‘End PJ Paralysis’ is more symptom than solution | David Mitchell

You don’t have to be seriously ill to realise the NHS is in trouble. In fact, ironically, some forms of serious illness would preclude the realisation. I’m sure that, as I type, delirious patients on trolleys in superbug-infested corridors are among a tiny minority of British citizens oblivious to the healthcare crisis. Let’s hope they get the treatment they need to bring into focus the desperate surroundings in which they’ve somehow got the treatment they need.

Research published last week in the medical journal BMJ Open says that two in five GPs are planning to quit their jobs within five years in what has been dubbed, perhaps in celebration of Passover, an “exodus of GPs”. Though in this case, the plagues will come after they’ve left.

The flaw in the research is that there’s no control: what’s the percentage of the UK’s overall employed population who are planning to quit their jobs within five years? It’s going to be quite high: everyone within five years of retirement, plus everyone from other EU countries who suspects they’ll have to (or will want to) return home, plus everyone who dislikes their job.

Because that’s what you say if you dislike your job but need the money: “I tell you what, I’m definitely quitting within five years.” You want to assert that this isn’t how life is going to be and yet you know you won’t quit now. And quitting within a year seems a bit close and scary. And quitting in 10 years seems too remote and dismal. So “within five years” is a nice, vague, woolly resolution to change.

So let’s assume that among those who, say, work for McDonald’s, the number who imagine quitting within five years is higher than two in five. But also that among those who, say, live their childhood dream of earning their living directing live opera or managing a large acreage of ancient woodland or being leader of the opposition, fewer than two in five envisage moving on in so little time as half a decade.

If you average that out – and since there are probably more in the former group than the latter – I wouldn’t be amazed if the overall rate of people with jobs saying they want to quit within five years isn’t also about two in five. I’m just guessing. I haven’t had research commissioned by a careers advice website or anything. But I don’t sniff Britain and get waves of job satisfaction pheromones coming off the workforce. And I live in London, where the streets are paved with oligarchs’ discarded onyx worktops and we’re all so rich we don’t hate immigrants.

Then again, GPs’ annual earnings are on average about £100,000, a salary that usually militates against dissatisfaction. Which makes the two in five figure more worrying again: it’s a well-paid job, and a worthwhile one, and it’s not physically dangerous, yet 40% of the people who do it want to stop. The unavoidable conclusion is that it’s horrible. Like Egypt under Pharaoh.

This report is just one recent example of troubling news about the health service, which also includes nurses balloting for strike action, a cluster of “avoidable” infant deaths, the number of people waiting more than 18 weeks for surgery “set to double” and new cancer drugs being ruled too expensive. Despite Trump, Brexit and Syria, the NHS is clinging to its share of column inches as doggedly as Mel B’s love life, and is just as bleak.

It’s clear that a solution must be found before the whole thing collapses into an enormous heap of rubble, crutches, wheelie drip-stands and little cardboard dishes of vomit. Well, it has been! Last week came news of a campaign, pioneered by Nottingham university hospitals NHS trust that aims to get patients out of bed, dressed and walking around. Obviously, in a sense, the whole NHS is supposed to be a campaign to do that. But the difference with this scheme, referred to as “End PJ Paralysis”, is that it aims for patients to do it before they’re necessarily better.

Illustration by David Mitchell.

The premise of the scheme is that lying around in bed feeling sorry for yourself becomes self-perpetuating. So staff are encouraging patients to get dressed, move around and in general act like they don’t feel terrible. At a time when the NHS is under unprecedented pressure to free up beds, this is a refreshingly direct approach. “Get out of that bed!” say the staff. The patient does. The bed is freed up. It’s much more efficient than waiting for them to die in the bed, at which point you have to send for a couple of guys and a trolley.

Instinctively I believe this idea works. We’ve all done it: just decided we can’t be ill, either because there’s stuff we have to do or because we’re fed up of the sweaty sheets, the daytime TV, the endless Lemsip. By getting up and pretending everything’s normal sometimes it becomes so. You get distracted from the symptoms and by the time you remember them, they’ve receded or disappeared.

This idea has much in common with alternative medicine. In that field, because patients are listened to, given time and respect in a comforting environment often involving a CD of wind chimes, they frequently feel better despite it having been proved that the actual treatment doesn’t do any good. It’s an effective mood-changer for someone who doesn’t feel 100% but is basically fine.

“End PJ Paralysis” is doing the same thing in a different way. It’s the “Pull yourself together!” to reflexology’s “I’m so sorry to hear that” and is much less costly in time, staffing and vaguely oriental-looking indoor water features. Like homeopathy, it absolutely cannot fail unless accidentally applied to someone who happens to be actually ill.

Some people’s recovery will be helped by greater pressure to get dressed and move around. But can we be sure patients will succumb to this pressure according to whether they’re really up to it, rather than because of their own personality – their instincts to obey authority or deny the seriousness of their condition?

The principle that people who have been hospitalised should restart normal life as soon as they can is already well established. So it’s suspicious that a campaign exclusively pushing the idea of getting up and going home should coincide so precisely with the NHS’s dire shortage of money. It feels like a treatment it’s financially convenient to prescribe.

‘End PJ Paralysis’ is more symptom than solution | David Mitchell

Amsterdam"s solution to the obesity crisis: no fruit juice and enough sleep

[unable to retrieve full-text content]

The city is successfully fighting fat by promoting tap water in its schools, along with healthy cooking classes and a ban on fast food sponsorship

The city of Amsterdam is leading the world in ending the obesity epidemic, thanks to a radical and wide-reaching programme which is getting results even among the poorest communities that are hardest to reach.

Better known for tulips and bicycles, Amsterdam has the highest rate of obesity in the Netherlands, with a fifth of its children overweight and at risk of future health problems.

Related: For children’s health, the government has to treat sugar like cigarettes | Gary Taubes

Continue reading…

Amsterdam"s solution to the obesity crisis: no fruit juice and enough sleep

The solution to the NHS funding crisis? Its property | Dag Detter

The NHS was offered little relief in Wednesday’s budget. The proposed spending increase of £250m in social care the first year and then £130m the following two years will hardly cover inflation, let alone other cost pressures that the shortfall places on the health service. With such austerity the NHS faces years of underfunding, according to a King’s Fund report.

Yet the most promising avenue towards financial salvation is not even contemplated. The NHS is one of the country’s largest property owners; but also one of the least efficient property managers. Decades of debate have raged between those who want to keep it that way, and those who want to privatise or outsource property management to the private sector. The glaring third alternative has been left by the wayside – professional management of NHS property while maintaining public ownership but isolated from short-term political meddling.

