals from government.
The success of the Plan will depend on having the NHS and Social Care workforce to deliver it and much will also depend on the Spending Review settlement ahead. The 3.4% average annual uplift for NHS England over the next 5 years does not include the public health grants which are central to prevention of ill health and reducing inequality, grants which this year are continuing to fall. Nor does the NHS settlement include the crucial funding for Health Education England which covers education, training and professional development.
The Plan also makes clear that it cannot deliver without a stable and realistic long term settlement for social care. The government's Social Care Green Paper is expected within weeks and it is not possible to fully assess the NHS Long Term Plan without also seeing the long term proposals, including the financial settlement, for social care.
Likewise for capital funding, which is also due to be announced in the Spending Review later this year, because this will underpin new facilities, technology and equipment as well as tackle a worrying maintenance backlog.
The Plan proposes to fund evidence-based NHS prevention programmes, including to cut smoking; to reduce obesity, doubling enrolment in the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and for the NHS to contribute to lowering air pollution for example. But for these to be successful there will also need to be cross government action with a willingness to be prepared to look at tackling health inequality and prevention in all areas of policy as these big issues cannot be properly tackled in isolation by the NHS.
In many ways the Plan mirrors themes and priorities that were also set out in the last long term plan, the 5 Year Forward View, many of which remain unfinished business. The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated. It is also important to recognise the many important changes that did get underway and a number of successful pilots are highlighted as pointing the way ahead for what delivers better and more joined up health and care for patients. This new plan will be trying to make sure that the best care is delivered everywhere rather than as scattered examples of best practice and that Integrated Care Systems make sure that all parts of the wider health system are working together more effectively.
My view is that there will need to be access to the up-front resources to transform services in the same way as is often available to pilot projects for them to succeed, and to cover the double running costs that make sure that new facilities are in place before old services are dismantled. It is also important to allow time for changes to demonstrate an effect. In the short term new ways of working may even appear to increase costs but if in the longer term they help to prevent conditions worsening and reduce the need for more expensive treatments down the line that is in the best interests of individuals as well as reducing long term demand.
It is easy to end up talking about systems but all those tasked with delivering this ambitious Plan must above all keep the needs of patients, families and communities at the heart of everything they do.
It is now just 100 days until we are due to leave the EU and businesses, public services and the Public Accounts Committee are again producing evidence and warnings that the UK is unprepared for the shock of a No Deal Brexit with no transition. Any talk of 'managed no deal' is no more than a dangerous delusion and no more reassuring than a 'managed' car crash. No responsible government could knowingly inflict this kind of pain on the people and I could not remain a member of the Conservative Party if they made that their main policy objective to deliver such a disastrous outcome. No one voted for economic, health and social problems on the scale that would be unleashed in the event of a chaotic exit at very short notice.
I will continue to campaign in Parliament for the people to have the opportunity to examine and give their own verdict on the Prime Minister's deal with an alternative option to remain.
Many people have asked what I would do if the result were the same and Britain voted to leave. The answer is straightforward, I would do all I could to make that work in the full knowledge that we would be going forward together as a nation with informed consent. It is not asking the people that undermines trust in democracy, rather it would be to blunder ahead with plans that neither please the 48% nor the majority of the loudest campaigners for Leave.
Last night's confidence vote has clearly demonstrated that there is no majority in the Conservative Party in the Commons, let alone across Parliament, for the hard Brexiteer's vision of Brexit. I supported the PM in last night's vote. The inescapable truth is that the Withdrawal Agreement and Future Framework will not pass the Commons either but it is the only realistic negotiated version of Brexit. We have reached deadlock and sooner or later the PM will have to take her deal direct to the people or risk us crashing out in a chaotic Brexit with inadequate transition arrangements in place. Britain is woefully unprepared for that and no responsible government could allow that to happen.
This whole episode was unwelcome and unnecessary but at least we will all be spared the weekly threats of the '48' letters for at least a year and the PM should now stop trying to appease the right wing of the Party.
I will be backing Theresa May in this evening's confidence vote. I hope that the ERG will finally be shown for what they are, a small and unrepresentative faction pushing for a version of Brexit that has no chance of passing the Conservative Party let alone the House of Commons. It was irresponsible and self-indulgent for a few individuals to be pushing their own leadership ambitions at such a time of national crisis and particularly to have done so whilst our Prime Minister was meeting EU leaders abroad.
No one should doubt Theresa May's personal integrity and sense of duty and the contrast with those scheming to take her place could not be in sharper relief. Whilst I continue to hope that the PM will move to take her deal direct to the people, I have great personal respect for her determined efforts to try to find a compromise through the Withdrawal Agreement and Future Framework.
I hope we will now be spared the ERG posturing for a while as, following an unsuccessful leadership challenge, there cannot be another for 12 months.
The Parliamentary vote on Tuesday has now been delayed and we are awaiting a Statement from the Prime Minister in the Commons at 3.30 today to set out what happens next. I hope that there will be an acknowledgement of the gridlock in Parliament and a pledge to return the decision on the final deal to the British people, with an option to remain with the deal we already have.
The European Court of Justice has this morning ruled that the UK can unilaterally withdraw Article 50 if that follows a democratic process and that if it did so we would remain on current terms. This matters because there has been some false speculation that Britain might face a penalty for remaining and this puts beyond doubt that this would not be the case.
Thank you to everyone who has written to me about Brexit and the Parliamentary votes due to take place on Tuesday. It used to be said that 'a week is a long time in politics', but the situation appears to be evolving far more rapidly than that.
As things stand, it looks certain that the Approval Motion for the Withdrawal Agreement and Future Framework will fail to pass the Commons. This defeat would then come on the heels of three avoidable defeats last week where the government was found in contempt of Parliament for refusing to abide by its own promise to publish its legal advice, and on the issue of Parliament's demand to be able to amend future motions on Brexit.
In 'normal' times, the official opposition would then move to a vote of no confidence in order to try to trigger a general election. That Labour now say that they will delay, this reflects their ongoing reluctance to come off the fence on the issue of a People's Vote, as they have long promised their members that they would move to back such a vote if their bid to trigger an election failed.
The simple reality of the situation we face is that both the main political parties are divided on Brexit. The same is true of our country, this constituency, communities and even within families.
Parliament has reached gridlock, with no majority in support of any of the options, not for the Prime Minister's compromise, not for the softest 'Norway' style Brexit, with or without a customs union, not for a Canada style free trade agreement and least of all, because of the scale of the consequences, for No Deal without any transition.
Once the approval motion falls, it is likely that the PM will try to seek further concessions from the EU but their position has remained united and that looks unlikely. Coming back to the Commons with cosmetic warm words will not yield a different result.
The fact is that this negotiation was always going to be far tougher than was claimed during the referendum campaign in 2016. Far from being 'the easiest deal in human history', breaking away from more than four decades of close ties will leave Britain poorer and more isolated. Brexit is about far more than free trade deals or being in the fourth division trading on WTO rules.
The uncomfortable Brexit reality is set out in the WA and FF, full of trade-offs, compromises and future uncertainties that please no one. If agreed this wouldn't end the wrangling, the real negotiations about our future relationship would just be beginning as set out in the 26 page wish list of the Future Framework, but with no leverage on the part of the UK.
I cannot support it for that reason, but also because I do not think it has the valid consent of the British people. At the time of the original referendum, Brexit was sold on a false prospectus of unrealistic promises and at a time when no one could say which of the many versions would be the final outcome. We now know what Brexit looks like and people are in a position to weigh up the risks and benefits of the negotiated deal as opposed to unrealistic promises that cannot be delivered. Rather than plunge us into weeks of constitutional crisis or risk crashing out with no deal or transition, I hope the PM will take her deal to the people with a simple question about whether they wish to proceed on these terms or stick with the deal we already have. I will be supporting a People's Vote.
The message from clinicians and scientists is clear; Brexit is bad for our health. It will be harmful for people who rely on the NHS, research, social care and public health as well as for the workforce on which these depend. Having listened to the evidence presented to the Health and Social Care Committee in Parliament over the past couple of years, I cannot remain silent about the impact this will have on the communities I was elected to represent, especially in the event of a chaotic exit with no deal and no transition. Hard Brexit in particular would knowingly, and avoidably, inflict reckless damage to the close partnerships, built up over decades, in place at every stage from research and development to medicines and devices arriving on the community pharmacy or hospital shelf.
There is no version of Brexit which will benefit the NHS, social care, public health or our life sciences sector, only varying degrees of harm. This, together with the wider economic fallout from Brexit, will have the hardest impact on the most disadvantaged in society. We would not be insulated from the economic damage here in Devon.
Brexit reality is vastly different to the fantasy Brexit miss-sold to the public during the referendum campaign. The promise on the side of the bus of an extra £350m per week has crashed into the inconvenient truth that there is no Brexit bonanza for the NHS, only a Brexit penalty. A new report, Brexit and the Health and Social Care Workforce in the UK - by the National Institute of Economic and Social Research (NIESR) - also highlights the vital role of EEA nationals across social care as well as the NHS, and the scale of the threat to recruitment and retention as a result of Brexit.
It is likely that there will be provision for doctors and nurses coming to the UK after Brexit, albeit at extra cost and bureaucracy, if the government follows the guidance of the Migration Advisory Committee. But the effect on the social care workforce and those who rely on them for care will be particularly serious because of the salary threshold of £30,000. We already have a serious shortfall of healthcare assistants in social care in our area. We cannot afford to lose or further demoralise those who have given so much to our health and care services.
Brexit is major constitutional, economic and social surgery and we are all being wheeled into the operating theatre on the basis of a vague consent form signed over two years ago when no one knew which of the many versions of Brexit would be taken forward. It is time to insist that our politicians apply the principle of informed consent. The Withdrawal Agreement has been published alongside a draft Future Framework for our relationship with the EU after Brexit. Only now can we properly weigh up the risks and benefits of the proposed surgery rather than the fantasy Brexit touted in the referendum. Parliament is in gridlock and there is no majority for any of the options. It is wholly disingenuous for Mr Corbyn or the right wing of the Tory Party to pretend that they could negotiate a better deal with less than 130 days until we could end up crashing out with no deal and no transition. Neither will an irresponsible leadership challenge help in such a moment of national crisis.
The Government needs to recognise the stalemate and suspend Article 50 to allow the public their say on the only realistic deal that could be negotiated. That People's Vote should include the option to remain in the EU.
People may come to the same conclusion to leave the European Union. To proceed without informed consent, however, would not only be grossly unethical, it would also place the blame for the unintended consequences squarely at the feet of all those politicians from across both main Parties who allowed it to happen.
Alongside a group of current and former clinicians in Parliament, I plan to bring forward an 'informed consent' amendment to the 'meaningful vote' approval motion on the final deal that would make the deal conditional on a People's Vote. It is not acceptable for MPs to sit on the sidelines claiming that the people have already delivered their verdict. Without informed consent there is no valid consent.
If you were about to undergo surgery, you would expect to know what the operation involved and to be informed about all the risks and benefits. It's called informed consent and no decent surgeon would go ahead without it.
Brexit certainly is major surgery with far-reaching consequences and the government is about to proceed without informed consent.
At the time of the referendum the choice was simply to leave or to remain. The type of Brexit was not on the ballot paper, which is like a surgeon asking their patient to consent to an amputation in two years' time without either of them knowing whether this would involve a few toes or their whole leg.
Voters were assured that this would be the easiest deal in history and that the world, including the EU, would be queuing at our door to trade on our terms. There would be cake and we would be eating it, alongside every fish that swam in our waters.
In the real world, instead of a bespoke deal we are all being marched briskly to the edge of the cliff. No deal and no transition look increasingly likely to be the outcome, and is the preferred option of those MPs who have deliberately and fatally undermined the Chequers plan.
The surgery looks set to be far more radical than anything set out in the referendum and the side-effects and complications of a hard, walk-away, no-deal Brexit with no transition are very different from the promised targeted surgical excision of just the parts of the EU that the Brexiteers didn't like. Shouldn't people have an opportunity to weigh up the risks and benefits before proceeding?
