Category Archives: Health

The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The US healthcare system – and with it the health and welfare of millions – is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Office’s (CBO) dismal “scoring” of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire America’s healthcare prospects are under Trump’s administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill – narrowly passed by the House on 4 May – is less a piece of healthcare “reform” than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesday’s CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of “essential healthcare benefits”, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, “over time, less healthy individuals … would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all”. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered – say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $ 800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

It’s worth noting here that Trump’s budget – released Tuesday – proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $ 1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget – best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes – would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and – more than anything – a big fat payout to Trump’s bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress – and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death – quite possible given the headwinds it faces in the Senate – we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with “high-deductible health plans” rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill – the “Expanded & Improved Medicare For All Act” – had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bill’s history.

This bill – like other single-payer proposals – is the precise antithesis of Paul Ryan’s AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

Cannabis drug cuts seizures in children with severe epilepsy in trial

A new drug derived from cannabis has been shown to reduce the convulsive seizures experienced by children with a severe form of epilepsy by nearly a half – and in a small number, stop them altogether.

Doctors involved in the trials say the drug could change the lives of thousands of children for whom there is little treatment, and might also help children and adults with more common forms of epilepsy.

Dravet syndrome, which affects one in 40,000 children in the UK, can cause life-threatening convulsions several times a day. The trial at Great Ormond Street children’s hospital in London and centres in the US and Europe was launched because some parents desperate to help their children told of improvements after giving them cannabis derivatives bought on the internet.

“There was a lot of interest on the internet three to four years ago,” said Prof Helen Cross, a consultant in paediatric neurology at Great Ormond Street. That led to the trial of a carefully formulated pharmaceutical form of cannabidiol with virtually no THC (tetrahydrocannabinol), which is responsible for psychoactive effects.

“This is cannabidiol. It is not the oils that are available over the internet and the results cannot be ascribed to that,” she said. “Families should not be feeling this is something they should be able to get [for themselves]. This is a pharmaceutical product.”

The trial involved 120 children, aged two to 18, with an average age of nine. They were randomly assigned to take either cannabidiol in liquid form twice a day or a placebo. Neither the families nor the doctors knew which children were getting the active drug.

On average, the seizures experienced by the children were reduced by nearly 40% and 43% of those taking cannabidiol saw their seizures cut by half. Three children – 5% – stopped having seizures altogether. There were side-effects, which included drowsiness, fatigue, diarrhoea and reduced appetite – but these are similar to those caused by other epilepsy drugs.

The drug is not a cure, however. Cross said seizures returned in those who had stopped the drug. Children would probably be on the medication for life.

There is a need for more and better epilepsy drugs. A third of people with epilepsy do not respond to those that exist. Doctors think cannabidiol may work in at least some of those cases too, although the reason it works in the case of Dravet syndrome is unclear. “I have to say we don’t know,” said Cross. But asked whether it could be effective in other children and adults, she said, “Probably, yes.”

In young women, there has been concern over the drug sodium valproate, which can cause birth defects. Women and girls who may get pregnant are faced with deciding whether to stop taking a drug that may successfully keep their epilepsy under control.

Cross said cannabidiol may also prove to be an option for them, although trials would need to be done.

The results of the trial are published in the New England Journal of Medicine. In a commentary in the journal, Samuel Berkovic, from the Epilepsy Research Centre of the University of Melbourne, called medicinal cannabis “a hot-button issue in the treatment of epilepsy”, after anecdotal reports in the media of “spectacular results, coupled with the allure of using a ‘natural’ compound and long-held beliefs surrounding its recreational use”.

The trial was the beginning of solid evidence for the use of cannabinoids in epilepsy, but more research was needed, he said.

GW Pharmaceuticals, which makes the drug, will apply for a licence to the authorities in the US and Europe. If it is approved, the National Institute for Health and Care Excellence will have to assess the drug for cost-effectiveness before it can be used in the NHS.

