Anticipating major debate over next few months about extraction of shale gas in the UK. Note the certainty which is held by many significant persons, but I sense its too early to fully commit. but it does seem to me that establishing the potential is a no-brainer. Which is why I met with Cuadrilla, the shale gas developer this week. Would like to visit the Balcombe site in West Sussex to see what's happening, but Cuadrilla have only a couple of weeks left on site - and the drilling there does not involve hydraulic fracturing anyway! Looks like lots of noise and wrong target!
Lets start by considering what we know about potential benefits. Developing UK-sourced shale gas as a major part of our energy mix would create between 50,000 and 100,000 direct jobs, create thousands more jobs in the wider UK manufacturing sector, provide massive tax revenues to the Exchequer, reduce dependency on imports from unstable regions of the world, reduce carbon emissions in several different ways and spread prosperity within the UK from the South East to the North of England. Rather a good CV I'd say.
Major issue for me will be impact on landscape/environment. How much unsightly disturbance will be caused. It seems that the great thickness of the shale seam (far greater than in the US) will allow several wells to be clustered on the same site. I'm told that a site of just two hectares could incorporate 10 wells, creating around 1000 jobs. Compared with onshore wind, the impact on landscape would be small - and the gas would be moved by pipeline rather than pylons!
Hoping that the any opponents of shale gas and 'fracking' will comment outlining the downside. What are the negatives? Those sometimes used are just not credible after minimal research. There is no evidence whatsoever that 'fracking' causes earthquakes. And this stuff about shale gas coming out of taps with the drinking water has been shown to be total nonsense. But we do need to have a regulatory regime in place to ensure o threats to water tables, and that water supplies are adequate.
Not sure how much on an issue this is going to be in Wales. Should find out when the Welsh Affairs Committee look at 'Shale Gas in Wales'. The Bowland Basin comes South as far as Cheshire, but not into Wales at all I think. Its going to be a big, perhaps transformative issue.
Wednesday, September 11, 2013
Tuesday, September 10, 2013
Keeley
Last night at around 9.00 a baby granddaughter was delivered unto us. She is to be named Keeley. Here is a photograph of Tim, Adrienne, (no longer to be known as baby) Darragh and Keeley. Cute or what!
Friday, September 06, 2013
How to perfect the art of 'Cow-Tipping'.
Am writing this blogpost for the benefit of Margo Lillie, Dr of Zoology from the University of British Columbia who has been telling 'The Modern Farmer' that it is not physically possible to push over a cow which is sleeping standing up. She was challenging the myth that 'cow-tipping' as its known, is a sport Young Farmers indulge in after being ousted from their local pub after a skinful. Ms Lillie reckons her mathematical formula dispels the myth of 'cow-tipping'. She says the idea that drunk men could steal into fields and shove sleeping cows onto their sides is not only absurd but scientifically implausible - and that it would take two strong men to overturn a cow, and at least six if the cow woke up.
Ms Lillie's analysis is based on Newton's Second Law, which as we all know states that force is equal to mass multiplied by acceleration. To shove over a cow of normal size would require 1360 Newtons of force. Well I've news for the professor. I have knocked over many a cow off her feet on my own - though never when drunk and never when she's been asleep. Its just a matter of technique.
For it to work, the cow has to be fairly quiet, and distracted in some way - perhaps by placing a bowl of delicious food in front of her. You stand alongside the cow's neck and reach your arm over to the other side and approach her nose. Moving like lighting, insert two strongest fingers in the nostrils, and pull powerfully upwards and backwards. It helps if your other hand grips the cow's ear for a firmer hold. The cow will simply topple over towards you. You have to be agile enough to move out of the way as she falls, and avoid pulling her too far back - so as not to create danger from flailing hooves. Its essential to ensure the head continues to be forced backwards at all times - with a firm grip kept on the nostrils. If your fingers slip, move away smartly, especially if she looks cross. Should add that I'm not recommending this. I realise modern men are not what we used to be in my youth.
Ms Lillie's analysis is based on Newton's Second Law, which as we all know states that force is equal to mass multiplied by acceleration. To shove over a cow of normal size would require 1360 Newtons of force. Well I've news for the professor. I have knocked over many a cow off her feet on my own - though never when drunk and never when she's been asleep. Its just a matter of technique.
For it to work, the cow has to be fairly quiet, and distracted in some way - perhaps by placing a bowl of delicious food in front of her. You stand alongside the cow's neck and reach your arm over to the other side and approach her nose. Moving like lighting, insert two strongest fingers in the nostrils, and pull powerfully upwards and backwards. It helps if your other hand grips the cow's ear for a firmer hold. The cow will simply topple over towards you. You have to be agile enough to move out of the way as she falls, and avoid pulling her too far back - so as not to create danger from flailing hooves. Its essential to ensure the head continues to be forced backwards at all times - with a firm grip kept on the nostrils. If your fingers slip, move away smartly, especially if she looks cross. Should add that I'm not recommending this. I realise modern men are not what we used to be in my youth.
Saturday, August 31, 2013
My take on this week's recall of Parliament
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.
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.
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. 
. 
Thursday, July 18, 2013
Vatterfall Wind Power Ltd sidesteps local opinion
Received a nice innocent seeming letter from a Swedish energy giant today. As always with these giant energy subsidy junkies, these 'nice' letters are not what they seem. Vatterfall Wind Power Ltd has withdrawn Planning Application No M20070972 - a planning application for a under 50 mw wind farm in West Montgomeryshire. Such applications are dealt with by Powys County Council, the Local Planning Authority. For those of us who are opposed to desecration of the Mid Wales landscapes by multiple wind farms and National Grid pylons, this is bad news - because Vatterfall is submitting an over 50 mw wind farm application instead.
The new planning application will not go before the Local Planning Authority at all. Because its over 50 mw, it goes directly to the Secretary of State at the Dept of Energy and Climate Change. And the reason behind this is that Vatterfall think the Sec of State will ignore local opinion. This cynical move will be dressed up to demonstrate that its actually beneficial to the area!Its the way they tell 'em. Its a straight forward strategy to circumvent local opposition by going direct to DECC, which it knows cares not for local opinion or landscape or disturbance to populations in areas like Mid Wales, which are of no consequence. What really grates on me is that I will have to sit in Parliament listening to DECC Ministers talking about this lunacy as wonderful investment in rural Wales.
