I like to reply promptly to emails and letters from constituents. But I have received so many expressing a view of the case for UK involvement in a possible military strike against the Syrian Gov't that I cannot. Any response on this matter is complex, and I just do not have the time to reply properly. So I'm writing a blog post and pointing those I need to write to in the direction of it.
Lets recap. A few days ago chemical weapons were used to murder over a thousand civilians in a suburb of Damascus. After initially refusing to allow UN inspectors to assess the truth of what happened (as far as possible), Bashar al-Assad allowed the scientists in. David Cameron entered into discussions with several national leaders and it seemed highly likely there would be a military strike against the forces of the President of Syria. Parliament was recalled on Thursday. Most of us fully expected the motion under debate would be to grant the Prime Minister the authority to involve British forces in the attack.
Like many other MPs, I was deeply concerned about voting for a military strike, and felt that I might be forced to vote against my Gov't (for the first time). Main concern was that I could not see what such an attack would achieve. I also decided to email those constituents whose addresses were held in my office to gauge opinion. I received a huge number of replies, the majority of which were opposed to British involvement. However, the motion tabled on the evening before the recall was not what I had been expecting. David Cameron had been seeking to create a consensus with Ed Miliband, the Leader of the Opposition, and a motion had been produced which was thought to satisfy his concerns - even though, after he had spoken to his own MPs it didn't. The motion condemned the Syrian Gov't, it allowed time for the UN inspectors to complete their investigations, and included the provision that before any British involvement in military action, there would have to be another vote of MPs (where the evidence of UN inspectors would be available) to authorise it. This was a great relief to me. I could no longer see any reason not to vote with the Government. In fact I could not really understand why we were being recalled at all. It was probably because it was too late to cancel when it was realised the motion tabled was meaningless.
Anyway, the MPs turned up (apart from a few notable exceptions). The Gov't motion was defeated. So was what I considered a politically inspired Opposition amendment which said much the same thing. David Cameron immediately announced that he accepted the 'view of the House' and that Britain would not play a part in any international military response. And we all went home. It is impossible to yet judge the implications of all this - except that there will be no more jokey references to the French as "cheese eating surrender monkeys"! I expect the President of Syria to be much pleased by developments.
Personally, I was disappointed that the Govt motion was defeated. While I am not at all convinced that Britain should be involved in a military strike, I would have preferred to keep options on the table. Actually, I do not think there would ever have been a second vote. But on the other hand, there is also a sense of relief that the matter has been killed off now. I do not think the people of Britain or the MPs that represent them would vote for a military strike against the Syrian Gov't.
Saturday, August 31, 2013
Wednesday, August 28, 2013
The Case for action against President Assad
Over recent days I have been in a real quandry about what I should do in the vote for which Parliament is being recalled tomorrow. Like everyone else I was appalled that the Syrian Gov't should have used chemical weapons against its own people. This despicable act is anathema to every concept of humanity and decency. But I need to feel reassured that military intervention will actually help the position, and be to the long term benefit of Syria, its people and its neighbouring countries. Was hoping that tomorrow's speeches by party leaders would help clarify. Best idea of what Prime Minister would say was in the Foreign Secretary's essay in today's Telegraph. So I thought I'd print it for anyone who wants to read it.
The faces of the victims of last week’s chemical weapons attack in Syria are haunting. We still do not know how many people died. Médecins Sans Frontières, an independent humanitarian organisation working with hospitals in Syria, estimates that there were 3,600 casualties, including 355 fatalities, among them many children.
According to the UN, the Syrian conflict is already the worst refugee crisis since the Rwandan genocide, creating nearly two million refugees and killing more than 100,000 people so far. But it is now infamous for another, equally chilling reason: this is the first time that chemical warfare has been used anywhere in the world in the 21st century.
For nearly 100 years, the international community has worked to build a system of defences to protect mankind against the use of weapons of mass destruction – including chemical weapons – to prevent the kind of attacks that are now taking place in Syria.
The First World War exposed the sheer horror that chemical agents inflict. Ninety thousand soldiers on all sides died agonising, choking deaths from the use of mustard gas, chlorine and phosgene on the battlefield, and up to 1.3 million people were blinded or burned by them. Wilfred Owen wrote in searing terms of the “froth-corrupted lungs” and “incurable sores” of his fallen comrades. Chemical weapons developed since that war, such as nerve gases, are even deadlier than those of a century ago.
The power of these weapons to inflict mass, indiscriminate death shocked the world into banning their use in international conflict through the 1925 Geneva Gas Protocol. Customary international law now completely prohibits their use, including in internal conflicts like that taking place in Syria.
There have been decades of painstaking work to construct an international regime of rules and checks, overseen by the UN, to prevent the use of chemical weapons and to destroy stockpiles. This is codified in the 1993 UN Chemical Weapons Convention, which seeks the complete global elimination of chemical weapons – a treaty that Syria refused to sign.
With a few horrendous exceptions, including the Iran-Iraq War and Saddam Hussein’s campaign against Iraqi Kurds in the 1980s, the global consensus surrounding the use of chemical weapons in war has held firm. Countries like our own have been able to focus their efforts on trying to universalise the UN Convention, and keep chemical weapons out of the hands of terrorists.