Once we know the final terms there is not just an opportunity but a duty to set out the unintended consequences as well as the potential benefits. There is a compelling case for that to be followed by a people's vote: we have to make it clear to government that it should not embark on potentially ruinous surgery without the informed consent of the British people.
It might be that a majority nevertheless decide to proceed, but there is no democratic mandate for Brexit until the choice is clear and an informed decision can be made. If the hard Brexiteers are confident about their walk-away, no-deal scenario they should be happy to agree.
The polls show that public opinion is turning on Brexit, especially as the sheer scale of the cost and consequences becomes clearer.
No responsible government should countenance deliberately and knowingly inflicting such economic and social harm on its people before at least checking that is what they really wanted.
During and after the referendum campaign I asked many people about the priorities behind their vote. The fact is that there was no one single issue. For some it was a promise on the side of a bus, for others, 'taking back control' over issues ranging from agriculture and fisheries to immigration and sovereignty. I met almost no one, then or now, who felt that we should accept being poorer as a result. As the reality hits home that the EU will reject sector by sector deals, 'the cake and eat it' approach, even if that means economic pain on both sides of the Channel, a stark choice lies ahead: Do we really want to march out through the exit door with no deal at all and with less than a year to put in place complex customs and borders arrangements? Rather than presenting a rose-tinted view, the hard Brexiteers need to level with the public on the scale of the unintended consequences. The government should not keep the economic impact analysis locked in a secret reading room accessible only to Parliamentarians but publish these so that everyone can examine the evidence.
In supporting New Clause 5, an amendment to the Trade Bill that would keep us in a form of customs union or customs arrangement after Brexit, I am not 'blocking' Brexit or 'obstructing the will of the people'. Britain is leaving the EU. This is an argument about the type of Brexit and that was not on the referendum ballot paper. The duty for MPs in carrying out the will of the people is to examine the evidence and press for the best possible Brexit, not to make their constituents poorer.
My view is that we should also opt for membership of the EEA and EFTA at least for the transition period. This would allow us to leave the Common Fisheries Policy and, like Norway, regain control over our fisheries, an issue of great importance to Brixham. But frictionless trade is also hugely important for both fishers and the processing sector, and in particular for exports to our most important markets in the EU.
Without a form of customs union or arrangement, border checks are an inconvenient inevitability. Without a customs union the current fudge over the border between North and South on the island of Ireland will inevitably become untenable. No one wants a return to the conflict of the past. The price of abandoning any kind of customs union is too high and I won't support it.
There is also a simple truth that there is no Parliamentary majority for a walk-away, no-deal Brexit. The small band of hard Brexiteer MPs need to stop throwing down red lines like spaghetti and stop threatening to remove the PM unless she bends to their will. The PM has herself spoken clearly of wanting a customs agreement with the EU and NC5 is compatible with that as it does not call for 'the' Customs Union on existing terms. My role as an MP is to read the evidence and to clearly state the case for what I believe is in the best interests of my constituency and the country even if that is sometimes wilfully misrepresented by those who simply want us to walk away, whatever the unintended consequences.
Below is an article I wrote for the Financial Times
There is nothing new about winter pressures in the NHS. What has changed is that those pressures have become relentless, extending year round into traditionally quieter months but deepening in intensity over the winter. The current crisis is not simply caused by the number of people turning up to A&E but because those who do are far more unwell and many more need admission. With hospital bed occupancy already running at unsustainably high levels and a growing shortfall in community beds and workforce, the health and care system can rapidly become overwhelmed. An upswing in norovirus and flu over the past fortnight seems to have been the final straw. NHS England had little choice but to implement its emergency plan to ease the acute pressure by cancelling routine surgery until the end of January. Unless we address the underlying issues across both health and social care this will however become the norm for every winter. Beyond that the unsustainable pressures will result in a collapse in routine waiting time standards.
Increasing life expectancy is one of the greatest successes of our age, but as we live longer and with more complex conditions, health funding has lagged behind. There has been an abject failure on the part of successive governments to plan for the sheer scale of the long term demand and costs associated with demographic change and for the change required to integrate of health and social care,
The House of Lords Select Committee set up to examine the long term sustainability of the NHS rapidly concluded that it could not do so without including social care. The government needs to take note before repeating the mistakes of the past. A green paper that looks solely at long term funding for social care will miss the point that these two systems cannot be considered in isolation from each other. Neither should anyone underestimate the challenge of delivering policy change in a hung Parliament or under a government whose energy is so consumed by Brexit.
There is a way forward but it will take political courage from both front benches and genuine willingness to put the public interest first. Before Christmas, 90 backbenchers from across both sides of the House of Commons, wrote to the Prime Minister urging a cross Party whole-system approach to the challenges and funding of the NHS, social care and public health. Select Committees could also play a role to help to build on existing work and set out the options for the public. Theresa May's former Chief of Staff has advocated a Royal Commission but we do not have the luxury of time to kick this important issue into such long grass.
Many of the options have already been described, for example by the Barker Commission and recent House of Lords inquiry. The reality is that we will all need to be prepared to contribute more if we want the NHS to remain a universal service, free at the point of delivery and meeting our needs both now as well as in the future. This cannot in my view fall entirely on working age employed adults but also needs to consider inter-generational fairness, wealth and contributions from those who are self employed. As graduates struggle with student loans it would be unfair to expect them also to shoulder the increasing costs of health and care for those in retirement irrespective of their wealth. We could look at ideas for a hypothecated health and care tax for example paid by those over forty and with income from any source above a set threshold. Some advocate introducing charging and top ups but these bring higher transaction costs and widen health inequality. The point is that all these options should be clearly set out alongside the consequences of a failure to invest more in the NHS, care, public health and prevention.
Since 2010, total health spending has risen by an average of just over 1% per year. This is far lower than the long term average increase of around 4% and comes at a time of extraordinary rise in demand and the costs of drugs and technologies. Real terms cuts to social care have added to the strains.
It is time to stop viewing health as a bottomless pit but rather as one of our greatest successes and make increasing investment a source of national pride. I cannot think of a better way for Theresa May to celebrate the 70th anniversary of the NHS than by helping to make sure that it has a sustainable long term future.
Below is an article that I wrote for the Sunday Express
There is nothing new about winter pressures in the NHS. What has changed is that those pressures are now year round but in winter the crisis is far deeper.
NHS England has put in place a plan to deal with this by cancelling routine surgery, but this will not feel 'routine' for those in pain awaiting a hip replacement for example. I understand the need to focus here and now on emergencies but we should not have to accept that cancelling this kind of life-changing surgery becomes the accepted annual response to winter.
The causes of these pressures are well known. It is of course great news we are living longer but as we do so we are living with far more complex long term conditions and the cost of treatment and technologies continues to rise faster than increases to the NHS budget. NHS staff have done an heroic job but they and the whole health and care system are stretched to the limit as they cope with far more people who are seriously unwell.
We cannot continue to provide the service we all expect on current finances, staffing and infrastructure. It is time for an urgent review to find the funding that both the NHS and social care need in order to make it happen.
We also need to end the culture of short termism and look not just at the here and now, but plan properly for the future and look at health, social care and public health together.
The public are being let down by a political failure over past decades to plan ahead, to be honest about the scale of the challenge and to work across Party lines to find a fair solution.
Before Christmas 90 back bench MPs from across political parties tried to change this, we wrote to the Prime Minister calling for this approach. Likewise in my role chairing the committee that calls the PM to give evidence, I told Theresa May that Select Committees (which work across Party political lines), stood ready to help. The fact is that no Party has a monopoly on good ideas on how this funding could be achieved and in a hung Parliament it needs cross Party working to get change such as this across the line.
No one wants to have to fork out but the truth is that we need to be prepared to pay more to support health and care services or services will decline. There are serious questions about whether it is fair for this to fall entirely on those of working age through taxes. My personal view is that it is not and that we should look at how it could be shared fairly across generations.
I know many people argue it is time to introduce charges to the NHS but this risks widening inequalities and also introduces costs and bureaucracy associated with collecting these relatively small payments. I know, as a former GP, that many of my sickest patients struggling on low incomes would have delayed coming to see me had there been a charge. This can end up not only with worse consequences for health but costing the NHS more in the long run. I also feel strongly that charging for appointments would go against one of the great founding principles of our NHS, that it is free at the point of need. It's what makes our system the fairest in the world and we should beware undermining that.
I believe the best way forward is stick with our tax and National Insurance based system as the core funding but look again at how National Insurance is collected and from whom so it can became dedicated to funding the NHS and social care.
It is time for an NHS and care convention to explore all the funding options and explain these clearly to the public and to look again at the options for sharing the costs of social care so that we no longer have the awful care costs lottery of one in ten people over 65 facing catastrophic costs.
A convention should not ignore the ongoing need to reduce waste in our NHS and I hear many examples of this in my work as chair of the Health Select Committee. Making sure that all areas learn from the best performing Trusts for example. Progress is being made in many areas already, for example driving down the huge variation in the amount the NHS pays for identical products. We also have to go further on prevention. Anyone who has spent time in an emergency department on a Friday or Saturday night will know how much drunkenness adds to the workload and avoidably ramps up waiting times.
It's easy to focus on the negative stories but the fact remains that our NHS and is doing a remarkable job and in its 70th year we should should celebrate it's successes and grasp the opportunity to make sure that it can not just survive but thrive. Rather than seeing health and care spending as a 'bottomless pit' we should view funding these properly as a source of national pride. These discussions have now become a national emergency and its time to ditch the Party politicical bickering and make it happen for the whole system our NHS, social care and public health.
This week I voted for an amendment to the European Union Withdrawal Bill because it was necessary to guarantee that there can be Parliamentary scrutiny and sovereignty as we return control of our laws from Brussels. There have been strong opinions on both sides of the argument about this, and even suggestions that by backing this amendment I have somehow blocked Brexit, or increased the likelihood of another election. This is not true. I respect the referendum result and voted to trigger Article 50. We are leaving the European Union but need to do so in a way that leads to as few unintended consequences as possible.
In returning powers from Brussels we must not exchange one system with poor democratic oversight for another. As we take back control of our laws, Parliament has an important role to play in scrutinising the government's work. Both in my role as Chair of the Health Committee and as a Constituency MP it is my duty to be look closely at both the pitfalls and opportunities of the various options for the type of Brexit ahead.
Clause 9, which I and colleagues voted to amend, had such far reaching consequences that I have copied it verbatim below:
A Minister of the Crown may by regulations make such provision as the Minister considers appropriate for the purposes of implementing the withdrawal agreement if the Minister considers that such provision should be in force on or before exit day.
If left unamended, this clause would have been incompatible with the Prime Minister's pledge to give Parliament a 'meaningful vote' on the deal. In effect, it allowed Ministers to make changes to laws with no democratic check by Parliament. Its breadth even concerned Brexiteers like Jacob Rees-Mogg, who said during the debate, "clause 9 gives some powers that trouble even Eurosceptics. I have never felt comfortable with the self-amending part of the Bill."
I and my colleagues had made our concerns clear to government for many weeks ahead of the vote and we feel that this vote was entirely avoidable. The clause should have been removed and the government could easily have done so. This would have avoided the need for an amendment.
Far from obstructing Brexit, this vote strengthened its democratic underpinnings, preventing major constitutional change from potentially being pushed through purely by ministerial decree.
I have been dismayed with how irresponsibly my vote has been misrepresented in some parts of the press. I welcome robust debate and I am always willing to listen and to defend what I believe. Labelling MPs 'traitors' for defending a fundamental democratic principle or judges 'enemies of the people' for upholding the law, just fuels a hateful division. It also entirely misrepresents why I voted as I did and why I felt it was necessary.
As we build an independent Britain – we will need to work constructively with our European neighbours. The more I hear, during Select committee hearings, about the consequences that would arise from a disruptive and chaotic Brexit, the more I feel that we must try to achieve a soft landing. The consequences of no deal and no transition would be very serious indeed.