Personally, I do not think we will recover any sort of control of our own destinies until DECC is would up. The takeover of our lives by the EU has nothing on the bullying domineering attitudes of DECC, with its advance attack units of foreign owned giant subsidy swallowing energy companies and the even less responsive National Grid.
The new planning application will not go before the Local Planning Authority at all. Because its over 50 mw, it goes directly to the Secretary of State at the Dept of Energy and Climate Change. And the reason behind this is that Vatterfall think the Sec of State will ignore local opinion. This cynical move will be dressed up to demonstrate that its actually beneficial to the area!Its the way they tell 'em. Its a straight forward strategy to circumvent local opposition by going direct to DECC, which it knows cares not for local opinion or landscape or disturbance to populations in areas like Mid Wales, which are of no consequence. What really grates on me is that I will have to sit in Parliament listening to DECC Ministers talking about this lunacy as wonderful investment in rural Wales.
Personally, I do not think we will recover any sort of control of our own destinies until DECC is would up. The takeover of our lives by the EU has nothing on the bullying domineering attitudes of DECC, with its advance attack units of foreign owned giant subsidy swallowing energy companies and the even less responsive National Grid.
Peruvian Lilies
The garden is looking a bit jaded in the current hot spell. No garden has much of a chance when its pushing 30 degrees every day. But we have lots of alsteomerias to brighten things up. They come in a range of colours and heights. We have about 20 different varieties. They flower for a long time. And if you just pull them up after the flowers die off, they will reward with a second flush in a few weeks time. My favourite is the little red peruvian lily in the first photograph.
Saturday, July 13, 2013
Cheating in the Cattle Judging Ring
Following Stuart Broad's act of non-sportsmanship yesterday, the Telegraph today has a truly shocking story about dirty tricks at the Great Yorkshire Show. For 155 yrs, the finest cattle breeders from across Britain have entered their finest in the battle for rosettes. A 'first' or 'champion' rosette can put thousands on the value of a beast and more importantly 'bragging rights' in the livestock market bar. Its a matter of honour, and cheating is unthinkable. But it seems not at this yr's Great Yorkshire.
I used to be a judge of dairy cattle, and in my YFC days represented Wales at the Dairy Show in London. First time I visited the great city, and learned about things I didn't know existed. Key to the best dairy animal is the udder, its general shape, its firm atachment at the escutcheon preventing any tendancy to by pendulous, the neat positioning of the teats, and being nicely pushed forward along the underbelly. Rarely would one see a perfect udder, there always being some minor fault. But it seems these may have been corrected by using superglue. In order to give more firmness and shape to the udder, air may have been pumped in before the judging and the teat blocked with superglue. Now I've glued the odd petal into head of a Chrysanthemum or a Dahlia immediately before judging, but I do think to glue up a teat is going too far.
Its not that I'm claiming sharp practise is unheard of at agricultural shows. Dental work, bit of false colouring, and there was even glueing false hair to tidy up the top line not unheard of. Telegraph reports that a false tail has been glued on, though this is new one on me. But I really do draw the line at superglueing teats. I dread to thing what might be happening in the Bulls competition.
I used to be a judge of dairy cattle, and in my YFC days represented Wales at the Dairy Show in London. First time I visited the great city, and learned about things I didn't know existed. Key to the best dairy animal is the udder, its general shape, its firm atachment at the escutcheon preventing any tendancy to by pendulous, the neat positioning of the teats, and being nicely pushed forward along the underbelly. Rarely would one see a perfect udder, there always being some minor fault. But it seems these may have been corrected by using superglue. In order to give more firmness and shape to the udder, air may have been pumped in before the judging and the teat blocked with superglue. Now I've glued the odd petal into head of a Chrysanthemum or a Dahlia immediately before judging, but I do think to glue up a teat is going too far.
Its not that I'm claiming sharp practise is unheard of at agricultural shows. Dental work, bit of false colouring, and there was even glueing false hair to tidy up the top line not unheard of. Telegraph reports that a false tail has been glued on, though this is new one on me. But I really do draw the line at superglueing teats. I dread to thing what might be happening in the Bulls competition.
Friday, July 12, 2013
Presumed Consent - Sorry cannot edit for some reason
Something strange is happening in the Welsh Assembly.
Professor John Fabre
Professor Emeritus, Kings College London, and past President (1992 – 1995) of the British Transplantation Society.
In January 2008, the Guardian commentator Polly Toynbee referred to the argument for presumed consent for organ donation as a “fight with the forces of superstition and reaction” www.guardian.co.uk/commentisfree/2008/jan/15/politics.publicservices. In this spirit, the Welsh Assembly is proceeding apace with legislation to enable doctors to presume consent for donation unless the deceased person has registered their name on a national “opt-out” register or has unequivocally told their family that they do not wish to donate their organs. The mantra is that presuming consent in these circumstances will increase donation rates and save lives – a heroic banner by any reckoning, especially for politicians.
In 2007 the then Chief Medical Officer, Sir Liam Donaldson made presumed consent an important component of his plans for the NHS, and the then Prime Minister, Gordon Brown, considered it the foundation for his “transplant revolution”. However, against this strong tide, the Department of Health’s Organ Donation Taskforce, after the most comprehensive examination ever undertaken of presumed consent, reported in November 2008 against it. The Taskforce encompassed a large committee of experts, and the report ran to several hundred pages. Here is the their conclusion. “The Taskforce’s members came to this review of presumed consent with an open mind, with many sympathetic to the view that presumed consent seems an obvious step forward. However, the more the Taskforce examined the evidence, the less obvious the benefit, and the more multifaceted and multidimensional the issue of increasing organ numbers was revealed to be. It became clear that what appeared to be a simple idea to increase numbers may not in fact generate additional donors in sufficient numbers to justify the significant investment needed to put a new system into place. Moreover, there are risks in going down the opt out route which could impact negatively on organ donation. The Taskforce reached a clear consensus in their recommendation that an opt out system should not be introduced in the UK at the present time”.
Nothing has happened since November 2008 to justify a change in this recommendation. Quite the contrary. Donation rates in the UK have risen spectacularly from 2008, after being static or falling, since 1989/1990. The number of donors per annum over the years 2007 to 2012 have been 809, 899, 959 1010, 1088 and 1212. This represents a rise of 49.8% over the 5 years from the 2007 baseline. The donation rate is still rising – the early figures for 2013 show a rise of 9.5% over 2012. This remarkable transformation, which presumably would fit Gordon Brown’s definition of a transplant revolution, has of course been achieved without presumed consent. It is a direct consequence of the carefully considered recommendations made in January 2008 by the Department of Health’s Taskforce, mainly in the area transplant coordination (for example the identification and referral of potential donors within intensive care units). Another crucial area is of course consent, to which we shall return.
