Monday, 31 March 2014

Older Women want babies too!

Don't you love it when the media uses words such 'soars'! The best one is 'more than doubles'. It sets the heart beating faster. two multiplied by 2 is 4. Now depending on context four is not a big number and nor is five, but 'more than doubles' is 'massive'! And so we have the headline for the numbers of women over 50 having babies.

It has 'soared' according to a headline in the Guardian - and they know what soaring is. It has indeed 'more than doubled' from 69 in 2008 to 159 in 2012. Then of course we get the speculation. It will continue to rise at the same rate. And then we get the doom and gloom. It will all be very bad and put pressure on scarce resources. Older women have more complications in child birth. Indeed they do - but not all older women. In truth there are more younger women having children than older women and some of them have complications too!

It is all part of this scare tactic about pregnancy. We are led to believe that these older women are in some way being careless or even selfish in wanting children at that age. In truth they are being no more or less selfish than any younger woman wanting children. Of course there are risks but women know that and quite frankly they still want the happiness and fulfilment of having children. They are not selfish - they are human and the Obstetricians can handle it!




Politicians are failing the NHS


Remember how the NHS was supposed to be 'safe' in Cameron's hands. Remember how the NHS was supposed to be 'ring-fenced' from the effects of austerity? Yes we remember. But we see an NHS starved of funds. But do the politicians care sufficiently to act?

The NHS Confederation’s survey of politicians has highlighted  that seven out of 10 MPs believe there is insufficient political will to meet the challenges facing the NHS.

Responding to the report, Dr Ian Wilson, Chairman of the BMA’s Representative Body, has said:

"The government must not risk the NHS' core value of being based on need, not ability to pay, purely because they are unwilling to take action and make the changes they admit are desperately needed.

"It is unbelievable that while eight out of 10 politicians agree change is essential, almost seven out of 10 say there is insufficient political will to allow this to happen.

"The reality is that the NHS is under intense pressure from a combination of rising patient demand and declining funding. Politicians must confront these challenges head on in order to ensure we can continue to deliver a high standard of care while remaining free at the point of use.”

We have been here before. It is no coincidence that the last time the Tories were in power the NHS was failing patients with unnecessary reform - remember the internal market? 

Cameron said there would be no top down reform of the NHS. He broke that promise!

Osborne and Cameron said the NHS would be ring-fenced. They broke that promise. The NHS has faced billions of pounds of cuts. It is not the NHS that is failing. It is the politicians  


Saturday, 22 March 2014

It is not 'insulting' to be concerned about pensioner finances

As the analysis of Osborne's budget unfolds there is concern that the changes to pension funds will leave pensioners vulnerable in relation to financial decisions. This has been dismissed by government spokepersons as being 'insulting' to the ability of pensioners to make decisions. This must be one of the most absurd statements of the week. I would not call it insulting. In the light of so much recent legal action on mis-selling of financial products and inappropriate marketing I would call it sensible concern.

Unless the market is regulated and appropriate safeguards put in place the I think we will all be vulnerable. It is clear that this has not been thought through. There will be a host of new and difficult to understand financial products flooding the market. It will be a mess.

Osborne has taken a bold decision but he appears to have taken it without proper regard for the consequences.

Friday, 21 March 2014

Osborne's budget headline unravels ?

As with a lot of budgets from Osborne the day after the night before looks less good. The rabbit he pulled out of his hat on pension pots is beginning to look less like a good deal in the cold light of analysis.

It is a good idea in principle to allow those retiring to invest or spend their pension savings how they wish. Certainly annuities are a bad deal with interest rates so low. Pensioners have suffered with their incomes falling.  It has a good ring about. It fits the 'being in control' on ones own finances. But how will these complex decisions be made and how do we avoid unscrupulous exploitation of pensioners?

I can see headlines in 30 years time about mis-sold investment schemes. There will be a mad scramble of financial companies creating difficult to interpret 'products' with difficult to read small print. It will be a mess.

Wednesday, 19 March 2014

BMA: 'Shameful' Budget does nothing for NHS shortfall


Calling today's budget presented by the Chancellor 'shameful' the BMA has condemned it for doing nothing to address the NHS funding shortfall. 

Responding to the Budget today Dr Mark Porter, Chair of BMA Council says

“Despite claiming the economy is on the up, today's budget does nothing to address the crippling funding shortfall in the NHS.

