Steve Double: May has misread the mood of the country over free movement. Now is the time to drop hostile rhetoric.

There is a now a window of opportunity for a better, more sensible and cross-party debate than the one we had in the referendum campaign.

Steve Double is MP for St Austell and Newquay.

Since the nation voted for Brexit in June 2016, our resolve to respect the results of the referendum by leaving the EU and the European Single Market has been unwavering. Talk of a second referendum has dominated the airwaves lately, but there is scarcely any evidence this would deliver a decisive result – the kind that some politicians are seeking in order to rethink Brexit – were we to have another vote tomorrow. If anything has changed, it is the way the British public views migration – its importance and its impact on our economy and communities.

Bringing an end to freedom of movement, one of the four indivisible and fundamental freedoms of the EU, has been a priority for the Prime Minister in her negotiations. Migration ranked highly among the reasons for the people’s vote to leave the EU. “We have no control over migrants coming in”, “open borders has not worked”, “they are putting a strain on local infrastructure and services” – these were the concerns many of my colleagues and I heard time and again on the doorstep and at town hall meetings, and the more-than-unexpected results of the referendum spoke volume about the extent that these concerns were felt across the country.

While it is certainly true that leaving the EU presents us with a once in a lifetime opportunity to build a fairer and more effective migration system that meets our needs and returns control of migration policy from Brussels to London, Number Ten would be misguided if they thought nothing has changed. Public attitudes have changed in profound ways and these changes have taken place on three levels.,

First, the Brexit vote has given rise to a more positive view of migration. Fewer people think that there are too many migrants in the UK, as Britons increasingly recognise the benefits that migrants bring to the country and are assured by the government’s commitment that there will be a reduction in migration levels.

Recent evidence from the National Conversation on Immigration has shown that our citizens are ‘balancers’, on the whole, who see the gains and pressures of migration when weighing up its impact. They appreciate the skills they bring in, the jobs shortages they fill and their contribution towards public finances. They understand that there are realistic trade-offs when it comes to controlling migration and know what is at stake for British businesses. There is also a broad consensus for a fair and humane migration system that places the welfare of families and individuals at its heart: The vast majority of us are ashamed of the treatment of the Windrush generation and none of us want to see administrative failures and incompetence lead to a repeat of the scandal.

While it is true that controlling migration remains to be an issue of concern for Leave voters, it is no longer the case that migration is seen by the public as the most salient issue. Two weeks before the nation went to the polling booths to decide our future with the EU, a YouGov Most Important Issues poll found that 56 per of those surveyed saw “Immigration & Asylum” as the most frequently-cited issue facing the nation – more than 10 points ahead of any other issues including the Economy, NHS and Public Health, Defence and Terrorism. This figure was most recently recorded at 29 per cent.

Third, with employment rates hitting record levels and virtual full employment across many sectors, businesses have raised legitimate concerns that they do not want an oversimplified approach to migration which will leave them worse off with fewer workers. Removing the numerical cap on Tier 2 skilled workers visas would be a good start, but any salary-based threshold must be driven by evidence and not imposed arbitrarily.

Furthermore, the importance of certain lower-wage roles for our economy and society needs to be adequately considered. In my constituency of St Austell and Newquay in mid-Cornwall, for instance, the seasonal nature of our visitor economy as well as fish stocks, fruits and vegetables mean that a flexible and dynamic migration system for temporary low-skilled labourers will be absolutely crucial to ensuring the continued success of the Cornish economy.

It appears quite clear that the approach from Number Ten has been that as long as we stop free movement people will view that as delivering on the referendum. However, regaining sovereignty over our own laws and trade has instead become a more important issue. The notion of ‘control over our own borders’ has moved away from a debate around migration to one focused on the so-called backstop and the integrity of the union.

The Prime Minister has misread the mood of the country by overemphasising and prioritising the stopping of free movement of people. The draft Withdrawal Agreement has not captured the shift in public mood with regards to migration, and fails to keep our commitment to regain sovereignty to the UK – a precondition to any true Brexit that delivers on the result of the referendum.

In a rare admission of fault, the Prime Minister told MPs recently that she was wrong to have referred to EU citizens as “queue jumpers”. Though she might have been able to get away with that kind of language in 2016, the British people have since moved on and have come to better appreciate what is at stake in the migration debate and migration’s impact on our country.

Despite the many irreconcilable differences that exist between Remainers and Leavers over Brexit, there is a now a window of opportunity for a better, more sensible and cross-party debate around migration than the one we had in the referendum campaign. The public wants us as politicians to lead the way in improving the quality and quantity of discussions on migration.