In their zeal to save lives and to blaze what they see as a bold new trail for Wales, and to set an example for the UK as a whole, Welsh Ministers and the large majority of Assembly Members are behaving in a rather depressing fashion. Uncomfortable truths are being ignored. False statements are being accepted without challenge. Silly propositions are being accepted as facts. Disingenuous statements are being made without obvious qualms. There appears to be a collective loss of common sense and suspension of critical judgement.
As often happens in these situations, we have rebranding. What is “presumed” consent in the rest of the world has become “deemed” consent in Wales. Whether one is deemed to have consented or presumed to have consented is a fine point – but in practice it is the same thing, and for the sake of clarity I shall stay with “presumed” consent.
Point 1. Spain and presumed consent .The fact that Spain does not operate a presumed consent system is being studiously ignored and sometimes misrepresented. This is important because Spain has consistently had the highest donation rate in the world, and the best consent rate. If the Assembly were to accept this simple truth it would have several crucial but uncomfortable implications - hence the averted gaze.
Spain passed presumed consent legislation in 1979. However, it was not until 1989, when crucial organisational changes were instituted, that Spain’s donation rate began to rise to the pre-eminent position it currently occupies. Many observers have, wrongly, attributed Spain’s success since 1989 to its presumed consent legislation. To correct this misconception, the Director of the Spanish Organ Donation Organisation, Dr Rafael Matesanz, was the senior author on a paper published in the British Medical Journal in October 2010 www.bmj.com/content/341/bmj.c4973. Here is what the paper says. “Crucially, Spain does not have an opt-out register for those who do not wish to become organ donors. Not a penny is spent on recording objections to organ donation by Spanish citizens, nor on public awareness of the 1979 legislation. Clearly, the presumed consent law in Spain is dormant, and it pre-dates key policy changes made in 1989. In these circumstances, Spain’s outstanding deceased organ donor rate cannot reasonably be attributed to its presumed consent laws”. How can there be a legally binding form of presumed consent without giving citizens the opportunity to opt out, and without even making any effort to inform citizens of the existence of the law? When this was pointed out to Lesley Griffiths, the former Minister for Health in Wales, she replied that the Assembly’s Social Research officials had found “…….a wide consensus in research papers which consistently categorise Spain as a country with an opt-out system of legislation”. That is true, but hardly a substantive response, on two counts. Lesley Griffiths and her successor Mark Drakeford must surely be aware that having presumed consent legislation is one thing, and operating a presumed consent system is quite another. Moreover, although most research papers over the years have indeed classified Spain as a presumed consent country, others have not, and the latter might be the better informed. The Ministers have simply gone with the majority because it suits them. When the Director of the Spanish Organ Donation Organisation seeks to explain the basis for the misconception about Spain and presumed consent, and makes it clear that Spain does not operate a presumed consent system, nobody seems to listen.
The Ministers seem unaware that in Spain the explicit consent of the family is required. The consent (presumed or explicit) of the donor is insufficient. The family must sign a permissions form for organ donation to proceed. The central role of the family is demonstrated in Spain’s approach to donor cards. Here is what the National Organ Donation Organisation (Organizacion Nacional de Trasplantes) website says: “The donor card is a document that testifies to our desire to be an organ donor after death. However, the card has no legal value. We need to tell our families our desire to be donors, to authorise the removal of organs after death” www.ont.es/informacion/Paginas/TarjetadeDonante.aspx. In Spain, the explicit consent of the donor at the time of death by the carrying of a donor card is not sufficient to permit donation. The responsibility for permitting donation rests with the family. In these circumstances, it is difficult to imagine how anyone can sensibly persist in the contention that Spain operates a presumed consent system.
Once it is accepted that Spain does not operate a presumed consent system, several issues need to be addressed:
• Lesley Griffith’s claim that the introduction of presumed consent legislation in Wales is an essential component of any strategy to improve donation begins to wear thin.
• Clause 102 of the Explanatory Memorandum to the Human Transplantation (Wales) Bill must be recognised as containing a misleading factual error. Under the heading of “Evidence base to establish impact of Proposed Legislation” it states “For example, an opt-out system is operated in Spain and it has the highest donation rate in the world…”. Such a false statement at the core of the official papers underpinning the proposed legislation makes a mockery of the democratic process, and could mislead Assembly Members to vote in favour of this controversial Bill.
• Several of the papers quoted as supporting the introduction of presumed consent (especially that by A. Abadie and S. Gay) incorrectly classify Spain as a presumed consent country.
Point 2. “Soft” or “hard” presumed consent - the proposed role of the family in Wales. The system proposed in Wales has consistently been described as “soft” presumed consent, to distinguish it from hard presumed consent where donation may proceed without consultation with the family. The importance of the family has been constantly stressed. For example, in an interview with The Observer in May 2010, the First Minister for Wales, Carwyn Jones, said “We have decided on soft presumed consent, where relatives can veto organ donation, because we want to make it as easy as possible” www.guardian.co.uk/society/2010/may/09/opt-out-organ-donation-wales. Clause 16 of the Stage 1 report of the Health and Social Care Committee (HSCC) states that “A soft opt-out system is one ……where the next of kin will be involved in the decision-making process”. In a letter dated February 2013 to a concerned Welsh citizen, a government official wrote “Organ donation will remain a clinical decision in which families are always involved” and “families will be fully involved in the decision-making process”.
However, the truth is that the family will not be involved in any substantive fashion. Doctors will check the opt-out register, and if the deceased person is not on it (and therefore consent can be presumed) the family will be consulted purely to confirm that the deceased person did not oppose donation. Clause 44A of the Explanatory Memorandum states that “the next of kin will be able to say whether they have any information that would lead a reasonable person to conclude that the deceased person would not have consented”. If they have not, it is proposed to proceed with the donation. Clause 245 of the HSCC report states that “The family are merely being asked if they have any information that the deceased would have objected”. Clause 253 of the HSCC report states that family members “are not being asked to make a decision on donation, but rather to provide information. This is because the deceased has already made a decision to have their consent deemed”.