We all live under the protection of this global system of arms control, just as the Nuclear Non-Proliferation Treaty has spared us from the threat of nuclear holocaust, which blighted my parents’ generation. These rules and conventions are a largely invisible part of the global landscape and are undoubtedly in our national interest. The work of maintaining and upholding them is a constant struggle in international diplomacy, and the events in Syria have the power to undermine them fatally.
Over the past year we have seen evidence of the repeated small-scale use of chemical weapons by the Syrian regime. We know this from physiological samples that have been smuggled out of Syria and from other sources of information.
This amounts to extensive, continuous and escalating use of chemical weapons by a state against its own citizens. We have tried to deter the Syrian regime from continuing these attacks, by raising our concerns at the United Nations Security Council and passing direct messages through diplomatic channels, working with Russia. But last week’s large-scale attack shows the regime has simply ignored these warnings.
We strongly support the work of the UN team on the ground in Syria. We hope that the information they obtain will help build a fuller picture of the attack – adding to the evidence which already exists – and to help ensure that those responsible for this war crime are held accountable.
The team has a mandate to gather evidence about the attack, but they are not empowered to determine who was responsible for it. All the evidence and information available to us, including from eye-witnesses, leaves us in no doubt that the Assad regime was responsible. The attack took place in an area already controlled by the opposition; regime forces were carrying out a military operation to clear that area; and there is no evidence that the opposition possess any chemical weapons stocks, let alone the capability required to deliver them on the scale needed to cause mass casualties.
For five days after the attack the regime bombarded the area with conventional weapons, refusing to allow UN inspectors to visit, during which time crucial evidence would have been destroyed or degraded. To argue that the Syrian opposition carried out this attack is to suggest that they attacked their own supporters in an area they already controlled using weapons systems they do not possess. This opinion is shared by our allies and by countries in the region. Yesterday the Arab League passed a resolution stating that it holds Bashar al-Assad and the government in Damascus responsible.
We cannot allow the use of chemical weapons in the 21st century to go unchallenged. That would send a signal to the Syrian regime that they will never face any consequences for their actions, no matter how barbarous. It would make further chemical attacks in Syria much more likely, and also increase the risk that these weapons could fall into the wrong hands in the future.
But this is not just about one country or one conflict. We cannot afford the weakening of the global prohibition against the use of chemical weapons. We must proceed in a careful and thoughtful way, but we cannot permit our own security to be undermined by the creeping normalisation of the use of weapons that the world has spent decades trying to control and eradicate.
This actual, repeated use of chemical weapons in Syria is a moral outrage, a serious violation of international humanitarian law and a challenge to our common security. We are now weighing with the United States and our other allies how to respond in a way that is legal and proportionate. The goal of any response should be to prevent further similar humanitarian distress, to deter the further use of chemical weapons in Syria and to uphold the global ban against their use.
The United Nations Security Council should rise to its responsibilities by condemning these events and calling for a robust international response. But all previous attempts to get the Security Council to act on Syria have been blocked, and we cannot allow diplomatic paralysis to be a shield for the perpetrators of these crimes.
Tomorrow, Parliament will have the opportunity to debate these issues, and to make its views known. This is a moment of grave danger for the people of Syria, a moment of truth for democratic nations to live up to their values, and a weighty test of the international community. The way ahead will not be without risks, but the risks of doing nothing are greater.
The faces of the victims of last week’s chemical weapons attack in Syria are haunting. We still do not know how many people died. Médecins Sans Frontières, an independent humanitarian organisation working with hospitals in Syria, estimates that there were 3,600 casualties, including 355 fatalities, among them many children.
According to the UN, the Syrian conflict is already the worst refugee crisis since the Rwandan genocide, creating nearly two million refugees and killing more than 100,000 people so far. But it is now infamous for another, equally chilling reason: this is the first time that chemical warfare has been used anywhere in the world in the 21st century.
For nearly 100 years, the international community has worked to build a system of defences to protect mankind against the use of weapons of mass destruction – including chemical weapons – to prevent the kind of attacks that are now taking place in Syria.
The First World War exposed the sheer horror that chemical agents inflict. Ninety thousand soldiers on all sides died agonising, choking deaths from the use of mustard gas, chlorine and phosgene on the battlefield, and up to 1.3 million people were blinded or burned by them. Wilfred Owen wrote in searing terms of the “froth-corrupted lungs” and “incurable sores” of his fallen comrades. Chemical weapons developed since that war, such as nerve gases, are even deadlier than those of a century ago.
The power of these weapons to inflict mass, indiscriminate death shocked the world into banning their use in international conflict through the 1925 Geneva Gas Protocol. Customary international law now completely prohibits their use, including in internal conflicts like that taking place in Syria.
There have been decades of painstaking work to construct an international regime of rules and checks, overseen by the UN, to prevent the use of chemical weapons and to destroy stockpiles. This is codified in the 1993 UN Chemical Weapons Convention, which seeks the complete global elimination of chemical weapons – a treaty that Syria refused to sign.
With a few horrendous exceptions, including the Iran-Iraq War and Saddam Hussein’s campaign against Iraqi Kurds in the 1980s, the global consensus surrounding the use of chemical weapons in war has held firm. Countries like our own have been able to focus their efforts on trying to universalise the UN Convention, and keep chemical weapons out of the hands of terrorists.
