Odds against fight to adjust meals culture | @guardianletters

3 cheers for Rosie Boycott and her “flagship task” to increase the nation’s diet program (Foods is a drug, and we have to discover to say no, 18 July). Most crucial, from my point of view, is tackling the issue in schools.

As a teacher-trainer in the 1980s and 90s, going to students on educating practice, I travelled round East and West Sussex in despair as I watched school lunches being replaced by banger and burger bars. “Why?” I asked one particular headteacher when I had the opportunity. “The young children desire them,” came the disingenuous reply. My attempt to talk about educational values was rapidly curtailed. Like the Coca-Cola machines set up in the canteens, it was, and even now is, about revenue-generating.

The legacy of Thatcher’s Britain. “Society”, which basically did not exist then, now faces the wider difficulties in the nation’s wellness that Rosie Boycott lists in her article. Tackling schools looks more than timely. We have a new minister for schooling who have to support this also.
Dr Lisa Dart
Eastbourne, East Sussex

• Superb post by Rosie Boycott about our food culture: “the setting in which we make foods choices … is extremely unhealthy”.

You manufactured your personal contribution in your Cook section the following day by providing us with six recipes for “guilty pleasures” such as “an unadulterated cheese and carb fest” and “very naughty chocolate chip-cookie ice-cream sandwich”.

With an eye to the potential, the very same section’s “10 very best children recipes” feature (“where healthier meets scrumptious”?) included seven that relied on cream, sugar, butter, chocolate and maple syrup. As Rosie mentioned, “the odds are stacked against us”.
John Roberts
Dursley, Gloucestershire

Odds against fight to adjust meals culture | @guardianletters

Tackling the mystery of Alzheimer"s, and consciousness itself | @guardianletters

A scan to detect Alzeimer’s condition. Photograph: Alamy

The development of novel biomarkers to identify sufferers at higher danger of developing Alzheimer’s dementia is encouraging and will hopefully translate into exams that can be used clinically (Blood test breakthrough in search for Alzheimer’s remedy, 8 July). Nevertheless, the diagnosis and treatment of dementia is multifaceted and there are a number of locations that require urgent consideration now. Although there is no cure for dementia, recent therapies can slow the progression of the illness, even if only for six months. Clearly more study is needed to develop better therapies, but recent therapies are related with modest enhancements in cognition and perform that are invaluable to patients and their families. It is essential that as analysis progresses so also do our clinical providers, incorporating equitable access to drug therapies and professional input.

The care that patients with dementia require cuts across classic speciality boundaries. Efficient care calls for collaborative functioning between a number of disciplines like basic practice, geriatric medicine, psychiatry and social services. On the ground, a amount of alterations want to get place such as raising awareness of the issue among non-specialists, incorporating basic healthcare experience into psychiatric instruction and making certain patients’ information can be transferred between various care settings. Some of these modifications can be implemented comparatively rapidly and other folks will get longer. Even so, to be implemented effectively, capabilities and attitudes will want to change amongst care professionals and there will want to be political/monetary support. In these occasions of austerity it is crucial that the practicalities of caring for men and women with dementia are not misplaced. 
Dr KD Jethwa
Former academic clinical fellow in psychiatry, University of Warwick 

• The publication of study that could allow a check to predict the onset of Alzheimer’s far earlier than presently achievable is really welcome, particularly as the burden of the disease will rise across the globe in the potential. Nonetheless, there is even now a lot to be accomplished to increase the diagnosis of Alzheimer’s, specifically in the Uk, as entry to early and accurate diagnosis and treatment can vary significantly. A current worldwide survey, commissioned by GE Healthcare between physicians and sufferers, discovered that 50% of Alzheimer’s patients in the United kingdom have to wait for up to 3 months for an MRI scan, an vital component in the diagnosis of dementia. This compares with ten% in the US and 15% in Germany. For PET scans, more and more critical for diagnosing neurological issues, 44% of Uk sufferers wait a lot more than three months, compared with 6.5% in Germany and twelve% in France.

The survey located that up to twenty% of individuals with progressive neurological ailments, like dementia, face the probability of getting incorrect treatment method whilst waiting for their diagnosis. Meanwhile, their issue can carry on to deteriorate, and the patient is exposed to the pointless anxiousness and tension of not realizing. Two-thirds of people surveyed said it was worse not to know what problem they had than to acquire a confirmatory diagnosis.

Accessibility to early and correct diagnostic tools is vital with neurological illnesses, affording the prospective of both better clinical outcomes and an improved quality of life. With the prevalence of dementia on the increase, more powerful diagnosis and management is essential. We hope that the likely of this analysis can be constructed upon to create an effective check for Alzheimer’s.
Karl Blight
General manager, GE Healthcare Northern Europe

• Current advances in brain imaging have taught us a good deal about how the brain, rather than the thoughts, performs (Arguments more than brain simulation come to a head, 7 July). Philosophers have failed above the centuries to explain the connection in between brain and mind, and scientists have prevented obtaining concerned in such conjectures, resulting in the “new age phrenology” we now see. An IT undertaking purporting to simulate the exercise of an entire human brain is not only premature, on account of its naive assumptions about complexity, but, except if the simulation benefits in an emergent house such as self-determination, it is doomed to failure. And since no one particular can think about how this kind of a house could be programmed to emerge, any this kind of emergence would remain as much a mystery as that of consciousness itself: the very difficulty that the task is created to help remedy.
Dr Allan Dodds
Clinical neuropsychologist, Nottingham

Tackling the mystery of Alzheimer"s, and consciousness itself | @guardianletters

Ageing revolution have to benefit us all | @guardianletters

‘By feeding a adverse narrative about ageing, Monbiot helps to delay severe debate on how to make certain that the ageing revolution advantages absolutely everyone,’ writes Alan Walker. Photograph: Graham Turner for the Guardian

As scientists attending the 64th annual scientific meeting of the British Society for Analysis on Ageing, we would like to respond to George Monbiot’s write-up (An elixir of life, if shared unequally, would be poison, eight July). His worries about the effect of our work seem to be: 1) population ageing is a difficulty only of the wealthy two) the cost of interventions that lengthen healthful lifespan will be “astronomical” three) such interventions will (a) strengthen tyranny, (b) develop a “geriatric underclass” and (c) exacerbate social inequality.

These impressions do not end result from conversation with the scientific mainstream. Nonetheless, we respond: 1) Ageing is a global problem. It ruins the top quality of daily life of older people in both wealthy and poor nations. It is offering the bad of the world short to pretend that only the wealthy increase old. two) Interventions that lengthen healthy lifespan will be cheap. A compound potentially efficacious in treating mild cognitive impairment is at present obtainable on the NHS for about £10 a day. The care expense to the NHS for these folks is at present about £60 a day. It is the promotion of well being, not the extension of existence, that is the purpose of our area.

3) With regard to dystopian visions, we propose the following: a) The “1,000-year Reich” was not ruled in excess of by a one,000-12 months fuhrer. The guy accountable for its depravities place a bullet in his head. This is how dictators will constantly meet their end. A treatment that improves later daily life health will no a lot more change this than did penicillin. b) A “geriatric underclass” already exists. By 85 nearly no one is in excellent well being. This is a social blight. Nonetheless, we hope that our function plays a tiny but substantial component in bettering factors. c) Scientific progress helps the poor. Denying the desirability of building therapy due to the fact they throw into sharp relief the previous political issue “who deserves what and why?” is perverse.

As biogerontologists, we believe that no one particular deserves a wretched previous age.
Professor Richard Faragher
University of Brighton
Professor Helen Griffith
Chair, British Society for Research on Ageing, Aston University
Professor Brian Kennedy
Buck Institute, USA and Editor in chief, Aging Cell
Professor Janet Lord
MRC-ARUK Centre for musculoskeletal ageing, University of Birmingham. Editor in chief, Longevity &amp Healthspan
Professor David Gems
University of London
Professor Peter Adams
University of Glasgow and Editor in chief, Aging Cell
Professor Valery Krizhanovsky
Weizmann Institute, Israel
Professor Claire Stewart
Liverpool John Moore’s University
Professor Anne McArdle
University of Liverpool
Dr James Brown
ARCHA Aston University
Dr Sue Broughton
Lancaster University, Centre for Ageing
Dr David Clancy
Lancaster University, Centre for Ageing
Dr Elizabeth Ostler
University of Brighton
Dr David Weincove
University of Durham
Dr Lesley Iwanejko
University of Liverpool
Dr Jennifer Tullet
University of Kent
Dr Suresh Ratten
University of Aarhus and Editor in chief, Biogerontology
Dr Don Ingram
Louisiana State University and Editor in chief, Age

• George Monbiot’s flight of fancy took off just following he reported his only instance of measured conclusions drawn from scientific investigation: that it may someday be possible, on the basis of rodent experiments, to slow ageing and delay multiple age-related illnesses. If realised this momentous outcome would reduce ache and enhance quality of existence for millions, but it is no a lot more than a distant likelihood. Yet Monbiot treats it as an established fact and launches into a rant.