It is clear that the family will not be asked for their views regarding donation. The repeated reassurances that the family will be involved in the decision-making process are plainly disingenuous. Wales is in fact proceeding with what most people would regard as hard presumed consent.
It is worth looking at the legal position. If someone makes it clear in their lifetime that they do not wish to donate their organs, for example by going on to the proposed opt-out register or indeed any opt-out register even if not backed by legislation, that is their legally recognised view. Nobody can overturn it, and doctors cannot remove their organs under any circumstances. Equally, if someone makes it clear that they do want to donate their organs, that too is their legally recognised view, and nobody can overturn it. However, doctors are under no legal obligation to comply with the deceased person’s wishes. Doctors can therefore use their discretion as to whether or not to proceed with donation, for example in the face of family opposition or distress or any other factor which might adversely affect transplantation. A family opposed to donation for whatever reason, and with sufficient social confidence to express their opposition to the process engulfing them, can in practice halt donation if they show severe distress or express strong views opposing donation.
Point 3. The wishes of the donor. The wishes of the deceased person are said to be of fundamental importance in all the discussions and documents emanating from the Assembly. However, there is quite obviously no way of ascertaining the wishes of a dead person who has not put their name on an opt out register, who has not subscribed to the existing Donor Register, and who has not discussed donation with their family. The reality is that the absence of an objection cannot be taken as a reliable basis for consent. It defies common sense to say so, however legally expedient it might be, and it is humbug to adopt the posture that the presumption of consent defends the wishes of the donor.
Point 4. The current system in the UK involves expressed consent from donors or their families - it is NOT an opt in system. It is frequently stated that the UK has an opt in system for organ donation (simply because it does not have an opt out system!). This is not the case, and it is a very important point to note. This misconception implies that the 69% of the UK population who have not joined the Donor Register cannot become donors, and is sometimes seen as an argument for presumed consent legislation. For example the BBC Wales political reporter Carl Roberts states today that the proposed presumed consent legislation “….would mean a change from the current opt-in system, where would-be donors have to sign a register”. Another example is a statement from the First Minister for Wales. In the interview mentioned in point 2 above he stated “At the moment, if people are not carrying donor cards then it is presumed that they didn’t want to be a donor”. This is completely wrong. If people are not on the Donor Register and do not carry a donor card, no presumption is made about their wishes. In the current system, where the wishes of the deceased person are not known, the decision rests with the family. It is of course very valuable to join the Donor Register. However, the reality is that more than 60% of organ donors in the UK have not joined the Donor Register.
Point 5. There is a “majority” in Wales in favour of the proposed legislation. Various surveys have shown that between 49% and ~65% of Welsh citizens are in favour of the proposed legislation. This usually just fits the mathematical definition of “majority”. However, for a controversial Bill affecting all citizens, this is what the French once referred to as “un petit oui” – a little yes. More importantly, those voting in favour assume that they are voting for a soft opt out system where the family is involved in a substantive fashion in the decision to donate. They also assume that there is no alternative to legislation. Respondents are unlikely to know that the country with the best donation rate in the world and the best consent rate does not operate a presumed consent system.
Point 6. The aspect of donation directly addressed by presumed consent legislation is consent. It has been repeatedly stated that the presumed consent legislation will be one of a package of measures to increase donation. However, there can be only one direct beneficial effect of presumed consent legislation - an improvement in the consent rate. All of the associated measures (e.g. publicity) can be instituted without the legislation. Moreover, some measures will have no effect on consent but improve donation by other means, for example by increasing admission of potential donors into Intensive Care Units. It would help to focus the debate to acknowledge that the legislation itself can improve donation only by improving consent rates.
The consent rate in the UK, i.e. the percentage of approached families who approved donation, was 56.7% in 2010 and 55.4% in 2011. The corresponding figures for Wales were 63.5% and 58.7% respectively. By contrast, the consent rates in Spain in 2010, 2011 and 2012 were 81%, 84% and 84%, without presumed consent. This is a huge difference, and represents a massive and dreadful waste of organs. If the consent rate in the UK could be increased to 80%, this would represent an increase in the donation rate of more than 40%. In Wales, it would represent an increase of ~30%, higher than that envisaged for the proposed legislation. This high level of consent has been consistently achieved in Spain by promoting better public understanding of transplantation, better public appreciation of its outstanding benefits, and optimal approaches to the family at the time of donation – not by legislation. This is surely achievable in Wales, and is an area where Wales could indeed lead the way for the rest of the UK.
Point 7. The recent fall in donation rates in Wales. The number of donors per annum in Wales over the six years 2007, 2008, 2009, 2010, 2011 and 2012 has been 45, 35, 41, 66, 67 and 52 respectively. These numbers are small, and it is essentially impossible to ascribe the large fluctuations in particular years to particular causes (e.g. the rise of 61% in 2010 and the fall of 22% in 2012). It is therefore unwise of those opposing presumed consent to attribute the fall in 2012 to possible negative effects of the proposed legislation. It is equally unwise of those promoting presumed consent to see the fall as a threat and to respond with unfounded blandishments. Here is what Mark Drakeford said in the debate in the Assembly on the 16th April. “What happened in the last year is simple when you understand it. It is not so much that the rates of organ donation went down, it is that the number of people who were able to be donors went down in the first half of that year. That is a good news story, because we do not want people to be in the awful circumstances where they can be donors”. The number of potential donors is influenced by many factors, for example the occupancy of ICU beds and hence the probability of admission of patients who might become donors, as well as other factors when the patient is in the ICU. To describe the fall in donor numbers as good for Welsh citizens, if not for transplantation, is nonsense.
Point 8. The “robust” international research. The research under-pinning the proposed legislation is almost invariably described as robust, presumably in order to give it greater authority. However, it is not so. The Department of Health’s Taskforce had concerns about the selective inclusion of countries for analysis in these research studies. This, and the incorrect assignation of Spain as a presumed consent country,are some of the problems.
But why cling to old studies with uncertain conclusions? The simplest and most convincing “international” research one can do is to look around the world today. If one does that, it is clear that two of the top five countries for organ donation (Spain and the United States of America) do not operate presumed consent systems.