Following concerns about long waits for ambulances and the withdrawal of local Rapid Response Vehicles, I invited South Western Ambulance Service NHS Foundation Trust, SWASFT, to an open meeting at Kingsbridge Community College. Chief Executive, Ken Wenman and the team leading operations in South Devon came to set out why services are changing and to answer questions. Many volunteer Community First Responders also joined the audience to share their experiences.
The Ambulance Service has undergone huge changes from one which primarily transported people to hospital to one staffed by highly trained paramedics with specialist equipment also capable of delivering treatment at home, backed up by a network of community first responders and co-responders from other emergency services.
The key challenge has been the rise in demand for their services. Over the past five years the number of calls has risen by 19.2% in the Totnes area, 29% in Plymouth and 23.7% in Torbay. One effect of this has been that once ambulances based in the rural South Hams have taken a patient to hospital in Torbay or Plymouth, they often get diverted to other calls in those urban areas rather than returning to base. The way that targets have been set in the past can mask poorer services in rural areas. Until now, those response targets only covered the most urgent calls with a requirement that a vehicle arrived on scene within 8 minutes in 75% of cases. Overall SWASFT met that target for the South Devon and Torbay CCG area at 75.65% of calls over the past year. But the figures I obtained for the Totnes constituency, which is more rural, tell a different story, with ambulances reaching just 61.1% of those calls in 8 minutes over the past three months. Targets need to be set in a way that doesn't lead to unintended consequences such as focusing on urban areas where they are easier to reach or allowing the arrival of an inappropriate ambulance vehicle to 'stop the clock' when measuring response times.
Now that many more treatments are available in specialist centres to help people who have suffered conditions like acute stroke and heart attack, it is more important than ever that the right vehicle attends a call. Ambulance cars, known as Rapid Response Vehicles, cannot take people to specialist centres but can distort the figures for waiting times. These vehicles are being removed but the meeting was told by SWASFT that overall ambulance hours cover would increase for the South Hams through a double crewed ambulance based at Totnes and use of a 'dynamic coverage tool', otherwise known as getting vehicles back out from urban centres to be closer to respond to emergencies across rural areas like the South Hams. Changes to targets will mean that all calls will count, and using mean average response times as well as the time taken to reach 9 in 10 calls will help to keep a focus on reducing long waits especially in rural areas. I will be following this carefully to make sure that the changes do lead to improvements in the service. These are being put it in place following the national Ambulance Response Programme trial and the following links give further background to this and to the changes:
At the meeting, volunteer community first responders spoke of their concern about not being able to deliver pain relief whilst waiting for an ambulance to arrive. Ken Wenman confirmed the good news that they will now be able to receive training in the use of pain relieving gas and air.
The service has been under increasing pressure due to rising demand and this has meant that it has been coping with 2.46% less funding per call over a three year period. SWASFT's operations director Neil Chevalier, told the meeting that they had received a £3.6m uplift in funding to implement the changes from the Ambulance Response Programme trial and, in response to questions about pay, said that paramedic staff had been put onto band 6 of the NHS pay scale up from band 5.
SWASFT representatives heard direct from volunteer community first responders and local residents about the pressure on services including examples of long waits and these were all examples of why the service needs to provide a better response to rural areas. I will be following this closely.
The message that came over loud and clear was the value that we all place on our ambulance service. Thank you to all our paramedics, support staff and volunteers.
Public sector pay increases, including for NHS staff, have been capped at 1% since 2013–14 and for two years prior to that subject to a pay freeze affecting the majority. NHS employees' pay fell by 10 per cent in real terms between 2009/10 and 2014/15 and continues to fall.
It is time in my view for pay restraint to be loosened but that cannot be done without a clear plan for how it will be funded.
In 2015–16, the Department of Health spent £48.7 billion on NHS provider staffing costs. The IFS estimates that each 1% increase in staff pay would add approximately £0.5 billion to the pay bill, just for the NHS. This means either additional funding for the service or painful reductions in other areas of the NHS or DH budget.
I agree with the pay review body that there are also costs in ignoring the need to increase pay. As the gap between NHS pay and jobs outside the public sector widens, this is hitting the recruitment and retention of key staff, especially when there is fierce international competition for skilled healthcare professionals. The fall in real incomes is also affecting morale, especially where staff are having to work under greater pressure to compensate for unfilled posts. Vacancies and staff shortages can also affect patient safety as well as lead to higher agency costs. Pay restraint is becoming a false economy.
For all these reasons I believe it is time for a rethink but it will require a clear plan from the Treasury as to how it will be paid for. Ending the pay cap won't happen through a simple amendment to the Queen's speech.
It is essential for all Political Parties to face up to the scale of the funding challenge across the NHS and social care and to work together to find a way forward. The reality is that the wider challenge in funding these vital services, in the face of an extraordinary increase in demand and costs, will be there for which ever Party is in Government after the next election. It is in everyone's interests for MPs to work constructively together across Party lines in the national interest. We have a responsibility to level with the public and with each other because the reality is that we are all going to have to pay more to put the NHS, social care and our other valued public services on a sustainable long term footing.
Much of the ground work has already been carried out and we should look again at the full range of proposals from the Barker Commission and the House of Lords inquiry into the sustainable long term funding of the NHS and social care.
This is the original article I wrote that appeared in the Times today.
One of the the most striking figures set out by the Chief Executive of NHS England, Simon Stevens, in his recent update to the NHS Forward View was that life expectancy is increasing by five hours a day. This extraordinary success has also driven an unprecedented rise in demand for health and social care to levels which can no longer be met from current spending. The Care Quality Commission is not alone in describing social care as being at a tipping point. In her manifesto, Theresa May has acknowledged that the elastic can stretch no further and promised to increase funding for social care as well as per capita spending on the NHS. The manifesto also includes a much needed boost for capital projects described as 'the most ambitious programme of investment in buildings and technology that the NHS has ever seen'. Funding promises have to be realistic and fair. The Prime Minister is right not to duck the issue of intergenerational fairness in meeting the challenge of funding social care and it would not be fair for the increasing costs of both the NHS and social care to fall entirely on the working age population. The options were never going to be easy but failure to increase spending risked the collapse of social care provision and a downward spiral of NHS performance. Hard choices on the means testing of winter fuel payments and downgrading a triple lock to a double lock on pensions after 2020 are fair if the money raised rescues social care from the brink for those who will need it the most.
It still takes many people by surprise that if they have assets over £23,250, they are liable to meet the full costs of their residential care and raising that threshold to £100,000 will be welcomed but the long awaited cap on the total that families will have to spend meeting the cost of care has been dropped. The greatest change however, is that many more people will be liable for care costs because the value of their family home will no longer be exempt if they need care in their own home. Any policy must avoid unintended consequences and ministers will need to clarify what period of grace will be applied for those who may only need short periods of care. Currently this so-called 'disregard' is set at 12 weeks for those needing residential care and it is essential that this also applies to home care. If not, it will exacerbate rather than reduce delays to hospital discharges.
The dropping of the care cap sadly leaves social care uninsurable, leaving in place the miserable lottery of care costs. A future government should at least look again at supporting state backed insurance for those who have not yet reached retirement age, so that they can begin to protect against this.
This is an article that I wrote for the Times.
As the Chancellor finalises his 2017 Budget he can no longer afford to ignore the stark warnings about the impact on individuals and the NHS from the crisis in adult social care. Last year the Care Quality Commission described the fragility of the system as approaching a 'tipping point'. The situation looks set to worsen without an immediate lifeline and one that goes beyond the uneven and inadequate sticking plaster of a 3% increase in council tax precepts. To put this in context, last year's uplift in the precept raised £382m but this was entirely swallowed by the £612m increase in costs from the National Living Wage. Precepts also entrench inequality as those areas least able to raise money also have a greater proportion of residents who are fully dependent on their local authority to fund their social care. The 2017 Budget needs to bring forward the so-called Better Care Fund already planned for later in the spending review and it needs to be 'new' money, not a smoke and mirrors device to transfer funding from an already overstretched NHS.
Over the last review period 09/10 to 14/15, local authority spending on adult social care fell by 10% at a time of profound and ongoing demographic change. Despite rising demand for services, more than a million people are estimated to be going without the care they need. It is a false economy because they are increasingly ending up in A&E or stuck in hospital when they could and should have been discharged. The knock on effect on NHS services has been the marked rise in waiting times, 'trolley waits', and cancelled appointments and admissions. What is surprising and unacceptable is that no government has assessed the full impact and cost of the shortfall in social care on the NHS.
The number of people with care needs is expected to rise by more than 60% over the next 20 years whilst the proportion of individuals of working age will continue to shrink in relation to those living in retirement.
It's time to stop presenting longevity as if it were a negative. It is amongst the greatest achievements of our age and government needs to highlight and support the extraordinary value that older people add to our communities. It also needs to set out how we will fund social care for the rising numbers of people who will need help to live with dignity in older age. There has been an abject failure of successive governments to plan for the future. Councils also need certainty about the Care Act provisions, delayed to 2020, which bring in a cap on care costs and change the financial threshold for entitlement.
The Prime Minister has already confirmed that she is looking at social care but it is worrying that her review currently excludes the NHS. The two systems are inextricably linked.
In his 2017 Budget, the Chancellor must show that he has grasped the seriousness of the situation and announce an immediate cash injection for social care. He should also set out plans to tackle the greatest domestic challenge of all; how to bring forward a fair and sustainable long term settlement for both the NHS and social care.
This is an article that I wrote for The Guardian
Donald Trump made no secret of his deeply divisive instincts during his long campaign for the White House. Vile racial and religious stereotyping, misogyny, his support for torture, even parodying those with disabilities. All his prejudices were worn as a badge of honour, displayed from campaign platforms and television studios for months on end.
Locker room talk, we were told, of his boasts of 'grabbing women by the pussy' as voters were assured that the office of Presidency would surround him with wise counsel and bring out the statesman in him. Less than a month since his inauguration, the stark reality must be dawning on Americans, that their choice of President isn't 'draining the swamp' but dragging them into one of his own making. We don't have to join them.
It would be a mistake to dismiss Donald Trump as some oafish 'man baby' impulsively blurting whatever comes into his mind. His actions seem calculated to offend, bully and control.
Some touted the hand holding with Theresa May as the seal of a special relationship and a gentlemanly gesture. To me it smacked of the unwelcome infantilising of a strong female leader, more than capable of negotiating the White House steps on her own.
In the rush to forge a trade deal Mrs May should remember that Trump's executive orders since assuming office don't just affect millions of Americans but our own citizens. Nadhim Zahawi MP, is just one of many thousands of our fellow Britons who are now barred from the USA for no reason other than the nation of their birth. All those countries on his banned list are predominantly Muslim countries apart from, as Andrew Neil points out, 'those where Trump Org has business interests'.
A shameful curtain of prejudice and discrimination is drawing across the Land of the Free and, if we are truly in a special relationship, true friends should be frank in saying so. By his actions as well as his words Trump is also turning back the clock on women's rights across the world. His executive order bringing in the so called 'global gag' will restrict access to safe contraception and healthcare as well as to safe termination of pregnancy for the world's most disadvantaged women.
The State Visit looks set to go ahead but symbols matter. Westminster Hall has long been reserved for those Statesmen and Stateswomen who have made a lasting and positive difference in the world. That does not include Mr Trump. No doubt there will be those who wish to fawn over him, but that must not be from the steps of our nation's greatest hall.
A few days into his Presidency, Donald Trump has signed an executive order dubbed the "global gag rule". It will have the effect of cutting off funding for overseas NGOs whose work is associated in any way with abortion services. This means that many international health workers and organisations, even those who receive part of their funding from other private sources for work or advice linked to abortion services, will have to decide whether or not to continue. These services risk losing crucial funding – meaning cuts to choice based contraception and other health services for the most disadvantaged women worldwide. Because the US is the largest health donor this will have an impact on unwanted pregnancies and could have a knock on effect on other areas of women's health care like screening programmes, prenatal check-ups and support for HIV sufferers.