It is absolutely right that as we leave the EU we do take back control of our borders. But having control over our own migration policy is not the same as stopping all migration. We should be able to manage migration in a way that suits our own economic and social needs and concerns whilst having a compassionate approach to those fleeing war, persecution and oppression. We should also be able to better ensure we have the infrastructure and services to meet any increase in population and protect those communities who have in the past felt overwhelmed by migration.

With the Immigration White Paper now published, the time is now to drop this hostile rhetoric against those who come legally to our country to contribute in our workplaces and communities, and begin a more mature and measured conversation around how we can put together a post-Brexit migration system that works for everyone.

Michelle Lowe: How local government can ease the pressure on the NHS

In Sevenoaks District Council we contact people that regularly miss appointments to find out why and how we can help.

Cllr Michelle Lowe contested Coventry South at the General Election last year, and is Deputy Leader and Cabinet Member for Housing & Health at Sevenoaks District Council.

With people living longer, and more of us living with more than one complex condition, combined with more expensive treatments available – the NHS constantly needs more resources. Only in the last year, Theresa May promised a further settlement of an extra £350 million a week – an increase of three per cent a year.

The NHS has been so successful at making people better after they have become ill that as a society we have forgotten how to prevent people from growing ill in the first place. During Victorian England it was not the health service that eradicated Cholera, but local government by dealing with the causes of the illness: cleaning up the water supply and tackling overcrowding in poor quality housing. Local government needs to return to its prevention roots and promote wellbeing, thereby reducing demand on the NHS.

Local government is starting to do just that. By introducing a health-in-all-policies approach to everything it does, councils can use planning, housing policy, environmental health, leisure, licensing etc to create healthy local environments. But local government can and is going further with social prescribing initiatives to support the NHS. Social prescribing helps to reduce hospital and GP appointments and tackles the underlying non-medical reasons that people seek medical help such as asthma caused by damp housing, anxiety caused by debt, and a range of conditions caused by loneliness, poor diet, and lack of exercise.

Often social prescribers are based at GP surgeries and have more time to discuss with people what could be causing an issue such as anxiety. They can then refer them to the relevant agencies that can help them. It makes more sense to help them with the cause then to keep prescribing medicines that are only masking the problem. Social prescribers can link patients into the services that can help with their problem: debt advice, private sector housing to tackle damp, voluntary activities or opportunities to tackle loneliness etc.

Every GP has at least four appointments each day from people that are lonely; and loneliness is as bad for our health as smoking 15 cigarettes a day; so these services make a big difference. Often they can be run in conjunction with housing associations and the voluntary sector such as Age UK, having the double whammy of supporting charities and other local volunteering groups.

Social prescribing can look after people holistically. Falls prevention classes for older people can take place in an indoor environment providing exercises or chair yoga; or can be gentle walks through a park or the countryside. They nearly always end with a cup of tea and a chat with more advice about fuel efficiency, internet scams, and other issues concerning older people – while combating loneliness. By linking the social prescriber with housing providers many of these activities can take place in retirement villages open to nearby residents – helping to create stronger communities.

Nearly half of all falls occur at home so falls prevention classes combined with home adaptations and using the planning process to build more supported housing across all sectors can help older people live more independently and out of hospital. Given that older people can lose up to five per cent of their muscle mass each day they stay in hospital it vital for their chances of remaining independent at home they are not admitted to hospital at all. Age UK estimate that falls in the over 65s cost the NHS £4.6 million a day – so this work really can make a difference.

For those who are admitted to hospital, many councils are using the Better Care Fund to adapt their homes while they are in hospital so they can be discharged as soon as they are clinically ready. It could be something simple such as moving a bed from upstairs to downstairs or fitting a key safe so carers can gain access to the home, to something more complicated such as ramps and rails. As a result despite last winter being one of the coldest on record many hospitals met their discharge times.

Missed GP appointments are estimated to cost the NHS £216 million a year. Sevenoaks District Council employ a number of “One You” Social Prescribers who contact people who regularly miss appointments to find out why and help to rectify the situation. Some stories are very sad. One man was blind and unable to record his appointment times. By contacting the RNIB technology was fitted in his home that enabled him to keep track of his diary commitments – completely revolutionising his life for the better. This story to me sums up the true value of social prescribing.

The role of local government is critical in helping people live healthier, more independent lives, taking the pressure off the NHS and indirectly social care. The new, recently published, NHS 10 year plan recognises the role of prevention and local government. When the new Health and Social Care Green Paper is published it will be great if that builds on the work of local government and supports this trend. There is no one way to keep people well and reduce demand on the NHS; but local government has a number of tools at its disposal that can help to make a big impact.

5 ways the UK’s health plan falls flat

Theresa May promised a £20.5 billion spending boost but there’s concern it won’t go far enough.

