Universities must do more to tackle use of smart drugs, say experts

Universities must do more to tackle the growing number of students turning to “smart drugs” to cope with exam stress, leading academics have said.

UK institutions are being called on to consider measures such as drug testing to stem the rise of cognitive enhancement drugs being used by young people to improve their academic performance.

As hundreds of thousands of students across the UK prepare to sit their summer exams in coming weeks, Thomas Lancaster, an associate dean at Staffordshire University, said we were entering a “dangerous world” where students have access to the “study drugs”. He called on universities to have “frank discussions” with students and to develop policies around their use.

“Universities need to seriously consider how to react to the influx of smart drugs on campus. Educating students about smart drugs and seeing if they view this as cheating is important here. If the trend continues, universities may need to think about drug testing to ensure the integrity of the examination process,” Lancaster said.

Smart drugs, also known as nootropics, are a group of prescription drugs used to improve concentration, memory and mental stamina during periods of study. The most commonly used ones are Modafinil, Ritalin and Adderall. These substances are normally used to treat disorders such as narcolepsy and attention deficit hyperactivity disorder.

Larissa Maier, a research associate at the University of Zurich, called for more education about the risks associated with the substances. Her concerns were echoed by Prof Tim Hales, the head of neuroscience at Dundee University. He said: “In the short term some of these drugs may not be harmful, but we don’t know about their potentially harmful cumulative effects. Different students will respond differently, particularly when taking other medications, alcohol or recreational drugs at the same time.”

The growth of smart drugs over the past five years has been well documented, especially in top institutions such as Oxford University. In May 2016 the Oxford student newspaper, the Cherwell, published a survey that showed 15.6% of students knowingly took Modafinil or another such drug without prescription.

Oxford has introduced workshops to educate young people about smart drugs.

A recent European study co-authored by Robert Dempsey, a lecturer in psychology at Staffordshire University, found that the majority of university students believe it is normal to use such drugs to enhance academic performance.

Maier said current estimates indicate about 10% to 15% of students have tried to enhance their cognitive performance with prescription drugs, alcohol or illegal drugs at least once. With a UK student population of 2.3 million, this works out at about 230,000 people.

Students at Oxford. Photograph: Pete Lusabia/Alamy Stock Photo

Oxford University said it had not seen evidence of a widespread problem, but added that students were strongly advised not to take any unprescribed drugs. “Students who are struggling to cope personally or academically will find a range of support at Oxford. They should talk to their tutors, their college welfare officers, Oxford University Student Union, their GP, or the university counselling service.”

The health risks that the drugs could pose are still unclear, but using them without a prescription is illegal and can lead to unwanted side-effects, such as increased anxiety and heart rate.

Maier said the number of students using the drugs could increase due to increased availability both at universities and online.

Dr Dominique Thompson, the director of the students’ health service at Bristol University, said she sees a handful of students a year who come in suffering the side-effects of the medications, such as insomnia. She put the rise in use down to increased competition and pressure on young people.

Thompson said: “There is a huge pressure to do well and excel and be different to everyone else as well as financial pressure now. That may be another factor as to why students feel they need to use any means to do well.”

The Guardian heard from several students who claimed to have faked ADHD symptoms in order to be prescribed Ritalin or Adderall. One student, from UCL, said: “I obtained the drugs from a friend who wanted Ritalin to use as a smart drug. She memorised the symptoms of attention deficit hyperactivity disorder and convinced a GP to prescribe it.”

Non-prescription sale of Noopept, a fine white powder that its makers claim enhances cognitive ability, was banned in the UK last year under the Psychoactive Substances Act. However, several British websites appear to be actively selling this substance.

Modup, a website selling Modafinil, told the Guardian that during exam time the volume of Modafinil shipped to the UK doubles. It claimed the campuses it mainly sent stock to were Oxford and Cambridge, followed by the London institutions Imperial and the London School of Economics.

One second-year student from Cambridge University, who asked to remain anonymous, said: “I know quite a few people who have used study drugs, including several of my housemates and friends. They all tend to take Modafinil rather than either Ritalin or Adderall … given the sheer volume and quality of work expected of people here, I would be unsurprised if my college is representative of the university as a whole.”

Another student from Leeds said they had been taking Modafinil or some variant for essays and exams since the middle of second year. “My own work rate has always been fairly pathetic without it so it’s been vital for me in completing my dissertation and other big projects at uni. I do know people who work very hard anyway, but take it for the non-stop work they have to do for degrees like medicine.”

Universities do not appear to have a plan in place for tackling the problem. Dr Cathy Montgomery, a reader in psychopharmacology at Liverpool John Moores University, said: “Many universities don’t have specific policies regarding use of cognitive enhancers as this is a new area. Most universities do, however, have a drug policy, stating that the use of drugs is prohibited on campus, but this does not necessarily extend to medicines.”

But she said that before policies were put in place, more research should be done: “We need a large-scale epidemiological study looking at use of enhancers across the UK.”

Neal Patel, a spokesman for the Royal Pharmaceutical Society, said: “Unfortunately, prescription-only medicines are available to just about anyone with some spare cash willing to buy them from unscrupulous online providers. You may or may not get what you pay for.

“Unrealistic expectations of the benefits of these powerful medicines, coupled with peer pressure to use them, is an unhealthy mix for students. Our advice remains for people to steer clear of prescription medicines unless they are being prescribed under the supervision of a health professional.”

Universities must do more to tackle use of smart drugs, say experts

If we want to improve mental health, first we need to tackle poverty | Dawn Foster

Mental health discourse welcomed an unexpected participant this month. Prince Harry, the fifth in line to the throne, spoke publicly about seeking counselling following his mother’s sudden death in his pre-teen years. Rightly, mental health charities praised his intervention, highlighting as it did that even extreme privilege cannot shelter us from depression, anxiety or any other psychiatric illness. Our bodies are fragile, and our minds equally so: this message is increasingly accepted as people with mental health problems, campaigners and medics alike have fought to end stigma by building a national conversation on mental health.

Removing the stigma around mental health is important but does little alone. Without services, treatment is still inadequate, and feeling less judged for your health issues means little if you’re faced with a lack of access to talking therapies and nonexistent community support. But the conversation on mental health also needs to examine how the structures of society cause and perpetuate poor mental health.

Poverty, poor housing and debt all have a detrimental impact on the mental health of children and adults. Money can’t buy happiness, but poverty can practically secure stress and misery. For children in particular, the impact of poverty early on increases the lifetime risk of long-term mental health problems. The National Child Development Study found children from the lowest-income families are four times more likely to display psychological problems than children from the richest families. Homeless children are four times as likely to experience mental health problems as settled families.

Across the UK, both women and men in the poorest fifth of the population are twice as likely to be at risk of mental health problems as those on average incomes, according to the Mental Health Foundation. Poverty increases the likelihood of developing mental illness, and mental illness increases the risk of poverty: combating only one factor does nothing to end the poverty cycle – the two are inextricably linked. Being as wealthy as the royals doesn’t preclude you from experiencing mental health problems, but it does lower the likelihood, cushion you in certain aspects and allow you access to a better standard of care more quickly.

Failing to address childhood mental health linked to poverty is like scrimping on a car repair only to crash into a wall

Refusing to recognise the link between socioeconomic deprivation and mental health creates a preventable drain on the public purse. Advocates for austerity argue that every penny counts, that “we are all in this together”, to borrow a famous phrase from George Osborne, heir to a baronetcy.

This is the ideological reasoning behind cutting the benefit cap to £20,000 outside London, implementing the bedroom tax, removing council tax benefit and forcing women to fill in forms confirming they were raped if they wish to claim child benefit for more than two of their offspring. But it makes no economic sense: these policies make rents unaffordable and increase homelessness, which contributes heavily to the deterioration of millions of people’s mental health. The Institute of Education found that poor mental health in children alone costs the UK £550bn in lost earnings. Children who experience poor mental health in childhood, disproportionately linked to poverty, earn less in their lifetime, requiring more financial support from the state, as well as seeking more medical assistance. It is akin to scrimping on a minor car repair only to crash the vehicle into a wall.