Government fails to block release of Andrew Lansley diary portions

The government has failed to block the release of sections of former health secretary Andrew Lansley’s diaries in the court of appeal.

Journalist Simon Lewis made a request under the Freedom of Information Act to see passages of Lansley’s ministerial diary from 2010 and 2011, covering the period when controversial health reforms were being drawn up.

He was only given a heavily redacted version, but in 2013 the information commissioner, who oversees the legislation, ruled that the majority of the withheld information should be disclosed.

The government has since been challenging that decision through the information tribunals and the courts; but three appeal judges unanimously ruled on Wednesday in favour of disclosure.

With Whitehall officials in pre-election purdah, which puts strict limits on the decisions they can make, the information is unlikely to be released until after the campaign is over.

A Cabinet Office spokesperson said: “We are considering the judgment, and we will make a decision in due course.”

Lansley was the driving force behind the radical Health and Social Care Act, which sought to expand competition in the NHS, and sparked controversy after the Conservative manifesto had promised to avoid “top-down reorganisation” of the health service.

Wednesday’s ruling was handed down by Sir Terence Etherton, master of the rolls, sitting with Lady Justice Black and Lord Justice Davis.

In the lead ruling, Etherton said the FoI Act created a general right of access to information held by public authorities, but allowed for exemptions from disclosure.

Sir Alex Allan, a former chair of the joint intelligence committee, was among government witnesses who gave evidence that disclosure “would not assist the understanding of the processes of government and would be liable to mislead and misinform the public as to the efficiency and extent of the work of the minister”.

But dismissing the government’s appeal, Etherton said the first-tier tribunal “actually identified 11 particular types of benefit from disclosure”, including “general value of openness” and “transparency in public administration”.

The judge also rejected the government claim that the Department of Health did not hold the diary information “for the purposes of the FoI Act”.

He declared that while Lansley was a minister in the department, the diary entries “were held by the department for itself even if they were also held – in the case of personal and constituency matters – for Mr Lansley as well”.

The judge added: “I cannot see that the termination of Mr Lansley’s ministerial position made any difference to that position.

“In particular it seems to me clear that it remained relevant or potentially relevant to the department to know, as a matter of historical record, where Mr Lansley had been and with whom on particular occasions, should there be a political, journalistic or historical interest raised with the department in relation to those matters.”

Black and Davis both agreed.

UEA course cut a blow for mental health work | Letters

All the parties in the general election have adopted mental health as a key issue. But this enthusiasm is not reflected on the ground and the electorate should not be fooled. We are students and former students on the internationally renowned counselling programme at the University of East Anglia. We trained to be counsellors, or “shrinks”, to quote Prince Harry in his recent interview. But now the university has closed the course and even made it impossible for some students to complete their professional qualification. As part of this draconian process, in which consultation was at a minimum, responsibility to students, staff and the wider local community has been completely deprioritised. This is exactly the opposite of what the princes, applauded by the government, were calling for.

The impact is not only on the course itself, but also on those therapy organisations where students have for many years worked as volunteers on placement and beyond, and on the availability of the kind of in-depth listening relationship – described as so crucial by the princes – in the university’s own counselling service. The management-speak reason given by the university for this closure is “a need for greater alignment of courses and a more coherent portfolio of activity centred on the teaching of education theory and practice”. What is the point of accenting mental health if there won’t be any counsellors to deliver it?
Sara Bradly, Dr Rachel Freeth, Bridget Garrard, Nikki Rowntree
Norwich

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Radiance review – a poignant vision of the power of sight

Naomi Kawase’s delicate movie Radiance lowers its eyes humbly in the presence of blindness with this story of a young woman employed to write movie audio commentary for visually impaired people, who falls in love with the semi-sighted photographer on the advisory panel offering guidance on her script.

Radiance attempts to find in this a metaphor for the act of noticing, for the need to communicate and the need to imagine what other people think, see and feel.

