Covid-19 and the expendables

 

Paul Embery is not an epidemiologist, virologist, or indeed a doctor of any description. According to his Twitter bio, his main claim to fame is being a columnist for UnHerd. Despite being a member of the National Union of Journalists, he appears to have missed the bit in his training where you're taught to properly analyse and responsibly report on statistics.

Unfortunately, his ridiculous tweet received a lot of traction, predictable support from the likes of Julia Hartley-Brewer, and, sure, it looks credible enough. After all, he has included a link to the NHS website. Why, he's just a humble journalist sharing Actual NHS Statistics to prove his coronavirus-minimising point. And given that we all love the NHS so much we used to applaud it every Thursday night, how could we possibly question his wisdom?

Quite easily, actually.

First, we have the ageist bigotry that says it's somehow OK for people over 60 to die of Covid-19, that once we all turn 60, our lives, our value to society, our purpose is diminished. Women over 40 already know they start to become invisible after a certain age. Now we are told that once we hit 60, we should consider ourselves lucky to have had such a good innings.  

From a purely cold economic standpoint, the NHS figures mean that an increasingly productive part of the economy is at risk and should be protected. According to the Department for Work and Pensions, between 1985 and 2015, women aged 60-64 represented the highest increase in employment rates of any demographic, rising from 17.7% participation in the workforce to 40.7%. In the same period, employment rates for men aged 65-69 increased from 12.8% to 25.8%. That's a lot of extra tax revenue and consumer spending from these demographics. As the government continues to raise the pension age, these figures should surprise nobody.

Then we have the sinister "pre-existing condition" part of Embery's out-of-context tweet. It's stunning how casually we can dismiss the coronavirus deaths of those with pre-existing conditions. This includes diabetes, asthma, heart conditions, immune system conditions, regardless of the person's age. Suddenly, we have a much larger group of people at risk from Covid-19. 

By and large, thanks mostly to modern medicine, plenty of pre-existing conditions can be managed so people can live healthy, productive, happy lives. You can't always see a pre-existing condition but if that person caught Covid-19, they could become seriously ill and possibly die way before their time. But Embery's thoughtless tweet devalues the lives and contributions of millions of people as he attempts to minimise how serious this global pandemic is.

And with a virus as easily transmissible as Covid-19, it's not just the deaths we need to focus on. There are plenty of blowhards who'll yell into the internet that there's "no need to panic about a disease with a [insert very low percentage here] death rate!". But that ignores not only the lost productivity from people who test positive, and their contacts, having to self-isolate - it also ignores the emerging data about the long-term effects even after a patient has recovered from the virus, including long covid, where people suffer ongoing health problems for weeks or months after the usual two weeks or so of illness. Even if you do survive Covid-19, that's not necessarily the end of the story - viruses can be nasty like that.

Of course, none of this has been helped by an incompetent government led by a self-serving, impatient, spoiled man-baby of a prime minister, a man more concerned with tomorrow's headlines rather than properly dealing with a major public health emergency. The UK lost the advantage of being an island in March with a late lockdown, no closing of international borders, and letting events such as Cheltenham go ahead.

Boris Johnson hates being the bearer of bad news, hence his pathetic WWII Blitz spirit cosplaying about it being all over by summer or Christmas or Easter or next summer. And don't forget his incoherent ramblings about the commonsense and pluck of the British people, even when this commonsense appears to be in short supply. But that suits Johnson too - it works for him for us to turn on each other for breaking lockdown rules or being "too careful", rather than to seriously hold him and his useless cabinet to account.

There is a desperation for things to "return to normal", which is perfectly understandable. We are all missing so many things from Before Times. But even after we have been sufficiently vaccinated and the virus sufficiently suppressed, there will be lasting changes. This means everything from irrevocably changed personal relationships to radical decisions made after taking stock over lockdown, through to a growing culture of flexible working, a collapse of the commercial property market, and a possible rethinking about how city centres can be repurposed to be more residential rather than merely places where we go to work before disappearing to the perimeters. 

We cannot and should not emerge from this awful time unchanged and none the wiser. But as long as nonsense, such as that ridiculous tweet from Embery, is shared, the stats unparsed without challenge or consideration, the emergence will be a long time coming.     

Of course COVID-19 is political

The COVID-19 pandemic should not be an excuse to score cheap political points. It is not an excuse to wish death on politicians and their loved ones like a psychopath. It is not the time for ridiculous, batshit conspiracy theories about 5G causing the pandemic. It is not the time for anti-vaxx pedlars of death and disease to spout ignorant, science-denying twaddle. And it is certainly not a time to become a racist bellend. But it is political. It is naive to think otherwise. 

Countries across the world are relying on their governments for leadership, to figure out the best way to manage this terrible virus, to support healthcare systems, to know what the hell individuals can do to stop the disease spreading, to ensure the scientists working on a vaccine and a cure have everything they need, to work out what role charities and the private sector should take, and so on.

This means, obviously, politicians everywhere are making decisions - and it is naive to expect that certain decisions won't be politically motivated rather than for the greater good. In every democracy, this means they should be held to account - every decision that our leaders make affects our health and our wealth. We all have a huge stake in this. And in every country that is not a democracy, this should be the catalyst for increased transparency and public participation as a positive after-effect of the pandemic - after all, if you think the official mortality figures coming out of China or Iran are accurate, I have some magic beans and a time share in Narnia to sell you. Then again, the UK isn't bothering to include care home deaths in official stats so we still need to lift our game in terms of accuracy and transparency.  

In no country should COVID-19 be a time for cultish, blind loyalty to any leader of any political stripe. I'm glad Boris Johnson didn't die of COVID-19. And I'm glad Carrie Symonds, his pregnant fiancee, is doing well. Hell, I'm glad that he is recovering for a few weeks rather than working because that is what every coronavirus patient should be doing after they leave hospital. I am also glad that the attempt to stir up a national round of applause for the prime minister's recovery was a massive damp squib. A nationwide chorus of clapping and pot-banging for one man would have been embarrassing, unnecessary and definitely cultish.

And while Johnson may now join the immune herd for COVID-19, he is not and should not be immune to criticism or scrutiny - and neither should the hapless cavalcade of assorted incompetents, yes-men and women, charisma-vacuums, intellectual lightweights and slippery moral bankrupts who are filling in for the PM at the daily briefings.

It is clear that political decisions have been made which are not necessarily in our best interests, such as declining an invitation to join a European Commission-funded scheme to stockpile essential medical equipment, to have constantly dropped pandemic planning from the agenda since 2016, and for Boris Johnson to have found better uses for his time, such as meeting a dancing dragon for Chinese New Year instead of attending a COBRA meeting - or indeed attending five COBRA meetings on COVID-19.

At a time when we should be re-evaluating our relationship with China on multiple levels, including taking a stand on human rights and animal welfare issues and getting over our reliance on cheap goods often manufactured to low standards and in awful working conditions, the photograph of Boris Johnson gurning gormlessly at the dragon is not ageing well.