But even if economic arguments do not sway the government, the humanitarian, emotional argument should be recognised. Social policy can actively lower people’s risk of experiencing depression, anxiety and other disorders.

Austerity is an economic choice: it’s a foolish one that saves nothing and harms millions. Any campaign on mental health should champion combating poverty to stop more people experiencing entirely preventable problems.

If we want to improve mental health, first we need to tackle poverty | Dawn Foster

Chocolate bars may shrink in drive to tackle obesity

Chocolate bars and sweets are likely to get smaller as a result of a major push from Public Health England, which is urging the food industry to help fight obesity by cutting 20% of sugar from the main snacks and foods that children eat.

After talks with the confectionery industry, which has said removing sugar and keeping the taste would be hard, PHE is recommending they make the change by shrinking the size of the sweets and chocolate bars they sell.

PHE says changes to nine food groups could lead to 200,000 tons of sugar being taken out of snacks and meals yearly by 2020 and cut the number of overweight children by 20%. The targets are biscuits, breakfast cereals, cakes and pastries, chocolate, confectionery, ice cream, puddings, sweet spreads and yoghurts.

But the agreement is voluntary and some obesity campaigners warn that food manufacturers and restaurants may drag their feet unless there is a way to force their compliance.

“We’ve seen over recent weeks that some companies within the food and drink industry have made great progress whilst others are seriously lagging behind and others claiming wrongly that they can’t do it,” said Graham MacGregor, a professor of cardiovascular medicine and chairman of the campaigning group Action on Sugar.

“If these recalcitrant companies don’t comply we need Theresa May to bring in tough measures to ensure compliance and put public health first before the profits of the food industry.”

The 20% cut in sugar from foods, along with the sugar levy on soft drinks, were the two measures recommended by PHE and accepted by the government for inclusion in the national obesity plan published last summer. The government has since been criticised for rejecting other measures PHE recommended on more curbs on advertising to children and an end to multi-buy and discounted promotions of junk food in supermarkets such as buy one, get one free.

Duncan Selbie, chief executive of PHE, said they had never advised government that the sugar cuts should be compulsory. “We didn’t want to spend the next two or three years arguing whether a Jaffa Cake was a biscuit in judicial review,” he said.

Manufacturers and retailers had responded well to the proposed voluntary measures. “With a few exceptions, they have engaged very positively in this,” he said. “In the event that we don’t see progress we will be giving advice to the government about what further they might need to do.” He would not comment on what that might be, however.

Alison Tedstone, chief nutritionist, said PHE would be publishing a “barometer” of the top 20 products children consume, showing whether the sugar levels were coming down. “Parents will be able to see,” she said. “We will put it straight into the public domain.”

But while the PHE targets and transparency were widely welcomed, critics questioned whether the food industry and retailers and restaurants would comply.

“If we’re serious about changing the nation’s sweet tooth, industry as a whole needs to commit to the government’s very welcome 20% target and take collective responsibility for change,” said Professor Russell Viner of the Royal College of Paediatrics and Child Health. “The noises coming from certain companies remain a concern, with some hoping that a 10% reduction in sugar will somehow get them off the hook of the proposed 20%. The government must keep a close eye on how industry is acting and be tough on those who claim lower targets should be deemed a success.”

Alison Cox of Cancer Research UK said: “It’s clear that obesity has a major impact on cancer risk. Without action, the problem is only going to get worse, so it’s vital this new programme works towards the goal of slashing the amount of sugar hidden in our food.”

The British Retail Consortium is concerned that removing sugar will be technically difficult and that some food companies will comply but others may opt out. “Significant progress has already been made but the complexity of the reformulation process gives us concern about the time scales. Furthermore, to achieve the objective as outlined by PHE, these targets need to create a level playing field for every food company, large or small, to commit to and address,” said Andrea Martinez-Inchausti, deputy director of food policy.

The Food and Drink Federation said it supported the PHE plan. “Today’s report represents a constructive platform on which to build a world-leading programme of voluntary sugars reduction, right across food and drink,” said the director general, Ian Wright. “All parts of the food industry – manufacturers, retailers, takeaways, restaurants and cafés – need to step up. The guidelines are very stretching but manufacturers, for our part, are willing to take on the challenge.”

PHE has warned that saturated fat should not be substituted for sugar. It will be extending the work to produce targets and guidelines for cutting calories generally from food. Next year, after a report that is anticipated from the government’s standing advisory committee on nutrition, it may turn its attention to reducing saturated fat in foods.

Chocolate bars may shrink in drive to tackle obesity

The app that aims to tackle the chronic NHS midwife shortage

The findings of a new NCT report, which revealed that tens of thousands of women were having to seek help at accident and emergency (A&E) departments or with their GP because they cannot reach a midwife, do not come as a surprise to Hannah Harvey.

Harvey has been a midwife for five years. She says that while she and her colleagues care deeply about the women they look after, a nationwide shortage of midwives and government cutbacks to training bursaries mean they often struggle to provide the necessary support to new mums. According to the report by the NCT (pdf) and National Federation of Women’s Institutes, 36% of women who were not able to see a midwife as often as they required postnatally said that it caused them a great deal of concern while almost a third (31%) said that it resulted in a delay of a health problem (for them or their baby) being diagnosed and treated. The Royal College of Midwives (RCM) estimates England has a shortfall of 3,500 midwives.

“It’s really difficult,” says Harvey, who works in West Sussex. “Of course [as midwives] we want to provide round-the-clock care, to spend two or three hours with a new mum teaching her how to breastfeed, and offering the other support she needs, but there’s just not the capacity to do it. We’ve got to look at other ways of helping people.”

It was this challenge, alongside spotting a review that found high numbers of pregnant women use the internet to search for advice, that prompted Harvey to take matters into her own hands. In July 2016, she launched Ask the Midwife, an app that enables mums-to-be to contact midwives for advice.

“I [wanted to] create something where users could ask questions and get a fast response from a midwife, instead of using Google or parenting forums, where you’re not getting professional advice,” says Harvey.

“I saw it as a way of helping the women, [somewhere] they could go and access advice and the extra care they needed and they wanted. It’s also a platform to alleviate the pressure on the NHS and the midwives working in the community and the hospitals, who don’t have the time to spend with people who might want a bit more help with their newborn baby.”

Harvey initially used £10,000 of her own savings and raised £50,000 from friends and family to help develop and launch Ask the Midwife on iOS last year. Eight months after starting the business, the app has 4,000 users across the UK, and a network of 45 registered midwives. Harvey initially found the midwives by advertising for consultant positions, even receiving 500 applications in three days. Each midwife gets paid 25% commission per question or chat they answer. Many of the midwives still work for the NHS but use Ask the Midwife to earn extra money. Harvey estimates that 15-20% of conversations need to be escalated to an in-person consultation.

For the expectant mothers, there’s a small charge (from 99p) to ask a question, increasing to £19.99 a month for support during the nine months of pregnancy and up to 12 weeks postnatally. This includes unlimited use of the “ask” and live chat services, with responses from a registered midwife promised within an hour. Midwives are available seven days a week, 14 hours a day, with plans to make it a 24-hour service in the near future.

“We get a lot of early pregnancy questions, after someone goes to their GP but before they have their first midwife appointment at eight to 10 weeks. And then, postnatally, we get a lot of breastfeeding and feeding questions. If you’ve never had a newborn baby before, you don’t know what is normal.”

Digital technology is rising in popularity among expectant mothers. According to the NCT’s study, 34% of women are choosing to use an app to support their pregnancy – two thirds (65%) used apps to track milestones, such as when the baby kicked or to track contractions, and a third (32%) used digital technology to access information about diet, lifestyle or health issues. Popular apps include BabyBump, What to Expect (from the authors of What to Expect when you’re Expecting), and My Pregnancy Today, although the majority available have been developed in the US.