It is a movie that, admittedly, has some of Kawase’s sometimes exasperating tendency towards sentimentalism and this subject will tend to amplify such a flaw. (I found myself thinking of my colleague Jonathan Jones’s comment on John Millais’s painting The Blind Girl, summarising its earnest, tactless empathy: “Wouldn’t it be terrible to be blind!”)

Reflective … Ayame Misake in Radiance.


Reflective … Ayame Misake in Radiance. Photograph: EPA

But the seriousness of the ideas at stake and novelty of the story command interest and, for me, this film represents an advance on Kawase’s previous film at Cannes – An, or Sweet Bean – which was too sucrose.

Misako (Ayame Misake) is a sighted young woman who we see and hear commentating on a film that at first fills the screen but then appears to us, as it were, between inverted commas, on a computer terminal. We realise that this is the work being screened in the audio sense for a committee of blind people while Misako reads aloud the first draft of her commentary text.

With humour and charm, the panel offer constructive criticism. Every word, every syllable counts. Too little, or too vague a description and she is not doing her job, but too much is intrusive and presumptuous, and does not let the blind cinema “viewers” exercise the only prerogative available to them – to imagine, personally, what is on the screen.

But the photographer Nakamori (Masatoshi Nagase) is abrupt and disagreeable. He challenges her textual interpretations and calls into question her competence, and Misako is visibly upset. Part of his anger is due to the fact that he has not yet entirely lost his sight, so still angrily claims the authority of the sighted, and has not yet come to terms with what has happened to him. But Misako spiritedly bites back – suggesting that the problem may be his imagination. A very daring riposte.

It is an intriguing, engaging scene and one that asks us to think about how much of any visual scene we fully engage in. The verbalisation makes this manifest. But it is also an act of interpretation, of translation.

This is hardly a meet-cute, but the relationship of Misako and Nakamori develops from here, in poignant tandem with his deteriorating sight. And the issue of care and dependence is complicated by the fact that Misako’s elderly mother is suffering from dementia and may have to go into a care home.

“Nothing is more beautiful than that which disappears before our eyes” is a key line and it gives us the movie’s guiding aesthetic, or ethic. The evanescent, elusive beauty of a flower or a cloud or a bird in flight – or simply any freeze-framed moment of existence – is entrancing because it is so brief. It reaches its peak of beauty in the moment of disappearing, and, in accepting that, we may accept that all of this world and our place in it are temporary. Humanity places enormous emphasis on the visual sense: being seen is held to be the key facet of existence. So the photographer who is going blind is an expressive image.

We touch on all this in the course of a gentle, thoughtful and reflective movie.

Christy Turlington: ‘The closest I’ve come to death? The birth of my daughter’

Born in California, Christy Turlington Burns, 48, was scouted to be a model at 14 and went on to become one of the original supermodels. After suffering a postpartum haemorrhage in 2003, she took a masters in public health and set up non-profit organisation Every Mother Counts, addressing global maternal health. The charity has partnered with Toms shoes. She is married to actor Ed Burns, has two children and lives in New York.

When were you happiest?
Before kids, when I was 13 or so, on the back of my horse, running at full speed in an open pasture. Post kids, happiness happens often, but in more subtle ways. I now prefer the word “content”.

What is your greatest fear?
I don’t fear anything but fear itself. Fear makes humans behave inhumanely.

What is your earliest memory?
I have a collage of memories beginning around age four: my first walk alone to a store or to school, and early trips to Central America with my mom to visit her family.

Which living person do you most admire, and why?
A midwife named Jennie Joseph. She is a tireless activist for women, family health and equal access to quality maternity care.

What is the trait you most deplore in yourself?
I sometimes set unreasonably high expectations of myself and those around me.

What was your most embarrassing moment?
There are too many to name, but none of them keeps me up at night.

What makes you unhappy?
Government policy decisions that negatively impact the health and wellbeing of women and families.

What do you most dislike about your appearance?
Having to talk about it.

Who would play you in the film of your life?
The world does not need a film about my life.

