30 NOV 2015

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

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

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

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

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

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

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

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

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

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

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

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

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


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27 NOV 2015

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

I wrote this article that appeared in the Telegraph today

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

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

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

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

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

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

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


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

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

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

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

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

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

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25 NOV 2015

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

I wrote this article which appears in today's Telegraph

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

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

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

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

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

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

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

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

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

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

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

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


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28 OCT 2015

Tampon Tax

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

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

1 comment

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

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16 OCT 2015

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

This article appeared first on Huffington Post

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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12 OCT 2015

Sugar Tax Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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04 SEP 2015

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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03 AUG 2015

Care Cost Lottery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My article first appeared in the Telegraph today.

1 comment

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

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30 JUL 2015

Coerced Consent is no Consent

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.


Well said Sarah. It's clear too that those who ask for help are often unable to source it; funding is limited.
- Lynne Roper

It also raises the question of what is 'appropriate treatment and support' and where are the resourses to provide it? What training will staff in local jobcentre's have that will enable them to address this question before referring a claimant for such treatment or support and considering whether to sanction them for a failure to comply? Bearing in mind that 60% of referrals to a decision maker to consider a sanction under the current provisions are found to be inappropraite (and the number of actual sanctions imposed that are overturned at the revision or appeal stage is significant). This is another example of the governement pandering to the predudices of the public about claimants (whipped up by politicians and the media over recent years) in return for cheap sound bites (which then obscures any informed debate on how to tackle the complex health & social issues that undurly addiction).
- Peter

Well said! I wonder as well why an outsider was brought in. The DWP has a team of about 50 medics and support staff who consider this question regularly - they must be miffed!
- Greg Wood

10 years on full duties with the Ambulance service, gave a huge insight into drug and alcohol addiction amongst other types as with gambling and eating disorders. Most had social or mental problems but others used their addiction as a way of life and the benefits it gave, without working for a living. One arrived here from South Africa with his family. Always worked but after coming to U.K. has become obese deliberately, his wife is his carer and they have all the benefits including being housed, car and scooter etc. Classed as disabled are now on easy street. Just one example. And not even British!
- Margaret Newton.

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13 JUL 2015

Time to consign hunting to history

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.


Sarah As a proud Devonian, and someone who has worked in London -- the centre of the political sphere and where everything now appears focused -- I can't see this Government, or the next, focusing on the issues that matter most to the people that live here or want to move here. If they did, then we wouldn't be having the same conversation as we did 30 years ago. In my view, if there was an appetite to 'fix' the infrastructure etc, then by now it would have been sorted. Perhaps the system itself is at fault -- let's face it if we had a 50 or 100-year strategy for the region then we wouldn't need to argue about different policies from different parties. Julian
- Julian Summerhayes

Thank you for this Sarah, I hope the ban is upheld and you are in the majority, and blood sports are consigned to the history books.
- Charlotte Davis

So pleased to see this, Sarah. Thank you.
- Ann Collyer

So glad to hear your comments. And yes the real issues are what MP's should be looking at, not a minority bloodsport that 80% oft this country don't want back. I have had many holidays in the South West for many years but the badger cull and now hunting could put me off from returning. I love the area and want to support our own holiday businesses but not at the cost of our wildlife.
- Simon Clarke

Also thank you. Riding out with other people on a drag hunt is a lovely day out but there should never be more than two hounds with the riders it is far too easy for the hounds to get involved in chasing a fox as they are definitely not the brightest dogs which is why the huntsmen can't always call them off.
- Lin Lobb

Thank you Sarah for being one of the enlightened MPs in this government. I am a rural landowner who suffers the same frustration as the rest of the country does on this issue. Fox hunting and other barbaric blood sports need to be assigned to the history books forever.
- Mary Dowson

Thank you for representing the views of many country folk. I graduated from agricultural college and worked in the agricultural industry for many years. I have also kept and ridden horses all my life. I am 100% opposed to foxhunting and I very much hope that the ban is retained - and made tougher and easier to enforce. I voted Conservative in the election and I hope that the MPs will give the country what the majority wants rather than bowing to the very loud and rather arrogant demands of the hunting fraternity.
- Hilary Boughton

Well said Sarah.
- Chris Libby

Thank you Sarah for presenting both a rational and democratic argument for retaining the ban. As you say, this issue is a moral one not a matter of freedom or choice, or even national boundaries. Fox hunting is neither necessary nor effective as the recent case of a hunt breeding foxes to kill proves. Killing animals for 'sport' is an act of gross depravity, which you rightly point out needs to be left in the past. Equally, this action by the pro-hunting element in Parliament is profoundly undemocratic as the Statutory Instrument cannot be amended by debate and is therefore a disingenuous attempt to subvert our normal legislative process. Hunting, whilst not the most pressing problem on the nation's mind is nevertheless a highly contentious matter that needs thorough examination before any amendments are made. I hope many other MPs will take note of this and vote down this measure on that basis alone if not on animal welfare grounds. I am concerned also that the elements of this amendment referring to terriers and underground working are aimed at further weakening the protection offered to badgers under the Protection of Badgers Act 1992 against interference by the hunts. The current situation regarding sett blocking and digging out by hunt members is already very bad and much of it goes on undetected let alone prosecuted by the authorities. As a previous poster has said, the reputation of the West Country in general and the Conservative party in particular has been severely damaged by the badger cull and now this. All power to your elbow in trying to bring it to an end.
- Peter Martin

Thank you Sarah for your opinions on what most consider a barbaric practice. I might even vote Conservative if there were more like you in the Party. Unfortunately I'm in the Tiverton and Honiton constituency - enough said!
- Jenny Keen

Fantastic news, thank you so much x
- Jenny Rogers

Thank you for representing our views so well. I am much relieved - you are so right that the torture of animals as a form of entertainment should be consigned to history. We support you in your stand.
- Lynn Alderson

Sarah, I would have hoped that you would have been better informed !. Without some control of the fox population (Hunting may in fact be the most humane method, culling the deceased/injured foxes). How do you think they will be controlled ?.... The Farmers, Keepers will have no choice but to shoot them, resulting inevitably in wounded foxes. Foxes as natural predators of other wildlife have to me managed.
- Charles Eyston

This isn't about 'relaxing the ban'; instead about making for more effective and humane control and management of the fox population. We know that farmers, including those in your constituency, would welcome these changes- please listen to them.
- Tom

Thanks. DEFRA doesn't even publish figures for fox predation on livestock because it's so minuscule yet it does for other causes. Farmers don't call in the hunt to control predators. Why would they when you see hunts like the Middleton Hunt raising cubs in outbuildings that can be hunted later in the season. You've restored my faith in the Tory party.
- David Thompson

I think it a great shame that there are still people that cling to the now comprehensively discredited notion that foxes 'need controlling' by humans. As a lifelong country dweller and keeper of free range chickens I fend these argument not only false but mendacious. The vast majority of foxes die of cold and starvation in the countryside because modern farming has stripped the rural landscape of much that foxes can eat (which is why so many end up in urban areas). The idea that ripping a fox apart is 'humane' would be laughable if it wasn't so cruel. Even if foxes did need controlling then hunting is the least humane method of all. However, no form of 'pest control' needs 40 people dressed up in 19t century costumes, riding horses over other people's land, damaging crops, fences and walls chased by forty out-of-control dogs. What other form of pest control begins with a glass of sherry? The public has rightly become tired of the dissembling, the lame excused and the outright lies put forward by the hunting lobby. MPs like Sarah Woolaston and Tracy Crouch are right to stand up to the bullying and patronising blandishments of those who claim to know about the countryside and the ecology of it's wildlife, but who clearly don't. Dr Woolaston and Ms. Crouch's attempts to bring the regressive rump of Conservative party into the 21st century are to be applauded. Their views not only represent those of the majority of the British people but also the true nature of the anachronistic horrors of hunting.
- Peter Martin

Thank you for respecting the views of the vast majority. Tom, hunts actually breed foxes for hunting...it isn't humane to tear foxes to pieces alive!
- Dave c

1. There is no evidence hunting is cruel: the Burns Inquiry rejected that suggestion. 2. Foxes are predators and require control - farmers (including us) DO call in the hunt to deal with foxes. 3. The Hunting Act was admitted by its proponents after the event to be class warfare ignoring the social mix of the hunting populace - it was a pure sop by Blair to his backbenchers (and he has consistently expressed his regret about it since). 4. The Hunting Act is bad law - unenforceable, illogical and wasteful of police and court time and limited resources. It is legal to use a dog below ground to flush a fox killing game birds, but not one killing lambs or chickens - that is about as illogical as one can imagine. 5. These amendments bring the law in England into line with that in Scotland. 6. All aspects of countryside management are a balance - lose the balance in respect of wildlife and disease soars - TB and mange being classic examples. 7. Evidence, not sentiment, is the proper basis for decision making in public office. 8.Laws are there to protect minorities rather than to persecute them. 9. A wrong, based on ill-conceived spite, was perpetrated on the hunting community in 2004 - the passage of time does not render that wrong any more justifiable - the Nazi theft of pure property of the Jews is only now being rectified 70 years later. 10. These amendments do NOT make hunting legal (more's the pity) but at least they make the ban logical and enforceable. 11. Your constituents deserve proper responses rather than a round-robin "Dear All" brush-off. 12. Try donning a pair of willies and leave the brown rice and sandals of Totnes alone for a few days - education is a worthwhile continuing process.
- Mark Treneer

Obviously my comment has not met with the approval required to actually appear on this page - censorship of a constituent's views is contrary to the fundamentals of democracy. Its rather unsurprising you claim a majority supports your view if you only read and post the one's you agree with and the most gentile of the others.
- Mark

The fox population does need controlling, I have given up keeping sheep because of the loss of twin lambs to foxes, adding insult to injury this morning I discovered all 19 of my lovely hens dead in their pen, a fox has scaled a 6 foot fence and killed the lot, eaten 3 heads and left the rest as it couldnt get the bodies out of the run. Terrible shame, but hunting with hounds still the best and most humane way to control their numbers. Predation much worse since the ban JANE
- jane

Sarah, The harsh reality is that foxes need controlling and this amendment provides for a sensible way ahead.
- David Larmour

What a pleasure to listen to sense being spoken by a politician! Well said Sarah, I wish you were my MP not Mel Stride. How is it that people think it perfectly acceptable to tear a fox to pieces but if it were their pet cat they would find it unacceptable - A fox kills to live, a cat kills for fun, neither deserve to be torn to pieces alive. PLUS I thought that the fox was supposed to be shot not killed by the hounds? I have yet to see a huntsman able to control the bloodlust in hounds that they have taught to kill!
- Diana D

Dr. Wollaston you are quite right: the desperate need for better rural housing, faster broadband, better bus services etc are all more important than fox hunting. It's a pity the Coalition didn't address these vital issues during the last parliament and of course the Labour government devoted 700 hours of Parliamentery time to banning fox hunting that could and should have been spent improving rural services. So you should therefore support your government's suggested changes to the Hunting Act to bring clarity to a defective law and to finally take fox hunting off the rural agenda so it can be replaced by issues that more directly affect the future and prosperity of the countryside. To that extent you are right, fox hunting should be consigned to history, but leaving the law ion the muddled state of the 2004 Act will only perpetuate its prominence on the rural agenda. By supporting your government's proposals you and your colleagues will create the space you need to concentrate to the more important issues affecting the country and the countryside.
- Henry Harington

Sarah, please consider your social conscience. Whatever opinions in and around Totnes may be, this great country of ours is underpinned by social and cultural diversity. Relative values vary regionally, for good and understandable reasons. Mutual respect for those differences is essential. I question your logic in assuming that local opinion is either relevant or appropriate on a national scale. More people hunt to hounds now than ever did before the ban. As such, your headline, “Time to consign hunting to history” appears as an attempt to impose, and possibly to curry local favour, rather than a considered appreciation of the many synergistic interrelations that comprise our national interest.
- Tony Hawkins

Sarah, you said you would listen to your constituents' views, that must include the hill farmers of Dartmoor that are in your constituency. So please respect their position and support this Bill.
- Margaret

Again, some quite astonishing intellectual vacuity on display here. Cruelty is not a matter of 'diversity' or 'opinion', or worse still 'tradition'?! What kind of thinking is that? We don't allow dog fighting on the grounds of 'diversity' or 'choice' and thankfully it's a 'tradition' that has long been illegal. That is because it is both cruel and immoral. The same applies to fox hunting; it is cruel and immoral and should be consigned to history. The fact that people actually enjoy it is a matter of grave concern. It is well established that people who are cruel to animals are also cruel to people. Equally, the fact that a law is badly drawn up is not an excuse for relaxing it but tightening it up. The law on hunting as it stands was a compromise designed to allow the tradition and socio-cultural aspects of it to continue but without the cruelty. It relied on those who continued with it to uphold their side of the bargain by being honest about what they were doing and to keep to the trail. The fact that the law has become 'unenforceable' is because the hunts have deliberately made it so. They have done everything in their power to subvert it, to lie and cheat and to go on killing. To then claim it should be repealed on these grounds is mendacious in the extreme. Shame on all of you. You bring shame on our nation, on our values and on our democracy.
- Peter Martin

Am very relieved to hear that you will be voting against. Thank you.
- Sarah Matthews

So many misinformed opinions regarding fox population control. Foxes are self regulating predators. They control their own population. This is governed by availability of habitat and food. Removing foxes only encourages more to enter the now vacant territory. This nothing more than basic ecology and backed up by hard scientific evidence. Those who believe foxes need to be controlled are either driven by a pro hunt agenda or are simply ignorant of the facts and blinded by pro hunt propaganda. The simple fact is hunts encourage and breed foxes to hunt. A somewhat strange situation when they cry "pest control" to justify their passion for cruelty. Lets hope these are the first steps to a total ban on all hunting with dogs, including the Beagling for Hares and Stag hunts.
- Accidental

This proposed amendment does not legalise fox hunting but merely brings the law into line with that in Scotland. I don't hear anyone suggesting that the Scots are more cruel as a result of their laws on hunting!! Indeed there is evidence to show that animal welfare is better supported by their law. The rumour that the SNP now intend to vote against this amendment is the sort of hypocrisy that brings politics into disrepute. Clearly this is an issue that still stirs strong emotions on both sides but this limited amendment would possibly lay it to rest for a generation and I therefore urge you to support the amendment.
- Graham Grose

Thank you for speaking for the majority unlike my MP charlie elthick who did not even have the courtesy to reply to my e mails !!
- Paula baker

There is no EVIDENCE that foxhunting is cruel. The Burns Inquiry established that, on the EVIDENCE. Fact. To assert that foxhunters are cruel to people is ridiculous - they do not go about in balaclavas and with staves in hand as the antis do. There is no EVIDENCE that foxhunters are baby-bashers or otherwise cruel to people. Fact. Evidence is the foundation of reason. Absence of reason is bigotry. A law based on bigotry rather than evidence has no place in a civilised society. Law based on evidence is the opposite of being mendacious - rather it is the illiterate in pursuit of the illogical.
- Deborah

You are very welcome to your new best friend Nicola Sturgeon and the SNP. They seem to want to vote on English domestic matters when it suits them. Where do you stand on that Dr W? It is pretty hypocritical of the SNP to want to vote against the amendments which bring the law in England into line with that in Scotland - which the SNP advocated.
- Barney

Killing foxes with a pack of hounds cannot be compared to pitching dogs bred for fighting against each other as a spectacle. That pack of fox hounds work together to kill efficiently and quickly. Hence the conclusions of Burns Enquiry; that there is no evidence for associated cruelty. There is no spectacle, other than of horses, hounds and people working together in the countryside, the kill itself very rarely being witnessed by any other than hunt staff. Working together, that is, because the fox population needs controlling. Hunts operate by invitation and permission of the landowner. If that landowner did not need foxes controlling, the hunt would not be there. In turn, the hunt needs financial support from its members, both landowners and others, who take pleasure and pride interacting within their community both to enable and help their huntsman effect such control. That huntsman trains his hounds to kill foxes more humanely than any known alternative. Whether in a majority or nearly so, the huge numbers of people that understand and support the control of foxes with hounds would not do so if, for a moment, they thought the practice either unnecessary or cruel. Anybody is welcome to support that practice and community. Those that prefer not to participate, perhaps because they have no immediate personal reason to see foxes controlled, should maintain respect for those that do, recognising that the patchwork comprising our diverse landscape and society will inevitably lead to different needs and priorities in space and time.
- Tony

Sarah, Put very simply to ease some troubled minds....In the real world, foxes need controlling - fact- and this proposed legislation therefore is a modification ONLY. The Hunting Ban was extremely bad legislation making a mockery of English Law and this will slightly improve things. Please listen to the countryside and vote with your party and not the SNP.
- Gavin Dollard

There is a great liberal tradition of tolerance here in the West Country and as a result your blog made sad reading. I urge you not only to read the Burns Report for a thorough science-based assessment (and endorsement) of hunting with hounds, but also to consider whether your own personal prejudices are not finding a convenient echo among a strident and illiberal few. Perhaps the greatest irony is that by voting against the amendment which will bring the English law in line with that currently operating in Scotland you will be handing a gift to the SNP. In your blog on Sept 20th 2014 you say "In my view that should mean that MPs representing English constituencies for Laws only affecting England should be considering devolved issues without interference from MPs representing other Nations within the UK".
- Gill L

So sorry that you appear so entrenched in your views Sarah and that you appear to have misunderstood the Amendment being presented. The vote tomorrow is NOT about repealing the Hunting Act, merely and at the request of hill farmers who suffer the most fox predation, to bring the Act into line with the law in Scotland. It is not about so called toffs on horseback, not about tearing apart a sentient animal, not about popularist blood lust. What is IS about is improving the ability of farmers, and hill farmers in particular, to control a pest species when necessary. I urge you to listen to your farming constituents and vote in favour of the Amendment. Not to support the Amendment will be to merely support the SNP and Labour in their attempt to give our PM a bloody nose. Do you want to be responsible for that? I had thought better of you.
- Suzy

Those stating fox hunting isn't cruel and there is no evidence to prove it is are very ignorant to the plethora of photographic and video evidence that exists already. What planet are you on? In addition, the hunters breed foxes for the purpose of hunting them, (again, proven) which immediately negates the argument that it is for control. The only animal that needs controlling are the hunters themselves.
- Sarah

As someone from a hill farming family (hundreds of sheep, 250 cattle) I couldn't disagree more with Suzy, if the farmer has a problem, he/she deals with it them self, or brings in a local marksman to dispatch of the animal quickly and humanely, not invite a bunch of want to be countrymen on horseback to tear up the land and knock down walls all in the pursuit of pleasure, what a ridiculous argument, you should be ashamed of yourself for being an apologist for this barbaric practice.
- Adrian

The fox hunting supporters disgust me to no end. I would welcome the opportunity to hunt you with horses and a pack of dogs and see how enjoyable you find it. Once we've cornered you and you're exhausted and terrified, then I will make a feeble attempt to call off the dogs as they rip into your flesh...but rest assured your agony will be short as I will then shoot you if you haven't been devoured. Then I will smear your blood on a child's face...indeed what a civilised way to spend a day. Time to end your archaic, bloodthirsty and psychotic views and step into the 21st century...are you surprised you're viewed as backward by city folk?
- Sabateur

Sarah, I was disappointed to read your comments, and receive your letter which I considered to be biased. Foxes do kill livestock! Predominantly hens and lambs. When they get into a hen coup it is not a case of taking one bird away for food, but a massacre of all the birds they can catch. This is not a pretty sight, and is most distressing for the owner. We need to control fox numbers as they have no natural predators, and flushing out foxes to a gun is more efficient and humane than ordinary shooting. When fox numbers become excessive they become diseased and often get mange, which they then pass on to domestic dogs and cats. Any dog walked in the country is in danger of catching mange which is a very unpleasant for both the pet and the owner. When we had a mangy fox locally it infected 9 pet dogs, and finally came into my barn to die where a friend put it out of its misery. It was in a terrible state, raw and skin and bones. The Amendment to the Act merely seeks to allow the hunts to go about their business in a more efficient manner and to help the farmers by controlling fox numbers. I am not asking you to agree with ‘hunting’, merely to point out that you blog is rather emotive and biased with the use for example of ‘blood sports’. You represent a constituency which has a large farming population and you are totally failing to give any consideration to their opinions and needs. I would urge that you re consider your stance. It is so important that our MPs are even handed and fair to all. Margaret
- Margaret

This amendment was not about hunting with hounds, it was about allowing the use of more then two hounds to flush a fox to guns, a change that would have animal welfare benefit, that is wanted by farmers and would have brought the rest of the UK into line with Scotland. You have shown understanding of this case; which makes your blog all the more disappointing. A 'shallow narrative' indeed.
- Jonathan

Adrian, no matter how many sheep and cattle your “family” may run, you cannot really believe that landowners “invite a bunch of want to be countrymen on horseback to tear up the land and knock down walls all in the pursuit of pleasure”. Landowners and farmers already find making ends meet quite difficult enough. Instead, hunts do all they can not to damage pasture etc, followers on horseback riding the margins or taking another route as may be appropriate, returning to repair any remaining accidental damage to walls and gates. Otherwise, the 190 fox hunting packs that thrive throughout the UK would not be invited back, and could not continue. Further to which, call me old fashioned if you like, but getting outside to help achieve something worthwhile in a broad social context deserves to be applauded, rather that sneered at.
- Hazel

The decision by Nicola Sturgeon on behalf of her Scottish Nationalist MPs in the English Parliament to vote against this amendment which would have only brought the law in line with that in Scotland which was supported by both the SNP and Labour party, proves without doubt the hypocritical and unprincipled manoeuvring of the SNP to give a bloody nose to the PM. The Westminster Parliament does not legislate on matters devolved to Scotland without the consent of the Scottish Parliament, and it is proposed that this be formally enshrined in legislation rather than existing as a parliamentary convention. Why should Scotland have the right to vote on matters affecting only England and Wales? Please Sarah can I ask you to join those asking for a strengthening of the proposals on English votes for English laws otherwise the rest of this Parliament is going to be dominated by a party led by a person who does not even represent a constituency in Parliament. A sad state of affairs whatever your view on the Hunting Act amendments.
- Suzy

Re. Peter Martin. Is it the hunting or the age old bitterness of those who seem obsessed by "gentry" ( nothing is further from the truth) out hunting .Hunts only traverse land over which they have permission ( more than some ramblers!!), hunt members are responsible to follow up any hunt and replace any broken fence etc( would members of the public were as good when traipsing happily through fields of growing corn, lambing fields or carefully managed coppices).By the way, can YOU recall your pet dog as well as the master's control over 20 couple of hounds? Try it !Go out with your friends with all their dogs ...20 will do for a start. Let 'em go in the local park and see how long it takes you to get them all back. By the way being a landowner is not the same as making your living from the land .Last but not least why is there no outcry over poisoning rats, which is not a kind death,or killing them with terriers? Or do you only care about "pretty" animals? Wind in the Willows mentality but real life is not like that..sorry.
- Ann

As a owner of land (who banned the hunt) in your constituency but living in an adjoining area, I can only wish you were my MP. Have a word with that woman Ann-Marie Morris will you? I understand she thinks this barbaric form of 'entertainment' should continue, no doubt believing she'll get some 'brownie points' from Dave for towing the party line. Well done you though, having intelligence, compassion and the balls to stand up for your principles.
- Tony

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This week, William Hague set out the options to ensure fair representation for England following the agreement to devolve greater powers to Scotland. Whilst 'English Votes for English Laws' is rarely top of the priority list, the subject regularly comes up at my open meetings as people are rightly annoyed that Scottish Labour MPs regularly vote on issues which have no effect whatsoever on their own constituents. Imagine the fuss if the situation was reversed! https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/387598/implications_of_devolution_for_england_accessible.pdf

Following the Scottish independence referendum, the transfer of additional powers to Scotland will significantly worsen this injustice to English voters.

In the Houses of Commons, William Hague set out the three options put forward by the Conservative Party:

1. Bills that deal with English matters could only be able to be voted upon by English MPs at all legislative stages.

2. Bills that deal with English matters could be voted upon by all MPs at Second and Third Readings but only by English MPs at Committee and Report Stages.

3. There would be the creation of a new legislative stage in between Report Stage and Third Reading at which English MPs could veto and approve legislation which deals only with English matters.

I am pleased that all three options look to address the 'English question' within Parliament rather than proposing that another raft of structures and politicians be created. The idea of regional assemblies was rejected during a 2004 referendum in the North-East and I have yet to meet a constituent who asks me to campaign for more politicians.

I'm keen to hear your views.

The first proposal has the advantage that it would not add extra stages to the already lengthy legislative process. Although it is true that some parts of bills may apply to devolved nations but not others, in reality Labour oppose this as it would reduce their ability to push through unpopular, burdensome and expensive legislation should they ever return to power. The SNP have long taken the view that they should not vote on English only legislation and rarely do so, thus demonstrating that it is not the complicated morass wrongly claimed by Labour.

This is about fairness to England.


Is it not the case that very very small numbers of Bills will only affect England to the extent that Scottish MPs votes will be restricted or banned ? For instance HS2 and an extra Heathrow runway are English affairs but have a knock on effect in Scotland and Scottish MPs could demand a vote on these Then there is the SNP opposition to Trident. How is that to be handled ? And how will the Barnet Formula be amended if English interests are to be protected ? William Hagues Bill sounds good but the devil will be in the detail
- Brian Boughton

Hopefully Sarah you will now pursue this strongly in view of Nicola Sturgeon's vole face over Scottish MPs not voting on purely English legislation this week. So much for her statement that the SNP will not interfere or note on purely English matters. If she can give the PM and our small majority a bloody nose over this, she will make the rest of the parliament a nightmare.
- Suzy

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Last week, I met with Kris Hopkins – Minister from the Department for Communities and Local Government – to discuss challenges for South Hams District Council (SHDC) with solar and wind farm planning policy.

In recent years, our area has seen a significant increase in the number of applications. SHDC has either approved or is currently processing applications for solar farms covering 305 acres – the equivalent of 170 football pitches. I have received a large number of representations on this from people across South Devon who are concerned about the impact that these development have on the countryside. The South Hams is renowned for its outstanding natural beauty and I am concerned that overdevelopment with vast industrialised solar arrays will impact on vital tourism and the land we need to feed the nation.

This year, the Government announced reforms to the subsidies provided to developers to remove Renewable Obligation Certificates from solar farm developments over the size of 5MW – removing the incentive for large solar farms to be built. While this news is welcome, there are concerns that this will lead to a large increase in applications in the short term, as developers seek to beat the 1 April cut off for subsidy.

At the meeting we discussed some of the problems that the Council faces when solar and wind farm applications come in. Developers have the right to appeal if applications are rejected and the associated costs for the Council can be high if their decision is then overturned. This can leave Councils with a difficult decision when rejecting an application as they need to sum up the risk to council tax-payers money if their decision is overturned on appeal. Additionally, I have concerns with the appeal process allowing unelected Planning Inspectors to overrule the decisions made by local representatives who have detailed local knowledge and opinion.

Of course all areas must take their share of renewables but it is clear that the South West has been far more attractive to developers because the returns on solar are greater. We have more than fulfilled that obligation locally and nationally we are already on course for reaching our target for energy generation from renewables. It is time to genuinely shift the balance to installations being where the public expect them to be, on rooftops or brownfield sites, not desecrating our beautiful landscape for the profit of a few at the expense of subsidies paid by those who are fuel poor.

We have asked the Minister for stronger and clearer guidance to help Councils reflect the wishes of local people and I look forward to seeing the Department's future plans to support local councils in achieving this. Councils must be able to turn down applications where they feel they are inappropriate, safe in the knowledge that council tax payers will not be doubly penalised in having to put up with these monstrosities as well as pick up the tab for the appeal.

Thank you to representatives from the council and the CPRE for coming to London to help to set out the position so clearly.

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I have recently moved to this area and I can only say I am appalled at the way the solar arrays have been sited in such a beautiful landscape. I agree totally with your sentiment that the place for solar panels is the roof tops of public and private buildings. Another issue which concerns me is how do the owners of the arrays keep the weeds down? If this is by use of herbicides then this should also be a matter for the planners to consider.
- Alan Parkin

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The Chancellor has promised almost £2bn in extra funding for the NHS. This will make a real difference as the pressures facing the health service from rising demand are becoming increasingly clear. This pledge also confirms the government's backing for the NHS 5 Year Forward View as set out by its new Chief Executive, Simon Stevens.

During our ongoing public expenditure inquiry, the Health Select Committee has heard that that changes in people's health needs, and an increase in the number of those living with long term health conditions mean that, without action, the NHS would face a £30bn funding gap by 2020. NHS England's Five Year Forward View has set out their plan to close that gap. However this plan will still require an extra £8bn funding a year by 2020 with £1.5bn this coming year. The funding announcement will protect high quality services for patients and allow the NHS to start work on improving community services including changes to invest in the front line in primary care . It was particularly welcome that future budgets will allow planning over several years to make it easier to plan services with more certainty.

Despite the good news this weekend, it is more important than ever to ensure to secure a strong economic recovery to safeguard funding for the NHS in future years.


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Scotland has decided; we remain a United Kingdom. Their referendum has been a triumph for democratic engagement and a vote of confidence in the most successful political union in history.

This was not a vote however, for business as usual. In Downing Street, the Prime Minister has set out his pledge not only to the Scottish people but to every part of Great Britain and Northern Ireland to deliver greater devolution of powers. For England, we have heard the promise of 'English votes for English Laws', ending the inequity of Scottish MPs voting on laws which do not affect their constituents. It is not just the so called 'West Lothian Question' however, which demands an answer. There are demands for devolved regional assemblies, even networks of greater city states but where is the evidence that people have greater affinity or satisfaction with extra layers of local government? I don't hear a clamour for more politicians. The more we spend on new regional structures and their inevitable layers of bureaucracy, the less we spend on people. It is also hard to see how a network of wider city states could feel relevant to rural England. Like many of my constituents, I identify with Devon but have no affinity with 'greater Exeter' or Plymouth. Likewise, regional government in the South West would hardly satisfy Cornwall. The fact is that whatever sub-national structures are set up there will be rumblings of discontent. The Scottish Referendum marked a decisive step towards a federal United Kingdom. In my view that should mean MPs representing English Constituencies for Laws only affecting England should be considering devolved issues without interference from MPs representing other nations within the UK. We should be joined by those MPs only for those decisions which affect us jointly. Where assemblies decide to share other powers, their MPs would of course be entitled to vote.

Labour claim this will create 'two tier' MPs but that is just the inequity which exists at present with Scotland's over-representation on issues which do not affect them. Scotland has had the opportunity to decide their future, now it is for England to decide as the future constitutional changes will affect us all. It is also for Westminster to change the way it operates and to spend more time looking beyond the M25.

On the issue of the so-called 'Barnett Formula', I am unhappy about the eleventh hour pre-referendum promise that this would be extended in perpetuity. The formula, which is the basis for allocating public money across the nations of the UK was designed with good intentions in the 1970s but it is no longer fit for purpose. It is this formula which allows Scotland to spend £203 extra per head annually on health services alone and over £1500 overall on services. Why should a person in need in Devon count for less than someone in Scotland? We need a formula which recognises deprivation and health inequality but also one which recognises the challenges of providing services in sparse rural areas and crucially the extra costs of meeting the needs of older people. I will not be voting for the Barnett formula in perpetuity but for a fairer settlement for people wherever they live. That in my view must be an important principle at the heart of a truly United Kingdom.


I agree with most of this, especially your comments on the Barnett formula. That part of what the three party leaders said before the Scottish vote was most ill-advised; and we should all make that clear to our respective leaders. In my view there is a role both for the powers of counties to be enhanced, and for greater voluntary collaboration across city regions - so not more local government, but more powerful local government, able to respond to local diversity rather than national edicts. Another worthwhile lesson from Thursday's vote was the inclusion of 16 and 17 year olds, a principle which should be extended to all UK elections.
- David

Well said Sarah. There is no demand for a south west regional assembly. Why can't non English MPs simply be excluded from voting on English matters in the existing House of Commons? This will avoid the expense of creating a new English institution.
- Steve Tucker

I agree entirely. I have lived in Cornwall, Kent ans now Shropshire. None of these areas would benefit from being part of their nearest urban neighbour. I remember the fight against Ted Heath's Tamarside. Let's settle the West Lothian and Barnet formula questions but let English regional devolution take a back seat.
- Andrew Chapman

Thank you for speaking so much sense. You have restored by faith in the Conservative Party. Unfortunately you are no longer my MP as we now live in Torbay but I support everything you have said.
- Jan Cadle

Thank you Sarah. Maybe enhancing the status of the counties could help. Getting rid of the district councils and transferring their powers and duties up to counties and down to the parish level. The added benefit of this is that we know our neighbours who sit on our parish council and politics could be really local.
- John Hawkins

Good grief Sarah- w actually agree that men wearing skirts are no more valuable than I am re the"Barnett Formula" There is simply no justification that now we are a UNITED KINDOM for different geographical areas to be treated differently from others. It would be an utter disgrace if taxpayers had to pay for yet more bureaucrats. Its just too bad that we have to have so many Eurocrats as the EEC is just one vast waste of money and the best it cando is legislate for dim light bulbs, inefficient vacuum cleaners and will no doubt reduce the power of ladies hair driers so that go round looking like pampas grass in Autumn
- Loris Goring

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It fills me with dread to think that, in less than a fortnight, we could be waking up to a dis-United Kingdom. Our Union is far greater than the sum of its parts but sadly, only the residents of one of those parts will have the chance to decide our future. Those with Southern accents are encouraged not to speak out loud for fear of alienating undecided voters. Why? I want to shout from the rooftops that I love Scotland, that I dearly want Scotland to stay.

We will all be diminished if narrow Scottish Nationalism and the siren lies of untold oil wealth win out against the success of our forward-looking Union. We will all be poorer; economically, strategically and historically. Of course national identity and pride matter but just as I feel proud to be English, I am also proud to be British and to share in the great history and success of Scotland. More than I can possibly say, I hope that, come the 18th September, the Scottish people will feel the same about us.


Fully agreed. And some of the stuff that the SNP are coming up with, such as the Named Persons thing (where the Scottish government will be making a non-parent person responsible for children in all Scottish families, where the parents will have little recourse or authority - here is the Scottish Government's sweetened version of it: http://tinyurl.com/qau7hfy) is decidedly scary. Why would they want to invent something so controversial coming up to the independence vote?
- Tony Cutcliffe

Absolutely agree, I also want to shout from the rooftops! We have just spent a marvellous nine weeks in Scotland (Caithness, the north west Highlands and the amazing Outer Hebrides and the Commonwealth Games) - we loved it and the Scottish people. My grandfather was from Glasgow so I guess there is something in the blood as well........... However, the thought of Scotland not being part of the United Kingdom I find very upsetting and a route which feels so very unnecessary. The result of these debates will surely provide the Scottish parliament with more devolved powers even if there is a 'No' vote. I so much hope that Scotland does not leave the United Kingdom, Team GB and all that! If the vote is a 'Yes' vote, then I think that the people of the rest of the UK should have the chance to decide whether an independent Scotland should have the benefits of remaining aligned with the Stirling Pound. As much as I feel a strong emotional attachment to Scotland and love visiting, if the Scottish people decide to be independent of the United Kingdom then I feel this should be full independence and not partial. I do not believe that the residents of the remaining UK should gain or support from the purse strings, of an independent Scotland. Somehow it feels like the SNP are wanting the best of everything! The emotional powers of independence whilst hanging on to the greater wealth and stability of the UK economy. Sorry, this is not fair! Please Scotland, stay with the United Kingdom and Team GB!
- Margaret Bickley

How is it that on the eve of a momentous referendum, the party you represent calling itself the "Conservative and Unionist party", has managed to permit and engineer a situation that could result in the destruction of the union between Scotland and the rest of the UK? If the Yes vote succeeds then the ramifications for Britain and its standing in the world will have far reaching negative consequences. How could anyone then vote conservative at the next election when its leader will go down in history as the PM who presided over the breakup of the Union?
- Chris Bishop

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Over the last week I have been listening carefully to the arguments on both sides of the debate over the Data Retention and Investigatory Powers Bill. I am grateful to all those who have written to me for sharing their views and while I respect the concerns surrounding the Bill, I will be supporting it this evening.

In April, the European Court of Justice overturned a European Directive enabling the retention of communications data for law enforcement purposes. The consequence of this is that police in the UK will lose their ability to access the telecommunications data they need to protect the public and prevent crime. The purpose of the new Bill is to ensure that the police continue to have the same tools as they had before the ECJ judgement.

The Bill will mean that in limited circumstances, the police will be able to access details such as the time and data that message was sent as well as who it was sent to. Importantly, the Bill does not change the powers that the police have to access to the content of a message – which can still only be accessed under exceptional and rare circumstances and only once a warrant has been signed by the Home Secretary.

