21 JAN 2016

It's time for a bold and brave strategy on childhood obesity

I wrote the following article for PoliticsHome

On the morning of the 2012 track cycling Olympics, the architect of Team GB's victory, Sir David Brailsford, attributed their success to the relentless pursuit of 'marginal gains'. He looked at absolutely everything that goes into riding a bike, from the rider and their bike to the environment around them. It was by improving every aspect, even if that was by a small margin, that the sum total struck gold.

There is no single easy solution to the crisis of obesity which is blighting the lives of our nation's children and I hope that David Cameron will look at the success of team GB and apply the same principle of marginal gains.

Some firmly believe that tackling obesity is all about education and information, others that exercise is the answer. Some will focus on the role of marketing and promotions, tackling super-sizing and reducing the levels of sugar in food or the role of taxation.

The fact is that we need all of the above, and far more. We need a bold and brave obesity strategy because of the sheer scale of the problem and the implications both for individual children, their families and wider society.

A third of children are now moving on to secondary education obese or overweight. Independent data also highlights the stark and widening health inequality associated with obesity. A quarter of children from the most disadvantaged families are leaving primary school obese, more than twice the rate for children from the most advantaged families.

The consequences for the physical and mental health of the individual children who are falling down that gap are serious: they face a significantly increased risk of type two diabetes, heart disease and cancer and they are more prone to bullying and marginalisation.

There are costs too to wider society and the NHS because of our failure to take effective action - diabetes care already consumes around 9% of the NHS budget and the total cost of obesity is estimated to exceed £5bn per year.

It makes sense to prioritise the measures that will produce the greatest gains and especially where they can produce those changes quickly.

The greatest gains lie in tackling our food environment because, whilst exercise is important whatever a child's weight, no strategy can succeed without tackling the prime culprit; too many calories. That is why we must tackle promotions, advertising and marketing, portion sizes and reformulation. The government must also take into account the potential of a sugary drinks tax.

Price helps to determine choices and relatively small changes can have an enormous impact.

The 5p plastic bag levy has driven a 78% reduction in the use of plastic bags at Tesco. It changed behaviour in part because most of us just needed that final nudge to change the way we shop and its acceptability was increased because all the money raised goes to good causes. One paper suggested that apparently outraged customers could defy the imposition of the tax... by taking their own bag... which was of course the whole point of it in the first place.

The same applies to a sugary drinks tax. No one would need to pay it at all because its primary purpose is to nudge consumers to low calorie alternatives. It should be included because we know that it works and that it works quickly. It particularly helps the heaviest consumers as demonstrated by the 17% fall within this group in Mexico one year after the introduction of a 10% levy on sugary drinks. If every penny raised went to funding programmes to benefit children and young people, it could provide financial backing for additional school sports, education and to teach cooking and nutrition skills.

The Prime Minister is right to focus on a childhood obesity strategy and his action list will need to be far longer than space in this article allows, including clearer information for consumers and giving local authorities and schools greater powers to tackle obesity. My plea would be to follow the lead of British Cycling on marginal gains and make a lasting and positive difference to our children's future.

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30 NOV 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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27 NOV 2015

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

I wrote this article that appeared in the Telegraph today

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

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

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

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

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

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

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

14 comments

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

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

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

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

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

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

Dear Dr Wollaston, Lest we forget I saw you at Brixham War Memorial on Memorial Day so I was surprised that you support the bombing of targets in Syria in order to combat terrorism in the UK “even though the innocent are likely to be among the victims of future bombing.” Here are some points that should be considered 1. In your lifetime the majority of terrorist atrocities in the UK were committed by the IRA. In the 40 odd years since the 1971 bombing of the Post Office Tower over 3500 people have been killed. Even last year Europol recorded 109 shooting and bombing incidents in Northern Ireland. Would you have supported bombing the IRA homelands of the Falls Road and Bogside? Would that have made the UK a safer place? The Bloody Sunday massacre didn’t . 2. DAESH is only one group amongst many such as Al Quaeda, Al Shabaab, and Boko Haram that have a similar ideology. Bombing Raqqa will be like beheading the Lernaean Hydra which caused the monster to grow two more. There are already reports that DAESH is establishing another headquarters in Sirte in Libya to control the oil and gas trade with Europe. How will we know when to stop the bombing? 3. Given that the crusades instigated by Pope Urban II in 1096 led to 200 years of Holy War by Roman Catholic Europeans on Muslims, other Christians, Jews and Pagans throughout the Middle East and Europe, there is a strong possibility that we will run out of money before we bomb DAESH and its affiliates into oblivion. How long do you think we can last financially in a war situation? 4. The 13th century Franciscan friar Roger Bacon said of the crusades "Those who survive, together with their children, are more and more embittered against the Christian faith". Do you think that is not happening already? My experience of muslim friends and colleagues in the UK, Saudi and Indonesia is that many assume that a European is, de facto Christian. 5. In about 2006 King Abdullah of Saudi Arabia visited China starting the “Look East Policy” in which there will be financial and technical cooperation in oil extraction and refining. I have seen a construction crane with Chinese writing along its boom in Saudi Arabia. The Chinese navy have built or are pursuing agreements to build ports at Darwin in Australia, Hambantota in Sri Lanka and Djibuoti in Africa. This will give them bunkering facilities for their warships to protect their trade from the Gulf to China. In April this year a Chinese naval frigate evacuated 225 foreign citizens from strife-torn Yemen. The Chinese are not judgemental in their dealings with foreigners and have no colonial baggage. Do you think that bombing Sunni Muslims will help the security of the oil supplies that our society is based on? I wish you well in coming to the best decision for us all. Edward Stone
- Edward Stone