"While the Government claims the NHS budget is protected, in reality it's suffered £20bn of cuts, billions of which have come from a sustained attack on staff pay.

"If growth forecasts are rising it’s even more shameful that the Government won’t even agree to a 1 per cent uplift, as recommended by an independent pay review body, for all front-line NHS staff.

"Doctors and other staff face increasingly challenging, high pressured and stressful work environments. Cuts to budgets and rising workloads are leading to a recruitment and retention crisis in many parts of the NHS, and we're already seeing the effect of this on emergency medicine. The announcement by the Chancellor to continue with pay restraint and more public sector cuts, if re-elected in the next parliament, will only compound this.

"If, as the Chancellor has said, growth is higher than expected then the Government needs to consider additional funding for the NHS. Without the investment needed to meet rising patient demand and put the NHS on a sustainable financial footing the Government need to face up to the reality that patient care, and indeed the very future of the NHS, will be at risk."

Commenting on tobacco and alcohol duty Professor Sheila Hollins, Chair of the BMA's Board of Science, said:

“The Government is giving with one hand and taking with another, with a step forward on measures to reduce smoking but backward on tackling alcohol related harm.

“The announcement to extend the tobacco escalator is an important and welcome one. It will reduce the affordability of cigarettes, which is key to deterring children from starting to smoke. With half of smokers dying from a smoking related disease anything that makes it less attractive is a step in the right direction.

"Scrapping the alcohol escalator and reducing beer duty, coupled with the Government's U-turn on plans to introduce a minimum unit price, shows the Government has abandoned any serious efforts to tackle alcohol related harm.

"With the costs of alcohol related harm estimated at £20bn in England alone, of which £2bn is on healthcare, there is a clear economic as well as a public health case for why urgent action is needed.

"The BMA will continue to call on the Government to introduce a minimum unit price. We know that minimum pricing reduces alcohol related harm amongst the heaviest drinkers while leaving responsible drinkers largely unaffected. This is because virtually all pub drinks, as well as the majority of shop-bought beers, wines and spirits would not be affected by a proposed 50p threshold.”

Expect the unexpected

Today is budget day - expect the unexpected! Much of what will be in the budget has already been trailed in the media, but there will most likely be a rabbit of some sort that the Chancellor of the Exchequer will pull out of the hat. There is an election next year - indeed there are elections this year too. There will be the waving of order papers and cheering from the coalition back benches.

I will not and cannot speculate on what the rabbit will be. It will be some kind of give-away that will please the bulk of middle Britain and appease disgruntled Tory backbenchers.

There will be lots of talking about how solid the recovery is and what kind of recovery. Unemployment is tumbling and growth is strong - and there are more clear skies. Spring is bursting out all over. People will begin to feel better, and the Scots are more likely than not to vote to stay as part of the United Kingdom. That will make people feel better - won't it?

The coalition - or at least Cameron, Clegg and Osborne - are making plans for life after the election. The Guardian newspaper will no doubt once again find some reason to urge its readers to vote Liberal Democrat - oh yes, I think it will. They will put it together in some neatly considered editorial all about how 'on balance' - nice phrase, neat phrase, useful phrase - the coalition has been a success.  There has been no change of substance in the way we elect our representatives - hardly mentioned now by the Liberal Democrats, neatly forgotten - and no reform of the House of Lords. So we meander on as we did before.

Postscript

So what was the unexpected? It was the fundamental changes in the rules governing what you can and can't do with pension pots.

Monday, 17 March 2014

A diplomatic solution must take account of the wishes of the people of Crimea

The resolve of the US and EU to ignore the wishes of the Crimean people is arrogant and inconsistent. I am no fan of Mr Putin or Mr Putin's Russia. Far from it. But my view of the Russian regime does not blind me to the clear expression of the overwhelmingly Russian-speaking people of Crimea to be part of Russia. To ignore that is to have a very one-sided view of what William Hague and others call 'legitimacy'. If it is legitimate for an uprising in Kiev to overthrow the regime in Ukraine then it must surely be so for the crowds of people who are now celebrating the outcome of their referendum in the Crimea. 

President Obama says he wants a diplomatic solution to the Ukraine crisis. But a diplomatic solution will have to take account of the genuine concerns of Russia about the instability on its doorstep where it has major strategic interests. 