Lone evangelicals like Aubrey de Grey catch the headlines with outlandish claims, this kind of as the one,000-yr lifespan that Monbiot repeats. But this speculation diverts our consideration from the much far more pressing issues of how to maximise healthier life expectancy between present generations of the two previous and young and make certain that the massive inequalities in lifestyle expectancies and well-getting are combated as rapidly as achievable.

Human life expectancy is growing, with no any genetic interventions, by an remarkable common of five hrs a day and, as a society, we are not prepared to meet this challenge. By feeding a negative narrative about ageing, Monbiot assists to delay serious debate on how to ensure that the ageing revolution benefits absolutely everyone.
Prof Alan Walker
Director, New Dynamics of Ageing Programme, University of Sheffield

• George Monbiot throws up a really intriguing query: if the science of life extension is advancing at this kind of a speed, how would we feed a population potentially a lot larger than recent projections in many years to come? As Mr Monbiot rightly notes in his piece, “grain is utilised to produce meat rather than feed folks directly” and this is wasteful. The actuality of today’s meals method – not in some dystopian long term exactly where individuals dwell to one,000 many years outdated – is that the grain presently fed to farm animals would feed an extra four billion folks. That is not to say that we should now or in the future automatically all be consuming a purely plant-based diet, but that we should be placing animals on ubiquitous pasture lands and using scarce arable lands to increase crops for individuals. No matter how lengthy we all reside, that would be a large frequent sense phase towards good food for everybody forever.
Philip Lymbery
CEO, Compassion in World Farming 

• George Monbiot’s concerns on hugely increased longevity had been foreseen in John Wyndham’s Difficulties with Lichen decades in the past. The clear resolution is for only individuals who are childless (so not me), sterilised and willing never ever to retire to be entitled to such remedy. Thoughts you, what’s so wonderful about all people moist November Sunday afternoons?
Iain Climie
Whitchurch, Hampshire

Ageing revolution have to benefit us all | @guardianletters

We want organ donor "opt-out" technique urgently | @guardianletters

7 years ago, the government ordered a review of the UK’s organ donation technique. Figures showed that the charge of demand for organs was far outstripping provide, major to hundreds of needless deaths each yr. The Organ Donation Taskforce identified that countries employing a presumed consent, or “opt out”, program had far increased donation rates. The United Kingdom was not in the prime 10. Tragically, absolutely nothing came of the evaluation. Given that then, seven,000 folks – such as kids – have died. With latest advances in science have come improved prospective, and demand, for transplantation. The gap is right now higher than ever.

In spite of laudable registration campaigns, the opt-in system can no longer be anticipated to fulfil its purpose. Organs are donated from just 1% of the numbers of deceased every single yr, although healthy organs from half a million folks are cremated or buried. As a consequence, currently being on the transplant waiting list has turn out to be a game of Russian roulette. For illustration, if you happen to be waiting for a liver, there is a twenty% chance that it will not reach you in time. For heart individuals, the figure is even increased. Youngsters struggling kidney failure are getting, in some circumstances, to wait for 5 perilous years.

In Wales, they are lastly moving forwards. Following a time period of careful public consultation and debate, an awareness-raising programme is underway ahead of the implementation of a new “opt out” technique subsequent yr. Individuals who object to organ donation can rest assured – as can their relatives – that their wishes will be respected below the new method.

For now, there are 7,000 people in the United kingdom – many younger young children amid them – waiting for a lifesaving transplant. Whilst we wait for the rest of the nation to catch up with the Welsh, we can at least make certain we are appropriately registered on the NHS’s donor database. For specifics, go to www.organdonation.nhs.united kingdom.
Ed Goncalves
Director, KidneyKids United kingdom

We want organ donor "opt-out" technique urgently | @guardianletters

Consequences of privatising cancer care |@guardianletters

Our fellows, the medical doctors who diagnose and treat cancer, have registered main issues with us about the planned model for commissioning cancer companies in Staffordshire (NHS cancer care faces privatisation, two July). We applaud the ambition of joining up care for a population larger than that typically served by a single NHS organisation and the want to focus solutions on the demands of patients. However, we fear that there could be unintended consequences.

Illustration by Gary Kempston GKIMAGES.COM

These changes could destabilise crucial cancer diagnosis and treatment method companies, and are previously major to organizing blight with regard to support enhancements. This could lead – in the quick-term – to worse companies for sufferers. This is a brave initiative but one particular that should be regarded a gamble in a well being economic system even now feeling the effects of the Mid-Staffordshire disaster. Lengthy-phrase arranging has proved an elusive goal in Uk public providers. The leaders of this initiative are in no position to predict, let alone handle, what might come about above the period of the 10-12 months contract – politically or financially. It appears unlikely that the architects of these alterations will be capable to see by way of their vision or to be held accountable for its consequences. What we could see is contracts that cannot be dismantled with no serious penalties. Higher clarity is essential with respect to the part of the “prime supplier” who will not in fact be supplying providers but managing services offered by other individuals.

It is clear that individuals on the ground who will be relied on to make this take place have nevertheless to be meaningfully engaged, and we have produced their issues acknowledged to Macmillan Cancer Assistance and NHS England who are foremost this initiative. Clinicians share the ambition for an integrated technique to cancer care and need to be more closely concerned if this gamble is not to fail.
Giles Maskell
President, Royal College of Radiologists  

• The Transforming Cancer and Finish of Life care programme in Staffordshire and Stoke-on-Trent is an progressive and brave instance of the voluntary and public sectors working alongside patients, carers and health and social care professionals to provide the best possible outcomes for folks affected by cancer.

Inspired by the experiences of people with cancer or those who have cared for an individual at the finish of their daily life in the region, this programme will test an integrated method to the commissioning and management of care. By appointing a single organisation to take responsibility for managing the complete cancer care journey, we can demand actually seamless care, and make certain no patient or carer will get misplaced in a complex method. 

Clinical commissioning groups (CCGs) and NHS England will appoint organisations with expertise in managing contracts, ensuring that all the services partners perform collaboratively all around each and every patient and will not change the organisations who immediately provide cancer care providers. Whoever is appointed will be topic to rigorous oversight and scrutiny for top quality, patient security and outcomes, no matter whether they are from the NHS, the voluntary sector, or from the personal sector.

At the heart of this programme is the want to truly reach and improve the lives of men and women affected by cancer. That is why Macmillan and our partners have manufactured positive men and women impacted by cancer, alongside clinicians, have been and will continue to be concerned in the programme at every stage.
Ciarán Devane
Chief executive, Macmillan Cancer Support

• Last night I attended and spoke at a guide launch of Mike Marqusee’s book The Value of Expertise: Writings on Residing with Cancer, in which he spoke movingly about his treatment method at Barts and his fears that the attacks on the NHS will imply sufferers in the long term will not have the exceptional care he has acquired. 

Absolutely the mixed CCGs in Staffordshire should have been speaking to their existing NHS hospitals and asking them to collaborate to offer a far more responsive and streamlined support just before embarking on this massive experiment with taxpayers’ money? In the earlier decade, the NHS (underneath Labour) made wonderful strides in strengthening cancer companies by means of networks this kind of as that in east London, but in 2011 Andrew Lansley withdrew funding for these regardless of their established successes.