What is the worst thing anyone’s said to you?
A boyfriend once told me there was always going to be someone smarter, funnier and prettier than me, which at the time felt pretty mean, but it was true.

To whom would you most like to say sorry, and why?
To strangers. Living in New York, I see individuals every day who are invisible to so many. I want to say sorry that so many of us think their pain and suffering is not our own.

What was the best kiss of your life?
The first kiss from my husband and every one since.

What has been your biggest disappointment?
My father’s death before my marriage, and motherhood.

If you could edit your past, what would you change?
I might speed up a few details, but wouldn’t change anything, other than my dad still being here.

How do you relax?
Yoga, running, recreational reading.

What is the closest you’ve come to death?
The birth of my daughter.

What keeps you awake at night?
The fact that at least 300,000 women die every year from pregnancy and childbirth-related issues that are largely preventable.

What is the most important lesson life has taught you?
That I am more than I thought I was.

How would you like to be remembered?
As someone who didn’t waste a minute.

Can you manufacture blood cells?

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Researchers may have found a way of making blood from human or mouse stem cells

How might blood cells be made?

Different groups of researchers say they have developed a way of producing blood cells from human or mouse cells that have been reprogrammed in the lab – an advance that has been touted as offering a solution to the need for blood donation. The latest studies are the result of 20 years’ work in the field.

Continue reading…

Coca-Cola’s ‘health by stealth’ wheeze is sneaky. But if it works so be it | Gaby Hinsliff

It had been a long day. I was knackered, and frankly not concentrating. Which is how I managed recently to bake a plum cake and forget to put the sugar in. The damn thing was already cooked and cooling by the time the penny dropped, so there was little option but to keep quiet and dish it up. But surprisingly, plates were licked clean. It tasted fine, if a little drier than usual. And yes, there is a point to this tedious domestic mishap, which is that Coca-Cola just did something similar to millions of its customers, in a move that has interesting implications for the debate over public health and the nanny state.

The soft drinks giant started by silently reducing the calories in Sprite. People didn’t seem to mind, so two weeks ago it secretly cut the sugar in Fanta by a third, and again sales held perfectly steady. So much for all the outraged spluttering over government plans to introduce a levy on sugary drinks next year – the reason Coca-Cola changed its recipes, since both drinks will now escape the tax – and how it would ruin much-loved brands. People literally didn’t notice.

There is admittedly something mildly disconcerting about the concept of “health by stealth” – although health is, in this case, a relative term. The acid in fizzy drinks is still no friend to teeth, and swapping sugar for other sweeteners does nothing to discourage the craving for sweetness. Who knows? In a few years we may all be panicking instead about some unforeseen side-effect of stevia, the natural plant-based sweetener substituted in Sprite. But it remains a rare example of a company fooling its customers into better choices, not worse ones – for once. They’re treating us like children. This is, after all, the equivalent of smuggling hated vegetables into pasta sauce and brazenly liquidising the evidence. But then, there’s nothing like a public health intervention for provoking a national tantrum.

Andy Burnham was accused of waging war on parents only four years ago for promising that a future Labour government would act to reduce sugar in cereals such as Frosties. Last year, when George Osborne finally unveiled plans for a tax on sweetened drinks, libertarian Tories were outraged.

Yet in a few years’ time we’ll surely look back and wonder what the fuss was about, for such is the way of health and safety interventions, from the ban on smoking in public places to the introduction of compulsory seatbelts. Outrage turns to grudging acceptance, before mellowing into surprise that things were ever any different.


If you announce you’re lowering fat, sugar or salt, then consumers glumly assume the result will be thin and joyless

It seems genuinely astonishing now that until 31 people died in the King’s Cross station fire in 1987, which was started by a dropped cigarette, nobody seemed to think smoking on the tube was a problem. My son boggles at the idea that back in the 1970s, kids would travel piled on top of each other in the backseat of a car or rolling around in the boot. But it still requires political courage to get past the initial wall of resistance, which is constructed of corporate inertia plus kneejerk irritation among consumers at being told what to do. Legislation can obviously overcome the former, but what’s less often noted is that it can also prompt imaginative responses to the latter.

