Tag Archives: Jonathan

Fear over healthcare locks Americans in jobs – and throttles creativity | Jonathan R Goodman

Millions of Americans are stuck in what some economists call “job-lock” or the inability to leave employment because of the risk of losing health insurance. A 2001 paper from Princeton’s Center for Economic Policy Studies showed, for example, that self-employed people are 25% less likely to have health insurance than office workers.

Uncertainty surrounding the future of the Affordable Care Act (ACA), widely known as Obamacare, has left many people feeling too scared to risk leaving full-time employment to attempt something on their own. After several failed attempts to repeal the ACA, the current administration may, in its latest tax plan, get rid of the individual mandate that requires most Americans be insured.

The cost of job-lock may, however, be more damaging than keeping people glued to full-time work: America may be becoming a less creative place – and a less attractive place for creative people.


Future generations who will be raised to shun creative careers in favor of healthcare-providing employment

A high job-lock rate is repeatedly linked to fewer small businesses, despite the seemingly universal agreement that small business is the “backbone” of the American economy. And yet a 2009 study by the Center for Economic and Policy Research showed that the US has fewer manufacturing small businesses than almost any other country – and a self-employment rate of about 7%, compared with 13.8% in the UK and 26.4% in Italy.

But what about the people who don’t want office jobs at all? America is full of creative minds, from mathematicians to photographers and artistic baristas. Shouldn’t Americans also place some importance on their country’s cultural position in the world?

The relationship between health insurance and economic freedom may be one reason the House minority leader, Nancy Pelosi, touted in 2012 that the ACA would allow Americans to quit their jobs and become “whatever”.

Becoming “whatever” doesn’t, after all, include only small manufacturing businesses – it includes an accountant becoming a comedian, a full-time steel factory worker becoming a poet, a tax lawyer opening an arts studio.

While the ACA’s effects on job-lock are not yet clear, the uncertainty of healthcare reform – coupled with the possibility that pre-existing conditions will be held against people by insurers – has left many people previously considering leaving salaried employment feeling trapped.

Expensive insurance rates for unemployed people are not the only concern. Drugs for chronic illnesses, from asthma to cancer, are hitting record highs in the US. Patients with a rare type of leukemia, for example, can now live a nearly normal lifespan with Imatinib, a kind of targeted therapy. The catch, however, is the drug can cost uninsured patients in America upwards of $ 145,000 per year – while in India a 30-day supply costs about $ 400.

Even with Obamacare, it’s understandable that people with insurance are terrified of leaving work to navigate the nebulous world of self-employment. If the ACA is repealed and pre-existing conditions lead to higher insurance rates, previous diagnosis of “chronic illnesses” from acne and anxiety to Crohn’s disease and cancer may prohibit people from obtaining health insurance at all.

Taken together, does it sound wise to strike out on your own in America just because you have creative talent?

Forcing people to remain employed for the sake of health has a high cultural cost: the cost of human creativity. This cost is, furthermore, not limited to the immediate workforce, but to future generations who will be raised to shun creative careers in favor of healthcare-providing employment.

Just imagine the absurdity of a parent convincing a talented child writer to plan for a career in public relations just because she has asthma, or a musically talented undergraduate switching majors to business just for a better chance at an office job.

Almost every European nation has signed the European social charter, which holds that healthcare is a human right. Combined with laws guaranteeing the freedom of movement of workers within the EU, this charter enables people from many backgrounds to work together, bringing innovation and creativity from one culture to many others. Why bother coming to the US?

Americans may be trapping the next William James, Herman Melville, or Bob Dylan in a cubicle: and for what? What cultural achievements are we costing this country by training future generations to aim away from their dreams only so they can afford exorbitantly priced medications? What could and should make America great is the freedom to follow one’s dreams, not a prison installed by unchecked insurance companies.

For America to really be great, it’s critical that people are given the freedom to be creative.

  • Jonathan R Goodman is the editor of Cancer Therapy Advisor and a researcher at the City University of New York’s department of biology, where he studies cultural evolution

Fear over healthcare locks Americans in jobs – and throttles creativity | Jonathan R Goodman

Millions of Americans are stuck in what some economists call “job-lock” or the inability to leave employment because of the risk of losing health insurance. A 2001 paper from Princeton’s Center for Economic Policy Studies showed, for example, that self-employed people are 25% less likely to have health insurance than office workers.

Uncertainty surrounding the future of the Affordable Care Act (ACA), widely known as Obamacare, has left many people feeling too scared to risk leaving full-time employment to attempt something on their own. After several failed attempts to repeal the ACA, the current administration may, in its latest tax plan, get rid of the individual mandate that requires most Americans be insured.

The cost of job-lock may, however, be more damaging than keeping people glued to full-time work: America may be becoming a less creative place – and a less attractive place for creative people.


Future generations who will be raised to shun creative careers in favor of healthcare-providing employment

A high job-lock rate is repeatedly linked to fewer small businesses, despite the seemingly universal agreement that small business is the “backbone” of the American economy. And yet a 2009 study by the Center for Economic and Policy Research showed that the US has fewer manufacturing small businesses than almost any other country – and a self-employment rate of about 7%, compared with 13.8% in the UK and 26.4% in Italy.

But what about the people who don’t want office jobs at all? America is full of creative minds, from mathematicians to photographers and artistic baristas. Shouldn’t Americans also place some importance on their country’s cultural position in the world?