The British Medical Association asks for a short-term £10bn funding increase, which would bring the NHS up to about 10.3% of GDP, still below spending in many other European countries such as Germany or Sweden. The government simply stalls, requesting NHS efficiency savings of £22bn by 2020. It refuses to clear the path towards professional NHS property management beyond the marginal initiative of the NHS Property Services, which manages only a fraction of the total portfolio.

The NHS in general, or each individual trust, has no detailed list of assets or even a basic understanding of the portfolio value and yield. Without a professional understanding of the extent of its real-estate portfolio, or recognising the market value, it lacks incentives to maximise value. Many of the buildings owned by the NHS are not even managed to maximise healthcare quality. For example, because of political pressures, opening new hospitals and health facilities is much easier than closing old, underused and inefficient NHS buildings, despite the fact that transferring services to more modern facilities will usually deliver better health outcomes.

International examples point to the benefit of specialisation by separating the property operations from the service providers, while retaining public ownership. In Sweden, local healthcare providers are serviced by a separate property company, both owned by the local government. A similar example in the UK can be demonstrated by London & Continental Railways, which has successfully helped to develop the commercial assets around King’s Cross, Waterloo and Stratford stations in London, and around the former Manchester Mayfield station.

A separate professional holding company at a national or local level would improve visibility of asset and portfolio data (floor areas, running costs, metrics such as building costs per medical procedure/patient) and would help make the case for closures, proving that a closure can be about good estate management and health outcomes, rather than being incorrectly attributed to “NHS cuts”, as usually seems to be the case. Over the coming years, many new ways of delivering digital healthcare can be realised, which makes it even more important to adapt facilities quickly and efficiently.

If the entire NHS portfolio were transparent and professionally managed, the value it would create would help to fund healthcare. One can draw a parallel to retail chains such as Tesco that earn more on their property management than on sales in their shops. Most NHS properties are in residential areas and so can easily be redeveloped in ways that yield more housing as well as better health provision.

If such a holding company for the property could generate a return of a modest 3% yield, it would mean almost £2bn in additional funding for the NHS. This may seem marginal for a budget of £116bn last year, but could prove decisive and, together with the operational efficiency gains, it could end up being a much larger sum since healthcare specialisation and new healthcare technology require functional, yet flexible facilities. With the two management organisations at arm’s length, it would help to raise quality, as well as release land for much-needed housing and offices, while earning a higher return on some of its property.

In recent years, investing in NHS facilities in cooperation with the private sector through private finance initiatives has gained a poor reputation, perhaps rightly so. This makes it even more important for an independent and professional property holding company to develop its own competence. That may also be a prerequisite for any future cooperation with private sector partners. Frustratingly, the political impasse creates a need for simplistic solutions – spend more or prioritise public fiscal balances. This solution may not suit those looking for a quick fix. But it may turn out to be the only realistic long-term funding plan for the NHS.

The solution to the NHS funding crisis? Its property | Dag Detter

National Intelligence Council Report Describes the Final Solution for “Fake News”

Trends or revolutions can be unexpected. Even with total information awareness. The best laid plans often go astray. Take “fake news” for example. A report released by the Office of the Director of National Intelligence on January 9, 2017 highlights one of the greatest trends and unexpected consequences of the information age. Produced over the last four years by the National Intelligence Council the report titled Global Trends Assessment: Paradox of Progress chronicles current and emerging trends in the geopolitics, military affairs, and technology. The only paradox is that the globalist’s progress has taken an unexpected turn.

Coming in at 235 pages it is bristling with themes on a dystopic future from malevolent AI to out of control geoengineering and break away civilizations. Not kidding. Echoing other globalist white papers with three future dystopian scenarios or a combination of them.

All with the same solution for “fake news“. Just like the World Economic Forum’s Global Risks Report 2017 with it’s calls to “smooth the information flow” and this report that questions “democratic ideals like free speech and the market place of ideas“.  Direct quotes!  These documents released at the end of the Obama Administration represent the capstone in globalist thinking about the problem of “fake news“.

In the chapter Trends Transforming the Global Landscape there is a section titled Converging Trends Will Transform  Power and Politics. This word product puts in stark terms how the internet has empowered individuals and alternative media to influence opinion and spread information on a global scale as never before. It offers only one solution at the end of the chapter to the problem of “fake news” that has broken the monopolies. Can you guess what that is?

Technology and wealth are empowering individuals and small groups to act in ways that states historically monopolized—and fundamentally altering established patterns of governance and conflict

The ICT revolution placed in the hands of individuals and small groups the information and the ability to exert worldwide influence—making their actions, interests, and values more consequential than ever before.    GTA p26

When the internet was introduced to the public it had already been in use for years by the military as ARPANET. Developed by the forerunners to DARPA this technology was given to the public for many reasons. One of the major reasons was to “close the loop” and get real time data on what populations are saying, thinking and doing. This allows for increasingly accurate prediction of future trends and how to influence them by introducing strategic stimuli at certain points along the way. Before this governments and corporations did not have instant and reliable methods of gauging the public mood and how they were reacting to social engineering and advertising. Total information awareness is now making the globalists totally aware that people around the world are fed up with them. Now the script has been flipped and the people are making up their own minds.

The information environment is fragmenting publics and their countless perceived realities— undermining shared understandings of world events that once facilitated international cooperation. It is also prompting some to question democratic ideals like free speech and the “market place of ideas“.  GTA p26

Undermining the “shared understanding” provided by complete corporate control of  almost all media that made globalization possible. Leading “some” to question democratic ideals like free speech and the marketplace of ideas. Wow. It doesn’t take a technocrat to figure out who the “some” are. The sky is falling and the information environment is fragmented because the globalists cannot compete in the market place of ideas. So shut it down. Competition is a sin.

 When combined with a growing distrust of formal institutions and the proliferation, polarization, and commercialization of traditional and social media outlets, some academics and political observers describe our current era as one of “post-truth” or “post-factual” politics    GTA p26

Growing distrust of formal institutions is putting it mildly. Trust in government and mainstream media are at historic lows since data began to be compiled by surveys. Once again that mysterious “some” pops up again. A little more specific this time identified as academics and political observers. Blaming citizens of the world for speaking their mind and finding facts that answer legitimate questions. Free speech is at fault is this “post truth” era with it’s “post-factual” politics muddying the waters so globalist programs cannot continue unopposed. These same nebulous academics and political observers identified in the document that question free speech and democratic ideals know that they have a fight on their hands.