Now we have groups of GPs, with no coaching in epidemiology, oncology or commissioning, generating strategies to invest millions on an untried technique with personal businesses, who have no expertise in cancer care, eagerly waiting to make profits from these sick sufferers. Similarly, the Cambridgeshire CCG, which desires to consider a radically distinct technique of care for the elderly, is organizing to commit above a billion pounds of our funds. This is madness, and the dishonesty of the existing government (“there is no privatisation” “there will be no best-down reorganisation”) is matched by the Division of Health’s spokesperson who explained: “NHS competition guidelines have not transformed underneath this government.” What about the Overall health and Social Care Act 2012, or the part 75 regulation that was passed this year? It is time for the public to wake up, stand up and fight for our NHS by lobbying their MPs.
Wendy Savage
President, Preserve Our NHS Public

• The finger of responsibility for the exponential privatisation of the NHS factors ineluctably at the Liberal Democrats, in distinct Nick Clegg and Shirley Williams. Given that this did not attribute in the coalition agreement, it ought to have been Clegg’s work to scrutinise Andrew Lansley’s white paper. Had he done so he could have halted the total scheme. Then Williams promised to have part 75 of the Well being and Social Care Act amended in the Lords to reduce, if not abolish, the necessity to tender for companies. This didn’t happen. But it is not good sufficient for Andy Burnham to say that the public has not offered the government permission to “place the NHS up for sale”. What is now necessary is a clear Labour election pledge to reverse all NHS privatisation since 2010.
Robin Wendt
Chester, Cheshire

• Certainly we should be concerned if cancer solutions are to be detached from the NHS and offered at the whim of private businesses? Well being minister Jane Ellison admits that the government has misplaced manage of the NHS so presumably huge businesses are chasing the NHS dollar with minor public manage. As a GP for virtually thirty many years, I know that patients are at their most vulnerable when they have a possibly fatal sickness, and are not in a position to make choices effortlessly or keep track of their care. Such patients particularly need to have to truly feel that the single goal of their carers is get them as properly as possible for as long as possible, and not to have at the back of their thoughts that organizations are creating choices for revenue rather than for them.
Dr Ron Singer
Chair, doctors’ part of Unite

• Will private contractors be paid on a charge-per-case basis, and hence make far more earnings if their individuals will not dwell for prolonged?
Dr Richard Turner
Harrogate, Yorkshire

Consequences of privatising cancer care |@guardianletters

We need to end FGM all over the place, not just in the Uk | @guardianletters

Tanya Barron: ‘Over years, not overnight, we can end this practice.’ Photograph: James Drew Turner for the Guardian

We welcome any new political target on the issue of female genital mutilation – and the media coverage that comes with it (Failure to defend girls from FGM is ‘ongoing national scandal’, MPs say, July 3).

But whilst it is of program essential to get our own residence in purchase and make certain that everything attainable is being carried out to stop FGM in Britain, the straightforward fact is that we will not end the practice right here till it is ended about the globe.

FGM is really a lot a international difficulty it doesn’t exist in a vacuum in the United kingdom. The beliefs and customs that lead to it, as well as the women who are subjected to it, cross borders.

So, as we heard in our latest roundtable discussion at the Guardian, to concentrate efforts exclusively on British legislation and British policy is to practically admit defeat in ending a practice that throughout the world has affected an estimated 125 million ladies and girls.

It’s by means of grassroots operate with communities in the countries across Africa and the Middle East in which FGM is prevalent that, above years, not overnight, we can end this practice.
Tanya Barron
Chief executive, Program United kingdom

• The police are proud of the reality fairly rightly, that they have been ready to prosecute celebrities for past crimes involving sexual abuse. Some of these have gone back almost 40 many years and the police have emphasised that they are inclined to investigate historical crimes what ever the situations or the longevity.

If these concepts are now to be applied to the prosecution of perpetrators of FGM, we can expect a veritable flood of situations involving 1000′s of women of all ages. This will inevitably be observed as the persecution of a cultural minority and possibly disturb race relations for a generation or a lot more. Whither then the goal of multiculturalism, with the state and the police witnessed to be coming down heavily on a broadly accepted cultural practice, even so horrific that practice is considered to be by the great bulk?
Ted Wilson
Stockport

We need to end FGM all over the place, not just in the Uk | @guardianletters

Resisting antibiotics | @guardianletters

Our PM has announced that we need to have new antibiotics (Report, two July), since resistance to present stock poses a significant international overall health risk. Properly carried out, though this is not news considering that the healthcare profession has been warning of the coming crisis for fairly a time. Nevertheless, he appears unaware of the irony of his place. The pharmaceutical industry has been slow to pursue research, because it is difficult and pricey and the fiscal returns on any new improvement might fail to satisfy their pockets. Antibiotics are brief-phrase therapies, unlike drugs designed for chronic illnesses, and new antibiotics will be utilized sparingly for essential problems or publish-operative care, since broader availability may possibly produce the dilemma it is attempting to fix – that of drug resistance. The lesson for Cameron could be that in an area the place society wants sustained investment, marketised medication is failing. But he prospects a government hell-bent on marketising massive swaths of socially presented companies, including healthcare. The proof suggests that markets can’t always supply what society needs, and with antibiotics the nightmare is currently starting.
Tony Tucker
Frodsham, Cheshire

Resisting antibiotics | @guardianletters

All have a element in debates on dementia and end-of-existence dilemmas | @guardianletters

George McNamara of the Alzheimer’s Society calls for “”leadership and integration across the program”. Photograph: Anna Gordon for the Guardian

In much of the current correspondence and features on end-of-lifestyle dilemmas (Campaigners fail to overturn ban on assisted suicide, 26 June The hidden costs of dementia, 26 June), the costs, the numbers, I have noticed tiny acknowledgment that inside the categories of the terminally unwell, the aged, Alzheimer’s and dementia lie – also typically hidden from view – the learning-disabled: individuals middle-aged and older males and women who lack capacity (or look to) but whose bodies are as powerful and match as their normal peers. No matter whether the alleged incapacity is a consequence of an autistic spectrum disorder, cerebral palsy, Down’s syndrome or other disabling handicap, they are there but seldom get mentioned. Individuals of us who, regardless of whether as mothers and fathers, siblings, carers or overall health specialists, are intimately connected with the lives and deaths of the understanding-disabled know there are problems all around illness, hospital therapy, finish-of-life plans, capacity, “do not resuscitate” diktats, consent and easy ageing that want as considerably consideration as any other group. The lives of the finding out-disabled (or intellectually disabled) are as worthy of recognition and respect as their peers. Just since these lives are seldom related with the workforce, firms and trade unions, they must not be excluded from the debate on, for instance, assisted dying, and what George McNamara of the Alzheimer’s Society pleads for in your report on dementia: “leadership and integration across the program”. That should be for all men and women.
Michael Baron
Chair, Nationwide Autistic Society, 1962-67

• Your specific report on dementia notes that the ailment is creating British company to shed billions of lbs. This is definitely correct in a single crucial, if obscure, spot of the savings organization. My wife is in a care house and I have an enduring energy of lawyer under which I have to use her sources for her very own demands. From her earliest days she has been a saver and, as the price of her care mounts, it seemed wise to enhance her accumulated financial savings by incorporating to a stocks-and-shares ISA she has had for more than a decade.

This more investment was initially accepted but I was then asked to give identity paperwork for her, though she had been receiving typical 6-regular monthly accounts from the organization. Her passport had expired three months earlier and her driving licence was revoked simply because of her sickness. Although she has a nationwide insurance coverage amount and receives a state pension it took nearly 6 months of bureaucracy to create that neither she nor I was laundering cash.

The Alzheimer’s Society estimates that there are almost 700,000 dementia sufferers in England and Wales. If only one% run into this sort of dilemma it is the equivalent of every one of the City of London’s everlasting residents becoming deprived of an important tax-free proper.

When we lived for some many years in the US a driving licence was the principal form of identification. Ought to unwell health prevent you from driving, all 50 states offer a non-driver’s licence with a photograph and other vital specifics, so that you have an acceptable official ID. Why cannot the DVLA run a similar service?
Harold Jackson
Woolpit, Suffolk

• I wholeheartedly agree with your report, which highlights that everybody has a role to perform in assisting to make daily life much better for folks with dementia.

In Surrey, our “dementia pleasant” programme has seen much more than 100 men and women and organisations – like well being secretary Jeremy Hunt – sign up with the objective of assisting folks and their carers with the challenges they encounter everyday.

The “dementia champions” contain a car museum, a plumbing company and a company of solicitors who assist men and women carry out fundamental duties this kind of as buying, withdrawing funds from the bank or filling in types, even though a network of suggestions and assistance centres has also been established across Surrey by a host of organisations.

Only by councils, the NHS and communities pulling with each other as a single staff in this way can we truly guarantee that the expanding variety of men and women with dementia continue to lead energetic and independent lives in familiar surroundings and shut to their loved ones.
Cllr Mel Number of
Cabinet member for adult social care, Surrey county council

All have a element in debates on dementia and end-of-existence dilemmas | @guardianletters

No way to sugar the pill on weight problems | @guardianletters

One particular can of fizzy drink includes an adult’s total everyday ration of sugar below government suggestions. Photograph: Lewis Whyld/PA

While it represents progress that the advisable everyday allowance for sugar is to be lowered (Guideline on sugar “need to be cut by half”, 27 June), it nonetheless defies logic. Sugar is tasty, mildly addictive and a slow-acting metabolic poison. The far more we eat, the higher its effects. While it could have a limited function in cooking and preserving foods, the logical recommendation from government should be to have no added sugar at all. – that would give a clear instruction with none of the mixed messages so beloved by our rather diabolical food processing industry.

As a GP dealing every day with diet plan-relevant troubles, I have been advising sufferers to end including sugar to scorching drinks or other meals, to end soft drinks altogether and to have biscuits or confectionary only on specific events. As a end result they have lost an typical of seven% of their body excess weight with out any special diet program becoming involved. This fat reduction will result in a significant reduction in morbidity, misery and cost for the NHS. Such reductions in sugar intake, utilized nationally, would significantly minimize the incidence of and issues from diabetes.