President Trump's policy is also counterproductive – fewer abortion services does not necessarily mean fewer abortions but more unsafe 'backstreet' abortions and maternal deaths. It turns back the clock on women's rights to exercise control over their own bodies.
While organisations are being coerced by the new rules into reconsidering their future programmes, it is a relief to hear that the Netherlands have already announced plans to try to compensate for the new administration's draconian policy, by considering an international fund to help provide these services.
Britain should join with the Netherlands to help protect women's right to access safe contraception and termination of pregnancy alongside the other health services that will be hit by the global gag.
Following their recent consultation, the South Devon and Torbay Clinical Commissioning Group has now published its recommendations . These will be put to their governing board when it meets in public on 26.1.17.
The most controversial aspect is that the CCG continues to recommend that several local community hospitals will close as part of their plan to introduce a new model of care. In my constituency that would mean the closure of Dartmouth hospital. Many Paignton residents will also be affected by the closure of their community hospital in the neighbouring Torbay Constituency.
Reading the document I am deeply concerned at the statements on page 24 which imply a lack of support for Dartmouth hospital from local residents and their representatives. This is simply not the case. There is huge support for our local community hospital and gratitude for the dedicated work of the staff. There was however pragmatism that the consultation was likely to result in the closure of the hospital, if nothing else by further undermining the ability of the trust to recruit staff, and therefore a determination to work to make sure that we have a commitment to an effective alternative.
Dartmouth would benefit from modern primary care facilities on the same site as Dartmouth Caring, community clinics and an enhanced primary care minor injuries service. The new service must also include commissioned beds in River View for local people who need extra care and re-ablement as a step between hospital and home, or to support them close to home at the end of life. A new combined facility could also allow us to provide better training and development for our local workforce. We know that there is a serious shortage of staff across community teams which is increasing the risk of unnecessary hospital admissions. But the support for this approach will depend on a clear commitment to put this in place and have the new facilities up and running before any closure goes ahead of our much loved community hospital. Clumsy language implying a lack of support for Dartmouth hospital should be withdrawn.
On the issue of Paignton hospital, I will be supporting Kevin Foster MP and again point out the need to have high quality alternative facilities in place before any closure goes ahead. It is also vital that the community are reassured about the quality of provision of social care following the damning CQC report on Mears.
I remain deeply concerned about the financial pressures across health and social care and will continue to press at national level in my role as chair of the Health Select Committee for an urgent review of and increase in the short and long term settlements. The pressures are not just financial but also as a result of a very serious workforce shortfall across health and social care and I would like to see greater emphasis on maximising training opportunities in the final CCG document.
I also remain deeply disappointed that there will not be a minor injuries unit with X-ray support at Brixham hospital. Concentrating services and facilities at Torbay hospital not only risks driving more people to A&E and increasing the risk of avoidable admission but also far longer travel times for Brixham residents.
I will be attending the public meeting this week to put these points to the board.
On a separate note, I have also been speaking in Parliament and directly to NHS leaders about the recent threats to Torbay's nationally and internationally respected model of integrated care. Whilst I have every confidence that Torbay council and the local NHS will continue to work closely together within the Integrated Care Organisation, ICO, it makes no sense to see their work undermined by outside threats to stop them pooling their resources to work in the best interests of patients.
I wrote the following article for the British Medical Journal (published on 3rd January 2017)
The current pressures in the NHS can be traced back to 2009 and what became known as the Nicholson challenge. In the aftermath of the economic crash this ushered in an unprecedented period of efficiency savings against a headwind of rapidly rising demand and costs. The incoming coalition government then imposed a disruptive and demoralising reorganisation that distracted from the key challenges. Rather than seizing the opportunity to integrate health and social care and to design a sustainable long term financial settlement, the Health and Social Care Act 2012 led to greater fragmentation at a time when our demographic changes demanded a different approach.
In the decade to 2015, the number of people living to age 85 and beyond increased by 31%.1That is a cause for celebration, but there has been a striking failure to plan for what this means for health and social care. The same is true for the rapidly rising cost of preventable conditions and expensive new drugs and technologies.
Over the last parliament, funding for the NHS increased annually by an average of just 1.1%, far below the actual increase in costs or the long term average of around 3.8% since 1978-79.2 The real terms increase in Department of Health spending for the current review period is just £4.5bn3 (€5.3bn; $5.5bn) and will result in reduced spending per person.2 The accompanying cuts to social care combined with a serious workforce shortfall have left more than a million older people going without the personal care that they need to live with dignity in their own homes.4 It is no surprise that so many are ending up in more expensive settings in an already overstretched NHS.
The political response to a health and care system in severe distress, and more importantly to the people it serves, has been dismal. No one listening to the yah boo of debate in the Commons would be filled with optimism. There has been a failure to grasp the scale of the financial challenge facing both health and social care and the consequences and inefficiency of their continuing separation. A serious shortfall in capital, as a result of ongoing raids to plug deficits, is undermining the prospects for the transformational changes necessary to produce future savings.
Likewise, area based joint commissioning is at risk if the financial squeeze is so unrealistic that health and social care retreat to protect their own budgets. Sustainability and transformation plans hold the possibility of moving away from a competition based approach to one based on integrated commissioning but they must be realistic and supported by the funds to deliver.
There have also been missed opportunities in public health. In her first speech on the steps of Downing Street, the Prime Minister, Theresa May, spoke compellingly of tackling the burning injustice of health inequality. That ambition now needs to be matched by effective cross government policies across the wider determinants of health. It will also require investment in public health in order to achieve the radical upgrade in prevention which underpinned the Five Year Forward View.5
At her recent appearance before the Liaison Committee of all select committee chairs, Theresa May confirmed that the government is working on a new settlement for social care but also that this doesn't currently include the NHS or involve other political parties. She should urgently revise her terms of reference to include them both.
The public has repeatedly made clear the value it places on our NHS and that it wants to see it properly funded. The financial challenge of providing sufficient funding for health and social care to cope with inexorably rising demand will be the same for whichever party is in power over the coming decades. It is in all our interests for them to work together to agree a way forward compatible with the founding principles of the NHS. Political instincts, however, have tended to focus on division and to duck the problem through arguments about data.
The most remembered statistic of the EU referendum campaign was the £350m a week for the NHS—a cynically deployed and rapidly disavowed non-fact for which no one can be held to account. Misleading data have consequences. If the chancellor believes that the NHS is receiving an extra £10bn, it is easier to see why he and the prime minister might resist the calls for more, especially having overseen far reaching cuts to the Ministry of Defence and the Home Office in their former roles.
The public has a right to expect accurate and consistent figures on total health spending, and it matters that we correctly insist on the true figure of £4.5bn. It also matters to keep setting out the facts on rising demand as well as the efficiency, fairness, and value of our NHS.
I often meet health professionals who think that politicians have no grasp of the scale of the problems they are facing. Never underestimate the impact you can make during a personal visit to MPs' surgeries or through an invitation to your workplace. We need as many MPs as possible to understand the urgency that they work together to find a sustainable long term settlement and the consequences for their constituents of political failure.
Celebrating the success of nature friendly Devon farmers:
This Friday (18th November) I will be celebrating the great progress in saving a bird that was nearly lost and the great contribution of Devon's farmers in making this possible.
The bird is the lovely cirl bunting, for which I am delighted to be a 'species champion MP'
Often called 'Devon's Special Bird' because, while it was once much more common across southern Britain, by the 1980's its numbers had declined and range pulled back into a small zone in south Devon. At this stage then, this bird of mixed farmland was in real decline and it began to look as if we might lose it altogether in this country. Devon had a special role to play. With these signals something stirred, the nature organisations, especially the RSPB, got stuck in. What was the problem? What has happening on the farms? Could farmers help save the bird? From what I have heard about the work, something wonderful began to happen.
Collaboration around the RSPBs research, the trialling and testing of farm based solutions, all swung into place. Saving this bird of farmland was absolutely dependant on farmers rising to the cause, and they did. The RSPBs 'recovery project' supported farmers, helping them turn the key that opened recovery success.
Local communities woke up to their special bird too, schools projects, a football team with the bird as its badge, and even a Devon village – Stokeinteignhead - celebrating the countryside around it as being special for this bird, all signalled peoples support for our special bird.
So, I will be enjoying celebrating some great news from Devon this Friday. And alongside this I'll take a serious message with me – that with the right approaches, and done well, we can do so much more for nature. The story of the cirl bunting - the bird we nearly lost - the farmers who have helped so much, the nature bodies like the RSPB, and all with the right kind of support from government and others, shines a light on how we can all do better.
This could not be more important right now as we look beyond Brexit and how subsidies might operate. I'm clear that these must continue to support the vital habitats for the cirl bunting and so many of our other native species.
(Photo courtesy of Matt Adam Williams)
I wrote the following article for The Guardian
In her first speech as Prime Minister, Theresa May promised to tackle the nine-year gap in life expectancy between rich and poor, placing this at the top of her list of burning injustices. This yawning inequality has defeated successive governments, and the gap is even wider between rich and poor for years lived in good health. Closing it will require action across areas such as poverty, housing and education, as well as those more conventionally thought of as affecting health. May will need to start early and look far beyond the short-term political cycle for results.
Public health seldom makes headlines. We tend not to recognise, let alone thank it for preventing disease or life-changing accidents, despite public health measures transforming our life expectancy. We are more likely to focus on and appreciate the specialists who treat a condition than to complain about the absence of the expertise or policy that could have helped to prevent it.
The childhood obesity strategy was the first test of the government's determination to take action on health inequality. It was greeted with near-universal dismay because of the wasted opportunities to make a difference. Whole sections from earlier drafts, covering promotions and advertising, were conspicuously erased and reformulation yet again left to ineffective voluntary agreements. The final paragraph sums up the tone that it will be "respecting consumer choice, economic realities and, ultimately, our need to eat". This crass statement entirely misses the point; of course children need to eat, but the childhood obesity strategy needed to make sure that they benefitted from a better diet.
Five years ago, amid the huge controversy surrounding the Health and Social Care Act, one proposal received a cautious welcome: the transfer of responsibility for public health from the NHS to local authorities. It was felt that local authorities could make a greater difference to the health and wellbeing of their communities if the right expertise, powers and funding were based there rather than within a health service more focused on treatment than prevention of disease. In a report published today, the Commons health select committee has looked at those changes and made a number of recommendations about how public health could be strengthened to make sure that it has the tools to do the job. These will be key to helping to narrow health inequalities.
The chief executive of the NHS, Simon Stevens, has rightly called for a "radical upgrade" in public health and prevention, not only for the benefits to health but because it will be essential to reducing future demand for health services. The future financial sustainability of the NHS depends on the prevention of more expensive long-term conditions. This was not the time to undercut the role of public health with budget reductions, including in-year cuts. Witnesses before the committee described their extreme frustration at these decisions, which they described as "irrational" given the current focus on reducing demand.
While local authority public health teams are doing their best to cope with funding cuts, the potential impact of this was clear, and unsurprising – figures from a survey conducted by the Association of Directors of Public Health show that large proportions of local authories are already having to reduce a wide range of different public health services.
Perhaps more surprising was that we heard from witnesses – both from local authorities and from NHS organisations – a sense that prevention is no longer seen as the responsibility of people practising in the NHS. While local authorities now hold the ring for funding and co-ordinating public health and preventative work across their local area, every NHS professional has the potential to advance the prevention agenda in every patient appointment they carry out – but they will also need the time and space to do so. It is also a shame that those messages on improving health will continue to be drowned out by the unfettered advertising and promotion of junk food and alcohol.
While the local mechanisms are in place to embed health in all policy decisions, this will not succeed without stronger, more joined-up action at a national level. At a time of budget cuts it is more important than ever that local authorities have the levers to make a difference. Unfortunately, they have their hands tied when it comes to negotiating with business interests even where the health of local communities is at stake. The government could and should introduce health as a material consideration in planning and licensing to allow proportionate action to develop healthier communities, homes and workplaces.