The relationship between health insurance and economic freedom may be one reason the House minority leader, Nancy Pelosi, touted in 2012 that the ACA would allow Americans to quit their jobs and become “whatever”.

Becoming “whatever” doesn’t, after all, include only small manufacturing businesses – it includes an accountant becoming a comedian, a full-time steel factory worker becoming a poet, a tax lawyer opening an arts studio.

While the ACA’s effects on job-lock are not yet clear, the uncertainty of healthcare reform – coupled with the possibility that pre-existing conditions will be held against people by insurers – has left many people previously considering leaving salaried employment feeling trapped.

Expensive insurance rates for unemployed people are not the only concern. Drugs for chronic illnesses, from asthma to cancer, are hitting record highs in the US. Patients with a rare type of leukemia, for example, can now live a nearly normal lifespan with Imatinib, a kind of targeted therapy. The catch, however, is the drug can cost uninsured patients in America upwards of $ 145,000 per year – while in India a 30-day supply costs about $ 400.

Even with Obamacare, it’s understandable that people with insurance are terrified of leaving work to navigate the nebulous world of self-employment. If the ACA is repealed and pre-existing conditions lead to higher insurance rates, previous diagnosis of “chronic illnesses” from acne and anxiety to Crohn’s disease and cancer may prohibit people from obtaining health insurance at all.

Taken together, does it sound wise to strike out on your own in America just because you have creative talent?

Forcing people to remain employed for the sake of health has a high cultural cost: the cost of human creativity. This cost is, furthermore, not limited to the immediate workforce, but to future generations who will be raised to shun creative careers in favor of healthcare-providing employment.

Just imagine the absurdity of a parent convincing a talented child writer to plan for a career in public relations just because she has asthma, or a musically talented undergraduate switching majors to business just for a better chance at an office job.

Almost every European nation has signed the European social charter, which holds that healthcare is a human right. Combined with laws guaranteeing the freedom of movement of workers within the EU, this charter enables people from many backgrounds to work together, bringing innovation and creativity from one culture to many others. Why bother coming to the US?

Americans may be trapping the next William James, Herman Melville, or Bob Dylan in a cubicle: and for what? What cultural achievements are we costing this country by training future generations to aim away from their dreams only so they can afford exorbitantly priced medications? What could and should make America great is the freedom to follow one’s dreams, not a prison installed by unchecked insurance companies.

For America to really be great, it’s critical that people are given the freedom to be creative.

  • Jonathan R Goodman is the editor of Cancer Therapy Advisor and a researcher at the City University of New York’s department of biology, where he studies cultural evolution

Brexit won’t help the NHS, it will destroy it | Jonathan Lis

Of the lies told during the Brexit referendum – and there were many – perhaps the most egregious was the claim that we could spend an extra £350m on the NHS as a result of leaving the EU. It has gained unique notoriety not simply because the figure was demonstrably false, or even because Brexit will shrink the economy rather than free up vital funds, but rather because of its calculated emotional manipulation. We value the NHS more than any other institution. As the defining icon of the post-war consensus and intrinsic component of our national story, it unites Britons across political, geographical and class divides. Crippled by austerity, staff shortages and low morale, our NHS is also on its knees. But far from offering a helping hand, Brexit threatens to bring it down altogether.

A report in the Lancet offers a comprehensive – and bleak – analysis of the dangers. Brexit stands to damage staffing, funding, access to new products and technology, and standards of public health. The softer the Brexit, the lower the harm – but as Theresa May’s speech in Florence made clear, the government still plans to leave the single market, customs union and other EU bodies after a transition ends in 2021, no matter the cost.


Telling NHS workers they can help us, but forget about ever settling or becoming British, may not prove attractive

The key area of risk is also the central plank of Brexit: restrictions on free movement of people. This is no coincidence. While millions of leave voters expressed the concern that immigration was posing an intolerable burden on public services, studies have repeatedly indicated that it in fact keeps them afloat. The NHS and adult social care employs 150,000 EU nationals; 10% of our doctors graduated in EEA countries. The government continually promises that the “brightest and best” will always be welcome, but this elitist and divisive slogan fails even on its own terms. Britain’s most vulnerable patients do not simply depend on EU surgeons, GPs and nurses, but on an army of notionally “unskilled” carers, porters and cleaners who help to keep people alive.

Even if the government prioritises NHS workers in its post-Brexit immigration strategy, grave damage has already been done. This week, a molecular biologist in Madrid told me that London was his favourite city, but its political climate now too hostile to consider returning. The figures bear out the anecdote: while 40,000 nursing positions currently lie vacant, the number of EU nurses registering to work here has dropped by a staggering 96%. While fewer arrive, more depart. About 10,000 EU nationals have left the NHS in the past year.

Britain no longer feels like a welcoming place for foreigners. Let alone the shame, we should also feel profound alarm. We do not have the doctors and nurses that we need as it is; and even if the government was adequately investing in training – which it isn’t – we would still have no time to replace those Europeans who either intend to leave or never even come. To add idiocy to injury, the recently leaked government proposals on immigration specified time-limited work permits, with permanent residency a possibility only for the most highly skilled. Telling NHS workers that they can help us for a few years, but probably forget about ever settling or becoming British, may not prove an attractive offer.

