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Tory manifesto: more elderly people will have to pay for own social care

More elderly people will have to pay for their own social care in the home and lose universal benefits under a new Conservative policy which, Theresa May will say on Thursday, is difficult but necessary to tackle the crisis in funding.

Introducing the party’s election manifesto, the prime minister will say it is the “responsibility of leaders to be straight with people about the challenges ahead” as she unveils a controversial policy that would reduce the value of estates that many people hope to pass on to their children.

The policy will be a flagship measure in the Tories’ election manifesto, which the prime minister will pitch as a programme for solving some of the challenges facing Britain. It means wealthier people with more than £100,000 in assets will have to pay for their own elderly care out of the value of their homes, rather than relying on the council to cover the costs of visits by care workers.

The Conservatives will attempt to soften the blow by promising that pensioners will not have to sell their homes to pay for their care costs while they or a surviving partner are alive. Instead, products will be available allowing the elderly to pay by extracting equity from their homes, which will be recovered at a later date when they die or sell their residence.

Labour responded to the announcement by saying that people could not trust the Tories’ promises on social care. Barbara Keeley, shadow minister for social care, said: “In their last manifesto, they promised a cap on care costs. But they broke their promise, letting older and vulnerable people down.

“It’s the Tories who have pushed social care into crisis; their cuts to councils have meant £4.6bn axed from social care budgets between 2010 and 2015, leaving 1.2 million people struggling to get by without care. And NHS bosses have recently said that the money the Tories promised them won’t help alleviate the problems.”

To provide a more immediate boost in funding for social care, the government will also end universal winter fuel payments of £100 to £300 a year for pensioners, bringing in a means-tested system instead. The Conservatives declined to say how much they would raise from this, or what limits they would place on who is eligible for the benefits, but the payments currently cost the government around £2bn a year.

The manifesto is set to have a markedly different in tone from Labour’s, which promised a populist programme of mass nationalisation, more spending on the NHS, the abolition of tuition fees and an end to the public sector pay cap.

May billed it as a “declaration of intent: a commitment to get to grips with the great challenges of our time and to take the big, difficult decisions that are right for Britain in the long term”.

“People are rightly sceptical of politicians who claim to have easy answers to deeply complex problems. It is the responsibility of leaders to be straight with people about the challenges ahead and the hard work required to overcome them,” she will say.

Other measures expected to be included in the manifesto are:

A pledge to scrap free school lunches for infants to pay for free
breakfasts for all primary pupils, saving around £650 a year per pupil, which will be used to increase schools funding by about £4bn over the parliament.

Extra charges for businesses that employ workers from overseas and higher charges for foreigners who use the NHS.

A ditching of the triple lock on increasing the state pension, as
signalled by May and other ministers during the campaign.

The care policy is an attempt to meet the cost of looking after the elderly in their homes, which councils across the country are struggling to fund in the face of severe budget cuts. In turn, this has been putting unprecedented pressure on the NHS.

At present, people have to pay for their social care at home if they have wealth of more than £23,500, excluding the value of their residence. Under the new policy, people will have to pay for their social care only if they have wealth of more than £100,000 – but the value of their homes will be included as well. As a result, more homeowners will be liable to pay for the cost of home helps and carers provided by the council.

It is better news for the elderly in residential care, whose homes are already included in calculations of their assets. It means they will now only have to pay for their care until they have remaining assets of £100,000, instead of £23,500. There are no details on when the policy would be implemented, but it is likely that it would require consultation and legislation.

The Conservatives will also say they plan to do more to integrate the NHS and social care, stop unnecessary stays in hospitals, and examine how to make better use of technology to help people live independently for longer. An additional measure to help family carers will be a new right to request unpaid leave from work to look after a relative for up to a year.

May will hope the measures address deep concerns about the long-term costs of funding social care, which have been having a knock-on effect on the NHS as more elderly people stay in hospital.

May said at a press conference on Wednesday that the manifesto would seek to address five major challenges in an echo of social reformer William Beveridge’s five “giant evils”.

The social care announcement is likely to get a mixed reception, as some Conservatives will worry about it going down badly with middle-class voters who want to pass on the value of their homes to their children.

Voter confronts Theresa May over disability benefit cuts – video

May is already under pressure from some on the right of her party over interventionist policies, such as her pledge to cap energy costs for households. Previous attempts to reform the funding of social care have met with deep hostility from the rightwing press, who branded Labour proposals for a levy on estates a “death tax”.

Her decision to include a measure that could be unpopular with middle-aged and elderly voters is likely to be taken as a sign of confidence in winning the election, given the Tories’ double-digit lead in the polls over Labour. Strategists also hope it will paint the prime minister as a realist and pragmatist in contrast to Labour’s manifesto promising more spending on public services paid for by higher taxes on companies and high earners.

Other measures in the manifesto are likely to include proposals on improving skills and apprenticeships, and a promised expansion of workers’ rights, which Labour has dismissed as spin.

The document is also likely to retain the Conservative commitment to bringing down immigration to the tens of thousands from hundreds of thousands. That approach was challenged on Wednesday by a leader in the Evening Standard newspaper, edited by the former chancellor George Osborne, which claimed that no senior cabinet ministers support May’s desire to keep the target.

In a leader column, the newspaper said there had been an assumption at the top of the Conservative party that May would use the election to “bury the pledge” made by David Cameron before he was elected in 2010 because it was unachievable and undesirable. “That’s what her cabinet assumed; none of its senior members supports the pledge in private and all would be glad to see the back of something that has caused the Conservative party such public grief,” the newspaper said.

Editorials are written anonymously as the voice of the newspaper, but Osborne tweeted a link to the column and the front page of the Evening Standard, which attributes a squeeze in the cost of living to inflation caused by Brexit.

Air pollution kills more people in the UK than in Sweden, US and Mexico

People in the UK are 64 times as likely to die of air pollution as those in Sweden and twice as likely as those in the US, figures from the World Health Organisation reveal.

Britain, which has a mortality rate for air pollution of 25.7 for every 100,000 people, was also beaten by Brazil and Mexico – and it trailed far behind Sweden, the cleanest nation in the EU, with a rate of 0.4.

The US rate was 12.1 for every 100,000, Brazil’s was 15.8 and Mexico’s was 23.5, while Argentina was at 24.6.

The figures are revealed in the WHO World Health Statistics 2017 report, published on Wednesday, which says substantially reducing the number of deaths globally from air pollution is a key target.

The report reveals outdoor air pollution caused an estimated 3 million deaths worldwide, most of these in low- and middle-income countries.

Wealthy European nations had high levels of air pollution from fine particulate matter. The UK had an average of 12.4 micrograms of fine particulate pollutants (PM 2.5) for each cubic metre of air, which includes pollution from traffic, industry, oil and wood burning and power plants in urban areas. This is higher than the pollutant levels of 5.9 in Sweden, 9.9 in Spain and 12.6 in France. Germany had higher levels of particulate pollution than the UK at 14.4 and Poland’s was 25.4.