We all live under the protection of this global system of arms control, just as the Nuclear Non-Proliferation Treaty has spared us from the threat of nuclear holocaust, which blighted my parents’ generation. These rules and conventions are a largely invisible part of the global landscape and are undoubtedly in our national interest. The work of maintaining and upholding them is a constant struggle in international diplomacy, and the events in Syria have the power to undermine them fatally.
Over the past year we have seen evidence of the repeated small-scale use of chemical weapons by the Syrian regime. We know this from physiological samples that have been smuggled out of Syria and from other sources of information.
This amounts to extensive, continuous and escalating use of chemical weapons by a state against its own citizens. We have tried to deter the Syrian regime from continuing these attacks, by raising our concerns at the United Nations Security Council and passing direct messages through diplomatic channels, working with Russia. But last week’s large-scale attack shows the regime has simply ignored these warnings.
We strongly support the work of the UN team on the ground in Syria. We hope that the information they obtain will help build a fuller picture of the attack – adding to the evidence which already exists – and to help ensure that those responsible for this war crime are held accountable.
The team has a mandate to gather evidence about the attack, but they are not empowered to determine who was responsible for it. All the evidence and information available to us, including from eye-witnesses, leaves us in no doubt that the Assad regime was responsible. The attack took place in an area already controlled by the opposition; regime forces were carrying out a military operation to clear that area; and there is no evidence that the opposition possess any chemical weapons stocks, let alone the capability required to deliver them on the scale needed to cause mass casualties.
For five days after the attack the regime bombarded the area with conventional weapons, refusing to allow UN inspectors to visit, during which time crucial evidence would have been destroyed or degraded. To argue that the Syrian opposition carried out this attack is to suggest that they attacked their own supporters in an area they already controlled using weapons systems they do not possess. This opinion is shared by our allies and by countries in the region. Yesterday the Arab League passed a resolution stating that it holds Bashar al-Assad and the government in Damascus responsible.
We cannot allow the use of chemical weapons in the 21st century to go unchallenged. That would send a signal to the Syrian regime that they will never face any consequences for their actions, no matter how barbarous. It would make further chemical attacks in Syria much more likely, and also increase the risk that these weapons could fall into the wrong hands in the future.
But this is not just about one country or one conflict. We cannot afford the weakening of the global prohibition against the use of chemical weapons. We must proceed in a careful and thoughtful way, but we cannot permit our own security to be undermined by the creeping normalisation of the use of weapons that the world has spent decades trying to control and eradicate.
This actual, repeated use of chemical weapons in Syria is a moral outrage, a serious violation of international humanitarian law and a challenge to our common security. We are now weighing with the United States and our other allies how to respond in a way that is legal and proportionate. The goal of any response should be to prevent further similar humanitarian distress, to deter the further use of chemical weapons in Syria and to uphold the global ban against their use.
The United Nations Security Council should rise to its responsibilities by condemning these events and calling for a robust international response. But all previous attempts to get the Security Council to act on Syria have been blocked, and we cannot allow diplomatic paralysis to be a shield for the perpetrators of these crimes.
Tomorrow, Parliament will have the opportunity to debate these issues, and to make its views known. This is a moment of grave danger for the people of Syria, a moment of truth for democratic nations to live up to their values, and a weighty test of the international community. The way ahead will not be without risks, but the risks of doing nothing are greater.
Monday, August 26, 2013
Access to Cancer Drugs in Wales
The Rarer Cancers Foundation has opened a can of worms today by informing us that people living in Wales and suffering from cancer are four times less likely to receive new cancer drugs than if they lived in England. Actually, this can of worms has been open ever since the National Asembly for Wales was voted into being in 1999. Health care is devolved and inevitably, differences in approach will be taken each side of Offa's Dyke. Fair enough in principle. But I live where this difference is most noticeable. Most of my constituents are referred to 'English' oncologists, but they live in Wales and their access to cancer drugs is limited by the Welsh Gov't. This is a recipe for public confusion and discontent.
But this debate is not as straight forward as much of today's reporting will portray. The position is that the Dep't of Health has decided to establish a Cancer Drugs Fund for England, which enables doctors to prescribe new cancer drugs which have not been fully and formally recommended by NICE, the National Institute for Clinical Excellence - (or 'Control of Expenditure! as its sometimes known). The Welsh Gov't does not treat cancer as a special case in accessing new drugs, believing its approach to be fairer to all patients. There is no special access to a cancer drugs fund in Wales.
I have taken an interest in this issue for many years - fuelled by my own experience of bowel cancer in 2002. So happens, I was not prescibed drugs. The tumour had not spread and the butchery was enough to do the job. But the experience was traumatic enough to give me an understanding of how I might have felt to be told I needed a specific drug - and then to be told that because I lived in Berriew (Wales) I couldn't have it. But if I lived 10 miles away, in England I could. This is not just hypothetical. Its exactly what happened to another Berriew man recently, Bernie Gill. He was refused access to a drug recommended by his oncologist. Sadly, Bernie died a few weeks ago.