The problem for the NHS is that unlike, say, the single market or Irish border issue, it is not in itself an EU competence and will not be negotiated at the Brexit table. What we do with our healthcare has always been a matter for us alone. But as with so much else in Brexit, problems both predictable and previously unforeseen are threatening key aspects of our national infrastructure.

While remain campaigners stressed the risks to the NHS of reduced immigration and a diminished economy, few mentioned the €3.5bn supplied by the European Investment Bank to the NHS since 2001, or publicised the dangers to cancer patients of leaving the European Atomic Energy Community or the European Medicines Agency. The government, for its part, is so consumed with fire-fighting that it is neglecting to recognise the NHS for what it is: one of Brexit’s key issues, and potentially its most high-profile piece of collateral damage.

Like the ravens at the Tower of London whose departure, in legend, presages the nation’s fall, the NHS’s success – or collapse – is also Britain’s. Brexit’s architects knew that people would respond to appeals to help it; faced with a false prospectus, the public duly chose British hospitals over Brussels bureaucrats. Those same voters may yet punish Brexit’s leaders, but the national consequences will profoundly eclipse any political ones. After all, the risk of deploying your most treasured family heirloom as a political football is not just that it could ultimately land in your own goal – but that in your recklessness, you may irreparably smash it.

Jonathan Lis is deputy director of the thinktank British Influence

Brexit could destroy the NHS. This will hurt us all | Jonathan Lis

Of the lies told during the Brexit referendum – and there were many – perhaps the most egregious was the claim that we could spend an extra £350m on the NHS as a result of leaving the EU. It has gained unique notoriety not simply because the figure was demonstrably false, or even because Brexit will shrink the economy rather than free up vital funds, but rather because of its calculated emotional manipulation. We value the NHS more than any other institution. As the defining icon of the post-war consensus and intrinsic component of our national story, it unites Britons across political, geographical and class divides. Crippled by austerity, staff shortages and low morale, our NHS is also on its knees. But far from offering a helping hand, Brexit threatens to bring it down altogether.

A report in the Lancet offers a comprehensive – and bleak – analysis of the dangers. Brexit stands to damage staffing, funding, access to new products and technology, and standards of public health. The softer the Brexit, the lower the harm – but as Theresa May’s speech in Florence made clear, the government still plans to leave the single market, customs union and other EU bodies after a transition ends in 2021, no matter the cost.


Telling NHS workers they can help us, but forget about ever settling or becoming British, may not prove attractive

The key area of risk is also the central plank of Brexit: restrictions on free movement of people. This is no coincidence. While millions of leave voters expressed the concern that immigration was posing an intolerable burden on public services, studies have repeatedly indicated that it in fact keeps them afloat. The NHS and adult social care employs 150,000 EU nationals; 10% of our doctors graduated in EEA countries. The government continually promises that the “brightest and best” will always be welcome, but this elitist and divisive slogan fails even on its own terms. Britain’s most vulnerable patients do not simply depend on EU surgeons, GPs and nurses, but on an army of notionally “unskilled” carers, porters and cleaners who help to keep people alive.

Even if the government prioritises NHS workers in its post-Brexit immigration strategy, grave damage has already been done. This week, a molecular biologist in Madrid told me that London was his favourite city, but its political climate now too hostile to consider returning. The figures bear out the anecdote: while 40,000 nursing positions currently lie vacant, the number of EU nurses registering to work here has dropped by a staggering 96%. While fewer arrive, more depart. About 10,000 EU nationals have left the NHS in the past year.

Britain no longer feels like a welcoming place for foreigners. Let alone the shame, we should also feel profound alarm. We do not have the doctors and nurses that we need as it is; and even if the government was adequately investing in training – which it isn’t – we would still have no time to replace those Europeans who either intend to leave or never even come. To add idiocy to injury, the recently leaked government proposals on immigration specified time-limited work permits, with permanent residency a possibility only for the most highly skilled. Telling NHS workers that they can help us for a few years, but probably forget about ever settling or becoming British, may not prove an attractive offer.

The problem for the NHS is that unlike, say, the single market or Irish border issue, it is not in itself an EU competence and will not be negotiated at the Brexit table. What we do with our healthcare has always been a matter for us alone. But as with so much else in Brexit, problems both predictable and previously unforeseen are threatening key aspects of our national infrastructure.

While remain campaigners stressed the risks to the NHS of reduced immigration and a diminished economy, few mentioned the €3.5bn supplied by the European Investment Bank to the NHS since 2001, or publicised the dangers to cancer patients of leaving the European Atomic Energy Community or the European Medicines Agency. The government, for its part, is so consumed with fire-fighting that it is neglecting to recognise the NHS for what it is: one of Brexit’s key issues, and potentially its most high-profile piece of collateral damage.

Like the ravens at the Tower of London whose departure, in legend, presages the nation’s fall, the NHS’s success – or collapse – is also Britain’s. Brexit’s architects knew that people would respond to appeals to help it; faced with a false prospectus, the public duly chose British hospitals over Brussels bureaucrats. Those same voters may yet punish Brexit’s leaders, but the national consequences will profoundly eclipse any political ones. After all, the risk of deploying your most treasured family heirloom as a political football is not just that it could ultimately land in your own goal – but that in your recklessness, you may irreparably smash it.