Point 9. The “robust” assessment of the effects of the proposed legislation. Given the substantial effort that has already put into the proposed legislation by various Committees and Assembly Members, and the very substantial future costs, it is frequently stated to be of the utmost importance that the effects of the legislation be not just assessed, but “robustly” assessed. Given the major fluctuations in donation rates in Wales in recent years (noted in point 7 above), the fact that the legislation in Wales will be introduced along with several other measures such as a publicity campaign, and the fact that the Department of Health is planning to introduce additional improvements nationally in the coming years, it is plainly obvious to all except the most credulous that to disentangle the effects of the legislation in any meaningful way is impossible.
Point 10. The future. If additional donors are to come from the proposed legislation, it will be from families who are not happy about organ donation by their loved ones, but who lack the confidence to say so if it is left for them to oppose the system unasked. This is not a healthy foundation on which to build transplantation in Wales.
In the debate in the Assembly on the 16th April, Byron Davies, the Shadow Minister for Transport, gave his view that “…..when someone dies without giving or withholding consent, the family, as the surviving representatives of the deceased, has the final say”. That must surely be the principle on which to move forward in Wales. It is the principle on which the outstandingly successful Spanish system is based.
The tragic irony of all this activity and lobbying for legislation is that the objective of substantially improving donation rates is achievable more cheaply, more effectively and in a socially inclusive manner without legislation. Wales should aim for a consent rate of 80%, which the Spanish have achieved consistently for many years, without presumed consent. The idea that you can legislate for consent is naïve. Addressing the issue of consent in a considered and comprehensive manner is the next logical step to build on the success of 2008 – 2013, both in Wales and nationally.
Professor John Fabre
Professor Emeritus, Kings College London, and past President (1992 – 1995) of the British Transplantation Society.
In January 2008, the Guardian commentator Polly Toynbee referred to the argument for presumed consent for organ donation as a “fight with the forces of superstition and reaction” www.guardian.co.uk/commentisfree/2008/jan/15/politics.publicservices. In this spirit, the Welsh Assembly is proceeding apace with legislation to enable doctors to presume consent for donation unless the deceased person has registered their name on a national “opt-out” register or has unequivocally told their family that they do not wish to donate their organs. The mantra is that presuming consent in these circumstances will increase donation rates and save lives – a heroic banner by any reckoning, especially for politicians.
In 2007 the then Chief Medical Officer, Sir Liam Donaldson made presumed consent an important component of his plans for the NHS, and the then Prime Minister, Gordon Brown, considered it the foundation for his “transplant revolution”. However, against this strong tide, the Department of Health’s Organ Donation Taskforce, after the most comprehensive examination ever undertaken of presumed consent, reported in November 2008 against it. The Taskforce encompassed a large committee of experts, and the report ran to several hundred pages
Nothing has happened since November 2008 to justify a change in this recommendation. Quite the contrary. Donation rates in the UK have risen spectacularly from 2008, after being static or falling, since 1989/1990. The number of donors per annum over the years 2007 to 2012 have been 809, 899, 959 1010, 1088 and 1212. This represents a rise of 49.8% over the 5 years from the 2007 baseline. The donation rate is still rising – the early figures for 2013 show a rise of 9.5% over 2012. This remarkable transformation, which presumably would fit Gordon Brown’s definition of a transplant revolution, has of course been achieved without presumed consent. It is a direct consequence of the carefully considered recommendations made in January 2008 by the Department of Health’s Taskforce, mainly in the area transplant coordination (for example the identification and referral of potential donors within intensive care units). Another crucial area is of course consent, to which we shall return.
In their zeal to save lives and to blaze what they see as a bold new trail for Wales, and to set an example for the UK as a whole, Welsh Ministers and the large majority of Assembly Members are behaving in a rather depressing fashion. Uncomfortable truths are being ignored. False statements are being accepted without challenge. Silly propositions are being accepted as facts. Disingenuous statements are being made without obvious qualms. There appears to be a collective loss of common sense and suspension of critical judgement.
As often happens in these situations, we have rebranding. What is “presumed” consent in the rest of the world has become “deemed” consent in Wales. Whether one is deemed to have consented or presumed to have consented is a fine point – but in practice it is the same thing, and for the sake of clarity I shall stay with “presumed” consent.
Point 1. Spain and presumed consent .The fact that Spain does not operate a presumed consent system is being studiously ignored and sometimes misrepresented. This is important because Spain has consistently had the highest donation rate in the world, and the best consent rate. If the Assembly were to accept this simple truth it would have several crucial but uncomfortable implications - hence the averted gaze.
Spain passed presumed consent legislation in 1979. However, it was not until 1989, when crucial organisational changes were instituted, that Spain’s donation rate began to rise to the pre-eminent position it currently occupies. Many observers have, wrongly, attributed Spain’s success since 1989 to its presumed consent legislation. To correct this misconception, the Director of the Spanish Organ Donation Organisation, Dr Rafael Matesanz, was the senior author on a paper published in the British Medical Journal in October 2010 www.bmj.com/content/341/bmj.c4973. Here is what the paper says. “Crucially, Spain does not have an opt-out register for those who do not wish to become organ donors. Not a penny is spent on recording objections to organ donation by Spanish citizens, nor on public awareness of the 1979 legislation. Clearly, the presumed consent law in Spain is dormant, and it pre-dates key policy changes made in 1989. In these circumstances, Spain’s outstanding deceased organ donor rate cannot reasonably be attributed to its presumed consent laws”. How can there be a legally binding form of presumed consent without giving citizens the opportunity to opt out, and without even making any effort to inform citizens of the existence of the law? When this was pointed out to Lesley Griffiths, the former Minister for Health in Wales, she replied that the Assembly’s Social Research officials had found “…….a wide consensus in research papers which consistently categorise Spain as a country with an opt-out system of legislation”. That is true, but hardly a substantive response, on two counts. Lesley Griffiths and her successor Mark Drakeford must surely be aware that having presumed consent legislation is one thing, and operating a presumed consent system is quite another. Moreover, although most research papers over the years have indeed classified Spain as a presumed consent country, others have not, and the latter might be the better informed. The Ministers have simply gone with the majority because it suits them. When the Director of the Spanish Organ Donation Organisation seeks to explain the basis for the misconception about Spain and presumed consent, and makes it clear that Spain does not operate a presumed consent system, nobody seems to listen.