I fully accept that its constitutionally proper to have different approaches to health care each side of the England /Wales border, whether it be access to free prescriptions or waiting times for treatment of variable length. But access to life-prolonging or life-saving drugs is a step too far for public acceptance, in my opinion. The issue is just too sensitive. The context in which the debate takes place is just too traumatic. Nothing does more damage to devolution in Montgomeryshire than this. Personally I do not join in the criticism of the Welsh Gov't over this issue, even if I do think the Cancer Drugs Fund is a good idea. But I do think the UK and Welsh Gov'ts should make a real effort to work together in this most sensitive of policy areas to deliver us a common England and Wales system.
But this debate is not as straight forward as much of today's reporting will portray. The position is that the Dep't of Health has decided to establish a Cancer Drugs Fund for England, which enables doctors to prescribe new cancer drugs which have not been fully and formally recommended by NICE, the National Institute for Clinical Excellence - (or 'Control of Expenditure! as its sometimes known). The Welsh Gov't does not treat cancer as a special case in accessing new drugs, believing its approach to be fairer to all patients. There is no special access to a cancer drugs fund in Wales.
I have taken an interest in this issue for many years - fuelled by my own experience of bowel cancer in 2002. So happens, I was not prescibed drugs. The tumour had not spread and the butchery was enough to do the job. But the experience was traumatic enough to give me an understanding of how I might have felt to be told I needed a specific drug - and then to be told that because I lived in Berriew (Wales) I couldn't have it. But if I lived 10 miles away, in England I could. This is not just hypothetical. Its exactly what happened to another Berriew man recently, Bernie Gill. He was refused access to a drug recommended by his oncologist. Sadly, Bernie died a few weeks ago.
I fully accept that its constitutionally proper to have different approaches to health care each side of the England /Wales border, whether it be access to free prescriptions or waiting times for treatment of variable length. But access to life-prolonging or life-saving drugs is a step too far for public acceptance, in my opinion. The issue is just too sensitive. The context in which the debate takes place is just too traumatic. Nothing does more damage to devolution in Montgomeryshire than this. Personally I do not join in the criticism of the Welsh Gov't over this issue, even if I do think the Cancer Drugs Fund is a good idea. But I do think the UK and Welsh Gov'ts should make a real effort to work together in this most sensitive of policy areas to deliver us a common England and Wales system.
Saturday, August 17, 2013
More on the 'Fracking' Debate
Had a text today from a friend in the food retail business, who has experience of being informed by the local police that safety of her business and people who worked within it could not be protected from a large gathering of protesters - animal rights extremist campaigners. She had been very frightened for her safety at the time. While she was supportive of peaceful legal protest, she thought it wrong that businesses going about lawful work should be harmed or stopped from operating. It was the decision by the police in West Sussex to 'advise' Cuadrilla that they could not provide protection and should cease to operate while the protest continues that instigated her text. Must admit this sort of threatening behaviour transfers my sympathy from the protesters to the 'frackers'.
It seems that the Church of England's sympathies are headed in the same direction. A few days ago we learned of reports from the Diocese of Blackburn that 'fracking' is a threat to God's Creation. I thought at the time it was a bizarre comment, and was surprised that the BBC gave it any coverage at all. Charles Moore, in the Telegraph today recalls the very same Church condemning the Thatcher Gov't for 'tearing the heart out of communities' by closing uneconomic coal mines. Work that one out! By today it seems the Church of England has done an about-turn and is now in favour of 'fracking' - and compares those who oppose it as akin to those who scaremongered about the MMR vaccine which caused the recent Measles outbreak.
Personally, I want to know if 'fracking' for shale gas is environmentally safe before committing to it. But its worth lifting a couple of points from the Charles Moore article. As much energy is produced on 4 hectares of shale gas producing land as the entire British wind farm industry. And because of where the Bowland Basin is located, cities of past glories like Liverpool will be given a real opportunity of renaissance. The reason the Church of England is so supportive of finding out the potential of shale gas is the impact it may have on the cost of living, particular for the poorest in society, and the creation of employment and prosperity outside of the South East corner of England. I cannot help but feel that much of the antipathy to shale gas is the threat it represents to wind turbines and the infrastructure needed to support it, so illogically loved by the BBC and others. When I think of a legitimate business being forced by intimidation to cease operating, see the BBC pursuing its usual agenda of huge imbalance in reporting positive/negative aspects of the shale gas story, and learn that it may kill off the proposals to desecrate the Mid Wales landscapes with 600 turbines and 100 miles of cable, I feel my sympathy in this debate heading one way only!
It seems that the Church of England's sympathies are headed in the same direction. A few days ago we learned of reports from the Diocese of Blackburn that 'fracking' is a threat to God's Creation. I thought at the time it was a bizarre comment, and was surprised that the BBC gave it any coverage at all. Charles Moore, in the Telegraph today recalls the very same Church condemning the Thatcher Gov't for 'tearing the heart out of communities' by closing uneconomic coal mines. Work that one out! By today it seems the Church of England has done an about-turn and is now in favour of 'fracking' - and compares those who oppose it as akin to those who scaremongered about the MMR vaccine which caused the recent Measles outbreak.