The power of individuals and groups to block outcomes will be much easier to wield than the constructive power of forging new policies and alignments or implementing solutions to shared challenges, especially when the credibility of authority and information is in question.    GTA p27

Questioning authority is the very bedrock of free speech and democracy. Freedom will get in the way of forging new globalist policies and international alignments. Implementing globalist solutions to manufactured challenges is difficult when being continually exposed by a fair and open press. This is considered “post-factual” politics.

So what does one do when confronted with this dangerous freedom where people decide what to think for themselves? What would be the solution for those who question democratic ideals like free speech and the market place of ideas?

For authoritarian-minded leaders and regimes, the impulse to coerce and manipulate information—as well as the technical means to do so—will increase.   GTA p27

Almost laughable if it were not so dark in it’s prescription for a final solution to “fake news” and echoed in countless other recent globalist white papers.

Visit RaptormanReports for news, science, and history.

Sources:

https://www.dni.gov/index.php/newsroom/press-releases/224-press-releases-2017/1467-national-intelligence-council-releases-global-trends-report

https://www.dni.gov/index.php/global-trends/trends-transforming-the-global-landscape

https://www.dni.gov/index.php/global-trends/letter-nic-chairman

Easier to read pdf at https://info.publicintelligence.net/ODNI-NIC-ParadoxProgress.pdf

 

National Intelligence Council Report Describes the Final Solution for “Fake News”

A Solution to Failed New Year’s Resolutions

I love New Year’s!  It’s a new beginning; a fresh start filled with optimism and hope. It’s like hitting the reset button on life.

I particularly love New Year’s resolutions.  My whole life, I’ve been a goal setter, which probably harkens back to my days as an athlete where each day was met with new goals.  And, success was clearly measured: If you achieved your goal, you succeeded.  If you didn’t, you failed.  Hence, New Year’s resolutions are like finding a pot of gold for goal-setters like me!  Each New Year’s bring a new opportunity to set new goals. Here are a two of my favorite resolutions from over the years:

1. “This year I will go to the gym twice a week.”


2. “I’ll lose 5 pounds by the summer so I feel comfortable wearing my bathing suit.”

The problem is: The New Year comes and goes and my New Year’s resolutions inevitably fall to the wayside. I start the year extremely motivated and then, life gets in the way.  I get busy, and I push the New Year’s goal off to the next month, and then the next month, and the next.  Until, before I know it, it’s time to make New Year’s resolutions all over again:

1. “This year I will definitely go to the gym twice a week. This year I’ll make it a priority.”


2. “I’ll lose 5 pounds by the summer so I’ll finally feel comfortable wearing a bathing suit. This time I’m serious.  This time, I’m going to do it. I’m tired of feeling fat.”

Does that sound familiar?

Why do we do that to ourselves?  It’s great to have goals. But, if setting goals isn’t working for you, why not try something different?

I recently read a book by Scott Adams titled How to Fail at Almost Everything and Still Win Big.  Scott Adams is the creator of Dilbert, the comic strip.  His book changed my life.

I no longer set goals.  Instead, I create systems.  

According to Adams, setting goals and assigning deadlines can set you up for failure. For example, if your goal is to lose 5 pounds, you may fixate on that number:

• Even if you lose 4 pounds, it won’t be “good enough” because you didn’t reach your goal.


• In addition, until you lose those 5 pounds, you may “exist in a state of continuous presuccess failure,” according to Adams.  In other words, you feeling successful hinges on that specific goal.   Consequently, you may not feel like you are “good enough” until that goal is achieved.

Alternatively, Adams proposes a system-oriented model, with no deadlines and no specific goals. Instead, you implement a system where you do something “on a regular basis with a reasonable expectation that doing so will get you to a better place in your life.” Using this approach, you succeed every time you apply your system because you did what you intended to do. This approach promotes lasting change.

I think of the system-oriented model as focusing on the “how” and not the “what.” For instance, Instead of setting a goal of going to the gym twice a week (the “what”), I choose to create a system of being more active (the “how”). But, there are no specific goals or timelines attached to the “how:”

• I create a system by making a list of what it looks like to be more active. For instance, I can choose to get up from my chair at work and walk a lap around the office, I can park further away from the grocery store, and if I walk down the stairs I can walk back up and down an extra time.


• But, I don’t set myself up for failure by attaching a timeline, such as walking up and down the stairs every day.


• That way, each time I choose to be more active, I have succeeded. And, if I’m not active on any given day, I haven’t failed because my activity level is not attached to a specific goal.

Instead of setting a goal to lose 5 pounds (the “what”), I choose to create a system of eating healthy (the “how”). But, there are no specific goals or timelines attached to the “how:”

• I don’t set myself up for failure by attaching a timeline, such as promising to eat healthier every morning, or on the weekdays.


• Instead, I create a system by making a list of what it looks like to eat healthier. For instance, I can choose to eat nuts instead of potato chips or a salad instead of fried chicken.


• Consequently, each time I choose to eat healthy, I have succeeded. But, if I don’t eat healthy on any given day, I don’t beat myself up about it. I simply keep moving forward.

This year, instead of setting specific goals with specific timelines attached, I am implementing systems (Technically, you could say I just set a goal!). Instead of setting myself up for failure, I am setting myself up for success. By creating systems, I am filling my year with hope:

• I hope to stop beating myself up for not achieving a “goal” in a specific amount of time that I arbitrarily establish.


• I hope to encourage myself to implement change when I can, instead of scolding myself for missing a self-imposed deadline.


• I hope to practice kindness by allowing myself the time it takes to create a new, healthy habit instead of expecting myself to change in an instant.


• I hope to give myself the gift of grace, instead of harboring the feeling that I’m still not “good enough.”

This year, I hope to end the failure that’s all too often attached to New Year’s resolutions, and goal-setting in general. This year, I hope to find a system that works for me.

I’d love to hear from you!

Have you implemented a system-oriented model? If so, has it worked for you?

A Solution to Failed New Year’s Resolutions

Theresa May pledges to seek long-term solution to social care squeeze

Theresa May has pledged to seek a “long-term solution” to the challenge of funding social care for older people, as she confirmed that local authorities would be allowed to bring forward increases in council tax to ease the pressures on the creaking system.