Dr Penny Woods, chief executive of the British Lung Foundation, said the report confirmed that deaths from air pollution were higher in the UK than many other comparable countries.

She said: “It is deeply tragic that around 3 million lives are cut short worldwide because the air we breathe is dirty and polluted. In the UK, air pollution is a public health crisis hitting our most vulnerable the hardest – our children, people with a lung condition and the elderly.

“Yet, we are in the fortunate position of having the technology and resources to fix this problem. It’s time to use what we have to sort this problem out as a matter of urgency and clean up our filthy, poisonous air. The next government needs to bring in a new Clean Air Act to protect the nation’s lung health.”

The worst countries for toxic air included India, where 133.7 deaths for every 100,000 people are attributed to air pollution, and Myanmar, where the rate was 230.6 deaths.

WHO said: “Outdoor air pollution is a major environmental health problem affecting everyone in developed and developing countries alike.

“Some 72% of outdoor air pollution-related premature deaths were due to ischaemic heart disease and strokes, while 14% of deaths were due to chronic obstructive pulmonary disease or acute lower respiratory infections, and 14% of deaths were due to lung cancer.”

The World Health Organisation said it was up to national and international policymakers to tackle the toxic air crisis

“Most sources of outdoor air pollution are well beyond the control of individuals and demand action by cities, as well as national and international policymakers in sectors like transport, energy, waste management, buildings and agriculture,” the WHO said recently.

Universities must do more to tackle use of smart drugs, say experts

Universities must do more to tackle the growing number of students turning to “smart drugs” to cope with exam stress, leading academics have said.

UK institutions are being called on to consider measures such as drug testing to stem the rise of cognitive enhancement drugs being used by young people to improve their academic performance.

As hundreds of thousands of students across the UK prepare to sit their summer exams in coming weeks, Thomas Lancaster, an associate dean at Staffordshire University, said we were entering a “dangerous world” where students have access to the “study drugs”. He called on universities to have “frank discussions” with students and to develop policies around their use.

“Universities need to seriously consider how to react to the influx of smart drugs on campus. Educating students about smart drugs and seeing if they view this as cheating is important here. If the trend continues, universities may need to think about drug testing to ensure the integrity of the examination process,” Lancaster said.

Smart drugs, also known as nootropics, are a group of prescription drugs used to improve concentration, memory and mental stamina during periods of study. The most commonly used ones are Modafinil, Ritalin and Adderall. These substances are normally used to treat disorders such as narcolepsy and attention deficit hyperactivity disorder.

Larissa Maier, a research associate at the University of Zurich, called for more education about the risks associated with the substances. Her concerns were echoed by Prof Tim Hales, the head of neuroscience at Dundee University. He said: “In the short term some of these drugs may not be harmful, but we don’t know about their potentially harmful cumulative effects. Different students will respond differently, particularly when taking other medications, alcohol or recreational drugs at the same time.”

The growth of smart drugs over the past five years has been well documented, especially in top institutions such as Oxford University. In May 2016 the Oxford student newspaper, the Cherwell, published a survey that showed 15.6% of students knowingly took Modafinil or another such drug without prescription.

Oxford has introduced workshops to educate young people about smart drugs.

A recent European study co-authored by Robert Dempsey, a lecturer in psychology at Staffordshire University, found that the majority of university students believe it is normal to use such drugs to enhance academic performance.

Maier said current estimates indicate about 10% to 15% of students have tried to enhance their cognitive performance with prescription drugs, alcohol or illegal drugs at least once. With a UK student population of 2.3 million, this works out at about 230,000 people.

Students at Oxford


Students at Oxford. Photograph: Pete Lusabia/Alamy Stock Photo

Oxford University said it had not seen evidence of a widespread problem, but added that students were strongly advised not to take any unprescribed drugs. “Students who are struggling to cope personally or academically will find a range of support at Oxford. They should talk to their tutors, their college welfare officers, Oxford University Student Union, their GP, or the university counselling service.”

The health risks that the drugs could pose are still unclear, but using them without a prescription is illegal and can lead to unwanted side-effects, such as increased anxiety and heart rate.

Maier said the number of students using the drugs could increase due to increased availability both at universities and online.

Dr Dominique Thompson, the director of the students’ health service at Bristol University, said she sees a handful of students a year who come in suffering the side-effects of the medications, such as insomnia. She put the rise in use down to increased competition and pressure on young people.

Thompson said: “There is a huge pressure to do well and excel and be different to everyone else as well as financial pressure now. That may be another factor as to why students feel they need to use any means to do well.”

The Guardian heard from several students who claimed to have faked ADHD symptoms in order to be prescribed Ritalin or Adderall. One student, from UCL, said: “I obtained the drugs from a friend who wanted Ritalin to use as a smart drug. She memorised the symptoms of attention deficit hyperactivity disorder and convinced a GP to prescribe it.”

Non-prescription sale of Noopept, a fine white powder that its makers claim enhances cognitive ability, was banned in the UK last year under the Psychoactive Substances Act. However, several British websites appear to be actively selling this substance.

Modup, a website selling Modafinil, told the Guardian that during exam time the volume of Modafinil shipped to the UK doubles. It claimed the campuses it mainly sent stock to were Oxford and Cambridge, followed by the London institutions Imperial and the London School of Economics.

One second-year student from Cambridge University, who asked to remain anonymous, said: “I know quite a few people who have used study drugs, including several of my housemates and friends. They all tend to take Modafinil rather than either Ritalin or Adderall … given the sheer volume and quality of work expected of people here, I would be unsurprised if my college is representative of the university as a whole.”

Another student from Leeds said they had been taking Modafinil or some variant for essays and exams since the middle of second year. “My own work rate has always been fairly pathetic without it so it’s been vital for me in completing my dissertation and other big projects at uni. I do know people who work very hard anyway, but take it for the non-stop work they have to do for degrees like medicine.”

Universities do not appear to have a plan in place for tackling the problem. Dr Cathy Montgomery, a reader in psychopharmacology at Liverpool John Moores University, said: “Many universities don’t have specific policies regarding use of cognitive enhancers as this is a new area. Most universities do, however, have a drug policy, stating that the use of drugs is prohibited on campus, but this does not necessarily extend to medicines.”

But she said that before policies were put in place, more research should be done: “We need a large-scale epidemiological study looking at use of enhancers across the UK.”

Neal Patel, a spokesman for the Royal Pharmaceutical Society, said: “Unfortunately, prescription-only medicines are available to just about anyone with some spare cash willing to buy them from unscrupulous online providers. You may or may not get what you pay for.

“Unrealistic expectations of the benefits of these powerful medicines, coupled with peer pressure to use them, is an unhealthy mix for students. Our advice remains for people to steer clear of prescription medicines unless they are being prescribed under the supervision of a health professional.”