Personally, I want to know if 'fracking' for shale gas is environmentally safe before committing to it. But its worth lifting a couple of points from the Charles Moore article. As much energy is produced on 4 hectares of shale gas producing land as the entire British wind farm industry. And because of where the Bowland Basin is located, cities of past glories like Liverpool will be given a real opportunity of renaissance. The reason the Church of England is so supportive of finding out the potential of shale gas is the impact it may have on the cost of living, particular for the poorest in society, and the creation of employment and prosperity outside of the South East corner of England. I cannot help but feel that much of the antipathy to shale gas is the threat it represents to wind turbines and the infrastructure needed to support it, so illogically loved by the BBC and others. When I think of a legitimate business being forced by intimidation to cease operating, see the BBC pursuing its usual agenda of huge imbalance in reporting positive/negative aspects of the shale gas story, and learn that it may kill off the proposals to desecrate the Mid Wales landscapes with 600 turbines and 100 miles of cable, I feel my sympathy in this debate heading one way only!
End of Season Premiership Table
First day of new Premiership season. Here's my prediction for the last day.
1st - Manchester City
2nd - Manchester Utd
3rd - Chelsea
4th - Arsenal
5th - Spurs
6th -Liverpool
8th - Everton
9th - Southampton
10th - Fulham
11th - Aston Villa
12th - Cardiff
13th - Swansea
14th - West Ham
15th - West Brom
16th - Newcastle
17th- Norwich
18th - Stoke
19th - Crystal Palace
20th - Hull City
1st - Manchester City
2nd - Manchester Utd
3rd - Chelsea
4th - Arsenal
5th - Spurs
6th -Liverpool
8th - Everton
9th - Southampton
10th - Fulham
11th - Aston Villa
12th - Cardiff
13th - Swansea
14th - West Ham
15th - West Brom
16th - Newcastle
17th- Norwich
18th - Stoke
19th - Crystal Palace
20th - Hull City
Thursday, August 15, 2013
Future of Stroke Services for Mid Wales and Shropshire
For many years I have taken a close interest in Shropshire NHS services because they are so important to Montgomeryshire. I want services we depend on to be as accessible as reasonably possible. And I was warned 30+ yrs ago that Shropshire could not support two DGHs. The warning came from Dr Paul Brown, who was the top 'guts' specialist and a squash playing colleague. He was fiercly opposed to the building of The Princess Royal Hospital. He predicted it would eventually mean the closure of The Royal Shrewsbury - though I do not believe this will happen. We discussed it a lot, and I've always known the day would come when reality would have to be addressed. A few yrs ago the plan was to build one new hospital to replace the the current two at Shrewsbury and Telford on a new site between the towns. Would cost best part of a £billion. Not feasible. So we are looking at a genuine merger into one hospital on two sites. The horrors of the Mid Staffs scandal has forced the issue. This post is about one aspect which typifies the questions that must be faced - stroke services.
Last June, the Trust was faced with a consultancy staffing gap at Shrewsbury, and felt there was no option but to transfer all hyper-acute and acute stroke services to Telford for a two month period. Stoke rehab was still at Royal Shrewsbury. A review of how it had gone was carried out on Aug 1st. This is what the Trust tell us emerged.
"The meeting received clear feedback that a single site hyper-acute and acute stroke service is delivering positive benefits for stoke patients."
In the first six weeks of operation, 129 patients were seen, half of whom would normally have been treated at Shrewsbury. 12% of patients were thrombolysed compared with 10% in the previous 7 mths. Transfer time led to no missed opportunities to thrombolyse. 95% of patients were admitted to the ward within 4 hours rather than 75%. 94% of patients received CT scanning as opposed to 87%. 99% of patients received at least 90% of care in an acute stroke unit as opposed to 84%. Now I've been around long enough to know that you can prove anything with statistics. But these outcomes must give us a difficult bone to chew on.
What we are being told is that the temporary move to 'maintain' services in the face of staffing problems has actually led to an 'improved' service with better outcomes - reduced mortality, reduced morbidity, reduced disability and shortened recovery times. We are also being told that clinicians have raised concerns that these improved standards (which have described to me as "astonishing") could not be maintained if the service returns to a two-site model as programmed in September. Now this puts the hospital bosses (and me) in a bit of a quandary. How can I ask for an early return to a model which we are told will lead a reduced service in an area of care in which I have a special interest.
Decisions. The Trust has decided to extend the single site service until Oct 14th to reinforce review findings. The Trust also proposes that an assessment should then be made about the way forward over the next year. The Trust will look at impact on pre-hospital, in-hospital and post-hospital care, considering access, clinical outcomes, patient experience, feasibility and wider operational impact. I feel I need another discussion with hospital bosses for satisfaction that we are not being fed stats that lead inexorably to their favoured conclusion. This will be done.
But the big issue for me is the longer term. I fully accept that a review of how best to deliver services across the range of care must take place. I'm keen that Montgomeryshire plays a part in this review. I have written to the Chair of the Powys CHC to ensure this happens. And its absolutely crucial that the 'interim' arrangements for stroke care do not rule out that the single site of future stroke care provision (if thats what is decided) could be in Shrewsbury. I warned you this was not a straight forward issue.
Last June, the Trust was faced with a consultancy staffing gap at Shrewsbury, and felt there was no option but to transfer all hyper-acute and acute stroke services to Telford for a two month period. Stoke rehab was still at Royal Shrewsbury. A review of how it had gone was carried out on Aug 1st. This is what the Trust tell us emerged.