Yes, it's true that the relevant cabinet minister chairs COBRA meetings but given these meetings were about a global pandemic, it is negligent at worst and lazy at best for Johnson to simply not bother with these ones. Imagine the outcry in an alternative universe if Prime Minister Corbyn missed five COBRA meetings because he was pottering about on his allotment or attending a Venezuelan solidarity Zoom meeting. The very same people who are demanding we leave poor little Boris alone would be foaming at the mouth at the very thought of Corbyn neglecting his duty so comprehensively. Hell, imagine any prime minister in living memory missing such meetings.

In January, when PPE supply chains should have been bolstered and early scientific advice heeded, Boris Johnson was distracted by January 31's Brexit day brouhaha, something which at the time he thought was going to be his greatest triumph, his most memorable speech, the iconic photograph for the history books - but now it seems like a lifetime ago. That was a political decision as well as a negligent one.

To those who are upset about the much-villified "mainstream media" going over past decisions of recent months, please try to comprehend that it is important to flag up the mistakes that have been made. If only we had a leader who could graciously admit to and apologise for mistakes in the way that Emmanuel Macron did - that would be a good first step on the road to accountability and to quickly learning from mistakes which have surely cost lives. There will almost certainly be some sort of inquiry further down the track as to how the government handled the pandemic, when lockdown restrictions have been lifted or at least relaxed. But for now, we need decisive action from accountable leaders who are prepared to admit to errors and work their arses off to fix them.

Getting upset because The Sunday Times and Reuters have pointed out these failings in great detail is absolutely pathetic behaviour. Michael Gove was on brand on Marr this morning when he admitted Johnson didn't attend five COBRA meetings but gave the mealy-mouthed excuse that cabinet ministers chair such meetings, while simultaneously making a dig at journalists, a more articulate but equally venal version of Donald Trump's constant whines of "fake news". This was political manouevring on Gove's part - he appeared to be Johnson's loyal footsoldier but his defence of Johnson missing meetings would collapse in a light breeze and he knows it. He is not an idiot. Gove, ably assisted by his wife, Sarah Vine, a Poundland Lady Macbeth, would most likely be delighted if the pandemic cost Johnson his job. Again, let's not be naive here.

The next political decision to watch is in regard to an extension to Brexit negotiations, which has a deadline of June 30. The government is adamant that the UK won't ask for an extension but they may be left with little choice if the EU decides it has bigger virus-shaped fish to fry for the rest of the year. The British economy can recover from COVID-19 or it can recover from a no-deal Brexit after December 31 this year, but to try and get through both economic and social shocks, most likely concurrently, will be wantonly destructive. We have no choice but to deal with COVID-19 but we do have a choice about taking a more responsible approach to Brexit. Either way, it's a political choice and it will affect us for years to come.




Image: Mikhail Denishchenko

Reflections on World Club Foot Day

There they are, in all their misshappen, scarred, unfiltered, modern Prometheus-like glory - my two club feet. The challenging appendages at the end of my pale, corgi legs, the body parts that cast a shadow across every aspect of my life. 

I was both fortunate and dead unlucky to be born in Australia in 1976 - fortunate because Mr Peter Dewey, an excellent orthopaedic surgeon happened to live and work in the town where I was born. He started work on my feet from the time I was a baby, right through to when I was 18 and 19 for my final surgeries, for which he came out of semi-retirement, in between doing amazing work with land mine victims in Cambodia.

Without him - or if I was born in a less developed era or lived in a less developed country - I probably wouldn't be able to walk. I would have been doomed as a sad, crippled girl who would not have had the opportunities to get educated, travel the world, drive cars, work as a journalist in three different countries, meet the love of my life in an Abu Dhabi newspaper office after chasing boys with varying levels of success, and generally have a pretty amazing time. I still laugh when I think of the time my friend Stephen said I could open a bar, call it Club Foot and the slogan could be "Club Foot: Where you get down and fall down". 

But since 1976, the Ponseti Method has come a long way and I will never know if it could have prevented me from having to go through 13 reconstructive operations, involving long stints up to my knees in plaster, multiple stitches on the tops of my feet, the sides of my feet and up the back of my ankles, internal clips, and heavy scarring.

Even with Mr Dewey's brilliant work on my feet, I still get intense swelling in extremes of hot weather (or even on this mildly warm British day...), ironically white-hot pain in cold weather, arthritis has bedevilled my left ankle to the point where I cannot be trusted to safely operate a clutch, the way I walk affects my knees, hips and back, it can can enhance my inherent clumsiness, and sometimes I have to sit down or lie down or take painkillers. Or I simply might not leave the house because it's too uncomfortable and I don't always trust my feet not to seize up on public transport or while trying to walk somewhere. It won't get any better as I get older.

Despite the desperation of a mansplainer on Facebook the other day who presumed to know my own reality better than I do, my experience of club feet is not a "minor condition". Forty-two years of experience with these damn feet means I know how to manage the condition but it's something that I am aware of every single day to a greater or lesser degree.

On a superficial level, I get frustrated when trying to buy vaguely attractive shoes - I can walk in plenty of ugly shoes but buying shoes for special occasions is a nightmare. If one more person, no matter how well-meaning, tells me I simply haven't found the right high heels or I just need to buy really expensive high heels, I cannot be responsible for my actions. I cannot walk in anything higher than about an inch and I do not need people telling me that I would suddenly dance about like a gazelle if only I bought Manolo Blahniks or had a pair of heels especially made for me. Trust me, I have tried and failed to wear heels and I am less gazelle and more stumbling, newborn foal. My feet are held together with clips and cannot bend into the unnatural pose required to convincingly wear skyscraper shoes. Leave me the hell alone with your obsession with getting me into shoes that will only cause me needless misery. I am at peace with my huge collection of flats.

But I write this not to wallow in self-pity - such innovations as DSG gearboxes, good painkillers, carrying Deep Heat and Deep Freeze in my handbag, cute flat shoes, kitten heels, physiotherapy, strapping for my ankles available at any pharmacy in the land, and simply being affluent enough to afford a warm, comfortable house and bed are among the things that improve my life. Even though I am too old to take advantage of the less invasive Ponseti method for club feet, I do not want the next generation of club foot patients to miss out, no matter where they are in the world.

In the UK, the Ponseti method is available on the NHS and Great Ormond Street Hospital and the Robert Jones and Agnes Hunt Orthopaedic Hospital in particular do great work in this regard. I met a beautiful little boy at a friend's baby shower a few years ago. He was resplendent in a pair of bright blue boots as part of his Ponseti treatment - and it was an absolute joy to reassure his mother that life with club feet will not hold him back. It would be amazing if this good fortune was global and therefore merely the way things are rather than a matter of luck in life's lottery.