Jacque Gerrard, the RCM’s director for England says such digital technology can be useful, as long as the advice is backed up by evidence-based information and carries a health warning. “Women have access to mobile phones, the internet and they want instant answers, so I think [such digital technology] is a positive step,” she says. “But what I would say is it has to be used with caution. Sometimes women do need access to a midwife or a doctor and that’s got to be the first point of contact. The NHS does provide access to a midwife 24/7, 365 days of the year, no matter where you are in the country.” The RCM is itself currently developing a hub for pregnant women, including a live help function.

Harvey is in talk with NHS trusts who are considering piloting her service in their areas, and says she’d eventually like to be able to offer the service for free – although finding funding will be the first priority; she’s currently plotting an investment round with angel investors. There are also plans to expand into other countries once the market is established in the UK.

But it’s been a learning curve for the midwife, who still juggles working night shifts with developing the business. “It’s completely different to my NHS work,” she says. “I’ve never been an entrepreneur, but the fact that I’m getting that feedback from people saying this is something they want is keeping me going and giving me that drive and determination to make sure it succeeds.” Harvey says the feedback so far has been very positive and the app recently won best parenting app and best educational app at the Mumii Family awards.

“[Entrepreneurship] has been the best experience I’ve had,” she says. “I was at a baby show in London recently and somebody said she’d used my app in early pregnancy and it was the best money she’d ever spent. She had been really worried she was losing her baby, her GP hadn’t reassured her and she didn’t know where to go. She had a 10-minute chat with one of the midwives and felt really reassured. Then she realised I was the one she’d spoken to and she burst into tears, giving me a hug. That for me felt like the icing on the cake – this is why I’m doing it, this is why I’ve put all the hard work in.”

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The app that aims to tackle the chronic NHS midwife shortage

Roving clinics tackle TB among Myanmar"s poorest people – in pictures

Tuberculosis is among the leading causes of death for people aged 15-49 in Myanmar, but the cost of reaching a hospital for a diagnostic X-ray is often prohibitive for those in isolated communities. A scheme that sends mobile teams out to test and give medication is helping people get much needed treatment

All photographs by John Rae/UN Office for Project Services

Roving clinics tackle TB among Myanmar"s poorest people – in pictures

What can be done to tackle the youth mental health treatment gap? | Paul Burstow

By 2020 one in three teenagers will have access to cancer treatment in England. Think about that: only one in three. There would be an outcry. It would be scandalous, horrifying, unacceptable.

It is not true, however. Unless you delete the word “cancer” and insert “mental health”, and then it is.

In medical terms, there is a treatment gap. The number of children and young people living with a diagnosable mental illness far exceeds the number who get any help. One in 10 children suffer a diagnosable mental illness, yet just one in four of them receive treatment. By 2020 the gap may close, a little, if plans in NHS England’s Five Year Forward View for Mental Health [pdf] are realised, but only a little.

Over half of lifelong mental illness and distress shows its first signs in adolescence. We have an opportunity to do something to change people’s lives for the better and dramatically reduce the number of adults living with entrenched mental health problems. This is a great prize.

In her first major speech of 2017, Theresa May stressed the importance of prevention. Green papers on social justice, family and the role of schools in monitoring mental health and wellbeing are in the pipeline.

But can the treatment gap be closed by scaling up access to treatment and providing more digital options alone? Where will the workforce come from to provide the extra services and sessions required?

What if we could reduce the number of people getting ill in the first place? What are the underlying causes of rising levels of mental distress in children and can we put in place measures that increase resilience and reduce risk? If so, what are the most promising approaches?

Our ambition is to look beyond treatment and containment towards prevention and early intervention.

These are some of the questions Birmingham University is setting out to explore in its new policy commission. I will be chairing the commission, working with a range of experts, and together we are calling for evidence from non-governmental organisations, academics, public agencies, thinktanks, and people with lived experience of mental health issues across the UK and internationally.

I first outlined the ambitions of the university’s mental health commission in my inaugural lecture last autumn. Our ambition is to put together a new approach that looks beyond treatment and containment towards prevention and early intervention.

There is already some good evidence of what works in mental health promotion and illness prevention. As minister for mental health I commissioned the London School of Economics to review the evidence [pdf] and rates of return on investment. Among the findings was that school-based social and emotional learning programmes return £84 for every £1 invested. However, often the “saving” does not land in the budget of those who must make the investment. Siloed budgets and misaligned institutional objectives get in the way.

Last year I wrote about my visit to New York to learn about Mayor Blasio’s mental health programme: NYC Thrive. Thrive is a city-wide action plan devised from a population health perspective. It is trying to break down some of the silos. It involves schools and colleges, housing providers, the police and businesses. Prevention and early intervention are at its heart.

The West Midlands has set out its ambitions in its own Thrive strategy and the mayor of London is also working on plans.

Over the next 12 months the commission will be taking evidence, looking at the most promising ideas and setting out the actions that government and other agencies can take to make the shift to an ethos of prevention.

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What can be done to tackle the youth mental health treatment gap? | Paul Burstow

The urgent need to tackle crisis in adult social care | Letters

We write to you as 45 former directors of social services with many decades of senior management experience behind us, to express our grave concerns about the current underfunding of adult social care services. Not a day goes by without well-informed groups expressing their dismay at the outcomes for vulnerable adults. Yet despite this the chancellor made no mention of this issue in his autumn statement.

We know that £4.2bn has been taken from local authority budgets over the past five years. The appalling consequences are there for all to see. Rapidly rising levels of dementia, but cuts in home care support. Hospital beds full, but insufficient residential places for vulnerable adults to be discharged to. Increasing suicide levels among young people, but draconian cuts in mental health provision. Many more people living – and dying – in the streets, but inadequate support and a lack of hostel accommodation.

Some 500,000 older people are abused every year while cuts are being made in safeguarding provision. At the same time services for people with physical and learning difficulties have been drastically cut leaving many isolated and unsupported. The Care Quality Commission says the residential care service is at a “tipping point”. But should we really have to wait for more homes to go out of business before the necessary action is taken?

These are not the indicators of a caring and just society. We don’t need further reviews and promises. Thousands upon thousands of people are suffering and sometimes dying in misery. They need help now, and we call on the government to provide it, with urgency.
Rob Hutchinson, Dr John Beer, Hilary Simon, Chris Davies, Pauline Oliver, Anne Parker, Professor Ray Jones, Peter Westland, Ian White, Roy Taylor, Richard Jones, Andrew Cozens, Liz Railton, Brian Parrott, Jean Daintith, Jo Cleary, Julia Ross, Eileen Means, Gary Birch, Bill McKitterick, Mimi Konigsberg, Helen Taylor, Mary Robertson, Ann Windiate, Susan Richards, Robert Ward, James Reilly, Graham Gatehouse, Stephen Pitt, Lynn Hopkins, Derek Law, Ian Davey, Tim Brown, Stephen Sloss, Margaret Sheather, Matt Bukowski, Ian Winter, Colin Smart, Jonathan Phillips, David Mason, Peter Bye, Joyce Mosely, Teresa Bell, Jef Smith

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The urgent need to tackle crisis in adult social care | Letters

Words are not enough to tackle the crisis in mental health | Letters

I am, of course, pleased that Theresa May recognises that increasing numbers of adults and children are suffering from mental health difficulties (May pledges to try to reduce stigma, 9 January). The huge emotional burden this puts on families only increases the risks. These difficulties have escalated in thesix years since massive cuts to public services and most preventive mental health services, alongside the increased culture of competition that leads to more anxiety and less security.

Having been part of primary prevention and secondary child and adolescent mental health services in my 30-year career in the NHS, it was soul-destroying to see services closed and specialist skills built up over decades being lost. It is galling to hear the plans presented as if they are new and concerning that one of the plans is for teachers to be trained to identify mental health issues and provide interventions. Often teachers, also struggling with cuts to services and increased pressures, can already recognise mental health issues but lack the time and expertise to offer interventions that could make a significant difference. Identification alone is not helpful unless combined with resources to deal with the issues.