I believe that it is essential that the police continue to have access to this 'metadata'. It has been used in 95% of serious organised crime cases handled by the Crown Prosecution Service and every major counter-terrorism investigate over the past decade. The use of this data has also aided the police in targeting drug dealers, fraudsters and paedophiles.

A recent Europol investigation into child sexual exploitation identified 371 suspects in the UK – leading to 121 arrests thanks to the use of metadata. The same investigation identified 377 suspects in Germany yet no arrests were made because no metadata retention powers were available to the police.

I do recognise some of the concerns which have been raised surrounding privacy and therefore welcome the Prime Minister's announcement of extra safeguards on the use of these powers. Before 2016, the Government will review this and other communications intercept powers and establish a Privacy and Civil Liberties Oversight Board. Additionally, the Government will restrict the number of public bodies which can ask for communications data.

Fundamentally, this Bill gives the police and security services no new powers. It will only renew the existing tools available to them while enhancing the safeguards in place to protect our privacy. If we were to stand by and do nothing, I believe this would put us at greater risk from terrorism. I am glad however, that a so called 'sunset' clause has be included to allow for an in depth review of the legislation, giving this the time it deserves.

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Be very aware of abuse by vested interests. Just using technical jargon such as metadata. does not make this a robust argument.
- Edward

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Labour scaremongering that we would end up with a US-style health care system, with people having to pay for their care, was patently false. The reality, after all the Coalition's reforms, is that patients are still seeing GPs (independent profit-making contractors to the NHS since its beginning, by the way) free of charge and being referred to their NHS hospital of choice, free at the point of use, based on need and not ability to pay. Some pundits issued dire predictions that half of those hospital beds would be privatised, likewise completely untrue.

The problem with party political myths is that they distract from truthful debate about the real challenges facing our health service.

The Commons Health Committee, which I chair, has a role to play in helping to gather the evidence that matters to people and to set it out so that they can judge for themselves. The Health Committee holds the health system to account – from the Secretary of State to the doctor's waiting room, including the army of regulators and inspectors, on behalf of patients and taxpayers. Scrutinising related health organisations is increasingly important now that so much power has been devolved to NHS England and Clinical Commissioning Groups.

Systems matter, but mostly in terms of the quality of the care they deliver, how safe and effective they are, how patients are cared for and whether they receive that care in good time.

Nothing wastes money like unsafe care and there is still unacceptable variation in the delivery of safe effective care across the NHS. In my view, it is right to focus on identifying and tackling poor practice, making it as safe to be admitted on a Saturday as on a Monday, for example.

There is also far more to do to reduce health inequality through public health and targeting help at those who need it the most as well as reducing demand through prevention of ill health.

Of course, there are also questions to be asked about whether the increased transactional costs from marketisation have genuinely improved choice and efficiency. Did we get more bang for our buck alongside better care because of the reorganisation, or was that outweighed by disruptive fragmentation? Many aspects of the NHS are improving; greater openness and improving patient safety, for example, alongside better attention to evidence and outcomes.

Overall, the NHS has coped remarkably well with the financial challenges it has faced and despite those pressures has just topped an international league table produced by the Commonwealth Fund. Staff from across the service accepted a pay freeze and an ongoing pay restraint in order to help to protect services for their patients. They should be congratulated and it is important that morale is not undermined by a drip drip of negativity. Most people experience good care delivered by compassionate and professional clinicians, but when workloads

become overwhelming it gets far harder to maintain high standards. It is easy to see why staff can feel unfairly berated for problems, which may have been created by unrealistic workloads.

2015 will be a crunch year for NHS finances and NHS England should set out what can be achieved at different funding levels alongside their plans for dividing and allocating the financial cake.

If there is not an overall increase, it is hard to see how we could maintain current levels of service, given the rising demand from an ageing population living with multiple long-term conditions. The NHS budget has been protected in line with background inflation but that does not keep pace with inflation in health costs.

Now the pay freeze has come to an end that funding gap is set to widen, even with ongoing efficiencies. The choice is stark, and it would help for the implications of different funding levels to be set out by NHS England. I don't want to see any reduction in services, I would like to see further improvements and yes, that will require an increase in funding.

The question is will that be affordable and if not, what would politicians cut elsewhere to fund it? We need an honest debate about that.

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Read with interest comment re allowing people to live independently. A close friend , 84 years of age, was told 10 days ago that he was fit enough to go home,after triple by pass op,also diabetic. The hospital he is in is in different County to his home and this this is causing major problems arranging social care needed to allow him to live independently at home. . Both he and his family totally frustrated at lack of action by powers that be to solve this problem and he is, therefore now 'bed blocking' and very upset which isn't helping his recovery
- Jacqueline Nuttall

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The appointment of Mr Juncker as President of the EU Commission has put a committed federalist at the head of this powerful body. David Cameron was right to oppose this, recognising the view, clearly expressed in the recent European Elections, that we do not want to be part of a United States of Europe. There were also important arguments about the way that the European Parliament dictated that Juncker was, in effect, the only candidate.

Far from being weakened by his principled stand, David Cameron has secured important concessions and these have been outlined in the mandate to the Commission for the next 5 years.

There is an instruction to focus its efforts on building stronger economies and creating jobs.

Importantly, the principle is set out that the EU should only act where it makes a real difference. Where it doesn't, it should be left to nation-states to decide for themselves with a greater role for

national parliaments.

It also mandates the Commission to address the abuse of freedom of movement by those who move to claim benefits, rather than to work.

All the Heads of Government have agreed that they will address Britain's concerns about the EU and perhaps most importantly there is an explicit statement that ever closer union allows for different paths of integration for different countries and respects the wish of those who do not want deeper integration.

I am all for two speeds to 'ever greater union'. In our case that should mean firmly applying the brakes and coming to a stop until the British people have the opportunity to vote in an in-out referendum. To do so in advance of the promise to address our concerns would however, waste the opportunity to see how a reformed Europe might look.

If there are no meaningful changes to allow greater powers for national governments, to allow greater control over immigration or flexibility for business then, given a referendum in 2017, I would vote to leave. If however, we can negotiate a place within a reformed EU that genuinely allows us greater independence whilst retaining the benefits of unrestricted access to a European free trade area, then it would be in all our interests for Britain to stay.


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It will not matter how often he promises a referendum or even whether he pledges to bring it forward to 2016; unless David Cameron makes it clear that he is prepared to campaign for an 'out' vote in the event of a failed renegotiation, many people will feel that promise is meaningless. For a negotiation to have teeth, there must be a realistic prospect that Britain could vote to leave the EU.

The aftershocks from the recent elections have strengthened the Prime Minister's hand. Across the continent it is clear that the Treaty of Rome's central drive for 'ever closer union' is having the opposite effect, leading to the rise of nationalism and increasing rejection of a United States of Europe. Far from protecting us from conflict, enforcing uniformity increases the risk of extremism as an alternative to an out of touch European elite forcing people in a direction they do not want to travel. An opt-out from ever closer union should be first on David Cameron's list for renegotiation. It is time to reverse the tide and allow powers to be devolved where possible back to Nation States. The EU's greatest benefit to its members has always been as a free-trading block and it should return to that core value.

That will mean a tough negotiation to push for a single market in services as well as goods. For too long this has been resisted by those with protectionist instincts. It also means removing the barriers to competitiveness which result from over-regulation of European businesses. The EU must stop trying to interfere with so many aspects of our lives and embrace the principle of subsidiarity. Some aspects of employment regulations have been particularly damaging, for example the European Working Time Directive which has hamstrung the training of junior doctors and disrupted continuity of care across the NHS.

The Prime Minister was right to describe the EU as 'too big and too bossy'. It is also too wasteful and at a time when people across Europe have been struggling with austerity it is completely unacceptable for this institution to continue the so-called Strasbourg Circus and lavish salaries and benefits for its own employees.

Like so many vast institutions, the EU seems too preoccupied with expanding its own power base and has lost its democratic legitimacy. I rarely meet anyone who has contacted an MEP, even over issues about which they feel passionately yet are entirely regulated by the EU. Likewise, few who could name more than one or two of their regional MEPs. EU commissioners have no democratic accountability whatsoever and Andrew Lansley would hardly be a popular new addition to their ranks to fight on our behalf. The prospect of an arch federalist, Jean-Claude Juncker, being appointed as president of the Commission would make it even harder to see a reversal of the one way street to federalism and David Cameron is right to be opposing his appointment so vigorously.

Undoubtedly the greatest source of dissatisfaction with the EU in my constituency has been around immigration and benefits. If he cannot address these core complaints, David Cameron is unlikely to regain public confidence as a result of renegotiation. Britain does benefit from immigration but it is the scale and pace of change which has placed such an intolerable strain on infrastructure such as our housing supply, schools and health service. Free movement of people should not extend to benefits; David Cameron must demand a complete end to payments of child benefit to dependents living abroad and extend to at least two years the requirement to have lived or worked in the UK before eligibility for any benefits in order to reduce the flow of net migration.

Britain has already opted out of the 133 European Justice and Home Affairs measures; the controversy will be over to how many of them we chose to opt back in. Whilst we may at times benefit ourselves from the powers of a European Arrest Warrant, there is great and understandable anger at the way it may be used against our own citizens who may be compulsorily detained with little supporting evidence and in poor conditions. On balance, we should first protect our own citizens from arbitrary justice.

There are undoubtedly economic benefits from remaining within the EU and that free market needs to be extended and strengthened. Our club membership is expensive as we are the third largest net contributor but a British exit would also incur great costs as well as creating uncertainty and risk. Of course our European neighbours would not want to jeopardise trade with the UK but equally they are unlikely to let us leave on generous terms.

Far better in my view to back David Cameron in his renegotiation; he has a strong record to date having already vetoed a rise in the EU budget and removed Britain from the obligation to bail out the Euro. Far from Britain being isolated there are other nations which now see the need for reform.

I would prefer Britain to remain in the EU but not at any price or on the current terms. If these cannot be renegotiated, I will be campaigning to leave. To those who demand to know in advance the red lines, there should be none other than the clear, unequivocal promise of an in-out referendum on the outcome. The choice will then be yours.


Are you able to say why UK should remain in the EU?
- GeoffM

Under Articles 5, 8 and 50 of the Lisbon Treaty. The EU is obliged to negotiate free trade agreements with any departing country. But when the Lisbon Treaty comes into force on 1st Nov 2014, withdrawal from EU becomes subject to majority voting of all states. Since we are 2nd highest contributor, certain to be turned down, so Cameron's 2017 referendum is deceitfully meaningless, like his "Cast Iron" guarantee before.
- Ron West

You say "There are undoubted;y economic benefits from remaining within the EU. On what do you base that remark? When I listen very carefully to the arguments put forward by those who believe there is an economic advantage in being in the EU, I find myself totally convinced that they are right. However, when I listen very carefully to the arguments put forward by those who believe there is an economic advantage in leaving the EU, I find myself totally convinced that they, too, are right. Actually it would appear that nobody really knows which argument is right. Both sides rely on projections that are, at best, intelligent guesses regarding the global economy in years to come.
- Rodney Willett

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It is now just one year until the next general election but in the meantime, on the 22nd May, we face a vitally important European vote. The UKIP balloon continues to be inflated by the relentless 'celebrity' focus solely on Nigel Farage and corresponding reluctance to turn the spotlight on his own performance and that of his MEPs in the European Parliament. It's a miserable record on both attendance and, where it really counts, fighting our corner in Europe.

In contrast, Conservative MEPs turn up and engage with the issues that matter, like cutting the EU budget (opposed by UKIP) keeping Britain out of EU bailouts and crucially exempting small businesses from new EU regulations. Conservative MEPs have helped to secure vital reforms to the Common Fisheries Policy and led the campaign to ensure the safety of patients by insisting that we should be able to assess the language skills of EU health professionals.

The Conservative message is very straightforward, we are the only Party committed and able to deliver an in-out referendum but in the meantime whilst we remain in the EU we need to be involved and fighting for Britain's interests. We have terrific candidates, two of whom, Julie Girling and Ashley Fox have great track records and experience of fighting on behalf of the South West. This will also be an opportunity to vote for James Cracknell who wants to bring the same determination and grit to our task in Europe as he did to becoming an Olympic gold medallist. Georgina Butler comes from Torquay and, after attending a local state school, went on to serve our country as a diplomat. She has the skills and experience to make a real difference on our behalf alongside our two other women candidates for the South West.

The European Elections decide on the people who will influence a vast number of the laws and regulations that affect our everyday lives in South Devon. That requires commitment and constructive engagement alongside an unbreakable promise to give you the final say in a referendum by the end of 2017 following a renegotiation.

In my view this election is far too important for a negative protest vote.


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I wrote this article for the Telegraph.

We've been here before; a political promise from Labour to guarantee all patients a GP appointment within 48 hours. Another soundbite has been delivered with no idea where Ed Milliband intends to magic up the army of primary care doctors required to deliver it. Last time this was enforced, patients were unable to book advance appointments because GPs had to clear their diaries to accommodate political victory in the waiting time numbers game. Continuity of care was further eroded and it was deeply unpopular with patients who could get an initial appointment but not the follow up.

GPs would love to be able to see their patients without delay, with continuity and longer face to face appointments but this simply cannot be delivered without addressing the workforce shortfall on the frontline of the NHS.

In the long-term the solution will only come when we start valuing primary care in medical school training and design post-graduate training with the needs of patients in mind. Currently the career preferences of junior doctors and the need to fill training posts in our hospitals trump long term planning. It was good to hear this recognised by Simon Stevens, the new Chief Executive of NHSEngland when he appeared before the Health Select Committee.

It takes many years to train GPs but less time to bring returners back into practice. Half of today's GPs are women; a cause for celebration but also for better forward planning for the reality that many will take a career break for child care responsibilities. Women are not a 'drain' on the NHS, the majority want to get back into practice and often do so alongside other essential roles within the service. It makes financial sense to put more return to practice schemes in place for medicine and nursing to encourage back this skilled workforce.

Given the increasing complexity of the health problems managed in primary care, the number of appointments we need rises every year. This however, bumps into a long-predicted retirement bulge of full time male GPs and an ongoing shift of resources into hospitals from the community.

The Better Care Fund aims to reverse this flow but it won't deliver more GPs.

It is time to look instead at greater diversity on the frontline of healthcare. Bringing in a greater range of expertise from pharmacists and nurse practitioners will be needed if we are to make sure people can see a doctor within twenty four hours.

It won't be helped by Ed Milliband sprinkling top down directives like fairy dust.


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The following is an article that I wrote for the Guardian.

Under the Abortion Act 1967, it is a legal requirement for two medical practitioners to sign form HSA1 notifying the grounds under which an abortion is carried out. Both practitioners must certify their opinion, formed in good faith, that at least one ground for termination of pregnancy exists, and they agree on that same ground.

Only in emergency circumstances involving grave risk to the life or mental health of a woman may a doctor act alone.

Last year, however, the director of public prosecutions (DPP) decided not to prosecute a number of doctors who had pre-signed these legal documents after the Care Quality Commission found evidence that this amounted to routine practice at 14 clinics. In one case so many forms had been "rubber stamped", that the doctor concerned was found to have left several years previously.

The DPP concluded that it was not in the public interest to prosecute, because there was no proof that any abortions had been carried out that would not otherwise have been carried out if two doctors had legitimately signed HCA1. In effect, as with the issue of gender selection, it was left for the General Medical Council to deal with as a professional disciplinary matter.

The row has re-ignited because the GMC has also decided not to take any action other than to issue the doctors concerned with formal notices and demand a commitment that they will, in future, act within the law.

Would they have taken this line had the practice extended to consent forms for medical or surgical procedures? Probably not, as that would have directly harmed individual patients, but it could also be argued that allowing doctors to disregard the law without even a professional sanction because it was routine practice or junior doctors were unfamiliar with the terms of the act also sets a dangerous precedent. It is hard to see how this decision fits with the GMC's core purpose, which is to protect patients by ensuring proper standards in the practice of medicine. How can any doctor "form an opinion in good faith" about whether the grounds for a termination of pregnancy are within the law, if he or she has no intention of ever discussing it, let alone seeing the individual concerned. The actions of the doctors who pre-signed the forms were surely both illegal and unethical.

The GMC decision may have been a pragmatic one based on a judgment that it would be unfair to single out individuals for punishment when this was routine practice, but it should not have excused those in senior roles who surely had a duty not only to understand the law but also to ensure that junior staff acted within it. Pre-signing was also symptomatic of wider attitudes within some abortion clinics where a "no questions asked" approach also risked turning a blind eye to the abhorrent practice of gender selection.

The GMC decision is also dangerous territory because it plays into the hands of those with an altogether different agenda: to deny women access to safe and legal termination of pregnancy.

Across the Atlantic, that right is under grave threat and it would be a mistake to take a complacent view that it could never happen here.

In 2012, 190,972 terminations of pregnancy were recorded, a rate of 16.5 per 1,000 women aged 15-44 resident in England and Wales, a figure that continues to fall steadily from the peak of 18.6 per 1,000 in 2007. The multiagency work to reduce teenage pregnancies and improve access to contraception is paying off and the focus on preventing unwanted pregnancies needs to continue. Contrary to some of the alarmist messages on repeat abortions, no woman chooses this as her preferred method of contraception.

Moving forward, it makes no sense to prolong outdated and paternalistic attitudes that only doctors can make judgments about whether the grounds for the Abortion Act are satisfied. It makes even less sense to leave the situation as it is now with doubts about the legal obligation for a doctor to have seen the woman to whom form HSA1 refers; clear guidance must be issued as to whether doctors may sign based on evidence from clinical nurse specialists. A change to allow clinicians other than doctors to certify directly would, however, require an amendment to the Abortion Act.

In my view, the act is no longer fit for purpose. This would be a good time for a wider review of the ethical arguments and public attitudes, and to establish a legal framework fit for the 21st century.


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In a few weeks, NHS England and the Health and Social Care information Centre (HSCIC) will begin extracting and linking vast quantities of patient data across the entire NHS. I won't be exercising my right to opt out; not because I don't understand that there are theoretical risks in data sharing but because those risks are far outweighed by the potential benefits of improving the quality of research and services. If I am not prepared to share my own data, should I also expect to share the benefits?

Individual identifying details will appear as nothing more than a line of code to the bone-fide researchers allowed to access patients' data under strict conditions. For this to be tracked back to named individuals without permission would be a criminal offence. Quite frankly, if anyone wants to snoop on my personal medical information there are already far easier ways for them to do so.

Nor do I fear that this is a cynical ruse to sell our records for profit; the HSCIC will not be allowed to share information about us with insurance companies or solicitors. That they will do so with medical researchers including those working in the pharmaceutical industry is a great step forward if that means that the side effects as well as the benefits of new drugs in wider populations come to light more quickly. Data sharing will also make Britain a far better place to conduct research and this will result in research that is more relevant to the UK population.

The old folders for hand-written GP notes are called 'Lloyd George' folders because from the outset of the NHS, the State has owned our medical records; it still does. Whilst paternalistic attitudes are gradually shifting and we are now at least allowed to look at our own records, in reality few choose to do so. I recommend it, if nothing else to check that they actually contain your own records; you may be surprised. It is time for patients to be given ownership of their records so that they can share them with whoever they choose across health and social care. It would have great advantages, not least because we would all insist on better quality and consistency of note keeping. No more lost referral letters or dangerously uncoordinated care across hospital and community boundaries.

The NHS needs to share more data not less but it also needs to get better at explaining how and why this reduces the toll from medical accidents and improves the understanding of what treatments work best. Variation in the quality of clinical practice has long plagued the NHS and sharing data would allow us to get better at identifying both excellence and incompetence.

Whilst I understand the calls for the default position to be that people have to actively opt in to data sharing, the reality is that few of us change default settings, ever. The question is whether we want this to work. Without the default being set to share data, the simple fact is that it will not work and for that reason I have changed my position and agree that, without this default on the system, it would not be worth introducing 'Care.data' at all.

If you remain concerned that this will put your own personal medical data at risk it is important to contact your doctors surgery as soon as possible to ask to exercise your right to opt out. You need to do this even if you have already chosen on a previous occasion to opt out of sharing your Summary Care Record as this is an entirely separate issue.

Perhaps part of the answer is to make sure that it is easy for us all to see how our data is being used and to see who has been allowed to access it.

The greatest danger in practice remains the individual malicious or casual snooper within the existing system. We should all be able to check who has accessed our personal information and deliberate unwarranted breaches of privacy should result in immediate suspension and investigation.


Well put. Not wrong... I'm also a GP and somewhat keen on use of data and IT in medicine. I've opted out. The project is not administered as if people who don't like it deserved listening to... Bad.
- Adrian Midgley

To help students on the Master of Public Health (MPH) course at Imperial College London better understand the issues around the care.data programme, I asked them to work in two groups to prepare presentations for and against the programme. This was then followed by a debate among the students about the merits of care.data. You can view the presentations via the Medical-Centre blog. http://medical-centre.blogspot.co.uk/2014/02/mph-student-presentations-on-nhs.html
- Prof. Azeem Majeed

Thank you Prof. Majeed. That link is very helpful. So in summary: Good idea. Flawed implementation.
- Roger Miller

Dr Wollaston, I agree wholeheardtedly with use of anonymised 'green' data. I support the NHS, my father was a GP. But I cannot support this care.data method, communications or consent process. This process takes fully identifiable data & stores it on a rolling basis without any clear governance and beyond the control of my children for their lifetime and beyond. There is no policy on cross-country governance and yet the HSCIC, TK
- Mrs.P

Aviva has just experienced a misselling of private data and 2 have been arrested. Aviva are offering no compensation to those who have had THEIR private records stolen. If the NHS were forced into making substantial compensation payments for lost and stolen records they may become a little more resolute in their enthusiasm to keep our records safe from the prying eyes of commercial interest.
- Dan

I appreciate your detailed comments and explanation which are very helpful but cannot support my data (with means of identifying my whereabouts) being shared without me personally seeing the data and seeing the controls in place. Nor can any of my Patients Group members and a vast number of patients - nor indeed I suspect can any of our practice doctors. How does doing things in a shambolic way make a difference to anybody?
- Paul

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An amendment to the immigration bill was tabled last week by Dr Philip Lee MP, which would have allowed the same pre-arrival screening for infectious diseases including HIV which are already in place for TB. In reality the purpose of late backbencher amendments is to trigger debate.

I do not agree with the wording but I do agree that it is time for an open and honest debate about whether and if so how, to introduce screening for those permanently settling in the UK from counties with a high prevalence of HIV.

Screening has very clear benefits for people affected by HIV and we should embrace it, particularly for those at risk.

In parts of subsaharan Africa prevalence rates of HIV exceed 1 in 5 of the adult population.

It could be argued that it is tantamount to neglect not to screen those from countries where there is such a high risk of symptomless carriage and not only because early treatment for HIV very significantly extends life expectancy. There are also avoidable risks to current and future partners and to the children of pregnant women if people do not know that they need to take steps to protect them.

We have long screened for TB in those settling in the UK from high risk areas. Airport screening for those at risk was replaced by a pre-arrival screening requirement in 2012

There was no public outrage, perhaps because of the rising number of cases of TB in the UK and a calm appraisal of the evidence that three quarters were occurring in those arriving from overseas. TB is treatable and it is clearly in an individual's best interests if they have the disease to seek that treatment early. It is also in the public interest to protect the wider community from a disease which can be spread by airborne droplets and saliva.

HIV is not transmitted in the same way and there is no risk whatsoever from casual social contact so the issues are different but no less serious for those who are at risk.

I can understand why any proposal to pre-screen for HIV has been greeted with dismay; there is an acutely painful legacy of stigma and discrimination. The trouble is that the long shadow of that stigma is now costing lives.

It is the compulsion entailed by pre-screening that is controversial; in effect a refusal to comply excludes entry. Most people expect a screening test that is applied to them to be voluntary so why should it be different when applied to others? In effect, public protection has trumped free choice for TB.

Even more controversial is the issue of a bar on entry; a potential immigrant with TB could in theory obtain curative treatment and reapply but there is no cure for HIV.

The Lee amendment would effectively have permanently barred entry to anyone with HIV. I do not agree that is ethically justified. It would reinforce dangerous myths about the risks posed to others by those living with HIV. If screening is introduced for those who settle in the UK from high risk nations it should be without the threat of a bar on entry.

Too many people still assume that HIV affects only gay men or drug users. It is mostly transmitted through heterosexual sex

It is time to confront the myths about HIV alongside an open debate about whether to introduce a screening programme which, if properly implemented, could save lives through early intervention and prevention.


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I wrote about this in an article for the Guardian which you can also read below:

A seismic change may be about to rock our National Parks and Areas of Outstanding Natural Beauty. Hidden within technicalities the government is about to decide on a proposal to grant landowners permitted development rights, without the need for planning permission. This would allow for up to 3 dwellings to replace or convert existing farm buildings.

If this addressed the desperate shortage of affordable housing in our National Parks then it would be worth considering. Sadly it is set to make a dire situation even worse whilst at the same time destroying both the landscape and a fragile rural economy.

The average house price within the Dartmoor National Park is in excess of £270,000; nine times the median local income and over sixteen times incomes in the lowest quartile. The chance of finding affordable rented accommodation is also grim as just 11% of the housing stock is defined as such compared with the national average of 17% . The situation is forcing out young people and families with serious consequences for rural communities.

An increase in housing supply will do nothing to reduce prices if it caters for an entirely different demand. The proposals would allow for new developments to be almost twice the guideline size for affordable housing. Rather than meeting a genuine need they would unleash a second and luxury homes bonanza, creating yet more ghost villages and hamlets inhabited only at weekends or in season.

The impact of a free-for-all on planning cannot be underestimated and not only because developers are likely to prefer to convert the last remaining heritage outbuildings but because of the chilling effect this is already having upon the schemes that have been successful in building homes for local people.

Since the reduction in capital grants, the best mechanism for achieving genuinely affordable housing has been through granting planning permission on so-called exception sites. Where the land owner knows that there is no possibility of selling to developers at open market housing rates, affordable housing is cross-subsidised by a small percentage of open market value properties.

But with the prospect of a free run at open market development with few strings attached, landowners are now waiting for the outcome of the consultation. Values are set to rise sharply and we will kiss goodbye to the only realistic opportunity for development land at prices that can deliver housing for local people.

Suburbanisation of our national parks might also deliver the final coup de grace to their fragile ecosystems, already under pressure from changing grazing patterns over recent decades. Whilst cattle and sheep make way for pony paddocks in lower lying areas, loss of grazing livestock from the open moor will lead to a further degradation from heather to gorse. Who can blame them if hill farmers, asset rich and cash flow near zero, opt to throw in the towel and fragment or sell-up their holdings along with their livestock. They have long been struggling to maintain their way of life with scant recognition of their service to conserve this precious landscape on our behalf.

The planning minister, Nick Boles, has been bold in his determination to build more housing. He has walked towards the NIMBY gunfire on behalf of the people he believes should have the opportunity to own their own home. I hope he will look again at the unintended consequences of the proposed changes and place the genuine need for affordable housing above pressure from developers.

When Lewis Silkin introduced the National Parks and Access to the Countryside Bill to Parliament in 1949 he described it as a 'People's Charter for the open air'. The open countryside of our National Parks deserves our protection but also the living, breathing communities which conserve them for the future. We can build more homes for local people by supporting community land trusts and incentivising investment in genuinely affordable housing projects. The proposed measures, by further inflating land values will kill off any hope for village housing initiatives and put at risk the landscape of all our National Parks and Areas of Outstanding Natural Beauty.


I am afraid you have missed the point Dr Wollaston and have been listening to the very people who' s interest are disingenuous namely those at the head of the national parks and second home owners. First these buildings you are talking about , are in general within the curtilage of an existing dwelling and have a presence that exists like it or lump it , largely not very attractive at all particularly when not used ,your answer , do nothing , secondly there is a need for rural housing without doubt , the dart moor parks answer to allow the building of 10 houses a year . over the last ten years to serve a population 10,000 poor by any standards and I would put money on it that they look cheap because the bureaucracy has cost so much , and that applies to other villages out side the parks . Thirdly .how do you argue about some thing that is already there generally served by some sort of access generally in a poor state of repair . Your remit should be those things that could be enforced like the burying of cables to serve them ,employing good use of materials in relation to their environment .thus making them interesting , fourthly your argument suggesting that paddocks next to these pseudo holiday homes would have horses in them is fine not sure who,s going to looking after them being that there no one there for most of the time . And finally the farming point that you suggest ,that an asset is only an asset if it is making money in this case, and with your suggestion that when short of cash they are likely to sell , well if that's going to make the difference then they are not going to be there long anyway , so not sure what the point is , I should know because I am one.I am not sure who you got your advice from but I suspect from the likes of the national trust and national parks , try speaking to real people who are not under their jurisdiction. In my opinion you are not representing the views those who count .
- Malcolm burrough

Our protected landscapes should not be subjected to this planning proposal. Permitted development rights should not be allowed for buildings in these special areas which depend upon their landscape quality to sustain the economy. These potential developments will have considerable impact with increasing urbanisation as the infrastructure is added. Any short term gain by landowners will be detrimental to the wider community which is in need of affordable housing in the villages that are part of these special areas.
- ken carter

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Many people have contacted me with their concerns regarding the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill or 'lobbying bill'.

The bill has now completed its final stages in the House of Lords and will now become law. I agree that the legislation could have gone further to increase transparency in the area of lobbying. I was disappointed that the government rejected the Lord's amendment to include special advisors in the list of people with whom communication would count as lobbying. I could not support the coalition in the vote on this issue. The government has however agreed to an amendment that would allow them to include these advisors at a later stage.

There is far greater detail on this and other issues relating to the lobbying bill in the excellent report from the Political and Constitutional Reform Select Committee and it is well worth reading even if only the summary, which you can view via the following link

The report also sets out why charities should not be excluded from the bill. It is simply not the case that they will be 'gagged' in the run up to elections.

Other amendments made in the House of Lords include:

  • removing the requirement for third parties who do register to make any report to the Electoral Commission if they turn out not to spend more than the threshold.
  • An increase in that threshold before they need to register to £20,000 in England (the total spend allowed in the run up to an election would be £450,000)
  • allowing third parties who are part of a coalition to report through a single lead member, rather than individually;
  • making the regulated period come into effect from September 2014, rather than May 2014, to allow the Electoral Commission time to issue comprehensive guidance;
  • having a statutory review of how the rules are working following the 2015 General Election.

These amendments, proposed by the government following consultation with interested parties, were widely welcomed by many of the organisations who had expressed concern that the Bill as originally drafted might have some unintended consequences. The Chief Executive of the National Council for Voluntary Organisations, Sir Stuart Etherington, said:

"We are grateful that the Government has listened to the concerns charities have raised in recent months.

The Bill provides a much more sensible balance than it did to begin with between creating accountability and transparency in elections, while still allowing for charities and others to speak up on issues of concern."

On a separate note, this legislation demonstrated why we need pre-legislative scrutiny. Bills are improved if their proposals are properly considered by cross party groups of parliamentarians and those with lived experience and expertise before coming formally to the Commons. As it is, yet another piece of legislation which could and should have been more consensual, generated great acrimony, had to be 'paused' in transit and significantly amended. Passage through the Commons was unduly rushed and insufficient consideration was given to the Select Committee's findings.

Parliament should have a greater say over the time-tabling of legislation and insist on pre-legislative scrutiny and I will continue to press for these necessary reforms to take place.


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This week, I welcomed the Chancellor's call for an above-inflation rise in the National Minimum Wage. I believe that now our economy is growing again, it is only right that those people who have worked hard on minimum wage should see the benefits of that growth reflected in their income. Locally people in Devon are hit by lower than average wages yet higher housing costs.

In Parliament, I have consistently voted to support the Government in increasing the personal allowance, meaning that someone working full time on minimum wage will be paying only half as much income tax by the end of 2014 than they did before the election.

I recognise, of course, that we must strike the right balance between increasing wages and supporting local businesses and I hope that the Low Pay Commission takes this into account when making its recommendations for the level of minimum wage because small businesses will need further tax cuts to compensate for increased wage costs. No one would want to see businesses laying off staff as the alternative, especially if that increased youth unemployment, which is why I also support continuing differential rates according to age.

In the long term, I would like to see implementation of the living wage and hope that all those businesses able to afford this rate will move to implement it.

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The FSB (Federation of Small Businesses) supported the National Minimum Wage when it was introduced and continues to support the measure, provided the level does not damage business competitiveness or employment. We want to see a longer term approach to setting the minimum wage wit reforms aimed at giving businesses greater certainty. We know that where our members can afford to pay higher wages they do, but we believe paying each staff member the Living Wage should remain a voluntary decision for employers. It is an important aspirational goal, but shouldn't become a statutory requirement of all businesses, nor should it become a contractual requirement. Only 23% of businesses pay the minimum wage 53% of small businesses pay their staff at or above the Living Wage 7 out of 10 members report raising staff pay over the past 12 months, with one third having raised wages for all staff.
- David Shephard

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This week the care bill committee is debating who should be eligible for social care. MPs will also consider whether to add a clause that would enable exemption from social care charges for those at the end of their lives.

The amendment would also establish the need for better forward planning about where we would like to die. Most of us would prefer to be at home surrounded by the people we love, yet fewer than one in three are currently able to do so.

Why is it that 89% of those who die in hospital do so following an unplanned admission? In many cases it is because of the sheer exhaustion that comes with providing around-the-clock care. At the end of life there may be a period of days, but sometimes far longer, of complete dependency. Families go to enormous lengths to cope but, especially where there is only one person in a position to provide care, the elastic can only stretch so far.

All too often, an admission to hospital feels like an admission of defeat that can haunt bereavement with an unjustified sense of failure and regret. Those needing palliative care are being failed by poorly joined-up NHS and social care at the time when they need it the most.

Just 5% of those who care for someone with cancer at the end of life are identified as carers and, even where they are, will find that assets of just £23,250 (not including the value of their home) exclude the sufferer from entitlement to help with the cost of social care. These self-funders often struggle to find information about who is available to help or worry about how to find the money to pay for the cost of that support. Too often carers battle on alone, sometimes putting their own health at risk, until the situation completely falls apart.

Free social care can be provided for those who fit the exacting criteria for NHS continuing care, but 97% of healthcare professionals surveyed by Macmillan agreed that the complexity of social care needs assessments and the time needed to complete them were barriers preventing appropriate care. In reality, the bar is set too high to meet the needs of those nearing the end of life, let alone those caring for them. Many professionals and families describe continuing-care assessments as a nightmare.

Including a commitment to the principle of free social care at the end of life on the face of the care bill would drive change and enable many more people to experience a "good death" in the place of their choice. The proposed rise in the asset threshold to £123,000 will still leave many families stranded without a commitment to free end-of-life support.

It makes no sense to continue to admit people to hospital where a worse experience is also more expensive. Figures from the national end of life care programme show an estimated net saving of £958 per person who dies in the community rather than in hospital.

The problem is that social care and the NHS are funded from different budgets. There is no incentive for over-pressed local authorities to agree to fund social care at the end of life and every financial inducement for hospitals to admit. The £3.8bn Better Care Fund for integration of health and social care should help but has already been earmarked for a number of other vital projects.

There are other barriers to improving end-of-life care, somewhat arbitrarily defined as the final six months of life. Reliable and timely support from palliative care teams and community nurses also improve the chance of remaining at home and yet there remains unacceptable variation around the country.

It helps if doctors recognise their patient is dying and do not shy away from open and honest conversations about their wishes. A Dying Matters pilot study found that 67% of GPs rated themselves either "not confident" or "not very confident" in initiating conversations about end of life.

Failure to start those conversations results in poor planning with patients about where they would prefer to die.

The ability to share medical records also reduces avoidable admission to hospital. Where implemented, electronic palliative care co-ordination systems have helped as many as 80% of people registered to die where they wanted: another project earmarked for the Better Care Fund.

Anyone who has witnessed the lonely, impersonal deaths that can sadly happen on busy general hospital wards or in A&E departments will know why it is so important to enable genuine choice at the end of life. That will not be possible unless the government commits to allowing rapid access to free social care.


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Open data really matters when it comes to pharmaceutical research and I'm glad that this will finally be recognised in legislation on the face of the Care Bill. Inconvenient data should never be suppressed because that distorts the evidence base for treatments and puts lives at risk. Inconvenient data should also be published in a timely manner; it is just as pernicious to delay publication until after any relevant decisions have been made.

These principles should apply equally to social research, especially when conducted by publicly funded institutions.

Why on earth then did Sheffield University agree to delay the publication of the important research which so clearly set out that a ban on below cost selling of alcohol would have a meaningless impact compared with a modest minimum price of 45p per unit? http://www.shef.ac.uk/polopoly_fs/1.291630!/file/Addendum.pdf . Why for that matter were they asked to do so in the first place?

All governments are guilty of shabby practice when it comes to the deliberate leaking of policy ahead of official announcements and of delaying or suppressing the publication of inconvenient data. It matters because that prevents open debate about the evidence.

Just as the suppression of data by big Pharma costs lives, so does the mishandling of social care research.