"The meeting received clear feedback that a single site hyper-acute and acute stroke service is delivering positive benefits for stoke patients."
In the first six weeks of operation, 129 patients were seen, half of whom would normally have been treated at Shrewsbury. 12% of patients were thrombolysed compared with 10% in the previous 7 mths. Transfer time led to no missed opportunities to thrombolyse. 95% of patients were admitted to the ward within 4 hours rather than 75%. 94% of patients received CT scanning as opposed to 87%. 99% of patients received at least 90% of care in an acute stroke unit as opposed to 84%. Now I've been around long enough to know that you can prove anything with statistics. But these outcomes must give us a difficult bone to chew on.
What we are being told is that the temporary move to 'maintain' services in the face of staffing problems has actually led to an 'improved' service with better outcomes - reduced mortality, reduced morbidity, reduced disability and shortened recovery times. We are also being told that clinicians have raised concerns that these improved standards (which have described to me as "astonishing") could not be maintained if the service returns to a two-site model as programmed in September. Now this puts the hospital bosses (and me) in a bit of a quandary. How can I ask for an early return to a model which we are told will lead a reduced service in an area of care in which I have a special interest.
Decisions. The Trust has decided to extend the single site service until Oct 14th to reinforce review findings. The Trust also proposes that an assessment should then be made about the way forward over the next year. The Trust will look at impact on pre-hospital, in-hospital and post-hospital care, considering access, clinical outcomes, patient experience, feasibility and wider operational impact. I feel I need another discussion with hospital bosses for satisfaction that we are not being fed stats that lead inexorably to their favoured conclusion. This will be done.
But the big issue for me is the longer term. I fully accept that a review of how best to deliver services across the range of care must take place. I'm keen that Montgomeryshire plays a part in this review. I have written to the Chair of the Powys CHC to ensure this happens. And its absolutely crucial that the 'interim' arrangements for stroke care do not rule out that the single site of future stroke care provision (if thats what is decided) could be in Shrewsbury. I warned you this was not a straight forward issue.
Wednesday, August 14, 2013
Facing up to the Shale Gas Question
Having a few emails condemning my support for shale gas. Which is interesting in that I've not declared any such support. Its true that I do think no UK Gov't can avoid establishing what the potential of this energy source is, and whether it is recoverable at acceptable financial and environmental cost. I do try to base my judgement on evidence, and assessment of benefits or otherwise. So lets consider some of what we think we know so far.
There is a lot of shale gas under the UK. The Bowland Basin, an area covering much of Lancashire, Cheshire and an area to the East contains enough gas to supply the UK's gas needs for 50 yrs, even if only 10% of is accessible. This is a bigger deal than North Sea oil. And it seems there may be another massive resource in the Weald Basin as well. And we haven't looked everywhere yet. We also know that the exploitation of shale gas has transformed the US economy, and is making the US independent of energy supplies from the the Middle East. However we do not know how accessible or recoverable this amazing resource is - or how much of it can realistically be recovered. But already we know shale gas has the potential to transform the British economy, and in particular create a wealth boom away from the South-East.
It does seem that the Coalition Gov't is becoming increasingly enthusiastic. I've felt that George Osborne has been supportive for some time - and Owen Paterson - and Michael Fallon. But now the Prime Minister has come out with all guns blazing as well. And even Lib Dem Energy Sec. of State is in favour. But there are also opponents, particularly on the Lib Dem benches. Not sure whether this is driven by a genuine concern about 'fracking' or a fear that their beloved wind turbines will become obsolete.
Anyway, I need to learn a lot more about shale gas. Are the scare stories just scare stories, or does the opposition have genuine substance. How intrusive are the wells in the open countryside. Similar oil wells have been accepted with little fuss. And I need to talk through the business case and the practical difficulties with people who know. So I have a meeting with Cuadrilla arranged soon after Parliament resumes in Sept.. And I intend to arrange a visit to an existing well site to see for myself. We are facing what may be a transformative economic opportunity, acceptable in environment terms, which we would be deeply unwise to ignore. We (and I) need to decide.
There is a lot of shale gas under the UK. The Bowland Basin, an area covering much of Lancashire, Cheshire and an area to the East contains enough gas to supply the UK's gas needs for 50 yrs, even if only 10% of is accessible. This is a bigger deal than North Sea oil. And it seems there may be another massive resource in the Weald Basin as well. And we haven't looked everywhere yet. We also know that the exploitation of shale gas has transformed the US economy, and is making the US independent of energy supplies from the the Middle East. However we do not know how accessible or recoverable this amazing resource is - or how much of it can realistically be recovered. But already we know shale gas has the potential to transform the British economy, and in particular create a wealth boom away from the South-East.
It does seem that the Coalition Gov't is becoming increasingly enthusiastic. I've felt that George Osborne has been supportive for some time - and Owen Paterson - and Michael Fallon. But now the Prime Minister has come out with all guns blazing as well. And even Lib Dem Energy Sec. of State is in favour. But there are also opponents, particularly on the Lib Dem benches. Not sure whether this is driven by a genuine concern about 'fracking' or a fear that their beloved wind turbines will become obsolete.