There is something unfortunately vague about the British foreign secretary's stance on the events in Crimea. He knows that a diplomatic solution must take account of the wishes of the people of Crimea. We may not wish to be where we are now. The fact is we are, and to ignore those wishes would be to deny the people of Crimea the rights that should be upheld by international bodies. 

Sunday, 16 March 2014

Crowd power, referendums and legitimacy in Ukraine

It is odd this talk by the EU and the US of 'legitimacy' or its absence in relation to the referendum in Crimea. As I write the result of the poll is being announced. An overwhelming majority in favour of the proposition that the Crimea be once again part of Russia. William Hague says the referendum is illegitimate. But is it any the less legitimate than crowds of protesters in Ukraine leading to the overthrow of a democratically elected President?

What it demonstrates more than an argument about legitimacy is an interest. The Russian interest in the Crimea and the outcome of the changes in Ukraine are palpable. The interests of the USA and the EU are opportunistic and full of bluster.

They talk of 'consequences' and 'costs' that will flow if the referendum goes ahead. The referendum has gone ahead. The one thing Putin knows is that the 'consequences' and 'costs' are a lot of hot air - minor restrictions aimed at certain individuals in Russia.

Saturday, 15 March 2014

Tony Benn, Thatcher and New Labour

One aspect of left-wing politics that irritates me is the propensity for those on the left to assume that theirs is the only moral position on the big issues of the day and in particular war and peace - everyone else is a war criminal or traitor to the cause. The same of course applies to right-wing politicians. There is an implied and often explicit distaste for those of the middle ground. What the left and right cannot accept is compromise. They talk about standing on principle - and we tend to admire more those who 'stand by their beliefs'.

Yet practical politics is the art of compromise. I have little doubt that Bevan was right in the compromises he made with the birth of the National Health Service - and compromises he made in dealing with the then opposition of the medial professions. Now, nobody believes that Bevan was not a man of great passion and principle. Indeed, when he could no longer compromise, as over the imposition of prescription charges, he resigned from the government - and Wilson also followed suit. Bevan also stood on principle when he argued that unilateral nuclear disarmament would be wrong - but then of course the left would rather put that aside as an aberration.

Harold  Wilson was of course noted later for, as he saw it, the virtue of pragmatism. The truth is that a bit of pragmatism goes a long way in getting things done. It was Wilson's pragmatism more than those of us marching in protest, that enabled him to say no to President Johnson's repeated requests for British troops on the ground in the Vietnam war. Few these days will applaud Wilson as being 'a man of beliefs' - and yet he was, just as surely as was Tony Benn. It serves little purpoe to distort history in creating the divide between 'those who stood by their principles' and those who compromised to get things done! Governing involves more than simply standing your ground.

Tony Benn and others of the Left were willing not only to oppose the Wilson and Callaghan governments but also to undermine them as traitors that didn't do what they said they would do. This of course is true if you accept their interpretation of what it was they were supposed to do! But I believe the achievements of the Attlee, Wilson and Callaghan governments are much greater than given credit at the time and certainly by those on the left. Increasingly, Wilson's premiership, at the time dominated by financial crises, is seen as advancing socially, particularly in spending on housing, social welfare, health and education.

My criticism of Tony Benn then is that he failed to support those and work with those who also wanted to change society for the better. His was an attitude of mind that said that only what he thought was right. On that he was wrong, no matter how much we grew to love him. That 'love' was increasingly proportionate to his remove from power, government and influence.

I know that this is not going to be liked by my left wing friends. But what I cannot accept is that in not speaking ill of the dead we must distort history. Arguably, the likes of Tony Benn did more than most to ensure 18 years of Thatcher governments and the birth of New Labour.

Ukraine crisis trapped in history?

Talks between the US Secretary of State, John Kerry, and the Russian Foreign Secretary, Sergei Lavrov, have failed to 'break the deadlock' on the Ukraine crisis. This is no surprise. Once again the main players are trapped by historical precedent. 

Russia has a genuine interest in the Ukraine, but to say that all sounds like Hitler's claims to the Sudetenland. Yet, if there is to be a diplomatic resolution to the crises there is not doubt that Russia's concerns will have to be - dare I say it? Appeased. 