Jonathan Lis is deputy director of the thinktank British Influence

Brexit could destroy the NHS. This will hurt us all | Jonathan Lis

Of the lies told during the Brexit referendum – and there were many – perhaps the most egregious was the claim that we could spend an extra £350m on the NHS as a result of leaving the EU. It has gained unique notoriety not simply because the figure was demonstrably false, or even because Brexit will shrink the economy rather than free up vital funds, but rather because of its calculated emotional manipulation. We value the NHS more than any other institution. As the defining icon of the post-war consensus and intrinsic component of our national story, it unites Britons across political, geographical and class divides. Crippled by austerity, staff shortages and low morale, our NHS is also on its knees. But far from offering a helping hand, Brexit threatens to bring it down altogether.

A report in the Lancet offers a comprehensive – and bleak – analysis of the dangers. Brexit stands to damage staffing, funding, access to new products and technology, and standards of public health. The softer the Brexit, the lower the harm – but as Theresa May’s speech in Florence made clear, the government still plans to leave the single market, customs union and other EU bodies after a transition ends in 2021, no matter the cost.


Telling NHS workers they can help us, but forget about ever settling or becoming British, may not prove attractive

The key area of risk is also the central plank of Brexit: restrictions on free movement of people. This is no coincidence. While millions of leave voters expressed the concern that immigration was posing an intolerable burden on public services, studies have repeatedly indicated that it in fact keeps them afloat. The NHS and adult social care employs 150,000 EU nationals; 10% of our doctors graduated in EEA countries. The government continually promises that the “brightest and best” will always be welcome, but this elitist and divisive slogan fails even on its own terms. Britain’s most vulnerable patients do not simply depend on EU surgeons, GPs and nurses, but on an army of notionally “unskilled” carers, porters and cleaners who help to keep people alive.

Even if the government prioritises NHS workers in its post-Brexit immigration strategy, grave damage has already been done. This week, a molecular biologist in Madrid told me that London was his favourite city, but its political climate now too hostile to consider returning. The figures bear out the anecdote: while 40,000 nursing positions currently lie vacant, the number of EU nurses registering to work here has dropped by a staggering 96%. While fewer arrive, more depart. About 10,000 EU nationals have left the NHS in the past year.

Britain no longer feels like a welcoming place for foreigners. Let alone the shame, we should also feel profound alarm. We do not have the doctors and nurses that we need as it is; and even if the government was adequately investing in training – which it isn’t – we would still have no time to replace those Europeans who either intend to leave or never even come. To add idiocy to injury, the recently leaked government proposals on immigration specified time-limited work permits, with permanent residency a possibility only for the most highly skilled. Telling NHS workers that they can help us for a few years, but probably forget about ever settling or becoming British, may not prove an attractive offer.

The problem for the NHS is that unlike, say, the single market or Irish border issue, it is not in itself an EU competence and will not be negotiated at the Brexit table. What we do with our healthcare has always been a matter for us alone. But as with so much else in Brexit, problems both predictable and previously unforeseen are threatening key aspects of our national infrastructure.

While remain campaigners stressed the risks to the NHS of reduced immigration and a diminished economy, few mentioned the €3.5bn supplied by the European Investment Bank to the NHS since 2001, or publicised the dangers to cancer patients of leaving the European Atomic Energy Community or the European Medicines Agency. The government, for its part, is so consumed with fire-fighting that it is neglecting to recognise the NHS for what it is: one of Brexit’s key issues, and potentially its most high-profile piece of collateral damage.

Like the ravens at the Tower of London whose departure, in legend, presages the nation’s fall, the NHS’s success – or collapse – is also Britain’s. Brexit’s architects knew that people would respond to appeals to help it; faced with a false prospectus, the public duly chose British hospitals over Brussels bureaucrats. Those same voters may yet punish Brexit’s leaders, but the national consequences will profoundly eclipse any political ones. After all, the risk of deploying your most treasured family heirloom as a political football is not just that it could ultimately land in your own goal – but that in your recklessness, you may irreparably smash it.

Jonathan Lis is deputy director of the thinktank British Influence

Blame the Saudis for Yemen’s cholera outbreak – they are targeting the people | Jonathan Kennedy

Over the past four months, Yemen has been ravaged by a cholera outbreak that the UN has branded the worst in the world. About 7,000 new cases are reported daily – 436,625 have been recorded since the end of April – and already there have been more than 1,915 deaths.

The epidemic is one aspect of a broader humanitarian emergency in Yemen. Two-thirds of the population – 18.8 million people – require some form of emergency aid. Food production has collapsed and 4.5 million children and pregnant and lactating women are acutely malnourished. Only 45% of health facilities are functioning, and 14.8 million people lack access to basic healthcare. About the same number require assistance to access safe drinking water and sanitation.

Cholera, a bacterial infection, is spread by water containing contaminated faeces. It can be easily prevented and easily treated. Cholera first spread from the Ganges delta in 1817, and the resulting pandemics killed tens of millions of people across the world over the 150 years. Modern improvements in water and sanitation infrastructure, and better access to medicines and healthcare, have brought a marked fall in the number of cases. Today, outbreaks occur chiefly in areas where water, sanitation and health systems are inadequate, or where they have been destroyed by natural or manmade disasters.