Anyway, I need to learn a lot more about shale gas. Are the scare stories just scare stories, or does the opposition have genuine substance. How intrusive are the wells in the open countryside. Similar oil wells have been accepted with little fuss. And I need to talk through the business case and the practical difficulties with people who know. So I have a meeting with Cuadrilla arranged soon after Parliament resumes in Sept.. And I intend to arrange a visit to an existing well site to see for myself. We are facing what may be a transformative economic opportunity, acceptable in environment terms, which we would be deeply unwise to ignore. We (and I) need to decide.
Tuesday, August 13, 2013
Introduction to Reorganisation of Shropshire NHS Services.
I've always taken a close interest in how the NHS is organised in Shropshire - despite it sometimes has been difficult to engage interest in Montgomeryshire. But I've stuck at it. Its also the case since devolution in 1999 (with health being devolved) that the Welsh Gov't has been keen that Welsh patients be treated in Wales wherever possible, rather than across Offa's Dyke in England. But this applies only to patients needing elective surgery of course. Those needing urgent or emergency treatment are still sent to Shrewsbury and Telford because they are nearer. I've always been antagonistic to this approach. Firstly, it has in my opinion inevitably led to less consideration for Montgomeryshire when services are being reconfigured in Shropshire. And it would not be surprising if some resentment might be engendered when the work with potential for 'profit' is retained in Wales, while work with potential for 'loss' is sent over the border.
Anyway last week NHS leaders in Shropshire announced a comprehensive review of services. Not a surprise. Three of the top bosses have announced that over the next six to nine months they will be leading a debate across Shropshire, Telford and Wrekin and Mid Wales focusing on how to provide acute and community services that best meet the needs of urban and rural communities. This is extremely important to Montgomeryshire - which is why I spent this afternoon travelling over to the Princess Royal Hospital in Telford to discuss this with Peter Herring, Chief Exec of the Shrewsbury and Telford NHS Hospitals Trust.
There are several drivers behind this process. Firstly, the fact that we are living longer disproportionately increases the demand on NHS services. Increased demand is putting ever more pressure on a system never designed for such a workload. But secondly (and this has an effect on me personally) there are the horrors of what happened in Mid Staffordshire. Huge numbers of vulnerable people dying as a result of unacceptably poor care. We can no longer take the risk of allowing acute services to operate without the presence of a consultant with the appropriate skills. This makes it very difficult in Shropshire, which is effectively one hospital split on two sites. This is driving the need for debate. The shadow of Mid Staffs is dark and long.
Most concern seems to about A&E. Media are reporting the possibility of one of the two hospitals losing its A&E. While I do not think this at all likely, (and was specifically ruled out in the announcement letter) I do think we could end up with two rather different A&Es. There could be one with a focus on major accidents and wounds associated with violence, while the other could be more focused on heart attacks, strokes etc. Such an arrangement might enable more patients to move straight to the treatment bed, bypassing A&E altogether. It could be an improvement.
Far to early to take a view on all this yet. My interest (and the reason I've always taken a close involvement in Shropshire health matters) is that I want the best access possible for patients from Montgomeryshire. And I want them to be an integral part of the discussions. I have written to the Powys Community Health Council asking that public meetings be held in Llanidloes, Newtown, Welshpool and Llanfyllin when we have more idea of what the discussion is about - probably early in 2014. There will be several aspects of this issue which will appear on this blog site over the next few months.
Anyway last week NHS leaders in Shropshire announced a comprehensive review of services. Not a surprise. Three of the top bosses have announced that over the next six to nine months they will be leading a debate across Shropshire, Telford and Wrekin and Mid Wales focusing on how to provide acute and community services that best meet the needs of urban and rural communities. This is extremely important to Montgomeryshire - which is why I spent this afternoon travelling over to the Princess Royal Hospital in Telford to discuss this with Peter Herring, Chief Exec of the Shrewsbury and Telford NHS Hospitals Trust.
There are several drivers behind this process. Firstly, the fact that we are living longer disproportionately increases the demand on NHS services. Increased demand is putting ever more pressure on a system never designed for such a workload. But secondly (and this has an effect on me personally) there are the horrors of what happened in Mid Staffordshire. Huge numbers of vulnerable people dying as a result of unacceptably poor care. We can no longer take the risk of allowing acute services to operate without the presence of a consultant with the appropriate skills. This makes it very difficult in Shropshire, which is effectively one hospital split on two sites. This is driving the need for debate. The shadow of Mid Staffs is dark and long.
Most concern seems to about A&E. Media are reporting the possibility of one of the two hospitals losing its A&E. While I do not think this at all likely, (and was specifically ruled out in the announcement letter) I do think we could end up with two rather different A&Es. There could be one with a focus on major accidents and wounds associated with violence, while the other could be more focused on heart attacks, strokes etc. Such an arrangement might enable more patients to move straight to the treatment bed, bypassing A&E altogether. It could be an improvement.
Far to early to take a view on all this yet. My interest (and the reason I've always taken a close involvement in Shropshire health matters) is that I want the best access possible for patients from Montgomeryshire. And I want them to be an integral part of the discussions. I have written to the Powys Community Health Council asking that public meetings be held in Llanidloes, Newtown, Welshpool and Llanfyllin when we have more idea of what the discussion is about - probably early in 2014. There will be several aspects of this issue which will appear on this blog site over the next few months.