I hope that the government will prioritise health inequality, but the early signs are not encouraging. If future policy is to be judged by the childhood obesity "plan", we can expect little real progress. Tackling health inequality requires far more than warm words on education and personal responsibility.
The childhood obesity strategy has been downgraded. The final paragraph sums up the tone that it will be 'respecting consumer choice, economic realities and, ultimately, our need to eat'. This crass statement entirely misses the point; of course children need to eat, but the childhood obesity strategy needed to make sure that they benefitted from a better diet.
Trying to capitalise on the feel good factor of the Olympics, the messaging has distorted the underlying evidence. Of course we need children to be more active but exercise matters whatever a child's age or weight. The key message on childhood obesity should have been front and centre about the importance of reducing junk calories with evidence-based action to match.
In completely removing whole sections from the draft strategy, it is hugely disappointing that the obesity plan puts the interests of the advertising industry ahead of the interests of children. The plan misses the opportunity to improve children's diets by reining in the saturation marketing and promotion of junk food. A staggering 40% of the food and drink we buy to consume at home is bought through promotional deals and the overwhelming majority of those deals are on junk food or alcohol. This was a missed opportunity to shift the balance of those promotions to healthier alternatives and to make them more affordable for those struggling on lower incomes. The plan has also completely failed to take junk away from the checkouts or restrict the hugely profitable end of aisle displays or deals flogging impulse purchases at point of sale. Responsible retailers wanted a level playing field in making those changes but their efforts will be undermined by the abject failure of the obesity 'plan' to recognise the impact of promotions and marketing.
Whilst it is good to see confirmation of the sugary drinks levy, the watered down obesity strategy is completely at odds with the pledge to tackle the burning injustice of health inequality. Even its title has been downgraded to 'plan' but it would perhaps have been better named a plan for inaction as even the proposals to reformulate are voluntary. Without 'teeth' voluntary reformulation looks set to be as ineffective as the miserable 'responsibility deal' which precedes it. Progress will be monitored against worthy but voluntary targets until 2020 but with no consequences for those manufacturers and retailers which put profits ahead of children's health.
Whilst all those in contact with children suffering from obesity are rightly urged to make every contact count in trying to help, they will be hopelessly undermined in their efforts. Big industry interests have been given free rein to continue to promote and advertise as they please including those that do so through online marketing masquerading as games or through the powerful use of cartoon characters on junk food aimed at children.
The confirmation of the increase in funding for school sport from a levy on sugary drinks manufacturers is very welcome but the levy will not come into force until 2018 and needs to be broadened to include all drinks with high added sugar content. The plan should also have given greater powers to local authorities to make changes to improve public health at local level. Especially at a time when their public health budgets are being cut, it was more important than ever to give them the levers to do the job by making health an objective in the planning system.
The gap between rich and poor children when it comes to obesity has widened every year since measurements began. One in four of the most disadvantaged children now leaves primary school not just overweight but obese, more than twice the rate for those from the most advantaged families. This plan for inaction will be remembered for its wasted opportunities, delays and spin when it could and should have been the opportunity to show that government is serious about tackling the gap in life expectancy between rich and poor. We will all be picking up the tab in the future costs of obesity for the NHS, already more than the police, fire service and judicial system combined, but no one will be paying a heavier price than the individual children facing a lifetime blighted by the consequences.
The independent Chilcot Report was expected to report rapidly, but such was the volume and detail of the evidence examined and the sensitivity of its conclusions that in the end it took seven years. It runs to 12 volumes and 2.6m words and the final summary should be compulsory reading for all who will in future be tasked with the heaviest decision for any government, to commit our forces to war. 179 British servicemen and women lost their lives alongside 24 British civilians and over 150,000 Iraqis. The consequences for their loved ones of our failures in Iraq have been appalling and the terrorism and violence continue to this day across the region and worldwide.
Chilcot is damning in his conclusions including that:
• Military action was not a last resort as all peaceful options had not been exhausted
• Policy on the Iraq invasion was made on the basis of flawed intelligence assessments. This assessment was not challenged as it should have been, preferably by an independent body
• The continuing threat from weapons of mass destruction was presented with unjust certainty
• The circumstances in which the legal basis for military action were established were "far from satisfactory" and the authority of the United Nations Security Council was undermined.
• There was too "little time" to properly prepare. The risks were neither "properly identified nor fully exposed" to ministers, leaving our troops dangerously exposed as a result of inadequate equipment.
• Plans for post-Saddam Iraq were wholly inadequate
• The consequences of the invasion were underestimated and this left a space for extremists to flourish.
I listened to Tony Blair's apology and his acceptance of responsibility but like many was aghast to hear that he would take the same course of action again.
Next week Parliament has dedicated two full days to debate this crucial report and how this should influence the future conduct of those who advise on or take the final decisions to take us to war. Whilst I do not feel that the lesson from the Chilcot Report is that we should never engage in military action, it should be a last resort and all future governments must make sure that the grave lessons are learnt from this catalogue of disasters.
Britain has spoken and now it is for Government and Parliament to respect the result of the referendum and carry forward the instruction to take us out of the European Union. It has been a long campaign which has divided families, communities and the nation. Almost three quarters of those under 24 voted to remain whilst their grandparents' generation voted decisively to leave. In Torbay the clear majority embraced Brexit whilst in the neighbouring South Hams most people did not. Scotland and Northern Ireland wanted in whilst England and Wales voted out. In the end, months of complex arguments seemed to boil down to a tug between immigration and sovereignty on the one hand versus the economy, stability and our links with Europe on the other. Now it is time to put the divisions behind us and move on.
My job as your MP will be to do everything I can to help to support the long task ahead. Taking us out of a 43 year relationship will not happen quickly. The tone of the debate with our 27 partners must remain positive if we are to grow Britain's place alongside them as European neighbours rather than descend into an acrimonious divorce. In setting that tone, the government must set out early to reassure those who are already living in the UK from other EU nations that they are welcome to stay. Without the 130,000 valued staff who qualified elsewhere in Europe, currently working in health and social care for example, our NHS would not be able to function. An atmosphere of mutual friendship and respect will be equally important for the hundreds of thousands of our fellow citizens living across the Channel. Britain has voted to leave the institution of the EU, not Europe and voted to be able to control our borders in the future, not to slam them shut.
David Cameron has made a dignified decision to step down to allow fresh leadership to negotiate the complicated path which lies ahead of us. My view is that this needs to be someone with experience, statesmanship and stamina who can be a unifying figure at home and command respect on the world stage. Britain needs us to move quickly and decisively on this so that the negotiations can begin. A long period of uncertainty will be damaging for an economy already under pressure as a result of such a seismic shift.
Our next leader will also need to be someone capable of handling complex negotiations at home as well as with our EU partners. So much of our own legislation is in some way connected with EU directives or regulations that it will be necessary to adopt the majority of them and then take a thoughtful measured approach to repealing or amending them in our best interests. Whilst the most urgent issues can be prioritised, given the timescale for legislation to pass through Parliament, this is likely to take many years and put many other important issues on hold.
Some have called for an early General Election, but under the Fixed-Term Parliaments Act 2011, no Prime Minister or their Government can dissolve Parliament without a 2/3 majority in the Commons. Others are calling for Parliament to block the result and there is a rapidly growing petition to re-run the referendum but I would strongly oppose such a move because Britain has already delivered its verdict. Those MPs who, like myself, came to a different view during the campaign must not seek to obstruct the decision of the people but actively to make it a reality in the most constructive way possible. My job as chair of Parliament's Health Select Committee will also be to hold Leave campaigners in the future Government to account for the promises they made to provide extra support for the NHS from the money which we currently send to the EU. The Government should also continue the essential support for farmers and poorer communities which flows back from our gross EU contributions as well as the scientific research which has long been a net beneficiary.
Challenging times lie ahead for all of us as a result of this momentous decision but our leaders must work together, not sow further division as a result.
My postal vote sits unopened in the kitchen. Far from tearing it open to do my bit for Brexit, I have been imagining how it would feel to wake up to that result on June 24th. It would not be elation or freedom but a profound sense that something had been lost and guilt too if my vote had contributed to the turmoil ahead.
It's far easier as a politician to stick immovably to a declared position but more honest to set out why I will now be voting for Britain to remain a member of the EU.
I came into politics to campaign on health so I've listened carefully to the evidence from both sides on this. The claims about health from the leave campaign have been shameful. They have knowingly placed a financial lie at the heart of their campaign, even emblazoning it on their battle bus alongside the NHS branding to imply a financial bonanza. It's an empty promise and one which would soon backfire. A strong economy has always been the cornerstone of funding for the NHS and for all the arguments about the scale of the economic turbulence, the clear consensus is that the effects would be significant and negative. Far from a leave dividend there would be an economic penalty and the NHS would suffer the consequences. The chilling effect would not just be financial, but on the workforce. If you meet a migrant in the NHS, they are more likely to be treating you than ahead of you in the queue and very many of our core health and social care workforce come from the EU. How does it feel for them? I know from my correspondence and from private conversations how intensely painful and alienating many of my EU constituents have found the tone of the debate.
The NHS is not just a passive beneficiary of a strong economy, health is a key driver for economic growth. Listening to the evidence, the EU has played a positive role in promoting good health whether that be in terms of water and air quality or the scientific research for which the UK is clearly a net beneficiary. We contribute 11% of the EU research budget and receive 16% of its allocated funding. The UK also plays a strong leadership role in the surveillance, shared intelligence and response to the health threats which are no respecters of national boundaries as evidenced by our ability to respond to the Ebola outbreak, saving countless lives.
Could services, research and public health be put at risk in the event of a vote to leave the EU? I believe the balance of evidence is that the isolation and instability of Brexit should come with a health warning.
I've also spent time over recent weeks observing the professionalism and care of the NHS from my father's bedside as he recovered from a heart attack and a triple bypass. We had the time for long conversations about the referendum and our place in Europe. Now 81, he started training whilst still a teenager, as a mine clearance diver with the Royal Navy. For him, the risk of war in Europe is not some abstract debate but a fearsome horror against which the EU, for all its imperfections, has brought us the protection of peace. He pressed this home all the way to the doors of the operating theatre. Whilst some would celebrate the instability that would be triggered across the EU by Britain's exit, even if that lead to its collapse, I do not. We all benefit from a stable Europe.
The leave campaign has redrawn its battle lines around immigration for the final weeks of the campaign. It looks increasingly indistinguishable from UKIP but the immigration card may prove an empty promise if the price of trade with the EU requires the free movement of people. It will also have left a bitter legacy of division.
This has been an unnecessarily acrimonious and divisive campaign. It has also highlighted the scale of our disconnect from the European institutions which control so many aspects of our daily lives. If the outcome is a vote to remain then we urgently need to reset that relationship and, before we slide back into indifference, start to connect with our MEPs and make our voices count in Europe.
With a month to go until the EU referendum, the public deserve better from this campaign. I came into politics urging for better use of data and, like so many who are grappling with the questions at the heart of the debate, I'm dismayed by the disingenuous and at times downright misleading claims from both official campaigns.
We have seen a spiral in recent days, with both sides making ever more outlandish claims. Most recently Vote Leave has blamed EU migration for NHS pressures, brazenly hijacked their branding and continued to make the absurd claim that Brexit could divert £350million extra per week to the NHS.
There are many reasons for the pressures on the NHS, but largely because we are living longer and with multiple and complex conditions. As many have commented; if you meet a migrant in the NHS they are more likely to be caring for you than ahead of you in the queue. The NHS Chief Executive, Simon Stevens, set out the stark dependence of the service, on overseas staff during his interview on the Marr Show and, whilst many health and care workers come from outside the EU, a vote to leave would have consequences if those from the EU were made to feel unwelcome. He also highlighted the dependence of the NHS on a strong economy and the knock on consequences for any uplift in funding of financial turbulence. In my view, it is an increase in the percentage of our national income that we spend on health and care that will save the NHS, not Brexit. After the rebate and funds already committed to support farmers, exporters, regional development projects and science, the leave campaign clearly does not have an extra £350m per week to promise the NHS and they should stop treating the public as fools.