The Ministers seem unaware that in Spain the explicit consent of the family is required. The consent (presumed or explicit) of the donor is insufficient. The family must sign a permissions form for organ donation to proceed. The central role of the family is demonstrated in Spain’s approach to donor cards. Here is what the National Organ Donation Organisation (Organizacion Nacional de Trasplantes) website says: “The donor card is a document that testifies to our desire to be an organ donor after death. However, the card has no legal value. We need to tell our families our desire to be donors, to authorise the removal of organs after death” www.ont.es/informacion/Paginas/TarjetadeDonante.aspx. In Spain, the explicit consent of the donor at the time of death by the carrying of a donor card is not sufficient to permit donation. The responsibility for permitting donation rests with the family. In these circumstances, it is difficult to imagine how anyone can sensibly persist in the contention that Spain operates a presumed consent system.
Once it is accepted that Spain does not operate a presumed consent system, several issues need to be addressed:
• Lesley Griffith’s claim that the introduction of presumed consent legislation in Wales is an essential component of any strategy to improve donation begins to wear thin.
• Clause 102 of the Explanatory Memorandum to the Human Transplantation (Wales) Bill must be recognised as containing a misleading factual error. Under the heading of “Evidence base to establish impact of Proposed Legislation” it states “For example, an opt-out system is operated in Spain and it has the highest donation rate in the world…”. Such a false statement at the core of the official papers underpinning the proposed legislation makes a mockery of the democratic process, and could mislead Assembly Members to vote in favour of this controversial Bill.
• Several of the papers quoted as supporting the introduction of presumed consent (especially that by A. Abadie and S. Gay) incorrectly classify Spain as a presumed consent country.
Point 2. “Soft” or “hard” presumed consent - the proposed role of the family in Wales. The system proposed in Wales has consistently been described as “soft” presumed consent, to distinguish it from hard presumed consent where donation may proceed without consultation with the family. The importance of the family has been constantly stressed. For example, in an interview with The Observer in May 2010, the First Minister for Wales, Carwyn Jones, said “We have decided on soft presumed consent, where relatives can veto organ donation, because we want to make it as easy as possible” www.guardian.co.uk/society/2010/may/09/opt-out-organ-donation-wales. Clause 16 of the Stage 1 report of the Health and Social Care Committee (HSCC) states that “A soft opt-out system is one ……where the next of kin will be involved in the decision-making process”. In a letter dated February 2013 to a concerned Welsh citizen, a government official wrote “Organ donation will remain a clinical decision in which families are always involved” and “families will be fully involved in the decision-making process”.
However, the truth is that the family will not be involved in any substantive fashion. Doctors will check the opt-out register, and if the deceased person is not on it (and therefore consent can be presumed) the family will be consulted purely to confirm that the deceased person did not oppose donation. Clause 44A of the Explanatory Memorandum states that “the next of kin will be able to say whether they have any information that would lead a reasonable person to conclude that the deceased person would not have consented”. If they have not, it is proposed to proceed with the donation. Clause 245 of the HSCC report states that “The family are merely being asked if they have any information that the deceased would have objected”. Clause 253 of the HSCC report states that family members “are not being asked to make a decision on donation, but rather to provide information. This is because the deceased has already made a decision to have their consent deemed”.
It is clear that the family will not be asked for their views regarding donation. The repeated reassurances that the family will be involved in the decision-making process are plainly disingenuous. Wales is in fact proceeding with what most people would regard as hard presumed consent.
It is worth looking at the legal position. If someone makes it clear in their lifetime that they do not wish to donate their organs, for example by going on to the proposed opt-out register or indeed any opt-out register even if not backed by legislation, that is their legally recognised view. Nobody can overturn it, and doctors cannot remove their organs under any circumstances. Equally, if someone makes it clear that they do want to donate their organs, that too is their legally recognised view, and nobody can overturn it. However, doctors are under no legal obligation to comply with the deceased person’s wishes. Doctors can therefore use their discretion as to whether or not to proceed with donation, for example in the face of family opposition or distress or any other factor which might adversely affect transplantation. A family opposed to donation for whatever reason, and with sufficient social confidence to express their opposition to the process engulfing them, can in practice halt donation if they show severe distress or express strong views opposing donation.
Point 3. The wishes of the donor. The wishes of the deceased person are said to be of fundamental importance in all the discussions and documents emanating from the Assembly. However, there is quite obviously no way of ascertaining the wishes of a dead person who has not put their name on an opt out register, who has not subscribed to the existing Donor Register, and who has not discussed donation with their family. The reality is that the absence of an objection cannot be taken as a reliable basis for consent. It defies common sense to say so, however legally expedient it might be, and it is humbug to adopt the posture that the presumption of consent defends the wishes of the donor.
Point 4. The current system in the UK involves expressed consent from donors or their families - it is NOT an opt in system. It is frequently stated that the UK has an opt in system for organ donation (simply because it does not have an opt out system!). This is not the case, and it is a very important point to note. This misconception implies that the 69% of the UK population who have not joined the Donor Register cannot become donors, and is sometimes seen as an argument for presumed consent legislation. For example the BBC Wales political reporter Carl Roberts states today that the proposed presumed consent legislation “….would mean a change from the current opt-in system, where would-be donors have to sign a register”
Point 5. There is a “majority” in Wales in favour of the proposed legislation. Various surveys have shown that between 49% and ~65% of Welsh citizens are in favour of the proposed legislation. This usually just fits the mathematical definition of “majority”. However, for a controversial Bill affecting all citizens, this is what the French once referred to as “un petit oui” – a little yes. More importantly, those voting in favour assume that they are voting for a soft opt out system where the family is involved in a substantive fashion in the decision to donate. They also assume that there is no alternative to legislation. Respondents are unlikely to know that the country with the best donation rate in the world and the best consent rate does not operate a presumed consent system.
Point 6. The aspect of donation directly addressed by presumed consent legislation is consent. It has been repeatedly stated that the presumed consent legislation will be one of a package of measures to increase donation. However, there can be only one direct beneficial effect of presumed consent legislation - an improvement in the consent rate. All of the associated measures (e.g. publicity) can be instituted without the legislation. Moreover, some measures will have no effect on consent but improve donation by other means, for example by increasing admission of potential donors into Intensive Care Units. It would help to focus the debate to acknowledge that the legislation itself can improve donation only by improving consent rates.