Once, food manufacturers who made their products healthier would shout it from the rooftops, but increasingly they’re learning to do it on the sly. If you announce that you’re lowering fat, sugar or salt then consumers glumly assume the result will be thin and joyless; since so much of eating is about anticipation, that may be exactly how it tastes to them. But do it quietly and – as any slapdash home cook will know – you can get away with murder. Even in baking, which does depend on measuring ingredients accurately, it’s the ratio of fat to flour and liquids that seems crucial to the chemistry, rather than the sugar. A diabetic friend was advised by nurses that most recipes will still work even if you halve the sugar – which is roughly what I did by accident, since the plum cake recipe I screwed up still contained honey, fruit and golden syrup – at least so long as you don’t tell. Sneaky?

Popular social media sites ‘harm young people’s mental health’

Four of the five most popular forms of social media harm young people’s mental health, with Instagram the most damaging, according to research by two health organisations.

Instagram has the most negative impact on young people’s mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young people’s feelings of inadequacy and anxiety.

The survey, published on Friday, concluded that Snapchat, Facebook and Twitter are also harmful. Among the five only YouTube was judged to have a positive impact.

The four platforms have a negative effect because they can exacerbate children’s and young people’s body image worries, and worsen bullying, sleep problems and feelings of anxiety, depression and loneliness, the participants said.

The findings follow growing concern among politicians, health bodies, doctors, charities and parents about young people suffering harm as a result of sexting, cyberbullying and social media reinforcing feelings of self-loathing and even the risk of them committing suicide.

“It’s interesting to see Instagram and Snapchat ranking as the worst for mental health and wellbeing. Both platforms are very image-focused and it appears that they may be driving feelings of inadequacy and anxiety in young people,” said Shirley Cramer, chief executive of the Royal Society for Public Health, which undertook the survey with the Young Health Movement.

She demanded tough measures “to make social media less of a wild west when it comes to young people’s mental health and wellbeing”. Social media firms should bring in a pop-up image to warn young people that they have been using it a lot, while Instagram and similar platforms should alert users when photographs of people have been digitally manipulated, Cramer said.

The 1,479 young people surveyed were asked to rate the impact of the five forms of social media on 14 different criteria of health and wellbeing, including their effect on sleep, anxiety, depression, loneliness, self-identity, bullying, body image and the fear of missing out.

Instagram emerged with the most negative score. It rated badly for seven of the 14 measures, particularly its impact on sleep, body image and fear of missing out – and also for bullying and feelings of anxiety, depression and loneliness. However, young people cited its upsides too, including self-expression, self-identity and emotional support.

YouTube scored very badly for its impact on sleep but positively in nine of the 14 categories, notably awareness and understanding of other people’s health experience, self-expression, loneliness, depression and emotional support.

However, the leader of the UK’s psychiatrists said the findings were too simplistic and unfairly blamed social media for the complex reasons why the mental health of so many young people is suffering.

Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “I am sure that social media plays a role in unhappiness, but it has as many benefits as it does negatives.. We need to teach children how to cope with all aspects of social media – good and bad – to prepare them for an increasingly digitised world. There is real danger in blaming the medium for the message.”

Young Minds, the charity which Theresa May visited last week on a campaign stop, backed the call for Instagram and other platforms to take further steps to protect young users.

Tom Madders, its director of campaigns and communications, said: “Prompting young people about heavy usage and signposting to support they may need, on a platform that they identify with, could help many young people.”

However, he also urged caution in how content accessed by young people on social media is perceived. “It’s also important to recognise that simply ‘protecting’ young people from particular content types can never be the whole solution. We need to support young people so they understand the risks of how they behave online, and are empowered to make sense of and know how to respond to harmful content that slips through filters.”