There’s life beyond Brexit, according to the U.K. government. Nobody else seems convinced.

Prime Minister Theresa May visited a hospital in Liverpool on Monday to lead a carefully choreographed announcement of the new 10-year plan for the National Health Service. Designed to show the government is capable of doing more than just leaving the EU, the plan aims to “save almost half a million more lives” in the next ten years by focusing on prevention and making better use of digital health services.

With most domestic policy initiatives on hold because of Brexit, the government has promised a £20.5 billion spending boost by 2023-24 to back up its health plans — money May said will come in part from the windfall to be enjoyed when the U.K. stops sending money to Brussels.

But the reactions from health care providers focused largely on the uncertainties facing the NHS ahead of Brexit, both in terms of finance and the departure of EU27 nationals that will worsen staffing issues. (Few believe a Brexit windfall is likely despite the Vote Leave’s red bus.) Lengthening wait times for services was another politically sensitive issue set aside in the government’s announcement.

“This is not about miracles — money will be tight and staffing will remain a headache for years to come,” Niall Dickson, chief executive of the NHS Confederation, which represents health service providers, said in reaction to the plan. Warning of the risks of “over-promising,” Dickson said: “Our plea is that politicians be honest about the trade-offs that will be required and that we are realistic about what can be achieved given the ever-increasing demands of an ageing population.”

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity

The announcement also suffered from the government’s strategy of pre-announcements: major policy initiatives from new cancer screening to mental health service improvements had been widely previewed, leaving praise confined to celebrating the “vision” of tying those initiatives together.

Here’s five reasons why the plan failed to match expectations.

1. Not enough money

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity. The figure amounts to a 3.4 percent increase in funding, but think tanks such as the Nuffield Trust say a 4 percent boost is needed at least to “put the NHS on a sustainable footing.”

“Ultimately, there is a need for honesty about how far the £20.5 billion over five years will stretch,” British Medical Association (BMA) council chair Chaand Nagpaul said Monday. “World class care requires world class funding and the investment in the long-term plan will still leave the U.K. falling behind comparative nations like France and Germany.”

Britain’s Health Secretary Matt Hancock | Ben Stansall/AFP via Getty Images

Plus there’s concern a no-deal Brexit would deplete the promised funding — “the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks,” Nigel Edwards, chief executive of the Nuffield Trust, said in a statement.

Health Secretary Matt Hancock has promised the extra funds will be available “irrespective” of the outcome of Brexit talks with the EU, which doesn’t quite fit with May’s suggestion it will come in part from money London will no longer be sending to Brussels.

2. Ignoring staffing woes

Staffing shortages are top of the list for nearly 60 percent of U.K. voters when asked where the extra NHS cash should be spent, according to a poll by The Times, but the government’s plan kicks that can down the road.

The plan promises “NHS staff will get the backing they need” by balancing “supply and demand across all staff groups.” The funding for hiring, training and professional development of NHS staff “has yet to be set by government” and won’t be published until “later in 2019,” it said.

Staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout” — Chaand Nagpaul, BMA council chair 

The BMA, which represents doctors, and NHS Providers, which represents various NHS staff, cautioned the NHS will be hard-pressed to make good on the plan’s promises if it doesn’t improve the staffing situation. One in 11 posts are estimated to be vacant and the situation is predicted to worsen after Brexit, with the King’s Fund, Health Foundation and Nuffield Trust predicting a shortfall of around 250,000 NHS staff by 2030.

Nagpaul of the BMA said doctors and staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout.”

3. Hedging on waiting times

The government’s plan commits to reducing waiting times for mental health services across the board, ranging from children to adults and community-based care to crisis situations.

But as the NHS continues to come up short on waiting times for emergency care and routine surgery, the new plan offers no clear path forward other than to say “sufficient funds” will be allocated to local NHS services to cut long waits.

NHS chief Simon Stevens | Tolga Akmen/AFP via Getty Images

“We also need immediate, practical solutions and the necessary investment for hospitals to deliver both in the long and short-term,” said Nagpaul of the BMA.

NHS chief Simon Stevens said there should be “tougher, faster” standards when it comes to emergency room waiting times in an interview with BBC Radio 4 on Monday, and suggested the existing four-hour guideline by which NHS progress is judged needed to be updated. “The problem with that is it doesn’t distinguish between turning up at A&E with a sprained finger and turning up with a heart attack,” he said. He declined to commit to specific targets.

4. Mixed messages on prevention

One of the main pillars of the government’s plan is prevention — stopping health problems before they start by trying to reduce smoking and drinking or increase exercise, for instance.