The link between mental health difficulties and environmental stresses is well known, and community services can only develop if mental health crises are safely managed. Links between mental health services and schools and GP practices work well and have been used before, but tend to be cut when there are huge pressures on other parts of the system. There is no mention of increasing funding to any mental health services or of any evidence-based focus to these policies.
Dr Julia Nelki
Retired consultant child and adolescent psychiatrist, Merseyside

• Re the prime minister’s announcement of new measures to end stigma and unjust life chances for young people with mental illness, schools and their linkage to healthcare and the voluntary and community sector are central to “improve mental health”. As the new UK services are set up and evaluated, could I beg Guardian readers to share their observations with colleagues in the World Health Organisation’s initiative Global Accelerated Action for the Health of Adolescents?

A global “sharing society” could strengthen our government’s planned green paper on mental health, and help planners in countries with less expertise learn from UK successes and failures. I guarantee there will be both failures and successes – but it is the responsibility of the whole spectrum of stakeholders in mental health to learn from the implementation of policy.
Professor Woody Caan
Editor, Journal of Public Mental Health

• So Theresa May is going to improve mental health care. Let me cite my son’s last two years. He is in the highest suicide risk group, single white males between 40 and 45. Recent talk about more support for teenagers is a distraction from the fact that adult mental health services are in a state of near collapse.

He had a major breakdown two years ago, when single and 42. Since then he has been in seven different hospitals. After each discharge, he has relapsed within a few weeks. “Care in the community” has been either conspicuously absent or totally inadequate. The shortage of beds has meant that on five occasions, he was assessed as in need of hospital readmission and, after a long wait in A&E, was transported to a new, strange hospital. The lack of continuity of care for someone already frightened, confused and distressed is absolutely counter to the kind of support necessary.

Providing supported residential accommodation, to ease the transition from hospital back into the world, is essential. The lack of available beds is in part due to “bed-blocking”, because of a lack of such accommodation. Community care teams would be more effective, working together with residential teams in supported accommodation, preparing people for rebuilding their lives in the community, providing a necessary bridge between hospital and the world.

This, Theresa, is a long-term problem in need of a seriously thought-through long-term strategy, and considerable investment.
Name and address supplied

• It is not only acute care that is in difficulties (A&E crisis deepens, 10 January). My local NHS mental health trust has had to temporarily merge two inpatient wards due to staffing shortages as they cannot recruit enough qualified staff. This is not surprising, given the government’s policy of pay restraint in the public services by imposing pay rises of no more than 1% in recent years, and with no sign of any change, despite the effect they must know this has on the ability of the NHS to recruit and retain staff.
Ian Arnott
Peterborough

• A Christmas card from an NHS forensic psychiatrist schoolfriend a few weeks ago said: “Don’t believe claims re money for mental health. We’ve just had millions chopped off our budget three weeks ago & meltdown consequently.” I expect to read next December that Theresa May gave it all back.
Mark Lewinski
Swaffham Prior, Cambridgeshire

• The prime minister’s pledge to implement new measures to improve mental health services for young people couldn’t be more timely, as new figures from the Prince’s Trust reveal that one in four young people don’t feel in control of their lives.

In response to these findings and the fact that more young people than ever before are coming to us experiencing mental health issues, we are addressing an urgent need to improve mental health provision by launching our own mental health strategy. We welcome the government’s pledge to implement new measures to improve mental health services for young people and bring more focus to an area where we’ve seen an increasing need for support.

The Prince’s Trust Macquarie Youth Index reveals that young people’s confidence and happiness are at their lowest levels since the report was first launched in 2009. It paints a deeply concerning picture for a generation of young people who feel that their future is slipping away from them.

Many young people feel desperate about their situation; it’s vital that we act now if we’re to help them get the right support to create brighter futures for themselves.

The most important thing we can do to empower these young people is to continue to help them find work, education or training. Now, more than ever before, we need to work together to help them build a brighter future and regain control of their lives.
Dame Martina Milburn
Chief executive, The Prince’s Trust

• As part of the work we undertake across the east of England, Ormiston Families works with children and young people struggling with mental health issues. We see Theresa May’s announcement about a new approach to mental health as hugely significant.

It is well documented that the provision of mental health services across the UK is inadequate and this lack of care has led to an increase in the number of children and young people suffering with mental ill health for prolonged periods of time. Through our services in Norfolk and Cambridgeshire we know early intervention in young people showing signs of mental health issues is critical.

The prime minister talked about focusing “on prevention as well as treatment, especially since so many adult mental health problems – which one in four of us will suffer from at any one time – begin in childhood”. As a charity working on the frontline with children and young people showing signs of mental health issues, we are relieved to hear this. Early intervention, and thus prevention, is key to reducing the number of people suffering with chronic mental health issues.

The numbers in Theresa May’s speech are exactly the type of statistics we are working to reduce.

Mental health is without doubt one of the biggest issues facing our society today and it is good to hear the prime minister is keen for the government to do more to address the problems and “not just in our hospitals but in classrooms and communities”.
Mark Heasman
Chief executive, Ormiston Families

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Words are not enough to tackle the crisis in mental health | Letters

What’s the best way to tackle bathroom condensation after a shower?

My wife insists on opening the bathroom window after a shower to let the steam out and reduce condensation. I maintain that this simply lets cold air in, which increases condensation, and that it’s better to allow the damp air to disperse around the house. Who is right?

Wal Callaby, Whatfield, Suffolk

• Post your answers – and new questions – below or email them to nq@theguardian.com. Please include name, address and phone number.

What’s the best way to tackle bathroom condensation after a shower?

High court rules UK government plans to tackle air pollution are illegal

The government’s plan for tackling the UK’s air pollution crisis has been judged illegally poor at the high court, marking the second time in 18 months that ministers have lost in court on the issue.

The defeat is a humiliation for ministers who by law must cut the illegal levels of nitrogen dioxide suffered by dozens of towns and cities in the “shortest possible time”.

Legal NGO ClientEarth, which brought the case, argued that current plans ignore many measures that could help achieve this, placing too much weight on costs. On Wednesday Mr Justice Garnham agreed. He also said ministers knew that over-optimistic pollution modelling was being used, based on flawed lab tests of diesel vehicles rather than actual emissions on the road.

The government said it would not appeal against the decision and agreed in court to discuss with ClientEarth a new timetable for more realistic pollution modelling and the steps needed to bring pollution levels down to legal levels. The parties will return to court in a week but if agreement cannot be reached, the judge could impose a timetable upon the government.

Air pollution causes 50,000 early deaths and £27.5bn in costs every year, according to the government’s own estimates, and was called a “public health emergency” by MPs in April.

James Thornton, CEO of ClientEarth, said: “The time for legal action is over. I challenge Theresa May to take immediate action now to deal with illegal levels of pollution and prevent tens of thousands of additional early deaths in the UK. The high court has ruled that more urgent action must be taken. Britain is watching and waiting, prime minister.”

He said the increased action required would very likely include bigger and tougher clean air zones in more cities and other measure such as scrappage schemes for the dirtiest vehicles: “The government will have to be tougher on diesel.”

The mayor of London, Sadiq Khan, who took part in the case against the government, said: “Today’s ruling lays the blame at the door of the government for its complacency in failing to tackle the problem quickly and credibly. In so doing they have let down millions of people the length and breadth of the country.”

A spokeswoman for the Department of Environment, Food and Rural Affairs said: “Improving air quality is a priority for this government and we are determined to cut harmful emissions. Our plans have always followed the best available evidence – we have always been clear that we are ready to update them if necessary. Whilst our huge investment in green transport initiatives and plans to introduce clean air zones [in six cities] around the country will help tackle this problem, we accept the court’s judgment. We will now carefully consider this ruling, and our next steps, in detail.”