Parents and mental health experts fear that platforms such as Instagram can make young users feel worried and inadequate by facilitating hostile comments about their appearance or reminding them that they have not been invited to, for example, a party many of their peers are attending.

May, who has made children’s mental health one of her priorities, highlighted social media’s damaging effects in her “shared society” speech in January, saying: “We know that the use of social media brings additional concerns and challenges. In 2014, just over one in 10 young people said that they had experienced cyberbullying by phone or over the internet.”

In February, Jeremy Hunt, the health secretary, warned social media and technology firms that they could face sanctions, including through legislation, unless they did more to tackle sexting, cyberbullying and the trolling of young users.

General election 2017: May says ‘there’s no Mayism’, only ‘solid Conservatism’ at manifesto launch – politics live

11:27

11:15

Tories plan to merge Serious Fraud Office with National Crime Agency

Buried in Theresa May’s manifesto is a commitment to merge the Serious Fraud Office with the National Crime Agency. It says:

We will strengthen Britain’s response to white collar crime by incorporating the Serious Fraud Office into the National Crime Agency, improving intelligence sharing and bolstering the investigation of serious fraud, money laundering and financial crime.

The idea has reportedly been on her to-do list for some time.

Reaction from anti-corruption groups and specialist lawyers has thus far been uniformly negative. Stephen Parkinson, the head of criminal litigation at Kingsley Napley, said:

This is a dreadful decision. The NCA does not have the capability or the expertise to investigate complex, serious fraud, nor, I suspect, the desire. This is a real step back from the UK’s commitment to tackle serious economic crime.

Robert Barrington, the executive director of the anti-corruption group Transparency International, warned the move would jeopardise the freedom from political interference that the SFO’s investigations enjoy:

The underlying concern is that this could be a crude attempt at either cost-saving or to neuter the Bribery Act so that the UK can increase its exports at the expense of the stability, security and economic development of our overseas trading partners.

An SFO spokesperson said: “This is a political pledge and we cannot comment. The organisation of law enforcement is a matter for ministers.”

Updated

11:07

11:05

The Conservative manifesto includes a proposal to overhaul voter registration laws by including a requirement for voters to show ID at polling stations, in order to crack down on election fraud.
The manifesto claims that the Tories will tackle every aspect of electoral fraud. “The British public deserves to have confidence in our democracy,” it states.

We will legislate to ensure that a form of identification must be presented before voting, to reform postal voting and to improve other aspects of the elections process to ensure that our elections are the most secure in the world.


But the policy is a controversial one, with evidence that strict voter ID rules in some US states have disproportionately disadvantaged poor and minority voters.

Furthermore, there is little evidence that electoral fraud is widespread in the UK, which has a system that is respected around the world, including by international monitoring organisations.

Labour has previously said that millions of people may be disenfranchised by the plans. In December, Cat Smith, Labour’s shadow minister for voter engagement, raised concerns that 7.5% of the electorate may not have the right kind of identification in order to exercise their right to vote.

Voter ID requirements were also criticised as a “sledgehammer to crack a nut” by the Electoral Reform Society, a pressure group campaigning for reform of the democratic system. “The government should think very carefully before introducing barriers to voting,” said its chief executive, Katie Ghose. “There is simply no evidence to suggest that electoral fraud is widespread across the UK. Where it has occurred it has been isolated and should be tackled locally.”

Updated

11:01

Tories drop pledge to halve disability employment gap

Updated

10:49

10:44

While the Conservative manifesto includes the easing of fracking rules and the capping of household energy bills there is a very significant omission – no mention at all of the fleet of new nuclear power stations the party has always previously backed.

The 2015 Tory manifesto promised “a significant expansion in new nuclear”. The new one promises nothing at all. The deal for a French-Chinese partnership to build the first new reactors in a generation at Hinkley Point in Somerset is signed. But vast costs of nuclear power are looking ever more expensive as renewables costs plummet and grids gets smarter at managing demand.