The delayed Sheffield Study set out that a ban on below cost sales BBCS, which prevents the sale of alcohol below the cost of duty and VAT, would reduce overall consumption by just four hundredths of one percent 0.04%. More importantly in harmful drinkers by only 0.08%

Comparing the effects on health and crime of a 45p minimum unit price MUP and BBCS their appraisal was stark.

23,700 fewer hospital admissions per year with MUP compared with a reduction of just 500 with BBCS. The corresponding figures for reduction in crime were 34,200 versus 900.

I tried repeatedly in the run up to the policy announcement on the 17th July, a cynically judged date just as Parliament went into recess, to obtain a copy of the report but was able to see it only minutes before the Statement in the Commons by the then crime prevention minister, Jeremy Browne. A complete misnomer in the light of the policy decision that he was about to announce.

Is this the way for government to lead by example on the need for open data and what message does it send to the NHS, academia and Pharma on transparency?

At a time when health professionals are instructed to reduce avoidable early mortality through the NHS mandate it cannot be right that such a vital public health measure has been withdrawn. Whatever measures that communities, councils, the police and the health service put in place to tackle problem drinking, they will always be undermined when alcohol can be sold for next to nothing.

As the delayed Sheffield study reminds, BBCS will still allow the sale of cider at less than 10p per unit. Government must review the use of data and lead by example.


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The government has published its full response to the Francis Inquiry into the terrible failings of care at Mid Staffordshire NHS Foundation Trust. It would be a mistake to think of the problems raised as isolated incidents yet sadly there has long been a culture of treating those who raise concerns as the problem rather than addressing the underlying issues. Whistleblowers in the NHS have been treated appallingly, often finding their careers blighted and themselves subject to gagging clauses and intimidation. Too often patients and their families have been ignored or made to feel ungrateful rather than seeing complaints as an important and valuable way to guide improvements. The rising tide and cost of litigation has often been because that has been the only way for people to cut through to the truth.

One million people rely on the NHS every thirty six hours and most will encounter compassionate and dedicated staff often working under great pressure. They need to have the confidence to be able to raise safety issues be that about staffing levels or any other unsafe practice in order to protect their patients.

The response to the Francis Report set out that there will be a legal duty of candour for hospitals to be honest, not only about serious mistakes but also about the statistics they publish so that people can have confidence in their standards. It will also make sure that doctors and nurses have this set out in their professional and contractual responsibilities. It will become completely clear that they must not obstruct colleagues who try to raise concerns.

One of the great frustrations following the Francis Inquiry was the inability to bring prosecutions. The law will now be changed to make that possible in future with a new criminal offence of wilful neglect for the worst cases. This is not about professionals being forced to practice defensively, it is about establishing the principal of fundamental standards which should never be breached. The Care Quality Commission to take swift action, including prosecution, if patients are badly failed.

Health Care Assistants are at the heart of providing high standards and more than 1.3 million, mostly women, support people in their own homes,in hospitals and in care homes across Britain. They are undervalued and too often parachuted into the most difficult caring roles with totally inadequate training. Making that training and further support available for their important role will be a great step forward. In my opinion the commitment of HCAs will need to be matched by an end to the practices which have meant some hard working staff have effectively been paid below minimum wage and booked with impossibly short appointments which cannot deliver compassionate or safe care. In the future people will need to be sure that HCAs have received that training and the tiny minority whose practice has been shown to put vulnerable people at risk will be barred from working as carers.

It would be wrong to think of the response to the Francis Report as being a series of negatives. At its heart it sets out the principals of openness and of fundamental standards of care and safety and how we can establish these across the whole NHS.

Too often reports gather dust on the shelves, this one is too important. I'm glad to be a member of the Health Select Committee which will be closely following the implementation of today's recommendations: https://www.gov.uk/government/news/francis-report-on-mid-staffs-government-accepts-recommendations


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The Totnes constituency is well known for its independent High Streets. I was fortunate to spend a day in Kingsbridge to visit one of them for Small Business Saturday.

The Chancellor's Autumn Statement included some great news for those small businesses which had been hit particularly hard during tough economic times alongside fierce competition from online and out of town retailers. Time and again business rates have been raised as a chief source of the problems alongside parking charges which drive people away from town centres.

Introducing a £1,000 business rates discount for retail food and drink premises with a rateable value below £50,000, effective for the next 2 financial years will certainly help hard pressed businesses. On top of this discount, the increase in business rates will be capped at 2% next year, allowing business owners to plan ahead.

The blight of empty shops will also be addressed with the new measures to be introduced from next April. If a business moves into retail premises that have been empty for over a year they will receive a 50% discount on their business rates for their first 18 months; any business which makes this move in the next two financial years will be eligible. Small businesses which seek to expand will also see the business rates relief rules relaxed for their first year if expansion. These changes will ensure that our high streets are vibrant and attractive, which will benefit new and old businesses alike.

These changes, as well as smaller changes to payments schedules and the appeals process, will help the viability of small businesses but none of them will succeed unless we as consumers do our bit and shop locally. Unless we use our High Streets we will lose them. So don't shop online this Christmas; use our local shops!

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hi, Sarah, how are you? As mentioned on Twitter. I think this blog post is misguided. It's lovely to buy in shops but: 1. Some people can't - I was amazed to see the number of comments citing disability/age/etc in comments on a recent Daily Mail article on high street shopping. 2. There's a massive opportunity for lovely, little shops to subsidise their offline presence with higher margin online sales. This is essentially what all the big high street shops have done - sad to accidentally discourage the small ones from competing. dan
- dan barker

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Scratch the surface of any Briton and you will find a migrant. In my case, it was my great-great-great grandfather John Israel Wollstein, who emigrated from Poland and settled in England in the 1830s after marrying a local girl, Mary Carter.

Fast forward three generations and his entire extended family in England simultaneously anglicised their names by deed poll, apparently after choosing the name from Burke's Peerage. It was more than a marker of patriotism; bricks through the window were a common problem for those with Germanic names during the Great War.

Sadly some attacks are again being levelled at some of today's eastern European migrants.

People fretted about them in Edwardian England, just as they do today. The "real" Wollastons took umbrage; in a book about their own family's achievements, my ancestors made the final pages, but only as a warning about the European Jewish family who had usurped their historic name.

Within a generation, the Wollstein's distant cousins back in Poland faced genocide under Hitler, a stark reminder of the potential consequences of scapegoating and xenophobia.

Language matters. Witness the disturbing stereotyping of Roma people. But there are also dangers in silencing debate. Branding people as racist when they questioned the benefits of mass immigration crushed open debate very effectively until Gordon Brown derided Gillian Duffy as a "bigoted woman". People listened to his sneering comments from the back of his limousine and something snapped.

Over 2 million people had moved to Britain within a decade but the infrastructure was not in place to accommodate them. The consequences of the scale and pace of change were not borne by the political elite or champagne socialists, but in deprived areas where young people in particular were already struggling to find homes and jobs.

Labour now admits that its failure to apply transitional controls to new accession nations was a terrible mistake. Roger Daltrey said he would never forgive the party for "destroying the jobs of my mates", pointing out that mass immigration had fuelled a resentment which was no fault of the migrants themselves.

In all the noise it is easy to forget the serious consequences for accession nations, too. While the NHS is keen to recruit more nurses, a mass exodus of skilled staff from hospitals in eastern Europe leaves behind far greater difficulties. It is the same with schools and industry.

Immigration from Bulgaria and Romania from January seems unlikely to be on the same scale as from Poland and elsewhere in 2004 as many Bulgarians and Romanians will choose to settle in Germany or Italy – but frankly no one knows how many will come. Our population is already rising faster than in any other country in Europe, with one-third of this the result of immigration. The pressures on infrastructure and employment can no longer be ignored.

This week, David Cameron will come under intense pressure from a small minority in his own party who want Britain to close its doors and refuse to accept its treaty obligations, even if that means eye-watering daily fines. According to some reports, the prime minister is considering extending the length of time new arrivals have to stay in this country before they qualify for state benefits – he will have to find a way that can be done without discriminating between British citizens and other Europeans in eligibility for benefits. He should try to find a way of reducing the "pull effect" for unskilled migration by increasing the length of the so-called habitual residence test. He could perhaps exempt anyone who has been educated or worked for a year in the UK.

Prime Ministers should not direct others to break the law. Nor should they pander to the hysteria that risks engulfing this sensitive issue. Immigration is putting strain on the infrastructure in some areas, but the British economy is recovering, unemployment is falling, and skilled migrants have always contributed a great deal to this country, and must be allowed to continue to do so.

However, it is also right that Cameron should concern himself with deteriorating community relations in places like Sheffield, and right that he consider the consequences of doing nothing. He must grasp the nettle.

Britain stands to gain just as much from migration today as it did when the multilingual Wollsteins brought their expertise and enthusiasm to the Victorian Baltic timber trade.

We must, however, get the balance right. Failure to acknowledge or respond to reasonable concerns about the scale and pace of change will only play into the hands of those with an entirely different agenda, fanning the flames of xenophobia and dividing our society.


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I originially wrote this article for the Western Morning News.

Since the start of this year there have been three occasions in Devon and Cornwall alone on which children between the ages of twelve and thirteen, acutely unwell with mental illness, have been detained in police cells as a 'Place of Safety' under section 136 of the Mental Health Act. A total of 25 occasions counting all children aged seventeen and under.

There isn't anything that feels safe about a police station to an acutely distressed child. Nor to an acutely distressed adult for that matter, which is why Home Office guidance is clear that they should be a last resort.

Section 136 allows a police officer to detain someone in a public place who they believe may have a mental disorder presenting a risk to themselves or others, to take them to a Place of Safety to allow for an assessment.

As Devon and Cornwall has such poor provision for appropriate Places of Safety, the Peninsula has the country's second highest rate of using police cells instead.

This year alone 674 assessments have taken place in police custody and only 277 in a medical or psychiatric setting. Nationally, nearly 22,000 people were subject to these police powers last year with Sussex the worst offender for use of cells.

The real scandal however, is that on so many occasions the use of compulsion could be avoided altogether if mental health services were to proactively assess and help those in difficulties before they became so acutely unwell. 82% of those detained under S136 don't go on to further compulsory admission which suggests that many more could have been helped by an alternative route.

This is not entirely a story of overstretched resources although undoubtedly it is the major factor. It is also a story of buck passing and on occasion of failure to put individuals before 'doing the system's business', to quote from the Francis Report. Psychotic individuals are unlikely to register as patients or ask for help if they do not recognise that they are unwell and yet too often an assessment is refused without a formal GP referral. Some GPs refuse to see people unless they request help. In such situations it must surely be possible for referrals and registrations to come from non-medical community workers before an individual descends into such a crisis that they need police intervention? The Health Service is far too rigid in the way it excludes individuals because they fail to exactly fit criteria for an assessment and carers too often face brick walls when they try to access help trying to avert an impending crisis. Of course there are important issues about capacity, confidentiality and the right to make decisions, even bad ones, about our own health, but there are times when these are deployed as a smokescreen to avoid caring for people with challenging behaviour.

Another problem is the way that funding streams in this area flow into the separate silos of health and policing. Mental Health services are still waiting for the much vaunted 'parity of esteem'. In the meantime, far better outcomes could be achieved for acutely unwell service users by better joint working with the police

The police are forced to spend unacceptably long periods of time taking individuals to Places of Safety in dedicated units, police stations or emergency departments and then waiting for assessments and transfers.

Once in custody under a section 136 the lack of doctors, approved under section12 of the Mental Health Act, to carry out the further assessments, usually taking place out of hours causes further delays. These delays however are expensive for the police rather than the health service so there is little incentive to change even though it is clearly a distressing ordeal for the person under detention.

If an individual does need to be admitted to hospital they then face delays through the lack of available beds. In the last month in Devon and Cornwall alone, four people were held in police custody for such long periods of time that a bed provisionally booked was no longer available once the ambulance arrived to transfer them to receive the care they needed. The CQC have found that in over 50% of psychiatric wards there is 90% bed occupancy and in 15% of wards in excess of 100% occupancy. For children the situation is dire with almost no provision for assessment in an appropriate medical setting, let alone in-patient beds.

Four percent of total police arrests relate to Section 136 and the scale of inexcusable delays and avoidable harm need to be urgently addressed.

A pilot, using street triage, with community mental health nurses working alongside the police in high risk areas to try to avoid the need for compulsory detention in the first place, is a step in the right direction. In the long term however, we need police and health resources to be pooled so that providing the right prevention and care makes financial sense too; more importantly it would benefit those who are amongst the most vulnerable in society.

On a final note, 71% of those in police custody under section 136 of the Mental Health Act are under the influence of alcohol. Many have complex dual diagnoses of mental health and dependency problems often fuelled by 24 hour access to ultra cheap alcohol at little over 20p per unit. They are paying a very heavy price for the failure to introduce a minimum price of at least 45p and the health and criminal justice systems are struggling to try to cope with caring for the people who fall through the cracks.

Perhaps if more politicians spent a night in the cells, they would at least understand why police stations are the worst place to care for an acutely disturbed child and end this national disgrace.


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It is highly likely that either you or someone you love will, at some point, depend on a Health Care Assistant. There are 1.3 million HCAs, almost all of them women, providing personal social care in our communities and making up almost a quarter of the NHS nursing workforce. Despite caring for the most frail and vulnerable in our communities they currently receive little or no training or recognition.

One HCA spoke to me about her dismay at turning up to an 'interview' where no one was interested in why she had applied for the job or whether she was suited, let alone had any qualifications for the role. She was then parachuted into an impossibly busy caring schedule with no supervision and expected to cope. Low pay, too often with no reimbursement for the time taken to travel between clients, pushes many HCAs on zero hours contracts below the minimum wage. The only surprise is that the attrition rate, currently over 20%, isn't even higher. That it is not is thanks to the dedication of those truly remarkable HCAs who carry on against all odds. In the face of dire staff shortages there is also a far greater risk that a small minority will continue to practice despite being entirely unsuited to any caring role. Dangerous enough in a care home but who is there to notice or blow the whistle when HCAs are working unsupervised in the community? Even if a vindictive individual is dismissed there is nothing to stop them accepting a post elsewhere and no mechanism for a potential employer to be alerted to the dangers faced by their own vulnerable clients or family. It is also extremely demoralising for the majority of dedicated HCAs to see confidence in their role undermined by a minority as was so appallingly demonstrated at Winterbourne View.

The current system is failing both patients and HCAs. The insightful and thoughtful review undertaken by Camilla Cavendish in the wake of the Francis Review sets out how to make a lasting difference and next week the government is due to set out further details around implementation. So far the news has been encouraging with a clear determination to improve recruitment and make sure staff are trained before starting work. This needs to be a clearly understood and portable 'Certificate of Fundamental Care' for both nursing students and HCAs completed by undertaking this practical training together rather than in separate silos. Many HCAs do not want to undertake a nursing degree but they do want to be able to access professional development and to feel included and more valued as part of the clinical team.

As a medical student I worked my way through university by working as an HCA. It left me with a lasting respect for the challenges of their role. It was also an insight into the hierarchical structure of nursing; auxiliaries, as they were then known, were expected to be seen and not heard. In too many places HCAs report that is still the case.

How refreshing to meet with those in this role today from Guys and St Thomas' to hear about the benefits for patients and staff alike from their model for training and professional development. HCAs there have voted to change their name to Nursing Assistants. The name matters because nursing is at the heart of their caring role and this should be adopted across the NHS linked to the attainment of the Certificate of Fundamental Care. Rolling out their model of training will be simpler across the NHS than social care but if we are to improve standards and retain a more valued workforce there must be greater linkage in training between the two. Joint training for nursing assistants in the community would be a good use for some of the £3.8bn earmarked from health to benefit social care and a single portable certificate would allow people to move from one sector to another. There are also some really promising models for training in my Totnes Constituency such as the Studio School at South Devon College valuing this as a career choice http://devonstudioschool.co.uk/students

Whilst training and professional recognition are important, the glaring unfairness of wages across social care must also be addressed; the cost of putting this right is small compared with that of the avoidable admissions that result when a fifteen minute visit inevitably delivers poor care. Amendments to the Care Bill in the House of Lords include a requirement for councils to consider wellbeing when commissioning care but this may not be sufficiently explicit to change existing practice. HCAs must be able to spend the right amount of time with each individual relying on them for support, that may cost more in the short term but good value compared with the human and financial cost of an avoidable emergency hospital admission.


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Sir David Nicholson gave evidence to the Health Select Committee on the 5th November, possibly for the last time before he steps down as the Chief Executive of NHS England. His core message was that politicians must stop reorganising the NHS and instead allow the service to focus on improving services for the million of us who use it every thirty six hours. There is an important difference between essential changes to local services and reorganising the entire structure of the NHS. The question is whether the Health and Social Care Act has made the first priority more or less difficult and whether we need to urgently amend the legislation.

The way that services are delivered across the NHS needs to change if we are to prevent unnecessary admissions to hospitals and reduce the pressure on A&E. The problem is that in today's NHS, commissioners and managers consult on changes but find their plans are doomed to sink in bureaucratic quicksand and legal challenge.

At least £3.8bn has been allocated from 2015 onwards from the NHS budget for joined up care with social services. This could be transformational in bringing about the integration of these services but it will not work unless those changes can actually be put in place.

Sir David spoke of being 'filled with frustration' by the obstacles.

He was clear that the intention of the Health and Social Care Act was that competition should be used as a tool to improve services for patients but in practice that is not happening. More worryingly he did not know the cost of the legal quicksand nor whether this was a problem that required amendment of the legislation or merely clearer guidance on interpretation.

The existing guidance is widely ignored. David Bennet, the Chief Executive of the regulator Monitor, has set out in a number of settings that commissioners are putting too many services out to tender and yet the waste of resources continues. Perhaps because no commissioners have the spare cash to fight a legal challenge themselves.

We should be in no doubt that real changes to services, ones that save lives and money, cannot happen under the existing rules without squandering the same resources that should be there to improve people's lives.

The so-called 'Nicholson Challenge' to spend £20bn differently in order to cope with rising demand on a flat, albeit protected budget has now grown to £30bn as demand continues to outstrip resources. Those savings are coming largely from wage restraint in all groups it seems apart from management.

It was extraordinary that Sir David could not set out the detailed costs of the gravy train of redundancies and re-employment elsewhere in the system. There was even a correction (via twitter) from a former management colleague who alerted him that she was in fact being paid as a consultant, not providing her services free as he had originally asserted.

Sir David is not alone in his concern about the lack of financial governance within the system but it seemed odd that the man at the top had such a poor grip on the level of the payments to those passing through the revolving door of re employment.

The news from Colchester came too late to raise with Sir David but he must urgently address the issue of data manipulation which was such a feature of the Francis Report. That anyone should think it acceptable to amend the medical records of people's treatments or appointments in order to massage the figures to fit waiting time figures is deeply shocking. The Care Quality Commission has rightly referred its findings to the police but on a wider note, cases like this highlight the need for a statutory duty of candour.

At an earlier meeting in September, organised by the Health Service Journal, Sir David spoke of visiting a trust which had used competition law to try to protect themselves from having to stop cancer surgery, even though they didn't meet any of the guidelines. The public must be able to have absolute confidence that clinicians and managers are putting their safety above their own organisational convenience or fear of embarrassment.

The final Nicholson Challenge really must be to set out what needs to be amended in the current legislation in time for this to be added to the Care Bill before Parliament.


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One lethal product, tobacco, used exactly as the manufacturer intends it, kills half its customers. For this the government has backtracked on plans for further regulation, claiming that it needs more evidence. For another product, e-cigarettes for which there is little evidence of harm, there is in fact mounting evidence to the contrary, we are rushing into the kind of regulation which will undoubtedly increase costs and potentially increase the harm from tobacco.

It matters because that harm could not be starker; smoking kills 114,000 people every year. It is, by a country mile, the single most important cause of preventable early death and health inequality. We cannot tackle the 17 year difference in life expectancy between the richest and the poorest parts of the UK without reducing the number of teenagers who take up smoking.

This is also about the living deaths caused by smoking; anyone who has witnessed the misery of long term severe disablement from emphysema, gangrene or smoking related strokes and blindness will be glad not to have become addicted themselves.

The point is that these conditions have their deep roots in addiction. Most smokers begin their habit as children. Among existing adult smokers, two thirds report that they started smoking before the age of 18. More worryingly, Cancer Research UK analyses of national data show that a round 207,000 children aged between 11 and 15 started to smoke in 2011.

Standard packaging is not about nannying adults, it is about making this fatal attraction less attractive to children and the evidence is that it does just that. Tobacco packaging is the last legal form of advertising; which is why the manufacturers are lobbying so hard to protect their flashy branding. The fact that they are so worried and lobbying so vigorously is a sure sign that they know it will be effective.

It is sometimes referred to as plain packaging but that is a misnomer, there is nothing plain about it at all. It presents the reality of those living deaths in a stark staring visual format; a far more compelling message than any verbal health warning. Handing someone a packet of gangrene is visually repulsive; the proposed packaging hands them a crystal ball rather than a marketing lie.

Doctors, nurses and smoking cessation advisors are out there rolling up their sleeves to reduce avoidable deaths; they are asking government to bring in standardised packaging to help to prevent the next generation of addicts. Every year we wait for the long term evidence from Australia we should bear in mind the hundreds of thousands of new teenage customers lured into a fatal attraction.

On the other hand, with very little evidence of harm, we appear to be rushing in to regulate e-cigarettes. Regular use of e-cigarettes amongst children is extremely rare, there is no evidence at all that these products are generating new addicts despite widespread awareness of these products amongst young people. Continued use is confined to current and ex- smokers. These products are being used to help people to quit or to reduce their use. There has been a fall in the uptake of formal smoking cessation advice but we should investigate to see whether that could be because people are quickly, easily and more cheaply able to access an alternative and far less harmful product.

Just at the time when we are witnessing a fall in tobacco sales across Europe and an increase in use of e-cigarettes, we should be assessing whether this is a casual or a causal link. The tobacco lobby blame this on illegal sales and insist, wrongly, that standardised packaging would cause a rise in the illicit trade. It is time to assess the role of e-cigarettes and before we rush to regulate these as medicinal products, to assess the potential impact on cost and harm reduction.

Of course, we want any product, on direct sale to the public which is inhaled into the lungs, to be safe but when that comes to electronic cigarettes we should not lose sight of the fact that the product they are designed to replace kills half of its customers; tobacco is not safe at all.

When it comes to burdening companies with regulation, frankly government should not lose sight of the villain of the piece; they should focus on burdening big tobacco.


OMG an MP who has a real grasp of the situation. The big tobacco companies are spending a fortune lobbying against E-Cigs and "Vaping" and not just in the UK. They seem to be winning in certain parts of the world, and it would be nothing short of a medical disaster if thousands and possibly millions of people wre denied easy access to a much safer product. Nicotine is addictive, I am a nicotine addict, but I hav'nt had a single cigarette in the past 15 months. I didnt quit nicotine, I quit smoking and started VAPING.
- James Shorrock

Having smoked 40 cigs a day for 42 years and tried every smoking cessation aid without success, I started using an electronic device and e liquid four months ago and have not had a cigarette, nor had any desire to have one since. The facts and not the myths must be publicised and I commend your article in forwarding that position.
- lynne

How unexpected to read an MPs thoughts on the ecigarette issue and to find them reasoned and heartening, and how sad that it should be unexpected. My own MP has repeatedly just sent me quotes about how the MHRA want to regulate them to make them "safe and work effectively". I'm one of many who don't use tobacco anymore because I prefer ecigs, absurd that there are plans afoot to replace a thriving marketplace selling hundreds of devices and thousands of juices with a medically regulated one selling just two.
- Liam Bryan

You are singing from the same hymn sheet as all us "vapers", please get this thinking over to the APPG, Jane Ellison/ Jeremy Mean and perhaps a word in the shell like ear of the PM. When you say "not to rush to regulation", not like Anna Soubry who rushed off to the EU to commit the country to the Tobacco Products Directive, overiding scrutiny, of which is still under scrutiny awaiting the DOH to announce a date for debate in committee C, whilst the TPD is already in Trilogue. please help to get our own house in order and be instrumental in bringing about the biggest advance in healthcare for decades due to the potential of E cigarettes as you have with your unblinkered view. Thank you
- Localpeasant

It is refreshing to see an MP willing to take the time to consider the impact of regulations disproportionate to ecigs. No Vaper i know uses the product under the impression that it is completely harmless. Nothing is. However as a smoker of 35 years i can attest that in the last 11 months my health has improved dramatically since i switched to vaping on an ecig. The MHRA wants to regulate ecigs as a medicine yet have stated openly that not one single product in the world would qualify for a medical authorisation. This would mean a complete and total ban on the ecig industry and a death sentence for many of us who would quite likely return to tobacco. E Cigs are not designed or intended to be a medical device and this is why they work. It is the diversity and the customisation options that makes them so attractive to ex smokers. Take away the flavours, variety of mechanisms and the ability to self titrate and they will lose all aspects that make them a viable alternative to burning tobacco. The vast majority of vapers are supportive of age restrictions but as adults we know what works for us and what doesn't. There is a saying. Nothing about us without us. If government wants to know about what they are. Ask the people who use them every day. Ask the very people who have staked their lives on them.
- Michael Barton

Thanks for the enlightened and reasoned blog Sarah , regarding regulation this lady (Jill Rutter) from the Institute for Government made some excellent suggestions to help regulators http://www.instituteforgovernment.org.uk/blog/6772/the-shock-of-the-new/?CMP=EMCSOCEML657&et_cid=53593
- Alan Beard

I've got COPD Emphysema and stopped smoking using a vapour cigarette nearly 4 months ago, my breathing is better and have not had an chest infection in all that time whereas before I was very ill on a monthly basis,I couldn't have done it without my vapour.I would recommend them to anyone.
- caz

It is more refreshing than we vapers can possibly explain, to read a blog such as this from an MP of any colour. For that we are really very grateful. I was a smoker of tobacco for 23 years and having tried all manner of NRT and quitting methods started to realise that I was likely to never be able to give up. That was a miserable state of mind when I have three children who would rather have their mum around for as long as possible. I am under no illusions that had I not tried an ecig (2nd generation for me, cigalikes had no appeal as I smoked roll ups) I would never have put the tobacco part of my habit behind me. 21st November 2012 was the last time I inhaled lit tobacco! The very next day, my husband did the same and now we are approaching our one year vapeversary. Neither of us have had a single puff on a ciggy since and have no desire too, our smoking has been completely replaced and, honestly, I will be a vaper for the rest of my life. If I can't? I will smoke again. Not long ago, my dad also took up an ecig after repeated failures at 'quitting' and a long, expensive, stint addicted to nicotine gum. He too has switched completely from the word go. Something my mum will tell you is remarkable! We have been trying so hard (the community) to engage the decision makers, the policy makers, the health experts, the health charities, our MP's and MEP 's and we have found support in there. Sadly many have simply ignored us, attacked us and accused us of being mouthpieces for the tobacco industry. Nothing could be further from the truth. It's very difficult to understand why some are so vehemently opposed to the concept of harm reduction, or why electronic cigarettes are being demonised at every turn when they should, surely, be celebrated. Every vaper, whether a dual or exclusive user, will have a similar story to mine and we are not being heard and our experiences are being ignored. We realise how close we are to having these taken from our hands and current smokers never having the chance to try them outside of a Dr's prescription or visiting a pharmacist to purchase a joyless clinical NRT device. The market will die, and so may many smokers, quite needlessly. I hope you will support us in our fight, as it is far from over.
- Lorien

Public health is power mad these days. They are hating on electronic cigarettes with serious venom that seems to stem from the whole thing not being their idea. Alas many legislators go along with whatever these people say instead of doing full research which is why it is satisfying when one does go and research and sees the hypocrisy being spewed forth. Electronic cigarettes are the first truly viable alternative to traditional smoking and the public has to be shown this and the lies have to be exposed.
- vereybowring

It's so refreshing to hear from a public official (not to mention a doctor!) who is actually thinking about this, rather than following the lobbying efforts by both Big Tobacco and Big Pharma. The truth is that the cumulative benefit of smokers quitting or even just reducing their intake of combusted tobacco could change the public health picture in many good ways. Sad to see the medical/pharmaceutical establishment fighting so hard against something that can only help their supposed aims.
- Jim

After 25 years as a heavy smoker I switched to vaping this February following a heart attack. I've tried to stop smoking many times in the past and nothing worked. Frankly, licensed NRTs are a complete waste of time and money. E-cigs are different. Instead of just focusing on the nicotine, which seems to be a very small part of the addictiveness of smoking, they mimic the habitual actions involved. This means they really work. I haven't had a cigarette in nine months and don't feel any urge to, either. I'm quite happy with the equipment I have now and dread the thought of being forced to rely on over-priced "medically approved" junk.
- Fergus

At last, a UK MP who has weighed the very small risks associated with widespread e-cig use against the massive risk of continued tobacco use and has come to the obvious conclusion. Chris Davies MEP & Rebecca Taylor MEP took up the fight in the European parliament and won the vote, thereby potentially saving millions of lives ( and gained the Lib Dems many vaper votes ). Hopefully Dr Wollaston will play a similar role at Westminster because there are many MP's who simply will not engage and slavishly follow the MRHA stance. Well done Dr W, you have done the right thing.
- RobW

Great and informed article. You are to be commended on having such foresight that the majority of our MP's seem to be sadly lacking. I smoked for 28 years and tried everything to give up and failed miserably, until ecigs came along and saved me. My mother died a horrible and prolonged death from a smoking-related illness. I just wish ecigs had been there for her.
- Keith Hunt

Thank you for thinking about the ecig issue and not just accepting the public health lobby position.MEPs have listened to vapers too although we had to accept a half-good amendment for expediency.We expect the Commission and Council of Ministers to try and wriggle out of the new amendment - listening to the people would set a bad precedent! Your government has,so far, by-passed the rules on scrutiny - the debate has still not been finalised even though the trialogue hopes to get full agreement by this year-end.Is there anything you can do to help ecigs avoid what will be a fatal dose of medicines regulation?
- Dodderer

A very balanced view-thank you
- steve

Fantastic, an MP that 'gets it'. The vaping revolution, for it is nothing short of that, has taken place in spite of, not because of the self serving Public Health bodies. It is nothing short of nefarious the way they portray vapers and vaping. A common assertion is the apparent lack of evidence that vaping leads to quitting as if 7 milion EU vapers do so to look cool in restaurants. Thank you
- mattdidius

Thanks Sarah for this very perceptive blog entry , my story mirrors many 40/day over 45 years tried and failed the NRT route and then by absolute fluke "discovered" Vaping in the most unlikely of places - a Pedelec Blog . I have not smoked a tobacco cigarette now for 10 months and have zero desire to do so as long as I may freely choose . With regard to regulation this lady (Jill Rutter) from the Institute for Government mirrors your thoughts see http://t.co/gfxVEAkxpx , sensible tailor made and proportionate regulation is what we hope results .

"Lorien" pretty well summed up my views perfectly. I stopped smoking cigars just over 8 months ago, having smoked almost every form of tobacco since the age of 17 (I'm 53 now). Prior to this I had tried on a number of occasions to give using NRT and failed miserably every time.....the last time I tried "Champix".....what a bloody nightmare that was, how it ever got medical approval I will never know!! Using E-cigs, giving up tobacco was easy and I haven't had the urge to smoke since. Thank you for your support
- Whipitup

It's good to see such clear thinking from an MP on the subject of e-cigs. I believe too many politicians think vapers are just smokers who've found a loophole in the law. Nothing could be further from the truth. We have each made a concious decision to improve the quality of our lives. Vapers are generally not opposed to some kind of regulation, but the MHRA's proposals are tantamount to prohibition. Thank you, and please keep up the good work.
- David

Thank-you Sarah. At last an MP gets it. My own has brushed me off, initially agreeing with me but then trotting out the party-line. The MHRA are about feathering their own nest through fees and placating the pharmaceutical companies that are their real masters. 45 years of smoking came to an end for me within the 1st month of trying a decent e-cig. The prospect of the MHRA (who really do not understand) implementing their 'measured dose' approach shows a profound misunderstanding of the issues. If their proposals are implemented, the existing market will disappear due to the cost of regulation and the result will be that the market will be given to the tobacco companies. It is really important that MP's sign the EDM regarding the MHRA and that they ensure that ministers are lobbied to approach the EU Trialogue in a sensible manner. Medical regulation is a nonsense designed to placate Big Pharma but resulting in giving the market to Big Tobacco. Please don't let this happen.
- Poldav

Many "vapers" have contacted their respective MP's across the country and I suspect I speak for most when I say that we are envious of your constituents. At least know when you respond to an issue that it is your own opinion you are expressing - not merely that of your political party. If I may quote Jean-Francois Etter who recently ran a study on the subject of e-cigarettes at the university of Geneva "It makes little sense to try to cripple the safer one so the deadly one maintains the market monopoly".
- slim

Another vaper here, sarah, with a similar story to tell as those above, such that I've reduced my chances of premature death by 50% by switching to e-cigs after 25 years of being a very committed smoker. So I really just want to say thank you, that as a politician you have a real harm reduction goal, rather than a pretend one like those seeking to effectively ban e-cigs through over-regulation. Chris Davies MEP and Rebecca Taylor MEP, acting within the EU parliament to save e-cigs, have in consequence probably saved more lives than any other politicians this decade. E-cigs offer the only viable route for dramatically reducing smoking prevalence in the UK, and thus diminishing the single greatest cause of preventable disease and death. An MP who stands up for that will be doing more for harm reduction than any other individual active in UK policy making. My very best wishes.
- Wilkuz

Thank you for taking a logical approach to ecigs and not losing sight of the massive harm reduction potential they represent. You are a breath of fresh air! I smoked 20-30 a day for over 2 decades yet had no real desire to stop. However, out of curiosity I tried vaping. Within 2 days I had fully switched from smoking to vaping. This happened simply because vaping provided me with a superior experience in every meaningful way (and continues to do so). That was 6 months ago...
- Andre

I have to tell you Sarah that reading your blog has brought me to the brink of tears - of relief! Many of us have spent almost a year battling to get the message across to the decision- makers that they have a massive opportunity to change the face of Public Health forever. Enlightened people like Rebecca Taylor and Chris Davies have listened to us and supported us at E.U level - we owe them a huge debt of gratitude - but I have always felt that here in U.K a deliberate attempt has been made, particularly by the MHRA to undermine and indeed to discredit the validity of the e-cig. Hence my relief to find that someone who is not only a Member of Parliament but a very widely experienced member of the medical profession actually "gets it" It is almost four years since I smoked my last cigarette; my 20 a day habit which dominated almost the whole of my adult life had left my health seriously compromised, but I still continued to smoke until my son chanced upon the e-cig. and bought me one. Suffice it to say I have needed no oral steroids or antibiotics since, even Salmeterol is finally off the menu. My aim is that others should have this opportunity, and this will not happen if the dead hand of medicalisation is allowed to stifle innovation. The e-cig I use today is a far cry from that first life-saver, and the flavours now available allow me to get as far away as possible from tobacco. H.M Government really need to be aware that they are gambling with the lives of almost 2 million "vapers" but we are in need of someone with political contacts to inform and enlighten them. Most MPs just move the paper around from one department to another and everyone gets an identical reply but we press on. I have written to Jeremy Hunt directly, as I'm sure others have done; all we ever get back is the repeat of MHRA mantra - we have to be sure they're safe - like tobacco cigarettes? Which a lot of folk will go back to' Sorry about the rant Sarah but I feel so deeply about this, and thank you for giving me a little hope.
- Dragonmum

If only more MP's had the logic to see things this way. Vaping has saved my life. I have not had a cold, flu or any chest problems since taking up vaping two years ago. Thank you Dr Sarah for thinking about how e-cigs are a much safer alternative to smoking.
- Lee

http://e-cigarette-summit.com/ One thing that may be of interest to you and happening next week. Some very respected people will be debating this issue.
- Michael Barton

Yes, I am yet another one of those boring ex smokers, as a result of trying an e cig last December. I had no intention of quitting cigarettes, it just happened overnight. Your stance on e cigs is particularly refreshing, because it is my impression that you initially had your doubts about them. BUT you did your homework with due diligence, and reached a logical conclusion based on the evidence that you found. That is what sets you apart from the other MPs who toe the party line like sheep. Heartfelt congratulations.
- neptune

Excellent piece, I was a smoker for 40 years & now a vaper for over 1 year
- Jon Holland

Chris Davies, Rebecca Taylor, and now you, Dr Sarah Wollaston will, I'm sure, get many more votes at your next elections. Another politician who "gets it", to coin a phrase used many times above. I'm another 25-year smoker turned 1-year plus vaper with NO tobacco in that time. We as a country, an EU and as a world need far more politicians such as your good self and the two MEPs mentioned above who can and will see through the Big Tobacco and Big Pharma propaganda and support what has the potential to to turn the health of the smoking world around. As for the politicians that worry about loss of tobacco revenue, point them at the potential savings across the NHS in not having to treat tobacco-related disease. Thank you for a refreshing blog piece, and if you have chance pop over to the All About Electronic Cigarettes (AAE-C) forum where I'm sure a warm welcome will be waiting from many, many vapers.
- GunJack