More than a quarter of young adults in the UK do not drink alcohol – in data

Young adults in the UK are more likely to be teetotallers than their older counterparts, according to figures released this week. More than a quarter of 16- to 24-year-olds do not drink, compared with just over a fifth of the broader adult population.

Last year, just under 21% of people surveyed in England, Scotland and Wales said they did not drink alcohol, equivalent to around 10.6 million adults aged 16 or over. That’s two percentage points higher than in 2005, when the ONS first collected data on alcohol consumption.

But the proportion of 16- to 24-year-olds who say they do not drink has accelerated at almost four times that pace. Ten years ago, 19% of young adults said they did not drink alcohol, compared with 27% last year.

Conversely, teetotalism among those aged 65 and over is falling: in 2005, almost 30% of people in that age category said they did not drink; last year, it was 25%.

But while people in the youngest age group (16-24) are increasingly likely to be teetotal, drinkers in this age category were also more likely to binge drink – defined as men who exceed eight units of alcohol on their heaviest drinking day, and women who exceed six units.

When teetotallers are excluded, women aged between 16 and 24 were more likely than any other group to have binged in the week prior to the survey: 41% admitting to doing so, compared with 34% of men of the same age.

More generally, the proportion of adults who say they drink alcohol is at its lowest level since 2005. In 2016, just under 57% of Britons surveyed said they had drunk alcohol in the previous week, compared to almost two thirds (64.2%) in 2005.

In its commentary, the ONS noted that drinking behaviour is likely to be impacted by characteristics such as culture and ethnicity: the wider survey found that teetotalism is lower among white respondents (15.7%) than all other ethnic groups (56%).

alcohol use in the UK – in data

Ona Gritz: ‘I had spent more than enough time hiding and pretending’

There are ways to cover for the fact that you can’t run like the other kids, or skate, or climb fences, or ride your flowered banana seat bike without training wheels. My own strategy was to suggest alternatives, offering to bring out a board game, colouring books and crayons, or my brand new, unopened jigsaw puzzle with the picture of a farm scene on its box. If my friends countered by asking to play hopscotch, a game that would require each of us to stand first on one foot, which I could do fine, then on the other, which I couldn’t do at all, I’d act like the idea was too dull to consider. If they suggested we play cards, I’d say yes, but reluctantly, willing someone else to insist on shuffling since it takes two good hands to bend and riffle each half of the deck. More often I told them, truthfully, that I’d rather grab our dolls and play house or store or any other game of pretend.

Pretending, after all, was the thing I was best at. It was the magic that allowed me to inhabit any capable, agile, graceful body I chose.

In our crowded box of curled family photos there is only one picture that includes the leg brace I was made to wear because of my cerebral palsy, though even here it is barely visible. A slight bulge beneath the fabric of my pants, a hint of metal peeking from the hem, the single angled strap that attached it to my shoe. I’m three years old in the photo, the same age I was the first time I held it in my hand. “Oh,” I said. I’d seen posters for the March of Dimes with images of children leaning on crutches or sitting in wheelchairs, and now I saw that I was like them in some way. This struck me as nothing more than an ordinary fact. “Oh.”

Shortly after that picture was taken, my doctor decided I only needed to wear the brace in bed at night. Daytimes, it lived in the back of my closet, tucked in a brown paper grocery sack. My mother allowed me to leave it home whenever I slept at a friend’s house, or in its hiding place when a friend slept at mine. Maybe this was how I got the idea that my cerebral palsy could and should be kept secret. This, coupled with the fact that my father never mentioned it, and that my mother, when she did discuss it, said, “It’s nothing, hardly noticeable”, dismissively waving her hand. To me, my body was simply my body, the only one I’d known, and so I thought the brace was my disability. As long as I kept it out of sight, I fitted in with my friends.

“Let’s pretend we walk like people who limp,” Lisa Lowenstein suggested one muggy afternoon in our sixth summer. She slid off the stoop and began hobbling in a circle, and though the game made me uneasy, I got up and did my best to imitate her awkward moves.

Lisa paused to observe me. “Just walk like you always do,” she advised. “You walk like people who limp.”

“Oh,” I said, just as I had when I first saw the photo where I’m wearing my brace. Only this time my throat tightened around the word.

In middle school, I found it helped to carry novels in my backpack. That way, if my friends decided to pay handball at the park or zip around the neighbourhood on their 10 speeds, I could pull out my book and say, “I’m too caught up in this right now”, which, soon enough, would be true.

I also got good at finding the girls who were happy to sit inside, listening to records, and the few left who, like me, were slow to give up Barbies and other daydreaming kinds of games.

Ona, aged three, with the leg brace she had to wear.
Ona, aged three, with the leg brace she had to wear.

“What do you want to do?” Jody might ask me.

“I don’t know. You?”

“I don’t know.”

“Rock star wives?” one of us would finally ask, sighing like it was a last resort.

“I guess.”

After that we’d play for hours, immersed in the elaborate stories we created for Elton, Paul and beautiful grownup versions of ourselves.

Still, the next time Jody and I got together, whoever asked would be tentative about it, afraid the other would be the first to outgrow the game.

By high school, pretend games were no longer an option, unless you count pretending to have my period so I could sit on the sidelines in gym class. Or claiming to be too behind in homework to join my friends at the ice rink. Or acting as though my dislike of disco was the only reason I stood pressed against the wall at dances while the other girls mastered those perfectly synchronised steps.

“Why don’t we go to the movies?” I was always the one to suggest. There, in the comforting darkness, all I had to do was sit perfectly still, along with everyone around me. Row by row by row, we imagined together, lost in the drama of fictitious lives. The movies offered a means of playing pretend that was still sanctioned, a way to be social that asked nothing of my faulty limbs.

For college I chose a small, artsy school where the only team sport offered was Ultimate Frisbee and there were signs posted on the bulletin boards throughout campus that proclaimed It’s Okay to be Gay. I extrapolated from this that here, in this heady oasis, it was OK to be different. Among my classmates were girls with unshaven legs, boys who wore lipstick, kids of both genders with spiky magenta hair and splatters of safety pins on their clothes. Still, while I admired these outliers for their boldness and originality, I hid my uneven legs under long gauzy skirts in my usual attempt to blend in.

If my new classmates noticed my limp, or my childhood friends had seen through my excuses, they were kind enough not to say so. This allowed me to believe my own fabrications. I see it now as a wilful and instantaneous form of amnesia. As soon as I succeeded in avoiding a physical challenge or a potentially embarrassing moment, the memory, along with any thoughts about my disability, dispersed.

The young Ona: ‘If my new classmates noticed my limp, they were kind enough not to say so’


The young Ona: ‘If my new classmates noticed my limp, they were kind enough not to say so.’ Photograph: Leonard Gritz

Even so, as I settled in at college, an unnamed tension left me. I now lived in a place where I could curl up with my books hour after hour, not because my friends were off having adventures I couldn’t keep up with, but because this was the adventure. I majored in literature and had plans to become a writer. As I read and honed my craft, it felt as though the body, my body, with its limits and awkwardness, was the least of who I was. Finally, I could live the life of the mind. How perfect was that? Except, of course, it was only part of the story.