There are legitimate concerns about pressures of population growth on housing, schools and certain areas of health provision but the current pre-occupation exploiting the NHS, and its protected branding, to support the leave campaign's argument on the EU is a cynical distortion which undermines the credibility of their other arguments. I will not hand out Vote Leave's deliberately misleading leaflets about the NHS.
The issues around this referendum are complex. People are sick of the deluge of misinformation and don't know who to trust. We cannot point to either official campaign as a trusted source. I'm suggesting people look at websites like Full Fact or the detailed research published by the House of Commons library.
I remain very torn about this referendum. I had never imagined that I would vote to leave the EU and welcomed the renegotiations as an opportunity for the institution to take account of the serious concerns not just from Britain but from across the continent. I wanted to stay in a reformed EU and yet the renegotiation only served to highlight that the EU appears neither interested nor capable of genuine reform. The democratic deficit at the heart of the institution and our own detachment from it are deeply troubling.
We tend to think of the EU as benign and remote but what if a federal and ever more centralising Europe moves against our national interest? We will be powerless to effect meaningful change just as we are already unable to vote its leaders from power. The situation in Austria should act as a wake up call to those who feel that the direction of the EU could not change. My fundamental concern is that in our own mature democracy we must retain the ability to remove from power those who make the decisions which govern our lives.
I am concerned about the increasingly ugly tone of the Leave campaign but I'm also sceptical about the wild claims of a descent into chaos, war and the collapse of security from the Remain camp. In the event of Brexit wise heads would surely prevail to ensure essential cross border cooperation.
Project fear however, appears to be working. I meet many people who are switching to Remain because they have been spooked by the relentless messaging on security and the economy. They will be holding their noses to vote for remain, not endorsing the status quo. There is still a powerful feeling that people want a relationship based on trade rather than tied to the rim of an ever more centralised and powerful federal Europe.
If the majority vote to stay - which I think is likely – we must fundamentally rethink how we engage with the EU and develop a meaningful relationship between people and the currently remote bodies which make up this institution.
The remain campaign is anxious, and as a result – they and the government are overhyping both the risks of leaving and the benefits of remaining rather than leading a nuanced and honest debate. The danger of that approach is that the result will be interpreted by the EU as a ringing endorsement of business as usual.
Our community hospitals are immensely valued and so any changes, especially those that could lead to bed closures are a serious concern. Community hospitals are about far more than their bricks and mortar, they are at the heart of delivering a service to local communities that allows people to be cared for closer to home, sometimes to be able to be cared for near loved ones at the end of their lives or to avoid having to be admitted to a larger hospital too far away for friends and family to be able to visit. Community hospitals provide personal, high quality and supportive care and are extraordinarily important to all the communities and individuals they serve.
To be clear, I do not want Paignton or Dartmouth hospitals to close. But our ageing population and the rising demand for services especially as a result of the growing number of people living with long term conditions mean that those planning services have to look at how we can care for as many people as possible close to home within the resources available. That means looking at the whole system of primary care, community nursing, social care, mental health services and voluntary services alongside community hospitals and Torbay hospital. We cannot look at them in isolation.
Across South Devon our primary care and community services are under great pressure with difficulty recruiting staff and in some cases working from totally inadequate premises. The closure of the minor injuries service at Dartmouth happened because they could not recruit or retain the highly skilled staff to maintain a safe level of service. Local health and social care is also under great financial pressure and our Clinical Commissioning Group is on course for a £15million shortfall in 2016/17.
Torbay and South Devon Foundation Trust and the CCG will be publishing their final plans on April 22nd but it is worth looking now at the links from the CCG website for Paignton and Brixham as well as Moor to Sea. These set out the challenges around age, deprivation and health inequality as well as the financial pressures facing our local area alongside the draft proposals.
If the plans just involve cuts to services and beds I will not support them. If a strong case can be presented for how money would be invested in genuinely improving services for patients then I think there must be a clear promise about how that will be guaranteed and greater detail on what it will look like.
The beds that are so valued by communities, close to home, can sometimes be provided as beds with extra support within a nursing home or residential care but there must be complete honesty about what the money saved, estimated at £3.9m would be invested in to make the overall service better at allowing people to be supported in their own homes without needing hospital admission in the first place.
Our community hospitals were gifted to local communities and supported over many years by generous donations and bequests. If any are sold, and it remains a big if, that resource must stay for the benefit of the local communities to which they were gifted and be used to build primary and community care facilities that are fit for the needs of today's patients. Those changes must have the support of communities and that will only come if the case can be clearly made for why the service could be better if provided in a different way. We know for example that NHS community bridge workers working alongside voluntary services can make a great difference in supporting people as they leave hospital and in reducing the risk of unnecessary admission. Community teams can include physiotherapists, occupational therapists and community mental health professionals as well as community nursing and social care but they need a base. Multidisciplinary teams can work even better if located alongside primary care so the consultation needs to set out a vision for the whole service and clear evidence for why that would be better than our highly valued local network of existing community hospitals. There is a strong case for community hospitals to do more, not less but that may mean using them in a different way focusing on prevention and care for people living with long term conditions.
There is not enough detail in the draft proposals on how the new arrangements would improve or work alongside GP services and far more detail is needed about where nursing home or residential 'intermediate care' beds would be provided if not at the local community hospital. The proposed closure of 28 beds at Paignton and 16 at Dartmouth would be a great loss and local people will need a clear explanation of how the money saved from closures would be invested both to improve services for local people and allow care to provided more efficiently rather than it just being sucked into plugging a financial gap.Whilst some admissions can be avoided with better community care, that is not always going to be the case. Torbay hospital is already under pressure and, without a clear plan for community beds, there is a danger that we could see people being admitted to even more costly hospital beds further from home as well as greater difficulty discharging patients at the end of their stay, one of the main causes of delays in casualty departments. It is very important that the beds from St Kildas are also taken into account.
The proposed closure of minor injuries units also means more people turning up in A&E from where they are more likely to be admitted unless there are really effective measures in place to avoid this. Anyone who has tried getting from Brixham to Torbay at peak times in the summer will know how difficult this can be and a Brixham hub should include access to a MIU in my view.
Amongst the many principles set out for the proposed reorganisation, there is a specific reference to improving life expectancy especially in the most deprived areas. There is a serious question therefore about the impact of closures on our most deprived communities in Townstal and Paignton and what services would be put in their place to reduce inequality and improve health and wellbeing.
I will be closely studying the final plans once these are published and attending as many of the community consultation meetings as possible. As Paignton hospital is in the Torbay Parliamentary constituency, Kevin Foster MP will be leading the discussions on the proposals there whilst I will be doing so for Brixham and Dartmouth hospitals. We will be working together as people from across the Bay use and value all our community hospitals.
I wrote the following article for the Guardian
I have great respect for junior doctors; it has always been a demanding role. Alongside my clinical practice, I spent over a decade teaching them before changing my initials from GP to MP. I should also declare a personal interest as my daughter is one of them, albeit currently working in Australia.
There is a long tradition of juniors spending a year or two abroad early in their careers before settling down to specialist training back in the UK, but now there is a genuine concern about the balance between leavers and returners. Many of my daughter's colleagues are not planning to join her on the journey home next year and there has been a marked increase in the numbers applying for certificates to work overseas.
The toxic dispute between the government and our core medical workforce risks driving an exodus of skills that we cannot afford to lose.
The contract sits like a festering boil with neither side ready to agree a way forward, and the dispute looks set to erupt into a dangerous full walkout by junior doctors. The British Medical Association (BMA) claims that the contract will harm patients by stretching doctors too thinly across seven days while reducing their take-home pay. The government insists that patients are being put at risk by understaffing at the weekends and that the contract reduces doctors' maximum hours and consecutive shifts while increasing basic pay by 13.5%.
The Department of Health and the BMA have spent so long shouting at cross purposes that they have forgotten their common purpose. In using them as pawns, both sides have lost sight of patients, the very people both claim to want to protect.
It was perfectly reasonable for the government to try to tackle the higher mortality at 30 days for those admitted to hospital at weekends, but entirely unreasonable to blunder on asserting that the new contract is the answer. Ministers are undermining their case and inflaming tensions by misquoting the evidence, which points more to the need to improve senior decision-making, nursing cover and rapid access to investigations at the weekends than to increase junior doctor cover. If the objective is to tackle excess weekend mortality at 30 days, the government should have followed the evidence and focused elsewhere.
It seems to me that the contract is more about the manifesto commitment to a seven-day NHS and the perceived barrier of premium Saturday pay rates. There needs to be a far clearer and more consistent definition of what the government means by a seven-day NHS and how it will be staffed and funded. Is it about convenient seven-day access to routine services and surgery, or about making sure that urgent and emergency care is available to the same standard every day of the week?
The Department of Health should have been more robust with No 10 that a routine seven-day NHS is unachievable within the current workforce and financial pressures and refused to accept underfunded new commitments.
Mine was the last generation of doctors to endure crushingly unsafe 120-hour working weeks and I have no romantic nostalgia for the 72-hour shifts commonplace in the late 1980s. Tired doctors can be dangerous doctors. What struck me, however, from the juniors I taught before coming to parliament, was that they felt every bit as exhausted and demoralised, not through lack of sleep but because while on duty they too often felt stretched to the limit. Medicine has also lost the supportive team structures and flexibility to work near partners and accommodation that once compensated for the stresses of the job. Today's juniors, feeling powerless and undervalued, are now prepared to walk out on their patients – but that will have lasting consequences.
A failure to recognise this until too late in the negotiations, alongside a disastrously timed and clumsy announcement, risks scuppering an important opportunity for change. The appointment of Professor Sue Bailey, chair of the Academy of Medical Royal Colleges, to examine how to improve juniors' working lives, should have been unequivocally welcomed by the BMA. Anyone who knows her will know that Prof Bailey is no mouthpiece for government and would be a powerful advocate for change.
Pressing ahead with a full walkout however, will serve only to harden attitudes and solves nothing. Most importantly, it will be disastrous for patients. The BMA has no doubt calculated that people will blame the government, but a strike that leaves patients without junior cover even for emergencies puts lives at risk. It cannot justify such drastic action by claiming to protect patients.
Given the agreement to pay the premium rate all day to any doctor working one Saturday or more every month, how can it be argued that patients will be safer only if all Saturdays are paid at the premium rate, however infrequently worked? Given the scale of concessions and protections on maximum hours and consecutive shifts, the BMA could have declared victory and moved on to focus on the deeper and longstanding causes of discontent.
Junior doctors are understandably concerned about being pressured into working unsafe hours despite the proposed safeguards, but this was all the more reason to work with Prof Bailey and new provisions in the contract to make sure that whistle-blowers are confident to come forward and fully protected when they do.
Both sides now need to put patients first and step back from this dispute. The government should do as it promised under the Health and Social Care Act and to stop trying to micromanage the NHS. If there was a clearer definition of their purpose behind a seven-day NHS, the service could better design the solutions and set out the costs.
It would also help for the government to make a clear statement of the obvious: that come August, junior doctors will see little change to their shift patterns. The simple reason is that there are not yet enough of them to achieve a truly seven-day service. That ambition requires a change in the workforce and a commitment to supporting and working alongside it rather than in an atmosphere of conflict.
NHS England, Health Education England and the BMA should work with Prof Bailey to undertake a fundamental review of junior doctors' training programmes, responsibilities and working lives, including facilitating them to coordinate placements with partners. Many more of their duties could be shared with others such as pharmacists, physician associates and admin staff. Patients are already benefiting from the greater use of the professional skills of specialist nurses and far more could be achieved.
In some hospitals, such as Salford Royal in Manchester, electronic patient records are finally reducing the scandalous waste of time and resources that come with duplication and paper trails. More could be done to make sure that best practice benefits patients everywhere.