While many groups supported this move, they couldn’t help but note the hypocrisy of the fact that government funding for local public health services has been cut in recent years. The latest projections are a cut of £85 million for 2019-20, to £3.1 billion.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again” — Nigel Edwards, chief executive of the Nuffield Trust

Nagpaul of the BMA urged the government to take bolder stances on issues such as a minimum unit price for alcohol and restricting sugar in food.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again,” said the Nuffield Trust’s Edwards.

5. Raised expectations

U.K. Chancellor Philip Hammond hit the nail on the head when he wrote in the Daily Mail on Monday: “The leaders of the NHS must now ensure they get the basics right. Alongside greater quality of care and ending waste, the public will demand that progress is made on the back of their investment.”

The widely-touted funding rise will leave people expecting a better and more efficient NHS, which requires delivery on the basics such as wait times that the plan doesn’t address.

The government’s major targets are focused around specific diseases: the plan aims to prevent 150,000 heart attacks, strokes and dementia cases, and 55,000 cancer-related deaths, and help 380,000 more people get treatment for anxiety and depression. As Conservative Party MP and health select committee chair Sarah Wollaston noted, some of the priorities mirror those set out in the previous five-year plan, “many of which remain unfinished business.”

“The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated,” Wollaston wrote in a blog post.

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20 December 2018 – today’s press releases

Today is topped and tailed by Brexit, hardly unusual, but there is also some good stuff responding to today’s events… Rival Brexit plans reveal Govt without a course Govt must act to prevent deaths on our streets Govt must end ‘wild west’ drone market Lib Dems: Public health cuts demonstrate Tories’ duplicity Alun Cairns Must […]

Today is topped and tailed by Brexit, hardly unusual, but there is also some good stuff responding to today’s events…

  • Rival Brexit plans reveal Govt without a course
  • Govt must act to prevent deaths on our streets
  • Govt must end ‘wild west’ drone market
  • Lib Dems: Public health cuts demonstrate Tories’ duplicity
  • Alun Cairns Must Resign if UK Government Back No Deal – Welsh Lib Dems

Rival Brexit plans reveal Govt without a course

Responding to rival Brexit plans set out by Amber Rudd and Andrea Leadsom, Liberal Democrat Brexit Spokesperson Tom Brake has said:

While people at home over Christmas will be worried about Brexit uncertainty, these rival plans reveal a Conservative Government without a course.

Theresa May is looking more and more like Captain Bligh. Her mutinous crew have lost faith in her. We even have Andrea Leadsom so lost at sea that she is speaking irresponsible gibberish about an impossible ‘managed no deal’.

Amber Rudd has land in sight by accepting a People’s Vote is ‘plausible’. Not only that, Liberal Democrats know it is the only way to break the parliamentary deadlock. It is time all parties got on board.

Govt must act to prevent deaths on our streets

Responding to Government figures that nearly 600 homeless people died on the streets last year, Liberal Democrat Housing Spokesperson Wera Hobhouse said:

These deaths are absolutely tragic. As a wealthy country, we simply cannot accept people dying on our streets.

The Conservative Government’s failure to look after these individuals is a shameful dereliction of duty. Conservative Ministers must recognise the urgent need to build more social homes. The Liberal Democrats want to see 50,000 social houses to be built every year, rising to 100,000 as soon as possible.

These figures also bring into sharp focus how homelessness services for mental health and substance abuse desperately need more funding.

The housing crisis is a human crisis. It is depriving people of a roof over their head with devastating consequences. The time for warm words and little action has long gone.

Govt must end ‘wild west’ drone market

The Liberal Democrats have demanded the Conservative Government end the ‘wild west’ drone market and tighten up laws on who can own drones following the disruption caused at Gatwick today.

Speaking after securing an urgent question in the House of Lords, Liberal Democrat Transport Spokesperson Jenny Randerson said the incident at Gatwick “illustrated the frightening ease with which drone vessels can inflict massive damage to our safety, our security and our economy”.

The Liberal Democrat peer urged the Government to set out plans for “proper controls on drones early in 2019”. In response, the Minister accepted the Government must “absolutely introduce new laws” but failed to set out in detail what that would mean and when.

Following the exchange, Jenny Randerson said:

The failure of Conservative Ministers, despite ample opportunity, to implement tighter regulation on drones has allowed an irresponsible act this morning to cause disruption to thousands of people trying to get home for Christmas.

It is estimated that hundreds of thousands of drones will be bought as Christmas presents. There is a greater risk to aircraft and public safety than ever before. The rules are ultimately too lax.

Liberal Democrats demand better. Conservative Ministers must end wild west drone market, not least by starting with a compulsory registration of drones and compulsory training for all users.