Challenged by Jeremy Corbyn on what he called the crisis in social care, May said her government would give councils more flexibility to raise more money in the short term – but would also seek a sustainable funding model.

“You cannot look at this question as simply being about money in the short term. If we’re going to give people the reassurance they need in the long term, it’s about finding a way forward that will give a sustainable solution for the future,” she said.

Sajid Javid, the communities secretary, is expected to announce on Thursday that local authorities will be allowed to increase council tax by up to 3% next year and the year after, with the money ringfenced to pay for social care.

The maximum increase had been 2% over each of the next three years, but councils will now be able to make upfront rises of 3% in each of the next two years.

Government sources were keen to stress that no further rises would be permitted – so the total increase in council tax over the three-year period would remain the same, at 6%.

Pressure has been mounting on Downing Street to tackle the demands on social care, since the chancellor, Philip Hammond, triggered a Tory revolt by failing to make more funding available at his autumn statement last month.

In a spirited performance at the final PMQs of 2016, Corbyn said older people were being left to live a “horrible, isolated life, when they should be cared for by all of us, through a properly funded social care system”.

He urged the prime minister to cancel planned cuts to corporation tax, which were confirmed by Hammond, and ringfence the money to fund elderly care.

Corbyn pointed out that increases in council tax raised more in wealthy parts of the country. “Raising council tax has a different outcome in different parts of the country,” he said, adding: “Is she saying that older people – frail, elderly, vulnerable older people – are less valuable in our cities than in other parts of the country?”

May insisted money was not the only answer to the problem, pointing to what she said were poorly performing councils, singling out Ealing council as an example of poor practice for failing to integrate social care with the wider NHS.

“There are also some councils across the country – some Labour councils – who have not taken that opportunity, and where we see a worse performance,” she said, pointing to a “twentyfold” difference in delayed discharges, where hospitals cannot send a patient home because there is no social care in place.

“We recognise that there are indeed pressures on social care, but we also recognise that this is not just about money; it is about delivery,” she said.

New research by the Nuffield Trust health thinktank shows that increasing the council tax precept for social care produces least benefit in the poorer parts of England where need is greatest.

Their analysis has found that this year the local councils in the ten most affluent places in England will raise almost 50% more per head of local population from applying the 2% precept this year than those covering the ten least well-off areas.

Local authorities, which are responsible for social care, have repeatedly said cuts to their funding from central government have put provision at risk.

Sarah Wollaston, the Totnes MP and chair of the health select committee, called for cross-party talks to come up with a long-term solution to the problem.

Hammond has also been considering whether to allow Javid to further boost social care by bringing forward to 2017-18 some of the £1.5bn the government has already pledged to put into the Better Care Fund in phased increases starting next April. That is the £4bn-a-year scheme, co-funded by the NHS and Whitehall and launched by the coalition government, to help keep older people healthier and reduce their risk of ending up in hospital.

However, sources close to the Whitehall discussions about that proposal, which the Local Government Association and NHS bodies have been arguing for, said it was unlikely Javid would increase the £105m injection already planned for the fund next April. One source said: “Theresa May isn’t keen on the Better Care Fund because she sees it as just more money for the NHS through the back door and more money going into the NHS black hole, even though it’s intended to relieve the pressure on overcrowded hospitals.”

Theresa May pledges to seek long-term solution to social care squeeze

Private providers are part of the NHS’s problem, not the solution | Letters

I’m afraid Stephen Dalton is wrong about pretty much everything (Private money is the NHS’s saviour, not its bogeyman, 22 November). Where sustainability and transformation plans have been published (most have been shrouded in secrecy, and for good reason) it is clear that cuts and closures are on the way. For instance, 600 GPs are to be reduced to 400 in one part of London alone, and maternity units and A&E departments face the axe. We have the second lowest number of hospital beds per capita in the EU, and that is set to fall further. Dalton says we must move care away from hospitals, but that means investing in primary and community care, both of which have been undermined and cut.

Dalton says that the private sector can help the NHS. Well, up to a point, Lord Copper. The private sector has always been there, but as a peripheral presence and not competing with the NHS. The compulsory competition introduced by Andrew Lansley has been a very costly failure. The private sector is expensive, unaccountable, and will walk away when it can’t make a profit. By cherrypicking profitable services it destabilises the local NHS, which can’t drop the expensive work or turn away patients with complex problems. And its ethos is questionable, leading, for example, to profits being sent offshore with no tax paid.

The answer for the current NHS crisis is to fund the NHS to the EU average (it is currently heading down to less than 7% GDP), to deal with the costly market and PFI schemes which are wasting money hand over fist, to value and support the staff, and to stop re-disorganising it every two years in a futile effort to sort out the last political mess inflicted on it.
Dr Jacky Davis
Founder member, Keep Our NHS Public

• The article by Stephen Dalton is simplistic in the extreme. Here in Cornwall we have examples of two of the privatisations he extols. Both failures.

Twelve years ago a panel I was a member of voted to give Serco the out-of-hours service for Cornwall. It was a mistake. They were condemned by a parliamentary committee for cooking the books and they have since abandoned the contract. I voted against them.

In 2014 the Royal Cornwall hospitals trust board of which I was vice-chairman voted to allow Mitie to run their hotel services, catering, cleaning etc. I voted against. They have proved to be a disaster. If Stephen Dalton wishes to write these misleading articles he should at least give examples of the successes of privatisation. Does Hinchingbrooke ring a bell with him?
Rik Evans
Truro, Cornwall

• Stephen Dalton argues that “examples of beneficial of private sector involvement include … more rapid discharge from hospital through well-established ‘recovery at home’ services and access to private sector community diagnostic facilities”. Meanwhile you report that the private company Mitie has said it would withdraw from its healthcare business, which provides home care for the elderly (Mitie profit warning as it bales out of elderly care, 22 November); your article quotes the chief executive as saying that government spending cuts had made the healthcare business unviable: “If we are serious about social care in the UK it needs significantly more than the funding that has been suggested.” Quite.

More generally it is worrying that Dalton, as chief executive of the NHS Confederation, still does not understand that for private companies profits come before patients, and that any system that has to fork out to shareholders has less to spend on care. Supposed benefits from “greater efficiency” usually means cutting corners and paying workers less.
Dr David Griffith
London

• Despite Stephen Dalton’s assertion of an apparent “political negativity” towards privatisation of the NHS, the non-public-sector involvement within our healthcare system actually continues unabated: the Department of Health’s funding of “independent sector providers” rose from £4.1bn in 2009-10 to £8.7bn in 2015-16. And a study published in the Journal of Public Health in July this year found that: “An increased use of private sector provision by NHS boards was associated with a significant decrease in direct NHS provision and with widening inequalities by age and socio-economic deprivation.”
Steven Jouanny
Sheffield

• We completely agree with Stephen Dalton’s assertion that we need to shift the focus away from hospitals in order to help create a more sustainable NHS. However, being more open to private providers is not the only answer.