It serves little purpose declaring the referendum in the Crimea unconstitutional. It begs the question of which constitution has legitimacy, and in the end the US and the EU will have to accept it. The Russians are not going to give way on it no matter what 'the costs', to use the phrase of the US and the EU. 'The costs' are rarely spelled out. It is a vague threat and has little substance to it. 

And so the tension increases with the possibility that Russia may move to 'protect' Russian speakers in East Ukraine. 

If there is to be a diplomatic solution, then let it not be hidebound by historical analogies. Given that a diplomatic solution is the only real alternative to conflict then this may be a time when 'appeasement' works!

Thursday, 13 March 2014

BMA Condemn Government pay cut for NHS staff

David Cameron once promised that the NHS was safe in Tory hands. But then he also said there would be no top down reorganisation. On both counts his lips say one thing, the government's deeds say another. The one thing we can do without in the NHS is a demoralised staff, yet this is what we have. We have an NHS struggling to make ends meet with cuts of billions of pounds from budgets taking their toll. Now we have an insulting pay increase to NHS workers.

Thursday's announcement from the Government that doctors will be subject to another real terms pay cut highlights its abject failure to find a fair and sustainable solution to the funding crisis imposed on the health service the doctors union, the BMA says.

The decision to yet again penalise doctors devalues and disrespects the vital role of frontline staff in the NHS.

Jeremy Hunt has said that the continued erosion of staff pay is ‘not sustainable’ yet he has chosen to ignore his own advice. Despite the Government announcing that staff will receive a 1% pay rise, the reality is the vast majority of doctors face another real terms pay cut, with some not receiving any uplift for up to three years.

Commenting, Dr Mark Porter, Chair of BMA Council, said:

“NHS doctors have now seen their real terms pay cut for the fifth year in a row. Despite how the government have tried to present it, doctors are being left worse off, year on year.

“This comes at a time when demand but also productivity across the NHS is rising, and demonstrates just how little the Coalition Government values its NHS staff given the fact they seem determined to balance the NHS budget on the backs of those working on the frontline.

“While the BMA understands the economic constraints the NHS faces, the continued erosion of pay undermines the excellent work and dedication to patient care from doctors and other NHS staff, and only goes to highlight the Government’s failure to find a meaningful and sustainable solution to the funding crisis imposed on the health service.

“At a time when doctors are working harder than ever before to meet rising demand, it is not surprising that doctors’ morale is going down when today’s announcement means that staff are once again bearing the brunt of the Government’s cuts.

“Overstretched doctors are covering for a recruitment crisis. In hospital emergency departments, severe doctor shortages combined with underfunding has produced the perfect storm – a crisis in patient care.

“The continued chipping away of pay means consultant pay is now, in real terms, lower than it was over a decade ago. GPs will also be unfairly hit. Despite delivering substantial efficiency savings while at the same time facing ever increasing workload pressures and patient demand, today’s announcement will continue to see practice income eroded as practice expenses increase disproportionately to income.

“How can the Government expect to engage constructively with doctors on pay and conditions when it continues to devalue them year on year?

“The Government has set itself the target of reducing the NHS budget by £20 billion but has so far found no realistic plan to achieve this except for punishing those on the frontline by chipping away at their pay and dressing this up as ‘efficiency savings’. Jeremy Hunt has said that the continued erosion of staff pay is ‘not sustainable’ yet he has chosen to ignore his own advice. “What message does it send to our hard-working doctors, nurses and other frontline staff when NHS managers have enjoyed a rise of 13 per cent since 2009 and yet doctors’ pay is being outstripped by inflation year after year? If we are going to meet the challenges the NHS faces head on the Government should be working with, not against, those doctors on the ground with the values, knowledge and professional judgement best placed to drive innovation and deliver real savings while all of the time protecting patient care.”

Thursday, 6 March 2014

Low saturated fat diets don’t curb heart disease risk says expert

I gave up on diets a long time ago - or at least I gave up on the formulated ones. There is nothing wrong with 'eating healthily' and taking exercise. But diet fads can be a menace.  At my local book shop I can sit and have a cup of coffee and a Danish pastry surrounded by the shelves of books. One shelf always strikes me as being full of contradictory dietary advice. There is a lot of money in publishing diet books it seems. 