One afternoon in the campus library, I highlighted this line in my slim paperback copy of Virginia Woolf’s A Room of One’s Own:

“Women have served all these centuries as looking glasses possessing the magic and delicious power of reflecting the figure of man at twice its natural size.”

I marked the sentence, having brushed past and already forgotten this, from earlier in the same chapter, about the fact that so many men have written books about women:

“…it was flattering, vaguely, to feel oneself the object of such attention provided that it was not entirely bestowed by the crippled and the infirm…”

Had I, a 19-year-old crippled girl, flinched when I read this? Had it stung? I don’t know. I’d forgotten those words existed, and only discovered them now, decades later, while searching for the looking glass quote that has stayed with me all this time. This was precisely how my self-protective amnesia worked. Virginia Woolf devalued people like me in a chapter about the importance of confidence? But I loved Virginia Woolf, so the insult quietly left through some back door in my mind.

Ona at home


Ona at home: ‘A poetry workshop, I sat beside a man named Dan.’ Photograph: Gene Smirnov for the Observer

What did interest me that afternoon was the metaphor of the mirror, and the idea that men used us to build themselves up. I’d recently joined a feminist consciousness-raising group, and had begun insisting, sometimes petulantly, that I be referred to as a woman rather than a girl. When I marked Woolf’s words it was because they struck me as poetic and true. What I couldn’t yet see was that I had begun to use men similarly, not to reflect me at twice my natural size but as attractive enough. As OK.

This is where my college life wasn’t all disembodied intellect. I had also begun seeking validation through sex.

Here is another truth. I wasn’t at all beyond the prejudices expressed in Woolf’s forgotten passage. The young men I pursued had to be not just smart, creative and interesting, but handsome too. It went without saying that they were also able-bodied. Everyone I knew was able-bodied. There may have been a handful of other students with disabilities on campus, but I paid them no mind.

I chose men for the wrong reasons and, in turn, none of them chose me for anything more than an occasional intimate night. Then, when I was 25, I met Richard. He was athletic and handsome in the way of the popular boys who were completely out of my league in high school. The two of us had very little in common. Richard’s passions included skiing and mountain biking, and though I could never join him on either terrain, he was passionate about me too.

Richard was earnest, playful and affectionate. He was also hot-tempered and impossible to please. Nonetheless, I invited him to move into my apartment. Soon after, we got engaged. All the while, my friends looked on warily.

One friend told me she had always imagined that the man I’d wind up with would be someone she found amazing.

“Someone smart and really kind. The type of guy I’d love for myself, only I’d be so happy for you I wouldn’t be jealous.”

She watched me carefully and I realised that her comment had not just one subtext, but two. First, and most obvious, Richard, who was more conventional and less intellectual than my previous love interests, didn’t meet her expectations. Worse, it seemed she’d always believed that only someone amazing and really kind could possibly choose me. What hung in the air, unspoken between us, was the reason she thought it would take such a remarkable person to love me. I was defective. This made me cling to my handsome boyfriend all the more.

One weekend, while Richard was off mountain biking with friends, I decided to spend an afternoon in the city. After a movie and lunch at a cafe, I found myself following a strange woman down a winding street.

Is that what I look like? I wondered, carefully studying her from a distance. She’s pretty enough, but how much does her limp detract from that?

Over the following weeks and months, for the better part of a year, I kept an eye out for women with physical disabilities. When I found them, I trailed them. For a while, my curiosity remained on the surface. Could women who moved like me still be considered attractive? Did I find them so? But as I continued my stalkerish experiment, something shifted. I began to want to know about their lives.

The best way I knew to process this, as with most issues I grappled with, was through writing. Alone at my desk, I entered into a kind of dialogue with these strangers I was too reticent to approach in person. I did this by writing a poem in the voice of a nonverbal quadriplegic woman who was in the news at the time.

By now I had completed an MFA in creative writing and had found my place in a community of poets. One winter afternoon, I ran into an acquaintance who invited me to take part in a poetry reading and panel discussion for Women’s History Month. Each participant would be from a different cultural background, she explained. She’d already lined up an African American poet, a Latina poet, and she wanted me there to represent disability. My initial response was to take a step back when she said this. But then I felt a stirring of interest.

“I’ll be there,” I heard myself say.

I had the persona poem, and one about my mother helping me on with my nightbrace, and a third, titled What the Mirror Knows, that used my partial disability as a symbol for other ways I felt divided. At the reading, I surrounded these pieces with poems that made no mention of disability and that, to my mind, proved I led a perfectly normal and interesting life.

The panel discussion ended with questions and comments from the audience. There was one woman, seated a few rows back, whose insights caught my attention. She referred to writers I loved, and made connections that surprised and intrigued me. Afterwards, as I was gathering my things, I looked up to find her waiting to talk to me.

“I really liked your poems.”

“Thanks. I liked hearing what you had to say.”

We smiled shyly at each other. “Well,” she said, “I should probably use the bathroom before I head home.”

It wasn’t until the woman, who had introduced herself to me as Hope, started to walk away that I noticed her palsied gait. What could I do but follow her into the restroom?

Cerebral palsy is caused by damage, most often at birth, to a part of the brain that controls motor skills. There are various forms, and it affects people to widely differing degrees. Many don’t have enough balance to walk or need crutches to do so. Some have uncontrollable tremors. Some are intellectually disabled, while others are assumed to be because their facial muscles are affected and their speech is unclear.

Hope and I both have relatively mild cases and forms of the disability that affect only half our bodies. She has diplegia, which means the palsy is just in her legs. I have hemiplegia, which means the split is vertical. The muscles of my right limbs are tight and underdeveloped, and the fingers of that hand lack the dexterity, tactile sensitivity and fine motor skills of those on the left.

“It’s lucky she’s left-handed,” a doctor once told my parents during a consultation, “since she’ll always have to depend on that side.” I was nine at the time, old enough to resent being spoken about in the third person, and also to see the flaw in his logic. Maybe I was born left-handed, maybe not. The body learns to compensate, just like the mind.

Years later, I read an article suggesting that right hemiplegics are likely to be more creative and less practical than our counterparts whose disability is manifested on the left. The hypothesis is based on left /right brain differences. Left hemiplegics have undamaged left hemispheres, which is where pragmatism lives. Meanwhile, we right hemiplegics need to rely on our intact arty and imaginative right hemispheres.

The theory appealed to me. It fitted me so well. But then, just as I understood at nine years old, when it comes to cause and effect it’s hard to assess the true order. Certainly, my cerebral palsy and my drifty, daydreaming ways are connected. But to what extent is this due to the physical brain as opposed to the simple desire to escape the confines of a limited and disappointing body by imagining it away?