The mixed economy for end-of-life care in the UK is a case in point, and the role of charitable hospices in this should not be overlooked. Last year hospices in the UK spent more than £868m on care and supported 200,000 people with life-limiting conditions – a significant contribution to the UK’s health economy.

Hospice care is provided free and yet hospices receive only a third of their funding from the NHS, having to raise the rest themselves through community fundraising. Hospices have a strong ethos of compassionate care, coupled with a vibrant culture of innovation and enterprise reflected in the new and different ways they raise income and successful partnerships developed with other providers.

In these hugely challenging times for the NHS, improving end-of-life care by working more closely with hospices could help deliver the sustainability that is so desperately needed.
Tracey Bleakley
CEO, Hospice UK 

• On the occasion of American Thanksgiving, as a British citizen who lives in the US but finds myself in the UK with an ailing father, I feel compelled to express my gratitude for one of the things that makes the UK exceptional: the NHS and associated strongly held value that good healthcare for all is a right not a privilege. I am a management consultant and have spent a large chunk of my career working within the American healthcare system. The recent US election troubles me greatly as the incoming administration seems to offer little vision for healthcare other than the aspiration to unwind the recent gains of improved access to all. In recent weeks I have sat holding my sleeping father’s hand as he moves beyond a stroke. As I’ve watched the wonderful staff on the Dunkery stroke unit at Musgrove Park hospital in Taunton, which, somewhat ironically, started as an American army hospital during the second world war, I have felt incredibly grateful for the compassionate care he – and my family – are receiving. Absent is the additional stress of wondering how we as a family will be able to pay for his care, which would already be well into the hundreds of thousands of dollars had he been born on the other side of the pond.
Celia Kirwan
Boston, Massachusetts

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Private providers are part of the NHS’s problem, not the solution | Letters

Jeremy Hunt"s plan to shame GPs with minimal cancer referrals is not the solution | Zara Aziz

A GP in consultation with a patient. Referral rates for cancer diagnosis will fluctuate in accordance to a variety of factors. Photograph: David Sillitoe for the Guardian

The well being secretary, Jeremy Hunt, desires to name and shame GP practices with lower cancer referral costs. The NHS Selections website will mark reduced-referral GP practices as “red”, or “green” if they refer far more. This is in response to significant variations in cancer diagnoses across England, which is becoming attributed to GPs not referring individuals early sufficient. According to figures from the Royal College of Basic Practitioners , three-quarters of individuals with cancer are referred right after one particular or two GP consultations. There is definitely room for improvement.

Several higher-danger symptoms are less difficult to refer, such as a persistent cough, a adjust in bowel routines or excess weight loss. It is the non-certain symptoms this kind of as tiredness that are typically the most demanding. Pancreatic cancer is a notoriously challenging diagnosis and can present with just malaise, reduction of appetite, new onset diabetes or back ache, all of which we see on a day-to-day basis in basic practice. Pancreatic cancer is the ninth most typical cancer in the Uk but the fifth most typical cause of cancer death.

GPs have clear tips on “two-week wait” referrals for all cancers, whereby any person who presents with specific high chance indicators or signs, known as “red flag”, ought to be referred straight away and seen in hospital within two weeks. The criteria for referral is really specific and does not consider into account a GP’s intuition or non-particular symptoms. In our practice we audit our two-week wait referrals, to guarantee first of all that the patient has been witnessed by a specialist and hasn’t been misplaced in the method and secondly, to see if a cancer diagnosis was produced. The vast bulk of our referrals are, reassuringly, not diagnosed with cancer.

Demographics also perform a large element when it comes to looking at cancer diagnosis and mortality costs. I educated as a GP in an affluent semi-rural practice and often noticed the anxious nicely. The appointments were longer, much less pressured and a lot of sufferers attended for an “MOT”. It was then that I saw my 1st malignant melanoma when a “well” patient came to have all their moles looked at. It was a quite early presentation and they made a full recovery with no spread or recurrence of the disease.

I now function in a massive urban practice with varied health beliefs. There is more deprivation and healthcare complexity and a lot of sufferers, specifically guys, will present right after weeks or months of worrying signs and symptoms. For some of our sufferers, their proximity to hospitals or cultural beliefs indicate that they will bypass GPs altogether and attend A&ampE departments for initial presentation of signs and symptoms.

Most GPs do not see plenty of new cancer diagnoses each year, however most of us will make one or two cancer referrals a day. Nationally, only 10% of two-week referrals turn out to be cancer, which is comparable to individuals referred from our practice. But we do see lots of coughs, colds, malaise, aches and pains. The danger with this “kneejerk” name and shame policy would be that we would see a sharp rise in anyone with a cough or cold getting referred. As a end result, this will rapidly saturate the capacity of cancer clinics and delay investigations. The last point that we would want is the two-week wait to improve to a four-week wait or even longer.

Statistics for every practice are presently offered on the internet for GPs and the public to appear at. GP practices are conscious if they are substantial or reduced referrers it would seem that the new proposals would include absolutely nothing but be tantamount to “naming and shaming” medical professionals. Any analysis of cancer referral prices need to seem at the patient demographics of a practice, its cancer prevalence and other parameters such as no matter whether it is an outlier in other respects. There will indeed be some GP practices that are a result in for concern, but this is normally currently apparent to commissioning groups and NHS England, and it would make much more sense to performance manage these locally rather than adopt a damaging culture of blame and dread.

Jeremy Hunt"s plan to shame GPs with minimal cancer referrals is not the solution | Zara Aziz

Are private health budgets the solution to integrated care?

‘Pulling well being and social care personalized budgets into one pot will aid make support about them a lot more integrated and responsive.’ Photograph: Alamy

Integration employed to suggest common assessments, merged teams and management restructures. Occasions have altered, and it’s no longer just about shifting occupation titles and Tupe – Transfer of Undertakings (Safety of Employment). Above the last handful of years the health and social care method has begun to embrace the concept of “man or woman-centred, co-ordinated care” that shifts the target from organisations back to the knowledge of the man or woman needing assistance.