ClientEarth defeated the government on the same issue at the supreme court in April 2015. Ministers were then ordered to draw up a new action plan, but now that new plan has also been found to be illegal.

Documents revealed during the latest case showed the Treasury had blocked plans to charge diesel cars to enter towns and cities blighted by air pollution, concerned about the political impact of angering motorists. Both the environment and transport departments recommended changes to vehicle excise duty rates to encourage the purchase of low-pollution vehicles, but the Treasury also rejected that idea.

Documents further showed that the government’s plan to bring air pollution down to legal levels by 2020 for some cities and 2025 for London had been chosen because that was the date ministers thought they would face European commission fines, not which they considered “as soon as possible”.

There had been a draft government plan for 16 low emission zones, which polluting vehicles are charged to enter, in cities outside London but the number was cut to just five on cost grounds.

All these proposals will now be revisited. Thornton said a national network of clean air zones needed to be in place by 2018. “If you put in clean air zones, it works overnight.”

Dr Penny Woods, chief executive of the British Lung Foundation, said: “We urgently need a new clean air act that restricts the most polluting vehicles from our urban areas and protects everyone’s lung health – air pollution affects all of us.”

Sam Hall, at conservative thinktank Bright Blue, said there should be more power and funding devolved to local authorities to enable all English cities to set up clean air zones and more support for electric cars.

Keith Taylor, Green party MEP, said: “The failure highlighted by the judge today is as much moral as it is legal: ministers have displayed an extremely concerning attitude of indifference towards their duty to safeguard the health of British citizens.”

Air pollution table

High court rules UK government plans to tackle air pollution are illegal

Leading ocean advocacy groups join forces to tackle microfiber pollution

Two leading clean ocean advocacy groups have joined forces to stop tiny synthetic clothing fibers from polluting the world’s waterways and poisoning the food chain.

Plastic Soup Foundation (PSF), a Dutch nonprofit, and New York-based Parley for the Oceans announced Tuesday a partnership to tackle the issue of microfiber pollution and to create a global alliance of companies, governments, NGOs and scientists. Microfibers – tiny, often synthetic threads shed from laundry, industrial clothing manufacturing and fishing nets – have been found in alarming numbers in recent studies of microplastic pollution.

“Microfibers pose a massive and complex threat,” said Cyrill Gutsch, founder of Parley for the Oceans, in a statement. “It’s all about funding, supporting and boosting new technologies… [and] the best way to achieve this is together.”

The partnership comes after PSF launched its Ocean Clean Wash campaign earlier this year to educate washing machine manufacturers, fashion brands, environmental organizations and the public about the problem. PSF says already 100 nonprofits and other organizations have signed on to support the campaign, including Greenpeace UK and Austria, Plastic Pollution Coalition and Fauna & Flora International.

A June study found that synthetic fleece jackets release, on average, 1.7 grams of microfibers each wash. These small fibers aren’t easily filtered out at local wastewater treatment plants. The study, funded by outdoor clothing company Patagonia, found that up to 40% of these small fibers land up in oceans, rivers and lakes, threatening wildlife and ultimately our food chain.

Synthetic fibers such as acrylic, polyester and nylon pose the most danger because they don’t disintegrate and disappear over time. Instead, they break down into smaller, increasingly toxic pieces, allowing them to be consumed by fish and other animals. These tiny fibers have the potential to build up and lead to a potentially poisonous accumulation of chemicals in larger species. A study from the University of Exeter found that crabs contaminated with microfibers ate less food and that the polypropylene plastic broke into smaller pieces when ingested, leading to a greater spread in the body – and consequently a greater threat to human health.

Clothing companies have been slow to lend their support to the issue, although that’s starting to change. Patagonia says it continues to fund research and provide grants to explore ways to reduce the release of microfibers into waterways. Dutch clothing brand G-Star Raw announced earlier this year it was supporting PSF to raise awareness among fashion and textile companies about the damage their clothing can pose to the environment and to public health. According to PSF, nearly 40 fashion brands have agreed to collaborate as part of the partnership with Parley. The brands involved will be announced during a Call to Action event early next year.

PSF and Parley will work with other organizations to launch a competition next year to encourage scientists, inventors and clothing makers to come up with ways to stop the release of microfibers in the wash. The winners will be announced in 2018, and will receive a cash prize to implement their ideas.

According to PSF and Parley, possible solutions to the issue include a mechanical filter in washing machines to catch tiny fibers, synthetic yarns and fabrics that don’t release fibers in the wash and environmentally safe coatings that prevent microfibers from releasing when rinsed.

Leading ocean advocacy groups join forces to tackle microfiber pollution

Alarm at NHS plans for closures and cuts to tackle growing deficit

Opposition politicians and NHS campaigners have expressed alarm after it emerged that health service bosses throughout England are drawing up plans for hospital closures, cutbacks and other radical changes to meet spiralling demand and close gaps in their finances.

An investigation by the Guardian and the campaign group 38 Degrees has revealed that the NHS at local level could be facing a financial shortfall of about £20bn by 2020-21 if no action is taken.

In an attempt to head off the crisis, NHS England has divided the country into 44 “footprint” areas, with each asked to submit a cost-cutting “sustainability and transformation plan” (STP).

The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Incisive Health to collate and analyse proposals from across the rest of England. Also collected are figures showing the projected financial deficits in 2020/21 that will have to be plugged by cost-saving reorganisations.

Projected deficits

The shadow health secretary, Diane Abbott, called the report “a damning indictment of this government’s underfunding and mismanagement of the NHS”.

She said: “It reinforces all the concerns highlighted by the recent NHS Providers report and the King’s Fund survey of trusts’ NHS finance directors. Emergency closures of vital units across the country testify to a real crisis.”

There are proposals in the Leicester, Leicestershire and Rutland region to reduce the number of acute hospitals from three to two. In the Black Country region of the West Midlands there is a proposed reduction of the number of acute units from five to four and closure of one of two district general hospitals.

More general plans include reducing the number of face-to-face meetings between doctors and patients in north-west London through the use of more “virtual consultations”, and a proposal to give patients coaching to help them manage their own conditions.

The Liberal Democrat health spokesman, Norman Lamb, said STPs made some sense in principle. He added: “However, it would be scandalous if the government simply hoped to use these plans as an excuse to cut services and starve the NHS of the funding it desperately needs.

“While it is important that the NHS becomes more efficient and sustainable for future generations, redesign of care models will only get us so far – and no experts believe the Conservative doctrine that an extra £8bn funding by 2020 will be anywhere near enough.”

However, Stephen Dalton, chief executive of the NHS Confederation, denied that the changes meant the NHS would “indiscriminately close services”.

He told BBC Radio 4’s Today programme that there had long been a reluctance by political leaders to address the NHS’s cumbersome organisation, and that local discussions were better than having a single plan for the whole country.

But Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, said a “glut” of hospital services could shut down.

He said: “Our members tell us that they are struggling to keep services open because of workforce shortages and they therefore face really difficult decisions about do you close down something either permanently or temporarily because you cannot staff it safely?”

NHS bosses were asking managers to identify “marginal acute services where you are trying to prop up what is really an unsustainable rota”, he said, adding: “So we would expect to see a bit of a glut of those kinds of decisions going forward because our guys have been specifically asked to identify them.”

Some of the proposals are likely to be given the go-ahead as soon as October, though consultation would then have to take place locally.

Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money needed, and radical reforms to the way healthcare was delivered would also be necessary to ensure the NHS stayed within its budgets.

A spokeswoman for NHS England said the health service needed to make major efficiencies. She said:“We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.

“It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.”

North-west London’s draft plan highlights risks to the implementation of the programme, including a failure to shift enough acute care out of hospitals, a possible collapse of the private care home market, and a failure to get people to take responsibility for their own health.

Two local authorities in north-west London, Hammersmith & Fulham and Ealing councils, have refused to sign up to the draft plans because of concerns about hospital closures. Officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.