Wonderful piece, thankyou for standing up against the tide and backing personal vaporisers (also called e-cigs). As a ex-smoker and fulltime vapor i have seen how this industry has changed lives 1st hand, i have encouraged other smokers onto pv's with 100% success, with more support from more people like yourself that are willing to stand up against the tide we may just making smoking a thing of the past for many more people. What we really really need now is proper education about these devices and how to use them more efficiently, with backing this is a real possibility.
- Peter Tozer

Great to read a sensible blog on this issue for a change. You are correct, we have a choice at the moment: let the e-cig market thrive (to the benefit of smokers, x-smokers and a number of small businesses) or over-regulate them (to the benefit of the tobacco companies who want people to continue smoking, and the pharmaceutical companies who sell ineffective NRT). We know that e-cigs are several orders of magnitude safer than tobacco - it seems nonsensical to consider any intervention which might reduce access to them. If this country did endorse actions that restricted access, it would be a public health disaster. Existing legislation that safeguards the public with respect to the safety of devices and the ingredients in e-liquid are sufficient.
- Sue Wilson

I have not read all the comments yet but can echo the first comment by James Shorrock. For me it will be the one year anniversary of giving up SMOKING on 10th November! I'd smoked around 20-30 for 35 years and gave up the day after I bought an e-cig, I can honestly say I've not had a single cigarette since and feel far better for it. My own doctor is also very pleased of course. From your article above - "Just at the time when we are witnessing a fall in tobacco sales across Europe and an increase in use of e-cigarettes, we should be assessing whether this is a casual or a causal link. The tobacco lobby blame this on illegal sales ..." I strongly suspect any fall in tobacco sales is a result of e-cigs, just about everyone I know who smoked has either totally given up using them, or have partially switched. Only one older friend in his 60s is doggedly sticking to his 'real cigarettes' and seems frightened to try switching. He needs to as his health is not so good. E-cigarettes should be looked at in a very positive way by health professionals and it does make me wonder why they are being so astonishingly slow to acknowledge such a powerful new weapon in the arsenal to wean smokers off tobacco. From what I have read over 1 million in the UK have now given up using e-cigs, given the time they have been available they've probably been more successful than any other form of NRT and all at no cost to the state!
- Steve Bartrick

After being a smoker for 29 years I had tried nearly all the (useless) NRT's on the market and had given up hope of ever breaking the habit until May of this year when I tried my first e-cig now just over 6 months later I am still smoke free.
- C.Stevens

Thank you so much Sarah for your thoughts on ecigs.Like most of the others who have left comments.I had smoked for 48 years and during that time tried everything under the sun to quit tobacco. NRT worked a number of times, however this was short lived and lasted the most 6 weeks. Since trying an ecig 9 months ago I haven't felt better for years.My family are over the moon not having to watch me struggling when walking and trying to get my breath..My GP is pleased as she knows how many times she has tried to help me stop smoking. I fear that if the British Government (Presently conservatives) try to medicalise ecigs,they will be condemning many people to illness and an early death. I honestly cannot see the sense in this.The only people that will benefit with such a decision is the pharmaceutical and tobacco companies.I know this because if I can't buy an ecig and eliquid then I will go back to smoking,and most likely need drugs for either COPD, Heart attack, Cancer etc etc. The person who is leading the medicalisation of ecigs in the EU is Linda MacAvan,a Labour MEP. Surely the conservative party cannot let this terrible act of manslaughter go ahead on their watch.Please educate and inform your colleagues what a very foolish act medicalising ecigs would be to their constituents,never the amount of lives and money which could be saved by the NHS. Your colleagues in the liberal coalition have listened to vapers and worked hard at speaking up for sensible regulations. Once again many thanks for speaking common sense,and not following the many other MPs who have not taken the time to look at the research and its outcomes. Linda
- Linda

Sarah, thank you. Your statement echoes everything that vapers have been trying to get our MP's and MEP's to understand. how can a known killer as tobacco cigarettes be more openly available than an infinitely safer alternative defies all logic. Public health MUST come first and not the 'all powerful' tobacco and pharma companies vast profits. Preserving the e-cig in its current legislative form will be the single greatest decision anyone can make to promote health, save billions in NHS funding, and could see the demise of tobacco cigarettes. How ANY politician can defy the true facts defies all logic and can only indicate an alterior motive. Sarah, please enlist as many colleagues as you can to support e-cigs as a general consumer product, and not regulate it out of existance. If they want a medicinal e-cig for 'NRT' (cos patches n gums domt work) then let them medicinalise the 'lookalikes' such as nicoliye and e-lite. But let us vapers choose our own devices and liquids as suit our needs and lifestyles. Kindest Regards
- Mark

Like all the comments here I thank you for your concern and applaud you for your insight. I think we all understand and welcome regulation of the vaping industry but it does not fit into either the medical nor the tobacco boxes. The nearest products are cosmetics. Just like them there is a worry that they should not harm the public. Cosmetics have not been found to need medical regulation. All that is needed is for e liquid to be made from Pharmacutical quality components, labeled as such and tested by trading standards. Nothing new need to be put in place to ensure they are as safe as they can be. I would welcome this especially knowing the track record of the tobacco companies adding chemicals that make cigarettes more addictive to prop up their bottom line. Sensible regulation is what is needed.
- David Moger

I smoked from the age of 13. I am now 51. I have tried periodically over the years to give up, going cold turkey, using patches, hypnotherapy and prescribed zyban among other things. None have significantly worked. I came across e-cigarettes during an discussion on an online forum in July 2012. Based on the independent, unrequested info, I searched and was surprised to find a huge market out there. To cut a long story short, I bought a starter kit in August last year and, without putting myself under pressure to give up, started using it. Very quickly I smoked less ordinary cigarettes and in a matter of max 4 weeks, I found my 40-a-day habit cut to 3. In October of that year I smoked my last cigarette. I no longer liked the taste. It is now just over 12 months since I had a cigarette. And it’s all thanks to an electronic cigarette. My partner who smoked the same, if not more, than me is exactly the same. Both hardened smokers, I never for one second thought we would stop smoking. How wrong could I be. We now no longer have night-time or morning coughing fits (there is no doubt it is healthier!), we don’t stink …and we have more money in our pockets. If we could give up, anyone can. And anybody who tries to put a spoke in the wheels of this phenomenal invention can only have a hidden agenda. Shame on them!
- Mike

Please remember this costs the government nothing. Apart from lost tobacco tax revenue, but then the government wants all smokers to quit, right? Millions of lives may be saved by e-cigarettes, there is only one position to take for an honourable politician and I am glad to say you are one of them.
- Flatfish

Thank you very much for taking the time to see the logic and to express it here. I have been a heavy smoker for more than thirty years. One day my husband and I just happened to try an e-cigarette and within a day or two neither of us were smoking tobacco any more. I had not expected this to happen as it was mainly curiosity rather than a desire to stop smoking that made us try it but I know we will never go back to cigarettes unless we are forced to by the government. At present e-cigarettes are an effective alternative to smoking. Nothing else has worked like this for us. My father died of lung cancer due to smoking and my own doctor told me to stop smoking due to my health and yet I could not stop smoking for longer than a few weeks. E-cigarettes have been a godsend and I have never felt healthier but the government now wants to make them less effective. The medicinal route is wrong. Correctly enforced consumer laws is all that is needed so they remain a good alternative to tobacco. However, nobody seems to be listening, including my own MP. It was wonderful to come across your article which gave me a little hope that perhaps the government will see sense before it is too late.
- Jan

You should stand tall and proud that you, Chris Davies and Rebecca Taylor are the front line for common sense. Looking back over history it took guts to listen and learn then stand up against blinkered opinions. Here we have people moving away from smoking and taking up vaping instead saving the NHS a lot of expense . Thank you
- mugwump

Thank you for your unbiased stance. i won't go into minute detail but `i'm another ex-long term smoker…25-30 a day for 33 years. My first vaping kit arrived on 1.11.12 and I've never smoked another cigarette. Like many vapers, my PV looks nothing like a cigarette and I feel many MPs simply have no idea that anything exists except cigalikes! I also feel very strongly about the biased, manipulation of evidence quoted by the MHRA and BMA to name but two. If a tobacco company used data in this way, they would be in court faster than you can say 'e-cig'. It is disgusting that these organisations are being allowed to distort the facts, to the point of medical misconduct and I sincerely hope that your voice will help to set matters straight. Thank you.
- Nell

I'm a member of the Labour Party and I have to applaud this blogpost from a political 'opponent'. I was a 60-a-day smoker who gave up completely by using e-cigs. Stupidly, I started again this summer when my partner was getting very cantankerous & snappy by trying to give up 'cold turkey'. However, I'm on about 12-15 a day, not 60. Smoke free makes a massive difference to everyday exercise and leisure activities such as cycling
- Geraldine Curtis

it is not The big tobacco companies are spending a fortune lobbying against E-Cigs and "Vaping" it is our own government along with others who are loosing tax but the big culprit is the big pharma companies who dont want e-cigs as it is not only killing their profit on NRT but it is showing them up for how bad it actually is. the nhs's own figures show nicotine replacement therapy (nrt) is between 95 to 97% INEFFECTIVE, so at best it only works 5% of the time long term, so why is the governments still using millions of £ to provide nrt on the NHS?
- k austin

ITV1 16/1/2014 the tonight programme, the issue is being raised on national TV. I`m in favour of ecigs, they work for me
- jeff travis

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This article first appeared on the Telegraph website

This week the Chief Executive of the NHS Sir David Nicholson, gives evidence to Parliament for the last time before his retirement. I hope he takes the opportunity to clarify how it can meet the demands of the future.

He set out his eponymous 'Nicholson Challenge', for the NHS to make efficiency gains of 4% year on year, long before the last General Election. This had cross party support because all sides recognised that the escalating cost of caring for our ageing population meant that change was both essential and inevitable. A quarter of our population now live with one or more long term conditions and at the other end our birth rate has increased by 22% in a decade. Add to that the escalating costs from new technologies and treatments alongside the rising tide of lifestyle factors such as poor diet and alcohol and it was clear that the NHS could not continue with business as usual and hope to provide the right care at the right time in the right place.

The National Audit Office, in its December 2012 report recognised that 'changing how health services are provided is key to a financially stable NHS.' The point is that this is not just about money, it is about a service that delivers what people need in this century rather than the last.

To date the 'efficiency gains' have largely been achieved through the NHS pay freeze, albeit with automatic annual increments for many staff, and by reducing the so-called tariff payments to hospitals for the treatments which they provide. Other economies have mostly been through one-off savings that cannot be repeated in future years. Critically however, almost none of the underlying purpose of the Nicholson Challenge has been achieved; changing the shape of the service to one which meets current needs. Pull a lever to shift the pattern of care in today's NHS and nothing happens.

The reality is that reconfiguring services has been made more rather than less difficult since the implementation of the Health and Social Care Act. Despite the clear evidence that there are times when it really is better for your ambulance to drive past your local A&E in order for you to be treated at a specialist centre and that money needs to shift from acute to community services, these vital changes are drowned in bureaucratic quicksand. Sir David needs to set out the underlying cost of the many failed mergers and reorganisations around the country. Did we really need the Office of Fair Trading as well as Monitor when the whole purpose of Monitor was to be the expert sector regulator? How on earth do patients benefit when vast resources are diverted into fighting legal challenges? I hope we will hear some clear evidence on the costs and what needs to change in order to actually make change achievable.

The stated aim of the reforms was to put clinicians at the heart of commissioning as they are best placed to understand the needs of local communities. This vision of a locally facing NHS with small charities, social enterprises or even private providers where appropriate, able to contribute was a good one. What a shame that many such organisations find themselves squeezed out by larger organisations without a local presence but with the resources to put together the most professional bid.

Monitor has already told the Health Select Committee that commissioners are unnecessarily putting many care pathways out to tender but that message is not getting through, perhaps in part because few commissioners have the spare cash to be the first in court facing a legal challenge.

Clinical commissioning groups are coping extraordinarily well with the challenges they face and NHS staff have rolled up their sleeves to deliver the kind of satisfaction from their users that politicians could only dream of. It is time for politicians to now help to clear the barriers to change.

When the HSC visited Copenhagen we were enthusiastically shown slides about their plans for integration; they were from my local Care Trust in Torbay. Their joined-up health and social care was held up as the international model of best practice and yet this same trust now faces unnecessary delays to further integration between the hospital and community care. This is at odds with Torbay being named as one of the Department of Health's fourteen integrated pioneer sites, designed to help their innovative plans to improve seven day access and mental health services.

The announcement of a further transfer of health spending for a social care need is welcome but will not go far enough without a revision of the NHS funding formula to recognise age and multiple morbidity as the principal drivers of need.

On a final note, the State does have a duty to help with prevention in order to reduce the demand on overstretched services. Front line NHS staff would like the politicians who talk about the need to reduce avoidable early deaths to put in place the vital public health tools that will best enable them to do their job.

Before he leaves the organisation he has served for 31 years, Sir David must set out what needs to change within the current legislation if the NHS is to cope with providing the best possible care to the one million of us who use its services every thirty six hours.


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The latest data (Feb 2013) showing the Employment Support Allowance (ESA) caseload shows that overall there were just under 2.5 million working-age claimants of ESA or predecessor benefits, Incapacity Benefit (IB) or Severe Disablement Allowance(SDA). Of these, just under 1.6 million were on ESA and just under 900,000 were still on IB or SDA.

Overall, 44% of these ESA/IB/SDA claimants had a main disabling condition of a 'mental and behavioural disorder'. Some of the remaining 56% may also have had a diagnosed mental or behavioural condition which was not recorded as the main condition.

The point is that mental health problems make up the single largest group of conditions for which people are claiming these benefits and yet our system of assessment and appeal is too often seen to be letting people down.

The percentage success rate for completed appeals fell from around 40% in the first year of ESA's existence to 30% in the most recent quarter's worth of data (Mar-May 2012). This figure is still too high and we need to pilot alternative approaches. I wrote about this for an article in the Guardian which you can also read below:

This weekend the government announced it was delaying changes in disability welfare because it was unable to assess claimants in time. I welcome this decision, which affects the rollout of personal independence payments to replace disability living allowance. But ministers should also use this breathing space to examine the continuing problems of ­assessment and appeal for those with other disabilities such as mental illness.

Around one in four of us will suffer from a mental illness at some point in our lives. In my case, the bleak ruminations and hopelessness of postnatal depression hit like a tsunami at the happiest time of my life. I would not wish to return to that place, but don't regret the experience. I was a more empathic doctor as a result, but also perhaps more conscious of the pitfalls around attitudes to employment and mental illness.

For many people, working is part of their recovery – not just because of the financial gain but for social identity and contact, structured time and a sense of personal achievement – and we must not send a blanket message to employers or sufferers that it is harmful to return to work until fully well.

When I stepped back into employment I was commuting long distances by public transport, still gripped at times with panic attacks and tearfulness. Painful as that was, forcing myself to travel and to work was important for my recovery.

Sometimes people need a push to get back into work, but that should not feel like a coercive or punitive shove. Sadly, I regularly meet constituents who have found the process of work capability assessments – the government's test to decide if you qualify for employment and support allowance or should rejoin the job market – to be humiliating. Far too many face an unacceptable delay to their appeals, and the hearings take place in the inappropriate setting of our criminal justice system. While those presiding at tribunals do their best to make people feel at ease, what message does it send to a person already crushed by low self-esteem or anxiety to be seen in the same setting as offenders? Not surprisingly, it adds to their sense of worthlessness – already stoked by a long-standing narrative from both sides of the political divide that they are "shirkers not workers" or a drain on Britain's "hardworking people". They are neither.

If the timing of a return to work is wrong and there is no support at either end of that journey, it is more likely to end in failure, or worse, deterioration and further loss of confidence. I was fortunate to have that support from my family but if that is lacking, it needs to come from elsewhere.

The challenge is to find a way of assessment that does not force people back to work when it is not in their best interest. For the variable, subjective but debilitating symptoms of mental illness, a tick-box process is doomed to fail unless it takes account of the fuller picture.

My experience as a trainer of junior doctors was that there was great variation in how GPs completed sick notes. A minority viewed them as a way to "catch up" in a busy surgery and rarely challenged a request. This variation was in part why work capability assessments took the place of GPs.

The problem with the current system is that it appears even less likely to deliver the right result for individuals or taxpayers. There needs to be an earlier and more thoughtful input from the "decision-makers" in appraising the evidence from all those who have been involved in a person's care – be they GPs, psychiatrists or psychiatric nurses, or carers.

Perhaps if remuneration for the assessors, Atos, was penalised according to the number of successful appeals, the company might be more likely to get its decisions right in the first place.

Though it is important to help people back into their existing jobs when they have been temporarily off sick, there are greater challenges in helping those who have been unemployed in the long term through mental illness. We are setting up too many of these people to fail.

One approach, Individual Placement and Support, has been shown to work well for people with long-term and severe mental illness in a number of countries, and psychiatrists here have argued that a trial is long overdue in the UK. Traditionally, work placements for those with mental illness have required skills training in advance: "train and place". IPS aims to find a job on the open labour market and then provide continued support to help people settle; in other words, "place and train".

Assessments and the work programme could do much more to support those with mental illness. For many people, working is a key part of their recovery. Yet, our system often reinforces low self-esteem rather than building confidence or long-term success. We should pilot alternative approaches.


Some disabled people already have a poorly paid full time job with compulsory overtime. It is called their illness.
- Mathew Mills

I often wonder what it would be like for me to have a job. My mental ill health started when I was a child, and by the time I should have been at university and embarking on my life plan--graduate, become a teacher, get married-- my mental illness was so severe that the next 15 years were consumed by it. The thought of having a job almost terrifies me-- I haven't worked in over 10 years, and with my illness I can only be fully active 2 or 3 days a week before succumbing to exhaustion. This is what a lot of people don't understand about mental illness-- it's physically exhausting, and if an employer doesn't understand that their employee may not be able to complete a 40 hour week, or might not be able to work the allotted days that week, and isn't willing to let them go part-time, or make their working days flexible, then that person may well have to quit the job in order to preserve their health. And if the person likes their job, and loves being in work, then having to leave might have a negative effect on their mental health and start the spiral of illness and low self esteem all over again. Placing and training sounds good, as long as the employer recognises that they must be flexible in order to keep hold of a good employee who cannot do a regular 9-5 schedule.
- Z Agbah

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Professor Sir Bruce Keogh's review into 14 hospitals with the worst mortality indicators over a two year period has been published today amid a storm of recriminations. It should not be an excuse for politicians to berate each other but rather an opportunity to focus on the lessons for the NHS.

It is well worth reading the original http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf

There is an explanation as to why the two main measures of relative hospital mortality, HSMR and SHMI, should not be used to claim any particular number of avoidable deaths. These statistics are far too open to manipulation and too blunt an instrument to give a true picture of overall care and most hospitals will have pockets of good as well as poor practice.

Statistics can add to a number of early warning signals but should never be relied upon as the sole indicator of failure. Excess mortality is however a good predictor of trusts where doctors and nurses do not feel engaged. Listening to staff as well as patients and their families is simple to do but some trusts simply do not do this; they are more likely to deliver poor care as a result.

Data can be misused in many ways; some Trusts ignore poor results and simply trumpet success. This misses the point that this data is primarily collected to help to identify problems and to put them right.

Another problem arises when transparency is used to blame rather than primarily to help drive a change in culture and practice. A message for politicians too.

Other problems such as poor medical cover at weekends, nurse staffing levels and locum cover are recurring and ongoing issues which NHS England and the Royal Colleges must work to address. Blame and recrimination however, just makes it even harder for these hospitals to recruit the best staff and demoralises those who remain.

We will all benefit from an NHS which is open to complaints and sees them as an opportunity to improve. Those who have been harmed deserve an open and honest apology but the best apologies are those that try to make sure that a team gets it right in the future.


Thank you for speaking up for the NHS. Through friends and relatives, I've been privileged to see some of what goes on. Over the years, I have witnessed only one doctor treat a patient , my eldest sister, badly. As soon as his colleague was made aware of the problem, everything possible was done to reassure my sister and explain what would happen. I have no doubt that awful things have happened within the NHS and they must be addressed but not at the expense of those who are doing a great job. I genuinely fear for the future of the NHS, even more so after today because it appears to be in the hands of people I wouldn't trust to apply a sticking plaster.
- Carol Gardiner

There are many problems in NHS and in medical regulation. Tens of thousands of patients have died each year unnecessarily and over 100 doctors while investigated by the GMC. There is Petition demanding Confidential Enquiry into those deaths: http://epetitions.direct.gov.uk/petitions/54034 There are many unlawful practices and GMC always gets splendid report from its overseer that has changed its name but not spots. Psychopaths can get jobs at GMC and in NHS and they too cause damage, including damage to politicians who honestly may be trying to do their best.
- Dr Helen Bright

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Plain packaging has been formally killed off and minimum unit pricing sits nervously on death row for its widely trailed execution. The only winners perhaps big tobacco, big alcohol and big undertakers.

The power of industry lobbying in forcing these policy shifts cannot be underestimated. Labour's lead is back into double digits as people register their distaste and few believe it is a coincidence that the biggest tobacco giant of them all, Phillip Morris Ltd, has said that it employs the services of Lynton Crosby's company CTF. You don't need to have a conversation about tobacco or alcohol if public health in its entirety is one of the 'barnacles' that has been scraped off the boat.

David Cameron should delay an announcement about minimum pricing until we know whether big alcohol interests are also paying for their services.

But there is an even better case for a stay of execution; the clear evidence from Canada that minimum pricing works.

Industry have relentlessly tried to undermine minimum pricing by arguing that it would make alcohol too pricy for those on low incomes and that it would penalise the poor.

It wouldn't raise the price of alcohol in the pub by a penny, neither would it make alcohol expensive but it would get rid of the ultra cheap white cider and spirits that are targeted by binge drinkers and those starting to lose control.

Overstretched casualty departments and liver units do their best to pull people out of the river but it's far better to help to stop people falling in upstream in the first place.

This has always been the role of public health but its contribution is unseen and unsexy; it's hard to count a teenager who didn't take up smoking or binge drinking and no one comes by to thank you for saving them from a lifetime of addiction.

Public health regulations are often controversial at the time but who would want to go back to the days of sitting in smoke-filled restaurants or cars without seat belts? Do we still feel these are examples of unacceptable State nannying?

A few weeks ago I went out on patrol on a weekday afternoon with Totnes' Police Community Support Officers; at three in the afternoon they were politely escorting home an abusive drunk. Brixham's special constables tell me that alcohol-related incidents take up almost their entire workload on Friday and Saturday evenings. Almost half of violent crime is linked to alcohol and more than 700,000 children in the UK live with a dependent drinker. If the real cost of ultra-cheap alcohol was added to the price-tag on the can instead of silently buried in our tax bills, there would be no argument at all about the need for action. £21bn per year is the current estimate.

Perhaps the only good thing that can now be said of the coalition's policy on public health is that they have devolved it to local government. What a shame that their ability to reduce avoidable early deaths and narrow health inequalities will be undermined by the politicians who have taken away one of the most effective tools to do their job.


Thanks for your concern, honesty and integrity in pursuing these policies. (not what I've come to expect from MPs) I have never in my life done it before, but if I lived in Totnes I'd vote Tory. Good for you (no reply required to this email)
- stuart barrie

Spot-on Dr Sarah - crikey, those are real honest fighting words and I bet they'd have the wholehearted support of all those people who deplore the making of profit at the expense of someone's health. I agree with Stuart - I might do the same thing if I lived in your constituency, and I've only ever done that once before when I voted for Ted Heath because he supported our remaining in the EU (EEC as it then was). I also do not request a reply, just keep up the good work!
- Michael Gray

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I don't doubt the risk we face from rising global greenhouse gas emissions and peak oil. Totnes should rightly be proud that Rob Hopkins and this community are at the heart of the internationally renowned Transition movement, taking practical steps towards sustainability and greater resilience.

There is widespread support for roof mounted and small scale solar installations and projects such as Transition Streets, which DECC minister Greg Barker, visited in April this year, bring people together to look at energy saving and micro generation.

Support for renewables is however at risk of collapsing as a result of large scale projects such as the vast acres of solar PV springing up across the South Hams. Despite clear statements that this kind of solar PV should be on commercial roofs and brownfield sites

that has not been the experience in the South Hams. Locally we have witnessed an insensitive industrialisation of our countryside with fears that existing projects are just the tip of the iceberg. Local people feel powerless and angry.

From the Renewables Obligation RO and Feed in Tariff FiT databases, the UK currently has around 1.6GWs solar capacity. This is mostly small scale with the average size of projects being about 4KW (or four thousandths of a MW)

To be clear, only 71 out of 369,912 sites are larger or equal to 500 KW ( that's to say over two and a half acres) contributing only 203 MW of the total 1.6 GW

That however is changing and changing very rapidly as a result of the uncontrolled proliferation of large scale, ground mounted solar arrays.

Looking at DECCs own planning database, there is 1.7 GW of solar capacity waiting in the wings, either going through planning or in construction.

Unlike our existing small scale solar, the vast majority of these projects are large scale and over half of it is very large scale, greater than 5MW

To put this in context, 1MW of solar takes up approximately 5 acres of land. In other words, more than half of these projects that will cover an area greater than 25 acres.

South Hams District Council SHDC has received 28 full applications for solar arrays of which 25 have been approved. These will cover an area of 108 hectares, that's 268 acres with a further site at appeal and only 2 withdrawn.

It is hard to convey the scale of these or appreciate the effect on our rural landscape without visiting them. Anyone travelling north from the small community of Diptford can see this for themselves. Over 20 acres of closely packed, ground mounted panels at Blue Post are a world away from the misleading pictures that are the mainstay of the advertising which is being targeted at farmers.

Let me be clear; there is one group I do not blame for any of this. I have worked alongside the farming community as a GP for over a decade and no one should underestimate the devastating effect of repeatedly having to cull their beautiful south Devon herds as a result of bovine TB. I also understand that dairy farmers struggle to survive on the current milk prices. What would any of us do faced with financial ruin and the loss of a family farm when glossy leaflets come through the door promising up to one thousand pounds per acre per year plus maintenance payments, no costs and not even any need to get involved with the planning process?

Particularly if they see the kind of pictures that I have been shown by prospective developers of panels high above ground, sprinkled across the field with wide spacing ...a haven for peacefully grazing sheep, wildflowers and bat boxes.

I have also been shown pictures that imply that lush grass and flowers flourish below huge ground mounted panels. The fact is that this kind of grass doesn't even grow beneath a slatted picnic table.

The reality is that many of these sites replace prime verdant grazing land with densely packed industrialised deserts which are completely sterile beneath. They may have a margin of grazing land around the edge but far from the screened idyll of the adverts they are often surrounded by high wire fencing, security cameras and humming transformers. This photo was taken from the roadside at the edge of the Blue Post site.

Self regulation with industry guidance is not working because the returns on offer are too great.

Diptford is already impacted by the arrays at Marley and Blue Post. Two further large sites have been approved along the nearby corridor of power lines including one of over 30 acres at Hazard.

I met recently with AEE renewables which is proposing to put in another application close to this beleaguered community with a further 83 acres in the pre-planning stage. These will directly border an AONB.

The cumulative impact is hard to convey.

I have a visceral sense that something is very wrong.

In the debate in Westminster Hall on Thursday 11th July I wanted the climate change minister to acknowledge and understand the feelings of local communities and the risk that this poses to support for renewables. I also wanted to see an update to planning guidance to protect our rural heritage from this kind of development and to explain the importance of not just defining sites by agricultural grade.

Agricultural land is graded 1-5 with 3 subdivided into 3a and 3b. Grades are determined by a range of factors such as gradient, flood risk, soil type, versatility and yield. The fact is that almost the entire are of the South Hams is grade 3 or 4 because the classification does not take account of the visual landscape value. In other words what would be assumed by the vast majority of people to be important verdant pasture would receive no protection whatsoever.

That was confirmed in the letter from the planning officer about the latest proposal in Diptford, where the land is dismissed as grade 3 quality with the additional note that there is an abundance of this in the South Hams. Developers will claim to site sensitively but these green fields do not stop being beautiful or of value to our future food security at the border of an AONB so why should they be allowed to site vast acres of glass and metal up to the very edge of its boundary.

Another very real grievance surrounds double standards over environmental impact assessments. Small-scale sustainable self-build projects like the Land Society which can deliver truly affordable local eco-housing are made to submit seemingly endless environmental impact assessments and as a result become less affordable and harder to deliver. Yet there is no requirement for a proposal which plans to cover over 80 acres of farmland with densely packed glass and metal?

This is from the planning officer to AEE, despite a recommendation from Natural England that there should be an environmental impact assessment it says;

' there would be a relatively small population affected by the development and the magnitude of the impacts, which would be mainly visual impacts on the landscape and possible ecological impacts, not such to warrant an EIA'. Just a Preliminary Ecological Assessment is suggested despite the site also being within 3 miles of an SSSI and a special area of conservation SAC for Horseshoe bats.

The scale of these should not be underestimated nor their cumulative impact. Yet the planning officers have little idea or seeming interest in the effect that will have on the local or wider ecology. In my view there should also be a review of the impact on local food webs and our future food security as the pace and scale of applications has exploded.

The planning officer goes further in the letter to refer to these as temporary structures. I will be 76 when these are due for decommissioning and entire generations of children in Diptford will have grown up and left home. That doesn't feel temporary. I asked the minister to give further detail about how these structures will be decommissioned, who will be responsible if the parent company disappears with the profits and, crucially, what is to stop these sites de facto becoming tomorrow's brownfield sites?

Communities are desperate to see the kind of reassurance and real meaning to the term localism so that they have the power to reject inappropriate development and planners and councils need the clarity to feel confident that where they reject proposals they will not be overturned on appeal.

Sadly we are at risk of a collapse in support for renewables as people feel these developments have nothing to do with saving the planet but everything to do with profit. Large scale solar arrays are destroying and industrialising our rural heritage and communities like Diptford are asking you to take action before it is too late.

The factor really driving these developments is the vast profit as a result of the scale of public subsidy and these profits are going to a tiny number of people.

There is growing resentment especially amongst those who are in fuel poverty. When I speak at public meetings I am often asked why they are paying higher bills in order to subsidise those who can either pay upfront for renewable installations or have the entire costs of larger arrays paid upfront.

There are many community owned or financed schemes, including community financed solar projects set up by the Totnes Renewable Energy Society. I was proud to open their first community owned array on the rood of Leatside doctors' surgery. TRESOC now has 502 members all of whom share the dividends from renewable energy profits they also have an equal voting right irrespective of the number of shares owned.

The problem is that you have to be able to afford shares in the first place to gain from your share of the profit and you have to be able to afford at least some shares in order to be able to vote. That excludes those in fuel poverty.

We need some flesh on the bones around subsidies in this sector. How much of our electricity bills are going towards subsidising renewables and large scale solar and how much comes directly from taxpayers? In my opinion we need a redistribution of profits so that those who suffer loss of amenity can directly benefit and not just from donations to local communities which are often deeply resented as undue inducements. I feel these need to directly result in lower energy bills or help with the installation of energy saving measures or micro generation.

When I asked AEE's representative about this, he assured me that locals could benefits from a discount ...but... from a far more expensive supplier. Not a discount at all.

On a wider note, the climate change minister in a recent speech referred to his ambition for 20 GW of solar capacity.

Given the impact of the current rollout of just 1.7GW of large scale solar in the pipeline that must not be at the expense of an environmental disaster in the South Hams and we must make sure this goes only in appropriate locations with proper safeguards for local communities to reject damaging proposals.

We must also address the wider energy issues of how this capacity is to be handled by the grid because the National Grid have already made it clear that they could not handle anywhere near this level of installed capacity.

I am fully aware of the urgency surrounding energy security and that we need to keep the lights on. The problem with solar is that it generates its greatest peaks on sunny days at the height of summer in the middle of the day...just when we least need to turn on the lights. At these times of lowest demand, we still have a background level of nuclear and other sources of supply which cannot be simply turned off and even if we had advanced grids to export to the continent, they would be asking to export to us. Until we have a better smarter grid how would we cope with that level of installed capacity let alone afford it at current levels of subsidy?

The South West understands it has a responsibility to contribute to the need to develop alternative forms of energy and recognises that for generations, other areas have had to suffer environmental impacts from generating the nation's energy.

A report from RegenSW this week shows that the total capacity of renewable energy in the south west has grown by almost 50% in the past 12 months so that we now have a capacity of more than 1 GW.

7.3% of our electricity now comes from renewable sources. Devon is the single biggest contributor to that followed by Cornwall and the great bulk of that comes from the rush to large scale solar in order to meet targets.

The fact is that we have a vast untapped, reliable energy source around our coastline that does not depend on the vagaries of the sun or the wind. There is great enthusiasm for tidal and wave energy and our tidal resources are amongst the best in the world.

We have local inventors like Alvin Smith who has developed Searaser, a wave energy device and projects from TRESOC conducting feasibility studies on tidal flows on the Dart Estuary. The marine energy park could go further to lead the world in marine technology.

I would rather see greater support for marine renewables in the South West so that we can realise that potential. It would surely benefit our economy more than current subsidies which mostly benefit companies which are based abroad?

We understand the need to keep the lights on and nowhere could be more supportive of the need to address climate change than Totnes.

I continue to feel that the greatest gains are from powering down, reducing energy use and investing the £42bn planned for HS2 to transform cycling infrastructure nationwide so that we could have the levels of cycling seen across Denmark and Holland.

The real legacy projects of this Government could and should be in electrification of the entire rail network, cycling infrastructure and marine renewables.

We must not let our legacy be the industrialisation of rural Britain under vast acres of closely packed, ground mounted PV. We need to reduce the incentives for inappropriate development and I am delighted to hear the announcement that we will have far greater safeguards in our planning system. We need to see genuine community benefit and direct benefit for those who suffer the greatest impacts from loss of amenity, especially those who are in fuel poverty.

I look forward to the revised guidance and incentive structures.


I have solar panels on my roof that are making me a very good return this summer. My roof is not needed for anything else and the panels up there are not visually intrusive. I think that small 4kw systems like mine should be incorporated into planning regs. on most new house builds and fitted with a built in water heater as part of the system. However, large scale rural solar systems are totally wrong and making someone a great deal of money.
- Harry Fenton

There is no real alternative to modern nuclear plants of the most recent generation. But they are only safe in countries the governments of which are uncontrolled by lobbyists.
- Rudolf Seuffer

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Falkirk hasn't changed colour at a general election since 1935. In effect, it is the selection of the Labour candidate that is most likely to determine who represents the constituency as MP, possibly for decades to come. This is why the allegations of vote rigging are particularly offensive.

Falkirk is not an isolated case, but an even wider issue affects all "safe seats": why should a handful of people, often fewer than 60, choose the MP on behalf of more than 60,000? The fact that local party membership continues to dwindle makes it even easier for activists to stack the deck and manipulate the outcome.

In Falkirk, Labour have belatedly pulled the plug but will now risk accusations of parachuting in their own favoured candidate. The only way forward is to trust local people to decide what type of Labour candidate they wish to represent them. Do voters want a local person with no previous political track record or a future high-flier from the political elite?

An open primary is the only way to settle that question and who knows, it could even show that Falkirk supports the views of Unite.

If it were a small hustings-style event then it would be easier to fill the room with activists rather than the general public. Perhaps that is why Ed Miliband is lukewarm about the proposal. Another reason may be that open primaries do not favour a favoured elite. Those with long political track records as special advisers and think-tankers are like fish in water once they arrive in the Westminster pond and have become too accustomed to having their pick of the safest seats. There is no need for Ed to worry; they are not on the endangered list. Voters, however, want more MPs with real-world experience and for Parliament to look and sound like modern Britain.

Open primaries create a closer link to a wider electorate within a constituency. Following my own selection in the first fully open postal primary where everyone got a vote, I am still regularly reminded by people who didn't vote for me at the general election, that they did do so in the first round.

As for the accusation that open primaries strip local parties of the main reason for attracting active members; they should not be concerned because local party members draw up the shortlist. If anything I have a better relationship and connection to the Totnes Conservative Association as a result. They were very fair in selecting a genuine choice of three different candidates, all of whom they would have been happy to work with. They genuinely wanted a candidate who would also be someone that the local electorate could support.

Another reason often stated for the coalition not proceeding with further primaries is their cost. At around £40,000, a fully open postal primary is impossible to justify at a time of austerity but that could be reduced at a stroke if secure electronic returns were trialled or even if people were asked to pay for their own postage to return a ballot.

I have just been sent voting papers to select who will be on the regional list of candidates for the European elections and had an option to return this electronically with a secure login to prevent repeat voting. Why shouldn't that be possible for open primaries and be extended to all voters on the electoral register?