Some of this has turn into necessary simply because men and women obtaining care are no longer willing to accept that specific models of institutionalised provision are proper for them just due to the fact they have a particular diagnosis. Decision and management, even though becoming policy terms that have been repeated so usually that there is a threat of shedding the meaning, do resonate with us all personally in the decisions in lifestyle that are most important: where we reside, who’s in our existence, and how we spend our time.

Much of this shift, although, has come about because the wellness and social care technique is dealing with increasing pressures that conventional remedies cannot address. For a man or woman with a number of extended-phrase situations, better co-ordinating the wellness and care they acquire will be significantly appreciated, and possibly much more powerful – but it only goes so far. One thing more than this is needed if we are to make a step adjust in how we react to the complicated health wants of men and women. With two thirds of emergency hospital admissions currently being associated to people’s lengthy-phrase situations, the health method has as considerably interest in assisting folks to handle their prolonged-term problems better as it does in diagnosing and treating acute illnesses.

Key to supporting individuals to remain as healthier as they can is interest to psychological properly-being, developing social capital, and discovering techniques to look right after their own overall health. These types of solutions and responses cannot be prescribed. They need to have to come from a deeper knowing of the particular person, and what they have and worth in their daily life. This skills is the person’s to deliver into the conversation – a different conversation with a various electrical power stability.

Revolutionary approaches to supporting people to remain out of hospital are combining a variety of health-related and non-health care answers, by means of a wider group of partners. The neighborhood and voluntary sector can play a important part in addressing underlying sensible issues this kind of as housing support, as effectively as loneliness, isolation and boredom. Rotherham’s social prescribing pilot does just this and early evidence about how people most at threat of hospital admissions are kept healthful at property is encouraging.

What if what would actually assist is possessing anything fully “off menu”? Elements to modify a bicycle so that a person with motor neurone disease can even now use it to hold match? Reflexology for an individual residing with MS? Not to deal with the issue, but to help cope much better with its results.

What if obtaining this variety of open strategy to planning their care actually produced an effect on peoples’ good quality of existence and psychological effectively-being? What if it also manufactured a substantial reduction in lengthy-keep hospital use? The massive-scale personal overall health price range pilot evaluation showed these outcomes.

Pulling collectively well being and social care personal budgets into one pot for people will support make assistance all around them more integrated and responsive, and less irritating. The real chance, however, is to co-make new solutions with the particular person from across medication and civic existence, creating on the person’s own skills and strengths. Some thing various is only achievable if we give people the room and control to envisage it, and the right assistance to enable it to happen. Anything various is attainable, and well being and social care personalized budgets are a effective element of the solution.

Zoe Porter is programme manager for the personal health budgets delivery staff at NHS England. She will be speaking about integrated health and care personal budgets – early learnings at Wellness+Care 2014.

Well being+Care 2014 takes spot on 25 and 26 June at ExCel, London. Passes are free of charge for NHS and public sector teams, but you need to have to register in advance.

Are you a member of our on the internet neighborhood? Join the Healthcare Pros Network to receive standard emails and unique provides.

Are private health budgets the solution to integrated care?

Loneliness is not a bug with a technological solution | Ros Coward

‘Anyone who has spent time with elderly people knows the real issues are much more complex.’ Photograph: Paul Doyle/Alamy

In the UK, four out of 10 over-65s do not have internet access. At a time when so much of our lives is conducted online – the payment of bills, access to information – that should be a real source of concern about potential social exclusion.

But does this mean that by widening internet access, elderly people will feel more socially connected? Or, even, more radically, as a new report suggests, could this be a solution for loneliness in old age?

The centre-right Policy Exchange thinktank makes such claims as part of its forthcoming technology manifesto. It recommends £875m should be spent on training the 6.2 million mainly elderly people who are without basic digital skills.

The report claims these skills would provide older people with a way to stay connected to friends and family, and could therefore ease the isolation of those who live alone, while saving many millions for the NHS and in state-subsidised care home places.

Loneliness among the elderly is certainly a massive problem. Recent research by Age UK has shown that one in three older people are plagued by loneliness, and that this has dire effects on their health.

On first sight, claims about the potential benefit of digital connection for the elderly appear to be backed up by research. The International Longevity Centre recently found that 7.5 million adults have never used the internet – most of them elderly, disabled or poor. Of those who had not been online, 63% often felt lonely, compared with just 38% of those who did use the internet.

But these figures, and their policy conclusions, need to be treated with caution – not least because they may lead to money being invested in a technological fix when the answers are more complex and human. Loneliness in old age doesn’t occur just because older people haven’t learned to use the internet (a problem that will increasingly disappear as a more technologically literate generation ages).

Loneliness among the elderly is also to do with poverty and declining health. On the one hand, financial hardship restricts their activities; on the other, it increases frailty – including the loss of mobility, eyesight or memory, all of which undermine confidence when moving around in the wider community.

It is often these other factors that will restrict access to the internet, even for those who might once have been able to use it. To access the internet, you need money, or skilled neighbours and friends, to fix glitches; you need eyesight to read screens and memory to recall passwords.

Those findings that “prove” that the elderly who are digitally connected are also more socially connected require caution. At first sight, they too appear to be common sense. We have only to think of the incredibly energetic 80-year-olds who are internet savvy, regularly emailing their family and friends, and appearing to gain huge benefit. Yet the truth is that these people are often the ones whose health and financial situation would have kept them socially connected and in the centre of their families and communities, with or without the internet.

Anyone who has spent time with elderly people knows the real issues are much more complex. Of course internet use comes into it. But at its core, loneliness among the elderly still has other causes and effects: missing seeing people regularly, missing casual conversations, missing being able to get out and feel safe. What the elderly value is seeing regular friendly faces, having their basic needs taken care of by real human beings, and being able to walk to places where they can still interact with real people.

It is ironic that these reports highlighting how the internet can solve loneliness for the elderly are running in parallel with reports and academic studies warning young people not to mistake social interaction on the internet with friendship.

This week, research from Australia on loneliness among teenagers showed that the “loneliest” were also the most prone to sharing – or “oversharing” – intimate details on the internet. News stories constantly highlight how teenagers who are suicidally unhappy can be extremely active on social media. Indeed, there are suggestions that internet dependency can be linked to social alienation rather than social connection.

None of which is to say that the provision of basic internet skills for the elderly would be anything other than a good thing. On the basis of social justice alone, promoting universal digital competence is to be supported, and there could be very real and immediate benefits. But we shouldn’t elevate it into something it isn’t – the solution to loneliness and a way of keeping elderly people out of care provision for longer.