A spokeswoman for NHS North West London insisted the policies were based on evidence, saying: “There is a whole body of clinical evidence, research and best practice that clinicians are using to deliver better clinical care for patients.”

Alarm at NHS plans for closures and cuts to tackle growing deficit

Female rugby player"s tragic death exhibits why girls must tackle this sport head on

The 23-yr-outdated player was tackled to the ground for the duration of a game for her crew Longton but walked off the pitch, despite some discomfort. She later on suffered a stroke very likely due to a blood clot and died a month following being harm.

Some have pointed to this as proof that females shouldn’t be playing such a rough sport.

But, with respect to Sarah’s household and close friends, I should disagree.

Yes, rugby is a get in touch with sport it is the nature of the beast. Knocks will happen and a handful of are far more significant than others. As Sarah’s teammate Lesley Thompson said at the hearing into her death: “It was just a tackle, absolutely nothing malicious or heated”.

Anyone who queries the rougher edge and suggests that girls would be much better off steering clear of rugby, is missing the point.

The reality is that we achieve so a lot more, in spades.

Sarah Chesters  Photograph: SWNS

We’re encouraged, by our coaches and teams, to search right after our bodies to stretch and problem them in purchase to avoid injury, acquire strength and consume nicely.

The teamwork doesn’t cease, ever. From instruction in the wind and rain on grim February nights to plaiting every single others’ hair on the bus to an away game. These are journeys when we shout, sing, get raucous and share cakes we stayed up producing the night before (it’s not just the staff, one particular of our star bakers is a player’s husband).

You feel ladies can’t perform nicely with each other? There’s no greater way to bust this ridiculous myth than seeing eight girls, working with each other in a pack to earn hard yards for the rest of their team.

We’re invariably called ‘butch lesbians’ and ‘man-hating hulks’.

Masculine, you say? Well, if you’d class strength, determination and a cracking sense of humour as masculine traits, we’d say: “too correct.”

There are even now too many lazy and hazardous stereotypes that surround women’s rugby. But shell out a pay a visit to to any club, and you will locate this kind of a selection of personalities, shapes, ages, sexualities, speeds and skill-levels – it’s the sport that brings us with each other.

Whether it’s busting our guts on the pitch for a single yet another, or busting our lungs singing S Club 7 songs in the showers afterwards although acquiring the mud out of our hair (3 shampoos and a rinse generally does the trick), there is amazing camaraderie that comes hand-in-hand with pushing your self to the limits in the worst climate circumstances Britain has to provide.

That is something that Sarah, who commenced playing rugby as a student at Manchester Metropolitan University, would have skilled initial hand and loved, just as we do.

Bath ladies in action  Photo: Paul Hughes

All the ladies I perform with are properly aware of the dangers involved. And they also have knowledgeable a tragic injury. Eight years ago, the team’s captain and a founder-player broke two vertebrae in her neck and broken her spinal cord. Her injuries had been life-changing. But she’s by no means blamed the sport, nor anybody concerned, merely saying it was “one of individuals items.”

In the days following her accident, she informed the crew they have to return to perform their largest rivals the following week. It was hard but they did. And they won.

I imagined of her this week, when I study a comment by Sarah Chesters’ father, right after the inquest. Michael, 65, explained that his daughter ‘loved’ rugby. “Despite her modest stature,” he additional, “she was really strong”.

To propose that ladies shouldn’t play rugby – that we are not physically capable – is to say we’re the weaker intercourse. Tragic accidents do take place in sport, as in numerous other walks of lifestyle. Only last month, 24-year-outdated Bavalan Pathmanathan died following currently being struck in the chest by a ball in the course of a regional cricket match in Surrey.

This kind of incidents need to not be taken lightly, of program. Any sports player is aware that severe damage is a real risk. But, as Sarah’s father rightly pointed out in saying how much his daughter loved rugby, it is just component of throwing oneself wholeheartedly into the game, with passion, enthusiasm and strength.

Sarah Chesters taking part in rugby  Photo: SWNS

Confident, as girls we occasionally appeal to a little concern from strangers who clock our black eyes and mutter quietly, “are you alright?”

But once they uncover out you play rugby, it problems their assumptions. It is not a bad conversation starter for your CV, too.

Player security is constantly proper at the best of the agenda. New protocols to deal with concussion are filtering down to grassroots degree from the prime tiers of the sport, with latest higher-profile circumstances – this kind of as the concussions experienced by Welsh player George North and Ireland’s Jonny Sexton – guaranteeing rapid progress.

• Rugby concussions soar by 59 per cent, says report

We have scrum caps, mouth guards, hi-tech strapping. There’s also been important advancement in sports armour for women’s bodies, which will give you even a lot more protection when you get that inevitable elbow to the nipple (ouch). All this means the game has never been safer.

England win Women’s Rugby Globe Cup ultimate   Photo: AFP

Following the achievement of the England staff in winning the 2014 Women’s Rugby Globe Cup, a lot more girls than ever are scrumming down.

The Men’s Rugby World Cup lands in England (and Cardiff) this September, with tournament organisers stating that upping participation and engagement is one particular of their key objectives. Soon after that we’ve acquired fast and furious Sevens in the Rio Olympics to seem forward to.

Yes, there are aches, knocks and bruises. There’s crying, there is laugher – most of the time in my group, it is crying with laughter.

And there are the horrible (though thankfully scarce) times, when our community has to come with each other in the encounter of heartbreaking injuries.

But in women’s rugby, there’s also determination, strength, respect and joy. And the most entertaining you could ever have. There’s in no way been a much better time to tackle lifestyle head on.

Bath Rugby Women are element of Bath RFC. Last season, recruitment and advancement of new players was so effective that a Bath Rugby Women IIs staff was formed, and will compete for the very first time in the 2015/sixteen season. New players are extremely welcome – if you would like to come and train with us, just pop along, email bathrugbyladies@hotmail.co.united kingdom or follow on Twitter @bathrugbyladies

Female rugby player"s tragic death exhibits why girls must tackle this sport head on

Weight problems includes each and every a single of us. We need to tackle it collectively | Sarah Boseley

Meals manufacture is now the biggest company in the economic system. Cafes, dining establishments, supermarkets, convenience stores and snack outlets compete to persuade us to eat much more. Photograph: Alamy

From the excess fat slowly strangling our organs to the junk meals pushed at our kids by means of video games on their mobiles – the far more I have looked into the leads to and consequences of our fat troubles, the far more outraged I have turn out to be at how little we speak about this and how minor is getting completed to flip the tide. The problem entails all of us and is not to do with sloth or greed but is embedded in the way we live today. What has took place to our consuming routines is element of the large social dynamic of the final half century or far more. Our community structures and to some extent our families have broken down.

That is why I am fascinated by an experiment that began in two modest towns in northern France and has because spread to a lot more French towns and other nations. It is an attempt to engage a entire community in efforts to fight the lifestyles that cause obesity.

Epode (the French acronym for Together, let’s avoid childhood obesity) began in Fleurbaix and Laventie in 1992, which, at the time, had six,600 people among them. “Absolutely everyone, from the mayor to store owners, schoolteachers, medical professionals, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and different branches of town government joined in an hard work to motivate kids to eat far better and move about a lot more. The towns developed sporting facilities and playgrounds, mapped out walking itineraries, and employed sports activities instructors. Families had been provided cooking workshops, and families at risk have been provided counselling,” mentioned Dutch nutritionist Martijn Katan.

It was led by the towns’ mayors and an obesity champion, appointed locally. They had drive and enthusiasm but also profound knowledge of their neighborhood. It was back, in result, to the old days when everyone felt a obligation for bringing up the local kids, as an alternative of the hands-off, none-of-my- business frame of mind we primarily have today. And it appeared to function. By 2005, obesity in young children had dropped to 8.eight%, even though in related neighbouring towns it had risen to 17.eight%. It wasn’t a rigid scientific trial, but many authorities are convinced.

There are now comparable projects in Belgium, Spain, the Netherlands, Greece and Australia. Would not it be wonderful if some modest towns or villages in the United kingdom were to consider an Epode-like undertaking?