_____________________________

To find out more about club feet and to ensure club feet patients everywhere here are some helpful links:

Steps Charity

The Robert Jones and Agnes Hunt Orthopaedic Hospital

Miraclefeet

Cure Clubfoot

Global Clubfoot Initiative

On vulnerability

This week, I have been reflecting on vulnerability, on my own vulnerability and that of others, especially those who are close to me, of why few of us want to admit to being vulnerable, of why it would be empowering if more of us were able to admit to our vulnerabilities, whatever form they may take.

Fear and vulnerability go hand in hand. In my case, my vulnerabilities are physical - I have two club feet, arthritis and a damaged lower back. While these afflictions cause me some level of pain most days, I do tend to just get on with things and, fortunately, I have a career in which skills such as mountaineering, skiing or tap-dancing are not required. 

But when I have a bad pain day, it doesn't just hurt me physically, it upsets me, although I seldom show this side of my psyche in public. I had one such bad pain day on Monday - I was too proud or vain or silly to retrieve my crutches from the cupboard under the stairs to help with my commute, even though that would made life so much easier. I got angry and annoyed when someone walked at me when I was using a handrail on the tube station staircase. By the end of the day, I was in so much pain, I had to cancel my plans for the evening and limp home to wallow in the bath.

On those days, the fear is that my feet or knees will seize up at an inopportune moment. Awful scenarios often pop, unsolicited, into my head - maybe I will be rendered immobile in a busy tube station in rush hour, or a cyclist or scooter rider will come up behind me on the footpath and I won't be nimble enough to get out of the way in time. This nearly happened to me this afternoon and all I could do was impotently shout: "Use a fucking bell, you twat, or ride on the fucking road!" when a cyclist silently rode up behind me on a footpath as I walked to the shop and gave me a massive fright. Not my finest moment, I admit, but it's just what came out as I realised that a stray step to the left or right could have put me in hospital.

For me, it is these feelings of powerlessness and the fear that one day, being in pain will put me in real danger that make me vulnerable. What if someone is chasing me and, despite my commitment to flat shoes, I just cannot run away? What if the next time I fall over, I'm home alone? So many what-ifs...

Getting older, and its inevitable physical consequences, add to this fear. And I hate it, I fight it, but sometimes I need to vocalise it. If I cannot go out because I genuinely cannot walk, I should not be afraid or embarrassed to say so.

For others, their vulnerabilities stem directly from mental health issues, rather than the psychological distress following on from a physical condition. Anyone who dares tell me that mental health issues are not real, that sufferers can simply "snap out of it" can, with all due respect, get the hell out of my sight. Mental health conditions cast long shadows over the lives of patients and everyone around them. 

Such conditions can be managed but they can also lead to irrational behaviour, to frustration and despair among those who love them, to ends of tethers being reached, to crippling feelings of guilt when one feels that one has not done enough or can do no more. 

Insidiously, mental illness does not discriminate. To say that someone is too pretty/rich/intelligent/successful/talented or whatever to suffer from a mental health condition is reductive and asinine. The suicide of Robin Williams is tragic, the suicide of a member of my family was also tragic, there is no hierarchy here, no one more or less deserving of help. Vulnerability has a distressing power all of its own.

Any one of us could be felled by mental illness - and the causes are myriad - so to dismiss someone's condition because they don't fit the perfect victim stereotype is to make it harder for these conditions to be understood. It creates stigmas, it makes it harder for people to seek the help they need. 

It's as awful and unhelpful as condemning rape victims who don't fit the perfect victim stereotype - as if a woman who had the temerity to sleep around or be a sex worker or walk home by herself in a short dress is somehow less deserving of sympathy than a violated virgin. This mentality causes monstrous behaviour. When a hitherto strong, gutsy woman is reduced to a fragile, vulnerable mental state after being raped, she too needs support rather than being merely expected to get on with things. 

But it's not just about us not being afraid to admit our vulnerabilities. We all have a responsibility as a society to ensure there is a safety net for the vulnerable, that it's not just left to charities to pick up the pieces, that governments ensure that their programmes and institutions are properly funded and offer real help, not false economy Band-Aid solutions. 

This weekend, I experienced first-hand an NHS emergency mental healthcare service and I was impressed with the patience, efficiency and compassion that was shown on behalf of a friend in crisis and towards me as well. It was reassuring to be told that I had done the right thing and not to be made to feel as if I was wasting time. But I know that the excellent work of NHS mental health workers is undermined by underfunding, overstretching of resources and overwhelming demand.

I have no easy answers but as I shut the door on an emotional weekend, I do know that the safety net is gossamer-thin and when someone falls through it, it doesn't really matter who they are. What matters is how we can do better, how we can not be brutes, and how we can be kinder to ourselves and to each other for we all have our vulnerabilities.

Photography by Beth Punches/Flickr

No winners in the tragic case of Charlie Gard

It is impossible not to be moved by the plight of Chris Gard and Connie Yates, parents of Charlie Gard, the 10-month-old baby suffering from infantile onset encephalomyopathy mitochondrial DNA depletion syndrome (MDDS). It is a cruel condition which causes progressive muscle weakness and brain damage. We have no real way of knowing if Charlie can feel anything because he can't see, hear, move, make any noises, breathe without the help of a ventilator or receive food without a tube. He is epileptic and his heart, liver and kidneys are failing.

At present, there is no effective cure for MDDS. However, specialists in the USA offered Charlie's parents hope in the form of an experimental treatment called nucleoside bypass therapy. Chris and Connie launched a fundraising appeal with a target of £1.3 million to cover the costs of treatment, which it passed after 83,000 donations came in.

But British courts and now the European Court of Human Rights (ECHR) have ruled that it is not in Charlie's interests to travel to the US for this treatment. This means that palliative care, including removing life support systems, allowing Charlie to quietly slip away, is the next step.

All courts which have heard the case have examined extensive medical evidence and have all come to the conclusion that nucleoside bypass therapy would have no real prospect of extending or improving Charlie's life. Those who are using this case as a stick with which to beat the EU are being absurd - if the Conservatives make good on their pledge to withdraw from the ECHR as part of the Brexit process, this option is gone forever. Without this court as an option, it is highly likely that Charlie would have passed away already.  

Nucleoside bypass therapy has never been tried on anyone with Charlie's gene before. In theory, the treatment could repair Charlie's mtDNA and help it synthesise so he is given the compounds his body is not producing naturally. So far, it has only been used with very limited success on patients, such as Arturito Estopinan, whose condition is not as serious as Charlie's and whose affected gene is not the same as Charlie's. 

The treatment is an oral medication which would be taken over a six-month period. A large proportion of the £1.3 million cost would involve the risky and highly specialised procedure to transport a gravely ill baby who cannot breathe on his own from the UK to the US, along with whatever the hospital would charge, and the costs incurred for Chris and Connie to stay in the US for the duration of the treatment. Money is also required to pay fees to the GoFundMe website, which has hosted the appeal - something for anyone considering an online fundraising campaign to take into account.