Lib Dems: Public health cuts demonstrate Tories’ duplicity

Responding to the Government’s statement that confirms the reduction of money for public health by £85 million for the year 2019-20, Liberal Democrat Health Spokesperson Judith Jolly said:

It is outrageous that after months of the Conservatives claiming they care about health and the NHS, they have today have confirmed a further reduction in funding for public health.

This just goes to demonstrate the Tories duplicity, promising one thing and doing another. The Conservatives must stop following warm words and policies with insufficient funding.

Liberal Democrats are clear about the critical importance of public health. It is time the Government listened and prioritised public health by halting these cuts to funding and reinvest the money previously cut.

Alun Cairns Must Resign if UK Government Back No Deal – Welsh Lib Dems

Welsh Liberal Democrat Leader Jane Dodds has written to Secretary of State for Wales Alun Cairns urging him to resign from the Cabinet and resign the Conservative Party whip if a no deal Brexit becomes UK Government policy.

The letter was sent after Justice Secretary David Gauke claimed “that several Cabinet members could resign if no deal became the government’s policy” and Conservative MPs Nick Boles, Anna Soubry and Sarah Wollaston said they would resign the Conservative Party whip if a no deal Brexit became party policy.

Welsh Liberal Democrat Leader Jane Dodds said:

Everyone but the most extreme Brexiteers knows a no deal Brexit would be a disaster. The Bank of England and the Government’s own figures show that a no deal Brexit would cause the Welsh economy to shrink by 9.5%. It’s deeply concerning the UK Government still appears to be treating a no deal Brexit as a serious option.

I was reassured to hear David Gauke claim that Cabinet Members will resign if a no deal Brexit becomes UK Government policy. I’ve written to Alun Cairns to ask if he will be one of them and whether he will join MPs Nick Boles, Anna Soubry and Sarah Wollaston in resigning the Conservative Party whip.

I urge the Secretary of State to resign from the Cabinet and the Conservative Party if a no deal Brexit does become UK Government policy. This is the only way to show he opposes a no deal Brexit, that Wales opposes a no deal Brexit and to avoid facilitating this disastrous outcome.

Health secretary: UK to deploy planes to cope with Brexit medicines disruption

Government also considering fast-tracking trucks carrying medicines through Dover.

U.K. Health Secretary Matt Hancock said Friday the government is drawing up plans to use airplanes and fast-track trucks at the border to ensure the supply of medicines is not interrupted in the event of a no-deal Brexit.

“We are working on ensuring that we have aviation capacity,” Hancock told the BBC on Friday. “If there is a serious disruption at the border we will have prioritization and prioritization will include medicines and medical devices.”

As part of its preparations for a no-deal Brexit, the government is also looking into fast-tracking trucks carrying medicines through Dover if “there’s a serious disruption at the border” and increasing refrigeration units for medicines that can be stockpiled, the health minister said.

Hancock also said pharmacies in the U.K. may be allowed to issue small quantities of medicines without the approval of general practitioners if there are “serious shortages” as a result of a no-deal Brexit.

The Times reported Friday that ministers would be able to tell pharmacists to alter medications and dispense a “reduced quantity” of medicines without contacting GPs first.

National Health Service providers, pharmaceutical companies and patient groups warned last month that the government’s plans for maintaining drug supplies in the event of no deal were so lacking that the warning level should be raised to “red.”

“If there’s a shortage of an individual drug and pharmacists can make clinical and professional judgments, then that will be a step forward,” Hancock said.

The U.K. government is currently consulting on the idea and will ensure that it has contingency plans in place before the country leaves the European Union in March 2019, Hancock said.

“In the health department, we deal with contingencies all the time and this is an extension of that,” Hancock said.

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EU agency offers free holidays in Amsterdam to help sway staff move

European Medicines Agency’s Brexit point-man says staff retention is looking up.

LONDON — The European Medicines Agency is sending staff on holiday to the Netherlands to persuade them what a great place it will be to live.

The agency, which is relocating from London to Amsterdam in March because of Brexit, is covering the cost of a two-night trip for staff and their partners — plus a guided tour of neighborhoods — to help employees decide if they could plant roots there.

Noël Wathion, the EMA’s Brexit lead, said in an interview Wednesday that while he could not quantify the impact of the visits, the EMA believes they are proving “very useful” as it attempts to keep staff on board.

“It’s a short visit but nevertheless it shows you [what the Netherlands is like to live in],” Wathion said. The agency is also offering free Dutch language lessons for EMA staff, their partners and children.

The number of staff forecast to stay has been on an upward trend since providing these incentives, Wathion said.

Staff are not just moving to Amsterdam but all over the Netherlands, he said, including to Leiden, the Hague and Utrecht.

The latest estimates show 24 percent of the EMA’s roughly 900 staff — including shorter-term and longer-term contracts — are forecast to leave, although he said that figure changes daily.

