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.