When Mrs Thatcher told us there was no such point as society and that we need to be self-reliant, there may possibly have seemed to be no downside as consumerism thrived and quickly-food shops proliferated. Grabbing a bite to eat on the go meant we could operate harder. Convenience meals meant we could perform tougher. The consequences are now extremely noticeable. Meals manufacture is the greatest company in the economy. In every single town and city cafes, eating places, supermarkets, ease merchants and snack shops compete to persuade us to consume a lot more.

No person is going to consider away our private obligation for our wellness. Each a single of us can change our diet plan. We can grow to be a lot more lively. We can drop excess weight. But our chances of prolonged-term good results are tiny without assistance from these around us and changes in the foods and constructed setting. Which is where governments have to come in. Laissez-faire has had its day. Performing nothing is not an alternative if obesity as a nationwide and a global overall health dilemma is to be brought under manage.

• This is an edited extract from The Shape We’re In, by Sarah Boseley (Guardian Faber).

Weight problems includes each and every a single of us. We need to tackle it collectively | Sarah Boseley

Finish this sugar rush it is the only way to tackle the weight problems crisis | Simon Capewell

‘Added sugars are hidden all over the place: often there are four teaspoons of sugar in a tin of soup, 5 in a common Tv dinner, 6 in a yoghurt, 9 in a can of cola.’ Photograph: Matthew Horwood/Alamy/Alamy

A third of British young children and two-thirds of British grownups are obese or obese. Diabetes levels have doubled in the past two decades. Nevertheless, contrary to common belief this is not mostly due to our more and more sedentary lifestyles. It primarily outcomes from excess calories in our food and sugary drinks.

Extra sugars are hidden all over the place in modern food: usually there are 4 teaspoons of sugar in a tin of soup, 5 in a typical Television dinner, six in a yoghurt, 9 in a can of cola. At greatest, these extra sugars are empty calories with zero dietary worth at worst, they are toxic.

Typical sugar comprises glucose and fructose. Several scientists are convinced that the current substantial quantities of fructose consumption are harmful. Fructose molecules are processed in the liver into unwanted fat. This triggers the release of insulin (producing a pre-diabetes state) and raises blood pressure. Sort two diabetes could suggest a existence of increasing complications and an earlier death from a heart attack, stroke, cancer or dementia. Each week, this scientific proof is strengthened.

My daughter’s friend Susan (not her genuine title) is a delightful 11-yr-outdated, but a little chubby. Her college not too long ago scheduled an further hour of games for her class each day. Susan might burn up off an additional 100 kcal at every session, a weekly complete of 500 kcal. But on the way property on Fridays, Susan stops off for her reward: a cheeseburger. Yes, you’ve guessed it, 500 kcal in five minutes. Plus low-cost sugary cola, a further 110 kcal. When residence, Susan sits down to view television and absorbs the hefty advertising of junk food, sweets and sugary drinks. If her mum is functioning late, Susan heats up a Tv dinner (400kcal), washing it down with a can of sugary pop (140kcal). And so her fat increases. Like millions of other children in Britain right now.

Meanwhile, multibillion-pound industries get wealthy via manufacturing, advertising and retailing junk meals and sugary drinks. Over all, they worry any regulation that may possibly threaten long term income. So they focus on other (ineffective) options, such as Andrew Lansley’s “responsibility deal” amongst 2010 and 2014, and market “nudging” as a stylish approach to alter behaviour. Public overall health scientists had seen voluntary agreement video games played previously. In 2010, they predicted it would not work.

The four years of the accountability deal largely concerned industry and government sitting about tables dreaming up higher-profile pledges to “cut a billion calories” or minimally lessen sugar content in isolated items. The deal gave businesses a good deal of publicity. The taxpayer has hence funded market PR, but weight problems has elevated. And just two weeks ago came more revelations that many effectively-identified organizations had reneged on their pledges.

Additionally, the deal was employed by government and sector as an excuse to reject far more successful approaches. Without a doubt, the tactics utilised by Massive Tobacco, Large Booze and now Big Food lobbyists look comparable: denial, delays, detours and dramatic distractions.

Government attempts to lessen calories and sugar have failed (although industry apologists attempt to disagree). So what is needed now? Massive Tobacco had 5 glorious decades of unregulated profit just before being managed by addressing the “3As”: affordability (taxes and value rises), acceptability (marketing and advertising bans and warning labels), and availability (licensing and smoke-cost-free legislation). These are probably transferable to junk food or sugary drinks.

Campaigners have urged the health secretary, Jeremy Hunt, to impose a sugary drinks duty, a advertising and marketing ban, mandatory site visitors light labelling, and progressive sugar and saturated fat reductions in junk meals. They also want him to lessen portion sizes, finish market sports activities sponsorship and set up an independent food policy institute.

Hunt, a gifted and ambitious politician, is caught among the rock-like Scylla of market lobbyists and the Charybdis whirlpool of public view, which now supports sugar regulation. My funds is on the whirlpool.

Finish this sugar rush it is the only way to tackle the weight problems crisis | Simon Capewell

Jeremy Hunt vows to tackle unreporting of safety incidents in hospitals

An global review final week identified that the NHS was the safest well being care technique in the planet, but Well being Secretary Jeremy Hunt says that ”we have to not be complacent”.

He would like to inspire all trusts to have an ”open and honest reporting culture” so that concerns can be shared by doctors and nurses at an early stage.

Mr Hunt believes that this will boost patient care across the country and comes as a lesson learned from the tragedy that happened at Mid-Staffs.

Jeremy Hunt vows to tackle unreporting of safety incidents in hospitals

Well being experts assault ketamine plan to tackle depression

Psychologist Oliver James is 1 of the experts calling for the Manchester University research to be dropped. Photograph: Murdo Macleod

A group of top psychological overall health professionals has named for researchers to abandon a £1m venture that would involve administering a blend of electroconvulsive therapy (ECT) and the banned recreational drug ketamine to patients. The project’s aim is to check the combination as a new strategy of tackling depression.

Nonetheless, several psychologists and psychiatrists, which includes the writer Oliver James, say they have grave considerations about the use of the effective combine of therapies that the analysis study – backed by the Uk Nationwide Institute for Overall health Investigation – intends to check. They very first question the security of ECT, in which an electrical recent is passed via the brain to produce an epileptic match, an event some medical professionals claim improves a patient’s condition. The group also argues that there is no proof ketamine has any lasting helpful results.

“Participants are getting informed that ketamine is believed to work collectively with the impact of ECT to enhance mood, but the evidence for the effectiveness of both remedy individually is really weak and evidence for a mixed result even weaker,” explained Professor John Read of Liverpool University’s Institute of Psychology. There was a danger a patient could endure serious adverse signs.

The principal centre for administering the ECT-ketamine study is based mostly at Manchester University, whose internet site claims it is the greatest investigation study of ECT in the Uk for much more than 30 years. A number of other centres – including clinics in Stockport, Leeds and Salford – would be concerned. The project’s website adds that ECT is the most effective antidepressant obtainable. “Even so, it is associated with confusion and impaired cognitive function, which includes memory and executive function,” the site acknowledges. The study’s aim is to find if ketamine can reduce impairments connected with ECT and lessen a patient’s depressive signs and symptoms. “Individuals who consent to consider element in the examine will be randomised to either acquire ketamine or a placebo injection,” the website adds.

But critics say, in a letter to the project’s organisers and backers, that its supporters appear “to be creating inaccurate statements about the dangers and benefits to people who are depressed – some of them suicidally depressed – and who might as a result really feel desperate ample to accept any treatment method that is supplied to them”.

The study’s critics argue that ketamine is a effective hallucinogenic drug. Giving it to a person who then has ECT, which leaves them in a disorientated state, will increase their discomfort, they say. As David Harper, a clinical psychologist at the University of East London, pointed out: “The likely dangers of combining an already risky ECT procedure with a hallucinatory drug seem to be very much to have been downplayed in this review.” This point was stressed by James. “It is absolutely ludicrous to claim that a potent euphoria-inducing drug like ketamine is going to be a lengthy-term or a quick-phrase technique for controlling clinical depression,” he stated.