A constructive relationship between doctors and government will take time to rebuild; it cannot be imposed and it will not happen unless both sides put patients first and start listening. Saving lives must take priority over saving face.
George Osborne's announcement in the Budget that he wants to help fight childhood obesity through a tax on sugary drinks has provoked the usual grumbles. But this is not a 'pious, regressive absurdity', as some claim. It is practical action that will help to tackle an avoidable health disaster for the nation's children, a quarter of whom from the most disadvantaged families are leaving primary school not just overweight but obese. This is double the rate for the most advantaged children and the inequality gap is rising every year. If that had no consequences for them, there would be no case for action, but obesity blights their future health and life chances. It also adds to the rising and unsustainable bill for the NHS of at least £5bn per year.
Finally, the manufacturers and importers of sugary drinks have an incentive to reduce the sugar content of their products so that they are below the 5 or 8g/100ml thresholds if they are to avoid paying increasing levels of levy.
'Why pick on sugary drinks?' bleat some of the manufacturers. Of course they are not the only cause, and this measure wouldn't work in isolation, but sugary drinks are the single biggest source of sugar intake in older children and teenagers' diets, making up around 29% of the total. These are wasted calories with no nutritional value whatsoever. Sugary drinks are also rotting children's teeth and, at a time when admission for dental extraction is also the leading cause for hospital admission for young children, isn't it time that manufacturers took some responsibility?
I hope they were listening to the Chancellor as he pointed out that passing the levy on in the form of a price differential at point of sale would have a further impact on consumption. In Mexico, there was a 17% fall in sales of sugary drinks amongst the heaviest users one year after a modest differential in the form of a sugary drinks tax. It is childhood obesity that is regressive, not a levy that will make a positive difference, especially because it will most benefit disadvantaged children through doubling the school sports premium and funding for breakfast clubs.
Manufacturers may choose to swallow the costs themselves, but the tax could still push them to get on with cutting down on the amount of sugar in their products, in the same way as we have successfully cut back on salt in food.
This is a victory for children's health and manufacturers and retailers should now step up to the plate, show that they understand the scale of the problem, embrace the change and prioritise the health of their customers.
The European Union has missed an important opportunity for reforms that could have benefited all its member states and their citizens.
As a result, the prime minister has returned with a threadbare deal that has highlighted our powerlessness to effect institutional change. If this is the very best that can be grudgingly conceded when EU leaders express concern at the prospect of a British exit, what hope is there of any meaningful reform in the future?
Come the referendum in June, the deal will be a distant memory and unlikely to influence decision-making so much as gut reaction and weighing the balance of individual and national interest. I expect that those campaigning for us to remain in the EU will win the day if they can persuade people that doing so is the only way to guarantee security and prosperity. They will not win because people have any love for the institution itself.
Referendums have a tendency to deliver the status quo. The point needs to be made, however, that neither choice delivers the status quo because, like it or not, within a decade our relationship with the EU will look radically different, whatever the outcome. Last week's deal has underlined the reality that our Eurozone partners are continuing their separate journey towards full political and monetary union. We will inevitably be bound by and disadvantaged by the decisions they make in their own interest.
The time has come for us to frame a new independent relationship as good neighbours rather than remain a discontented junior partner picking up the bills but with no power to influence the rules of the club.
The costs go far beyond our considerable net financial contribution, annually variable but between £8.5bn and £10.5bn over the past three years. The Common Fisheries Policy has been disastrous both for fish stocks and for our once thriving industry. Nearly a quarter of our quota is now landed overseas by a single Dutch trawler and policy has been mishandled for decades with no accountability to parliament. There is a tendency to think of EU regulations and the European Court of Justice as benign, but interference with decisions like minimum unit pricing in Scotland show the power of big business interests to win out over important public health protections.
The concern about the level of migration is genuine and could have been addressed but the EU has failed to take the opportunity for measured and sensible reforms to benefits. The emergency brake is cosmetic, merely adding rafts of bureaucratic complexity with no meaningful impact on migration.
For all the dire warnings from Project Fear, I simply do not believe that co-operation on issues as important as trade, security, defence and science would collapse in the event of a vote to leave. No possible good would come for either the EU or Britain in an acrimonious separation.
We would set out on a new path as the world's fifth largest economy, confident, outward looking, keen to maintain close co-operation with our European allies and open for business. We would regain control over our own laws and borders and be free to negotiate our own trade deals with emerging markets.
There would undoubtedly be turbulence in the short term but we should balance that against the long-term risks of remaining bound to an institution that we will never learn to love.
I am always struck by the scale of our disengagement from the EU. When I ask at public meetings, few people can name a single one of the MEPs; fewer still have ever contacted one. It is hard to see why they would bother, given the democratic deficit at the heart of the institution.
In June, we face tying ourselves in for the long term to be increasingly governed by a body that few understand or trust and whose powerful commissioners we cannot vote from office. For anyone concerned about issues such as TTIP or the "tampon tax", the reality is that these are the domain of the unelected and unaccountable in Brussels and the list will only get longer.
In the run-up to the referendum, the most compelling request I hear is for more information and the opportunity to debate the issues without the shouting or sneering. People want clear, unbiased information from trusted independent sources.
Commentators should also set out their own voting intention so that their messages can be judged accordingly. We should not shy away from any aspect of this debate but the public do not want a campaign that is dominated either by immigration or by Project Fear.
My vote will count for no more than anyone else's but, for what it's worth, I am optimistic for our future, I believe the balance of our national interest now lies outside the EU and I will be voting to leave
I have always been a Europhile and before becoming an MP would not have imagined voting to leave the European Union. So why am I heading towards the door? I am in love with the possibilities of the EU but can no longer ignore the grinding reality of the institution.
The Prime Minister has set out the terms of his provisional deal with the leaders of our EU partners and it is a threadbare offering. What use are 'emergency brakes' when the driver has no control or 'red cards' that have no credible chance of being deployed? Apart from a small concession on sham marriages, the truth is that the proposals will have no significant impact on our ability to limit inward migration from the EU. They will however, usher in rafts of bureaucratic cost and complexity with sliding scales for length of residency and nationality for child benefit.
David Cameron was right that the EU will need further reform but if this is the best that can be grudgingly conceded when there is a serious risk of a British exit, what chance of any meaningful further reform if and when we are tied-in long term by the referendum? The proposed red card system to halt unwanted EU diktats will need a majority of other leaders in support...so it is vanishingly unlikely to be of use if future policies are imposed against our national interest.
I am glad there has been recognition that we will never join the Euro and that non-Eurozone countries are on a different course rather than ever closer union but the safeguards remain too weak. It is inevitable that the Eurozone bloc will make decisions in their best interests. We have in effect already opted for life on an outside track, tolerated largely for our considerable net financial contribution but the renegotiation has made clear that we are powerless to change the rules of the club.
Those who wish for us to remain in the EU, are ramping up the rhetoric, warning about a risk to our national security in the event of Brexit due to a collapse in cooperation. It will clearly be in everyone's best interests for such cooperation to continue and to foster positive relationships on both security and trade. We are warned that we will become like Norway, subject to all the rules and fees but with no hand on the levers of power but arguably that sounds pretty much like the current situation, except of course that Norway control their own fishing grounds. In the event of Brexit there would be every incentive for Norway and others to join Britain in a different and more positive relationship with the EU based on trade and cooperation.
The case is often made that we should vote to remain in order to prevent internal conflict in Europe, but the anti-democratic nature of the EU is already fomenting the rise of extremism across the continent. When it comes to external threats, our national security has long depended on our membership of NATO rather than the EU.
When I ask at public meetings, few can name a single one of their six MEPs, fewer still have ever contacted one. Why would they bother when their representatives are powerless in comparison to the elite corps of unelected, remote and unaccountable commissioners?
Referendums have a habit of delivering the status quo, especially as project fear gets into gear. If they are to have any hope of persuading the undecideds, the leave campaigns must settle their differences and inspire. We need a clear blueprint for Britain working alongside the EU in a constructive new partnership. We would join as the world's fifth largest economy, not isolated but confident, outward looking and open for business.
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.
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.
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.
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.
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.
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.
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.
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.
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.
There is a dark question at the heart of Professor Black's call for evidence on the work challenges facing benefit claimants who are struggling with addiction and obesity and it should worry us all. She asks, 'What are the legal, ethical and other implications of linking benefit entitlements to take up of appropriate treatment or support?
The inclusion of this question calls into doubt the independence of her review as Professor Black cannot be in any doubt about the fundamental principles of medical consent; that it must be freely given and informed. There are only a few strictly limited circumstances, covered by the Mental Health Act, when people may receive medical treatment against their wishes. It would be abhorrent for the State to extend that to others in order to tackle a perceived reluctance to accept help for conditions of which society disapproves.
A threat to remove benefits unless a claimant accepts treatment, would represent coerced consent to that treatment and that is no consent at all because it would not be freely given. Treating a patient without valid consent would put any clinician in breach of their duty as a doctor let alone in breach of the law.
Any proposal to change the law to allow such coerced consent would be a seismic change and threaten us all. Where would it stop?
It would also be completely pointless. The roots of addiction are complex and treatment is far more likely to be successful when the person affected is actively seeking help. We would also end up depriving or delaying access to the people who want to benefit in favour of those who are not yet ready or willing to change. It would be a criminal waste of time and resources to fill NHS clinics with addicts reluctantly gaming the system or issuing prescriptions for discarded medicines.
Professor Black's call for evidence also misses an important opportunity to comment on the clear evidence base for prevention of alcohol harm. There is still time to follow Scotland's lead in implementing a minimum price for alcohol. It would be perverse indeed for government to be coercing people into treatments from which they are unlikely to benefit at the same time as failing to act on the saturation access to and promotion of ultra cheap booze which fuels their addiction.
Rural voters deserve better than to be typecast as pro blood sports by the hunting lobby. It is clear to me that most people, living in both rural and urban areas of the Totnes Constituency, would prefer to see the hunting of foxes by packs of hounds consigned to the history books. There is no clamour from the countryside to relax the ban, rather a plea for government to focus on the issues which would really make a difference to their lives, like improving infrastructure and addressing the inequality of rural funding for schools and healthcare. This week's vote on relaxing the ban will, if passed by the Commons, cast a shadow over the reputation of the Conservative Party. MPs voting in favour will have failed to listen to the majority on an ethical issue about which public opinion could not be clearer. Few people go to the polls with hunting uppermost in their minds but reputation matters. I hope my colleagues will reject the shallow narrative from the hunting lobby that the proposals are a necessary measure for the countryside; they are not.
A free vote was promised in our manifesto. I hope that Conservative MPs will use it to send a clear message that the Party has moved on from hunting and instead signal our intention to focus on the real issues facing rural Britain.
18 of our citizens are amongst those confirmed dead in Tunisia and we can only imagine the grief of their families. Once again, ISIL has waged its cowardly war against the softest of targets. In times of war we should stop helping their propaganda machine to act as a gruesome recruiting sergeant.
Instead of publicising the names and smirking faces of terrorists or their sympathisers, let's see and hear the personal stories of the courageous Tunisians who formed a human shield on the beach; theirs is the true face of Islam. As David Cameron announces his resolve to end the online grooming through social media, isn't it time for the print and broadcast media to question their own editorial policies? The killers crave publicity for their crimes not just for their own vanity but because they know that this draws others to follow their example. We rightly criminalise child pornography but must now also stop the pictures and links to horrific snuff videos which enable ISIL to deploy the oldest weapon in history; to terrorise and undermine the enemy.
Whilst we grieve with the families of all the dead we should also keep countering ISIL's message of twisted grievance against the West by being clear that overwhelmingly it is Muslims who are being slaughtered by ISIL.
There is no doubt that female foeticide, notably in China, India and Korea, is distorting the gender balance of their societies and devaluing women and girls. That has consequences for all women reinforcing disempowerment and a lesser status.
There is no room for complacency in the UK and we need to remain vigilant.
The Department of Health has updated their analysis of male to female birth rates with data from 2008-2012 and this now includes ethnicity. Without exception, birth ratios were within the expected range for all UK communities, including analysis by ethnicity and birth order.