It may be that the serious financial woes at Toshiba, which has placed another proposed plant in jeopardy, was the final straw. The Tories may have realised that hiking energy bills to fund large subsidies to foreign state-owned companies is not the best way to power the UK.

Updated

10:37

10:27

Ukip accuses Tories of ‘biggest tax raid in history’ on pensioners

10:22

Corbyn accuses Tories of unleashing ‘nasty party triple whammy’ on pensioners

10:17

The Tories appear to be fishing for votes in the Scottish Borders with the same zeal as an angler fishing for salmon on the Tweed. The party has a new manifesto pledge to create a major “Borderland” investment plan, for a region where the Tories are fighting to protect their only MP and hopefully secure at least one more.

Theresa May’s manifesto said:

Building on the city and growth deals we have signed across Scotland, we will bring forward a Borderlands Growth Deal, including all councils on both sides of the border, to help secure prosperity in southern Scotland.

By coincidence, the Scottish secretary, David Mundell is defending a slender 798 majority in Dumfriesshire, Clydesdale and Tweeddale, while John Lamont, a prominent ally of the Scottish Tory leader, Ruth Davidson, is fighting to unseat the Scottish National party’s Calum Kerr in Berwickshire, Roxbugh and Selkirk.

Kerr is protecting the smallest majority among Scotland’s 59 Commons seats, of 328 votes, and is widely expected to lose to Lamont, who is Tory MSP for the contiguous Holyrood seat.

No further details have yet emerged about the shape and value of the Borderlands offer, but in a party statement Mundell said:

From the Borders to the North Sea, this manifesto delivers for Scotland. It shows that a re-elected Conservative government will continue to ensure that Scotland benefits from its membership of the United Kingdom.

The SNP, which has itself faced Tory accusations of buying votes with Scottish government announcements before the council elections on 4 May, said it had reopened the Borders railway and was planning a new South of Scotland enterprise agency linked to the new city deal for Edinburgh.

Calum Kerr added:

The usual routine by the Tories is they announce these growth deals, put up a bit of the money and then rely on the Scottish government to stump up the rest.

Updated

10:12

The Conservative manifesto pledge to increase school funding in England gets a tepid response from Geoff Barton, general secretary of the Association of School and College Leaders. He says:

We welcome any improvement to school funding, but unfortunately the Conservative pledge of a £4bn boost includes a large element of sleight of hand. The schools budget would have to increase by about £2.8bn in any case because the pupil population will rise by 490,000 by 2022. So, the “extra” money is in fact just over £1bn, which is not enough to counteract the rising costs which are hitting schools and will amount to £3bn a year by 2020.

Barton is also unimpressed by the promise to revive grammar schools and selection.

The evidence we have seen does not support the premise that the further expansion of selection will improve education for the majority of young people. The evidence indicates that it will have a damaging impact on the life chances of the majority who do not attend a selective school.

10:07

How the Tory manifesto differs from David Cameron’s – Analysis

The headlines will focus on the Conservatives abandoning triple lock protection for pensions and an end to David Cameron’s “tax lock” promise of no increase in income tax, national insurance or VAT.

But what else has changed in the small print between today’s Tory manifesto and David Cameron’s two years ago?

On child poverty

Tory manifesto 2015: We will work to eliminate child poverty

Tory manifesto 2017: We want to reduce child poverty

What it means: Four million of our children are living below the official poverty line and the IFS projects the number will pass 5 million by 2020. That demands a muscular response. But the Conservatives have abolished the child poverty unit which has been subsumed into the DWP. This looks like no muscular response on the rising numbers will be forthcoming.

On balancing the budget

Tory manifesto 2015: Deliver a balanced structural current budget in 2017-18

Tory manifesto 2017: “A balanced budget by the middle of the next decade”

What it means: A far less specific commitment, and ten years later than George Osborne promised.