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Delivering equipment or extra support to someone at high risk of a fall may save lives, not to mention millions of pounds for the health service, so why doesn't that happen automatically? Too often because those services cannot be paid for from health budgets but have to come from a separate silo in social services. This illogical separation has been a source of endless frustration for those working in both health and social care. Where pooled resources and good working relationships are in place, they make a difference in reducing unnecessary admissions to A&E and hospital.

The announcement in the Spending Review that, from 2015, £3.8bn will be allocated to a combined budget for health and social care, will help to break down the barriers that lead to so many avoidable tragedies and hospital admissions.

Success doesn't necessarily follow the pooling of budgets but depends on how that combined spending is put to use. Behind the headline figures there are conditions which make sure that we put people, not organisational convenience, at the heart of services.

We know that allowing social care teams, ambulance staff and hospitals to share notes with GPs, reduces errors and delays. Of course patients must be able to opt out if they wish to do so but in practice most will be relieved not to have to endlessly repeat their story to a string of professionals. They may be shocked to see the extent of the errors in notes once we finally make patient ownership of and online access to records the norm.

Better seven-day working so that people can be discharged safely at weekends will free up hospital beds and reduce the delays in A&E that occur as a result of the gumming up of admissions outside of the conventional working week. Whilst other services have responded to seven day working, the NHS has for too long ignored the unacceptable increase in weekend mortality.

The NHS pay freeze has always been cushioned by automatic annual increments for many staff. There have been some serious knock-on effects upon recruitment to key specialities such as A&E and general practice and the announcement of a review of automatic increments should not be rejected by health unions. Too many students leave medical school encouraged into training rotations for which we already have a surplus of doctors. Training rotations are expensive. It may be unpopular, but the NHS can no longer afford the luxury of this wasteful training of unneeded specialists and could reduce the incentive to train in oversupplied specialties by setting a rate for the post rather than for years in service. Patients would benefit if we rewarded excellence in public service rather than automatically link to the numbers of years in the job.

The NHS has been insulated from the icy blast of spending cuts but that does not mean it doesn't feel the chill. Our population is ageing and the numbers of people over 80 with multiple long term conditions is increasing demand far beyond the ability of a small increase in spending to cope by trying to do more of the same. A transfer to joint budgets with social care is desperately needed but will inevitably lead to increased pressures elsewhere.

As someone who has worked on the frontline for decades, I recognise the stresses faced by those working in the NHS as well as their professionalism and dedication. Many will argue that their service deserves more generous settlements but no-one should pretend that any government could further increase the health budget. Given that salaries are the greatest cost to the NHS, realists accept that changes to pay structures save jobs and will be essential if we are to protect services for the people the NHS exists to serve.


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In 25 years of marriage my husband has never felt the need to "emphasise a point" by grasping me around the throat.

The recent publication of photographs has emphasised an entirely different point: that domestic violence can happen to anyone.

The figures are stark. One in four women is physically abused by their partner during their lifetime and two women are killed each week in England and Wales by a current or former partner. On average a woman is assaulted 35 times before first contacting the police.

Society still prefers to look away. If you witnessed a woman being assaulted in a restaurant would your first instinct be to carry on with your lunch in shocked embarrassment or to snap a photo and sell it to the media? Or would you feel confident to intervene?

Domestic violence has the highest repeat victimisation of any crime. In part that is because of the shame people feel about reporting it but also because of the fear of reprisals. Perpetrators bully victims into feeling that they are to blame to minimise their own culpability.

It disturbs me that a high profile individual has chosen to make light of his behaviour. He will rightly find that public disgust and his police caution hang around him like a bad smell.

The only deodorant will be to unreservedly apologise, accept that he has a problem and seek help to address it. He could find that in doing so he turns his personal PR disaster into something that could help thousands of others to address their propensity to violent behaviour.

In family households where domestic violence is occurring, 90 per cent of incidents take place with children in the same or next room. Half of those children also become victims at some point as perpetrators learn that they can act with impunity.

Violence is not untreatable but it has to start with a perpetrator accepting that they, not the victim, are to blame. Wherever domestic violence is minimised as nothing more than a "tiff", it is doomed to continue. One in seven children know that to their cost.

In the meantime the current publicity around this subject will hopefully reduce the sense of shame and isolation felt by so many victims. They are not alone and should contact Refuge or the National Domestic Violence Helpline on 0808 2000 247 to find their local support network.


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First the good news; we are living longer. But as older people live with increasingly complex conditions so they need to see their doctors more frequently and for longer appointments. The pressure on GPs has never been greater and yet there is a shortfall in those able to deliver the service, especially in inner cities and rural outposts. Over the coming five years we expect a retirement bulge from male full-time GPs which will not be plugged by an increasingly female workforce more likely to be working part-time to balance family commitments. That is not a criticism, merely a statement of fact.

Jeremy Hunt, in his speech about the future of primary care, talked of the need to return to the core principle that GPs should be the champions of their individual patients and that the personal doctor-patient relationship should be strengthened. Who could argue against the need for continuity of care and a more holistic approach? The only issue is that this takes time and cannot happen unless there are enough of the right professionals to deliver it.

The nub of the problem is funding. The NHS is coping with a 4% year-on-year efficiency saving as set out by David Nicholson as long ago as 2009. This has never been achieved by any health system anywhere in the world. It has been managed over the past year but that has largely been because NHS staff have accepted the need for pay restraint to avoid redundancies.

There has always been rationing in the NHS, usually managed through waiting lists and restrictions on the availability of certain treatments. In the past if a treatment was unavailable it was possible for GPs to blame it on hard-nosed management at the Primary Care Trust. Since the reforms, with a clinically led NHS, doctors are having a greater role in weighing up the relative costs and benefits of treatments and priorities for their local areas.

Spending a large amount on a single patient has always had knock on effects upon the money available to spend on everyone else. As a result some patients, for example those with mental illness, have long found themselves at the end of the queue with more fashionable expensive technologies prioritised by consultants in hospitals. In future, GP commissioners and local health and wellbeing boards may return more funding to the Cinderella services which help to keep the frail elderly at home because that will be good for them and saves money for the whole health economy by preventing unnecessary admissions.

There is a problem however; if individual GPs do as Jeremy Hunt suggests and take a view that, "every patient is the only patient", it will not be possible for them to also take a wider perspective to balance the needs of their whole community.

There will be those who demand that the Treasury writes a larger cheque but where would that come from? Other departments have already taken even greater pain and health has been relatively protected. Large increases in money in the past under Labour made some impressive gains but a scandalous amount was squandered, missing the opportunity to change the way services were delivered in return for pay rises.

Jeremy Hunt has been criticised for blaming the botched GP contract for a rise in A&E attendance. The contract had to change as GP recruitment was in crisis but it is an uncomfortable reality that since that change, the vast majority of GP partners have stopped providing of any out of hours care for their patients. In part that was because the ill-judged balance of routine and out of hours payments meant that they could easily afford to do so.

The Health Secretary acknowledged that it would not be possible to return to the situation that used to exist. GPs were run into the ground manning 72 hour weekend shifts responding to ever increasing demand and unrealistic interpretations of an 'emergency'. He talked instead of returning their responsibility for the service delivered by others. That then begs the question of what that entails? At present GPs have responsibility for their patients only during the working week and after that it is up to others to carry the can. GPs themselves feel uncomfortable when the service their patients receive falls short and there is an unacceptable level of variation in the quality of out of hours care around the country. The argument runs that if they were responsible when things went wrong, they would be more likely to do something to put that right. GPs should do something if they fear there is a failing doctor working a night shift at their local out of hours service. Doctors have to be interested in everyone who may be seeing their patients and be far more prepared to step in and report colleagues who make mistakes. The Francis Report focused on the events at Stafford Hospital but the lessons are for all NHS staff; they must not look the other way when their patients are at risk.

There is also an uncomfortable reality; that GPs can earn more money for working with healthier patients in wealthier areas as targets are more easy to achieve. Our most deprived areas with the greatest health inequality often have the worst paid GPs.

It may be unpopular with former colleagues to say it, but GPs are well paid. Unpopular because there have been no pay rises for several years and in many cases GPs have taken reductions in pay. This has made Jeremy Hunt's suggestion that they take back responsibility for out of hours even harder to stomach and if it were to be imposed unilaterally the retirement bulge would be more like a dam busting flood.

The answer lies in first acknowledging the pressures and addressing the workforce crisis. There will not be enough GPs unless medical schools stop churning out junior doctors who have been given a message that only hospital medicine matters. The challenge and importance of generalism is sidelined in favour of hospital specialties for which there are no consultant vacancies. The waste in terms of training is expensive as these juniors either emigrate or cross to GP training on their higher grade salaries. In medicine salaries are linked to years in service rather than the grade of post so there is no disincentive to pick an unrealistic training rotation. Training more GPs however is only part of the solution, we must train more nurse specialists to take on greater and more rewarding roles as part of their primary care teams. Nurse specialists in dementia, palliative care and other specialist areas such as epilepsy and diabetes are already demonstrating how effective they can be in getting the best results for patients.

A tired, overstretched workforce will not be able to respond to the challenges of the next decade.

Despite all this, most GPs still get the kind of feedback that politicians can only dream of.

The problem is that the quality of primary care is so variable. Returning responsibility for the whole service to GPs will help to drive out poor care but that can only happen if there are sufficient numbers of the right professionals in the right jobs paid at appropriate rates for out-of-hours as well as working-hours care.

Addressing the workload and staffing pressures are absolutely essential if we are going to improve out of hours primary care and the quality of the service in our most deprived communities.

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A major issue is the illusion of the provision of care. Examples are physiotherapy (a dozen sessions and that's your lot, even if you need more), and counselling or talking cure for mental health issues (6 sessions, 10 if absolutely required, and that is your lot, even if you need more). By providing care and them making it impossible for the care to deliver a real result, the NHS is providing care that lifts the hopes of those needing the help, and dashing those hopes with a "Your time is up so you must be cured" message. Getting rid of a layer of middle management which only exists to manage other mangers will allow budget to be devoted to helping those who are unwell. Some of the staffing pressures are pressures to fill in an increasing number of forms created by middle managers whose objectives 'must be met' even if they run counter to the provision of healthcare
- Tim

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The number of cases of measles in Wales is expected to rise to over a thousand in the coming weeks. It is far more than 'just a childhood illness'. In Dublin 3 children died as a result of this vaccine-preventable illness between 1999 and 2000 and many more required intensive care.

Wales was vulnerable to the current outbreak because more than 10% of children were unvaccinated and this allowed the virus to spread through schools and communities.

In Totnes the risk of a measles epidemic should the virus arrive from Wales is even greater as 30% of five year olds have not received both doses of MMR.

The term 'herd immunity' is used in medical literature to describe the protective effect that results from a high uptake of vaccination. We should dump this terminology. No parent wants to feel their child is part of a 'herd'. A better description would be 'community immunity'. We need a clear message that vaccinating your child not only protects them but protects the most vulnerable children of your neighbours and friends who may be too young or too unwell to receive the vaccine. In other words you can help to prevent another child in your own community suffering serious consequences from measles as a direct result of protecting your own family.

Last year 93.9% of five year olds were fully protected against measles in Brixham yet only 70.4% just a few miles up the road in Totnes. In other words, the chances of a virus circulating in Totnes are far greater than in Brixham but unvaccinated children and adults are at risk in both. Those over 20 as well as the very young are more at risk of complications http://www.nhs.uk/Conditions/Measles/Pages/Complications.aspx

Why do so many parents in Totnes reject MMR? For most it is a legacy from the now discredited work of Andrew Wakefield, who was struck off for his deceit in 2010.

The real 'herd' effect may be an unwarranted fear that vaccination is harmful or the belief that 'natural' methods like homeopathy can boost a child's immunity and thereby offer a safe alternative to protect against this virus.

Ainsworths were recently found to be marketing homeopathic products labelled as 'vaccines'. Such labelling clearly implies protection and risks misleading parents.

Most homeopaths do encourage parents to vaccinate alongside the use of homeopathy. Given the current outbreak in Wales, it is also time for their their governing bodies to issue an unequivocal statement that homeopathy offers no protection whatsoever against this serious illness. It is not sufficient to encourage vaccination if those using your products believe they can boost immunity and might offer any protection as an alternative


I'm neither a Totnes resident nor a Tory voter, but nice to see a politician of any stripe and in any part of the country talking sense with regards to science. Good on you, Dr. Wollaston.
- Rob

I'm curious that if homeopathic remedies called vaccines imply protection then so too do vaccines themselves? Vaccines are sold as protection but do not guarantee immunity, nor do they confer immediate immunity meaning all those children being vaccinated in Wales will take weeks to develop immunity. I've often wondered the same thing about the tetanus vaccine. Infants are not supposed to go swimming in public pools until they have been vaccinated with the tetanus vaccine; once they have had it they can go swimming but it takes 12-14 weeks (NHS guidelines) for immunity to develop so surely swimming should be allowed only several months after the administration of the vaccine? This also applies to injuries which are considered a risk for tetanus - why is the recommendation often for the vaccine when this would offer no immediate and relevant protection? I'm also wondering if you can supply details on the deaths from measles - did these cases involve patients who had interfered with the natural healing process by using fever suppressants as is frequently suggested by the NHS but warned against by the WHO? It's also interesting to me how cases of measles in those over 20 and those under 1 have increased since the MMR was introduced - this is clearly not desirable as those over 20 and under 1 are at greater risk of complications. I think there is now enough evidence to support the efficacy of homeopathy- so much so that Switzerland recently considered it both effective and cost-effective. I think it would rather irresponsible to discourage people from taking ownership of their health by means which are scientifically supported and are based on an appreciation of self-care - all of which do support immunity to manage disease. I'd love to hear a doctor espousing the importance of maintaining a healthy gut for example (the GALT comprising the majority of our immune system)...please write about boosting immunity the natural way, it will save the NHS money :-)
- Lisa

Unfortunately this is not just a hangover from the Wakefield nonsense. There is an active anti-vaccine movement, driven by the libertarian contrarian right in the US, that continues to perpetuate false information about the effectiveness and safety of vaccines whilst promoting un-safe alternatives. The hospitalised children in Swansea are the unwilling footsoldiers in this campaign. Keep up the good work on this issue Sarah, and don't be afraid to tackle the anti-vaccine movement head on. (see http://www.skepdic.com/antivaccination.html and http://www.guardian.co.uk/science/punctuated-equilibrium/2011/oct/11/1)
- Simon

I am a Tory voter (although not on your patch) and also a mother of three children aged 17, 14 and 2. I am also a parent who has rejected the MMR, not because of Andrew Wakefield’s legacy, but because as a child in the 1970s I had an extreme reaction to the single Measles vaccine. I am old enough (only just!) to remember how devastating Measles can be. Due to my adverse reaction to Measles, my mother did not vaccinate my brothers and both went on to catch it. Even though I was quite young I can recall how unwell they were. I also remember a little boy called Daniel, a neighbour when we lived in London, who caught the disease and seemed to make a full recovery, only to be struck down a year later with brain damage, tetraplegia and blindness, as a delayed complication of the Measles virus. He died a couple of years later due to this and the funeral was a very sombre event for us all. I agree strongly with you that vaccinating children is a very good thing, both for your own children and also the community. However, I was very worried about the possibility of my children reacting badly to the Measles vaccine. I was also concerned that the MMR contained 3 lives viruses and if my children did have a bad reaction, their immune systems would have to deal with 3 viruses instead of 1. I made my decision that I would prefer to opt for single vaccines. However, the Wakefield story was just breaking and Labour put a block on this NHS option and made it difficult for parents to obtain privately. I discussed the matter with my doctor who was unable to help. A few years elapsed and obtaining the vaccine privately, at a huge cost, became easier. I managed to save the money and took my two children to a private clinic where a GP administered the single Measles vaccine. Both children were fine after the vaccine but unfortunately I was not! As their mother, I experienced terrible guilt and anxiety that I had entrusted the health of my children to a complete stranger. I did not have the same “safe” feeling that I had at my local GP surgery when the children had received their other vaccinations. It is because of this that my two eldest children have not had their Measles booster. Recently, I was fortunate enough to have another baby. At the six week baby check I discussed MMR with another doctor at my surgery and was again advised that they were unable to help unless I opt for the MMR, so my 2 year old remains unvaccinated. I am desperately worried about the current Measles epidemic. I would love for my older children to receive a booster vaccination for Measles and for my youngest to receive the first. I do appreciate that MMR is provided free by the NHS and is the recommended course of action. However, it is not the choice I wish to make for my children for the reasons I have already explained. I recall that a number of Conservative MPs spoke out against Labour’s decision to block single vaccinations on the NHS. I also recall that David Cameron said some time ago that he would consider single vaccination as an option should the need arise. The UK currently has many children who for whatever reason have not received the MMR. The UK also has a growing problem with the Measles epidemic in Wales and other areas. Reintroducing the option of single vaccination could just make the difference in closing the gap for “community” vaccination. I have also written to my local MP Mark Prisk who has forwarded my correspondence to Anna Soubry. I know the Government has bigger fish to fry but I do feel that the Government should try to do everything they can to alleviate the current Measles epidemic. Surely vaccination on the NHS, whether MMR or single, is better than none which is the choice that many parents, including myself, are making.
- Sharon

Lisa must be disabused that 'Switzerland recently considered (homeopathy) both effective and cost-effective.' No it did not. The work she referes to was carried out by homeopathich manufacturer's sponsorship of a small group of swiss folks. Not 'Switzerland.' There is NO 'scientific support' for the use of homeopathy as a vaccine. Sorry, but there it is. Keep the faith! There's a Nobel Prize awaiting Lisa if she can adduce any such scientific evidence, for she would have discovered a hitherto quite unknown principle at large in the universe. P.S. Vaccines are 'natural' - so no worries there.
- Dr Richard Rawlins

I had an option, and I have spent £30 a month on possible Funeral Bills, now I cannot afford it because I have to pay Council Tax. Now the Council will , have to pay for my Funeral, you will still have to pay for my Funeral because I cannot afford to pay more.
- Des

My son Henry has leukaemia. He is at huge risk from a measles outbreak because his chemotherapy suppresses his immune system. Although he's been fully vaccinated, the jab is ineffective. We have to keep him off school because not enough children have had the MMR jab. Please get your children vaccinated. Henry could be left disabled or be killed by measles. It is a serious disease and should be treated as such. Well done Sarah Wollaston! Let's protect our kids.
- John

Dr Wollaston's input on this vital issue is most welcome. As a south Devon GP it is vital that we do everything possible to achieve herd immunity. Only through this will young people such as John's son be protected from potentially fatal illnesses. We live in a civilised society with social responsibilities. We all have responsibilities to act for the common good. Whilst I actively promote choice in all its guises in healthcare I must also promote choice for children, and I praise Sarah for her vocal support for those too young to express their own views
- Dr Adam Morris

I would like to ask 2 things. Are the people who have caught measles (in Wales) previously not vaccinated? and does the MMR contain any live vaccines? this information would be important to me in making a decision about my child and the effectiveness in herd immunity, thank you.
- sally

This is a link to the MMR FAQ page http://www.nhs.uk/Conditions/vaccinations/Pages/mmr-questions-answers.aspx
- Sarah Wollaston

I have not vaccinated my two children as I do not believe that vaccines are the best way to protect children from disease. I believe that naturally supporting their immune systems with wholesome organic foods, and using natural remedies to treat their illnesses as and when they arise is the best way to keep them healthy. I had measles as a child and recovered within a week with no complications. I breast-fed both my sons for two years and trust I will have passed on antibodies to them through the breast milk. If they did get measles, I doubt they would get it badly with the protection I will have passed on from breast feeding, their immune systems would be exercised from fighting off the illness and they would have immunity for the rest of their lives, naturally. I do not believe that parents are given full and complete information about the ingredients in vaccines, which include neurotoxins such as aluminium, mercury and formaldehyde (not things that a two month old baby would normally come across or be expected to deal with), or the possible side-effects of the vaccines. Here is a link to a radio interview of a mother who before these events trusted the medical system and took her sons to be vaccinated as she believed at the time it was the right thing to do. http://www.youtube.com/watch?v=YAhoHdnsLnc I feel very strongly that every parent has the right to do what they think is right for their child. I find it hard to put all my trust in the NHS when I know that there are huge vested interests going on with the manufacturers of the vaccines (vaccines are big business for the pharmaceutical industry), doctors getting bonuses and the media and GP's under huge pressure to promote vaccines as that is the current government policy. I do not believe that many parents are making fully informed decisions. The organisation The Informed Parent has a very good website where parents can get more information. http://www.informedparent.co.uk/ In the grand scheme of human history, the MMR vaccine is very new. If there is a chance it is damaging children and potentially leading to autism and bowel damage in susceptible children, shouldn't we err on the side of caution, and instead give parents sensible advice for nursing children through measles, which in most healthy children is not a dangerous disease? All over the world now, the parents of vaccine-damaged children are being given compensation through the courts as evidence has shown the vaccines have been implicated in the development of their children's autism. On this subject, I think there is no smoke without fire. Why has a single measles vaccine not been made readily available for parents who want to vaccinate but are wary of the MMR jab? If my children did catch measles, mumps or Rubella, it would be one at a time, not all three at once. Why should we expect such young and immature immune systems to be able to suddenly be able to deal with all three diseases at once? This is not how it happens in nature. I am very glad my children have not been vaccinated, I am much more worried about the potential damaging effects of vaccinations than I am about the common childhood illnesses. I am sorry if other people feel this puts other people's children at risk. Surely if the vaccinated children are protected, unvaccinated children pose no risk to them? This is a huge and complex issue, and a big decision for parents. I hope parents will take all the time they need to research this issue fully before making these decisions for their children.
- Becky

Approx 150,000 people die each year from measles worldwide according to the WHO. Not exactly a harmless disease in my book.
- Andy

Well said, Becky. It's a stomach-churning, agonising decision for any parent to have to make and it's not helped by the patronising and condescending attitude displayed by many NHS staff, politicians and much of the media. Trying to find simple, un-biased and propoganda-free information seems to be virtually impossible. It's the same on both sides of the debate. You read one article and it makes you think you're a sinfully irresponsible parent for not having given your kids the jab, the next article makes you feel the opposite. From all the trawling I've done, the one website which seems to offer the most balanced discussion is http://anh-europe.org/campaigns/vaccine-choice/mmr-vaccine. The Alliance for Natural Health may imply, by virtue of the name alone, a bias, but do they stand to make vast profits from the uptake of their views by the public? Hardly. Let's look at some of the people in the pro-MMR camp: 1) Politicians. Given their track record in recent years when it comes to cover-ups, scandals, deception and duck ponds, can they really be suprised when people don't jump up and salute them whenever they open their mouths? 2) Drugs manufacturers. Not much of a shock that they are keen to promote their own products. Let's look at how their business operates. A person develops some kind of malady and they go their GP who prescribes a drug which suppresses the symptoms so the patient feels better. That is until the efficacy wears off and some added problem emerges as a result of side effects, thereby giving the drugs manufacturer an opportunity to push another drug and so on. If this isn't a textbook definition of a nice little money-spinning racket I don't know what is. The pharmaceuticals have a vested interest in keeping people ill. 3) Doctors, who now imply that measles is this predatory, killer disease, when a 1959 British Medical Journal described it as being a "normally mild infection". Are you telling me that they were all hopeless and incompetent fools back then? And even if measles HAS somehow magically transformed in the intervening years into something much more likely to kill you, could that possibly have anything to do with compromised immune systems perhaps caused by the daily onslaught from the chemicals in the air we breathe, the water we drink, the food we eat, the toiletries we smother our bodies in, the cleaning products we marinade our homes in, the sofas we slump in, etc, etc? Not to mention the fact that the food we eat has been shown to contain significantly reduced levels of nutrients since the introduction of intensive farming and the routine use of pesticides and herbicides, but I'm sure it's just a coincidence. Take a look at the evidence around you, in the streets, in the supermarket. Do you see a happy, healthy and vibrant public? No, nor do I, and I'm fully aware that I may be one of the people you might see out in the street that would only strengthen this impression. Something that never fails to amaze me is the number of people who seem so utterly convinced of their opinions, which are most likely to be the product of someone else's opinion and so on. On this little blog alone the self-righteous attitude evident in some of the comments beggars belief. And the brevity of the comments in that sort of "MMR is safe - shut up and inject your kids"-style is hardly indicative of a subtly persuasive argument. Or perhaps I'm wrong, and the people who have commented here all just happen to be leading world experts on vaccinations, and have conducted their own un-biased clinical studies, or failing that, have analysed, cross-referenced and exhaustively examined all the available data and existing studies, taking great care to investigate the backgrounds of the authors of each and every study to ensure that they have no undisclosed conflicts of interest. I am fully prepared to stand up and be counted as one of the 'don't knows', because I don't know. And I can't help but be suspicious of anyone claiming that they do know, especially 'experts'. If history is anything to go by, it would seem to suggest that, bizarrely enough, wherever there is big money to be made there also often resides corruption, deceit and bare-faced lies. No one knows the long-term ramifications of global vaccination programs. If anyone does claim to know, perhaps they can lend me their crystal ball some time. The statistics comparing the numbers of vaccinated 5 year olds between Brixham and Totnes was very revealing, but not much of a surprise. If nothing else it demonstrates what we already knew: that Totnes is a bit of an enclave, whose residents are perhaps more likely to question and resist the views of the establishment, and that the '60s weren't entirely in vain. It is all too easy, and tempting, to fall under the soporific spell of someone in a white coat and with diplomas all over the wall, calmly reassuring you that the concoction they're about to inject into your child is "perfectly safe". It takes courage to resist this kind of pressure; it takes guts to go with your gut feeling. Let's remember one thing: being alive is inherently risky. It's risky (whatever anyone claims to the contrary) to vaccinate and it's risky not too. The final question must be one of trust. Who do you trust more - the totally transparent and agenda-free popular media such as the We-had-no-idea-what-Jimmy-Savile-was-doing-right-under-our-noses-for-20-years-BBC, who's very existence relies on transforming news stories into saleable commodities; the 100% scandal-free 'honest guv' government who are very concerned about our health but they'd rather not ban cigarettes thank you very much, and the industry that gave us thalidomide and causes an estimated 100,000 deaths (from PROPERLY prescribed drugs) per year in the U.S. alone - do you trust that lot, or the tiny lone voices of dissent in the wilderness, with no more to gain than a derisory and comparitively miniscule compensation payout from the courts?
- Matt

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Thirty years ago I fell in love on a tandem. I may never be the fastest or the most stylish but I'm often at my happiest on a bike. I would like to see cycling become as normal a choice in Britain as it is in Denmark because that can bring benefits for everyone, even those who are not cyclists.

The influential All-Party Parliamentary Cycling Group (APPCG) has completed a four month inquiry, 'Get Britain Cycling'. Our report, launched today, sets out what needs to happen to make sure that many more people can enjoy cycling in safety. We heard evidence from individuals and organisations, including representation from Totnes and Devon County Council. If you would like the recommendations of the report to come to fruition, you can help by signing this e-petition

At present just 2% of journeys are made by bike but we could do so much better.The report calls for one in ten of all journeys to be made by bike by 2025. Many European cities have successfully transformed the way that people travel and achieve levels over 20%. We should not accept that so much of our national transport funding goes on cars; here in the UK we could make a huge difference if we spent just £10 per head from the existing transport budget on cycling infrastructure and training instead. It is long term sustained funding that makes the greatest difference rather than individual short term initiatives.

Segregated cycle lanes and off road routes are the ideal but where cyclists and motorists cannot be separated the report recommends the extension of 20mph speed limits in urban areas and lowering the speed limit on a network of rural lanes to 40mph. We know that this has made a difference to reducing serious accidents elsewhere. Worries about safety are most often quoted as the reason for not cycling but where people see safe infrastructure and lower traffic speeds they do start to cycle.

Encouraging more people to cycle will help to reduce traffic congestion, bring environmental benefits and be good for the health of the whole population, all positive results. It will also be good for business. Where safe leisure routes have become established they attract visitors who spend money supporting local economies.

To increase cycling from less than 2% of journeys in 2011 to 10% of all journeys in 2025, leadership is needed and the government should appoint a National Cycling Champion. We have an opportunity to build on our wonderful Olympic and Tour de France legacy and we know that inspirational figures like Bradley Wiggins make a real difference.

We also need to give parents the confidence to get their children cycling. The report calls for cycle training through Bikeability to be available to all children at school. The Steiner school locally has successfully increased non-car journeys to school via an off road route and has also shown how cycling can become a normal part of school sport.

There are so often unnecessary barriers to increasing cycling and we heard about many of these in Parliament. The local campaign to create a cycle path between Littlehempston and Totnes came to Parliament to describe how such a route would allow children to cycle to school and create a green leisure trail. In my opinion it is a shame that a bridge built half with public money is dividing rather than uniting two communities. This is a wasted opportunity to boost our local economy, get children cycling and take the pressure off our congested roads. More information about the campaign and how you can support it can be found here.

Cycling saves money, improves fitness and can transform quality of life; any perceived dangers are far less than the risks of inactivity.


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The General Medical Council has issued guidance to doctors on their use of social media. It comes into effect later this month to howls of protest from some online medics that it is sinister and draconian.


Every one of the doctors who have contacted me agrees with the GMC on the duty to protect patients' confidentiality online . Their concern comes around the following clause; "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

It could be dubbed the 'trust me, I'm a doctor clause'. Many feel this could undermine the willingness of doctors to act as whistleblowers others just feel it undermines their right to privacy. 'Why should I have to identify myself if I want to write about football?' writes one complainant.

Despite GMC's statement that 'serious or persistent failure to follow this guidance will put your registration at risk', the chances of any doctor being struck off for anonymously commenting on football have to be zero. It seems to me that the cards are heavily stacked in favour of doctors even following significant complaints so online sports commentary carries a minuscule risk of professional suicide.

The bigger issue is whether this is unwarranted intrusion and bullying by the GMC which infringes upon the rights of professionals to open commentary and criticism, especially if that could then prevent doctors raising concerns.

One of Robert Francis' criticisms in his report into the failings at Mid Staffs was that too many doctors were prepared to look the other way and put their careers before the need to raise concerns about patient care. Whistleblowers need protection but we will never achieve the required culture change in the NHS by accepting the situation as it currently stands. Too many workers have faced long term consequences for raising concerns and that is rightly being prioritised in the response to the Francis Report.

We should expect professionals to put patients first and there is no doubt that putting your name to any concerns about their safety allows for better investigation than retreating behind anonymity. If professionals want to put their careers first they are necessarily putting their duty to patients second and that cannot be acceptable. We have to start welcoming complaints as a way of improving the service rather than see complainants as the problem. Anyone who feels that facilitating anonymity is the way forward will actually be encouraging failure. Confidential inquiries do have a place but the confidentiality should be in the publication not the investigation.

Anyone can blog or tweet anonymously and there is nothing to prevent any doctor from doing so. But if they seek the credibility and trust which accompanies their professional title why shouldn't they identify themselves? If a doctor wants to write about a failing colleague or hospital he or she should be prepared to provide the evidence for those criticisms not hide behind a self interested anonymity.

As for the would be sports blogger, no one could suggest that an anonymous doctor commentator is 'speaking on behalf of the profession as a whole'. It seems to me that the GMC guidance refers to the wider risk to medical professionalism. Anonymity online can bring out the worst in people; like road rage even the mildest individuals can flip. Being open about who you makes you focus on your personal responsibility for what you say, what you advise and the implications for others.

The GMC guidance is a reminder to doctors that professionalism brings responsibilities and I agree with them that this is about good medical practice. Doctors may choose to ignore it and in practice few are likely to be held to account except for major failings like breach of confidentiality.

Personally, I have far greater respect for commentators who are prepared to put their own reputation on the line as well as the reputations of others. I would never accept any kind of prescription from doctor anonymous.


I have always used my own name for blogging, but it's easy for me because I'm senior enough (i.e. old enough) that I can't be fired. Even so, it's risky because I've been threatened with lawsuits for defamation three times now and our appalling defamation laws do little to protect scientists or doctors. I'm really surprised that, straight after the Francis report, you support the GMC's action. All it will do is to inhibit whistle-blowing, and that is the opposite of what Francis recommended and the opposite of what the NHS (and politics in general needs), Despite the constant promises to protect whistle blowers, gagging still goes on. Of course you are right to say that reports of bad behaviour, whether in the NHS or in banks, is likely to be more effective if it is not anonymous. But I think that you underestimate seriously the terror than people have of voicing any sort of criticism of their employers. The more junior they are, the more they are terrified. But often it is the more junior people, those at the sharp end of the job that see what's going wrong. They are the people we need to listen to. Far better that they speak anonymously than not speak at all.
- David Colquhoun

I'm confused. I don't care if a doctor blows a whistle anonymously, not at all. The NHS needs many whistles blown long and loud. I care if a 'doctor' gives medical advice that is unattributable, by whatever medium. The article speaks of both almost as though they are similar topics, but they are not. So please unconfuse me.
- Tim Trent

I think that Tim Trent has hit the nail on the head. The GMC seems to have confused two quite different problems.
- David Colquhoun

Thank you for a clear and commonsense viewpoint. Detractors have been putting fear into those who have nothing to worry about. Sensationalism in tweets such "gmc's plans to ban anonymous blogs" are too frequently being seen - they are misleading and stir up individuals who do not have time or inclination to read the original source documents. You may be interested in the piece published in Croakey at http://blogs.crikey.com.au/croakey/2013/04/05/its-all-just-a-social-media-and-medicine-storm-in-a-teacup-says-one-surgical-tweeter/
- Henry Woo

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Whenever alcohol is too cheap and easily available, there will be problems for society, families and individuals. It cannot be right that currently it is often cheaper to get drunk than to buy a meal. At present, alcohol is often sold at a maximum price, with white cider at less than 23p per unit. We are all paying to clear up the destruction this causes.

Today the Chancellor scrapped the beer duty escalator and has also cut 1p off beer duty from Sunday. Unless this is now combined with a minimum price per unit it will make a bad problem worse. On its own, scrapping the escalator will do nothing to level the playing field between on and off licence sales to support our pubs.

Approximately half of all crime is alcohol related and the Crime Survey for England and Wales indicates that the proportion of violent incidents where the victim believed the offender(s) to be under the influence of alcohol was 47% in 2011/12, a significant increase from 41% in 1995. Furthermore 40% of child protection cases and 74% of child mistreatment cases in the UK are alcohol related.

It is no surprise that around half of all violent incidents take place at the weekend when binge drinking is prevalent and 66% of stranger violence and wounding offences take place between midnight and 6am. It is shocking that a third of people say that they avoid visiting their local high street on a Friday and Saturday night because of alcohol related disorder.

In Devon, there were an estimated 152,289 alcohol-related admissions and attendances in 2010/11 with 40,396 people drinking at very heavy levels, which significantly increases the risk of damaging their health, have they not done so already. In 2009, there were 59 estimated deaths from chronic liver disease in the county.

These are the reasons why I have been so vocal in my support for minimum unit pricing (MUP), this measure is not about penalising responsible drinkers and the introduction of a MUP would not make alcohol unaffordable. 45p per unit would mean that a 12.5% bottle of wine would cost £4.21 and a slightly lower strength 10% bottle of wine would cost £3.37.

Introducing a MUP would help to change the norms surrounding alcohol in our society. The ability to buy alcohol so cheaply sends a message that tacitly condones the sort of behaviour that is causing destruction and costing the country millions.

There is evidence that MUP works, in Canada it encouraged people to switch over to lower strength beers and reduced alcohol related deaths by 32% when the floor price was raised by 10%.

I have urged the Government to introduce a minimum unit price for alcohol and show the courage to tackle the devastation to families caused by alcoholism and the fortune spent by the NHS every year treating disease caused by alcohol misuse.

If you would like to sign the e-petition on this matter, you can do so via the following link:



Hi Dr Wollaston. I am Alan O'Neill and have worked for 30 years in the alcoholic drinks industry, both selling and marketing, mainly, wine. I read with interest your comments on the subject and am in full accordance with everything you say. HOWEVER, although MUP would help alleviate the problems caused by over consumption, It does not quite go far enough. it would be necessary to prevent the big supermarkets from irresponsibly promotiong all types of alcohol. This can be a dangerous substance if abused and these organisations are indeed irresponible in the way they price promote. Please adopt a zero tolerance on alcohol pricing. STOP ALL PRICE PROMOTIONS AND MAKE MULTI -BUY OFFERS ILLEGAL, the supermarkets won't like it, but it would result in sensible pricing across the industry and not encourage stocking up.
- Alan O'Neill

“It cannot be right...” is a bold assertion but it doesn’t make sense and it opens up an endless list of similarly sweeping prescriptions. It’s a recipe for limitless interference in both the free market, and freedom of choice. It rests on the assumption that increasing the price will limit the appeal and the availability of alcohol: surely nonsensical. This argument has been tested many times, not least with tobacco; I gave up smoking decades ago but it wasn’t the cost, and that clearly doesn’t stop smokers today, most of whom are in the poorer classes; the most extreme test was the USA’s flirtation with outright prohibition – a notorious failure that was actually counter productive since criminality mushroomed to supply booze to all those people who declined to let the government stop them drinking, and it also brought the law itself into disrepute. Does cost figure much at all? I just returned from Germany, and as usual I brought a couple of crates of beer – at less than one-third the UK price. Is Germany (a country I am very familiar with) filled with drunks and anti-social public behaviour? No more than this country, probably a bit less in my experience. Cost doesn’t count: it’s culture. If people engage in criminal behaviour when drunk, subject them to the force of the laws we have governing this. Don’t let the government engage in dictatorial Socialist-style attempts at nudging our personal preferences: don’t inflate our taxes still further, especially when these should be reduced. I’d have thought any Conservative MP would sympathise automatically with these points – especially one who respects the record of the late great Margaret Thatcher.
- Tony Harrison

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The 'Counting Women In' campaign is a new coalition set up by five leading campaigning organisations in democracy and women's rights. The Centre for Women and Democracy, The Electoral Reform Society, The Fawcett Society, The Hansard Society and Unlock Democracy. Together, the groups are campaigning to demand an equal voice for women in politics at all levels of national, local and devolved government.