UN agencies, respected media outlets – including the BBC and New York Times – and influential medical journals such as the Lancet all argue that two years of conflict have created conditions conducive to a cholera outbreak. This narrative, while true, tells only part of the story. It fails to account for the possibility that one party might be more culpable for the outbreak and the other more affected by it.

The Yemeni civil war began in September 2014 when Houthi rebels, a group of Zaydi Shia from northern Yemen, took control of the capital, Sana’a, and then, with help from forces loyal to Ali Abdullah Saleh, the former president, overthrew the government the following January. The internationally recognised regime led by President Abed Mansour Hadi set up a parallel government in the southern port of Aden.

Since March 2015, Saudi Arabia has led a coalition of Sunni Arab states that has attempted to restore the government using airstrikes, an air and naval blockade, and ground troops. The US and UK provide the coalition with logistical support and military equipment. The Saudis have accused Iran of assisting the rebels, but there is limited evidence for this claim and it is denied by the Houthis and Iran.

At least 10,000 people have been killed and 40,000 injured in the conflict. Both sides stand accused of disregarding the wellbeing of civilians and breaching international law. The rebels have indiscriminately fired artillery into residential areas in government-controlled areas and Saudi Arabia. But as the Saudi-led coalition commands far greater resources, it has been able to cause destruction of a totally different magnitude.

The Saudi air force has carried out indiscriminate attacks that have caused the majority of civilian deaths and injuries during the conflict. Airstrikes have targeted civilian infrastructure, including hospitals, farms, schools, water infrastructure, markets and the main port of Hodeida. They complement a Saudi-led naval and air blockade of rebel-controlled areas that has caused shortages of many essential items, including food, fuel and medical supplies.

It was not until four weeks after the start of the outbreak that the first plane carrying medical aid was allowed to land in Sana’a. The government no longer pays public employees working in rebel-controlled areas. About 30,000 health workers have not received a salary for almost a year. Sanitation workers and water engineers in Sana’a have been on strike for months, leaving uncollected rubbish on the streets and municipal drains clogged.

So it is not surprising that rebel-controlled areas are disproportionately affected by the cholera outbreak. About 80% of cases – and deaths – have occurred in governorates controlled by the Houthis. In rebel-controlled areas the attack rate – the number of cases among every 1,000 people – is 17, compared with 10 in government-controlled governorates. The percentage of people with cholera who die is 0.46% in rebel-controlled areas, compared with 0.3% in government-controlled governorates. Thus, a person living in areas under rebel control is 70% more likely to contract cholera and, if they do, 50% more likely to die.

These numbers indicate that the outbreak is not simply an inevitable consequence of civil war. It is rather a direct outcome of the Saudi-led coalition’s strategy of targeting civilians and infrastructure in rebel-controlled areas. Criticism of the US and UK governments’ support for the Saudi-led intervention, this has not led to a policy change. In December 2016, the Obama administration banned the sale of precision-guided bombs to Saudi Arabia due to concerns about civilian casualties in Yemen, but in May 2017 the Trump administration agreed to sell $ 500m such weapons as part of a $ 110bn deal. The following month a bipartisan effort to stop the sale failed by a few votes in the Senate. Last month in the UK, the high court rejected activists’ claims that ministers were acting illegally by continuing to sell fighter jets and precision-guided bombs to Saudi Arabia when they might be used against civilians in Yemen. In the absence of strong international condemnation of Saudi-led operations, it is hard to foresee a quick end to this public health emergency and the broader humanitarian crisis.

  • Jonathan Kennedy is a lecturer in global health at Queen Mary University of London

The fog of Brexit is engulfing the NHS. It’s up to Theresa May to provide clarity | Jonathan Ashworth

Everyone knows that after seven years of neglect from the Conservative government, the NHS is undergoing a serious crisis of funding and staffing. The last thing needed is more uncertainty. That is exactly what the NHS faces with Brexit.

On Wednesday Theresa May will trigger article 50 and later this week health bosses publish the updated Five Year Forward View. It is time for the prime minister and the health secretary, Jeremy Hunt, to give the NHS and its patients the certainty needed through the Brexit process. May has already turned her back on the promise of £350m a week for our NHS and now she is walking away from her responsibilities to protect the health service through a turbulent Brexit process that will hit it hard.

The complacency in government is astounding. Last week Hunt published the department of health’s Mandate to NHS England to set “the government’s objectives and any requirements for NHS England”. Amazingly, the 24-page document made no mention of Brexit whatsoever.

It should come as no surprise that the NHS is not a priority for the government. Hunt isn’t even a member of the cabinet committees managing the exit strategy. Yet Britain’s health and social care system is dependent on tens of thousands of European staff, many of whom have settled and built lives here while caring for our sick and elderly. Safeguarding the future of these staff should be an absolute priority in the Brexit negotiations. But in the House of Commons last week Hunt failed to offer any reassurance that he’s prepared to stand up for this essential section of the workforce he oversees.

Will health professionals from other EU countries be able to come to work in our NHS after Brexit, or will there be a cap on their numbers? As long as the issue is left unclear, more and more EU workers are voting with their feet and leaving on their own terms. In a recent survey, 42% of European health staff working here said they are now thinking of leaving the UK. Almost 5,500 have left since the Brexit vote according to NHS Digital, a 25% increase on the 2015 figures. And others are being put off from coming here at all: only 96 European nurses registered to work in the UK in December – that figure was 1,304 for last July.