Additional sugar has as significantly of a spot in our diet program as smoke does in the air we breathe. It must be taxed heavily enough to at least pay out for some budgetary difficulties is it leading to the NHS. This would cut consumption and the misery causes for men and women whose excess consumption prospects to them turning into patients.
Dr Colin Bannon
Plymouth

• As a signatory to the Action on Sugar campaign, the British Dental Association supports a tax on sugar to curb childhood obesity, and we would include, tooth decay. Sugar is the foremost result in of obesity and tooth decay, the two of which are preventable. It is the main cause why unacceptably high numbers of youngsters are admitted to hospital each and every yr to have a common anaesthetic: final 12 months alone above 25,000 younger folks in England had a basic anaesthetic in order to eliminate rotten teeth.

While other healthcare pros may possibly find diet regime a delicate topic to raise with individuals, dental professionals are uniquely placed to broach this topic by means of conversations about chance aspects for creating oral ailment. That is not the only way that dentists contribute to the battle towards obesity. The BDA, by way of its lengthy-working Make a Meal of It campaign, has also been engaging the dental profession and public in the fight against sugar consumption. The effect of sugar on tooth decay need to not be lost in this important debate about childhood weight problems.
Dr Graham Stokes
Chair, health and science committee, British Dental Association

• The United kingdom Scientific Advisory Committee on Nutrition draft report on carbohydrates and overall health is a extensive and thorough review. As the report recognises, obesity is a complicated situation. The overwhelming scientific proof points to the more than-consumption of total calories across all meals groups, rather than a single ingredient, together with our increasingly sedentary lifestyles as the principal leads to of weight problems. Provided the relevance of complete calories we are amazed to see that the committee has come to a draft recommendation to halve the consumption of free sugars on a population-wide level to about five%. At the identical time the committee has also produced a draft recommendation for folks that totally free sugars ought to be no much more than ten% of complete calorie intake. This runs the risk of confusing consumers even additional and sets a degree that will be really tough for most men and women to meet. For illustration, this would be the equivalent of consuming the sugars found in a small glass of orange juice and a 125 gram yoghurt.

We think the work to be accomplished is to aid buyers comprehend the value of balancing power in and power out and to support men and women to make their own informed and healthier selections. We all need to work together to assist tackle the weight problems epidemic and we are committed to playing our part.
Richard Pike
Managing director, British Sugar

• Simon Capewell’s certainty that the issue of obesity lies solely with “massive food” and sugar does not accord with the proof (End this sugar rush, 26 June). It is a gross oversimplification to suggest 1 item or ingredient is to blame. It generates a harmful illusion that simply by reducing sugar consumption, 1 can eradicate obesity. What is essential from government, market, campaigners, academics and the general public is a dedication to tackle the problem from all sides – sugar yes, but also fat, balanced diet programs and workout.

For our part, we have led the way in reformulation and solution innovation. This has offered a dramatically enhanced selection of lower- and no-calorie options, empowering buyers to make their very own selections about what is proper for them. Key firms in the industry are also growing promoting invest on reduced- and no-calorie drinks by 49% this yr, and sales of these merchandise have elevated by 5% more than the last two years.

Obesity is an urgent dilemma triggered by many elements, and will want numerous solutions to remedy it. More than-simplification could satisfy Simon Capewell’s agenda but it jeopardises the likelihood of collective action to deal with the dilemma.
Gavin Partington
Director general, British Soft Drinks Association

No way to sugar the pill on weight problems | @guardianletters

Lead to for celebration as NHS is rated the ideal healthcare system | @guardianletters

The findings of the study come as no shock to those who have campaigned to preserve the NHS publicly funded, says Dr Jacky Davis. Photograph: Alamy

As a complete-time employee of the NHS for a lot more than forty many years I was delighted to go through that the Washington-based mostly Commonwealth Fund, seeking at healthcare across the created world, puts the NHS in pole position total, in spite of astonishingly lower fees matched only by New Zealand (Expert panel costs NHS world’s greatest healthcare system, 18 June). This is a colossal achievement and probably represents the very best and most reasonable assessment of what the NHS is today – despite a lot of pressures and, of course, imperfections, still a exceptional mix of “quality, access and efficiency”. One require hardly add fairness and equity because this blazes out so obviously in comparing our program with, say, the US, where the extremely very best is outstandingly excellent (I worked there for a 12 months), but the peaks are obviously outweighed by the tragic and shameful troughs (I noticed these initial-hand too).

It is usually a pleasure to search soon after visitors from the US unexpectedly requiring emergency healthcare right here (I have knowledgeable this a lot of times in a lengthy job) and hear their comments – nearly usually a mixture of admiration and disbelief that our significantly-maligned healthcare technique can supply this kind of compassion and quality with no unwelcome and exhausting concerns of payment at the point of need to have.

My pride in reading through the report was much more-than-somewhat diminished not just by the unfair and repeated brickbats thrown at us by mainly hostile media coverage, but also, and far far more importantly, the threats posed by continual reorganisation and what numerous see as a gradual unravelling of the founding concepts of the NHS.

It truly is wonderful to see the robust report from Jeremy Hunt, who recognises that the wonderful difficult operate of NHS workers has now been effectively and impartially measured by international specialists, but we need to trumpet this great achievement far more entirely.

Large marks to the Guardian for the front-page story, but why relegate it to the foot of the webpage under the photo of a grieving Brazilian football fan?
Jeffrey Tobias
Professor of cancer medication, UCL, and advisor in clinical oncology, UCL NHS Hospitals Believe in

• Steve Richards hits the nail on the head (If folks come to feel powerless it is because they are, 18 June). Last 12 months I wrote to my regional MP and asked how choices have been produced about the amount and spot of GP practices. I was concerned because the developing of huge new estate had not been supported by a new, nearer, overall health facility. My MP advised me to get in touch with the clinical commissioning unit – even I knew that was incorrect – but I wrote and asked for my request to be passed on. I at some point spoke to an official. She was valuable but there was no way I could have recognized (or located out) that her particular workplace was accountable for GP practices. I invested the latter component of my job as an ombudsman’s investigator. If I could not locate out in which and how to trace this info, what hope, as Steve Richards says, for the patient who just desires to know why they are not able to get an appointment to see their medical doctor?
Maureen Panton
Malvern, Worcs

• The findings of the Commonwealth Fund’s most recent review come as no shock to those who have steadfastly campaigned to maintain our NHS publicly funded, publicly delivered and publicly accountable. The media now requirements to challenge the politicians’ mantra of “we can’t go on like this” and “we cannot afford the NHS”. We require fewer stories focusing on difficulties and far more celebrating the one.5 million patients noticed by the NHS every 36 hours. We need to have to inquire politicians: “If we cannot afford the NHS, now acknowledged as the most value-effective services, what are they suggesting we can afford?”
Dr Jacky Davis
Founder member, Preserve our NHS Public

• So the NHS has been rated the world’s greatest healthcare system? Its only black mark is its bad record on retaining individuals alive. Nothing at all significant then.
Christiane Goaziou
Wotton under Edge, Gloucestershire

Lead to for celebration as NHS is rated the ideal healthcare system | @guardianletters

Statins, the ethics of preventive medicine, and the nocebo response | @guardianletters

The standard medical doctor-patient partnership. The GP contract can shell out physicians to encourage wholesome lifestyles, but is not that morally dubious? Photograph: Popperfoto/Popperfoto/Getty Photos

The Royal Colleges of Physicians and GPs are opposed to Good proposals for population-level prescription of statins (Medical doctors call for rethink on prescribing statins, eleven June). As 1 of the designers of the Newcastle University simulation on healthier ageing, it is gratifying to see this scenario currently being played in the true world. Coming in the very same week that we hear that one-third of the population is at high danger of kind two diabetes, probably we can consider an even far more fascinating situation: tagging obese patients with stepometers? If this is combined with rewards and penalties, the question is also ethical and philosophical, not health care: by what moral authority should medical doctors handle behaviour? A scenario today, but actuality tomorrow?

Prevention of avoidable diseases is starting up to look like the only way to save the NHS from bankruptcy, but this calls for the NHS to become a behavioural-adjust organisation that promotes specific lifestyles. The energy is there to do this. The GP contract can pay physicians to fill this new part, but is not that morally dubious? Well being follows an income gradient: the reduce the cash flow, the a lot more unhealthy the “lifestyle”. Unhealthy lifestyles of folks on lower incomes are not freely chosen. Minimal pay, unemployment, and minimal social and financial standing funnel by means of to lower self-esteem. Stress and depression improve the threat of self-treatment by way of tobacco, alcohol, sugar and fat. Lower earnings also increases your likelihood of living in poor housing, and not getting capable to afford healthful meals or exercise appropriately.