On Monday 25th February Counting Women In launched a report 'Sex and Power 2013: Who runs Britain?' which considers women's access to public life and why they so often fail to do so. For example just 22 per cent – or 1 in 5 - members of the Westminster Parliament are women and the number of women MPs has increased by only 4 per cent since 1997. The figures are even lower for local government. For example The proportion of women councillors in the UK sits at just 32 per cent.

There are six key findings to the report, which amongst other things indicates that Britain is falling down the global league tables when it comes to women's access to power and representation in politics; that this continued 'drift' is inevitable without real, committed and targeted action; and that political parties should take steps to ensure an increase in the number of women candidates fielded in winnable seats at all levels of politics. We have now fallen to 60th in the international league tables for women's representatives.

To deliver a more equal government takes decisive action at every level, from encouraging applicant's right through to Cameron's cabinet. You can view my piece in the Guardian about how to address the gender imbalance in Government.


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You have to read almost to the end of the Royal Charter before the elephant in the room gets a mention. A 'relevant publisher' refers to a person who publishes in the United Kingdom in a newspaper, magazine or a website containing news-related material.

The Royal Charter is unrealistic and unworkable precisely because websites can be hosted anywhere in the world. In practice it is only our paper press which will be affected.

Robert Buckland MP described the code as voluntary, but if the stick being wielded is sufficiently painful, the code becomes coercive and the press will start to self-censor. What on earth would be the point of the exercise if it did not do so?

If our press becomes more bland then readers may decide to save their money, deserting the newspapers for the freedom of the internet. It is unlikely that the code will apply to Twitter. A neutered press will only boost the power of bloggers and tweeters.

What will happen to our vulnerable regional and local press? Who will be there to report from the courts or hold local bureaucracy to account if they go to the wall? What will happen if our national press suffers further decline and can no longer afford to fund world-class investigative journalism?

In all the talk about the victims of the press we have downgraded the victims of big pharma, big corporations and big government.

We can all be commentators through the internet but we cannot all be investigative journalists.

Hacked Off is taking shelter behind the wrong done to families like the Dowlers. Phone hacking was illegal then and remains illegal now. The underlying agenda has always been to protect the powerful and spare their blushes, hence the big money behind this powerful group of campaigners.

The Royal Charter is a back room deal stitched up at the last possible minute with Hacked Off solicited for approval.

I asked the Prime Minister whether a free press deserved a free vote. He told the Commons that MPs should vote with their conscience but the three line whip remained in place. Parliament voted overwhelmingly in favour of a coercive measure to muzzle the press through the exemplary damages that will face those publishers who refuse to surrender. Our press should refuse to raise the white flag.

Far better our two-fingers-to-the-establishment, slightly out-of-control press than a nervous, bland and controlled press.


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In a chilling opening to his report, Robert Francis refers to 'conditions of appalling care being allowed to flourish' at the hospital between 2005 and 2008.

These failures were not isolated but systemic; tolerated by hospital staff and management at every level. Hundreds died and many others suffered lasting harm. No one should feel reassured that Mid Staffs was an exception... It seems barely credible, particularly at a time when the wider NHS was riding a wave of investment. How could it have happened in the first place and been allowed to continue for so long? The NHS is awash with regulatory systems and yet despite glaring and repeated failures none were of any use. But for the persistence of victims' families those failures would have continued.

Francis is clear that the primary responsibility lies with the Trust Board but he is also adamant that scapegoating individuals would be a mistake. To do so merely allows others to duck responsibility. The main purpose of the Inquiry was to learn lessons for the future rather than perpetuate a cycle of 'defensiveness and concealment'.

The warning signs were flashing but management only had eyes for narrow targets rather than patient care. Poor clinical leadership, recruitment and training led to declining professionalism and a culture where staff kept their heads down and ignored the appalling standards of care they witnessed and allowed to be inflicted on their patients.

At the core of the failure was a culture of defensiveness to complaints and a lack of openness. Management was distracted by organisational churn and meeting targets rather than seeing what was happening to the patients in their care.

The culture in the NHS has to change. Patient care must be at the top of the list rather than a footnote. Individuals have to take responsibility not just for their own professionalism but should be prepared to challenge a lack of it in others. Francis recommends fundamental standards of care should be applied across the NHS with a zero tolerance for breaches and a simplified regime for detecting them so that overlapping regulatory systems cannot simply assume that they will be dealt with by someone else. Francis recommends that regulator should be the Care Quality Commission. It will have to do far better than it has up until now for that to feel like a reassurance; it is an organisation with its own history of blind defensiveness.

Complaints and the way that organisations handle them are a barometer of the willingness to accept responsibility and embrace the need to improve.

The report makes recommendations around public engagement, training and education, commissioning and standards of nursing. The need to examine the role of Healthcare Support Workers is specifically identified. Poorly paid, unregistered and with almost no access to proper training or professional development, these are the people who carry out so much of the personal care on our wards and in the community. They may also carry out more complex clinical tasks. Most do so with compassion and dedication but where they do not, as they are unregistered they are free to work elsewhere even if dismissed for poor care. Whilst degree level nursing becomes the norm it seems wrong that those who provide such intimate care are virtually excluded from access to training.

The report also highlights the need for clinical leadership and for more proactive professional regulation. Staff should be liable to criminal prosecution in the event of major failures.

Openness requires access to reliable high quality data. That information about quality should not be reserved for NHS staff but shared with the wider community. It should also include the answers to important questions such as whether you would be happy to see your family treated at this hospital. A good experience of care reflects higher standards and better outcomes; most of us would expect to have a right to know.

The need for stability is clearly stated and particularly for the impact of transitions to be properly considered in the future.

The report reveals the failures at every level. Complacency and defensiveness have to be addressed across the NHS and the recommendations made by Francis should be implemented.

As Clinical Commissioners and the NHS Commissioning Board take over from the Secretary of State in April, the message has to be first and foremost to keep their eyes on the patient; they matter more than the performance targets.


The truth is Sarah the NHS has been used as a political tool/bribe for 50 years, and to hide its deficiencies the elites poured in dollops taxpayers money . This State Monolith needs breaking up, yes privatising, but no one seems able to say it. Bring in Health Companies, NHS Professionals, Charities and Cooperatives to bid for trusts up and down the land. Only this way will we get real choice and transparency, only this way will the patient receive the care and treatment he pays for at a hospital of their choice. Real Patient choice will transfer power from the hospitals to the patients Chief Inspector of Hospitals et al is a nonsense and we all know it, including the Prime Minister. It is dishonest to pretend otherwise
- Richard Calhoun

The NHS has been a political football with the 2 parties using it as a political bribe for 50 years. Whenever the NHS hits a crisis more taxpayer money is shovelled in to hide the deficiencies. The result is 3rd World standards and thousands of patients have died needlessly. The talk of a Chief Inspector of Hospitals to change the culture is dishonest and the Prime Minister must know it. It's a knee jerk reaction to an appalling problem and the last thing we need. We need to face this problem head on and be honest enough to acknowledge that politicians can't run the NHS. The answer is to break up the NHS into its disparate parts, allow Health Companies, consortia of NHS Professionals, Charities and Cooperatives to bid for trusts up and down the land.. This will enable the patient to have real choice which will drive up standards of care, infection and outcomes like nothing else can. Power will pass to the patient, where it belongs and not with the Hospitals.

A little disappointing each comment has to be vetted first, Hardly a good example of transparency
- Richard Calhoun

I would like to know why no one seems to have been sacked or even had criminal charges brought against them for negligence. In fact it seems that the case against them is worse than negligence they seem to have chosen to act against the interests and well being of the people in their care. Hearing the testimonies of the families of those who died in this hospital was shocking and heart breaking. When will those who work in the public sector be held accountable for their behaviour?
- Jan Cadle

Well done Sarah, i saw you for the first time on the news last night. You were commenting on the recent Sir David N farce in Staffs. You came across as very knowledgeable and keen to get something done about Sir Davids denials and failures. Can we hope to see you run the NHS trust in his place as its obvious to all that he is incapable and a liar. He needs to be tried for multiple manslaughter 1200 of them. Why is it that Camoron isnt doing this to him , why is he being protected?? Good luck with it and keep up the honest comment as it severely lacking elsewhere in the party.
- Dennis

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Like car clampers before them, rogue bailiffs are about to find they must change their ways or go out of business. Legislation is to be introduced to stop them from entering premises at night or where children are alone in properties. The abusive charging of multiple or unreasonable fees will be tackled and bailiffs will need to undertake mandatory training to recognise vulnerable people, who will also be entitled to assistance and advice. There will be a clearer complaints mechanism open for those who have been badly treated by debt collectors. It is time to clean up the industry and make sure that those who break the new regulatory regime will not be allowed to continue to practice.


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EUrosceptic Europhiles expect vision and leadership from Cameron on Friday

Cameron delivers his long awaited EU speech on Friday and it must be more than just an exercise in managing expectations.

It is an opportunity to set out how we could remain within the EU as constructive partners to the Eurozone Nations whilst setting out what needs to change for us to stay. Unless there is a clear intent to seek consent in a referendum, it will of course be pointless to expect a genuine negotiation.

Eurosceptics are used to being dismissed as 'mad', 'swivel-eyed', 'right wing' or 'dangerously irresponsible' by those who fear a public vote on Europe, but it is time for the sneering to stop.

As a centre right politician who recognises the benefits of the EU I don't fit the stereotype and there are many from the left who also share a deep unease at the federalist quicksand. The refusal of Eurosceptics to be dismissed out of hand means that those comfortable with the status quo can no longer assume that sceptics will be safely outmanoeuvred. Instead of applying insulting labels to all of those who seek a reappraisal of our place in Europe they should focus on how Europe could better serve all of its people.

Europe's democratic deficit and waste are causing even greater misery in countries like Greece. If a single currency such as the Euro is set up to fail then the right course of action is not to ignore the problem but to either abandon it or adopt the fiscal union which they know to be required. We cannot be part of that and so a renegotiation is inevitable and has nothing to do with British blackmail.

This is the time for Cameron to set out the Conservative position for those negotiations. We may not achieve everything we demand and no one doubts the complexity of the task when in coalition with a Party which would gleefully accept even greater European integration.

The Fresh Start project lists a set of proposals for a looser and more constructive relationship, one which emphasises and seeks to enhance trade. The EU is the world's largest economy and trading bloc. It accounts for around 40% of the UK's total exports of goods and services and is still the most important market for UK business. The point is that we are equally important to the EU.

I believe our place is in Europe not least because our access to the single market secures our place as one of the most favoured destinations for foreign direct investments. But there is a cost; the over regulation of UK businesses undermines our efforts to compete with other growing economies.

Despite the trade benefits, does anyone seriously feel that if the current state of our relationship with Europe had been put to the British people in 1975 we would have had the same result? Is that trade worth the loss of sovereignty, the loss of control over immigration and over so many aspects of our lives? Would voters have approved the vast subsidies to large landowners within the unreformed CAP or the devastation of fish stocks via the CFP had they realised what that would cost?

The extent to which the EU now controls so many aspects of daily life is a cause of deep unease. In the Health Service the working time directive has adversely impacted on medical training and we are still unable to adequately test healthcare workers can speak English. Sensible measures to prevent the sale of ultra cheap alcohol will be held up for years in the European Courts, perpetuating the cycle of violent crimes and rising liver deaths as Parliament is impotent to set our own controls without legal challenge.

It is time to end the cycle of negativity that characterises our relations within the EU. This is not about wanting to cherry pick the parts that will bring greatest self interest whilst gaining a competitive edge over other member States. It is about establishing the principle that Britain does not want to join a federal State and should not be disadvantaged by the block votes of those which do.

There is room for European Nations to have flexibility as was established by the 2001 Laeken Declaration, which allowed for the EU to adjust the division of competencies and restore tasks to member States.

It would be in everyone's best interests for the British to fall back in love with the EU and for us to be a constructive partner, but that can only happen if we review the terms and commit to asking the question at a referendum.

People will bluster that there are more important things to worry about like the cost of living and fuel prices but these are all closely linked with our European obligations and not always for the better. It is time to set out how these could be improved by a looser relationship with the EU based on trade rather than conformity.

The Fresh Start proposals should be given serious consideration.


Our EU membership is a disaster the longer a referendum on our membership is delayed the more opportunity it will give the EU to create even more jobs for plagues of parasitic officials. These officials take home huge salaries when they have not even done a fiver’s worth of productive work for the country. All the taxes to keep them have destroyed the livelihoods of those doing real work in our manufacturing industry making us much more reliant on importing cheap shoddy rubbish from China. We shall end up like Greece we are probably not far off all ready. There is talk that we could lose an A from our triple A rating we shall have to start Quantitative easing the A rating as well. On January 2014 the UK will open its doors to Romania and Bulgaria if all that lot can get UK citizenship and go on the social the Tories can kiss goodbye to any hope of a majority in future elections. Much is made about all these EU grants to help businesses and funds for small to medium sized enterprises . The problem with EU grants is that in order to give them the EU has to rob Peter to pay Paul and because there are so many officials and administration costs involved the EU has to rob Peter a hell of a lot more than they are prepared to pay Paul. It is a fat lot of cop giving grants to new businesses when the existing ones are getting crucified with crippling business rates plus all the other stealth taxes including the green ones to pay for it all.
- Andrew

Below is an extract from the Department For Environment, Food And Rural Affairs (DEFRA) Annual Report And Accounts 2011 2012 It can be found on page 44 by visiting their website and using the DEFRA search box to bring up their accounts . Up to 31 March 2012, Defra’s Accounts have included cumulative transactions for Disallowance penalties totalling £590m. Of this total, £278m has been paid to the EU over time (Stage 3), £187m remains accrued for accepted liabilities and is awaiting deduction by the EU (Stage 2), and £125m remains in provisions for possible future deductions pending resolution of confirmed liability. Despite inflicting this enormous burden on the British-taxpayer there are DEFRA officials who continue to receive shameful salaries and bonuses galore.
- Andrew

One big question remains unanswered about our Eu membership. You say we do 40% of our trade with the Eu countries. Then what profit is there on this trade and how does that stack up against what we pay them each year? Nobody i ask can tell me of one thing that the Eu has funded in the UK. In other countries like Spain they get the biggest development grant payments, Portugal got a ne Portimau bridge, Majorca got new roads, Sth ireland got a new motorway from Loughaire port to the Dublin airport and beyond etc etc. We got and get nothing....So why stay in???
- Dennis

MPs' would be well advised to listen to the Waitrose CEO who has warned of the serious implications to UK business and jobs in holding this referendum. He has real livelihoods and jobs to contend with. In relation to Dennis' comments concerning EU funding in this country many of the previous appalling roads in the Highlands were replaced with the help of EU funding as well as many other capital projects. He obviously does not look out for the EU insignia on many buildings and other sites. When a country joins the EU, assistance is often given to that country's infrastructure so that its economy can grow and in turn its GDP improves, This has the effect, in good economic times, of increasing trade between EU members. Yes, the EU is going through difficult times but our exit would be disastrous to the UK economy with 3.5 million jobs depending on it. David Cameron has been on begging missions to India who along with the Japanese control most of our car manufacturing . Does anyone really think that they will stay here long if we exit from the EU? They are here because they have access to the largest free market by GDP in the world with a market of approximately 500 million people. Our exit would bring about a relocation of much of our manufacturing base to countries like Romania and Bulgaria with a reverse migration to these countries. We also need the protection of the EU to counter the growing influence of country's like China and protect us from large companies like Monsanto and Google who take little notice of the laws that are imposed on them by national governments. At present China's inefficient and heavily state subsidised solar panel industry is undercutting the far more productive EU sector and the EU is likely to respond by placing a tariff on these goods. If the EU does not take action this important industry is likely to go under with the loss of many EU jobs. Once China had the monopoly of this industry prices would go up and they could then use their heavy state subsidies to pick off another industry and so on! Are Dennis and Andrew unaware of the huge investments China are making in Africa and parts of South America and the dominance that this is giving to a communist country that is able to influence the movements of the Dalai Lama? I would far prefer to have the protection of the EU than be controlled by Xi Jinping!
- John Roadknight

Andrew and Dennis may not be aware that The Eden Project has benefited from £50m of EU funding since 1998 that has brought an estimated £1.2 billion boost to the Cornish economy,employs 500 people and supports 2000 peripheral jobs in the area. The UK exported 114,000 tons of beef to EU nations in 2012, 95%of our total beef exports. The USA have still not lifted its embargo after the BSE crisis. The liberalisation of European air travel has driven down the cost of EU flights allowing companies like Easyjet that employs 5000 people to flourish. Free emergency medical treatment within the EU is appreciated by many travellers The cleanliness of Britain's waterways has dramatically improved following several EU directives.The Thames once declared "biologically dead" is now home to salmon,sea trout and otters. The high- Speed rail link to the Channel Tunnel provided 8000 building jobs . The £7.3 billion project is estimated to have created a further 50,000 jobs delivering £20bn in economic benefits. The European Arrest Warrant has brought about the extradition of many suspected murderers, rapists, human traffickers and child sex offenders. The Spanish police were very recently involved with the capture of Terence Moran who escaped from our custody in 2009. Think also of Hussain Osman and Jeremy Forrest The EU Parliament is behind a 70% cut to the cost of using a mobile within the EU.
- John Roadknight

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I am delighted that the Government has backed a minimum unit price for alcohol. 45p per unit will bring an end to the ultra cheap off-licence sales that mean a can of lager can be bought for 20p. Cheap alcohol fuels problem drinking which blights families and communities. It is estimated that this costs taxpayers £21bn per year.

Alcohol specific deaths rose by 30% between 2001 and 2010 and an estimated 15,000 deaths per year in England are at least in part caused by alcohol. Nearly half of all violent crime is caused or aggravated by alcohol.

A minimum price of 45p will save around 714 lives per year and will help heavy drinkers to cut down. We will all benefit if this cuts crime and antisocial behaviour and reduces the carnage in our A&E departments. The price of alcohol in pubs will be completely unaffected but it will mean that a bottle of 10% strength wine cannot be sold for less than £3.38 or a bottle of whisky for less than £12.60. These are not unreasonable prices but will help to save lives and prevent crime. It will also help our local pubs which have been hit by the trend to drinking cheap alcohol at home.

The local impact of problem drinking can be seen at the following site

This is a link to a drinks impact site to calculate the cost of your favourite drinks under minimum pricing.

Here is a link to the consultation if you would like to respond

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Hi, I am an astrophysicist in Cambridge and a member of the Executive Ctee of the Cons Assn for Cambridge. As a physicist I am puzzled that the debate about using a pricing mechanism to reduce alcohol consumption is flawed by its complexity. We don't really tax alcohol anyway: we tax beer, wine and spirits with a variety of tariffs that has led to great complexity I would like to suggest that the duty is set and calculated strictly on the amount of absolute alcohol by volume. That is very fair because the duty would then be strictly in proportion to the ABV strength (%age). If the duty were set at the equivalent of about 30p per "unit", it would result in duty of around £3.00 for a bottle of wine at 12% and a duty of about £8.00 for a 750 ml bottle of spirits (37.5). There's 20% VAT on top of course. But don't you agree that this approach would have the merit of great simplicity and transparency? The government thereby avoids a silly fight with the alcohol industry, supermarkets and the EU trade police. The price increase benefits the public purse not the retailers. A stick-in-the-mud might argue that champagne should bear more duty than still wine, or cider less duty than beer (the present state). But that's not rational: a bottle of champagne, for example, has VAT of at least £2.50 whereas on still wine the VAT can be less than £1
- Dr Simon Mitton

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Women from across the world are meeting in Parliament today to discuss how to increase women's representation. Britain does not do well with just over 20%.

I have been making the case that we need to actively encourage more women to apply even if they have not previously been politically active. The barriers are high but the electorate is happy to vote for women and do not discriminate against them if they are given the chance to stand in winnable seats. Networks in political life do discriminate against women once they are elected but this cannot change unless more women are elected in the first place.

How depressing therefore to see a colleague accepting a role where her prime function is to make herself ridiculous for public entertainment.

If politicians want to be taken seriously they need to take their role seriously.


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The British press may have enjoyed the longest pub crawl in history through last chance saloons but they have also protected our freedoms, entertained and informed us. I wouldn't want to live in a country where the press are at risk for criticising the powerful.

The report from the Leveson inquiry runs to nearly 2000 pages yet its glaring central omission was the role of online journalism. If our newspapers are over regulated we will simply drive more people to seek their scandals from the Internet with almost no accountability at all. If newspapers become irrelevant who will buy them in any case?

Leveson's most controversial recommendation is for legislation to recognise or 'underpin' a new self-regulatory body. The question is whether this represents statutory regulation of the press? Once that is written into Law it is all too easy for the lines to be re-drawn to regulate what the press can or cannot say or to exclude those whose views are unsympathetic to the Government of the day. Whilst Leveson explicitly states that he does not feel this would be the case and also suggests that we could legislate for the independence of the press, it should concern us that once a line has been crossed to 'underpin' the regulator in law, it may result in a press that is directed or restricted.

In my opinion, it is right that we should be wary. Any compulsion to join a regulator would amount to State regulation, threatening free speech and democracy and that would be a high a price to pay. The clamour for action has been driven by activities which were already illegal.

There are those who point to Ireland and say that their regulatory underpinning has not gagged their press, but neither has it provided protection against the innocent victims. Only this summer the Duchess of Cambridge suffered a gross intrusion through publication of photos taken with a snoopers long lens published in an Irish paper.

Cameron is right not to rush to accept Leveson. We need a full debate about the wider implications not a rush to change the law on the say so of a single judge. For Labour to accept all the recommendations before even reading the report was in my opinion an extraordinary misjudgement.


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It seems obvious that doctors should have clear and accurate information about the drugs they prescribe. How else can they weigh up the benefits and risks with their patients?

The fact is that the evidence base for drugs, many in widespread use, is undermined by the problem of missing data. Drug trials which are conducted into the safety of medicines are sometimes deeply flawed in their design or do not compare new drugs with existing treatments to allow judgements to be made about which is the best to use. Trials which show that medicines are useless or even have significant side effects are less likely to be published, even online. Studies which look at the pooled results of many trials are therefore statistically biased to make treatments seem safer and more effective than they really are. Patients are harmed and money wasted on expensive and sometimes dangerous treatments.

Politicians, regulators, professional bodies and even those journals publishing trials need to hold the Pharmaceutical industry to account. Legislation in countries such as the USA has sought to make trial data more transparent but despite changes, publication of trial data has been worryingly incomplete.

This week in Parliament I am calling on the Secretary of State to recognise the scale of the problem and to set out how he will work with the drug industry and regulators to make sure that patient safety comes first. The NHS should never risk lives or waste money on useless or dangerous treatments; making sure that drug trial designs and anonymised results, both from the past and in the future, are open to scrutiny would be a great step forward.


We've had MPS expenses, 'phone hacking(Leveson), Hillsborough and now Saville. All scandals which a lot of people knew about for a long time, but took years to really be exposed. IMHO the dreadful behaviour of the drug companies who seem to be much more interested in their balance sheets than the country's health, will one day be one of these scandals. For instance, I know from personal experience that CCSVI is in many cases an effective treatment for MS-and would save the NHS billions on the drug bill and billions more because people can still work- yet the drug companies have almost succeeded in suppressing it by a campaign of disinformation. Why are they left in effective control of licensing of treatments? Anyway, when this all comes out, at least you will be on the right side.
- Robin

Good work! Just found you via Ben Goldacre. Have offered to help with any co-ordinated campaign. http://www.badscience.net/2012/10/questions-in-parliament-and-a-briefing-note-on-missing-trials/comment-page-1/#comment-40368 Feel free to contact me.
- David Gould

Heard you on Radio 4 this week, and was so glad to hear you coming out in favour a balanced evidence base with pharmaceutical research! Because of your background and hands-on experience of trying to cut back on unnecessary costs (and suffering) in prescribing, I hope Parliament really listens. Thank you!
- Prana Simon

please see the latest media alert from the people at media lens.org and dr wolfgang wodarg site re flu
- chris

Congratulations on getting to such a pivitol position to attack the long-standing problem of Pharmaceutical research transparency. It would be good if you could put the case with the support of the Lancet, the BMJ and in particular Sir Iian Chalmers. Best wishes.
- John Creasey

Campaigning at EU level (EU Commission and EMA in London) is also needed, see: Access to EU's documents is essential to advance transparency and to serve public health http://english.prescrire.org/en/79/207/46302/2095/1884/SubReportDetails.aspx Ch Kopp editor with Prescrire at english.prescrire.org
- Christophe Kopp

Having seen the presentation by Ben Goldacre on TED and waiting to read the copy of "Bad Pharma" doing the rounds of my partners in my GP practice, as well as the significant correspondence in medical media I can only support your efforts to push for transparency in the presentation of data about drug trials. The current reported industry approach to suppressing negative data just sabotages our efforts to keep modern medical practice on a scientific footing.
- Andrew Frankland

Sarah, I am really glad to see you working on this issue, thank you
- Isabella Lazlo

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Today MPs will be asked to rubber stamp a negotiating position on the long term EU budget. Those negotiations matter because they are the only opportunity for our Prime Minister to wield a veto on the seven year budget between 2014-2020.

One of the key roles I have as a backbench MP is to hold the Government to account for its spending decisions. How can I go back to Brixham and explain that whilst Torbay has a cut in formula grant of 11% last year and will have to make painful economies to cope with a further 6.7% cut this year, we should increase our contributions to the EU? All my constituents are feeling the impact of cuts and most understand that we cannot keep spending what we do not earn. How then can I justify sending a huge proportion of those savings to an institution that is blind to the economic challenges facing real people across Europe? I want to strengthen the Prime Minister's hand, to make it crystal clear to the EU that we expect them to change. They could start by ending the 'Strasbourg Circus' where 736 MEPs and 3000 staff relocate back and forth from Brussels to Strasbourg. Would my constituents like to send a large percentage of the savings we are asking of them to the EU? Would they like us to borrow the money to do so? I don't think so.

It would be better to allow a free vote on this important issue and let Parliament demonstrate the true strength of feeling.


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Almost one in five children are obese before they leave primary school and we know that around 85% of them will become obese adults. This will put them at greater risk of heart disease, diabetes and cancer. It is time to stop ignoring the problem.

We now know that the tendency to put on weight is strongly linked to our genetic inheritance and that only 15% of normal weight children will go on to become obese. It makes sense to focus help on the children who are most at risk and to look at the evidence for what will make the greatest difference.

The fact is that exercise, whilst it has many health benefits, makes less difference to weight loss than cutting calories. Around a fifth of children consume more than 500 calories per day in high sugar carbonated drinks alone. Junk food is often cheaper and more convenient than healthy alternatives and so it is no surprise that obesity is so closely linked with poverty. Even the most active children have no need for aggressively marketed junk food or 'sports drinks', but some children are at far higher risk from becoming obese as a result.

Parents want their children to lead happier, healthier lives but there is confusion about food labelling and diet. It is time to invest in our children's health but when finances are so tight we should focus on those children who are slipping into a lifetime of obesity. That has to start by identifying them early. Children are currently weighed in reception and year 6 and we know that the percentage who are obese doubles over that time.

In my view we should be weighing children every year in primary school and offering early help to those running into difficulties. That should include offering children free school meals, together with support and advice for their families about how to continue with a healthier diet at home.

Of course it would help if low sugar drinks were less expensive than high calorie alternatives, if confectionary giants reduced the size of portions and if supermarkets stopped piling junk food at the checkouts but no Party is likely to press for 'fat taxes' or 'sugar surcharges' after the 'pasty tax' debacle.

There are those who would give up on obesity because they feel that it is entirely a matter for individual choice and responsibility but this would also mean giving up on the one in five children who face a lifetime of health problems. I think we could and should do more to help.

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Of course we should do more to help. Nobody would suggest that we allow free access to (advertised) Heroin and ask the kids to be restrained! Its well established that we instinctively seek out high calorie food, because we evolve in an environment where calories are difficult to get. What is needed is a escalating tax on Sugar as it leave the factory gate. The legislation should stipulate that the cost can't be passed on to the consumer. Result should be that the amount of added sugar will go down, in all our foods. You mention the pasty tax: But the govt. was quite happy to tax sports supplements! Why not go the other way and make gym memberships tax free??
- Robin

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I am very disappointed to hear that Costa Coffee will be moving into Totnes High Street. I am aware that I am not alone in feeling this way. The strength of feeling on this issue has been evident and it is not too late for Costa to look at local opinion and decide to take their business elsewhere. I am proud to represent such a strong local community that put such effort into uniting on this matter and would like to congratulate all involved in the campaign to protect the character of our Town.

I understand the strength of feeling around the decision; however applications are approved on planning grounds alone and the Council must also weigh up the cost to local taxpayers of an appeal if they feel it would be likely that Costa would be successful.

Totnes is unique and much of its character stems from its independent High Street; my own view is that the Planning Policy Framework should allow that to be protected by planners and I will be asking the Government to look at how this case has not demonstrated localism in action. I know how passionate local people are about this and I did write to the owners of the premises when Costa Coffee first applied to take it over asking they that they give consideration to independents in choosing a tenant.

I realise the people of Totnes are disappointed and feel their views were not fully taken into account. I now advise people to vote with their feet! There are so many wonderful independent coffee shops in Totnes, all contributing to its vibrant atmosphere and I wholeheartedly encourage people to continue to give them their custom. Taking part in Transition Town Totnes's Independent Coffee Week earlier in the year enabled me to appreciate just some of those on offer.

I understand that Costa Coffee shops have a place in the market. If I am at a motorway service station or the centre of an unfamiliar city I may go in one, but if Costa impose themselves on Totnes I won't be using them anywhere.


According to This Is North Devon: "Long-term unemployment figures have more than doubled in Devon over the last five years. According to official statistics, the number of jobless people claiming benefits for more than a year rose by 1,080 between 2007 and 2011." I think the priority here is getting people back into work. What business is it of yours or the local council, that a legally constituted company can or cannot open a shop? One presumes that they bid for the lease/freehold on the open market like anyone else can. Also what business is it of yours to instruct people which establishments they should patronise? Surely the viability of a business should be left to market, i.e the good citizens of Devon and elsewhere to decide it. Why should the politburo of Totnes decide where people buy their lattes?
- Dave Atherton

Sarah, I speak as someone who has grown up in the town, I have brought up a family here and also have run a business in the town for 28 years. Why are you as our local MP getting involved in which shops can come into the town and which are not welcome? If some other local coffee shops are unhappy with a little competition then so be it. I feel the local authority could maybe tackle the problems of parking and traffic jams before all the customers go to out of town shopping centres. David Endean
- David Endean

Totnes is a special town, one aspect of which is the almost the entire absence of chain stores. Instead the high street is dominated by an interesting and rewarding range of shops and cafes owned and run by local business people. This is just one of the reasons why the town is unique. Do we really want it to change so that its centre looks like any other town? Three quarters of the town's population signed a petition against Costa's application. When such an overwhelming majority express a view then the Town Council should have the power to uphold that view and the Government, which has stated that it will give powers back to local communities, should legislate to give those powers to councils. The point regarding jobs is an important one but any business taking the property would have created employment. I say a big thank you to Sarah Wollaston for championing the will of the people. This is precisley how an MP should act.
- Geoff White

A big thank you for voicing your concerns, at least two thirds of Totnes, do not want this chain in our high street, and with very good reason, the amount of money that goes back into local economy from local cafes is 80 pence in the pound, other than the 12 staff that costa will employ the rest of the money will head out of the area completly, Local businesses use local tradesmen, farmers, growers etc, costa will use their people from a central office up country. It is vital to keep the special nature of Totnes, as it is that very thing that brings tourists to our town, and it is vital that they keep coming and giving us the fresh energy that they bring, to see a slow decline in local shops that is likely to happen the more chain stores coming into the high streets, pushing up the rents and rates so that locals cannot afford to have their own shops here. Totnes is a vibrant and beautiful place, and I hope very deeply that costa will not come here.... They are not welcome by the majority...!
- maia sutherland

The change of use approval of planning permission for the unit on Fore Street will increase in the proportion of coffee outlets relative to non food retail businesses, which is not necessarily a move in the right direction for the town. Totnes is in a region with high unemployment, but with its lower than average proportion of vacant units, it is less fragile than many towns, and qualitative research has indicated that the town’s vibrancy is likely to at least in part be down to the nature of its high street. The planning decision that will enable another coffee outlet the size of three independent cafes to open its doors has the potential to trigger wider changes in the character of the town. Change should be embraced since times move on, but the plans for Totnes should be underpinned with local knowledge and vision, not by parties that have little understanding of how the town works. Whether the arrival of this new coffee shop will ultimately be detrimental to the economic sustainability of Totnes remains to be seen. Regardless of outcome this has been a failure in localism and I am supportive of Dr Wollaston’s effort to get to the bottom of this failure. Furthermore, the development of a local plan is welcome but the processes involved in planning decisions need to be assessed to ensure that local plans carry real weight and are not worth less than the paper they are written on. Looking at the bigger picture, Totnes has a much broader range of businesses than the high street outlets that comprise the public face of the town. We have a small technical export business and we made an active choice to re-settle in Totnes for quality of life and to be close to family again after many years of living out of the area. Small companies like ours contribute to UK GDP and re-circulate money in the local economy. In common with visitors to Totnes, it is the high proportion of independent and local regional outlets that collectively make the town an interesting place to live and do business. Looking to the longer term economic resilience of Totnes, it makes sense to maintain a diverse range of businesses in the town.
- C Norton

You probably already know that Costa opened two shops in Bristol, including the prized independent Gloucester Rd without planning permission. There was a fairly big drive to get them closed. The council wanted them closed. The planning committee ordered them to close. http://stephenwilliamsmp.wordpress.com/2012/01/18/speaking-up-for-bristols-high-streets-in-parliament/ Costa appealed to central Govt and were allowed to stay. :(
- David Gould

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The Coalition is in trouble; since the very beginning there have been a minority of wreckers from both Parties trying to steer it onto the rocks. If they are successful they will be sinking their own ships alongside.

I have had almost no correspondence about House of Lords reform but it was clear when directly asked that people were concerned about losing cross bench expertise. No-one outside the Westminster bubble viewed reform as a constitutional crisis or demanded a referendum. The collapse in the legislation does not mean that anyone other than Labour should be celebrating. It will add to the discontent with coalitions in general and this one in particular. A compromise that recognised the genuine concerns of voters rather than the wreckers would have been far better than the unseemly political tit-for-tat on display.

Mid- term unpopularity was inevitable given the dark financial storm. There is no money; people know this but the siren calls that it doesn't have to be this way are hard to resist now that the impact of cuts and reducing disposable incomes hits home. The immunity of the internationally mobile super-rich and bankers has added fuel to the smouldering discontent. The reality is that almost everyone feels that they are bearing the brunt of it; be they doctors paying higher pension contributions or those really struggling on low pay or benefits.

If there is an election now I fear that Labour would be back; the impact on our national debt and borrowing would be unthinkable. If we think that our financial situation is dire now, imagine that with increased interest rates and take a look at Spain, Italy or Greece.

More than anything right now we need leadership not squabbling. The wreckers should retreat from the cliffs and let Cameron and Clegg head back to the rose garden. The country looks to politicians to behave more like our inspirational athletes and behave like a team.


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Care Quality Commission

The Health Select Committee held an accountability hearing on September 11th with the Care Quality Commission, the body responsible for the registration, review and inspection of health and social care services.

Crucially it is also supposed to ensure that organisations have cultures which support the open discussion of patient safety and whistle blowers in order to protect the public. The Chair, Dame Jo Williams, may have resigned a few days beforehand but her appearance before the committee only reinforced the widespread belief that this is an organisation which should first take a look in the mirror.