So our first test of the government plans will be whether they deliver a right of remain for the 140,000 EU nationals working in the NHS and social care system. Secondly, on funding, we know that the EU’s Horizon 2020 scheme is due to invest £7.5bn in health research across the EU over the next five years, and the UK will be by far the largest recipient of those funds. We also receive EU funding from the Innovative Medicines Initiative, the European Cooperation in Science and Technology programme, and the Active and Assisted Living programme for older people.

This long-term funding is vital in giving security to those medical institutions and universities planning major research projects. They cannot just wait and see what will happen after 2019. So we need to know whether access to these funding streams will continue after Brexit. If not, how do the government propose to make up the shortfall?

Our third test is on reciprocal healthcare arrangements. It is a key principle that British citizens can obtain free healthcare elsewhere in Europe, just as they would at home. That is an important safety net for British holidaymakers, and for UK citizens living elsewhere in Europe. Does the government intend to maintain those arrangements? If not, how will it address the increased insurance costs for UK holidaymakers?

Our fourth test is on EU healthcare collaboration. Working effectively with our European partners, on everything from infectious disease control to the licensing and regulation of medicines, has been vital for the NHS in recent years. The sector desperately needs to know whether it’s the government’s intention to maintain the UK’s participation in pan-European public health initiatives after Brexit. Will the UK continue to participate in the centralised marketing authorisation procedure for the licensing, sale and regulation of medicines, governed by the European Medicines Agency? The government needs to be clear about how Brexit will affect the UK pharmaceutical industry when exporting medicines to other member states in future.

These are difficult and detailed questions, but they are all of absolute importance to the future of our health service and of our medical research sectors. There is no reason why May should refuse to give us the answers. That will allow us to understand with greater clarity what the impact of Brexit will be on the NHS – and most importantly, it will allow patients and staff the opportunity to scrutinise the government’s plans closely over the next two years.

The NHS is already in crisis over funding and staffing. But Brexit has the potential to tip those crises into disasters. Patients and NHS staff should not be bargaining chips in May’s hard Brexit negotiations. They want a world-class NHS delivering the best quality healthcare. As article 50 is triggered, the very least the public deserves is clarity and certainty from its government.

‘Dad was an alcoholic’: MP Jonathan Ashworth urges action on drinking

Childhood memories of growing up with an alcoholic father have prompted the shadow health secretary to call for greater recognition of the damage done by excessive drinking.

Jonathan Ashworth said there was a need for urgent action because the cost of alcohol-related harm was not just the £3.5bn NHS price-tag, but up to £7bn in lost productivity for the British economy.

During an interview with the Guardian, the Labour MP said he also wanted there to be much more focus on the needs of families affected by alcoholism, claiming the issue would be a priority for him and Labour in 2017.

Ashworth said he was surprised to find himself disclosing, for the first time to a national newspaper, the reason he felt so passionately about the issue.

“It’s quite personal for me, because my dad was an alcoholic,” he said, suddenly spilling out early memories of his father falling over drunkenly at the school gates and of returning home to a fridge stacked with cheap booze and no food.

Ashworth said he had never really considered his experience as something relevant in policy terms. “You didn’t think there was a problem, you just thought ‘that is the life I’ve got’,” he said.

Then he came across the work being carried out by his Labour colleague, Liam Byrne, whose childhood was affected in a similar way.

The MP’s all-party parliamentary group dedicated to the children of alcoholics has revealed that local authorities across the country tend to have no specific strategies to help young people affected in this way.

The group, which is publishing research on the issue in the new year, said that millions of children were “suffering in silence”.

Inspired by Byrne’s work, Ashworth felt he wanted to make the issue a priority in 2017. “I wanted to do something on alcoholism so that if nothing else I’ll have done something on that,” he said, before adding: “I know it’s cliched.”

As well as backing Byrne’s ideas he wants to support a phoneline run by the National Association for Children of Alcoholics to help make it a nationwide service. He also wants more specialised training for professionals to support children and for councils to be properly funded to be able to reach out to families affected by alcoholism through schools, via community nurses and in Sure Start children’s centres.

Liam Byrne


Ashworth was inspired by Labour MP Liam Byrne who has set up an all-party parliamentary group dedicated to the children of alcoholics. Photograph: Peter Macdiarmid/Getty Images

Ashworth talked about his own experience as an only child in a working-class part of north Manchester after his mother, who worked as a barmaid, and his father, a croupier in a Salford casino, divorced.

He spoke vividly about the days that he stayed with his father – whom he said he loved dearly.

“I remember him falling over when he picked me up at the school gates and we’d get home and there would be nothing in the fridge other than bottles of wine – he drank cheap horrible bottles of white wine … and cans of lager and Stone’s bitter,” said Ashworth.

“When I got to 11 or 12 then I was effectively looking after him on the weekends because he was drunk all weekend,” he said, pausing before adding: “And eventually he died.”

Ashworth recalled trying to persuade his father not to move to Thailand one Christmas. The MP said he knew in his heart it would end badly, but his father replied: “No, I’m going,” and he went.

“I never saw him again,” said the MP.

About a year later he received a call telling him to travel to the small apartment where his father had been staying. When he got there he found his bed surrounded by empty whisky bottles. “He was in Thailand for that last year drinking a bottle of whisky a day … I had to clear it up. That was my life. He was 60.”