On the Human Rights Act

Tory manifesto 2015: Scrap the Human Rights Act and curtail the role of the European Court of Human Rights, so that foreign criminals can be more easily deported from Britain

Tory manifesto 2017: We will not repeal or replace the Human Rights Act while the process of Brexit is underway but we will consider our human rights legal framework when the process of leaving the EU concludes. We will remain signatories to the European Convention on Human Rights for the duration of the next parliament.

What it means: Another ditching of a flagship Cameron pledge, and a promise May made during her leadership campaign to remain signatories to the ECHR. A U-turn maybe, but one that will be welcomed by many progressives.

On defence

Tory manifesto 2015: We will maintain the size of the regular armed services and not reduce the army to below 82,000.

Tory manifesto 2017: We will maintain the overall size of the armed forces, including an army that is capable of fielding a war-fighting division.

What it means: No numbers here, because the Conservatives have failed to meet this pledge, the numbers are currently 78,500. Defence secretary Michael Fallon has been regularly castigated in TV interviews about the figure.

On prosperity

Tory manifesto 2015: We will pursue our ambition to become the most prosperous major economy in the world by the 2030s

Tory manifesto 2017: It doesn’t appear

What it means: This was a key pledge by George Osborne as a case for deficit reduction. The UK is the fifth largest economy in the world though it slipped to sixth below France in the direct aftermath of Brexit. With such economic uncertainty surrounding the Brexit negotiations, it seems unsurprising this has been quietly dropped.

On rail travel

Tory manifesto 2015: We will keep commuter rail fares frozen in real terms for the whole of the next Parliament

Tory manifesto 2017: It doesn’t appear

What it means: It means rail fares could rise above inflation under the Tories. Labour has pledged to renationalise the rail network, prompted in part by rising fares.

On Heathrow

Tory manifesto 2015: We will deliver on our National Infrastructure Plan and respond to the Airports Commission’s final report.

Tory manifesto 2017: We will continue our programme of strategic national investments, including High Speed 2, Northern Powerhouse Rail and the expansion of Heathrow Airport

What it means: Heathrow’s third runway is going ahead and Conservative candidates in seats where they at risk against anti-Heathrow Lib Dems will have to explain that on the south west London doorsteps. Among them will be Zac Goldsmith, standing again for the Tories in Richmond Park after quitting and sparking a by-election to protest the decision, which he subsequently lost to Lib Dem Sarah Olney.

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10:01

10:00

Tories promise to review honours system

One small element of the Conservative manifesto promises to examine the method for selecting people for honours. It says:

We will review the honours system to make sure it commands public confidence, rewards genuine public service and that recipients uphold the integrity of the honours bestowed.

While there is no further explanation of what this will involve, it follows briefings from those around May that she wanted to move the system away from giving knighthoods and other gongs to civil servants and former special advisers, instead rewarding more people outside Westminster, particularly those who assist social mobility.

It follows controversy about the last two lists of honours. David Cameron’s resignation list brought recognition to a series of No 10 and Tory party staffers, and the New Year’s collection – in part drawn up under Cameron – had awards for a series of senior officials.

What the promised review of the system will actually bring remains to be seen. But it shows May remains keen on the idea.

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09:37

09:31

No mention of air pollution in Tory manifesto

The manifesto made no mention of air pollution, which MPs have described as a public health emergency. The Tories commit to investing £600m by 2020 to pursue a desire for “almost every car and van” to be zero-emissions by 2050, but they make no mention of pollution from diesel vehicles and the 40,000 premature deaths each year from air pollution.

There is no mention either of tax changes to support the public to ditch their diesel cars in favour of less polluting alternatives, or a diesel scrappage scheme.

David Timms, from Friends of the Earth, said:

The lack of policies to deal with the dirty air crisis is astounding. Polluting car manufacturers will sleep easy knowing that they have been let off the hook, while children with asthma will continue to choke. This is a national disgrace which can’t be hidden behind planting a few trees.

The one mention of air quality is a commitment to planting one million trees in towns and cities.

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