Doctors can intervene by filling individuals up with statins or forcing patients to dress in new technological innovation to monitor activity, blood sugar and cholesterol. Delivered at the population level, these measures will perform by skating in excess of the biggest trigger of poor wellness, which is low earnings. Are medical doctors prepared to do this dirty work? They have a choice. Physicians and GPs are firmly camped in the leading one% of income. As inequality is turning out to be a hot topic and we are heading towards an era when unequal incomes may possibly be addressed, may possibly the schools set an instance by voluntarily limiting doctors’ shell out to a a number of of typical earnings? Taking a hit in your own wallet is a potent stage, as befits the hallowed standing of medicine.
Kenneth Charman
Going to fellow, Changing Age Network, faculty of health-related sciences, Newcastle University

• I was interested in Sarah Boseley’s mention of the “nocebo result” (Professor at centre of statins row says public becoming misinformed, 14 June), although it didn’t quite describe the nature of this phenomenon, which truly has small if anything to do with middle age, and maybe far more to do, as she says, with people just not wanting to be on capsules. My late father, Dr Walter Kennedy, very first coined the term “nocebo response” in a health-related paper back in 1961. He utilized the Latin nocebo (“I shall injure”) as the opposite of placebo (“I shall please”) to indicate any unpleasant response to real or dummy remedy, this being a response within the patient themselves, and not due to the pharmacological action of a medication.

In other words, there is not a “nocebo effect”, only a “nocebo response”. Unfortunately, the term nocebo is occasionally utilized incorrectly for an lively drug’s unwanted pharmacologically induced unfavorable side-effects. Kennedy plainly stated that nocebo responses ought to in no way be baffled with real pharmaceutical side-results.
Dr Peter Kennedy
Wivenhoe, Essex

Statins, the ethics of preventive medicine, and the nocebo response | @guardianletters

Diabetes and obesity are a crisis for households and the NHS | @guardianletters

‘The government urgently needs to review its strategy for tackling the underlying causes of variety two diabetes: obesity, lack of action and poor diet plan.’ Photograph: PA

The review published this week in the BMJ, which displays that the current threefold rise in prediabetes has led to a third of adults in England being at high chance of type 2 diabetes, tends to make shocking studying (Report, 9 June). It is a stark warning, and the government wants to react in a severe and coordinated way. Otherwise the number of diabetes-associated deaths and folks enduring devastating well being problems this kind of as blindness and amputation will proceed to rise. The pressure and monetary effect on the NHS will cause problems for all overall health services consumers and for taxpayers.

Initial, we want to determine people at substantial threat. The NHS Health Check out is doing an important job in this, but less than half of the eligible population obtained a check out last 12 months. Individuals recognized need to have to get successful assistance to make the lifestyle alterations that can prevent them from building diabetes.

But we want to go past this. The government urgently needs to overview its approach for tackling the underlying leads to of kind 2 diabetes: weight problems, lack of activity and poor diet program. The voluntary approaches to bettering the nation’s diet regime, this kind of as by way of the Responsibility Deal, are not working. The government need to take into account legislation to drive reformulation, introduce restrictions on the advertising and marketing and distribution of unhealthy foods, and inspire healthful life style through taxation and price signals.

We need schools to do a lot more to educate youngsters and normalise healthier eating behaviour by delivering cost-free school meals and possessing necessary food- and nutrient-primarily based requirements for college foods. This is an epidemic. With out strong and decisive leadership, the crisis for households and the NHS will be inexorable.
Barbara Young
Chief executive, Diabetes United kingdom

• Your health correspondent, Denis Campbell, informs us of the danger to NHS personnel of a jail sentence for wilful neglect of individuals (Report, twelve June). Of program this method is suitable in the main. Even so, as a recently retired GP, I see the loss of patient duty in many places of wellness in contrast with the start off of my occupation in 1974.

What does Denis consider about a proposed “Go direct to jail” Monopoly-fashion card for people 1000′s of NHS sufferers with enormous excesses of obesity top to profoundly skewed health paying and consequently lowering the well being rewards to the much more prudent folk in today’s nanny NHS?
Dr Gavin Ewan
Whitchurch, Aylesbury

• I do want writers like Ms Gold (Obesity is not a disability, twelve June) could get it into their heads that obesity has leads to other than overeating. For 20 years I had an undiagnosed sickness that induced me to acquire excess weight relentlessly: I enhanced one dress dimension every single year. I advised my doctor that I could starve myself to death and I would still die excess fat. “With your issue, you would,” he (at some point) agreed. I was frequently informed to “lose excess weight”, as if it have been underneath my manage. At final it was diagnosed as a complete collapse of my endocrine technique. I was not diabetic because I was excess fat I was body fat because (amongst many other things) I was diabetic.

This misconception about a lack of self-discipline in weight problems sufferers (and the causes of conditions like diabetes) not only hurts obese folks it also contributes to the lack of a wise remedy.
Sara Neill
Tunbridge Wells, Kent

Diabetes and obesity are a crisis for households and the NHS | @guardianletters

"The NHS stripped down like a derelict house" | @guardianletters

Harry Leslie Smith’s account of his sister’s death in 1926 and his eulogy to the NHS moved numerous readers. Photograph: Sarah Lee for the Guardian

I was born in 1937, and when I was a month outdated my father collapsed in Stratford Substantial Street with pneumonia and pleurisy. When he was sufficiently recovered, he invested some weeks convalescing, for the duration of that time my mother had no revenue and the last of my parents’ funds went on having to pay for an ambulance to deliver him home.

Later on I keep in mind my father when he was working as an orthopaedic technician, receiving off his pushbike, and possessing heard about the new NHS, greeting my mom with the phrases “Thank goodness, we shall never ever have to fear about obtaining sick once more” (What happened to the globe my generation developed?, G2, five June)

So my generation is healthier and living longer thanks to the care we have obtained throughout our lives from a support run by devoted clinicians and not run for profit by the least expensive supplier. We have heard so a lot about the excessive “cost” of the NHS, but this belies the truth that in England we devote much less per capita on overall health than most other produced nations.

Of course those promulgating this myth typically have vested interests in the private firms, typically foreign, that are gathering like vultures in the hope of the excess fat earnings they hope to make from our illnesses and well being demands.

The politicians behind these insidious programs are intent on dismantling a service which was, before they interfered, the envy of the planet. But then they are far too youthful to bear in mind life prior to the NHS, and if factors get actually grim they can afford to shell out for private care.
Mabel Taylor
Knutsford, Cheshire

Illustration: Gary Kempston

• The solution to Harry Leslie Smith’s question is that Conservative MPs, this kind of as Oliver Letwin and John Redwood, received their hands on it. When doing work for Rothschild bank’s international privatisation department, they laid strategies for the Well being and Social Care Act which have been fleshed out in the Adam Smith Institute’s report, The Wellness of Nations, in 1988, the very same year Previous Etonian Letwin published his book Privatising the World. In 2004, Letwin, then Tory shadow chancellor, invited businessmen to his West Dorset constituency, encouraging them to work with each other to win contracts for a new PFI regional hospital. In accordance to a single participant, Letwin informed his audience that inside of five years of a Conservative victory “the NHS will not exist any more”.

Letwin, now minister of government policy, has overseen each overall health secretarys’ operate considering that the 2010 election. The bill widens the door, opened by New Labour, to NHS privatisation, closure of hospital solutions, promoting off hospital land to produce a support funded, not from standard taxation but by personal payments to insurance companies. As Harry puts it: ” … the NHS stripped down like a derelict home …”

As Michael Portillo said: “They [the Tories] did not think they could win an election if they informed you what they have been going to do [to the NHS]…”
David Murray
Wallington, Surrey

• My father was born in the workhouse infirmary in Colchester in 1900. My mother’s loved ones fled from the horrible poverty of Glasgow’s Gorbals to London in 1904. I was fortunate to invest my early life in a country in which situations enhanced. I am only 79, but I keep in mind when the Labour get together defended the weak the sick and the bad. I pray that the two Eds, Miliband and Balls, read through Harry’s touching story of his sister Marion’s life and death.
John Munson
Maidstone, Kent

• Dear Harry, thank you for reminding us of the terrible conditions that the NHS replaced. Rarely have I been so moved by an report in the Guardian. The piece by Harry Leslie Smith, so superbly written, ought to be sent to every MP and member of the Home of Lords who voted for the Health and Social Care Act so that they can realise the enormity of what they have carried out.
Ann Lynch
Skipton, North Yorkshire

• I am in my 70th 12 months, rather than the 91 many years of Harry, but I also despair at the dismantling of the welfare state that meant so a lot to working-class folks. How is it that the elderly can neglect so effortlessly and vote for political events, which now includes the Labour party, who want to privatise all the services that working-class men and women rely on?
Colin Lewis
Blackwood, Gwent