However, the neurologist who would be overseeing the treatment told the Family Division of the High Court that Charlie is in the "terminal stage" of his illness. He also said that the treatment will not reverse the brain damaged which Charlie has already suffered, and that he had not at first realised the full extent of Charlie's condition. The sad reality is that even if Charlie survived the trans-Atlantic journey, by the doctor's own admission, his life expectancy is heartbreakingly short and the treatment does not represent a cure.

Pope Francis issued a statement from the Vatican's Academy for Life in relation to Charlie's case which outraged many Roman Catholics, although I think he showed a combination of compassion, humanity and realism. The statement acknowledges that there are still limits to modern medicine saying that we do "have to recognise the limitations of what can be done, while always acting humanely in the service of the sick person until the time of natural death occurs". The statement goes on to refer to Encyclical Evangelium Vitae in regard to "avoid[ing] aggressive medical procedures that are disproportionate to any expected results or excessively burdensome to the patient or family".

I do not for a moment think the British or European justice systems are in the business of wanting to exterminate babies. And neither is Great Ormond Street Hospital, the excellent children's hospital which has been treating Charlie. It is one of the world's best paediatric hospitals and every day, it does wonderful work, saving the lives of children, and offering the very best palliative care for those who sadly will not make it to adulthood. Depressingly, people have publicly stated they will no longer make donations to the hospital because of the Charlie Gard case.

The Ashya King case has been cited as an example to follow in the case of Charlie Gard - that was the 2014 case of the parents of Ashya King removing him from a British hospital and taking him to the Czech Republic for proton beam therapy for a brain tumour. But in that case, Ashya, then aged five, was able to travel to Prague without medical assistance and the treatment was effective. The farce of an international manhunt for Ashya's parents was not a high point in crime fighting but as a result of the successful treatment Ashya received, the UK is to get its first proton beam therapy machine at a cost of £17 million. It will be installed at the Rutherford Cancer Centre and is expected to treat 500 people each year.

That is a wonderful legacy and the best possible outcome of the Ashya King case. The legacy of Charlie Gard will most likely be his parents starting a charitable foundation with the £1.3 million in donations - if this means further research for mitochondrial conditions can take place in the UK, who knows what amazing scientific advances might be achieved on British shores? 

For now, Charlie's case represents an awful intersection between the right of parents to seek medical treatment for their children and the often devastating realities of what is medically possible. Pope Francis again said it well in his statement when he said that "the wishes of the parents must be heard and respected, but they too must be helped to understand the unique difficulty of their situation and not to be left to face their painful decisions alone."

The case also exposes the astronomical costs of American healthcare for the uninsured, along with the decisions which balance finance with medicine faced on a daily basis by NHS trusts across the UK. Neither health system is perfect and, based on medical evidence, neither system is currently in a position to help Charlie beyond making his last days comfortable, peaceful and dignified.

______________

Here is the link to the Supreme Curt judgement

Here is the link to the Court of Appeal judgement

Here is the link to the High Court judgement

Photography by Lindsey Turner/Flickr

Dear Mr Hammond, a few questions on behalf of Wimbledon constituents before the election...

Dear Mr Hammond,

I know that I could email you directly, as I have done so in the past, and that you would be obliged to respond as I am one of your constituents, but I'd like my questions in regard to your campaign leaflet to be asked and answered publicly in the interests of transparency. I'm sure you have no objections to such openness during this election campaign. Feel free to post your answers in the comments section at the end as I am sure plenty of constituents will be interested in what you have to stay. Let's start, shall we?

Brexit

1. Why is the bit about Brexit in hard-to-read blue-on-blue at the bottom of the page and why is it not included in the top five priorities? Leaving the EU is the biggest political, economic and social upheaval of our lifetimes, and the constituency of Wimbledon voted overwhelmingly to remain in the EU, so surely it deserves more than this cursory effort? You claim to have "consistently opposed a hard Brexit" yet you helped Theresa May wave through Article 50. Given that today the story has broken about Theresa May's disastrous and embarrassing dinner with Claude Juncker, it is obvious she is not competent enough to lead such complex negotiations. Why should we trust Theresa May not to send us over a hard Brexit cliff or potentially leave us with no deal and therefore calamitous WTO rules?

St Helier Hospital and local health services

 

2. In 2012, you voted for the Health and Social Care Act. This act led to the creation of Clinical Commissioning Groups (CCGs) to make decisions at a local level. It is the CCGs who will decide the future of St Helier Hospital, not the hospital chief executive, so why have you not included any reassurances from Merton CCG? While holding a public meeting is a great way to create warm, fuzzy feelings of doing something, what have your public meetings achieved? How many CCG meetings have you personally attended? If you have attended any CCG meetings, did you ask any questions about the future of local health services? If so, what questions did you ask and what responses did you receive?

3. Why have you referred to the Nelson Health Centre as the Nelson Hospital? It has not been functioning as a hospital for quite some time now. It is not exactly a busy facility. Are you campaigning for the centre, or the Raynes Park health centre, to include a walk-in clinic to relieve pressure on local GPs and A&E departments? Our area has lost a walk-in clinic with the closure of the Wilson Health Centre in Mitcham. This means our nearest walk-in clinic is in Teddington, a six-mile drive or public transport nightmare from Wimbledon. Do you think this is acceptable?

Morden town centre (Disclaimer: I live in Morden)

 

4. Did you press the previous Mayor of London, one Boris Johnson (Conservative), on the planned regeneration of Morden town centre or are you just pressing Sadiq Khan, the new, Labour mayor? Boris Johnson's 2015 plan achieved nothing. Indeed, Boris wasn't even interested in Morden tube station being rezoned as Zone 3 rather than Zone 4, which would have saved commuters money. Is this something you're interested in campaigning for on behalf of cash-strapped constituents? 

You have been the MP for Wimbledon since 2005 - you have had 12 years to campaign on behalf of Morden, and in five years I've lived here, the town centre still looks much the same. Can you please furnish us with some details of your tireless campaigning for Morden and any achievements?

Wimbledon town centre

5. Again, you have had 12 years as MP to improve the Wimbledon town centre. What have you been doing during all that time in regard to improving the area? I lived in Wimbledon in 2011 and, like the Morden town centre, it still looks much the same now as it did then, save for the moving of a statue. What is taking you so long? Exactly what does your pro-Wimbledon town centre campaigning involve and what results have you achieved since 2005?

Transport: Tramlink

 

6. The Rail Accident Investigation Bureau has found that in last November's Croydon tram crash, in which seven people were killed, the tram was travelling at 46mph in a 13mph zone. Is it worth trumpeting about 50 per cent more services when there has been a fatal accident on a Tramlink tram? Where is your concern for the victims, or do they not matter because they all lived outside the constituency? Is the push for more frequent tram services compromising passenger safety along the entire Tramlink lines?

Transport: Raynes Park station

7. OK, it's nice that the litter has been cleaned up from the embankment but, again, Raynes Park station has not changed one iota since I moved to the area in 2011. It is still terrible for disabled people, the platform still makes the train really hard for people to get on and off safely, the toilets are still terrible, there is still nowhere to change a baby's nappy. And, again, you've been the MP for 12 years. So I ask you, what have you been doing all this time in regard to improving Raynes Park station?