Hope and I spent several hours in a coffee shop that late afternoon, commiserating about what it felt like for each of us to be the one kid on the block who couldn’t run, climb fences, or ride a bike without training wheels. I learned I wasn’t the only one who coped by making excuses, hiding behind books, and living too much in my head. This was the first time either of us had ever spoken about these experiences. It was also the first time that I could remember when I wasn’t expending effort and energy to pretend my cerebral palsy didn’t exist.

While Hope took the fuel of our connection and almost immediately got involved in disability activism, I went home to Richard and my belief that his love for me meant that my cerebral palsy was, as my mother had assured me all those years ago, nothing, hardly noticeable.

A few months later, Richard and I married. With Hope now in my life, I had a growing consciousness about disability that came close to acceptance, but it was a place I visited, not yet one where I lived. More real to me was my marriage licence, which I saw as a kind of passport. It proved that where I really belonged was in the enviable world of the unscathed.

Something I had wanted since I was a child trying to coax my friends away from their games of hopscotch and tag to play house with me was to one day be a mother. Six years into our marriage, Richard and I agreed the time was right.

Through my pregnancy, my midwife never once mentioned my cerebral palsy, so neither did I. She did suggest a number of tests to rule out potential birth defects. Always I declined, feeling vaguely insulted, though I couldn’t have said why.


The daily and very physical tasks of caring for a baby forced me to recognise my disability for what it actually was

Our son Ethan was perfect: seven-and-a-half pounds, 14 inches, with active limbs, the right amount of digits, and a hearty cry. For the first hours after his birth, Richard and I sat together in the hospital room and stared at him in wonder. Eventually, a nurse came in to help me with breastfeeding.

“You need to lift your elbow so his head sits a little higher. Not working? How about we try the other side? Can you shift him so he’s in a better position? Let me show you something called the football hold…”

Nothing we tried worked so she brought in another nurse and then a third. They piled cushions around us until I could finally hold Ethan at the right angle and height.

“There we go,” the nurses said once he began to suckle.

“Problem solved,” Richard put in.

This tiny new person nuzzling at my breast depended on me. Yet, somehow, as I’d drifted through my pregnancy, daydreaming as usual, it had never occurred to me that I wouldn’t be able to meet his needs. Now, as I touched his cheek with the one hand that could really feel him, I understood that I didn’t have the balance or coordination to be this fragile, trusting person’s mom. I may have learned early in life to cover for being unable to run, skate or climb fences, but there would be no covering for being unable to safely bathe a newborn, carry him on stairs, or walk any distance while he flailed in my arms.

From that moment on, the daily and very physical tasks of caring for a baby forced me to recognise my disability for what it actually was. A set of very real and specific limitations I had to either work with or around. There were constant puzzles to solve, along the lines of, I’ve arrived home with a baby and a bag of groceries in his carriage and now I find that the one elevator in our apartment building has broken down. What do I do? Often the only answer was to ask for help from a neighbour. The first few times I did so, I stammered and felt myself flush. Then one day I simply stopped feeling apologetic. So, I had a disability. It was what it was.

Meanwhile, Ethan had begun reaching his perfect pudgy little arms towards me the moment we were together in a room. His absolute acceptance, despite my funny walk and clumsy touch, struck me as both lovely and familiar. It reminded me of my three-year-old self, noticing my brace in a photo without judgment.

It’s tempting to end the story here with the happy ending of a renewed self-acceptance. I would, except it gets even better.

It’s neither a surprise nor a tragedy that my marriage to Richard ended when Ethan was still small. Richard remains active in Ethan’s life and the divorce proved to be the best choice for us all.

One holiday weekend, when Ethan was eight, he stayed at Richard’s while I went to a writers’ retreat. There, in a poetry workshop, I sat beside a man named Dan, who had a soft-spoken gentle manner and, I could tell from his responses to poems, an incisive mind. When he brought out his own poem to be critiqued, I liked him even more. His piece had rhythm, wit and heart. This was definitely someone I wanted to know.

I watched him read and take notes by tapping on a braille laptop, his guide dog sprawled at his feet. After the workshop ended we stayed in our seats an extra few minutes talking, then he slipped his hand into the crook of my elbow, and we strolled together to the next event. I wondered if he noticed the lilt in my walk, and actually hoped he did. I wanted Dan to know that, along with poetry, disability was something we shared.

A week later, Dan called me and we stayed on the phone for four hours. In many ways, it was like my first conversation with Hope in the coffee shop. We were so happy to share our stories with each other, and while, in this case, the details of our disabilities bore no resemblance, when I talked about the long and circuitous road I took to making peace with mine, he let me know he’d been there too.

Still, I thought about how, as a young woman, I’d considered my disability a cosmetic flaw, akin to having a bad complexion or being a bit overweight. My concern had been whether people noticed. Now, it occurred to me what an indulgence that was. Born blind, Dan never had the luxury to pretend.

When we met, Dan and I lived a hundred miles apart. This meant we only got to be together on weekends. The rest of the week, we talked on the phone, building our relationship on a foundation of ideas and conversation. From the start, I was captivated by how smart he was, and by how intently he listened. Of course Dan listens well. Hearing is the sense he relies on the most. But I’d never met a man who did so with such presence and interest, and somehow I knew that this had more to do with who he was and what he valued than with the fact that he was blind.

Long before Dan and I got to know each other, he’d begun to write beautifully and candidly about his life as a blind man. He also had a community of friends who were writers and artists with disabilities. I wanted in, and they embraced me without hesitation. Soon, I began to seriously take on disability as a subject in my work. It felt scary at first, a little like pulling my childhood brace out of the closet and putting it on display. But I had spent more than enough time hiding and pretending. I wrote as truthfully as I could about how it felt to live in my particular body, which allowed me to see how universal my experiences actually were.

Dan and I were married on a bright, breezy day in June. Hope slept on our couch on the nights bracketing our wedding day. Ethan stood with us at the altar, holding my palsied hand.

We have been together for 12 years now. The work we do includes disability awareness presentations, literary readings and panel discussions about disability poetics. During one such event at a large poetry festival, a member of the audience, a man with a visibly awkward gait, took the microphone during the Q&A portion and asked in a shaky voice, “How did you learn to like yourselves?”

There were four of us up on the stage and for a long moment we were silent, touched by the vulnerability in the question. I thought of Hope who’d approached me after hearing my first tentative poems about disability. I thought of Dan and our community of disabled friends, including those with us up on that stage. It struck me that, in some way, we were each a pleasing and accurate mirror for the others.

“Do you like us?” I asked.

The man nodded.

“Well, that’s a start.”

Ona Gritz is the author, most recently, of On the Whole: A Story of Mothering and Disability (Shebooks, 2014) and the poetry collection Geode, which was a finalist for the 2013 Main Street Rag poetry book award. Her essay, It’s Time, which appears in the Rumpus, was named a Notable Essay in Best American Essays, 2016

Neglected no more: ending trachoma, an infectious eye disease rooted in poverty

In proportion to their collective contribution to human suffering, neglected tropical diseases (NTDs) have received insufficient attention. Today, thanks to incremental progress in the science of public health, growing programmatic experience and commitment from endemic country governments, donors and other partners, we are better equipped than ever before to recognise, prevent, control, eliminate and eradicate them.