• 3 words stood out for me: “taxation advantages absolutely everyone”. Go over.
Mike Pender
Cardiff

• Harry Leslie Smith’s eulogy to the NHS measures the amounts of improvement in society following the second globe war and the opportunities that have been missed. The NHS did not develop an equal society, but it gave accessibility to healthcare irrespective of signifies to pay out and created strides in medicine which have been offered to absolutely everyone. It grew to become a model to aspire to. The NHS as a public services has saved or ameliorated many lives during most of Harry’s daily life. The answer to the growing value is raising contributions, not offering it off. If we were a more equal society, there wouldn’t be a difficulty.
Dr Graham Ullathorne
Chesterfield, Derbyshire

• My mother is 89 and misplaced the sight in one eye as a little one simply because her parents could not afford any treatment method. I was born in 1945 and survived pneumonia and rheumatic fever as a young little one because of the NHS. Harry Leslie Smith’s great lament created me weep.
Andrew McCulloch
Collingham, Nottinghamshire

• Very best piece of creating I’ve observed in years. Mr Gove should make it compulsory studying in all colleges.
Rosemary Adams
Hunmanby, North Yorkshire

• How ironic that at a time we are commemorating the outbreak of the initial planet war and the D-day landings of 1944, we are betraying the hopes and aspirations of the generations involved. They desired a better long term for their kids and grandchildren, one which eliminated the worry of sickness, poverty and lack of chance. We, their young children and grandchildren, should be deeply ashamed of our wilful destruction of their legacy.
Carole Rowe
Bradford-on-Avon, Wiltshire

"The NHS stripped down like a derelict house" | @guardianletters

"The NHS stripped down like a derelict house" | @guardianletters

Harry Leslie Smith’s account of his sister’s death in 1926 and his eulogy to the NHS moved numerous readers. Photograph: Sarah Lee for the Guardian

I was born in 1937, and when I was a month outdated my father collapsed in Stratford High Street with pneumonia and pleurisy. When he was sufficiently recovered, he spent some weeks convalescing, for the duration of that time my mom had no income and the final of my parents’ funds went on paying out for an ambulance to deliver him house.

Later on I bear in mind my father when he was doing work as an orthopaedic technician, obtaining off his pushbike, and having heard about the new NHS, greeting my mother with the phrases “Thank goodness, we shall never have to worry about acquiring sick again” (What took place to the planet my generation developed?, G2, 5 June)

So my generation is more healthy and residing longer thanks to the care we have acquired all through our lives from a services run by dedicated clinicians and not run for profit by the cheapest provider. We have heard so significantly about the excessive “price” of the NHS, but this belies the truth that in England we devote less per capita on health than most other designed nations.

Of course individuals promulgating this myth usually have vested interests in the private firms, frequently foreign, that are gathering like vultures in the hope of the fat income they hope to make from our illnesses and wellness requirements.

The politicians behind these insidious programs are intent on dismantling a service which was, just before they interfered, the envy of the world. But then they are far also young to don’t forget daily life ahead of the NHS, and if items get actually grim they can afford to shell out for personal care.
Mabel Taylor
Knutsford, Cheshire

Illustration: Gary Kempston

• The answer to Harry Leslie Smith’s query is that Conservative MPs, this kind of as Oliver Letwin and John Redwood, got their hands on it. When operating for Rothschild bank’s international privatisation department, they laid strategies for the Wellness and Social Care Act which have been fleshed out in the Adam Smith Institute’s report, The Wellness of Nations, in 1988, the very same year Old Etonian Letwin published his book Privatising the Planet. In 2004, Letwin, then Tory shadow chancellor, invited businessmen to his West Dorset constituency, encouraging them to function together to win contracts for a new PFI local hospital. In accordance to one participant, Letwin told his audience that inside of 5 years of a Conservative victory “the NHS will not exist any more”.

Letwin, now minister of government policy, has overseen both health secretarys’ work given that the 2010 election. The bill widens the door, opened by New Labour, to NHS privatisation, closure of hospital services, marketing off hospital land to generate a services funded, not from general taxation but by personal payments to insurance companies. As Harry puts it: ” … the NHS stripped down like a derelict house …”

As Michael Portillo explained: “They [the Tories] did not believe they could win an election if they told you what they had been going to do [to the NHS]…”
David Murray
Wallington, Surrey

• My father was born in the workhouse infirmary in Colchester in 1900. My mother’s loved ones fled from the terrible poverty of Glasgow’s Gorbals to London in 1904. I was lucky to devote my early life in a nation in which situations enhanced. I am only 79, but I bear in mind when the Labour party defended the weak the sick and the bad. I pray that the two Eds, Miliband and Balls, study Harry’s touching story of his sister Marion’s life and death.
John Munson
Maidstone, Kent

• Dear Harry, thank you for reminding us of the terrible circumstances that the NHS replaced. Seldom have I been so moved by an article in the Guardian. The piece by Harry Leslie Smith, so superbly written, ought to be sent to every single MP and member of the House of Lords who voted for the Overall health and Social Care Act so that they can realise the enormity of what they have completed.
Ann Lynch
Skipton, North Yorkshire

• I am in my 70th 12 months, rather than the 91 many years of Harry, but I also despair at the dismantling of the welfare state that meant so significantly to operating-class men and women. How is it that the elderly can forget so very easily and vote for political events, which now includes the Labour party, who want to privatise all the services that operating-class people rely on?
Colin Lewis
Blackwood, Gwent

• 3 words stood out for me: “taxation positive aspects everybody”. Discuss.
Mike Pender
Cardiff

• Harry Leslie Smith’s eulogy to the NHS measures the ranges of improvement in society following the 2nd planet war and the opportunities that have been missed. The NHS did not generate an equal society, but it gave entry to healthcare irrespective of means to spend and manufactured strides in medicine which were available to everybody. It became a model to aspire to. The NHS as a public service has saved or ameliorated a great number of lives all through most of Harry’s daily life. The resolution to the rising price is raising contributions, not offering it off. If we had been a a lot more equal society, there would not be a difficulty.
Dr Graham Ullathorne
Chesterfield, Derbyshire

• My mom is 89 and misplaced the sight in a single eye as a kid due to the fact her dad and mom could not afford any remedy. I was born in 1945 and survived pneumonia and rheumatic fever as a young youngster simply because of the NHS. Harry Leslie Smith’s great lament created me weep.
Andrew McCulloch
Collingham, Nottinghamshire

• Best piece of creating I’ve seen in years. Mr Gove ought to make it compulsory studying in all colleges.
Rosemary Adams
Hunmanby, North Yorkshire

• How ironic that at a time we are commemorating the outbreak of the 1st globe war and the D-day landings of 1944, we are betraying the hopes and aspirations of the generations involved. They needed a greater future for their kids and grandchildren, one particular which removed the fear of illness, poverty and lack of possibility. We, their young children and grandchildren, need to be deeply ashamed of our wilful destruction of their legacy.
Carole Rowe
Bradford-on-Avon, Wiltshire

"The NHS stripped down like a derelict house" | @guardianletters

Addressing the large challenges dealing with the NHS | @guardianletters

We, as leaders of NHS organisations and organisations supplying NHS care across England, believe that the NHS is at the most challenged time of its existence. Growing demands indicate that the cost of providing the overall health support rises each and every year by about four% over inflation. At the very same time, the companies we commission and run are not developed to cope with the care needs of the 21st century – especially the big number of folks with a number of extended-term conditions and an increasingly elderly population.

As local organisations, we are urgently planning the transformation of how we care for individuals to ensure we carry on to supply a support that meets people’s demands and improves the public’s wellness. Our ideas start to deal with the issues that are nicely set out in the 2015 Challenge Declaration, published by the NHS Confederation on six May, in association with health care royal colleges, regional government and patient organisations. But far more will want to be done if we are to be profitable.

With a yr to go to the standard election, it is essential that the political events recognise the scale of the challenge we are addressing – and that their manifestos should address. At the 2010 basic election not 1 of the political parties talked about the fiscal challenge facing the NHS in its manifesto. In 2015, the parties have to handle the complete selection of issues dealing with the NHS or take duty for it getting to be unsustainable in the type individuals want it.