Transport: Crossrail 2 and the tube

8. Crossrail 2 will benefit the area as it means we will have another form of transport. It is impossible for such a major project to be undertaken without any disruption. Indeed, if Crossrail 2 results in a complete rebuilding of the Wimbledon Centre Court shopping centre, that would be a good thing. Do you not agree it is currently cumbersomely laid out? Do you not agree that the food court is now just an embarrassment? It has been reduced to a McDonalds, a defunct yoghurt stand and a photo booth. Would an overhaul of the shopping centre not draw in new businesses to the town centre?

9. While Wimbledon is undergoing work in regard to Crossrail 2, whenever that may be, will you campaign for businesses to consider relocating to Morden temporarily? This could give Morden the shot in the arm it needs to regenerate and improve the diversity of businesses on the high street.

10. Do you have any costings on extending the Northern Line to St Helier or is this merely a belief? The Northern Line extension to Nine Elms and Battersea Power Station from Kennington will cost £1.2 billion so that might help you come to some sort of realistic figure. Where will this money come from?

Employment and local businesses

 

11. My questions are about to come full circle... 

As per one of my Crossrail 2 questions, will you be encouraging more businesses to set up shop in Morden town centre? This is not just about temporary shops during Crossrail 2 construction but also long-term businesses on a high street that has not changed on your watch in at least six years.

12. Are you confident that Theresa May will negotiate a Brexit deal with the EU that will not adversely affect local businesses? What evidence do you have for your answer?

Thank you for your time and consideration, Mr Hammond. I look forward to your responses to my questions as a concerned constituent.

Kind regards,

Georgia Lewis

(You have my address, I have written to you before and I am obviously not going to publish it here)

NHS reform for dummies

Amid this week's entirely justified furore about the Daily Mail's "legsit" front page in which Theresa May and Nicola Sturgeon's Brexit/Scottish independence discussions were reduced to body parts, there lurked another steaming turd that demanded closer inspection.

Directly below the calf-obsessed photo of our two most senior politicians, there was a deafening headline about NHS reforms that will apparently fix everything and save billions of pounds. The Daily Mail was selling the story as if the reforms are a good thing, the Daily Mirror was taking the opposite view, pointing out longer waiting times and no extra money being spent on the NHS by the current government.

But without an electable opposition, this does not really amount to a hill of beans. That said, shadow health secretary Jonathan Ashworth did a solid job when he was interviewed by Sophy Ridge on Ridge on Sunday this morning. Whenever Jeremy Corbyn quits hanging around the Labour Party leadership like a fart in a car, I'd urge his replacement to keep him on.

In the meantime, however, people continue to prove the notion I put forward last time I blogged on the NHS which is that there is still plenty people will tolerate in terms of stupid healthcare reforms before they will get angry.

The Tories currently own the "free at the point of use" rhetoric - as long as people are not noticing any real difference to the healthcare they receive, it is very hard to get people to care about issues such as taxpayer money going to private companies to provide services formerly provided by the NHS, or private companies getting away with all manner of crap because they are exempt from Freedom of Information laws. The cost of administration of NHS contracts, which renders any cost savings meaningless, is not being discussed especially widely and the billions that are sucked into the PFI debt vortex each year is a problem consigned to the too-hard basket.

The cold reality is that stories such as the Daily Mail's splash about a "blueprint to save the NHS" are swallowed en masse without too much thought. If only more people got their news about the NHS from Private Eye instead.

"Dramatic drive to cut costs unveiled that will see dolling [sic] out of painkillers scrapped and GPs ordered to crack down on health tourists" is the online headline that sets the tone and the agenda.

The health tourism line is routinely trotted out because it appeals to xenophobes. Sure, there is an argument for ensuring that those who are not entitled to NHS care pay up but it is delusional to expect that to magically fill a funding hole - it makes up around 0.3% of NHS spending. Additionally, since 2015, non-EEA citizens who come to the UK for more than six months as students or temporary migrants have paid a health surcharge as part of the visa process. But because the figure is estimated at £300 million, the outrage ensues. Daily Mail readers are held in utter contempt by the paper with the editor and his acolytes assuming they will be dazzled by a big number, the kind of figure very few of us will ever see in our bank accounts.

And the Daily Mail is at it again in this week's report, dazzling its readers with the claim that Simon Stevens, chief executive of NHS England, has a plan that will "save the Health Service up to £1 billion in two years". So all these plans might save around half a billion per year out of an annual budget of around £120 billion. Meanwhile, PFI has left the country £222 billion in debt.

As ever, people are getting excited over plans for the NHS that are the equivalent of getting 20 plumbers over to fix a leaking toilet while nobody is being called on to look at the house's crumbling foundations.

As for the painkillers crackdown, if the NHS simply used its enormous purchasing power better, it would be procuring painkillers far more cheaply. In any case, painkillers will still be given to patients in hospital and the whole "make people pay for their own Panadol" rhetoric is pretty lame. Don't tell Simon Stevens this, but most of us already do buy painkillers for ourselves.

The plan also includes making people pay for their own indigestion and hayfever remedies. Again, millions of us across the country already do this. Even the most die-hard NHS defender probably just pops a pill from the bathroom cabinet in the event of a hangover, a springtime sneezing fit or a growling stomach after too much curry.

The move by Stevens to crack down on GPs prescribing gluten-free food is another pretty stupid distraction. At a cost of £25 million a year, it is far from the NHS's biggest cost pressure but the NHS does get ripped off by suppliers charging it more than supermarkets, but a voucher system for supermarkets would solve that problem - or, once again, better procurement.

In any case, prevention is better than cure, for patients' wellbeing and in terms of cost-efficiency, and ensuring coealics have access to gluten-free food is a good example of this. But it's another easy, lazy headline if people think the NHS has become a gluten-free outpost of Greggs.

Then there is the scandal of the NHS funding unscientific, non-evidence-based homeopathic treatments. It is hard to come by exact figures on how much of our money is spent on woo and bunkum but the excellent Good Thinking Society estimates it at around £5 million per year. Again, it is a drop in the ocean - although still a dazzlingly large sum of money in Daily Mail land - but any plans to entirely scrap this bullshit from the NHS is absent from Stevens' plans. At least the funding of gluten-free food and painkillers is based in science. But with Jeremy Hunt being a homeopathy-loving health secretary and Jeremy Corbyn being a homeopathy-loving ageing student protester, this won't change any time soon.

Unsurprising to anyone who has been paying attention, Brexit will cast a long shadow over any attempts to fix the NHS, including this latest blueprint from Simon Stevens. It is all well and good to desperately tweet "FORGET ABOUT BREXIT! THE NHS IS BEING DESTROYED!" but the harsh reality is that Brexit is now inextricably tied to the future fortunes of healthcare in this country.