Dr Dr Wollaston You state a good case but like all but one of the comments above I can't see the point in more British military action over Syria. Serious sanctions need to be put in place against those that fund these groups. We can't just pretend we are going to destroy them from the air. They will just move further into Libya and the other areas laid lawless by decades of Civil war and corrupt governance to which, in some cases, the West has turned a blind eye. As your constituent I beg you to desist on voting for Military action in Syria and urge you to consider bringing all our troops in the region home. Alastair Prichard
- Alastair Prichard

Dear Dr Wollaston. I am most concerned that we are likely to use air strikes in Syria. First we need to consider the people of Syria and then look at our involvement in Iraq, Afghanistan and Libya, these countries are not considered safe since our military action, Please no air strikes, this is extremely complicated and we need to act with great care. June Wood
- June Wood

Will we never learn! Having created and trained ISIL in order to help overthrow Assad because he wouldn't allow the gas pipeline we wanted built across Syria what we actually created was an inhumane mess. This is an extraordinary and dangerous situation. The Russians are backing Assad because of course they do not want an alternative supply of gas to theirs in Europe whilst the USA want the pipeline to reduce Russian influence Neither Russia nor NATO wish the pipeline that Assad is backing built by Iran so increasing Iranian power and influence. Is it any wonder that the Wests cavalier attitude to the lives of people in the Middle East has resulted in the increase in terrorism? This is a war of smoke and mirrors. Have you really been given intelligence from David Cameron which makes you as a doctor believe that our killing more civilians in the Middle East is actually going to have a positive affect? Surely there are still too many lies and deceptions to make the decision to increase bombing.
- Timothy Kendall

Dear Dr. Wollaston, I cannot equal the excellent and eloquent arguments posted here in opposition to bombing, but alike, and for all those informed reasons, I urge you to use your conscience and agency to vote against the barbarous and presumptive act of bombing a people based on the rationale you have listed in your argument. It can only be disastrous to add to the present chaos. I sympathize with the difficulty of your position, but I hear unmistakably in your and the Party's statements the monotone of rhetoric that allows us to slide words over the possible death of civilians as implicitly justified under the guise of protecting our own. In the smallest matters of life, and all the more at this scale, the deepest wisdom at times is inaction, waiting, and listening, until we know what is the right thing to do, to have the ethical courage of non-action until we know what part to play, rather than forge ahead with the bombast of our collective ego. Is this not the ultimate opportunity for all politicians trapped within their party identities to test their own truths, act on them, and change the foundations on which we govern? Please consider carefully the concerns that your constituents and many members of the public are expressing, Regards, Vaughn Barclay
- Vaughn Barclay

This article for the Telegraph is merely a propaganda puff for which Dr Wollaston will I am sure be amply rewarded by Mr Cameron in the future. ( gong or peerage ? ) Most of the funds for ISIL comes from Qatar and Saudi and ISIL taking root in Syria and Iraq is a consequence of the US policy of regime change. As for the Paris bombers , most of them lived in Brussels not in Raqqa and has more to do with modern France's attempt to absorb and integrate millions of its former colonial subjects from north Africa. Today we see the first bombs falling on Syria from the RAF which are not " precision " British Brimstone missiles but in fact Paveway bombs manufactured in the United States. End result ; more money for arms manufacturers at the same time as increasing refugee flows in Syria and adding to the toxic mix in the Middle East.
- Peter Thompson

What eloquent letters above. I cannot attempt to match with understanding and knowledge of the complexity of the matter but I liked the phrase by the last writer; 'propoganda puff'...... One evening I watched ITV, BBC and C4 news one after the other. Each carried exactly the same news reports and video clips. Surely there is more than 4 news stories on the immense beautiful and diverse planet that we live on. (Yet we don't hear much about corporate pollution, the struggles of the amazon rainforest people, the fires in Indonesia etc. etc.) Years ago, when my sister lived in South Africa we were really concerned about the riots we heard about on the news over there, so called her. She barely knew of what we were talking about. Then she called us when she heard on her news about riots over here: Again, life was carrying on as normal to us. I read George Monbiot's bio. a little while ago (he writes for the Guardian) and he said he had been so excited about working for the BBC but when Thatcher became prime minister she got rid of the chairman in the 80's and the new ruling was 'no more investigative journalism'!! Replaced by propaganda puff? (So, after all this austerity by the Conservatives, suddenly there is millions and billions for killing people again.) Where DID Cameron get his emotive speel from? (Same place as Blair?) Can we believe what we hear on the news? Is it only countries 'we don't like' that have propaganda? Do politicians really question what is going on? Who is behind everything? What are the motives? Who will benefit....... Follow the money. I was struck watching the film 'Amazing Grace' that the slave trade continued for 500 years. Not least because politicians were making money out of it. 100 years ago over a million men were killed and traumatised in the trenches fighting over a metre of mud. Why? What lies were they told? (Apart from the shaming if they didn't do it) Oh where are the wise elders that make decisions led by their heart, not media, propaganda and profit?
- Karen Evans

Disappointed. If a foreign government ordered the bombing of Totnes due to a possible radical/ terrorist cell would you let that happen? D
- DAVID ROPER

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25 NOV 2015

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

I wrote this article which appears in today's Telegraph

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

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

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

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

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

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

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

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

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

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

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

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

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28 OCT 2015

Tampon Tax

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

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

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.

2 comments

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

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

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12 OCT 2015

Sugar Tax Report

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4 comments

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

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

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

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

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04 SEP 2015

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

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

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

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

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

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

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

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

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

6 comments

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


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

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

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

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

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

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03 AUG 2015

Care Cost Lottery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My article first appeared in the Telegraph today.

1 comment

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

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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.

4 comments

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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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.

2 comments

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.

1 comment

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.

6 comments

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.

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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.

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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.

6 comments

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.

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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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