We get in touch with on every single of the party leaders to publicly recognise the problems dealing with well being as spelt out in the NHS Confederation’s 2015 Challenge Declaration – and to ensure their manifestos are written to assistance how we will deal with them.
Rob Webster Chief executive, NHS Confederation, Ron Kerr Chief executive, Guy’s and St Thomas’ NHS Basis Believe in, Peter Homa Chief executive, Nottingham University Hospitals NHS Believe in, Prof Tricia Hart Chief executive, South Tees Hospitals NHS Foundation Trust, Dr Matthew Patrick Chief executive, South London and Maudsley NHS Foundation Believe in, Stuart Bain Chief executive, East Kent Hospitals University NHS Basis Trust, Jonathan Michael Chief executive, Oxford University Hospitals NHS Trust, Tim Goodson Chief officer, Dorset Clinical Commissioning Group, Christopher Baker Chair, Aintree University Hospital NHS Foundation Believe in, Marie Gabriel Chairperson, East London NHS Basis Believe in, Dr Avi Bhatia Clinical chair, NHS Erewash CCG, Stephen Swords Chairman, Hounslow &amp Richmond Neighborhood Healthcare NHS Trust, David Edwards Chairman, Cambridgeshire and Peterborough Foundation Believe in, Michael Luger Chair, Airedale Hospitals NHS Basis Believe in, Dr Nick Marsden Chair, Salisbury NHS Foundation Trust, Prem Singh Chairman, Derbyshire Community Wellness Companies Believe in, David Griffiths Chairman, Kent Local community Wellness NHS Believe in, Ken Jarrold Chair, North Staffordshire Combined Healthcare NHS Believe in, Stuart Welling Chairman, East Sussex Healthcare NHS Trust, Stephen Wragg Chairman, Barnsley NHS Basis Believe in, Chris Wood Chair, Burton Hospitals NHS Basis Believe in, Gary Web page Chair, Norfolk and Suffolk NHS Foundation Trust, Robert Dolan Chief executive, East London NHS FT, David Wright Chairman, James Paget University Hospital FT, David Jenkins Chair, Aneurin Bevan University Health Board, Ruth FitzJohn Chair, 2gether NHS Basis Trust, Stephen Ladyman Chairman, Somerset Partnership NHS Foundation Trust, Harry Turner Chairman, Worcestershire Acute NNS Believe in, Jane Fenwick Chair, Humber NHS FT, Hugh Morgan Williams Chairman, NTW NHS Wellness Believe in, Jo Manley Director of operations, Hounslow Richmond Community NHS Trust, Dr Christina Walters Programme director, Community Indicators Programme, David Law Chief executive, Hertfordshire Local community NHS Believe in, Julia Clarke Chief executive, Bristol Local community Wellness CIC, Matthew Winn Chief executive, Cambridgeshire Neighborhood Providers NHS Trust, Simon Perks Accountable officer, NHS Ashford CCG &amp Canterbury and Coastal CCG, Stephen Conroy CEO, Bedford Hospital, Stephen Firn Chief executive, Oxleas NHS Foundation Believe in, Katrina Percy Chief executive officer, Southern Health NHS Basis Trust, Mark Hindle Chief executive, Calderstones Partnership NHS Basis Believe in, Christine Briggs Director of operations, NHS South Tyneside CCG, John Wilderspin Managing director, Central Southern CSU, Alison Lee Chief executive officer, NHS West Cheshire Clinical Commissioning Group, Andrew Funds Chief executive, Sheffield Teaching Hospitals NHS Foundation Trust, Christine Bain Chief executive, Rotherham Doncaster &amp South Humber NHS FT, Sarah-Jane Marsh Chief executive officer, Birmingham Children’s Hospital, Tracy Allen Chief executive, Derbyshire Local community Health Services NHS Believe in, Chris Dowse Chief officer, NHS North Kirklees CCG, Stuart Poynor CEO, SSOTP, Dominic Wright Chief officer, Guildford &amp Waverley CCG, Steven Michael Chief executive, South West Yorkshire Partnership NHS Foundation Believe in, Dr Mark Newbold Chief executive, Heart of England NHS Foundation Trust, Andrew Donald Chief officer, Stafford and Surrounds and Cannock Chase Clinical Commissioning Groups, John Matthews Clinical chair, NHS North Tyneside CCG, Lisa Rodrigues Chief executive, Sussex Partnership NHSFT, Jonathon Fagge Chief executive officer, NHS Norwich CCG, Steve Trenchard CEO, Derbyshire Healthcare Foundation NHS Believe in, Louise Patten Accountable officer, Aylesbury Vale CCG, Jane Tomkinson CEO, Liverpool Heart and Chest Hospital FT, Allan Kitt Chief officer, South West Lincolnshire Clinical Commissioning Group, Darren Grayson Chief executive, East Sussex Healthcare NHS Trust, Katherine Sheerin Chief officer, NHS Liverpool CCG, Edward Colgan Chief executive, Somerset Partnership NHS Basis Believe in, David Stout Managing director, NHS Central Eastern Commissioning Help Unit, Andrew Bennett Chief officer, Lancashire North CCG, John Brewin Interim chief executive, Lincolnshire Partnership Foundation Believe in, Andrew Foster Chief executive, Wrightington, Wigan &amp Leigh NHS Basis Trust, Richard Paterson Associate chief executive, Royal Brompton and Harefield NHS Basis Believe in, Glen Burley Chief executive, South Warwickshire NHS FT, Joe Sheehan Managing director, Healthcare Companies Ltd, Robert Flack Chief executive, Locala

• I am grateful to Ian Birrell (The NHS need to evolve – or encounter a agonizing death, 2 June) for assisting to hold the debate about privatisation of the NHS alive. Final Thursday I resigned from my place as vice-chairman and non-executive director of the Royal Cornwall Hospital Trust in excess of the choice by the board to privatise hotel providers – catering, cleaning, portering, safety and reception. I had been a board member for nearly seven many years and a member of NHS boards in Cornwall for a lot more than 25 years.

My opposition to this selection is based mostly on pragmatism. A quantity of years ago I sat on the small committee which established the out-of-hrs contract for Cornwall. I was the only member of that committee who didn’t support the granting of the contract to Serco. I had researched Serco’s governance procedures and found them wanting. Sadly for patients in Cornwall it was not long just before the committee’s decision became a pricey error.

A cursory trawl reveals a long list of employment tribunals and strikes by minimal-paid employees in these outsourcing firms. The only way these businesses can reap large profits for shareholders and pay ludicrous salaries to senior executives is by reducing the terms and situations of employment of the workers they inherit from the NHS. 

At least Birrell is currently being steady with his preceding post (Salute the super-rich, 13 May possibly). The continued movement of taxpayers’ income into the bank accounts of private well being companies is certainly going to obtain an enhanced flow of cash to the wealthy.
Rik Evans
Truro

• While I am positive there are wasteful practices in the NHS, managers and clinicians would have much more time to deal with these if the services was not being frequently reorganised and topic to cuts which make planning challenging. We are a wealthy nation, as Cameron reminded us in Gloucestershire, and because 2009 have slipped down the OECD list of expenditure on the NHS.

Considerably money could be saved by receiving rid of the marketplace, the place massive sums are going to accountants and lawyers due to the fact CCGs believe they are forced to put companies out to tender underneath the Wellness and Social Care Act 2012. This was supposed to have decreased bureaucracy and place clinicians in charge but this has not happened nor has the overall health secretary stopped managing the NHS whilst being relieved of the legal accountability to “safe and provide a complete well being support”. The private firm that runs Hinchingbrooke hospital has a excellent PR machine but it has not managed to accomplish the savings it proposed when it created its bid, and this was a nicely-run hospital destabilised by the private unit constructed in their grounds.

The NHS has handed back to the Treasury a lot more than £3bn in the last two years. This cash could be utilized to assist the hospitals whose finances are inadequate for their workload or have high PFI charges. We can afford our NHS, despite our ageing population, as lengthy as politicians quit striving to restructure it and the wasteful competition enshrined in the 2012 act is eliminated by repealing this pernicious piece of legislation. A lot more cash wants to go to the GP companies, which have acted as efficient gatekeepers that allowed the NHS – regardless of getting underfunded for decades – to be rated by independent sources as a single of the most expense-successful wellness services in the world.
Wendy Savage
President, Maintain Our NHS Public

• Ian Birrell is certainly proper in pointing out that the debate around the large issues faced by the NHS largely revolves close to low cost politics. But then his post reproduces two of the main delusions at the centre of that debate: that the NHS is excessively expensive, and that privatisation would minimize fees. Even a cursory comparison with the overall health programs in other industrialised countries suggests that the NHS is underfunded, but comparatively productive. In comparison with methods that systematically pay physicians far more for treating individuals far more, the NHS tends to undertreat individuals. Funding it even though taxation charges a lot less than paying out-of-pocket or through insurance coverage and charges have spiralled out of handle in nations such as the US or Switzerland that have allow the marketplace rule and the insurance firms cash in. Thinking about the reality that most of us think about our wellness to be rather more essential than most of the other issues that make up the economy, we must continue to be sceptical of pundits who think privatising is the response, with out even understanding what the true troubles are.
Thomas Smith
Neston, Wirral