That would leave around 216 vacant posts. Around 100 of these are people on short-term contracts, such as maternity cover, which would not relocate, he said. In August, a survey found 30 percent were expected to leave.

The agency has received more than 5,000 job applications for the vacancies, Wathion said. The agency is also putting together a reserve list of candidates who have passed interviews and would be willing to work in Amsterdam if certain jobs become available.

“We can’t wait and see,” Wathion said. The agency has asked staff to inform them as soon as possible if they plan to leave.

Relocation underway

Sixty staff have already moved to the Netherlands. The Spark building in Amsterdam will house the EMA from January until its permanent home, the newly named “EMA Building,” is ready in November.

These are primarily employees with children who wanted to move early for the start of a new school year, Wathion said.

These “early movers” are also influencing other staff members. “We have positive feedback and people say, ‘it seems to be working,’” he said.

Wathion said the bulk of staff are expected to relocate in January and February. However, the agency has also adapted its flexible working policies to allow people to move later during 2019, for example for parents of children that need to sit for school exams.

Staff are not just moving to Amsterdam but all over the Netherlands, he said, including to Leiden, the Hague and Utrecht.

Despite the sheer complexity of decoupling the U.K.’s expertise from the agency, sharing out its workload and relocating all operations, Wathion sounded more upbeat about the process than in previous interviews.

He said the agency has adopted a mantra for the relocation: “‘United we stand, divided we fall.’”

CORRECTION: A previous version of this story misstated the agency’s relocation mantra, and misstated when the EMA will be housed in the Spark building. 

WHO chief: EU needs to boost HPV vaccine supply

European countries need to help increase supply of a vaccine to prevent cervical cancer, said the World Health Organization chief, especially as they plan to offer the shot to both boys and girls. WHO Director General Tedros Adhanom Ghebreyesus told POLITICO in an interview that gender-neutral vaccination against the human papillomavirus — which causes cervical […]

European countries need to help increase supply of a vaccine to prevent cervical cancer, said the World Health Organization chief, especially as they plan to offer the shot to both boys and girls.

WHO Director General Tedros Adhanom Ghebreyesus told POLITICO in an interview that gender-neutral vaccination against the human papillomavirus — which causes cervical as well as oral and throat cancers — is “important.”

“But the supply is short,” he continued. “There should be commitment to increase the supply and do it gender neutral.”

Tedros in May issued a call to action toward a goal of eliminating cervical cancer, which is highly treatable if caught early and can be prevented by HPV vaccination.

However, his position appears to differ slightly from that of his key advisers on the disease, who told POLITICO in October that wealthy countries’ moves to expand the HPV vaccine to boys could hurt the supply to immunize girls in lower-income countries.

“If globally we would like to make more progress, it would be better if the available vaccines at the moment would be used to vaccinate girls … until we have resolved the supply issue,” said Anshu Banerjee, WHO’s director of maternal, newborn, child and adolescent health.

WHO officials said it can take several years to boost manufacturing to respond to new demand for the vaccines.

Vaccinating at least 70 percent of adolescent girls is key for creating herd immunity. However, Germany, the U.K. and Ireland recently announced plans to expand the availability of the vaccine to boys, and the U.S. approved immunization for people up to the age of 45.

Countries taking this route should contribute money toward expanding supply, Tedros said, “but at the same time, domestic resources should be mobilized, and the pharmaceutical industry should be more help.”

EU health chief compares Brexiteers to Soviet plotters

Can you tell the difference between the European Research Group and the State Committee on the State of Emergency?

The European Commission’s health chief compared a hardline Brexit group to high-level Soviet officials who wanted to stop the reforms implemented by Russian leader Mikhail Gorbachev.

Vytenis Andriukaitis on Thursday tweeted a photo of the European Research Group at a meeting this week in which Jacob Rees-Mogg called on Tory MPs to force Theresa May from office next to a photo of the State Committee on the State of Emergency, a group of senior Soviet officials who launched a failed coup against Gorbachev in 1991.

Both photos are composed entirely of middle-aged white men in suits. “I’m not comparing anything,” said Andriukaitis, adding, “If i did, maybe I’d say a word on gender representation.”

The tweet appears to be a dig at the ERG’s failure, so far, to trigger a leadership contest in the Tory party. But it also revives a spat with U.K. Foreign Secretary Jeremy Hunt, who in September compared the EU to the Soviet Union during a speech at the Tory party conference.

Describing the EU’s approach to Brexit as an attempt to “keep the club together” by punishing “a member who leaves,” Hunt asked: “What happened to the confidence and ideals of the European dream? The EU was set up to protect freedom. It was the Soviet Union that stopped people leaving.”