For dietary advice from health care professionals we might expect a great deal more evidence base. The British Heart Foundation emphasise the importance of the type of fat we eat. Essentially the mantra is that saturated fats are bad. 

But in a new article in the journal Open Heart Dr James DiNicolantonio suggests that the dietary advice to switch saturated fats to carbohydrates or omega 6 fats is based on flawed and incomplete data from the 1950s.

DiNicolantonio points out that the demonisation of saturated fats dates back to 1952, when research suggested a link between high dietary saturated fat intake and deaths from heart disease.

But the study author drew his conclusions on data from six countries, choosing to ignore the data from a further 16, which didn’t fit with his hypothesis, and which subsequent analysis of all 22 countries’ data, disproved, says DiNicolantonio.

Nevertheless, the 'bad boy' image stuck, particularly after US President Eisenhower had a heart attack in his 50s, points out DiNicolantonio in an accompanying podcast.

And it prompted the belief that since these fats increase total cholesterol—a flawed theory in itself, says DiNicolantonio— they must also increase heart disease risk. And as foodstuffs with the highest calorie density, the thinking was that reduced saturated fat intake would naturally curb obesity, diabetes, and metabolic syndrome.

But the evidence, which continues to mount, suggests otherwise, he says.

There is now a strong argument in favour of the consumption of refined carbohydrates as the causative dietary factor behind the surge in obesity and diabetes in the US, he says.

And while a low fat diet may lower ‘bad’ (LDL) cholesterol, there are two types of LDL cholesterol. And switching to carbs may increase pattern B (small dense) LDL, which is more harmful to heart health than pattern A (large buoyant) LDL, as well as creating a more unfavourable overall lipid profile, he says.

Furthermore, several other studies indicate that a low carb diet is better for weight loss and lipid profile than a low fat diet, while large observational studies have not found any conclusive proof that a low fat diet cuts cardiovascular disease risk, he says.

But in the race to cut saturated fat intake, several dietary guidelines recommend upping polyunsaturated fat intake.

However, a recent analysis of published trial data shows that replacing saturated fats and trans fatty acids with omega 6 fatty acids, without a corresponding rise in omega 3 fatty acids, seems to increase the risk of death from coronary heart and cardiovascular diseases.

“We need a public health campaign as strong as the one we had in the 70s and 80s demonising saturated fats, to say that we got it wrong,” urges DiNicolantonio in the podcast.

The best diet to boost and maintain heart health is one low in refined carbohydrates, sugars and processed foods, he recommends.

And anyone who has had a heart attack should not be thinking of replacing saturated fats with refined carbs or omega 6 fatty acids—particularly those found in processed vegetable oils containing large amounts of corn or safflower oil, he says

So here we have it - another set of dietary recommendations to chew on. 

Wednesday, 5 March 2014

Accountability of town and parish councils

I discovered something disturbing about our local governance arrangements. I should have known, but I didn't and it surprised me. We can complain to the Local Government Ombudsman about the behaviour of a whole range of public authorities including fire and rescue authorities, national park authorities and a host of other public bodies whose decisions affect our lives.

You would think that you could complain to the local government ombudsman about the behaviour of all local councils. But you would be wrong. The ombudsman does not consider complaints about town or parish councils. So, should we be concerned? I think we should.

Town and Parish councils will soon be able to take a range of decisions that affect our lives - arguably they can already take such decisions. But they are soon to get a larger role in planning. It is all part of the governments 'localism' agenda. But woe betide you if you think decisions of your town or parish council have been taken inappropriately. You have no clear body of accountability to refer it to.

Monday, 3 March 2014

The press should stop speculating on Michael Schumacher

It is inevitable that the Media should speculate on Michael Schumacher's condition. But it would be better I think if neurologists not directly involved in the care of Michael Schumacher were not asked to speculate on the possible outcome. It was made clear at the outset that health care workers and family would make announcements if there was significant change in his condition and that they didn't want to deal with speculation. Quite right, and this should be respected. It serves little purpose to speculate, and Neurologists should say so if they are approached for their opinion.

It is natural for fans of the former Formula 1 champion (including me) to want to know how he is progressing. But clearly day by day commentary would serve little purpose on a process that can take months. Only when that process is completed will we know the extent of any functional damage. Let's wish him and his family well and be patient for news.