There may be individual cases but it would be entirely wrong to stigmatise entire communities in Britain by suggesting that this is in any way a common or systematic practice here ...it is not.
For those individual women who do feel under pressure not to continue with a pregnancy purely on the grounds of gender, Fiona Bruce's proposed amendment to the Serious Crimes Bill, will have unintended consequences. Far from protecting them, fear of criminalisation means that these women will not attend their doctor's surgery or clinic prepared to discuss the pressures they face but will present with an entirely different reason for requesting a termination of pregnancy. The opportunity will be lost to talk about any threats or actual domestic violence an individual may face for giving birth to female children.
The amendment is also unnecessary because doctors already know that it is against the law to carry out an abortion solely because of the gender of the foetus unless there are other grounds, for example the risk of a sex-linked inherited medical condition. The updated guidance from the Department of Health and the Chief Medical Officer clearly allows the Director of Public Prosecutions to prosecute should any cases arise. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have made it clear that they consider the amendment unnecessary as sex selection is already unlawful. Their members know this.
If passed there is a grave danger however, that it will create uncertainty in the law for those families affected by serious sex-linked medical conditions for example X-linked severe combined immunodeficiency syndrome and X-linked spinal muscular atrophy. There are a number of these conditions and it is not always possible to detect them by genetic testing. The proposed amendment may make it impossible for these families to retain the choice not to proceed with pregnancies where there is a risk of one of these terrible diseases.
There is another reason to oppose the amendment and that is because it is a veneer, its underlying effect will be to erode the Abortion Act. The term 'unborn child' within this amendment completely changes the framework of abortion law. Across our legislation and common law, children are afforded a wide range of protections and rights that are not afforded to the foetus.
It would be entirely wrong to effect such a major change on the basis of a short debate on an amendment sneaked onto the coat tails of wording which appears at first sight to have the intention of protecting women.
This is a Trojan horse. The underlying agenda of many of those behind this amendment is to erode women's access to safe and legal abortion altogether and I will be voting against it.
Several press reports describe the latest trio of teenagers as 'jihadi brides' fleeing the country for Syria. In what sense can their actions be described as 'fleeing' when that is defined as running away from a place or situation of danger? There are risks in glamourising these girls by describing them as 'A-grade' students yet in the same paragraph portraying them as if they are merely passive victims of social media grooming. That is an insult to the countless thousands of women and girls who are the real victims of IS. Even the most cursory of Internet searches starkly sets out the consequences for brave women human rights defenders like Samira Saleh Al-Nuaimi, tortured and publicly murdered last year in Mosul. Do those who actively choose to join IS bother to consider, let alone care about the mass murder, enslavement and rape of Yazidi girls, Shia, Christians, atheists, members of the LGBT community or in fact anyone not following the same bigoted world view as IS? Do bright teenagers with capacity share any responsibility for doing their homework on the horrors that lie ahead or the lives they may endanger in any attempted rescue?
Girls sometimes join ultra-violent gangs because they are forced to do so as a result of extreme coercive control and abuse; they desperately need help and support rather than punishment. Ultimately it is for the courts to decide the capacity these teenage gang members have to make decisions for themselves and the degree to which they are victims of grooming or culpable for colluding with terrorism.
In the meantime it only helps to fuel the pipeline if they or their actions are glamourised as 'jihadi brides'. Try replacing that term with 'ultra-violent gang member' to tell it how it is.
Time too to ask why it is so easy for unaccompanied minors to fly to countries that have become the known supply routes for the murderous ranks of IS.
Most people experience really great care in the NHS but sometimes things can go wrong. Most of those who complain about NHS services do not seek financial redress. They do so because they wish to have their concerns and experiences understood and for any failings to be acknowledged and put right so that others do not suffer the same avoidable harm.
Where such errors occur, patients and their families deserve to be met with a system which is open to complaints, supports them through the process and which delivers a timely apology, explanation and a determination to learn from mistakes.
The current system for complaints handling however, remains variable. Too many complaints are mishandled with people encountering poor communication or at worst, a defensive and complicated system which results in a complete breakdown in trust and a failure to improve patient safety.
The Committee welcomes the progress made since our last report but in this, our final report on complaints and concerns in this Parliament, we set out an overview of the developments and recommendations to date as well as those expected in 2015. We also make a number of recommendations where we feel further action is required.
As we aim to move to a culture which welcomes complaints as a way of improving NHS services, the number of complaints about a provider, rather than being an indicator of failure, may highlight a service which has developed a positive culture of complaints handling and it will be important for system and professional regulators alike to be able to identify the difference.
Complaint handling remains overly complex and we recommend a single gateway for raising complaints and concerns with clearer, adequately resourced arrangements for advocacy and support.
The removal of primary care complaints handling from local areas has resulted in a disconnection from local knowledge and learning and led to unacceptable delays. We recommend that this is rectified.
There is also a strong case for integrating complaints about health and social care under the same umbrella and this should start with a single rather than separate ombudsmen. There is now no excuse for any health or care organisations not to implement the recommendations of the 'My Expectations' report on first tier complaints as this has clearly set out a user led guide to best practice.
Just as we expect the NHS to respond in a timely, honest and open manner to patients or families raising complaints or concerns, we should expect the same for staff. The treatment of whistleblowers remains a stain on the reputation of the NHS and has led to unwarranted and inexcusable pain for a number of individuals. The treatment of those whistleblowers has not only caused them direct harm but has also undermined the willingness of others to come forward and this has ongoing implications for patient safety. Whilst this committee is clear that professionals have a duty to put patients first and to come forward with their concerns we recommend that those who have suffered harm as a result of doing so and whose actions are proven to have been vindicated, should be identified and receive an apology and practical redress.
How should we respond to the murderous attack in Paris at the offices of Charlie Hebdo? Their editor, Stephane Charbonnier, wrote that he would 'rather die standing than live on his knees'. He was murdered defending for all of us the right to free speech, which includes the right to mock and deride. Cartoonists have been holding the powerful up to ridicule on our behalf for centuries, especially those who exert power through religious oppression.
Across Europe, but not in the UK, a number of papers responded to the murders by covering their front pages with Charlie Hebdo cartoons. Good for them. Who had the greater courage, the masked murderers armed with assault rifles or the cartoonists armed only with their pens? It will be a tough decision for editors as printing cartoons poking fun at Islam now means weighing up the risks not only to themselves and their families but to their staff.
If that means we all pay to increase their protection if they decide to do so, that is a price we should be prepared to pay.
Around the world fundamentalism seeks to crush freedom, be that the right to an education for girls or even the right for women to express an opinion or show their faces in public. The West must respond to this chilling advance of barbarism and be prepared to stand up for our values, including the right to lampoon religion, or we too will live on our knees.
Muslims were among the victims in Paris and worldwide the fanatics have especially targeted their vicious hatred against those not following their own warped version of the faith. Of all the responses to the massacre, the most cowardly would be to stigmatise or attack the vast majority who reject violence. It is time for the media to give a louder voice to the outrage of the many Muslims who are saying loud and clear; not in my name.
Earlier this week, before the long shadow from events in Paris, the news was focused on waiting times in A&E. They matter because are a barometer of pressures across the whole NHS. The underlying causes are often complex and vary from hospital to hospital. Delayed discharges leading to difficulties admitting to the wards may be the principle cause in one area or a surge in demand and complexity at the front door in another. Across England the NHS is coping with around 2500 more people every day in casualty alone compared with 2010 and they are arriving with more complicated conditions. Anyone who has spent a Friday night in A&E will also know the unwelcome and avoidable strain caused by those arriving drunk and insensible. In some areas, staffing levels are a contributing factor as there is a national shortfall in doctors training to become A&E specialists and GPs. NHS 111 also needs to go further in reviewing how and where it signposts callers needing further face to face advice.
Politicians must not pretend there are simple causes or solutions, in fact A&E waiting times are far worse in Labour run Wales despite higher spending power per head and across Europe. It is an insult for Ed Milliband to have spoken of 'weaponising' the NHS for political gain. There has been no extension of charging for health services in England and neither are we moving towards a 'US style' health system because both Coalition Parties are absolutely committed to healthcare remaining free at the point of use, based on need and not ability to pay.
Instead of the mud slinging, it's time for all Parties to back the independent NHS Five Year Forward View and to set out in their manifestos whether and how they will commit to funding it in the long term.
To those talking down the NHS a reminder from the international Commonwealth Fund, it remains the best in the world.
As the nurse Pauline Cafferkey fights her own battle with Ebola at an isolation unit in London, questions have been raised not only about why she was allowed to board a flight from Heathrow to Glasgow, but also about whether all returning aid workers should be placed in quarantine.
In fact, the greatest risk to the UK from Ebola would undoubtedly come if the disease raged further out of control across west Africa. Aid workers, our Armed Forces and NHS volunteers are putting their lives on the line to help to stop this happening. They deserve our thanks and huge respect, not to be treated as pariahs on their return as a result of alarmist reporting.
Some of the commentary on social media about returning humanitarians – from the likes of Katie Hopkins – has also been ugly. There will be serious consequences to whipping up a panic that appears to blame aid workers for exposing us to an avoidable risk, when the truth is that we are all far safer as a result of their courage.
Ebola continues to take a terrible toll across west Africa, having caused more than 7,000 deaths, so no one doubts the need for extreme caution. Thankfully, the efforts of our aid workers are already making a difference: the R0, the number of new cases passed on by someone who is infected, has fallen from 1.6 to 1.2 as a result of our involvement in Sierra Leone.
Education about the risks from body fluids and traditional burials, alongside measures such as early identification, isolation and treatment of those affected, are helping to turn the corner where fragile local health systems had collapsed. Other measures – such as the mass treatment for malaria – have reduced the number of people with near-identical symptoms but who do not have Ebola turning up for avoidable isolation and testing.
In the UK, any outbreak would be rapidly contained as our isolation and treatment facilities are ideally placed to cope with the very small numbers of expected cases in exposed aid workers.
It's worth remembering that brave nurses like Pauline Cafferkey are at risk because they are treating patients at their most infectious – in the later stages of the disease, when diarrhoea and vomiting have set in. They are also doing so in extremely difficult conditions.
The call for mandatory quarantine on their return to the UK may at first sight look reasonable but Public Health England (PHE) is right to weigh up the potential unintended consequences of such a policy, which could encourage those returning from high-risk areas not to report their travel history for fear of being placed under virtual house arrest.
It's surely far better to have a system where returning aid workers and high-risk travellers can remain under active surveillance with regular contact from the NHS and clear pathways to immediately report the earliest onset of any symptoms. The risk to others in the first stages of Ebola is negligible as it is spread by direct contact with infected body fluids. Sitting next to someone incubating Ebola does not carry a risk because the virus isn't airborne.
The disgraceful hounding of the aid worker Kaci Hickox in Maine exemplified the dangers of a panicked response to returning humanitarians. Her quarantine order was eventually overturned by a judge in favour of our own evidence-based active surveillance and reporting approach.
Of course, PHE will urgently need to review their criteria for transferring at-risk returning aid workers for formal testing, given that Pauline Cafferkey reportedly raised concerns about early symptoms but was checked several times at Heathrow and found not to have a fever. It must also issue clear, consistent advice on social contact for those returning from Sierra Leone and share that with the public.
If, however, we deter future aid workers by ostracising them or submitting them to draconian confinement, even if they have no signs or symptoms, we will risk fuelling the humanitarian disaster in west Africa. If we lose the fight there, we would soon be fighting it on multiple fronts here in Britain. The real danger would then be from an influx of returning travellers and those trying to escape the risk of infection who had already been exposed. It's all the more depressing, therefore, to read the mean-spirited and alarmist comments about returning aid workers. If risking your life to help strangers and to protect us at home in the UK doesn't make you a hero, what does? The very least we owe them is a decent welcome at the airport and an individual journey home. Would I be happy to share a cab with one of them? It would be an honour.