“The lesson from history is clear: If you turn the EU club into a prison, the desire to get out won’t diminish. It will grow and we won’t be the only prisoner that will want to escape.”

That went down badly in the EU and especially with Andriukaitis, a Lithuanian who is European commissioner for health and food safety. He had a personal response for Hunt. “I was born in Soviet gulag and been imprisoned by KGB a few times in my life. Happy to brief you on the main differences between #EU and Soviet Union. And also why we escaped the #USSR. Anytime. Whatever helps,” he tweeted.

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Superbug risks fail to dent attitudes to antibiotics

Antimicrobial-resistant infections could be killing more than 33,000 people a year in Europe.

Warnings about drug-resistant superbugs aren’t enough to change most people’s behavior on using antibiotics, according to a Europe-wide poll out Thursday.

The Eurobarometer survey reported seven in 10 people who received information telling them not to take antibiotics unnecessarily said it didn’t change their views on using them.

Excess use of the drugs is contributing to a growing threat of antimicrobial resistance and related infections. As germs multiple they can develop the ability to defeat the medicines designed to kill them — and those infections could be killing more than 33,000 people a year in Europe, according to recent estimates.

“It is ridiculous,” European Health Commissioner Vytenis Andriukaitis said in response to the fact that people aren’t responding to warnings, at an event in Brussels Thursday. “We have science on one hand and lack of trust on the other.”

“Unless we act decisively, immediately and together, we could face a public health and financial disaster,” he added.

The EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Eurobarometer survey showed the number of people who had taken antibiotics in the last 12 months fell from 40 percent in 2009 to 32 percent in 2017. But less than half of people said they were aware that antibiotics don’t work to treat viruses, and 20 percent said they take antibiotics to treat flu or colds.

Seven percent of people said they took antibiotics without having seen a doctor or getting a prescription.

Andriukaitis said the survey, which polled around 27,400 people in 28 countries, shows Europeans “are still not sufficiently aware of the dangers of AMR.”

A report from the European Centre for Disease Prevention and Control (ECDC) on Thursday raised particular concern about the rise of superbugs in hospitals and care centers — estimating there are around 8.9 million cases of health care-associated infections in European facilities each year, many of them caused by multidrug-resistant bacteria.

Brussels is largely forced to take a backseat to national capitals | George Frey/Getty Images

The ECDC said these infections are being fueled in part by overprescribing of so-called broad-spectrum antibiotics, which wipe out multiple forms of bacteria and are stronger than traditional, more targeted antibiotics such as penicillin. Prophylactic antibiotics, meaning those prescribed before a surgery in anticipation of potential infection, are also being prescribed for too many days, it said.

Meanwhile the EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Commission released a One Health Action Plan in 2017 that included guidelines on how to ensure prudent use of antimicrobials in people, and promised to promote global standards in areas such as trade. It also set aside funding for research to monitor and control potentially fatal infections, and develop new antibiotics or vaccines to combat transmission.

But the EU’s limited competence in health means Brussels is largely forced to take a backseat to national capitals. While governments such as the U.K., Sweden and Finland have made fighting antimicrobial resistance a priority, Andriukaitis said Thursday he’s frustrated the EU can’t be more effective.

“Our main goal is to show that the EU is a best practice region fighting against AMR. But it will be empty words if you do not have concrete instruments at member states level,” he said.

Last line of defense

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals.

Andriukaitis said he is expecting a “major breakthrough in a few days” when the Council of the European Union will greenlight new rules on veterinary medicines and medicated feeds. These are designed to phase out the prophylactic use of antimicrobials as well as preventing their use to promote growth in cattle.

The EU will also under the new rules ringfence a protected list of antibiotics for human-use only — part of an attempt to keep drugs that still work in humans from becoming obsolete.

Malta and Croatia were named for their poor performances | Joe Raedle/Getty Images

The proposed list, a joint effort between the ECDC, the European Medicines Agency and the European Food Safety Authority, is expected to be put out for consultation next month, according to the ECDC.

ECDC Director Andrea Ammon said at the event Thursday that getting patients, health care providers and national governments to cut down on unnecessary prescribing will take time but there is still a chance to limit the threat from AMR.

The ECDC’s efforts to monitor antimicrobial resistance country-by-country in Europe have been “quite powerful because no one wants to be at the bottom” of the list, Ammon said. The agency also visits European countries at their request to assess their national antimicrobial resistance plans and recommend improvements.

Eight European countries saw a statistically significant drop in public consumption of antibiotics between 2013 and 2017, according to ECDC data released Thursday: Finland, Germany, Italy, Luxembourg, the Netherlands, Norway, Sweden and the U.K.

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals | AFP via Getty Images

Malta and Croatia were named for their poor performances, recording increases in antimicrobial consumption in hospitals.