The plan includes trying to ensure NHS managers don't hire expensive locum doctors but we are facing a Brexit-induced doctor shortage. A British Medical Association study found that 42% European doctors are considering leaving the UK following the Brexit vote and another 23% are unsure. Out of 10,000 EU-trained doctors, that is a significant number we could lose.

On top of this, from July GP surgeries will be acting as border control when they will be obliged to check if all patients registering have a European Health Insurance Card (EHIC). These are issued by one's home country and entitle EU citizens to NHS care on the proviso that their government pays back the costs. If someone is turned away from a surgery for not having the EHIC, they can simply go away and obtain one and then register. But this alleged reform sounds like it's going to be punitive for EU citizens so it holds appeal for Brexiters.

Additionally, we in the UK are entitled to the EHIC so we can receive medical treatment in Europe. It is a wonderful thing because it works both ways - but once we leave the EU, we will probably lose that entitlement. Possibly. When the blisteringly incompetent Brexit secretary David Davis was quizzed on this by Hilary Benn at the Brexit Select Committee this month, he said he did not know what would happen to our access to the EHIC. He admitted that his department had not looked into this not-insignificant matter.

So there you have it, kids. A blueprint to save the NHS that merely tinkers around the edges, with bonus features that will probably be rendered pointless thanks to the idiocy of Brexit, all brought to you by the Department of Smoke and Mirrors.









Photography by Elliott Brown/Flickr

The day after the NHS march...

As most people in the UK are probably aware by now, there was a rather large march for the NHS in London yesterday. Most people know this because it actually was covered by the much-derided mainstream media, including the BBC, ITV, Channel 4, the Mirror, the Daily Mail, the Daily Express, the Evening Standard, the Guardian, the Telegraph, Sky News and Metro.

This did not stop the internet lighting up with people claiming the march was not covered or seeking out conspiracies where none exist.

"It's the mainstream meeja's fault!"

On the Big Up The NHS Facebook page, one person thought it was suspicious that the Evening Standard and the Mail Online used the same photograph, even though it was an agency photo which would be available to any major news outlet with a PA subscription, which is all of them. 

On the same page as well as on Twitter, multiple people pounced on the inverted commas used by the BBC in an online headline about the march, with "hospital cuts" in inverted commas. If anyone bothered to read the story, they would see that the inverted commas are used to refer to quotes from the protesters rather than any specific cuts and it is, therefore, accurate journalism, but the left-wing media bashers are not interested in accuracy or learning about how journalism works. They'd rather scream about media conspiracies, as if we journalists spend our spare time in a darkened bar, smoking unfiltered cigarettes, drinking whisky neat, and colluding with each other about how to create a Tory dictatorship. 

This is a shame because such paranoid nonsense only serves to distract from the very real issues facing the NHS. And speaking of distractions, one of the biggest and dumbest banners at yesterday's march, bafflingly, said: "SICK OF MEDIA LIES ABOUT JEREMY CORBYN". 

Firstly, Jeremy Corbyn's address to yesterday's march was very well covered, including by the right-leaning Daily Mail, Express and Telegraph. The brutal truth is that marches are usually not that interesting to cover unless violence breaks out. In terms of media coverage, you have images of marching, shouting people with placards and banners, footage or quotes from the speeches and, er, that's about it. From a journalistic point of view, it is pretty limiting as to what can actually be said about a march before it gets repetitive. So for yesterday's march to glean the coverage it did should be seen as a positive. Whining about media conspiracies makes campaigners look certifiable.

Secondly, that banner is absurd at a march specifically about the NHS. Campaigners who want people to seriously focus on the many things that are bringing the NHS to its knees and want to attract people of all political persuasions - as well as the apolitical and apathetic - need to look outside the Corbyn-loving echo chamber in which many of them are stuck. These people (and I hasten to add this is not all NHS campaigners) need to realise that NHS campaigns which come across as Corbyn fan clubs, when he is simply not resonating with people outside the Labour Party and Momentum in particular, will not be effective.  

And then it gets complicated...

On top of all this, the Health and Social Care Act 2012 devolved all responsibility for health services to local Clinical Commissioning Groups (CCGs) and that is where the real lobbying and engagement needs to take place, with elected MPs and local councillors along to ask hard questions about where money will be spent in their regions. In theory, CCGs make sense - the healthcare needs of a seaside retirement town will be vastly different to an inner city borough of young families, for example, so one size does not fit every area. 

That said, the basics such as accessible A&E, cancer treatment, and GP services should be available to people equally across the country - although in the case of GP services, this also varies between different areas. The retirement town won't have the same demand for GP services on evenings or weekends that the inner city area full of time-poor working people will. 

If the message that engagement is required locally at CCG level as well as nationally has not been properly communicated to the wider community as a result of the march, better communication from campaigners is required. This is also needed from Labour at all levels if they are serious about being a proper opposition and forming a government at the next election. 

Yes, the future of the NHS is about adequate funding at the Westminster level, where plenty of MPs have vested interests in private healthcare, just as much as it is about CCGs being financially responsible and lobbying the government if there are local shortfalls, particularly if people cannot be discharged from hospital because of inadequate social care. The financial interests of CCG members are as important in this equation as that of MPs because right now there is nothing to stop members commissioning from businesses or non-profits in which they have an interest.

It is complicated and it is not simply about throwing money at the NHS if it will only end up mismanaged at a local level and the CCGs are not held accountable. 

Do not be naive - we will have a Conservative government in this country until at least 2020 and therefore we will have CCGs at least until then.

So, what next for the NHS?

What happens next for the NHS will depend on what is seen as politically expedient because, like it or not, the NHS is political. 

It is pretty clear that there is an appetite for destruction when it comes to the NHS under Theresa May's government. If she genuinely cared, one of her first orders of business would have been to ditch Jeremy Hunt, the failed marmalade mogul who has been play-acting at the Health Secretary job since September 2012.

The government is smart enough to know that British voters will not stand for a complete replication of the American system. While there are always calls to charge so-called health tourists for NHS services, the free-at-the-point-of-use mantra has been effective. Except it has been effective for the Conservative Party and this is a hurdle for the opposition.

The privatisation conundrum

As long as health services remain free at the point of use and people are not filing for bankruptcy because of medical bills, it is really hard to get people to care about whether the services are being provided directly by the NHS or the NHS has farmed it out to a private company.

On top of this, Corbyn's rhetoric about stopping all NHS privatisation is simplistic. For starters, GPs have always been privateers. Any attempt to nationalise GP services, forcing GPs to work certain hours and potentially reducing the flexibility for GPs to work part-time, will result in a shortage, particularly among GPs who are parents - this will disproportionately affect women GPs so hardly a great victory to be had there. 

The big financial pressure here is the cost of administering the tender process, with estimations between £4.5 billion to £10 billion per year. But if we keep farming out services - which can be anything from cleaning the loos to cancer treatment - the government has to run a proper tender process, which is not cheap. Thus the government needs to acknowledge that this will be the case as long as services are open to tender - this is not an expense it can pretend doesn't exist.