It’s a means to an end. The end, in this case, is human contact, human warmth, human kindness. A better way to those ends are services designed to bring about that face-to-face human contact, and communities designed to meet the needs of groups of people who are less mobile and able-bodied than they once were but still crave company.

Loneliness is not a bug with a technological solution | Ros Coward

Healthcare is not a solution, no matter what neoliberalism has taught us | Humphrey McQueen

“We are all socialists now”, explained Britain’s chancellor of the exchequer, William Harcourt, in 1894. He was remarking that his liberal opponents have been united in favour of municipal reservoirs. Must socialists these days intone, “We are all neo-liberals now”? Not that we support promoting off the waterworks rather, 120 many years following Harcourt, we have been forced to defend the (figurative) water provide against people who would.

Opponents of neoliberalism have absorbed several of its presumptions. The most pervasive is to repeat the lie that sell-offs are privatisations. To say personal and not corporate is to do the function of our enemy’s spin physicians. The word private helps make the counting-house sound neighbourly. Similar mischiefs movement from parroting reform rather of denouncing de-types.

Health is the latest and most prominent de-kind, even though education, employment, housing and transport are also topic to comparable inequities. Unequal outcomes from people 5 pillars of each day lifestyle compound each and every other, possibly nowhere far more so than for psychological sickness.

Our well-being is the outcome of their interaction, not just a physical situation of an individual. As the socialist epidemiologist Fiona Stanley puts it, the actual brain drain commences just before birth. Consequently, provisions for equitable care have to be created on “social” equality. Each and every policy should encounter this test: is it likely to increase social equality across the generations?

From that beginning point, I have usually been vital of Medicare (and its ancestor, Medibank) as a curative model funded in component by a flat-rate tax. My objection has never been to a universal technique but to the fact that Medicare has never ever been one particular. Nothing at all right here has come within coo-ee of Britain’s nationwide overall health support.

I appreciate the positive aspects of Medicare. Without having it, in the United Blunders for illustration, I would be either dead or homeless. As it was, from 2001 I was at least $ 5,000 out of pocket for treatment method-related expenses above five many years of diagnosis and adhere to-up, not such as reduction of earnings.

The surgeon warned that I would in no way once again be ready to bend it like Beckham but that the reduction of a thigh muscle was a small price to shell out for getting alive. So was the $ 5,000. Nevertheless, its outlay was a reminder of how far Medicare has often been from universal coverage. Not everyone has the money or friendships to meet vital extras.

In spite of these prolonged-standing complaints about Medicare, I caught myself frothing against a co-payment for GP visits. That surprise sent me back to the source of my objections, Richard Titmuss’ 1962 tome, Cash flow Distribution and Social Adjust. He showed why universal services delivery is the only route towards better social equality, because in a single technique of healthcare the wealthy and powerful have a existence-and-death curiosity in generating it work.

So what is our activity? We want to fight our way out of the corner into which neoliberalism has backed us, and insist on universal programs funded by steeply progressive tax-costs on capital more than on profits, on house as properly as on revenue.

The Coalition’s proposed $ seven co-payment is regressive. But the flat-rate Medicare tax, even though it calls for those on typical weekly earnings to spend a greater lump sum than someone on the minimal wage, isn’t much much better. one% on $ 35,000 of taxable cash flow collects $ 350 on $ 70,000, it is twice as much at $ 700. That doubling is not progressive.

A progressive charge would run like this: 1% stays at $ 350 out of $ 35,000 but 2% on $ 70,000 would be $ one,400. Alternatively of the increased revenue earner paying out only twice as considerably in total, she would contribute 4 instances as considerably. However, increased earners are much more most likely to lessen the taxable element of their income by deductions and dodges – they have to be abolished.

Medibank and Medicare taught us to wear this kind of flat-fee impost – the GST, the flood levy, and the national disability insurance coverage scheme. Now we have the deficit tax. My only objection to the last is that it is not everlasting and not steep ample. In an perfect globe, Westpac’s Gail Kelly and her mates would be on a marginal charge of 90%.

In a even more concession to neoliberalism, we’re all encouraged to advocate equality of chance when the call must be for equality of outcomes. It is one particular point for each Australian to have the identical charge of accessibility to heart surgery. It is an additional to get the same top quality of care at Bourke as in the Jesus Hilton (aka St Vincent’s Personal).

Also few defenders of Medicare recall the local community health program (CHP) from the 1970s. The first CHP was set up in 1964, in Footscray, Melbourne, by the Australian meat market workers union. Its purpose was to supply remedy to injured meat workers and research the brings about of industrial accidents.

The trade union clinic and research centre, as it was referred to as, became the model for related services for girls and Indigenous Australians which nonetheless exist these days. Campaigners for the extension of Medicare need to put an even higher effort into rejuvenating CHP centres, to make them our universal provider. They need to be the heart, brain and lungs of wellness in each and every neighborhood and at each and every workplace.

But this kind of a point looks hard these days, if not extremely hard. It truly is not that neoliberalism is a vicious idea in the twisted minds of evil men and women, whether or not John Howard and Tony Abbott, or Julia Gillard and Bill Shorten. Neoliberalism expresses the necessity that capital has to expand by commodifying each and every factor of our lives.

To stop the spread of that illness it is important to reassert the vision that Titmuss celebrated in his 1970 masterpiece, The Present Romantic relationship. He contrasted volunteer Uk blood donors with the US victims of a free market place in plasma and noticed that wellness care has practically none of the characteristics of a consumer good.

Nevertheless, Australia’s commonwealth serum laboratories were privatised in 1994, below Paul Keating, who produced Medicare a important plank of his “social wage”. How long will it be prior to the efficiency of supplying blood is completely de-formed by market place signals? If we go on settling for Medicare, for the third best, we shall end up with a futures marketplace in blood.

Titmuss was appropriate: healthcare is not a merchandise. Unlike when we buy footwear, as patients we have little thought of what remedies we will need. Lastly, we are not in a position to return them, least of all from the grave.

Healthcare is not a solution, no matter what neoliberalism has taught us | Humphrey McQueen

Activity shifting explained: a viable solution to health worker shortage?

Training community members to give HIV treatment method delivers a treatment to a shortage of educated wellness workers. Photograph: Siphwe Sibeko/Reuters

Job shifting is a lower-value solution to tackling gaps in well being providers in the developing world, for instance individuals in HIV and mental overall health treatment. The need to have for each is ever present.