The group’s other major objection is to the study’s declare that ECT is safe and efficient. It is sometimes related with extended-lasting cognitive dysfunction and requires a tiny but substantial mortality danger, generally by way of cardiac arrest or stroke, it states. “We think that ECT recipients need to be informed of that danger,” they add in their letter.

Well being experts assault ketamine plan to tackle depression

Sisi gets on his bike to tackle Egypt"s bulging fuel subsidies and waistlines

President Abdel Fattah al-Sisi, in white, prospects a mass cycle ride around Cairo in a push to minimize Egypt’s enormous fuel subsidies. Photograph: Reuters

“On your bike” is a phrase employed in British politics as a metaphor. But Egypt’s new president, Abdel Fatah al-Sisi, indicates it virtually: he desires more Egyptians to cycle – and to display he indicates organization he took hundreds of cyclists, which includes a group of public figures, on a rally by way of Cairo at five.30am on Friday .

A set of surreal pictures showed a helmetless Sisi straddling a Peugeot bicycle at the head of a huge swath of all-male bikers as he led them – like a puffing, peddling Pied Piper – by means of the streets of Cairo.

“This is the only way to build Egypt,” he explained in a speech ahead of the rally, claiming that cyclists would save Egypt funds. The common two-way bike trip fees the state about £1.30 significantly less than if the identical journey was by car, Sisi stated. Egypt spent E£170bn (£14bn), or about a fifth of its budget, on energy subsidies – a bill it can no longer afford.

Sisi’s move was met with some bemusement in Egypt, exactly where Cairo in distinct is seen as hell for those on bicycles and temperatures can attain 46C (116F). But he was naturally welcomed by a modest but growing band of cyclists.

“Of program it’s wonderful,” stated Ahmed El-Dorghamy, co-founder of Cairo Cycler’s Club, who says the capital’s flat terrain and sunny climate has the makings of a secure area to cycle. “We are often making an attempt to get celebrities to join us – and the ultimate purpose is to get ministers and even presidents.” Increased bike use, he said, could aid counter a growing weight problems difficulty – Egypt is the seventh fattest nation in the world – as well as chronic visitors jams and an unsustainable fuel subsidies bill.

Others had been much less convinced: in Egypt, driving a auto is usually harmful sufficient. In accordance to the Planet Wellness Organisation, there are 42 annual street deaths per 100,000 Egyptians – in contrast with just two.75 in Britain.

There are no cycle lanes, drivers hardly ever adhere to lane discipline or street markings, and pedestrians have to stage into the path of oncoming traffic to force autos to permit them to cross a street.

Deliverymen do use bikes for regional errands: bakers can be usually be noticed gliding via visitors jams on their bicycles, balancing vast trays of bread on their heads. And in two provincial cities close to Cairo, authorities want to encourage much more cycling along a few principal roads.

But in general, really number of commuters cycle, put off by the danger and the lack of infrastructure. Female cyclists also report regular harassment from passers-by.

El-Dorghamy, whose doctoral analysis centres on sustainable transport in Cairo, hopes Sisi’s photocall encourages a modify in culture. But he mentioned it needed to be followed by correct action: the renovation of Egypt’s potholed roads and the promotion of cycling as an acceptable action for each men and women. Pictures suggested Sisi had only males with him.

“But I truly hope that’s only a first phase,” El-Dorghamy stated. “It has to be clear that this is accepted socially for both guys and women.”

Sisi gets on his bike to tackle Egypt"s bulging fuel subsidies and waistlines

Tories strategy Labour MP Frank Area to aid tackle NHS deficit

Frank Area is drawing up proposals that he says will assist to fill a looming £30bn a 12 months ‘black hole’ in NHS funding. Photograph: Martin Godwin for the Observer

A Tory minister has asked Labour MP Frank Field to meet the wellness secretary, Jeremy Hunt, to talk about his ideas for raising national insurance contributions to pay for the NHS, in a sign that the Conservatives are considering radical alternatives to plug the large funding gap.

Area told the Observer that he was approached by the minister, who explained the economic crisis in the NHS needed to be addressed and that he was right to be floating tips on how the service could be maintained and put on a sound monetary footing for potential generations.

Discipline informed the minister he would be willing to meet the health secretary, but not ahead of he had held talks with shadow chancellor Ed Balls about his proposals, which he did last Tuesday.

According to Discipline, the minister also said that the financial crisis in the NHS had been the subject of discussions at large ranges in government in recent weeks.

Discipline is drawing up proposals that he says will aid to fill a looming £30bn a 12 months “black hole” in NHS funding that will arise by 2020.

With no action, he says, a Labour or any other government would be faced with the prospect of having to make swingeing cuts across the other public providers, far deeper than envisaged so far, to maintain the NHS in anything at all like its existing form.

Field mentioned: “A Conservative minister approached me and mentioned they had been speaking about the NHS’s financial crisis and my concepts on how to deal with it inside the department.

“The minister stated it would be a very good concept to go along and talk to the wellness secretary about it and agreed that something had to be carried out.”

Some Conservatives now feel that drastic action wants to be taken on NHS funding, and regret that David Cameron has not proposed some kind of NHS tax to underpin his dedication to sustaining the present support free at the point of use. The chancellor, George Osborne, however, is identified to be strongly opposed to any move that would compromise a Tory standard election message based mostly close to the thought of decrease taxes, and is said to believe that radical alternatives can be delayed right up until the up coming parliament.

Latest figures, based on information from NHS England and the Nuffield Believe in and made by the Commons library, suggest that NHS costs alone will go from £95bn a yr now to far more than £130bn a 12 months by 2020.

As a end result, Discipline argues that a one% rise in nationwide insurance coverage, equivalent to that ordered by Gordon Brown to shell out for enhanced spending on the NHS in 2002, would be welcomed by the public if it was guaranteed that the cash would be invested especially on health and social care.

In his meeting with Balls, which he described as “extremely friendly and constructive”, Discipline explained that any rises in national insurance coverage on best of an first emergency improve, must be matched with an accompanying pledge to decrease income tax by the very same amount – which means that deep cuts would have to be created elsewhere.

The Observer revealed final month that Field’s concepts were getting fed into Labour’s policy review. Balls has been opposed to such a move, fearing it would leave Labour open to charges that it is returning to a high-tax agenda. At Tuesday’s meeting, Discipline explained how radical his proposals are – a progressive nationwide insurance base to raise revenue, to be matched by tax cuts.

Signs, nevertheless, that the Tories are interested in the Field prepare suggests they could be examining ways to outflank Labour, and depart it vulnerable on an concern regarded as one of its strongest.

Discipline stated the additional NI contributions need to go into a devoted fund that would be run as a mutual, with elected members negotiating every year’s level of contributions. “What we require is a new settlement for the NHS, an NHS mark two, that will reassure people that the most popular public support is protected for long term generations.” He is now concerned that unless of course Labour moves on the situation, the Tories will steal the thought. Area proposed the sale of council homes in 1979, only to see Margaret Thatcher take up the thought and flip it into one of her most emblematic policies.

Labour is presently committed to combining the budgets for wellness and social care but the party’s public place as a result far has been that it will not appear at a certain NHS tax.

Shadow wellness secretary Andy Burnham is wary of rising NI in a way that would mean younger men and women in function possessing to pay out the care charges of these previously of pensionable age.

He favours other options, which includes a prepare floated by Labour before the last election for a levy of 10% to 15% on people’s estates soon after death to pay out care costs. To tackle Burnham’s issues, Discipline proposes that people now over pension age would be asked to carry on to pay NI, if they wished cost-free care. Otherwise, they would have to pay below the present method.

Tories strategy Labour MP Frank Area to aid tackle NHS deficit