Trachoma is one of many NTDs that are rooted in poverty. It is an infectious disease of the eye caused by a bacterium, and marked in its early stages by inflammation of the inner surface of the eyelid. Infection is spread by the transfer of discharges from the eyes or nose of an infected person.

More severe manifestations, such as trichiasis, typically occur in adulthood after multiple untreated infections. Trichiasis is present when turned-in eyelashes scratch the eyeball – a debilitatingly painful condition that may lead to progressive and irreversible visual impairment.

At present, about 0.45 million people are blind and 1.4 million people are severely visually impaired as a result of trachoma. Very basic interventions – simple eyelid surgery, the antibiotic azithromycin to clear infection and facial cleanliness, water and sanitation – can significantly reduce the impact of the disease. These interventions (surgery, antibiotics, facial cleanliness, environmental improvement) are represented by the acronym Safe: the strategy recommended by the World Health Organisation (WHO) to eliminate trachoma as a public health problem globally by 2020.

Morocco succeeds with Safe

Morocco adopted Safe in the early 1990s, becoming the first country to implement the strategy at national scale and one of the first to benefit from Pfizer’s now long-running donation of azithromycin to trachoma elimination programmes.

In November 2016, Morocco was validated by the WHO as having eliminated trachoma as a public health problem, joining Oman and Mexico as the only countries documented to date as having beaten the disease. Other countries have made similar progress, and further official validations are likely to follow later in 2017.

Azithromycin being used to treat trachoma in Morocco, 2016


Azithromycin being used to treat trachoma in Morocco, 2016 Photograph: Dr Jaouad Hammou/Ministère de la Santé, Maroc

Mapping trachoma

Trachoma’s natural home is among populations who live furthest from services, and so, until recently, data on where to intervene were grossly incomplete. The Global Trachoma Mapping Project (GTMP) sought to remedy this with surveys covering more than 1,500 districts in 29 countries. The project was completed in just over three years – running from December 2012 to January 2016 – and involved the training and deployment of more than 600 field teams, who collectively examined more than 2.6 million people. Its successful implementation now provides health ministries with the information they need to plan interventions, where required, for worldwide trachoma elimination.

Visionary backing

The success of the mapping project is attributable to a number of factors. First, it had financial backing from the UK’s Department for International Development and the United States Agency for International Development. Second, in each of the countries in which the GTMP operated, it benefited from high-level political commitment and strong health ministry leadership. Third, a worldwide partnership of NGOs and academic institutions, spearheaded by Sightsavers, the International Trachoma Initiative and the London School of Hygiene and Tropical Medicine, fostered synergies rather than inter-organisational competition. Fourth, the mapping project was held to strict quality standards, despite operating in some of the most difficult environments in the world. And fifth, the mapping was innovative in its use of technology, which kindled the interest of partners on all sides.

A surgeon operates on a young boy with trachoma in Nigeria.


A surgeon operates on a young boy with trachoma in Nigeria. Photograph: Graeme Robertson/the Guardian

Field teams collected all data into a purpose-built app running on Android smartphones. Those data, including geospatial information, were uploaded to a secure cloud-based server as soon as the phones were within range of a suitable network. Raw data were then cleaned, reviewed by the health ministry, and once approved, automatically displayed on the online Trachoma Atlas. This system was far more rapid and reliable than previous paper-based survey tools – and saved approximately 4.2m sheets of paper.

Work is ramping up in the 42 countries where trachoma remains a public health problem. In the next few years, with continued political support, collaboration and donor investment, we will finally be able to write the closing chapters in the long history of this devastating disease.

Victor Florea is an intern and Anthony Solomon is a medical officer for trachoma in the Department of Control of Neglected Tropical Diseases, World Health Organisation.

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Smokers and obese patients face more curbs on NHS surgery

NHS bosses are planning a massive expansion of the controversial rationing that forces smokers and obese patients to wait months in pain before they can have surgery, a leaked letter reveals.

The move will see local NHS bodies across England implement restrictions on access to treatment that will hit what doctors’ leaders believe will be tens of thousands of patients.

The plan is disclosed in a letter sent on 15 March by Dr David Black, NHS England’s medical director for Yorkshire and the Humber, to Rotherham Clinical Commissioning Group (CCG). In it, he praises the GP-led group that controls the NHS budget for treating the town’s residents for introducing what critics call “lifestyle rationing”, which compels dangerously overweight patients or those who smoke to wait for hip or knee surgery. “We are very supportive of your work to best manage resources for the benefit of all patients and understand that this may mean that difficult decisions need to be made,” Black wrote.

And he added: “We expect that many CCGs will be in the process of developing similar schemes and initiatives to deliver plans for 2017-19. This is something we would encourage, where plans are well developed and clinically validated.” He then told the CCG to give him four weeks’ warning of any further plans “to change access thresholds” so that NHS England can prepare for the fallout.

The move has triggered a storm of protest, with ex-health minister Norman Lamb warning that condemning patients to long, painful delays for care is destroying the NHS’s fundamental principles and obliging those affected to pay for private treatment.

“This is yet more evidence of the creeping advance of rationing. Guidance based purely on medical judgment on weight loss is fine, but what is happening around the country goes well beyond that in practice. It will inevitably result in those people with money paying for speedy treatment, while everyone else is left waiting,” said Lamb, who is the Liberal Democrats’ health spokesman.

“We are seeing, bit by bit, the destruction of the solidarity that this country has been so proud of with the NHS – the idea that whatever your income or wealth, you get access to the care you need, in your hour of need,” he added.

Labour claimed that underfunding of the NHS lay behind the extension of rationing. “This secret memo from NHS chiefs reveals the truth of what’s happening to the NHS under the Tories – more and more rationing of treatments. People will be waiting longer and longer in pain and discomfort for surgery such as hip and knee replacements,” said Jonathan Ashworth, the shadow health secretary. “There is now a very clear choice in this election. Cuts, longer waiting times and restrictions on treatment under the Tories, or Labour, who will return our NHS to its founding principle of universal provision, free at the point of need, with best quality of care for all,” he added.

As many as one in five patients awaiting a hip or knee operation ends up being denied surgery for months after such schemes are introduced, it emerged last week. Seventy-nine out of 408 patients needing a knee replacement in Scarborough and Ryedale, and also in Yorkshire, have not been referred to hospital for the procedure since the CCG brought in that policy last November. The 79 have been told to lose weight or stop smoking during the delay – which the CCG calls “a six-month period of health optimisation” – before they have their surgery.

The figures, uncovered by the Yorkshire Post, led the Royal College of Surgeons to claim that “it is disgraceful that one in five patients is having … surgery delayed for at least six months based on what are, frankly, arbitrary criteria.”