• I welcome Ian Birrell’s plea for an open and honest debate. But there are some concerns he does not refer to. There are effective publicly run hospitals in the NHS what are their characteristics? Is the psychology of profit-creating to be accepted as the only inspiration? Can we not identify and cultivate the attributes of good leadership and management in the public support? Rethinking the funding basis is naturally crucial. Procurement traditions and other habits can certainly be shaken up inside of a public service. Is all the world a industry?
Howard Layfield
Newcastle on Tyne

• Ian Birrell says that £100bn is “roughly the current expense of the health services”. Roughly the existing price of corporate and elite tax avoidance and scams is £120bn. Now what could we do with the excess £20bn?
Ted Woodgate
Billericay

Addressing the large challenges dealing with the NHS | @guardianletters

Depressing news | @guardianletters

Churchill called depression his Black Dog, and in difficult environments this serious illness can spiral down into disability and early death. I am glad that all our work in the 1990s Defeat Depression campaign to train GPs to recognise and treat depressed patients still bears fruit (Use of antidepressants exploded after financial crisis, study finds, 28 May) and it is no surprise that more pills are prescribed in Blackpool than in Brent. Three very common experiences when depressed are helplessness (including feeling trapped in a dead end job with a bullying boss); worthlessness (including feeling on society’s scrapheap); and hopelessness (feeling stuck in a neighbourhood for “losers”). The coalition’s policies on austerity (ie more suffering is good for the poor), patricians and plebians (eg what Etonian needs to know the price of milk?) and housing (renting is for riff-raff) have made many people feel helpless, worthless and hopeless for a long time. Do we look behind these statistics about pills and explode the depressing policies of despair?
Professor Woody Caan
Editor, Journal of Public Mental Health, Cambridge

Depressing news | @guardianletters

Children"s wellness harmed by increasing poverty | @guardianletters

A rise in respiratory troubles amid youngsters could be down to far more mother and father residing in damp and cold circumstances. Photograph: Voisin/Phanize/Rex Characteristics

As health pros we are alarmed, dismayed and disappointed by the most recent evidence, contained in a new report by Conserve the Kids that five million young children in the United kingdom could be living in poverty by 2020 (Report, 28 May possibly). The increasing statistics and study bear out what we are seeing on a day to day basis: a lot more youngsters with signs which are plainly linked to decrease standards of residing, such as asthma, bronchitis and anxiety-related illnesses. However, we are hearing from far more mother and father describing their living situations as damp and cold, which could be why we are seeing much more young children developing extended-phrase respiratory issues. The analysis also shows more families forced to get the cheapest foods achievable, regardless of its dietary content, reinforcing the enhanced likelihood of diabetes and weight problems in poorer young children.

The influence of poverty on children’s health and wellbeing cannot be underestimated. Reduced earnings can lead to bad well being, even though coping with sickness can outcome in a decrease earning capacity – perpetuating a cycle of deprivation. And we know that a lot of of the causes of little one death – like perinatal deaths and suicides – disproportionally have an effect on the most disadvantaged in society. We simply cannot disregard these warnings. We need to act now and put youngsters at the really heart of any approach to tackle poverty and overall health inequalities.
Michael Marmot, Dr Hilary Cass President, Royal College of Paediatrics and Child Wellness, Dr Mark Porter Chair, British Medical Association

• In a breathless 3-page post (Politics or technology, Review, 24 May possibly) David Runciman asks rhetorically: When did a government last develop anything as beneficial for the public welfare as Wikipedia? I would recommend 1948, and the NHS. Or, he wonders, when did a bureaucracy ever invent anything at all as lifestyle-enhancing as Google? How about a cradle-to-grave welfare state? Runciman’s frothiness regularly collapses under closer inspection. “We all would like laws made to suit us,” he says: no, some of us would like laws that supply social justice. Probably the most ridiculous of all: “It is a signal of broad satisfaction with the political program that most men and women don’t want to have anything at all to do with politics”. And so Runciman perpetuates the delusional view of the present elites. What a good deal of pernicious tosh.
Professor Huw Davies
Newport on Tay, Fife

Children"s wellness harmed by increasing poverty | @guardianletters

Complex causes of little one psychological unwell overall health | @guardianletters

Madeleine Bunting makes some essential points (Our kids truly are facing a psychological overall health crisis, 21 Might). 1 of the most crucial factors is that young children and young folks are vulnerable. They are topic to a lot of pressures and opportunities. However, it is also important not to leap to straightforward conclusions about causes of apparent distress. To do so risks premature and potentially inappropriate labels. 1 of the symptoms of this may be noticed in the way that young people’s expression of their issues is occasionally medicalised. The practice of educational psychologists working inside communities and schools aims to aid colleagues disentangle anxieties and discover answers that do not more disadvantage youngsters via separation, labelling or mistreatment. Bunting says we are “raising young children who are ill”. By providing an inappropriate setting, anyone’s overall health may possibly be jeopardised. We need to recognise the complex triggers that may produce distress and deal with these cautiously. Cholera was eradicated that way.
Dr Simon Gibbs
Reader in educational psychology, University of Newcastle

• Thank you for coverage of the troubling rise in demand for children and younger people’s psychological health solutions. Madeleine Bunting says young people’s psychological overall health ought to be the subject of crisis seminars at government level. But it is not. And that is simply because psychological sickness remains unpopular and numerous desire to blame beleaguered employees for failing kids than face actuality. Referral costs are growing at all around ten% a 12 months to the kids and younger people’s companies my believe in provides in Kent, Medway, East Sussex, Brighton and Hove, West Sussex and Hampshire. Comparable increases are reported across the country. Demand is outstripping supply and the complexity of three sets of commissioners – regional authorities, clinical commissioning groups and NHS England – does not support. Several places have witnessed cuts to help and expert services. This is not function for the faint-hearted, but staff are deeply anxious. Most adults with drug or alcohol problems, key mental illnesses and/or in prison have expertise of trauma and psychological distress in childhood. It does not get a genius to function out that lack of investment in companies for young children and young individuals, and in research to aid us understand why we are seeing this unprecedented rise in demand, is storing up problems we will reside to regret. It is not tough to give wonderful care. We have outstanding models and strategies, and due to the fact young people are so resilient, we get speedy, life-changing results. What could matter more?
Lisa Rodrigues
Chief executive, Sussex Partnership NHS Foundation Believe in

Complex causes of little one psychological unwell overall health | @guardianletters

Complex leads to of youngster psychological ill overall health | @guardianletters

Madeleine Bunting tends to make some crucial points (Our young children genuinely are facing a mental well being crisis, 21 Could). One particular of the most critical factors is that youngsters and youthful people are vulnerable. They are subject to numerous pressures and possibilities. Even so, it is also critical not to jump to straightforward conclusions about leads to of apparent distress. To do so dangers premature and probably inappropriate labels. One of the signs of this might be noticed in the way that young people’s expression of their troubles is sometimes medicalised. The practice of educational psychologists doing work within communities and schools aims to help colleagues disentangle anxieties and discover options that do not additional disadvantage kids via separation, labelling or mistreatment. Bunting says we are “raising youngsters who are ill”. By supplying an inappropriate setting, anyone’s wellness may possibly be jeopardised. We need to have to recognise the complex triggers that might produce distress and deal with these very carefully. Cholera was eradicated that way.
Dr Simon Gibbs
Reader in educational psychology, University of Newcastle

• Thank you for coverage of the troubling rise in demand for kids and younger people’s mental overall health providers. Madeleine Bunting says youthful people’s mental health must be the topic of crisis seminars at government level. But it isn’t. And that is simply because psychological illness remains unpopular and a lot of prefer to blame beleaguered personnel for failing young children than encounter reality. Referral charges are escalating at close to 10% a yr to the youngsters and younger people’s providers my believe in supplies in Kent, Medway, East Sussex, Brighton and Hove, West Sussex and Hampshire. Related increases are reported across the country. Demand is outstripping provide and the complexity of 3 sets of commissioners – local authorities, clinical commissioning groups and NHS England – isn’t going to support. Numerous locations have observed cuts to assistance and professional providers. This is not work for the faint-hearted, but personnel are deeply anxious. Most adults with drug or alcohol problems, significant psychological illnesses and/or in prison have knowledge of trauma and psychological distress in childhood. It does not get a genius to perform out that lack of investment in providers for children and younger men and women, and in analysis to support us understand why we are seeing this unprecedented rise in demand, is storing up problems we will dwell to regret. It isn’t challenging to give wonderful care. We have excellent versions and methods, and because young men and women are so resilient, we get speedy, life-altering final results. What could matter much more?
Lisa Rodrigues
Chief executive, Sussex Partnership NHS Basis Trust

Complex leads to of youngster psychological ill overall health | @guardianletters