When board member Kay Sheldon, publicly expressed her concerns about the CQC, she found herself the subject of smears about her mental health including an inference that she might be suffering from 'paranoid schizophrenia'. Ms Sheldon was dismayed to hear her decision to put information to the Mid Staffs enquiry labelled a self-created opportunity to criticise the board rather than formal whistle-blowing. This kind of technique for sidelining those raising concerns will be familiar to all whistle-blowers and was demonstrated by Dame Jo at the HSC when she effectively sanctioned organisations sorting out their problems behind closed doors.

Asked if she would in retrospect have managed the treatment of Kay Sheldon another way, Dame Jo conceded that she would have managed it 'slightly differently', but then proceeded to further disclose sensitive medical information without her colleague's consent. This is disheartening and shameful behavior for the chair of an organisation with responsibility for monitoring the operation of the Mental Health Act.

The new Chair of the Care Quality Commission should make it an absolute priority to ensure that whistleblowers at every level in Health and Social Care should feel secure when expressing their concerns.


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Science and technology are dismally under-represented in both the Commons and the Lords. There are over 80 lawyers in the Commons but just a handful of MPs with any scientific background. The Lords is hardly any better; out of 783 peers in May 2012 only 42 had a primary background in science, engineering or medicine.

At a time when the staffing for the Lords Science and Technology Committee is also being cut we should all be concerned if the proposed Lords reforms do not take further steps to protect scientific expertise.

If our second chamber acts as a mirror to the first, where legislation may be whipped through with minimal expert scrutiny, our legislation will be far poorer. If it does so without oversight from those who can read a scientific paper or understand statistical significance it will leave us wide open to those who deliberately misrepresent science. At a time when our future depends so much on science and technology we should be taking great pains to ensure that it is fully and expertly represented.

Lords reform is seen by most people as completely irrelevant but given that it is on the agenda it would be wrong to rush into a reform which failed to address the Chamber's overriding duty; to ask the Commons to reconsider legislation and to suggest amendments.

Asking my constituents what they value most about the House of Lords it is always cross bench expertise which scores most highly and never Party allegiance.

The 80:20 split between elected and appointed members is too high and we should take the opportunity to have a greater proportion of independently appointed cross bench peers from a range of specialties and to depoliticise those appointments. The Commons would retain its primacy but we would all have the benefit of improved scrutiny.

On a final note, having asked the British people in a referendum which voting system they favour, it seems odd to reject the one which they so emphatically favoured.

Who feels any 'ownership' of their MEP? I doubt we feel any greater bond with our Senators.


I whole heartedly agree with the constituents' opinion that we need expertise rather than Party allegience. This reform proposal is much too policitically driven rather than dealing with representational democracy. With another tier of elected party people I feel it would lead to blocking of true reform and the bringing in of sensible policies
- John

I have waited for the promised Reform of the House of Lords for years and yet it keeps being postponed for a variety of ineffectual reasons. It was to result in ousting people such as Jeffrey Archer, which is something that needs to be done in order for the House to be taken seriously. How can we have people such as this sitting there as a convicted criminal and yet responsible for making decisions for our country? In my opinion, this reform is well overdue. If the people are calling for Parliament to be cleaned up, that means the Lords as well as the Commons. We cannot have one cleaned up without the other if we want our Government to be taken seriously by the people of their own country, as well as the rest of the world. What sort of impression is all we see and hear about sleaze in Parliament, giving everyone? What does it say about a House of Lords that allows convicted criminals to keep titles that have been bestowed upon them by our queen? In Archer's case one given at his own request and for something later proven to not be as he claimed. It makes a mockery of our Government, the Honours system and honest people of our country.
- Lorraine Holloway-White

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Around 5% of the NHS budget is spent on education and training for its workforce. The Health Select Committee has just reported on how we could achieve better value for patients and staff alike from that £4.9bn.

Over recent years we have witnessed several shocking failures in the basic care provided to vulnerable elderly and disabled patients. The accusation has been made that too much reliance is placed on the 300,000 Healthcare Assistants (HCAs), who comprise around a quarter of the NHS workforce. The same number again are working outside the NHS within peoples' homes and care homes, often undertaking vital clinical tasks. The service would grind to a halt without them but it is surprising that only 3% of the entire training budget goes towards supporting the 40% of the total NHS workforce who are not healthcare professionals.

HCAs do have NVQs and apprenticeships but there is a strong argument for strengthening their training. Providing continuing professional development and better access to career pathways would mean that many more could progress to become Assistant Practitioners. The government wants any registration to be voluntary through the Council for Healthcare Regulatory Excellence CHRE. It is a good start but statutory regulation would be stronger in the long term. Mandatory regulation would give greater assurance to those needing care by setting standards and ironing out the undoubted variation in supervision and training. It would also permanently exclude those who have proved unsuitable to care for others in such an intimate position of trust.

For years the NHS has suffered from a kind of boom and bust in staffing with too many expensively trained specialists in one field whilst others are struggling to cope with shortages. Hence the Centre for Workforce Intelligence CfWI, the clue being in the name, which was set up to keep a finger on the pulse of changing healthcare needs and advise where we should be expanding or contracting training places.

As the Health Service structures are changing, they must not lose sight of the need for the whole service to plan ahead. There are too few generalists and there is inflexibility within medical career pathways. Too often a highly and expensively trained specialist has to start back at the beginning of another career pathway with the taxpayer continuing to foot the bill for a high grade salary. By 2020 the CfWI estimates that the NHS will have 2800 more specialists than it needs but a shortage of GPs and those with the generalist skills to look after patients admitted to hospital. There is also the ongoing problem created by the European Working Time Directive restricting junior doctors to an inflexible 48 hour working week.

Traditionally the NHS has poached trained doctors and nurses from overseas, even where their home countries can ill afford to lose their skills. More recently there have been scandals involving inadequate language skills or training and it is good news that the government have taken steps to protect the public.

32% of doctors hold medical qualifications obtained outside the UK; the NHS would not have coped without them. The increase in medical school training places means we should now be filling junior doctor vacancies from doctors trained in the UK. It is unethical to poach NHS staff from poorer nations and improved workforce planning should also help to reduce the £1.9bn annual bill for locum staff.

There should be widespread support for a move to a multi-professional approach to training. We will all benefit from a better skill mix and the breaking down of rigid professional boundaries. Nurses will become more involved in prescribing and are likely to play a greater role in delivering roles traditionally covered by doctors. Likewise pharmacists and other professionals are likely to adapt and expand the services they are able to provide to the public.

The report also focused on the changes to the funding of health education and training. It has long been recognised that private providers deliver their service using staff trained at public expense. It is only fair that they should contribute to the cost of that training and the move to a training levy will address this. Equally they should benefit if they are able to provide training if the money follows the student rather than the current system where blocks of funding have little or no link to quality or value for money. Funding healthcare training should be focused on the needs of the patients using the service and make sure we have the right people in the right place, properly supported and confident that they have the skills for their important and valued roles. Click here for the full report


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As a member of the All Party Cycling Group in Parliament I sent an open letter to all MPs to try to encourage them to share, donate or lend a bike to a colleague. Our roads will be safer for cyclists only if more people take to two wheels and demand change. If you are interested in joining the campaign why not start your own scheme with fellow enthusiasts in your community or workplace?

Here is my letter to MPs. The response has been both encouraging and entertaining:

Dear Colleagues,

This is the summer of cycling!

It has stopped raining and the All Party Cycle Group would love to persuade you to join us. Leave the tube and taxi behind and borrow a bike to get to your meeting or spend a week speeding past stationary traffic.

I cycle in on a Brompton; a miracle of British engineering which folds away smaller than a carbon footprint. I'm really happy to lend it out, complete with stylish trouser clips, garish taxi repellent and all you need to perfect your helmet hairdo.

Julian Huppert has a Trek 30 with basket, who could refuse? Meg Hillier can even cater for babies.

Sir George Young and Norman Baker have bigger wheels and are among many others ready to lend their bikes and share the joy of cycling.

If, like Nadhim Zahawi, you have a spare lurking in your shed which you could dust off for the summer of cycling please let me know.

Just email direct if you would like to get on a bike; no Lycra required.

£ Times article


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The British Medical Association is trying to persuade doctors to vote in favour of strike action. In doing so the BMA has shown how out of touch it has become with the interests of patients and doctors alike.

When I first joined the BMA after qualifying in 1986, I was unaware that it was a union. I had assumed that it was a professional organisation supporting standards and education. Like most doctors I joined for the weekly British Medical Journal, which at that time was the only way to find out what jobs were available.

This week in a 'Pension Ballot Special', BMA news tells members that they had no choice but to ballot on industrial action for a 'fairer' approach. It splashes on the 14.5% that only the highest paid doctors will have to contribute towards their pensions and tries to sell the line that no patients would be harmed by industrial action.

It tries to persuade GPs that they could open for their usual hours during industrial action but not carry out any pre-booked or routine appointments or issue any repeat prescriptions. Likewise hospital colleagues are invited to turn up and make decisions about what is or is not an emergency.

The results would not only be farcical but also frankly dangerous and doctors would of course find themselves catching up with an exasperated and irritated public over the following days... Except of course if that feels unreasonable, in which case the BMA industrial relations officer will be on hand to give guidance. He or she can expect to be very busy.

The public is unlikely to have much sympathy.

In the 1980s doctors were relatively overworked and underpaid but professionalism and vocation commanded public respect. As a result of a spectacularly mishandled negotiation by Labour the much needed investment in the health services went to funding large pay rises hand in hand with a reduced service to the public. GPs ditched out of hours and Saturday surgeries because ministers misjudged the relative value of payments to doctors for these services and failed to ensure that patients' needs came first. They also waved through the European Working Time Directive that undermined continuity of care and if anything worsened working conditions and training for junior doctors. Assuming that all consultants were on the golf course or seeing private patients, the Government insisted that they should be paid only for the time they spent on NHS work. It should have come as no surprise that they ended up paying even more on account of unpaid time that consultants were previously happy to gift to the service.

A decade later, doctors are well paid and few GPs work Saturdays or nights; their out of hours work has largely been delegated to others and the days of continuity of care have been eroded. The public are unlikely to feel the same about doctors earning over £100,000 per year, sometimes for a 4 day week, who decide to go on strike over their pensions.

To put this into perspective, doctors currently earning over £120,000 currently pay 8.4% and this would eventually rise to 14.4% but for those on £45,000 contributions would rise to just 9.3%.

Is that so unreasonable? To get an equivalent pension in the private sector would require about a third of their salary and doctors are living around 10 years longer than they did in the 1970s.

The rest of the country has woken up to the reality of pensions affordability and in the coming weeks we may all witness what happens to a country like Greece which fails to do so at all. No government wants to pick a fight over pensions, but to ignore demographic and financial realities would dump the entire burden on the next generation. Who could blame them for refusing to pick up the tab?

I hope doctors will follow at least one aspect of the BMA's advice; 'Whatever your views it's vital you vote.' I hope they will not vote for action that would have such a significant impact on their patients; the public will neither understand nor sympathise.

I'm often asked what's the difference between being a GP and an MP? One wag put it like this; 'about £40,000 a year'. I would add for the record that as an MP I now pay 13.75% towards my pension and like most of my colleagues work evenings and many Saturdays.

Of course one of the main differences is the way people feel about you. I hadn't realised how much people like and respect doctors until I swapped the G for an M! That support matters and the public will be unlikely to respect a vote for strike action over doctors' pensions.

Perhaps every doctor should ask a friend who doesn't work in the State Sector how much they will be getting when they retire and how much they have to contribute; they may be in for a shock.

This would not be a victimless strike. The BMA have made the wrong call and I hope that doctors will vote to put their patients first.


Dear Dr Wollaston, Good article in to-day's Telegraph and here. In particular, your comment about future generations struck a chord. Below is the letter I had published after the recent local elections. Best regards, John Bell North Wales Area Chairman Welsh Conservatives 4th May 2012 Economic Realities Haven’t Changed There is no doubt that the local elections are a disappointment for the Conservative Party. Disappointing for many excellent, hard-working councillors but, just as important, disappointing for the many new, young, enthusiastic candidates who put so much energy into their campaign and who would have been such an asset to their communities. Disappointing, but not surprising; governments that have to make difficult decisions are never going to be popular. Popularity is a luxury that only opposition parties, without the responsibility of office, can aim for. However, when the dust has settled, what has changed? The economic and financial realities are still with us. A budget deficit of £126 billion, adding to our National Debt of £1.04 Trillion which, by 2016 will be £ £1.5 Trillion, costing £46 Billion in interest each year. In addition, the government (which means us) have current and future unfunded state and public sector pension liabilities of £5 Trillion, the equivalent of £179,000 per household. The government already spends £100 Billion a year on pension-age benefits, a seventh of all public spending. We can also add that the taxpayer is committed to paying £229 Billion for projects with a capital value of just £56 Billion through the Private Finance Initiative deals over the next 30 years. The consumer too has to reduce its £1 Trillion of private debt before it can start to spend again. This is with an economy which needs long-term re-balancing away from ever-expanding government spending, financial services and housing price bubble -induced consumer spending. Of course, this is also against a backdrop of a fragile world economy and a Euro Zone that is in freefall and cannot survive in its present form. Our education, welfare and health services are also in need of urgent reform and, crucially, because of demographic changes, an aging population (I’m one of them!) brings massive and expensive increases to the demand on the NHS and care for the elderly that the parties have yet to resolve. These are costs that we are increasingly laying on a future and declining working age population. We are taxing future generations that have not been consulted. In 1776 the American colonies proclaimed, ’no taxation without representation’. Who represents our children and grandchildren, who will have to pay these bills? There are those that are surprised that the economy is not already expanding and seem to believe that our problems can be overcome by a couple of years of austerity then we continue as before. The truth is, we’re in an economic and financial situation that will take many, perhaps 5/10 years or more, to solve. To suggest there is some quick and easy solution is dishonest. In this situation, the time has passed when Labour can complain that the government is cutting ‘too far and too fast’ without adding how far and how fast it should be. Nor can it agree that the deficit must be reduced while opposing every spending cut or tax change. If not this cut, what? If not this tax change, then, what? Clever sound bites and class warfare are no substitute for policy. John Bell North Wales Area Chairman
- John Bell

I so agree with your comments about doctors' pensions. This strike cannot be justified in my view on any sensible criterion. I am a doctor but retired and so not eligible to strike. If still working I would be delighted to continue and be called a blackleg. Thank you very much for your comments in the House about your experience of postnatal depression. I am chairman of a small charity called Rekindle based in Newtown Wales. We try to bring direct support to people in the community who suffer from mental health issues. This is especially relevant at a time of cuts as mental health is always the easiest to hit when there is cutting to be done. Lose no opportunity to publicise your feelings about this. Thank you.
- John Scott

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The viciousness of online commentary following any opinion piece is enough to make anyone think twice before expressing their views. Trolls vent their spleen confident in their anonymity and take great pleasure in their faceless spite. For most in the public eye the answer is to grow a thicker skin and resist the temptation to rise to the bait.

For rape victims, it is altogether more serious and increases the risk that sexual violence will go unreported. In recent years we have begun to make progress in persuading victims to come forward. One in four women reading this may be a victim of sexual violence at some time in their lives but few will make a formal complaint to the police. For men, the taboos can be even greater and support networks available to women are often unavailable.

If you have sex with someone who is too drunk to be able to consent then he or she is not consenting and this means that you are a rapist. That message was delivered loud and clear by the jury in the trial of Ched Evans and his victim deserved respect for having the courage to come forward. The law should also have ensured her lifetime anonymity. That she has been named and abused online is a contempt of court and unless those responsible are held to account, we can expect this to continue.

There are those who see the internet as a forum which is above the law and who regard any restriction as an assault on free speech. I disagree, just as we do not want the State to trample on our privacy neither should we allow the equivalent of an online mob to do so. We all deserve the protection of the law, none more so than the traumatised victims of sexual violence.

I hope the police will investigate and take action. We have seen that this is possible with the conviction of a student, Liam Stacey following his hateful online racist postings about Fabrice Muamba.

The argument that there were too many who posted Ched Evans' victim's name to make it possible to take action is wrong. The police could and should use this case to take action and make an example of those who seek to hide behind their own mask of anonymity to abuse the more pressing right of victims to this protection.


"The argument that there were too many who posted Ched Evans' victim's name to make it possible to take action is wrong." yes. this could be a watershed for twitter users. interesting to see how it develops.
- johnny morris

Can't say i wholly agree. Ordinary people, especially young people are not well versed in the law, especially laws, which in the past, have only really affected media companies. Criminalising people will just end up ruining more lives and we will end up with a situation where everyone loses. Educating people is the what we should be doing. What good would it do to criminalise 20, 30, 50, 100 people who tweeted the girls name? This isn't just the Muaba case, where the the Tweets were made by one person. There were hundreds, possibly thousands of people Tweeting her name. Some because they were engaging in gossip, others for more malicious reasons and some because they were simply wondering what everyone was talking about. Take a step back and try to see the whole picture, not just part of the picture in which seems to have outraged some people. I can't help but think that prosecuting people will only enrage those who are already enraged at what they see as a miscarriage of justice and could possibly make things worse, although you couldn't blame the police if they did pursue Tweeters. It is easy to take a hard line approach, especially on such an emotive subject, but calmer heads have to prevail.
- Craig

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'There are truths, economical truths and statistics' might be a better version of the original quote about them. Since tweeting that waiting times for 18 week waits had decreased, a story was printed in the Guardian claiming the opposite, so can both be correct?

We collect so much data on NHS performance that it can sometimes be difficult to see the wood for the trees. Information is collected on those who are currently waiting, the most up to date figure, as well as those who have completed treatment. There is also data that separates those admitted from those not admitted to hospital.

The Guardian story was based on a report from the Patients Association which showed the average waits from an incomplete sample of those who had completed their treatment rather than those still waiting in the system.

If you treat people who have been waiting the very longest, the so-called statistical outliers, then you improve the average wait of those currently in the system but this does then skew the average times that appear in the statistics for those who have completed treatment...especially if you only look at a sample rather than the whole picture.

It is why overall it would be better to move towards a focus on measures of outcomes; did it work and did the patient feel happy with the way they were treated. The problem is that this is also fraught with difficulty; for some conditions improvements may be difficult to measure or entirely subjective. It doesn't mean we shouldn't try, certainly the move to improve data on both one year and five year cancer survival will help to identify and improve early cancer diagnosis.

In the meantime, based on the most up to date measures, current waiting times for NHS treatment have never been lower and we should celebrate the successes as well as highlight areas that need improvement.

Next week the House of Commons debates the impact of the European Working Time Directive on the NHS. Please write to me if you have personal experience of this.

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Very easily manipulated statistics, which in the past have messed patients around with a 5min "consultation" using up hours of patient time just so they were "seen" within arbitrary timescales. As you say its all about results; surveys of "satisfaction" are as you say very subjective and relatively easily distorted by how the questions are asked, as such they don't provide absolute comparability. The NHS will probably get relatively high ratings given the something for nothing perception; although of course most public services aren't subjected to the most telling measure of customer satisfaction, competition.
- IW

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Thomas Newcomen 1664-1729

I am very pleased to celebrate the Newcomen Engine's Tercentenary. This is an important part of local and international history and it is a wonderful opportunity to shine a light on the birthplace of great inventions, in this case, the beautiful town of Dartmouth.

Thomas Newcomen, often labelled the "Father of the Industrial Revolution", lived in Dartmouth and was an Ironmonger by trade. Despite being uneducated in mechanical engineering, in 1712 Newcomen invented the world's first successful working steam engine.

Newcomen's engine was able to pump water out of deep mines, this helped to provide coal, iron and other metals that were vital to the expansion of industry. The innovative thinking behind this leap for technology heralded the Industrial Revolution of the 18th Century.

Before Newcomen steam technology was in its infancy and his pioneering vision meant that for the first time power became portable and factories were not limited to being located near water. Newcomen was the first real hero of the steam age and during the 18th and 19th centuries more than two thousand Newcomen Engines were installed in Britain and across the continent.

Newcomen's engines contributed directly to Britain's prosperity and world reach as later improvements to Newcomen's engine design made it efficient enough to power the cotton mills whose vast profits bankrolled the building of the British Empire. This is why Newcomen's engine is important not only to Dartmouth but to the world.

The Government has just published its consultation on whether to introduce standardised or plain packaging for cigarettes. There are arguments for and against; some will object in principle to anything which could be seen as an extension of the 'nanny state' whilst others will raise concerns that it might increase the illicit tobacco trade. If the latter cannot be prevented then a change could do more harm than good and Government needs to look closely at the evidence.

As for the State's duty to protect public health, we expect the State to do so when epidemics strike and to ensure that our water and food are safe so why not to step in when one in two long-term smokers die from a smoking related disease?

In my experience many addicted smokers are desperate to quit and even at a late stage will benefit from doing so, most of them wish they had never started in the first place. I'm not suggesting that standardised packaging will be the answer for addicted smokers but it may help to reduce the appeal for those who are just starting. In my view Government does have a duty to try to reduce the number of children and young people taking up smoking every year so that they do not join the 100,000 who die every year as a direct result.

I accept that for many this is an issue of personal choice and responsibility but 2 million children live in households where they breathe cigarette smoke without that choice and are more likely to suffer ill health and become smokers themselves as a result.

Please add your view to the consultation which will also ask for your opinion on how the packets should look if this is introduced http://consultations.dh.gov.uk/tobacco/standardised-packaging-of-tobacco-products/consult_view

I would also welcome your opinion via the poll on this website


Dr. Wollaston, I say with no irony that I hope you are well. Allow me to introduce myself I am David Atherton Chairman of Freedom2Choose a pro choice rights group. Our group nor me are paid remunerated, or expensed by tobacco companies, nominees or affiliates. However I have been paid and remunerated by Pfizer who make smoking cessation drugs. Before we go into the ethics of yet more state sponsored 'denormalisation' and 'leparisation' of an identifiable group minority group as identified by Professor Hilary Graham in a report to the Department of Health let me address some of your major concerns. Firstly smuggling. Under EU rules it is quite legal for British citizens to go to for example Belgium and purchase as much tobacco and cigarettes as they like, as long as they are for personal consumption. Justine Greening MP, Economic Secretary to the Treasury is in my opinion clearly in breach of the Single Market when she councils for 800 cigarettes and 1kg of hand rolling tobacco. Of course there is substantial illegality too. (1) Current estimates for the amount of tobacco of both persuasions is about 20%, I have read 22% as a more precise figure, costing the treasury £2billion in lost revenue. One has to say the Laffer Curve is the biggest motivator here. Some criminals are small time 'white van man' variety but as Action on Smoking and Health, Scotland identify some more sinister and criminal people and I quote. "The enormous profits to be made by evading tobacco duties make smuggling an attractive option for unscrupulous criminal interests. The Taliban, al-Qaeda, Hezbollah and the Kurdistan Workers Party (PKK) are involved in smuggling cigarettes as is the Columbian FARC. Both the Provisional IRA and the splinter group the Real IRA have been linked with tobacco smuggling as a way of raising money to fund their activities. Chinese Triads are central to the traffic to the UK of counterfeit cigarettes produced in highly sophisticated factories in the Far East.” (2) In my opinion this is due to largely the obscene amounts of tax that smokers pay, typically at least £4 a packet and a deeply regressive tax on the poor too with 14% of ABC1s who smoke vs 28% C2DEs. It is purely a government made problem with its addiction to nannying, tax and spend. With the 37p tax hike in the last budget the criminal networks established in the UK will only expand and consolidate. They will have no scruples to what age group they sell too. I believe there are 200 brands in the UK and with plain packs all you have to do is change the lettering on the font. You may not be aware but there is a brand of cigarettes called Jin Ling. Manufactured in Kaliningrad (correct spelling) a Russian enclave, surrounded by EU Baltic states, the factory produces 24 billion cigarettes a year and has captured 7% of the European market. Not one is ever bought or sold legally. (3) A recent survey found that 97% of smokers could name one fatal disease associated with smoking. If smokers are making an informed choice then they should be left alone by the state. Especially if stops the freedom of assembly of consenting adults to consume a legal substance on private property, i.e. the smoking ban. This is suspiciously authoritarian. You mention that smokers are desperate to quit, I disagree. While ASH cite 70% of smokers would like to quit, I was speaking at the British Medical Journal's debate in February 2011 'Is smoking a disease or a habit' and Director at Global Smokefree Partnership, Antonella Cardone said if you ask the question of quitting 'within one month' the figure drops to 20%. There is not one shred of evidence that plain packaging will work. In Australia where I can find homogenous data, that is compare the same age group, I cannot do it with DoH data, the try rate of tobacco is 12% for 11-15 year olds. Cannabis is 22.5%, nearly twice as high and if you include all hard drugs 34.5%, nearly three times as much. Of course all drugs come in plain packaging. (4) On children with exposure to second hand smoke (SHS) and illness, I am afraid that we are being misled on a Biblical scale. It is a stain on science and the medical profession that this appalling mistruth is perpetuated, while accepting most of the evidence on active smoking. On SIDS the latest research from Havard Medical School is that it is a lack of serotonin in the brain which is the sole cause. On asthma and atopy nicotine ironically suppresses these conditions. I have after this post also included my list of references which you may have to rescue from your spam folder. I have written to Professor Dame Sally Davies and Professor Terence Stephenson with the scientific case based on the relevant papers. (5) In conclusion plain packaging will have no effect on youth smoking, and in fact may have the unintended consequences of increasing it, as the allure of the forbidden fruit becomes stronger and the illegal market more prevalent.
- David Atherton

Here are the URLs. 1. http://www.hmrc.gov.uk/thelibrary/tobacco-products.pdf 2. http://www.ashscotland.org.uk/media/3403/Illicit_tobacco_August_2010.pdf 3. http://www.publicintegrity.org/investigations/tobacco/articles/entry/763/ 4. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/drugs_teenagers?open 5. http://daveatherton.wordpress.com/2012/04/01/an-open-letter-to-professor-terence-stephenson-and-professor-dame-sally-davies/
- David Atherton

Dear Dr Wollaston, Please name one person -- man, woman or child -- who has definitively died from second-hand smoke exposure. And yes, we grow weary of government protecting us from ourselves. Also, the consultation's questions are unfair and loaded, particularly for the online form. There are several in which a consultee has no choice but to answer affirmatively in favour of plain packs, which we do not support. If you fail to speak out against the bias of the consultation, we have no choice but to assume you support an unfair and most undemocratic process. Very kindly yours, Jay Public
- Jay

"The Government has just published its consultation" It's not a consultation at all. It's a joke. Smokers are never consulted. And we getting very angry. http://cfrankdavis.wordpress.com/2012/04/21/not-angry-enough/
- Frank Davis

So you have just equated the government stepping to help with an outbreak of Cholera, Plague, smallpox or any other such epidemic, with government telling people what colour schemes they are allowed to see...Hmm David Atherton, Jay and Frank Davis sum it up for us perfectly. Leave us alone politicians... www.handsoffourpacks.com
- Hands Off Our Packs

Plain packaging and hiding tobacco products behind shutters are meant to stop children taking up smoking, but youngsters get their first cigarettes from their friends and not from shops. It is also illegal for shops to sell to anybody under 18 so whats the point.
- Charles

Wow David, how nice of you to hope somebody is well without any irony. I could almost hear the drum-roll as you introduced your very important self. I'm going to point out that although Dave says his freedom group nor he, himself or him receive any funding from the tobacco industry, he regularly posts news links concerning plain-packaging on the facebook page of pro-smoking lobby group, so regularly in fact, just like many of the members of that group, that it is bordering on obsessive. He encourages all it's members to leave comments on these news articles showing their support against plain packs. This lobby group most certainly is receiving funding from the tobacco industry.
- Ian Herrick

No, Dave Atherton isn't funded by the tobacco industry. And neither am I. And neither are any of the countless angry smokers in the world. We don't need to be paid to be angry about what's being done to us. The only person who's being paid by the tobacco industry is Forest's Simon Clark. Everything else is a smear. And probably one that's actionable in a court.
- Frank Davis

The government has published an "evidence review" of all the available evidence on plain packaging alongside the consultation. In that review it clearly states that "it has not yet been possible to conduct research that could fully evaluate the potential impact of this policy". Why would any government, or MP, seek to implement a policy, when the outcomes are so unknown? There are far more effective measures available to address the uptake of smoking amongst the under 18s: education and information; recognising ‘PASS-hologrammed’ proof of age cards (e.g. Citizencard) as valid ID; clamping down on the sale of counterfeit cigarettes and increasing penalties for smuggling; making proxy purchasing of tobacco for under 18s illegal. All of these should have been considered before taking a leap into the dark. Why not wait until the impact of the ban on cigarette vending machines or the tobacco display ban measures have been assessed? Why not wait to see what happens in Australia - where plain packaging is being introduced later this year? I can see why there is such anger at this particular government consultation; ignoring safer options, no clear answer to what the actual impact will be, hurting local legitimate businesses, making it easier for criminal counterfeiters and more. But the biggest sense of outrage is that £500,000 of local NHS money in the South West has been siphoned off and handed to Smokefree South West to spend lobbying your local voters to support this policy. How is spending much needed NHS money on advocacy of a government policy justifiable? Voters have the right to be presented with both sides of the argument on plain packaging of tobacco. The alternative view can be found at www.handsoffourpacks.com.
- Angela Harbutt

Ian Herrick you said: "This lobby group most certainly is receiving funding from the tobacco industry." I said: "Our group nor me are paid remunerated, or expensed by tobacco companies, nominees or affiliates" Would you like to withdraw that comment?
- David Atherton

No I will not withdraw my comment. If I didn't make myself clear the first time, the group I was referring to, which you are so closely linked, is the one which Angela is plugging above, a campaign owned and managed for forest. Forest also opposed the smoking ban. In my local area, I havent heard of or witnessed first hand any public places that have had a problem enforcing the ban. Why? probably because even smokers themselves don't want to be in such an awfully smoky environment. And a few years on from the ban we are seeing the improvements in health rates. If Forest had their way and we took a step back into the uncivilised days of allowing smoking in public places, I'm convinced there'd be far more outcry when people remembered how bad it is to be in a smoke-filled pub with watering eyes, not being able to wear your clothes again the next day because they stink so badly. Forest is set to receive £330,000 this year from the tobacco companies. I'm sure many people out there would gladly leave their morals behind and back a campaign when offered that sort of money. Anything that might affect the tobacco industries profit in selling their harmful, highly addictive products is going to affect the amount of money they can feed lobbying groups such as forest. That's the real reason why Forest, who are running the hands off our packs campaign, don't want to see plain packaging brought in! Outrageous that the National "HEALTH" Service are supporting this campaign that will help people lead Healthier, disease-free lives? I'm not outraged. What I am outraged about is that I have had close members of my family taken away from me by their terrible addiction to cigarettes. You can't blame the government for not wanting to involve the tobacco industry when they've tried for so long to cover up how harmful smoking tobacco really is, and even denying that nicotine is an addictive drug! http://www.youtube.com/watch?v=jQUNk5meJHs
- Ian Herrick

The BIG news today is that Diabetes is bankrupting the NHS. Years ago people smoked to dull their appetites, but since the decline in smoking there has been a BIG increase in obesity which is the biggest cause of Diabetes Type 2.
- Charles

"probably because even smokers themselves don't want to be in such an awfully smoky environment. " What utter drivel. "And a few years on from the ban we are seeing the improvements in health rates." No, we're not. You're referring, I suppose, to the heart attack 'miracles'. They've been debunked, by Chris Snowdon and several others. " a step back into the uncivilised days of allowing smoking in public places..." It was much more civilised back then. There was a civility and tolerance and forbearance which has gone now, as we approach civil war. " I'm convinced there'd be far more outcry when people remembered how bad it is to be in a smoke-filled pub with watering eyes, not being able to wear your clothes again the next day because they stink so badly." Nobody ever did any of those things, so there won't be an outcry when we get our pubs back. And we will get them back.
- Frank Davis

With respect Dr Wollerston, I do believe that you would be hard pressed to find ONE smoker, out of the 20 million or so in this country, who have started smoking because of the size/ colour or shape of a cigarette packet. It is utter nonsense. As a long standing Conservative voter, I did not strive to get this Government in place, only to find that we are all still in the grip of political correctness, spin and general sillyness. I can speak as an ex- smoker. I stopped several years ago. I was not comfortable and consequently started again. The continuous bullying and persecution of people using a legal product is not going to lead to any enthusiasm or great desire to stop. Quite the reverse in fact. This initiative is being pushed by the same organisation that declared more people would go to the pub if there was a smoking ban. Result. Businesses closed down. Jobs lost. Loss of excise to the Treasury. I am concerned the same thing will happen again. Price hikes and packets being easier to copy could lead to an explosion of the illegal tobacco trade. Loss of small shops, loss of excise to the Treasury but most of all, putting children,s health at risk from using a product that will clearly be unregulated and unsafe. Finally I must say, I have been smoking cigarettes since before you were born. I have raised four children who are perfectly healthy and who do not smoke. Another myth busted. I will continue to smoke as long as I enjoy it and frankly I consider the Government has much more important things to be doing. Perhaps a focus on the economy and jobs. This must surely be a joke!!!
- Sheila

As we're all having fun posting links, here's an old Forest piece talking about the original founder of freedom2choose, Rod Bullough - a tobacco supplier!. Dave is there, referring to the first website address for freedom2choose as "our old web address". http://takingliberties.squarespace.com/taking-liberties/2007/11/11/in-defence-of-cigarette-vending-machines.html More recently he's been denying any links to the freedom2choose established by tobacco supplier Rod Bullough, but back in 2007 it was "our old web address" As for tobacco supplier Rod Bullough's freedom2choose becoming defunct in 2005, here's a link that shows that he was still posting on the original freedom2choose website up to 2008. http://www.zoominfo.com/#!search/profile/person?personId=643130677&targetid=profile History is hard to rewrite in the internet age.
- Tony Green

Frank claims that the only person who's being paid by the tobacco industry is Forest's Simon Clark. Isn't Angela Harbutt of handsoffourpacks also paid by the tobacco industry? Frank also says that 'smokers are never consulted', but everyone is being consulted on this - that's why they call it a "public consultation".
- Tony Green

Ian Herrick and now Tony Green have libeled me. Freedom2Choose was incorporated as an organisation on the 31st of July 2007. You will find that the Freedom2Choose he is referring to had a .co.uk address, ours is .info. Freedom2Choose from our incorporation on the 31st July 2007 have never received any funds, expenses, remuneration from tobacco companies. Their subsidiaries, nominees or proxies. Can I have an apology please.
- David Atherton

There are two sides to every argument. Each side needs money to present it. I don't see why anyone is getting excited if tobacco companies invest in their side of the argument. Nobody should be surprised when that happens, but questions are not asked about the other side. 'Ooohhh tobacco money!!' is used as a weapon as if it proves that the side with tobacco money behind it is 'the baddie' and the money that comes from the other side is pure as the driven snow. In the case of the UK, publicly funded groups lobby the government to carry out policies that they have every intention of carrying out anyway, using vital public funding in order to press their case for these policies. Pretending only tobacco money has a dishonest story to tell is naive in the extreme.
- Belinda

How many millions of taxpayers money does the Government give to anti-smoking groups in order to influence the Government into carrying out anti-smoking policies?
- Charles

I don't know how Dave Atherton thinks he's been libelled. I was quoting HIM referring to the original freedom2choose website as "our old web address". Rod Bullough's freedom2choose website address was www.freedom2choose.org.uk, the one given in Simon Clark's piece and referred to by Dave Atherton as "our old web address". I think Dave Atherton owes me an apology.
- Tony Green

To try to denormalise 21% of the UK population, through lies regarding SHS (ETS) is an affront to civilisation the smoking display legislation and plain packaging is just a continuation of this socially divisive policy, the people who are perpetrating this evil, will be called to account, thousands of jobs have been lost in the hospitality industry because of these lies, and the social exclusion of many millions of people due to the dreconian smoking ban, which could not have been brought in by the HSE (adequate ventilation was the answer) as they had no evidence that SHS is significantly harmful,(see HSE OC255/15) this is tantamount to what Germany did to the Jews in the early stages by forcing them to wear yellow stars. Freedom of choice is what this is about, should they be young or old they have this right, smoking may be harmful in the long run but in my opinion is a far better option than illegal drugs, without cigarettes I would not be here, as I suffered serious depression in my teens and tobacco pulled me through. I also back Dave Atherton up that F2C was formed in 2007 as I was one of the people who attended the meeting at David West's nightclub on Jermyn street, London, Colin Grainger was the Chairman and I was one of the twelve on the commitee who voted for the constitution of F2C/info at this time.
- Greg Burrows

UKIP use the slogan Freedom to Choose. Are they also tied to tobacco companies? There are probably other organisatons who believe in the Freedom to choose.
- Charles