Ian Eardley, the college’s vice-president, told the Observer: “It is deeply concerning that one in five patients are now being denied immediate surgery because they smoke or are deemed obese. There is no medical evidence to justify restricting referrals for entire groups of patients; it is effectively a form of discrimination. These figures are just the tip of the iceberg as we know that over a third of commissioning bodies are pursuing similar policies, meaning tens of thousands of patients across the country are facing restrictions on their surgery.”

Patients denied hip or knee surgery can end up in severe pain or have trouble walking, “making it near impossible for them to lose the required weight to allow them to access surgery in the future. Patients need all of the support they can get to lose weight or to stop smoking, but removing their rights to timely NHS surgical care will obviously not achieve this,” he added. Eardley called on all political parties to make it clear during the election campaign that they do not think the NHS should impose such restrictions on those who are obese or who smoke.

Prince Harry, mental health and the need for a more caring society | Letters

In my view, those who try to come up with totalising explanations of mental health are misguided (Letters, 20 April). It’s neither purely social nor purely individualistic, though effective help should start from actually listening to and honouring the individual case. Often in practice it does not, and I would agree with Professor Read that a biogenetic medical model is generally inappropriate and can actually be damaging. It also goes radically unacknowledged that there are various different types of bereavement, some of which are far more traumatic than others, and are not directly comparable. The effects of traumatic sudden bereavement experienced in childhood or adolescence can last for years and ultimately for a lifetime, as the princes have now highlighted. It is known that this type of bereavement can sometimes result in lasting shock followed by delayed grief years later, yet there is often little or no acknowledgment readily available, never mind any effective support.

On top of this, and especially in a culture of competition, the bereaved are often subjected to cutting comments, judgments and dismissals. Sometimes these are from those who claim to know what it’s like because their grandparent or cat has died, while sometimes they are from people in medical or authority positions whose callous judgmental ignorance can be devastating. Why does it require the intervention of princes to highlight the issue? At least they get taken seriously.
LE Collier
Cheltenham, Gloucestershire

It seems to me that a potential key to improving psychological provision for common human grief and misery (Freud’s term) is not only more better-trained, organised professionals, but also a more compassionate and empathic caring society attuned to the emotional needs of others. Where many families are so economically impoverished, they barely have the inner resources, strength and resilience left to attend to each other’s mental pain and suffering. What chance this election gives us all an opportunity to change our minds about the material hardship and distress we are causing those most in need of help, so they can move on?
Ya’ir Z Klein
London

Keith Farman asks whether bereavement is a mental illness. Before answering, note that Harry says he suffered from denying grief when his mother died, not from the grief itself. While grief is a normal reaction to loss that cannot be blamed on others or self, its first stage is usually denial, which may help deal with events following the loss and which I believe is an illness. However, as confidence recovers, fear should subside and a second stage of grief usually occurs when the rage or fear roused by the loss is normally expressed. This is not evidence of mental illness. Alison Sesi says children cannot yet express their feelings effectively. This should not be so. But they may not experience grief but the simpler hate, sadness, anxiety or rage. I suggest that when our species acquired verbal language, most societies came to believe in gods and devils. Though later religions used these to help sustain laws and customs, they do not exist. So mental illness has long been endemic.
George Talbot
Watford, Hertfordshire

Professor Samuels never misses an opportunity to take a swipe at the evidence-based psychological therapy now available on the NHS. Prince Harry is at liberty to choose whatever sort of therapy he wishes and his comments, which seek to normalise and reduce the stigma attached to mental health problems, are very welcome. We don’t know what sort of therapy Prince Harry had, but scientific evidence suggests that had he attended eight to 12 sessions of cognitive behavioural therapy (CBT) at his local GP surgery for the traumatic bereavement he experienced, the outcome would have been a good one.
Hal Westergaard
(Cognitive behavioural therapist), Bath  

It was with interest that I read Andrew Molodynski’s comments regarding ECT as a useful option for treatment resistant major depressive disorder (Shock treatment on increase again in NHS, 18 April). I have experienced this horrible illness along with anorexia for a number of years. I underwent a significant number of ECT treatments. Apart from some short-term memory loss, it is painless, and one is unconscious for a very short period. For me it was life-saving. I don’t  think I would be alive today without it. If the need arose I would willingly have it again. Although medical treatments may help the many symptoms of severe depression, it frequently returns time and time again.

The causes of this life-altering illness need to be untangled if treatments are to succeed. This is where psychologists/psychotherapy may have the answers. In an underfunded and understaffed mental health service, therapy can be difficult to access. I have been one of the fortunate ones. Let no one underestimate the distress of severe depression on the individual and their loved ones, and the challenges it presents to mental health staff. ECT is an important life-saving treatment for people like myself.
Sheila Cook
London

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On mental health, the royal family is doing more than our government | William Davies

The public profile of mental health experienced another boost this week, thanks to some moving comments made by Prince Harry and the Duke of Cambridge about the impact of their mother’s death, nearly 20 years ago. The two royals are working for the Heads Together campaign, which seeks to combat the stigma surrounding mental health issues, and to encourage people to speak more openly about their difficulties.

Harry’s admission that he had ignored his own emotional distress for several years before eventually having counselling was a valuable contribution, from a figure more commonly associated with laddish machismo. William’s focus on male suicide statistics was also a good use of his celebrity.

The royal family cannot get involved in divisive party political issues, and so we can only conclude from these interventions that mental health is something that exists beyond the fray of politics. Breaking the “stigma” surrounding mental health issues is certainly not something that one would want to identify as a leftwing or a rightwing agenda.


There is no more damning indictment on British society in 2017 than the prevalence of mental distress among children

On the other hand, political parties have been keen to make the mental health agenda their own. Theresa May has established mental health as one of the key areas where she hopes to signal her government’s concern for everyday human suffering, making a high-profile speech in January that also stressed the importance of breaking the stigma that clouds the issue.

All of this presents something of a riddle. Mental health problems have risen in profile to the point where the prime minister and the heir to the throne are personally committed to combating them. Yet there is scarcely any public discussion about where they actually stem from. Losing a parent at a vulnerable age, as Harry did, is terrible and harmful – but epidemics do not arise purely out of private tragedies.

The stigma attached to mental health is a real problem in workplaces and schools, as are the benefits of overturning it. But stigma can scarcely be viewed as the cause of what it stigmatises.

The orthodoxy that has taken root since the 1980s is that mental health problems are disorders of the brain. The success of SSRIs since the launch of Prozac in 1987 has helped to entrench this view. This doesn’t mean that mental illness can’t be treated with “talking cures”, such as cognitive behavioural therapy or by being more open about one’s emotions, as Prince Harry has argued. But the idea that mental health problems are illnesses just like any other illnesses has become one of the main ways in which the stigma is challenged. Comparisons with cancer have become common.

The idea that one is simply “unwell” no doubt provides comfort to many people wrestling with their own depression or anxiety. But it also blocks out a whole host of more fundamental cultural, political and economic questions regarding the distribution of distress in our society – the sorts of questions that the Duke of Cambridge would be less likely to grapple with.