The consent rate in the UK, i.e. the percentage of approached families who approved donation, was 56.7% in 2010 and 55.4% in 2011. The corresponding figures for Wales were 63.5% and 58.7% respectively. By contrast, the consent rates in Spain in 2010, 2011 and 2012 were 81%, 84% and 84%, without presumed consent. This is a huge difference, and represents a massive and dreadful waste of organs. If the consent rate in the UK could be increased to 80%, this would represent an increase in the donation rate of more than 40%. In Wales, it would represent an increase of ~30%, higher than that envisaged for the proposed legislation. This high level of consent has been consistently achieved in Spain by promoting better public understanding of transplantation, better public appreciation of its outstanding benefits, and optimal approaches to the family at the time of donation – not by legislation. This is surely achievable in Wales, and is an area where Wales could indeed lead the way for the rest of the UK.
Point 7. The recent fall in donation rates in Wales. The number of donors per annum in Wales over the six years 2007, 2008, 2009, 2010, 2011 and 2012 has been 45, 35, 41, 66, 67 and 52 respectively. These numbers are small, and it is essentially impossible to ascribe the large fluctuations in particular years to particular causes (e.g. the rise of 61% in 2010 and the fall of 22% in 2012). It is therefore unwise of those opposing presumed consent to attribute the fall in 2012 to possible negative effects of the proposed legislation. It is equally unwise of those promoting presumed consent to see the fall as a threat and to respond with unfounded blandishments. Here is what Mark Drakeford said in the debate in the Assembly on the 16th April. “What happened in the last year is simple when you understand it. It is not so much that the rates of organ donation went down, it is that the number of people who were able to be donors went down in the first half of that year. That is a good news story, because we do not want people to be in the awful circumstances where they can be donors”. The number of potential donors is influenced by many factors, for example the occupancy of ICU beds and hence the probability of admission of patients who might become donors, as well as other factors when the patient is in the ICU. To describe the fall in donor numbers as good for Welsh citizens, if not for transplantation, is nonsense.
Point 8. The “robust” international research. The research under-pinning the proposed legislation is almost invariably described as robust, presumably in order to give it greater authority. However, it is not so. The Department of Health’s Taskforce had concerns about the selective inclusion of countries for analysis in these research studies. This, and the incorrect assignation of Spain as a presumed consent country,are some of the problems.
But why cling to old studies with uncertain conclusions? The simplest and most convincing “international” research one can do is to look around the world today. If one does that, it is clear that two of the top five countries for organ donation (Spain and the United States of America) do not operate presumed consent systems.
Point 9. The “robust” assessment of the effects of the proposed legislation. Given the substantial effort that has already put into the proposed legislation by various Committees and Assembly Members, and the very substantial future costs, it is frequently stated to be of the utmost importance that the effects of the legislation be not just assessed, but “robustly” assessed. Given the major fluctuations in donation rates in Wales in recent years (noted in point 7 above), the fact that the legislation in Wales will be introduced along with several other measures such as a publicity campaign, and the fact that the Department of Health is planning to introduce additional improvements nationally in the coming years, it is plainly obvious to all except the most credulous that to disentangle the effects of the legislation in any meaningful way is impossible.
Point 10. The future. If additional donors are to come from the proposed legislation, it will be from families who are not happy about organ donation by their loved ones, but who lack the confidence to say so if it is left for them to oppose the system unasked. This is not a healthy foundation on which to build transplantation in Wales.
In the debate in the Assembly on the 16th April, Byron Davies, the Shadow Minister for Transport, gave his view that “…..when someone dies without giving or withholding consent, the family, as the surviving representatives of the deceased, has the final say”. That must surely be the principle on which to move forward in Wales. It is the principle on which the outstandingly successful Spanish system is based.
The tragic irony of all this activity and lobbying for legislation is that the objective of substantially improving donation rates is achievable more cheaply, more effectively and in a socially inclusive manner without legislation. Wales should aim for a consent rate of 80%, which the Spanish have achieved consistently for many years, without presumed consent. The idea that you can legislate for consent is naïve. Addressing the issue of consent in a considered and comprehensive manner is the next logical step to build on the success of 2008 – 2013, both in Wales and nationally.
Sunday, July 07, 2013
The Planning Inspector and the Man from DECC
This is for the few with specialised interest. I like to keep visitors to this blog up to date with what's happening on the local 'Mid Wales Connection Project' front. Early this year I raised some issues about the local public inquiry into the six wind farms currently being considered by an 'Independent' planning inspector. There had been some concern that a representative of the Department of Energy and Climate Change had been sharing 'top table' with the Inspector when he first outlined his plans for running the Public Inquiry. Looked very odd in that its a DECC Minister who will receive the Inspector's recommendations and decide. I did say in a Westminster debate that I would write to the Minister about this concern - but he wrote to me first. It did not address the points I was concerned about. So on 16th April, I wrote formally to the Minister of State for Climate Change. Here is my letter.
16 April 2013
Rt Hon Gregory Barker MP
Minister of State for Climate Change
DECC
Dear Minister,
Thank you for your letter of 20th March. It does raise one point on which further clarification would be helpful.
In your letter you refer to the “line” which the Inspector took during the PIM for the Mid Wales turbine applications and you reproduce some of the response from him to one or more requests from your officials. There is widespread anxiety among my constituents who express concern that:
(i) a representative of your department was engaged in discussions with and was present at the table with the Inspector at the first preliminary meeting and
(ii) that DECC and the Inspector appear to be engaged in yet further discussions and exchanges ‘behind the scenes’ without the public being made aware of the existence, nature or content of those exchanges.
In order completely to allay concerns over these aspects, it would be helpful if you would make available to me copies of all correspondence, exchanges and notes of discussions to from and between (or on behalf of) DECC and the Inspector and PINS from the first date leading to his appointment to the present (naturally redacting personal details).
Because of the great local concern over this matter I await hearing from you at the earliest opportunity.
Yours sincerely,
Glyn Davies
I did not receive a reply, so I raised the matter in the chamber, when speaking on the Energy Bill, which led to a response that my letter could not be traced. So I sent it again, and received the following reply.
Department of Energy & Climate Change
3 Whitehall Place,
London SW1A 2AW Your ref:
T: +44(0)300 068 5677 Our ref: FOI/EIR Request 13/0725
E: gareth.leigh@decc.gsi.gov.uk
www.decc.gov.uk 1 July 2013
Glyn Davies MP
House of Commons
London
SW1A 0AA
Dear Mr Davies
Thank you for your letter of 16 April 2013 where you requested the following information:
“Copies of all correspondence, exchanges and notes of discussions to from and between (or on behalf of) DECC and the Inspector and PINS from the first date leading to his appointment to present (naturally redacting personal details)”.