A report on antibiotic use in humans by the World Health Organization published Monday concluded Greeks consume the most antibiotics on average in Europe, with Italy, France and Belgium also named as having high use.

Improvements are “not something that will happen very quickly because this epidemic has built up over years and it will take some years until it goes down. It needs sustained efforts,” Ammon said.

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David Simmonds: The case for more investment in early intervention

The long-term dividends for individuals, local services, employers, and the Exchequer can far outweigh initial costs.

David Simmonds is a Conservative councillor in Hillingdon and trustee at the Early Intervention Foundation.

As we learn more about the long-term benefits of early intervention, the case for long-term investment becomes clearer.

The basic principle of early intervention is as straightforward as it is familiar: it’s better to step in early, when a problem first starts to appear, than to wait and deal with the consequences later.

When it comes to children’s development, from their earliest years through to their transition into adulthood, the long-term consequences of failing to act early can include an increased risk of mental health problems, poorer academic achievement, reduced employment chances, increased antisocial behaviour, risk of offending, and reduced adult relationship quality – which, alongside other factors, can simply serve to perpetuate the cycle from one generation to the next.

In short, too many children are facing challenges or disadvantages that can threaten their future life chances, health, and happiness.

While early intervention cannot solve every problem, it can substantially improve children’s lives, if it is delivered to a high standard to the children or families who need it most. It is vital now, today, to ask whether this is being done, or whether some fundamental changes are required so that effective, early support can be provided to all those who stand to benefit.

First, however, we need to come to terms with the wider benefits that effective forms of early intervention can achieve. Leaving problems unresolved in childhood doesn’t only impact on the lives of individuals and families – it also impacts on society and our economy, by undermining the wellbeing of communities and reducing people’s opportunities to live positive, productive, successful lives.

Intervening early is crucial. There are good grounds to believe that investing early rather than later will lead to cumulative benefits – that the skills children acquire when they are young will lead to greater additional gains as they get older. And these benefits are widely shared, accruing to the whole of society and the wider economy, not just to public services and government bodies.

This ‘pay-off’ may be particularly large where early intervention leads to labour market gains. For example, the Department for Education has estimated that individuals who achieve five or more good GCSEs have additional productivity gains (counting benefits to the individual, Exchequer, and future employers) of around £100,000 over their lifetime, compared with those with qualifications below this level.

The flipside to this potential benefit is the potential extra costs associated with dealing with the long-term impacts of problems rooted early in life. The Early Intervention Foundation (EIF) has estimated that the cost of ‘late intervention’ – covering expensive, acute services such as mental health support, youth justice, and tackling school absenteeism or domestic violence – is nearly £17 billion a year across England and Wales. Though clearly these costs cannot be reduced to zero, this does outline the quantum of resources that are wasted in tackling issues that could have been dealt with sooner, and where the long-term outcomes for society could have been improved.

In short, we know that the costs of intervening early are likely to pay off to society in the long run. The sums can be difficult to do with great accuracy, given the complexity and assumptions involved, but there is a wide body of research which suggests that the value of these benefits to society is often far higher than the costs of intervening.

Now, those of us who advocate for early intervention – among which I count myself, as a trustee of the EIF and long-time champion of local early help services – are sometimes tempted to raise expectations just one peg too high, to alight on early intervention as a means of saving money in local services this year or next.

Early intervention can achieve such ‘cashable’ savings, but that’s when commissioners are able to turn around and decommission services or settings that are no longer required. If early intervention succeeds in reducing demand on a local service, but this additional capacity is immediately soaked up in dealing with other demands – perhaps issues or cases that have simply been on the waiting list – then what looks like a gain may not appear on the bottom line.

Of course, this is still a gain, if front-line services can address a wider range of problems or focus more time on the most urgent cases, but that’s not the same as saving money. As my colleagues at the EIF say, early intervention is not a financial coping strategy for local or central government, and arguments that rest on the potential for short-term cashable savings miss the bigger picture – and risk undermining the good case altogether.

Is enough being done to capitalise on the potential of early intervention? We know that there are some longstanding, oft-cited barriers within the system – from familiar challenges around funding and political short-termism, to less familiar issues, like just how much of what local services provide remains untested, and thus has not been shown to be working, with empirical evidence.

In their new report ‘Realising the Potential of Early Intervention’ the EIF has made a bold case for change, including some fundamental changes to happen at the national and local levels. As they argue, there are resources in the system, but more needs to be done to understand what impact it is having, and what scope there is to redirect funding to things which are more likely to be effective.

In early intervention. as in all areas, public money must be spent in ways that are more likely to improve people’s lives and which build our understanding of ‘what works’ to better inform future decisions.