Additionally, the NHS is not subjecting private companies involved in bidding for contracts to the same freedom of information rules that government departments are subjected to - so this makes transparency much harder. Indeed, I tried and failed to get solid information from my local hospital trust on whether the rise in MRSA infections had anything to do with farming out the cleaning services to a private company, but I was stonewalled. This government is not going to do anything about this given it already has form in trying to restrict existing FOI access. 

Similarly, there doesn't seem to be any bans on companies being able to bid for or keep contracts after catastrophic events. G4S should have been banned from any government contract after the Olympics security debacle and they continue to run the patient transport services at my local hospital despite killing an amputee in one of their vehicles owing to insufficient staff training. Virgin, meanwhile, has also done an abysmal - and lethal - job of running the Urgent Care Centre at Croydon University Hospital, yet continues to hoover up NHS contracts, including a £700 million contract over 200 hospitals late last year. 

These are fundamental problems with the way things are run at the moment but even if all NHS services were returned to the NHS, the NHS still has to procure stuff it can't make itself. 

It is absurd to expect the NHS to set up its own factories for bedlinen, cutlery, crockery, windows, uniforms and the thousands of other things it needs to purchase in order to function. 

While one idiot once said to me with a straight face that the NHS will indeed make all its own things once the workers control the means of production, that is clearly ridiculous. Instead, the NHS should use its huge purchasing power to get the best possible deals on all it procures. There is no excuse for waste here and the NHS will continue to buy stuff from private companies. Sorry, it will. It's just that the procurers should do a better job of it.

The technology conundrum

Actually, this should not be a conundrum at all. If there is good technology out there that can contribute to saving lives, money and time in the provision of healthcare, the NHS should look into procuring it for the best price possible. 

I have noticed a rejection of technology among elements of NHS campaign groups. There was a placard at yesterday's march that said "TECH IS CHEAP BUT AN APP CAN'T WIPE YOUR BOTTOM". This is very true - there will always be a need for human beings in hospitals to perform such tasks but if there are apps that can improve the way care is provided, this should be looked into.

I've seen NHS campaigners complain about advances such as telemedicine, even though it can be used as a way to improve access to care and relieve pressure on GP surgeries. Again, it cannot always be used as a substitute for an in-person physical examination but it can play a role and this sort of thing should not be dismissed out of hand.

I suspect nostalgia for the good old days of the NHS comes into play here instead of recognising that society has changed since the NHS was established in 1948, the population has increased, amazing advances have been made in medical science, and technological changes have happened and a modern NHS needs to be about making all this work for everyone.

And again, if there is technology that can be used to improve patient care, it will have to be purchased from private companies. Like I said, Corbyn's anti-privatisation rhetoric is simplistic.

The Australian model?

As I said, if services are still free at the point of use, there are millions of people who won't care if the services are provided by a private company.

What I do see happening is a move towards the hybrid Australian system rather than an all-American system, with a mixture of public and private services side by side. I dared to suggest this on a local campaign Facebook page last year and was howled down. I never said the Australian system was perfect in my comments, merely that, as someone who has experienced both the Australian and UK systems, I could see the trends happening over here.

It is important to bear in mind that just as we have postcode lotteries with care in the UK because of differences in how CCGs spend their money, the American system is actually multiple systems on a state-by-state basis - so to simply say: "We're going all American!" is also simplistic. We will see more involvement by American companies in the NHS, particularly if we are left wide open to this in a post-Brexit trade deal with the US. It is important to remember here that American companies are very nimble and thus good at adapting to trading in diverse markets. 

From McDonalds varying its menus across cultures to big oil companies making money in countries with a wide range of tax and regulatory systems, it's what American companies do. Healthcare is seen as no different by American companies.

Like America, Australia has differences in health systems between states but with public-private hybridisation across them all. I can see this Australianisation happening in microcosm form at my local hospital, St Helier.

St Helier could well lose its A&E department in the near future, which will be disastrous, forcing people to spend longer in ambulances or in traffic or on public transport seeking medical attention. 

But I predict it will keep its maternity unit, bolstered by its expanding assisted conception unit. Currently, IVF patients undergo pre-IVF testing and appointments as well as egg extraction at St Helier but the eggs are fertilised at Kings Hospital. The transfer of fertilised eggs also takes place at Kings. When St Helier's assisted conception unit expands to include its own embryology department, it will become a one-stop shop for IVF patients. Under local CCG rules, one round of IVF per patient is funded on the NHS but there is nothing to stop St Helier from receiving paying private patients - this should prove a handy source of income for the hospital and I suspect we will be seeing more and more of this across NHS hospitals all over the country. This sort of thing is not unusual in Australia and the funds raised from the private business helps keep the public services afloat.

The IVF example is an interesting one because, like privatisation but services being free at the point of use, it is also an example of what the public will tolerate here in the UK. In Australia, there are some Medicare rebates on fertility services but, by and large, it is an expensive undertaking with plenty of couples spending thousands in their quest to have a family.

It would not surprise me if, in the coming years, IVF on the NHS becomes virtually unheard of. I believe this is something the public will tolerate overall. Breast implants, unless they're for mastectomy patients, is another service I can see being chipped away, along with transgender procedures. Prochoice activists will also need to be vigilant about any attempts to limit abortion access - Jeremy Hunt has publicly said he'd like to see the time limit reduced to 12 weeks and if the government thinks it can save a few more pennies this way, or give the impression of being fiscally sensible, without taking too much of a hit on election day, I wouldn't put it past the May regime. Hunt was shot down in flames by people across the political parties last time but that was 2012. Britain has become a more conservative place in just five short years. 

I am not saying any of this is right - especially as such cuts would target women disproportionately - but it is the kind of thing this government can get away with if it doesn't anticipate harm at the ballot box. Hell, you've only got to look at Labour's catastrophic humiliation in the Copeland by-election, losing a safe seat to the Tories at a time when local maternity services are under threat to see what resilience this government has right now in terms of withstanding removing NHS services. 

The other Australian trend that has already gained plenty of traction here in the UK is increased take-up of private insurance. The advertising is ubiquitous, the deals often sound affordable, there is an increase in employers offering private cover as part of the package for staff. Around 50% of Australians have private health insurance, compared to an estimation of around 8.7% of people in the UK. Figures up to the end of 2015 show a surge in uptake of private health insurance in the UK. Again, plenty of people will not see this as a bad thing, especially if they find they can be treated faster if they go private.

Apologies for the long blog post

I have ranted for longer than usual this time but it is a complex subject. Just as there needs to be follow-up after the women's marches in the wake of Trump's election, there is a long road ahead if the NHS is to be preserved. I do not expect the NHS to survive in its current form and, despite yesterday's impressive march turnout, there is plenty that voters will tolerate in terms of cuts particularly if it doesn't affect them directly. Too old for an abortion? Not a woman? Intolerant to transgender people? These are the people who probably will turn out to vote in 2020 and they might not seek to punish the Tories over the NHS. 