As Anjoum Noorani, Greg Barker’s, Senior Private Secretary’s e-mail message to Mr Carlick, your Office Manager/Secretary, of 5 June 2013 explained, it appears that, for some reason, your letter was never received by our correspondence system.
Your request is now being considered under the Environmental Information Regulations 2004 (‘the EIRs’) on the basis that the information you have sought disclosure of, does in our view, fall within the definition of ‘environmental information’ as stated in the EIRs.
We are writing to advise you that the time limit for responding to your request for information needs to be extended. This is because it includes some information provided by third parties that is not already in the public domain and it is necessary therefore to first seek their views before we can release that information.
Under the EIRs, we are required to respond to requests as soon as possible and in any case no later than 20 working days after receiving a request. However, by regulation 7 the period of 20 working days may be extended up to a total of 40 working days if we reasonably believe that the complexity and volume of the information requested means that it is impractical to comply with a request within the earlier period or to make a decision to refuse to do so.
In respect of your request, we believe that regulation 7 applies. Therefore, although we shall not be able to respond fully to your request within the 20 working day period, we shall do so as soon as possible within the extended period. We hope to provide you with a response by 17 July 2013.
Appeals Procedure
If you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within 40 working days of the date of receipt of the response to your original letter and should be sent to the Information Rights Unit at:
Information Rights Unit (DECC Shared Services) Department for Business, Innovation & Skills
1 Victoria Street
London
SW1H 0ET
E-mail: foi.requests@decc.gsi.gov.uk
Please remember to quote the reference number above in any future communications.
If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF
Yours sincerely,
Gareth Leigh
Section Head, National Infrastructure Consents
Now make of this what you will. But my guess is that I'm not going to get an answer that tells us anything meaningful. I'm afraid that's how it is. But I know there are a few of you who are interested in this stuff, so I thought I'd share it.
16 April 2013
Rt Hon Gregory Barker MP
Minister of State for Climate Change
DECC
Dear Minister,
Thank you for your letter of 20th March. It does raise one point on which further clarification would be helpful.
In your letter you refer to the “line” which the Inspector took during the PIM for the Mid Wales turbine applications and you reproduce some of the response from him to one or more requests from your officials. There is widespread anxiety among my constituents who express concern that:
(i) a representative of your department was engaged in discussions with and was present at the table with the Inspector at the first preliminary meeting and
(ii) that DECC and the Inspector appear to be engaged in yet further discussions and exchanges ‘behind the scenes’ without the public being made aware of the existence, nature or content of those exchanges.
In order completely to allay concerns over these aspects, it would be helpful if you would make available to me copies of all correspondence, exchanges and notes of discussions to from and between (or on behalf of) DECC and the Inspector and PINS from the first date leading to his appointment to the present (naturally redacting personal details).
Because of the great local concern over this matter I await hearing from you at the earliest opportunity.
Yours sincerely,
Glyn Davies
I did not receive a reply, so I raised the matter in the chamber, when speaking on the Energy Bill, which led to a response that my letter could not be traced. So I sent it again, and received the following reply.
Department of Energy & Climate Change
3 Whitehall Place,
London SW1A 2AW Your ref:
T: +44(0)300 068 5677 Our ref: FOI/EIR Request 13/0725
E: gareth.leigh@decc.gsi.gov.uk
www.decc.gov.uk 1 July 2013
Glyn Davies MP
House of Commons
London
SW1A 0AA
Dear Mr Davies
Thank you for your letter of 16 April 2013 where you requested the following information:
“Copies of all correspondence, exchanges and notes of discussions to from and between (or on behalf of) DECC and the Inspector and PINS from the first date leading to his appointment to present (naturally redacting personal details)”.
As Anjoum Noorani, Greg Barker’s, Senior Private Secretary’s e-mail message to Mr Carlick, your Office Manager/Secretary, of 5 June 2013 explained, it appears that, for some reason, your letter was never received by our correspondence system.
Your request is now being considered under the Environmental Information Regulations 2004 (‘the EIRs’) on the basis that the information you have sought disclosure of, does in our view, fall within the definition of ‘environmental information’ as stated in the EIRs.
We are writing to advise you that the time limit for responding to your request for information needs to be extended. This is because it includes some information provided by third parties that is not already in the public domain and it is necessary therefore to first seek their views before we can release that information.
Under the EIRs, we are required to respond to requests as soon as possible and in any case no later than 20 working days after receiving a request. However, by regulation 7 the period of 20 working days may be extended up to a total of 40 working days if we reasonably believe that the complexity and volume of the information requested means that it is impractical to comply with a request within the earlier period or to make a decision to refuse to do so.
In respect of your request, we believe that regulation 7 applies. Therefore, although we shall not be able to respond fully to your request within the 20 working day period, we shall do so as soon as possible within the extended period. We hope to provide you with a response by 17 July 2013.
Appeals Procedure
If you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within 40 working days of the date of receipt of the response to your original letter and should be sent to the Information Rights Unit at:
Information Rights Unit (DECC Shared Services) Department for Business, Innovation & Skills
1 Victoria Street
London
SW1H 0ET
E-mail: foi.requests@decc.gsi.gov.uk
Please remember to quote the reference number above in any future communications.
If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF
Yours sincerely,
Gareth Leigh
Section Head, National Infrastructure Consents
Now make of this what you will. But my guess is that I'm not going to get an answer that tells us anything meaningful. I'm afraid that's how it is. But I know there are a few of you who are interested in this stuff, so I thought I'd share it.
The Winning Artwork of Harriot Bates
Last week, I was invited to the unveiling of a statue welcoming the world to Welshpool. It was designed by local artist, talented Harriot Bates. The construction work was done by local man and Town Cllr, Steve Kaye. Very enjoyable event. Parents, Michael and Elaine were clearly very proud of their girl. And I enjoyed a chat with her two grannies, who were well chuffed. On disadvantage of being an MP (in Gov't) is that I can so infrequently join in local stuff like this, being 'whipped' to be in Westminster. But it worked out this time. Anyway the artwork is located outside the Tourism Information Office in the town. Y Trallwng (Welsh for Welshpool) is on the other side. Conveniently there are 9 letters in both Welshpool and Y Trallwng.
Subscribe to:
Posts (Atom)