Theresa May


‘There is scarcely any public discussion about where [Britain’s mental health problems] actually stem from.’ Photograph: SilverHub/Rex Features

There is no more damning indictment on British society in 2017 than the prevalence of mental distress among children. Nearly a quarter of a million are receiving mental health treatment from the NHS, and those contacting Childline complaining of anxiety and exam-related stress have been climbing year-on-year. Rates of self-harm amongst young girls have risen by 42% in a decade.

Are we to believe that it was simply “stigma” that swept all this under the carpet in the past? Or might children be telling the truth, when they say they feel overwhelmed by the requirement to perform, excel, keep up? The NSPCC reports that some children are having to sit mock exams just a few weeks after returning from the summer holidays. Think about what that means and does psychologically. What does Theresa May have to say about that? British children have become damagingly competitive, and less forgiving of failure. Which minister will have the guts to stand up and say to children that being average is OK?

Adult mental health problems may present themselves as medical and be treated as such, but they are not immune to sociological analysis. Researchers have found that adult mental health is worse among those who frequently moved house as a child. Today’s housing crisis is tomorrow’s mental health crisis.

Rising household indebtedness is another major culprit, especially the kinds of problem debts that are associated with week-by-week financial precarity. Children suffer when their parents are too stressed or depressed to listen to them or play with them. Debt problems break up families.

Austerity has been disastrous for the nation’s mental health. The British Psychological Society has called for a termination of benefit sanctions (which are effectively designed to produce anxiety); academics have shown the deep emotional harm wrought by the bedroom tax. Teachers, who live under the constant spectre of monitoring and performance assessment, are seeking medical help for stress in shocking numbers.

The seductive concept of “public sector productivity gains” conceals thousands of personal tragedies among doctors, paramedics and local government service providers, many of whom cling to a dream of exiting their profession. And these are the same people who look after the wellbeing of our children and mental health patients.

No doubt mental health will feature prominently in party manifestos, now that it’s gone mainstream. Whether any of the above gets a look-in remains to be seen. Labour should be shouting about it, and not allow the hypocritical architects of austerity an inch of this territory. Next time a Labour politician is patronised as being too leftwing by a journalist, the evidence on what inequality does to our minds should be slung back.

So, yes, we need to talk more. And, yes, stigma surrounding depression and anxiety makes things worse. But it’s not just ourselves and our medical histories we need to talk about. We also need to talk about what sort of society we’ve built, and what the alternative might look like. For all their good intentions, Harry and Wills might need to sit that one out.

British teenagers more competitive than peers but more likely to bullied

British teenagers are highly motivated about their school work, but are more anxious, more likely to be bullied and are less satisfied with life than many of their peers elsewhere in the world, according to a survey.

Almost a quarter of British pupils who took part in the poll say they are being bullied a few times a month, while more than 14% say they are bullied frequently, making the UK the fourth worst affected of all 34 countries surveyed.

Anxiety levels are also high in British classrooms with seven out of 10 pupils (72%) admitting they feel anxious before taking a test, even if they are well prepared – the third highest in the survey. Girls are particularly badly affected, with 81% reporting anxiety before exams, compared with 63% of boys.

Possibly compounding the problem, UK students are also shown to be highly ambitious and competitive at school, with 90% claiming they want to be the best in whatever they do, compared with an average of 65% across the countries surveyed.

UK students are also among the highest users of the internet, with one in four 15-year-olds admitting to spending six hours online outside school hours on a typical weekday – the second highest of any country, and far higher than previous studies have suggested, prompting experts to call on the government to look at possible links between internet use and wellbeing.

The global survey of half a million 15-year-olds, carried out by the Organisation for Economic Cooperation and Development (OECD), will add to growing concern about the mental health and wellbeing of young people in the UK.

Particularly worrying is the increased risk that disadvantaged teenagers face, according to the survey, with pupils from less privileged families worse affected by high rates of bullying, unhappiness and anxiety than their wealthier peers.

Three in 10 UK pupils from less privileged backgrounds said they had been bullied, complaining of being physically abused by other students, made the target of negative rumours and deliberately left out of things.

There are also wide variations of expectation about higher education. Across OECD countries, 44% of students expect to complete university, but that number rises to three in four students in Colombia, Qatar and the US.

And while students from an immigrant background fare well in the UK, their experiences are less positive elsewhere. In 2015, 12.5% of students in participating countries were from an immigrant background. In some countries, those from an immigrant background were more likely to report feeling like outsiders, which impacts on satisfaction levels.

In the UK, while 42% of pupils polled expect to complete a university degree, less than a quarter of disadvantaged pupils expect to do so, compared with more than two-thirds of the most advantaged pupils.

The study, part of the OECD’s programme for international student assesment, also reveals that young people in the UK experience lower than average life satisfaction. Just 28% describe themselves as very satisfied with their lives, compared with an OECD average of 34%. Girls again fare worse with 28% very satisfied, compared with 33% of boys.

Students in a restaurant in La Candelaria, Bogotá


Students in a restaurant in La Candelaria, Bogotá. Colombian teenagers reported high levels of life satisfaction. Photograph: Alex Segre/Alamy

Elsewhere in the world there are huge disparities in life satisfaction among students. While in the Netherlands fewer than 4% are dissatisfied with their life; in Korea and Turkey the figure rises to 20%. In Montenegro and Latin American countries, including Colombia, however, more than one in two students reported high satisfaction levels.

The report also shows that despite reported links between eating a good breakfast and improved attainment, almost 30% of 15-year-olds in the UK do not eat breakfast before school – with the figure rising to more than 35% for the most disadvantaged pupils. Girls once again are worse affected, with more than two-thirds skipping breakfast compared with 22% of boys.

Natalie Perera, executive director and head of research at the Education Policy Institute (EPI), which hosted the launch of the report on Wednesday, said the findings on UK teenagers were stark, particularly for those from poorer backgrounds.

“Disadvantaged pupils are more likely to be bullied than their peers, and are more likely to skip breakfast before school – with the gap between the proportion of advantaged and disadvantaged pupils in the UK doing so the second biggest out of all 34 countries.”

Emily Frith, EPI director of mental health, said: “The findings show UK pupils have lower than average levels of life satisfaction, high levels of anxiety in the classroom, and are more likely to be bullied, compared to children in other countries.

“The government should explore how children’s wellbeing can be improved, including through the education system. It should seek to understand the causal relationship between internet use and young people’s wellbeing, and look to implement a strategy help young people develop the resilience and skills they need to live safe, digital lives.”

Responding to the report, a Department for Education spokesperson said: “These findings show young people have the motivation and desire to go as far as their talents can take them and that their parents are supporting them throughout their time at school.

“Assessment is an important part of education but it is also important that the test period is managed so students feel supported throughout. Our reforms have also put a stop to the endless treadmill of exams for young people, giving them more time to gain a greater understanding of the subject.”