It's a massive issue and none of it fits nicely on a placard.

Photography: Loco Steve/Flickr

Random rants from a busy Rant Mistress...

I've started a new job, I've been in and out of the country, I'll be out of the country and back again soon, I've been busy, I've neglected to rant. Here, in no particular order, are some random thoughts that I have not gotten around to committing to paper, or indeed the internet.

- Frankly, if the junior doctors' strike was only about pay, so fucking what? I want to live in a country that respects doctors enough to pay them properly. The race-to-the-bottom nonsense of wanting everyone to live in penury is pathetic.

- Richard Dawkins' absurd (and now deleted) tweet saying Queen Rania of Jordan is a good Muslim, showing off her lovely hair, is merely another tragic example of the fetishising of said queen. Sure, she is an attractive, articulate woman with good hair. But, thanks to her position of privilege, she has the luxury of being outspoken in a way that many in her country, particularly journalists do not.

- I don't think Jeremy Corbyn will ever win a general election.

- Trying to get people to understand that PFI and the cost of administering the marketised NHS are the two main cost pressures is bloody exhausting.

- The world will need fossil fuels for a while longer. If you own anything made of plastic or a T-shirt that is not 100% cotton, or you'd prefer to abseil using nylon ropes instead of hemp ropes, then you are using petrochemicals. Sorry.

- Stop asking stupid questions of women over 35 who do not have any children. If she wants to discuss the reasons behind her child-free life in detail, regardless of whether she is childless through choice or circumstance, she will volunteer the information. If not, butt out of her uterus.

- The Revenant is a completely overrated film.

- It is tiresome and ridiculous that the Zika virus outbreak is once again dragging non-scientific anti-vaxx arguments out of the woodwork yet again. Give it a rest. Learn some science. You are embarrassing yourselves.

- Hillary Clinton will be the next president of the United States of America.

- The UK will vote to stay in the EU - and I suspect the vote won't be as close as people think it will be.

- If you seriously think the homeopathy-mad, failed marmalade mogul, Jeremy Hunt, is a good Health Secretary, you are deluded and I am not sure I can help you.

- Does anyone find Keith Lemon funny?

- It was really moving to see the Stade de France full of spectators watching the France vs Italy Six Nations match yesterday.

- David Cameron, Boris Johnson and Jeremy Hunt are all pathetic negotiators and I refuse to take any of them seriously.

- It is time for long-standing refugee camps in the Middle East to be turned into proper towns with proper schools, hospitals and economic activity, such as businesses and industry.

- Deutschland 83 is excellent television and should cure people of Ostalgie, even if it is a fictitious account. If not, read Stasiland by Anna Funder instead. Romanticising East Germany is ridiculous and makes elements of the left look completely stupid.













Photography by Kim Rempel

Period dramas...

I'd never heard of Ella Whelan before last week and I am quite sure she doesn't much care about my existence either. But, Christ on a cracker, has she missed the point of Plan UK's #JustATampon campaign.

Or, what is probably more likely, is that she understands Plan UK's campaign perfectly well but she fancied being the voice of contrived contrarian lefty-bashing feminism that The Spectator clearly needs among its bloggers.

She unleashed a bucket of faux ignorance on the world last week in her piece about the West being obsessed with the contents of the knickers of developing countries. In particular, she called out Plan UK's campaign to help women and girls in developing countries become more educated about menstrual health and to help these women and girls access sanitary products.

Ella seems to object to Plan UK's assertion that "stigma and embarrassment attached to women's periods contributes to gender inequality worldwide". Except that it does, Ella. But instead of acknowledging that women and girls around the world suffer enormously because of a lack of menstrual care, she insists that the campaign will only serve to perpetuate the perception of African countries as being dirty, unhygienic and unaware of periods. Except that many women and girls in many African countries do experience their periods in horrible conditions that would make the average western woman recoil in horror.

Why pretend this isn't happening?

Probably because it is easier and more clickbait-friendly for Ella to use her soapbox to bash popular targets of the right as Jenny Eclair and Jon Snow. Why is she afraid to acknowledge that having your period in horrific conditions, often with the added stigma of cultural taboos and myths about menstruation, means that you might miss days of school and not complete your education, or you might not be able to go to work, or care for your family properly? These are real issues and helping girls and women have less horrific periods is part of the solution.

Ella is partly right to say that the problem for women in developing countries is not a lack of education about periods but that there isn't a branch of Boots on every corner. Of course, it'd be nice for women in Africa's deprived regions to have the same easy access to pads, tampons and Mooncups that we enjoy here in Britain. But getting many African countries to that point will take time. Some parts of Africa are already there. It is a big and diverse continent.

This is why the countries in which Plan UK works are called "developing countries". It is short-sighted and defeatist to slag off an entire campaign because it seems easier to sit back and wait for capitalism to happen. Plan UK does great work to help women and girls in particular to be part of the solutions to poverty, such as ensuring they have access to healthcare and education and do not disappear from the world in forced marriages.

The #JustATampon campaign just one component of the wide-ranging work Plan UK does. Sure, it's  a gimmick to have people take selfies with tampons and I frequently scoff at such campaigns because I am unsure how many selfies actually convert into donations (See also, the ice bucket challenge and no make-up selfies). But if the campaign leads to more people choosing to support Plan UK, a secular charity with no ulterior motivation to convert anyone to or from religion, that's a good thing.

Plan UK cannot solve the world's problems alone but, in particular with their programmes involving access to education and eliminating child marriage, they are doing something. Access to clean drinking water and access to reliable energy are other challenges which need to be addressed so that developing countries can attain Ella's Boots-on-ever-corner menstrual utopia.

And lack of menstrual care is not just a problem for girls and women in developing countries.

Given the lazy approach Ella took to her piece in The Spectator, I wonder if she could be bothered to acknowledge that it is an issue for homeless women in Britain and in other supposedly civilised countries. The Homeless Period campaign explains this more eloquently and powerfully than I can. Click here to find out about this great campaign.

And, as outlined in this rather upsetting piece in the Guardian, lack of access to menstrual products is an issue in some US prisons. Just don't read the comments at the end unless you really enjoy reading the work of dullard mansplainers who have never had a period in their life advocating a system where women in prison as deserve to spend days caked in their own menstrual blood.

Having a period that is as comfortable as it can possibly be is something most of us take for granted. Is Ella having to wad her own underwear with toilet paper scavenged from a public toilet like a homeless woman every month? Is she banished away from her community until her period is over because menstruation is seen as a taboo? Has lack of access to pads and tampons impacted on her ability to get an education or work for a living? Is she imprisoned and forced to ration her maxi-pads?

These things are still happening to girls and women in 2015. Anyone who is taking steps to ensure these things don't happen should be congratulated. They do not deserve the petty vitriol of an arrogant columnist.