Tantamount to what Germany did to the Jews? Greg Burrows, well done for copying the recent controversial comments of West Virginian politician John Raese who's running for the U.S. Senate. He's recently been labelled as an idiot for the comments he made, perhaps he made them on a whim. Whereas you've obviously read his comments, had time to comtemplate them, making them even more idiotic and downright offensive. Here's an extract from an article I read which sums it up pretty well... For what it's worth, the experience of a Jew in the Holocaust and a smoker in America are comparable in only one regard: the death toll. The Nazis killed 6 million Jews in 12 years. Cigarettes kill that many Americans every 13 and a half. Of course, a smoker has a choice. A Jew had none. And the idea of equating the two is ridiculous, offensive and unworthy of serious people. That should go without saying. The key word there being, "should."
- Tom

"I also back Dave Atherton up that F2C was formed in 2007". Dave Atherton said on Simon Clarke's blog on November 12, 2007 at 21:43 "Simon, alas you have put our old web address on". The address that Simon had put on was that of tobacco supplier Rod Bullough's Freedom2choose. It is Dave Atherton who, in 2007, described Rod Bullough's Freedom2choose as "our old web address". You should stop trying to rewrite history when it is still available online, eg http://abcnews.go.com/Health/story?id=3335994 and http://uk.groups.yahoo.com/group/beattheban/message/1 from July 2007.
- Tony Green

Standardised tobacco packaging will not discourage young people from taking up smoking. A young person's first cigarette will be given by a friend. The young person THEN makes a conscious decision weather to become a smoker or not, and if standardised packaging were introduced, the cheapest cigarettes are liable to be the option of choice. In any walk of life you get what you pay for...the cheaper they are, the poorer quality they'll be. Once this "new smoker" starts on the cheapest option, this will only progress to them buying their cigarettes from "white van man."It's all common sense really.
- Belgarion

Dr Wollaston, I would suggest that you don't believe a word that comes from the fanatics at tobacco control. It's well known amongst "proper" medical experts and scientists that second hand smoke is entirely harmless. The "myth" of SHS was perpetuated by those in the pay of big pharmaceutical companies, to push through the smoking ban and to get us all on nicotine replacement products, which, incidentally have a 98.4% failure rate, and anti-depressants. Why is arsenic in SHS such a "killer," but is entirely safe in a glass of water? There's more arsenic in a glass of water than there is in 10 years worth of a smokers second hand smoke! Why is hydrogen cyanide such a killer in SHS, yet perfectly safe in almonds, tapioca efc? Why is it not well known that children of smokers are 70% LESS likely to get asthma? It's not well known because the tobacco control juggernaut makes sure its not well known. The public have been deceived and brainwashed on a massive scale. "Second hand smoke may be an irritant and an annoyance, but it’s not a cause of death. There are no body bags filled with those who have developed tumors or heart disease as a result of second-hand smoke. The body bags are filled, however, with scientists and physicians who dare go against the anti-smoking lobby and state the obvious—the science isn’t there." Dr Terry Simpson MD: scientist, surgeon P.S....Have a quick read, it's a real eye opener! http://www.joejackson.com/pdf/5smokingpdf_jj_smoke_lies.pdf
- Belgarion

ASH. Is it a make of shoe, a pop group, an anti-smoking group or are they all one and the same?
- Charles

Dr. Michael Siegel is a physician with 21 years of experience in tobacco control who recently became disillusioned by the direction in which the anti-smoking movement is going. He recently founded an organisation called "The Center for Public Accountability in Tobacco Control." His reason for this..."the anti-smoking movement is increasingly becoming more extreme, getting out of control, going too far in its agenda, and losing its solid public health basis. The tactics being used by many anti-smoking organizations have become questionable, including misleading and deceiving the public, improperly attacking individuals, and improperly using kids to promote a political agenda. The agenda itself has become less and less public health-based; it now include efforts to deny employment to smokers, treat smoking parents as child abusers, and ignore basic issues of individual privacy and autonomy to coerce smokers into adopting healthier behavior." ...and this is from one of your own!! http://www.tobaccocontrolintegrity.com/id1.html
- Belgarion

It's a waste of time trying to reason with Dr Wollaston - the results of the so-called 'public consultation' have already been decided. This is basically true of all government consultations. The Tobacco Control agenda was mapped out long before this government came to power. Furthermore, it really makes little difference that not one person voted for the current administration. It's pathetic - The Tories were too weak even to gain an overall majority over the Gordon Brown disaster. NGOs have never had it better...
- prog

@Tony Green I will ask you once more. Since Freedom2Choose was legally constituted on the 31st of October 2007 do you accuse us of having received money or grace and favour from tobacco companies, affiliates, associates, nominees or subsidiaries? Yes or no?
- Dave Atherton

@Dave Atherton. No. Do you deny that freedom2choose was originally established by tobacco supplier Rod Bullough in 2004? There seems to be an awful lot of evidence of this happening, including you, on Simon Clarke's blog on November 12, 2007 at 21:43 "Simon, alas you have put our old web address on". The address that Simon had put on was that of tobacco supplier Rod Bullough's Freedom2choose. You're trying to convince us that freedom2choose didn't exist before 31 October 2007, yet you describe Mr Bullough's web address as "our old web address" less than 2 weeks after that. I'm sure you don't seriously expect the world to believe that there was no "freedom2choose" before 31st October 2007, do you?
- Tony Green

@Dave Atherton. No response Dave? Are you too embarrassed at having described tobacco supplier Rod Bullough's Freedom2choose website as "our old web address" less than 2 weeks after you say that Freedom2choose was constituted? Your earlier list of means of support from tobacco companies that you say you don't get (and I don't suggest that you do) didn't extend to advice, training, intellectual support and similar ways in which a tobacco company could use your group as an front group. Do you want to clarify this? Do you or your members ever talk to people from tobacco industry bodies, or their paid advocates, and get a steer on how to play things? I'm sure you don't, but I wanted to give you the chance to say 'no'.
- Tony Green

speaking of so-called 'freedom to choose', the pathetic hands off our packs page on facebook only allows comments from their small minority of followers who happen to agree with their views. I urge anyone reading this to type "Sex, Lies & Cigarettes': Vanguard Sneak Peek" into youtube and watch the documentary. It highlights how international tobacco companies are brain-washing indonesian children with advertising. The only reason that they can't get away with that in the U.K is because our government doesn't allow it, and if our government gets accused of 'nannying' because of that, then that is something I am more than happy to live with
- tom

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I don't sympathise with those who criticise Andrew Lansley for asking the Care Quality Commission CQC to investigate abortion clinics.

Some insist that he was wrong to step in and that his involvement jeopardised the independence of the CQC, even that this was a politically motivated attack on abortion itself.

The critics overlook an important point; he had a duty to step in as the Secretary of State has direct responsibility for the registration and safety of abortion clinics. He is the custodian of the Abortion Act and had to discuss any concerns with the CQC.

How did it compromise the independence of the CQC when it was the authority which first notified the Department of Health that it had received complaints about illegally pre-signed paperwork? That in itself should have triggered a request to investigate but there was an additional complaint about possible sex selection abortions from the Daily Telegraph.

I am pro-choice in the matter of abortion and dismayed that some have sought to portray the CQC investigation as evidence that women's right to choose is under threat. How is it in the interests of the pro choice movement for clinics to flout the law? Women everywhere should be revolted by the practice of devaluing girls and actively aborting them in favour of male children.

For the CQC to complain that the investigation diverted from their routine work is absurd. They have 900 staff and were criticised by the Health Select Committee last year for failing to prioritise unannounced urgent inspections protecting patient safety above their routine assessments and registrations.

There would have been no point delaying inspections once concerns of such a serious nature had been raised. Does anyone seriously feel that giving clinics advance notice of inspection would have uncovered administrative fraud? Circumventing the legal requirement for two doctors to agree that a termination of pregnancy fulfils the requirements of the Abortion Act is clearly illegal.

Clinics must operate within both the spirit and the letter of the law to protect women seeking help and counselling following unwanted pregnancy, failure to do so just makes it easier for those who would seek to close them for ever to achieve their goal.

The greatest challenge and priority remains to prevent unwanted pregnancies in the first place.


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'Sustainable means ensuring that better lives for ourselves don't mean worse lives for future generations'.

That statement sets the tone for the National Planning Policy Framework published on March 27th.

The draft framework did not reassure those concerned about safeguarding our countryside and historic towns from inappropriate development so I'm glad that it has changed as a result of the consultation and successful lobbying by environmentalists, community groups and MPs.

Planning needs to cover a number of roles; economic, social and environmental and these are not mutually exclusive. It is vital that local communities have a genuine say in how any development can improve their neighbourhoods rather than degrade them.

The development plan remains the starting point for local decision making. Proposed development that is in tune with the local plan should be approved without delay and those which run contrary should be refused. The importance of having a good local plan cannot be over stressed but it is a relief that the default 'yes' to development in the absence of a plan has been removed and that there will be a one year transition to allow communities to prepare.

I am particularly relieved to see that the value of the 'intrinsic character and beauty of the countryside' has been recognised even outside specially protected areas such as SSSIs and national parks.

The NPPF also recognises the importance of our town centres and calls on local planning authorities to draw up local plans which support their viability and vitality as well as reflecting their individuality. That will be particularly welcome for our own distinctive market towns in South Devon and it is good to see that out of town shopping centres should be a location of last resort.

All developments that generate significant traffic movement should be supported by a Transport Statement or Assessment and priority should be given to pedestrians and cyclists.

I know that everyone will welcome the recognition of the importance of early engagement. Good quality pre-application discussion leads to better results for the whole community.

On a final note, after his statement in the Commons, I asked the minister, Greg Clark MP whether this document held out any hope for the residents of Churston and their much loved but rare cirl bunting. Eric Pickles, a keen twitcher, sitting by his side nodded so let's hope Torbay retains this lovely green space.


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I have received deeply felt letters from both sides of the argument on assisted suicide. As a former GP I know only too well that some people suffer through protracted, undignified and sometimes painful illnesses and would like to be able to opt for assisted suicide. I understand their view that this should be a matter for their individual conscience rather than the State.

I also know from experience that many people who have a terminal illness go through a stage during which they may contemplate suicide but who then subsequently adjust to their diagnosis and are glad to have more time with family and friends.

Some of my former patients may have opted for assisted suicide during that stage and would have had the capacity to do so if screened by a tribunal. By that I mean that they were able to take in the information, understand and retain it, weigh it in the balance and communicate their decision. They would not have had the chance to reach the other side of their hopelessness and why would they need to do so if painless medical suicide were an easy alternative?

For many, fear, uncertainty and loss of control lie at the heart of the problem. As patients we have choices over all aspects of our care but none that allow for medically assisted suicide within the UK.

It is understandable that many would like the choice; I have a long list of conditions for which I might consider it myself. But that doesn't mean that I should have the right to expect another person to share responsibility for ending my life and I hope the law will continue to act as a very considerable barrier. The guidelines drawn up by Keir Starmer, the Director of Public Prosecutions, set that bar at the right height. It should in my view remain an offence to encourage the suicide or assist the suicide of another person unless there are clearly understood mitigating factors.

Balancing the rights of the individual against the common good is never more difficult than in the case of assisted suicide. Should the State have the right to prevent an atheist, with no hope of recovery and in uncontrolled discomfort or distress choosing to take control over the time and manner of their death?

If a person has capacity to make decisions they should be allowed to make them, even bad ones that might result in their death, on condition that those decisions do not cause harm to others. Assisted suicide however, would lead us all down a dangerous road; there are many reasons to avoid it.

I also wonder what effect legalisation of assisted suicide would have on my former colleagues. How would they deal with a direct appeal from a patient they have known for many years who pleads for their help to end their life? Currently the reply is straightforward; it is illegal to do so. Doctors do not kill their patients and should never be expected or pressured to do so; it is moral quicksand.

With the current debate about the rising toll from dementia and an aging population we could soon find doctors sliding into decision making about the value of life and a right to die can easily become a duty to die especially if the elderly feel worthless and fearful for the future.

On a personal note, I know that pain cannot always be controlled. Even though she died in a hospice, nursed with great care and compassion, my mother's final weeks were distressing and undignified. Looking back, whilst at times it seemed as if her body would never let her go, it was precious time that none of us would have wanted to miss.

The alternative is to draw up a clear advance decision setting out the limits to your wishes for life saving intervention and to share that with your family so that they can confidently support your wishes without feeling burdened by guilt. By law, a valid advance decision refusing life saving treatment means you cannot be treated. It is also possible to choose someone to make decisions on your behalf through a lasting power of attorney.

Before closing the page on a somewhat downbeat posting, you can do something really positive, sign the organ donor register and you might help someone to live.


This looks very muddled to me, although possibly caused by the need for brevity? For example, you talk about the 'common good' as something that would be adversely affected by allowing PAS, but you don't explain what you think you mean by that term nor how it might be negatively affected. "Assisted suicide however, would lead us all down a dangerous road; there are many reasons to avoid it." Slippery slope arguments are specious at the best of time; none more so when what you think it might lead to and why are not stated. It is simply a diversion from the issue at hand. "Should the State have the right to prevent an atheist, with no hope of recovery and in uncontrolled discomfort or distress choosing to take control over the time and manner of their death?" The State doesn't have that right or power at present as long as a person has the physical ability to commit suicide, but what's being an atheist got to do with it? I'm really not sure why you think that someone in 'uncontrolled discomfort or distress' shouldn't be able to choose 'to take control over the time and manner of their death'? I'm sorry your mother suffered - it's unfortunately something many of us will know. However, you say, "...it was precious time that none of us would have wanted to miss." I'm glad you were able to share that time with her. But that is completely different to someone who is fully aware of their own situation and wants that suffering to end at a time of their choosing.
- Alex

We must also consider the fact that our current 'technology' enables us to ARTIFICIALLY prolong someone's suffering by keeping people alive longer than nature would normally allow them to endure. So in some cases we may have actually created a moral dilemma which might not otherwise have existed. So withdrawing that 'technology' and allowing nature to take its course might not be the same as initiating a process that results in death (e.g. a lethal injection). We must also consider that sometimes changes in law with moral implications have applications not intended (or foreseen?) when the law was originally passed. Consider, for example, the original debates concerning legalising abortion and compare how abortion is used today. How does society protect against such unintended consequences or is it prepared to accept when people will test its scope to the extreme?
- Curtis

...'whilst at times it seemed as if her body would never let her go, it was precious time that none of us would have wanted to miss'. Really? My father took 4 months to die at home without dignity or peace, despite the best care available. I would have wished him to be spared this suffering as I am sure he would, given the choice. One day we will look back on these times and wonder why it took so long to enable people to choose their own manner of dying.
- Helen

I have severe ME, and I am aware that I am likely to end up committing suicide if my condition worsens significantly (and it has been steadily deteriorating for 15 years). Suicide is the second cause of death amongst ME patients, after heart disease and before cancer. This is because it is such a terrible disease, one of the most disabling in existence, with a quality of life lower than in AIDS patients. Look at the case of Lois Owen, who recently died of ME. She was in her early thirties and her doctor had allowed her to starve to death, as her illness had progressed to the point where she was unable to eat. She weighed three stone at the time of her death. At the extreme stage of ME, the patient is unable to move, unable to be washed, cannot tolerate light or noise, is completely socially isolated, and is in extreme pain. They are also unable to kill themselves. This is an illness that affects 250,000 people in Britain. If my condition worsens to that point, then yes, of course I would rather die. It is an absolutely horrific situation to leave anybody in. We are perfectly capable of setting up safeguards to prevent people making rash decisions shortly after diagnosis, to avoid murder, and to avoid people being pressured into suicide by their supposed "carers". It's a pity we are not also capable of providing suitable care to everyone who needs it - many ME sufferers die largely from lack of suitable support - but that's a different matter. As for your appreciation of your last weeks with your mother, I'm sorry to have to ask this, but you only speak of how her surviving family is glad this happened. Was she happy about it too, or did she just want to die and cease her suffering?
- E.M.

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During a Radio 5 panel discussion after Prime Minister's Questions I was asked if I would be buying the Sun on Sunday.

I had just paid tribute to the compassion, courage and professionalism of Sunday Times journalist Marie Colvin. She was the female role model I would like my own daughters to look up to. Rupert Murdoch could and should take this opportunity not just to honour her memory with words of praise. The Sun on Sunday could become a paper that reflects Marie's achievements rather than promoting a page 3 stereotype. If they do the right thing for today's women then I will be happy to buy it.


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I have received many emails and letters regarding the proposals to legislate for same sex marriage. There is great strength of feeling on both sides of the debate on this issue. I would like to set out how I feel about this issue but do accept that there are some who will profoundly disagree with me.

A person's sexuality is a fundamental part of who they are and I do not feel that it is right to discriminate against someone on these grounds.

I feel that marriage is a lifelong commitment to another person and that it should not matter how a person loves, more that we recognise the validity of their commitment. I do not believe that the purpose of marriage needs to be linked to childbearing although I realise that there are many people who do and neither do I feel that the term marriage should belong to any religious faith.

The Government do not propose to alter religious marriage in any way. We are talking about civil marriage ceremonies — the sort currently conducted in registry offices, country houses and hotels. Civil marriages can't happen inside a church now and won't under the proposals.

People who are gay should be allowed to celebrate their love and commitment in a context that society understands. Civil partnerships do play a valuable role and we have made great strides forward in recent years but if we deny gay people marriage we are continuing a cycle of prejudice that in my opinion devalues their relationships.

I do listen to and value your feedback but hope you will understand that this is a matter of individual conscience and that I will have to follow my own strongly held belief in the value of marriage for all my constituents whatever their sexuality.


I'm glad you've made this analysis in such a clear and unbiased manner. Too many people are running around making weird and spurious allegations based upon their religion, and not actually using logic to determine the real facts. The marriage of homosexual people is an expression of a wholehearted desire to make a commitment, each to the other. In that it is congruent with heterosexual marriage.
- Tim

The difficulty with this issue is how to define marriage, and here there will always be considerable difference in opinion depending on background, religious beliefs and social groups. The challenge lies in that many of our long-held beliefs about all sorts of issues have changed considerably because of changes in society and 'technology'. For example, if someone believes that marriage is about "having children" then that is challenged by those couples unable to conceive or who choose not to have children by means of modern birth control. Also there are increasing numbers of couples having children outside of marriage or who opt to be a 'single parent'. If you think marriage is about joining together in the sight of a divine being, what about atheists? Should they be denied the right to marry? At the other end of the spectrum is the idea that marriage represents a celebration of love and a commitment to another person, then why not extend this to polygamy and polyandry, for example? Some of the science suggests, after all, that multiple partners is a human trait for some so who are we to demonstrate prejudice against their human nature by denying them marriage, providing people's rights are protected and no harm is done? And what about those rare cases where siblings have been separated at birth and find each other later on in life and fall in love... what is the TECHNICAL reason why they can't get married in an age of modern birth control? I am not advocating any of these, just asking the question: do we deny these individuals the right through prejudice or some other reason? How do we decide what Society allows and doesn't allow? Conscience, which changes across a lifespan and from person to person? The crux of the matter is that before we can sensibly change the law we need to work out what marriage actually means; what's it for? Particularly when our ideas of marriage originated in the Judaeo-Christian tradition which many no longer hold to? Why do we have marriage anyway? Does Society as a whole benefit from having it, or from giving stable heterosexual relations a special status BECAUSE if how it might benefit Society as a whole over and above what other relations can provide? We need to first answer these questions before changing the law, otherwise we are simply hanging our 'reasoning' on something we feel at a particular point in time (and how mercurial such thoughts and feelings can be)rather than something that will stand the test of time and that we can apply when other issues of relationships arise in the future.
- Curtis

You are incorrect to assert that Civil Marriage ceremonies will not happen in a church under the proposals They will initiate the beginning of such. The Church of England's' own lawyers has intimated as much. The equalities minster Lynn Featherstone, has stated that it will not compel any religious organisation to permit “gay marriage” in a church, a synagogue, a mosque, a temple or any other building used to observe a faith. It isn't hard to see that once the simple definition of marriage between man and woman has been undermined it will only be a question of time before those who called for the recognition of Civil Partnerships demand, probably through the European Court of Human Rights, the right to marry in a Catholic or an Anglican Church or elsewhere. The history of Euorpean human rights leglisation and particularly that involving the well organised gay lobby, has shown that it trumps the values of religious conscience every time. Churches will be forced to do so by law. By voting the way you intend, you will help bring such coercion about. Is that really what you want to see?
- Chris

I just wanted to say thank you very much. Your support means a lot to people who are tired of the constant arguments, and just want to marry the one they love in peace. Thank you.
- Nicole

Chris: You comment that Churches who are unwilling to marry same-sex couples may be taken to court. Have you considered: 1. The proposal as it stands does not only allow for religions NOT performing same-sex weddings but actually BANS those religions who would wish to from doing so e.g. Unitarians and Quakers. 2. Since CP are now allowed in religious premises then by your logic same-sex couples would already be clamouring for anti-gay religions to marry them; are they? Where is the evidence? 3. Catholic and other non-established churches already have to right NOT to marry anyone if they so choose not to e.g. I, as an atheist, would not get far in demanding that my local catholic priest marry me to an opposite sex partner in his church, would I. So why would you expect same-sex people to be granted such when it is not granted to opposite sex couples now? Equality works both ways.
- Deb

I am very glad to hear you standing up for equal marriage! One point to note, however. While no one is campaigning to force any religious institution to wed a same-sex couple against their will, just as no one is campaigning to force them to change their other criteria for marriage (e.g. Catholics do not permit divorce, Orthodox Jews have strict criteria about who counts as Jewish), there are a growing number of religious institutions which have requested the right to conduct religious same-sex marriages. C4EM has set up a Faith in Marriage group to cover this very issue. It includes Quakers, Unitarians, Liberal Jews, Reform Jews, and many others. Please consider their views and rights as well.
- E.M.

I was pleased to hear that my local Conservative MP would be supporting the same sex marriage bill. I am from the South Hams but I have lived in Spain for nearly 10 years and have been with my Spanish partner for 5 years. Same sex marriage has been recognised in Span for over 7 years and we always assumed that we would one day marry in Spain - due to the UK's distinction between our relationship with that of our heterosexual peers. While Civil Partnerships provide legal equality it also produces a cultural and linguistic inferiority which we were uncomfortable with - I don't want to get "civil partnered" I want to get "Married" - "oh we got civil partnered 3 years ago" - it sounds ridiculous and creates a unfavourable distinction. Does it matter that black people had to sit at the back of the bus if it got them to where they were going? Of course it does. I don't want my relationship to be less valued by our society then my brother's. I should go to his wedding but he comes to my civil partnership? I grew up as a gay child in the late 80's and early 90's and I remember lots of arguments against people like me that gay men were promiscuous and incapable of long lasting stable relationships. Now 25 years on our community has grown in confidence, literally a 'collective & honest coming out' to our society and we are demonstrating that we are able to form long lasting relationships and families which can contribute to our society. Yet those same voices that once said we were not capable of such relationships now wish to deny us the tools and the legitimacy that prove our relationships are equal, valid and indeed valued by our friends, family and our society as a whole.
- Neil

"A person's sexuality is a fundamental part of who they are and I do not feel that it is right to discriminate against someone on these grounds." So you're okay with a farmer marrying his farm animals, right? Because you wouldn't dare judge his sexuality, right doc? Let me guess...you've made an exception in this case...
- Lord Bugabluga

Glad to know I have an MP with an ounce of sense! Lord Bugabluga, that's a ridiculous argument. As ridiculous as those who used to think interracial marriage would bring down society.
- Annie

I have just listened to you speak in the commons and want you to know you were like a breath of fresh air along with Jane Ellitson .i am giving you a standing ovation! Well done and thank you for your support for this bill. It is time. It is right. It is what most people want.
- Rachel

Let them get married. If marriage is about kids then gay couples adopt and the adopted child would be better off if their parents could get married.
- ana

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This is National Apprenticeship Week, a successful initiative by the Government and supported across Parliament. Apprenticeship programmes develop skills across all types of industry. A measure of its success is the number of young people joining the scheme, increasing from 280,000 to 443,000 in one year, but more relevant to the South West is that 48,000 apprentices started training with over 12,000 employers. Apprenticeships have changed over the past few years. Not only are there twice as many but the range of occupations today is far more diverse.

The government has announced a new incentive to encourage thousands of small firms that do not currently employ apprentices to take on a young apprentice aged 16 to 24. This will support up to 40,000 new Apprenticeships. The £1,500 incentive is for employers with up to 50 employees but will be available to small firms in all industries and for apprenticeships at all levels from April 2012. The incentive is part of a wider £1 billion package of support to encourage small businesses to employ young people.

A huge range of organisations are supporting Apprenticeship Week by organising activities including employers, apprentices, business support and sector organisations, learning providers, colleges and schools. I am taking the opportunity to meet with some young apprentices in the constituency this week and I will be meeting with Dr John Chudley, Divisional Area Director of the National Apprenticeship Service to offer my support.


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I've just read the 'risk register' for ibuprofen. If I take the medicine I may bleed to death from a stomach ulcer, develop a rare but potentially fatal skin reaction or collapse from asthma. All this if I don't succumb to kidney failure, depression, drowsiness, light sensitivity, vertigo or heart failure beforehand. There's more; pancreatitis, hepatitis or a rare blood disorder but by now I've started to pour myself a glass of water.

So why did I take the tablets? Because risk registers are designed to point out every eventuality but shouldn't stop me balancing the risks against the benefits.

It is the same for Governments. Risk registers are important and many feel that the greater risk is that civil servants could stop giving those rare side effect warnings altogether if they were made public.

My personal view is that the information should be released as long as it is made clear that these are explorations of every conceivable risk...much as the warnings about every medicine your doctor might prescribe in your local surgery.

Of course I'm not trying to trivialise the NHS reforms nor do I underestimate the importance of getting this right but perhaps the unions could also contribute to open and honest public debate by stopping their cynical manipulation of peoples worst fears. Implying or even openly stating that patients would have to pay for treatment after the reforms has been used to drive opposition. There is no threat to the core commitment that NHS treatment remains free at the point of use based on need and not the ability to pay. That protection is enshrined in the bill as is the principle that ultimate responsibility lies with the Secretary of State.

Polly Toynbee writing in the Guardian last week referred to 49% of beds being set aside for private patients, she should know that the private income cap has nothing to do with bed numbers. NHS patients are not disadvantaged at the Royal Marsden because the trust generates over 20% of its total income from private sources as a centre of excellence. It is likely that the majority of trusts will generate only a small proportion of total income from the private sector and that will go directly to benefit NHS patients' care. If they wish to go above that threshold they will have to make it clear just how patients will benefit and have this agreed by their boards.

Some of the shameless shroud waving that has been taking place is an insult to those who have spent the past year developing better pathways of care for their patients. These doctors need clarity and a legal footing for their clinical commissioning groups. Frankly I do not know any GPs who want to 'privatise' the NHS and since they are the ones who will be referring patients and commissioning their care, how would it happen without them doing so? GPs do not want to destabilise their local hospitals but might like to be able to sideline services which are failing their patients. There are many charities and social enterprises who might be able to provide a service that actually serves.

Some of those who have jumped onto the vested interests' bandwagon without troubling to read the amendments which protect integration and cooperation should look instead at how they can improve services for the people who really matter; the patients.


I'm glad that Dr Wollaston agrees that the risk register should be made public and I trust that she is putting appropriate pressure on the government. The days of Sir Lancelott Spratt telling his patients “Don’t worry my good man, you won’t understand our medical talk” are fortunately long gone. As a fellow GP, and one who met Dr Wollaston when I gave evidence to the Commons health committee, I am surprised that she claims now that I am part of a movement of opposition that includes 'cynical manipulation' and 'shameless shroud waving'. One of the core principles of modern medical ethics is that we should examine carefully the evidence before proceding with treatment, especially when the treatment proposed is experimental. Criticisms of the bill, which I have been posting on my blog at http://abetternhs.wordpress.com/about/ since 2009 have been very carefully referenced and where necessary expert lawyers, policy specialists and others have added their opinions and all have added references to their criticisms. The contrast with the Health Bill is stark, there were (and remain) very few reference and very little published evidence to support the claimed improvements, never mind the unpublised report about the risks http://abetternhs.wordpress.com/2012/01/31/scrutin/ It is noteable that the first 2 pathfinder GP commissioning groups to call for the bill to be withdrawn were from very deprived inner-city areas, Tower Hamlets and City & Hackney in East London. Patients here have very low health literacy, meaning they struggle to understand even very simple writtten information. The emphasis on choice and competition threatens to widen inequalities and our patients stand to lose most of all. The Faculty of Public Health (hardly a cynical, shroud-waving organisation) produced their own risk assessment and said, "It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill" http://abetternhs.files.wordpress.com/2011/07/risk-assessment-bill-final-copy.doc
- Dr Jonathon Tomlinson

One point to mention is that you are able to dismiss the unlikely side effects of ibuprofen because you know how unlikely they are. The problem with the risks of the NHS bill are that some negative consequences, such as CCGs being unable to commission effectively, are very likely. On the point about allowing up to 49% income to be generated through the sale of private hospital services, how does this square with the NHS continuing to provide high quality services free at the point of use. Who is going to be paying for these services? People from overseas? People feeling forced into paying privately because the NHS no longer provides? If there will be no change in the number of people paying privately or through insurance, then why raise the cap?
- Susie F

As a consumer deciding whether to take ibuprofen I can read all potential side-effects and make my own decision. As a politician deciding whether to vote for the health bill, you cannot read potential side-effects. You must follow the government whips. Very sad.
- Sunil Bhopal

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David Lammy is calling for parents to have the right to smack their children, claiming that parents in his constituency have lost control and are 'no longer sovereign in their own homes'. All this because they fear the social worker's knock on the door if they use smacking to discipline their children? He then points out that he has smacked his own children to protect them from danger and presumably felt confident to do so without the heavy hand of the State coming to seize them.

There is a difference between a loving parent smacking their child as a reflex reaction to them darting off, say towards oncoming traffic and the kind of violence that many children suffer as a routine every day. Social workers are frankly too busy with the overload from these cases to interfere with normal families and David Lammy is perpetuating a myth that social services operate like the Stasi, snooping on families, poised to snatch children from happy homes.

How does it help children to avoid violent gangs by using violence as a deterrent? Teaching children that pain controls the person you strike just normalises violence as the correct reaction to annoyance and can lead to fearful subservience or patterns of bullying and control.

No one doubts the challenges facing single parents in Tottenham, or anywhere else for that matter and David's mother must have been an inspirational role model who tempered any physical discipline with lessons in self worth and aspiration.

Children join gangs for a host of reasons; when that is the norm, to feel accepted or protected, when they have nothing to lose or perhaps to control and enjoy the power that comes with intimidating others for a change, especially when that has been the pattern of their own lives.

David refers to the 'private schools and tennis lessons' enjoyed by the middle classes as their own antidote to gang culture. He misses the point and it is wrong to assert that poverty inevitably results in violent feral youths terrorising neighbourhoods without parents slapping their children into place. It would be better to deal with drugs and alcohol, to trash the violent and misogynist subtext of popular culture and press for higher expectations from families and schools. Too many children from deprived neighbourhoods grow up surrounded by adults who assume they will not succeed. I suspect that David's mother knew and expected otherwise.

The Law simply makes it clear that children have a right to be protected from physical punishment but no one is on a witch hunt against loving parents who occasionally use a gentle smack.

Some still argue that 'six of the best' never did them any harm, but the fact is that corporal punishment did brutalise or crush especially when meted out behind closed doors by sadists with a penchant for control. It still does and the Law is right to set out that violence can never be the right role model.


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For all those women waiting to hear about whether their surgeon had used cheap PIP breast implants this must be a worrying time. If the expert review does advise removal and the private clinic involved has gone out of business, then I do think that there is an important principle that the NHS should be there to treat without making value judgements about people. Where otherwise would we draw the line? Would anyone want an NHS that declined treatment to people who took part in high risk sports or smokers? That said, given the long history of failed implants, there is a case for asking those who have cosmetic implants in future to take out insurance at the time of their surgery to cover the cost of removal should their clinic not be there to correct future problems. There is a wider issue about the adequacy of adverse incident reporting for these surgical implants to the MHRA. If private clinics are found to have been withholding data on the true level of long term harm, then I hope the GMC will investigate. I also think there is an issue around the ethics of fitting oversize implants which, in my view, promotes a damaging stereotype and cannot improve the health of individual patients. Surgeons, like all doctors have a duty to put the interests of their patients at the heart of their practice but that is not always the same as agreeing to fit anything that they ask. I am not making any value judgements about cosmetic surgery or implants in general, only the kind that are clearly outside the normal range and which promote an unrealistic stereotype. I was dismayed to see that my article for the Guardian on this issue had been edited to leave out the word 'oversized' in relation to implants which gave the impression that I was referring to all implants. This is categorically not the case and my criticism is for the surgeons who fit them rather than those requesting them.


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Plymouth Hospitals NHS Trust would like to become a Foundation Trust. For many people the question is what on earth is the difference? Basically a change to greater financial independence and flexibility over decision making as well as greater involvement by local people and staff. The hospital still has staff on NHS contracts and provides services to NHS patients free of charge in exactly the same way but financial probity and the quality of management is overseen by a different regulator known as Monitor. Follow the link to their consultation document and please let me know your views especially if you have been treated or worked at Derriford.


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Today the House of Commons debated the issue of food poverty. It was reassuring to hear Richard Benyon MP confirm the commitment to introduce a Groceries Code Adjudicator to protect consumers. I hope that the adjudicator will also consider some of the wider issues around food poverty and the way that supermarkets can aggravate the situation particularly in the way that they operate loss leaders.

Data from the Health and Social Care Information Centre shows that almost a third of children are overweight or obese. It also shows the link between food poverty and obesity.

There is a clear link in reception year but this is even starker by year 6 where 23.6% of the poorest but just 12.8% of the richest are obese. Obesity not only affects children's life chances but will be costing us £10bn per year by 2050 because 85% of obese children go on to become obese adults and are far more likely to develop conditions like diabetes or joint problems.

The reality is that if you are on a tight budget price is a huge driver for choice and the supermarkets are driving those choices by discounting the kinds of foods that are harming their own customers. High fat, high salt food processed food is already cheaper than healthy alternatives yet loss leaders are so often based on products like alcohol, carbonated drinks, crisps and chocolates.

The Competition Commission, in their investigation of supermarket below cost selling did find that this practice distorts consumer choice and found many examples of loss making products being cross subsidised by other lines.

They were clear however that countries with outright bans on below cost selling, such as Ireland, Germany, France and Spain don't benefit from lower prices overall, in fact the reverse so I wouldn't want to see a ban...just some common sense.

Why tolerate the myth that all these loss leaders result in savings when they are being cross subsidised with more expensive products in the rest of your shopping basket?

The role of the Groceries Code Adjudicator should include:

Transparency in how these loss leaders are cross subsidised as well as clear price comparisons so that customers can easily identify the cheapest products.

A code of practice which promotes loss leaders only on healthy or unprocessed foods but which isn't subsidised by our farmers or local food distribution webs.

But Government cannot do everything; ultimately families have to take responsibility for their children's diet and exercise. It does not have to be expensive; the CPRE and Transition Town Totnes should be congratulated for their work on local food webs and for showing how local traditional shops and markets reduce food miles and deliver fresher healthier food with less waste. The view that local food is always more expensive should be challenged and boosting local seasonal produce is part of the solution.

Ultimately food prices are volatile and most of the changes are the result of global commodity prices and the influence of factors like fuel prices but that does not mean that Government cannot have a role in trying to make sure that the best choices are also affordable choices.


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Today I caught up with Rob Hopkins and Frances Northrop from Transition Town Totnes to discuss their new book, The Transition Companion, and the extraordinary progress of the Transition Movement both locally and nationally. The introduction to the Transition Companion asks the question, 'what would it look like if the best responses to peak oil and climate change came not from committees and Acts of Parliament, but from you and me and the people around us'. The Transition movement is now working to put these ideas for increasing local resilience into practice.

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Transition town now making the connection with Neighbourhood Health Watch see more at http://www.neighbourhoodhealthwatch.org.uk and the project in Harbertonford #neghbourhoodhealthwatch
- Peter Aitken

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The Health Secretary Andrew Lansley, confirmed today that all women will have the option to be treated by the NHS even if their private clinic has gone into liquidation or declines its moral duty to follow up and treat former patients. I think it is in all our interests that the NHS continues to put the needs of women first. I am also pleased to hear the announcement that the Care Quality Commission will be conducting a swift review of private clinics and use its powers to protect patients. Bruce Keogh's expert group will now expand their review to look at the wider issues around cosmetic surgery and this needs to consider how we improve the quality of the data on long term harms from procedures like implants and dermal fillers. My question to Andrew Lansley was about the conflict of interest that private clinics have when reporting side effects and especially as reporting is voluntary. I would like to see a national register as we have for artificial joints and a facility for women to be able to report directly to the registrar when they have problems. It is unacceptable that there is such variation in the reported rates of problems between different countries. The FDA, which is the US regulator reports that 1 in 5 cosmetic implants need replacement within 10 years and it is clear that many implants can leak without women having obvious symptoms. How many women are being given sufficient information to make a fully informed decision and is the cosmetic surgery sector colluding in promoting an unreasonable stereotype?


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