Sunday, August 11, 2013
Hiring immigrant labour.
Today's Telegraph has a headline which activated my interest. It read 'Tesco hiring immigrants on the cheap, says Labour'. It seems that a Labour MP intends to make what's termed a 'keynote' speech tomorrow in which he intends to name Tesco and Next as being 'unscrupulous employers' and being 'guilty' of employing immigrant labour at rates lower than would be paid to British labour. I suppose this sort of talk feeds into the paranoia which surrounds the whole immigration debate. Anyway, its an issue that did once crop up in my experience. I will share it with you, dear reader - in a 'factual' rather than an 'opinionated' way.
Between 1999-2007, I represented Mid and West Wales in the National Assembly for Wales. Around ten years ago I was approached by several constituents, including councillors in one of the towns (not going to identify it) complaining about an influx of hundreds of Poles who were taking all the jobs of locals, and behaving in a threatening way, preventing local people being able to walk their own streets. I decided to raise these concerns with the local Police, and with two of the employers who were deemed 'guilty' of bringing all these Poles in. Let me share with you what I was told. Firstly, the Police. They had not received a single complaint, though people had discussed the issue with them. Its true that there were a lot of young men, sometimes loud and boisterous, outside pubs, in largish groups speaking in a foreign language, Polish. The Police told me there had not been any trouble at all. None.
My discussion with the employers was even more interesting. For years both had not been able to recruit enough dependable staff locally. The benefit system was encouraging potential employees to accept a job, and leave after a few days. The recruitment process was so costly, they both decided to enter into contract with an agency, which bussed in workers every day. For some reason (which I cannot recall) the agreement terminated, and a new agency was engaged, which sent nothing but Polish immigrants - lots of them. They were described as excellent workers, enthusiastic, committed and dependable. Far from costing less, they were actually more expensive than local employees. Both businesses were mostly employing labour at around minimum wage - but plus the agency fee for the Poles. Very soon, the Poles stopped being bussed in, and rented flats and houses locally. Generally they were said to be hard-working, family orientated, church-going with many keen to attend English language classes.
At the time, I thought the sudden influx of so many Polish workers all together may well cause trouble. It did not. I still think it would have been better if there had been some control on numbers at the time, but it was absolutely not true that local businesses were employing immigrants because they were 'unscrupulous employers'. Come to think of it, it was a Labour Gov't in power at the time. Brass necks come to mind.
And that's what I thought of when I read today's Telegraph article. Must admit I might have been influenced by an interest in the Second World War, and the suffering of the Polish nation on behalf of the allies. There may even actually be something in the 'keynote' speech I will definiely not be listening to, but I suspect that a lot of it will be b******.
Between 1999-2007, I represented Mid and West Wales in the National Assembly for Wales. Around ten years ago I was approached by several constituents, including councillors in one of the towns (not going to identify it) complaining about an influx of hundreds of Poles who were taking all the jobs of locals, and behaving in a threatening way, preventing local people being able to walk their own streets. I decided to raise these concerns with the local Police, and with two of the employers who were deemed 'guilty' of bringing all these Poles in. Let me share with you what I was told. Firstly, the Police. They had not received a single complaint, though people had discussed the issue with them. Its true that there were a lot of young men, sometimes loud and boisterous, outside pubs, in largish groups speaking in a foreign language, Polish. The Police told me there had not been any trouble at all. None.
My discussion with the employers was even more interesting. For years both had not been able to recruit enough dependable staff locally. The benefit system was encouraging potential employees to accept a job, and leave after a few days. The recruitment process was so costly, they both decided to enter into contract with an agency, which bussed in workers every day. For some reason (which I cannot recall) the agreement terminated, and a new agency was engaged, which sent nothing but Polish immigrants - lots of them. They were described as excellent workers, enthusiastic, committed and dependable. Far from costing less, they were actually more expensive than local employees. Both businesses were mostly employing labour at around minimum wage - but plus the agency fee for the Poles. Very soon, the Poles stopped being bussed in, and rented flats and houses locally. Generally they were said to be hard-working, family orientated, church-going with many keen to attend English language classes.
At the time, I thought the sudden influx of so many Polish workers all together may well cause trouble. It did not. I still think it would have been better if there had been some control on numbers at the time, but it was absolutely not true that local businesses were employing immigrants because they were 'unscrupulous employers'. Come to think of it, it was a Labour Gov't in power at the time. Brass necks come to mind.
And that's what I thought of when I read today's Telegraph article. Must admit I might have been influenced by an interest in the Second World War, and the suffering of the Polish nation on behalf of the allies. There may even actually be something in the 'keynote' speech I will definiely not be listening to, but I suspect that a lot of it will be b******.
Friday, August 09, 2013
Horse and Teak Balls as Art
After a month and more without access to my blog, have managed to get it fixed. And am just getting back into the swing of things with a blog about developments in the garden. New additions this year are a horse made from African oil drums, bought at Hampton Court Flower Show, and a few teak balls bought from Charlies at Coed-y-dinas. As is my practice I leave my spade in the photographs to give perspective. 
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