Ashworth said his father, also called Jon, had not been offered formal help, although he himself had tried to raise the issue of his drinking as an adult. He said his dad thought he was OK because he didn’t touch alcohol during his working hours. “But as a child I didn’t see him at work,” he said.

Ashworth, who was politically active for the Labour party from the age of 15, through college and on into a job advising Gordon Brown, said the experience with his dad left him feeling “not damaged but determined”.

The MP for LeicesterSouth – who was promoted to shadow health secretary by Jeremy Corbyn after his second victory in a leadership contest – now feels he has an opportunity to take action.

As well as the work he outlined with charities and councils, he believes that part of the solution must also be a cultural drive to have alcoholism taken more seriously. Ashworth recalled how “people used to think it was funny – a right laugh” that his dad was a drinker.

He remembered his father in goal in the work football team and people pointing off the pitch and shouting: “Oh Jon Ash is in goal – just throw a crate of Stella in that direction and he’ll go after that.”

“And I was like ‘oh yeah that’s funny’, but actually that was my dad and for my teenage years I was looking after him. It just became a norm. I had to grow up very fast.”

But he is not just concerned about alcohol. “Public health has been cut back by the Tories but they are storing up huge problems,” he said. “Obesity is a huge problem that costs the NHS billions. The debate on obesity and diabetes hasn’t punched through.”

Ashworth said there were lessons to be learned from the bold action to ban smoking in public places, which had a massive impact. He called for much more direct action on poor diet.

“I think we have to be bold about what we say to the advertising industry – not just with kids programmes but families sitting down watching The X Factor. Think of the hundreds of thousands of calories being advertised this winter in the run-up to Christmas,” said Ashworth, arguing that fast food and supermarkets selling “tasty treats” were all over family viewing times.

“The government watered this down. There were going to be stricter restrictions on the industry, [David] Cameron was going to go for it and the story is that Theresa May got her red pen out and cut it out. I think we have got to be bold.”

‘Dad was an alcoholic’: MP Jonathan Ashworth urges action on drinking

Childhood memories of growing up with an alcoholic father have prompted the shadow health secretary to call for greater recognition of the damage done by excessive drinking.

Jonathan Ashworth said there was a need for urgent action because the cost of alcohol-related harm was not just the £3.5bn NHS price-tag, but up to £7bn in lost productivity for the British economy.

During an interview with the Guardian, the Labour MP said he also wanted there to be much more focus on the needs of families affected by alcoholism, claiming the issue would be a priority for him and Labour in 2017.

Ashworth said he was surprised to find himself disclosing, for the first time to a national newspaper, the reason he felt so passionately about the issue.

“It’s quite personal for me, because my dad was an alcoholic,” he said, suddenly spilling out early memories of his father falling over drunkenly at the school gates and of returning home to a fridge stacked with cheap booze and no food.

Ashworth said he had never really considered his experience as something relevant in policy terms. “You didn’t think there was a problem, you just thought ‘that is the life I’ve got’,” he said.

Then he came across the work being carried out by his Labour colleague, Liam Byrne, whose childhood was affected in a similar way.

The MP’s all-party parliamentary group dedicated to the children of alcoholics has revealed that local authorities across the country tend to have no specific strategies to help young people affected in this way.

The group, which is publishing research on the issue in the new year, said that millions of children were “suffering in silence”.

Inspired by Byrne’s work, Ashworth felt he wanted to make the issue a priority in 2017. “I wanted to do something on alcoholism so that if nothing else I’ll have done something on that,” he said, before adding: “I know it’s cliched.”

As well as backing Byrne’s ideas he wants to support a phoneline run by the National Association for Children of Alcoholics to help make it a nationwide service. He also wants more specialised training for professionals to support children and for councils to be properly funded to be able to reach out to families affected by alcoholism through schools, via community nurses and in Sure Start children’s centres.

Liam Byrne


Ashworth was inspired by Labour MP Liam Byrne who has set up an all-party parliamentary group dedicated to the children of alcoholics. Photograph: Peter Macdiarmid/Getty Images

Ashworth talked about his own experience as an only child in a working-class part of north Manchester after his mother, who worked as a barmaid, and his father, a croupier in a Salford casino, divorced.

He spoke vividly about the days that he stayed with his father – whom he said he loved dearly.

“I remember him falling over when he picked me up at the school gates and we’d get home and there would be nothing in the fridge other than bottles of wine – he drank cheap horrible bottles of white wine … and cans of lager and Stone’s bitter,” said Ashworth.

“When I got to 11 or 12 then I was effectively looking after him on the weekends because he was drunk all weekend,” he said, pausing before adding: “And eventually he died.”

Ashworth recalled trying to persuade his father not to move to Thailand one Christmas. The MP said he knew in his heart it would end badly, but his father replied: “No, I’m going,” and he went.

“I never saw him again,” said the MP.

About a year later he received a call telling him to travel to the small apartment where his father had been staying. When he got there he found his bed surrounded by empty whisky bottles. “He was in Thailand for that last year drinking a bottle of whisky a day … I had to clear it up. That was my life. He was 60.”

Ashworth said his father, also called Jon, had not been offered formal help, although he himself had tried to raise the issue of his drinking as an adult. He said his dad thought he was OK because he didn’t touch alcohol during his working hours. “But as a child I didn’t see him at work,” he said.