Last month, a report showed that South Africa has the highest price of new HIV infections in the world, with in excess of 400,000 happening in 2012 – and only a third of people becoming handled with antiretroviral treatment (Art).

Meanwhile, the variety of folks impacted by mental illness globally is increasing, as humanitarian crises from conflict and natural disaster multiply – in Syria, South Sudan and the Philippines – but funding is hardly ever allocated to treat them. The WHO reviews that humanitarian emergencies enhance mild or reasonable mental ailments ( such as depression) by 5% to 10% and a lot more serious mental health issues such as schizophrenia by 2% to 3%.

“Funding is typically tough, as mental well being is not on the radar for donors,” says Inka Weissbecker, global psychological wellness and psychosocial adviser at Global Medical Corps.

What is task shifting?

Alternatively of lamenting the lack of qualified healthcare experts, activity shifting starts with a useful “we are are the place are” technique and helps make the most of the sources in the country. The WHO defines it as as “the rational redistribution of duties amid health workforce teams” including – in worldwide guidelines issued in 2008 – “particular duties are moved, the place appropriate, from hugely qualified overall health staff to wellness employees with shorter education and fewer qualifications”. Margaret Chan, director standard of the WHO, says she sees task shifting as “the vanguard for the renaissance of major overall health care”.

What is the downside?

A review of activity shifting in Mozambique and Zambia identified unhappy and overworked workers. The report concluded “process shifting alone cannot reply to the demands of poor countries, particularly if other problems are not addressed at the exact same time … staff have clear concepts about how to improve the availability of solutions it stays to be observed if choice-makers will listen to them.”

What do improvement groups say about it?

Weissbecker says activity shifting is an revolutionary answer to the scarcity of trained psychiatrists and psychologists in reduced cash flow countries. “The truth that a community well being worker can deal with an individual with depression successfully offers us a great deal of hope and encouragement,” she says. “Task shifting presents a sensible and sustainable solution to most African countries’ critical wellness worker shortage,” says African wellness NGO Amref.

A systematic evaluation of task shifting identified that it delivers “high-quality, cost-effective care to a lot more patients than a physician-centered model”. The study warned that the issues are “adequate and sustainable coaching”, but advisable that the approach must be regarded for “careful implementation” in which a shortage of healthcare human resources threatens programmes.

Read far more stories like this:

• How Africa’s researchers are solving Africa’s overall health troubles

• Energy to the folks: how open information is enhancing wellness service delivery

• Mental overall health demands sensible remedy – or we encounter decades of wasted time

Join the community of global improvement pros and experts. Turn out to be a GDPN member to get a lot more stories like this direct to your inbox

Activity shifting explained: a viable solution to health worker shortage?

Searching stunning in sequinned socks – a quite Tory solution to the sports gender gap | Alex Andreou

Helen Grant, holder of ‘a portfolio so disparate it may well as nicely be Miscellaneous Stuff None of The Guys Needed to Do’. Photograph: Jan Kruger/Getty Photographs

Helen Grant, the minister for sports, equalities and tourism – a portfolio so disparate it may as well be Miscellaneous Things None of The Men Wanted to Do – has uncovered the centrepiece of government policy to tackle the gender gap in sports activities uptake. It essentially boils down to encouraging ladies to engage in sports that involve cuter outfits.

The complete interview in which Grant described her views reads like some thing scripted for an edition of Brass Eye. She suggests “[t]here are some superb sports which you can do and execute to a very high degree and I feel people participating look absolutely radiant and very feminine this kind of as ballet, gymnastics, cheerleading and even roller-skating.” For adult females, she suggests “a Zumba class or a game of rounders following they’ve dropped the kids off”. She described her response when, just lately, she was a spectator at a roller-blading occasion: “Individuals women arrived and they looked definitely lovely. They have been sporting their socks pulled up, gorgeous socks with sequins and their hair was accomplished.”

The government has identified a gender gap in sports activities uptake – the recognition of the difficulty is a important phase. It needs to encourage more women to get up sport – this is an admirable objective. It has recognized that stereotypes about femininity may possibly play an essential element in this gender gap – an excellent and crucial observation. To then determine that part of the resolution entails classifying some sports as “butch” and other people as “girlie”, to endorse this kind of stereotypes, seems to me to display a cackhandedness which no volume of sequinned socks can make palatable. How does it inspire ladies to consider up sport, by incorporating to the strain of sportswomen to search “feminine” – what ever that entails – and incorporating to the scrutiny of their look, consistently alluded to by male sport commentators? Remember John Inverdale’s idiotic comments about Marion Bartoli’s physical appearance, as she won Wimbledon.

It is only superficially surprising to hear this kind of policies expressed by a female minister in David Cameron’s government. Cameron does not just have a “ladies difficulty” he has many. Support for his celebration from females is declining and has been for some time. The party is losing female MPs left, correct and centre – some resigning mid-phrase, some declaring they will not stand yet again, whilst other individuals are controversially deselected, as rumour has it, for being “a silly girl”.

The prime minister himself has appeared, on occasion, unable to quit himself from making remarks with a sexist hue, like telling Angela Eagle, a parliamentarian of expertise and clout, to “calm down dear”.

Cameron is under stress to appoint female MPs to ministerial positions, but the pool from which he can pick is small and ever-diminishing. He is taunted by Miliband for his all-male frontbench. Former female Tory MPs like Anne Widdecombe are queueing up to criticise “silly modern day” ones. The strategic Cabinet coalition committee contains not a single woman.

Secretary of state Philip Hammond would seem unable to distinguish amongst female shadow ministers, repeatedly mistaking Liz Kendall for Rachel Reeves on the BBC’s Query Time on Thursday evening. In his defence, he has been in back-to-back Cobra meetings and has most likely not witnessed a girl in two weeks.

In this hostile setting, with whom might junior ministers like Helen Grant discuss tips, to discover their flaws? If 1 can only poll rich, straight, white, middle-aged men on regardless of whether they would like to see a lot more girls cheerleading in tight lycra outfits, the answer ought to hardly come as a shock.

All this contributes to the government’s female deficit, but the dilemma, I feel, runs deeper than that. Conservative ideology explicitly seeks to preserve conventional values and roles and this involves gender ones. With Thatcher’s legacy fading, the Tory celebration might in no way yet again be a all-natural political house for ladies.

Searching stunning in sequinned socks – a quite Tory solution to the sports gender gap | Alex Andreou