Ashworth, who was politically active for the Labour party from the age of 15, through college and on into a job advising Gordon Brown, said the experience with his dad left him feeling “not damaged but determined”.

The MP for LeicesterSouth – who was promoted to shadow health secretary by Jeremy Corbyn after his second victory in a leadership contest – now feels he has an opportunity to take action.

As well as the work he outlined with charities and councils, he believes that part of the solution must also be a cultural drive to have alcoholism taken more seriously. Ashworth recalled how “people used to think it was funny – a right laugh” that his dad was a drinker.

He remembered his father in goal in the work football team and people pointing off the pitch and shouting: “Oh Jon Ash is in goal – just throw a crate of Stella in that direction and he’ll go after that.”

“And I was like ‘oh yeah that’s funny’, but actually that was my dad and for my teenage years I was looking after him. It just became a norm. I had to grow up very fast.”

But he is not just concerned about alcohol. “Public health has been cut back by the Tories but they are storing up huge problems,” he said. “Obesity is a huge problem that costs the NHS billions. The debate on obesity and diabetes hasn’t punched through.”

Ashworth said there were lessons to be learned from the bold action to ban smoking in public places, which had a massive impact. He called for much more direct action on poor diet.

“I think we have to be bold about what we say to the advertising industry – not just with kids programmes but families sitting down watching The X Factor. Think of the hundreds of thousands of calories being advertised this winter in the run-up to Christmas,” said Ashworth, arguing that fast food and supermarkets selling “tasty treats” were all over family viewing times.

“The government watered this down. There were going to be stricter restrictions on the industry, [David] Cameron was going to go for it and the story is that Theresa May got her red pen out and cut it out. I think we have got to be bold.”

Jonathan Trott’s situation demonstrates we nevertheless are extended way off accepting imperfection

Sadly for Trott, commentators are suggesting his job at worldwide degree now seems to be more than with the ECB hugely unlikely to thrust him into a high-strain circumstance that is creating him so numerous problems.

But he is dealing with criticism as well – former England captain Michael Vaughn has stated that if Trott’s exit was not for mental health factors as critical as then suggested, he for one feels “conned”.

Trott’s story apparently demonstrates numerous of the problems nevertheless surrounding mental overall health: the difficulty of labels, uncertainties about severity, the non-patient’s need to have for a “cure” – all of which may possibly be amplified when the patient is heroic – and very profitable.

Element of the dilemma is that mental sickness, which influences 1 in 4 Britons, is broad-ranging: it encompasses a whole host of diagnoses from relatively brief episodes of lower mood (which might not need specific intervention, although help from loved ones is beneficial) to the sort of severe enduring mental illnesses this kind of as schizophrenia with which the public is much much more au fait.

Recent healthcare orthodoxy is that psychological sickness, thanks to advances in talking therapies and pharmacology, can be handled or managed. This is all very good information. But probably our optimism goes as well far?

Because the actuality is that medical professionals can not usually intervene and make our individuals much better – or manage their condition – for great.

Actually, we know now that in some circumstances, mental illness can be a recurring illness with episodes – of depression, say – which come and go, irrespective of therapy.

And despite the fact that the public is much far more conscious of psychological illness and a lot more compassionate towards these with it, there really is a great deal much less sympathy for someone who just keeps falling unwell.

It is understandable. If you knew a person who stored breaking the same leg in the very same place, wouldn’t you shed patience with them?

There is a theory that society can be understanding towards the sick as lengthy as the sick play by the guidelines – in other words, if you get assist, you must then get much better. Fail to do that, or fall sick again, and you breach the guidelines, and society starts to turn away.

This is exacerbated in circumstances of workplace tension. “Stress” itself is a nebulous term – is it an sickness, a symptom, a fashionable complaint? It is utilized indiscriminately.

How much worse this perspective is when the perpetual patient transpires to be well-known as well – like an international cricketer. Here, we see a guy who has a life so several of us aspire to (or did).

His inability not to get greater – especially from an illness that is neither defined or noticeable – can appear almost insulting to anybody whose personal life or profession is mundane. Why can’t he try harder?

Yet, possibly we need to be making use of them as an instance for why this variety of unpredictable, difficult to diagnose, recurring metal illness should be regarded as a lot more kindly. Elite athletes are put underneath incredible strain – considerably of it monetary.

They are mindful of possessing devoted thousands of hrs to getting great at a single, often really narrow, skill. If that ought to fail, it is not just a match that could be lost, but an whole occupation. This in turn, piles on a lot more inner nervousness.

Plus – unlike the instructor or physician who will take time off for mental health issues with privacy – sports activities folks are publicly exposed. We all come to feel some type of ownership and the correct to comment.

Thankfully, there are therapies that can assist with performance-associated anxieties, which are useful no matter whether you are an England cricketer or run your own organization.

I’ve discovered straightforward suggestions about work can help: pointing out that you can stroll away from your recent occupation to yet another which may possibly be more satisfying and profitable has been liberating for some anxious individuals.

Usually if a patient feels it is Ok to get a break, that can totally free them from nervousness ample to get back to operate.

Certainly, we are acquiring far better at accepting and comprehending psychological well being troubles – but Jonathan Trott’s case exhibits that there is even now a prolonged way to go before the public can accept imperfection.