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Workplaces ‘should cater for menopause as they do for pregnancy’

Workplaces should start catering for the menopause in a comparable way to pregnancy, according to one of Britain’s leading women’s health experts.

Myra Hunter, emeritus professor of clinical health psychology at King’s College London said that menopausal symptoms remained a “taboo issue” in many workplaces and, while policies to support pregnant women are now standard, there is still little awareness of the impact that the menopause can have on women who are often at the peak of their career.

“Often there’s a will to address this among managers, but they just don’t know how to talk about it,” said Hunter. “Women want it to be raised if appropriate. They don’t want to be treated as ill, they just want some understanding and awareness of it.”

The call comes as Hunter and colleagues publish the results of one of the first major studies looking at how symptoms such as hot flushes affect women at work. The study, which tracked 124 female employees in the public and private sectors, found that such symptoms could have a significant impact, but that following a simple programme of cognitive behavioural therapy, delivered via a self-help booklet, hugely reduced the degree to which women felt their symptoms were problematic.

The menopause occurs at the age of 51 years, on average, and the way women experience this transition can vary a lot. About 80% of women experience some hot flushes and night sweats and for 20 to 30% these symptoms are severe enough to have a significant impact on quality of life. Some women also report tiredness, “brain fog”, mood swings and loss of confidence. For some women, the transition period lasts just a few years and in others it can last a decade.

There is no strong evidence that the menopause causes women to leave jobs in large numbers or that it has a negative impact on professional performance. “The evidence we’ve got from surveys, it’s subjective, but it suggests that women might over-compensate,” said Hunter.

The trial recruited 124 women who were struggling with their symptoms (the women experienced 56 flushes on average each week). Half the women were provided with a self-help booklet that provided guidance on how to cope with work stress, how to discuss the menopause at work and which challenged negative stereotypes associated with the menopause, such as “being past it”.

The booklet also set women cognitive behavioural therapy (CBT) exercises, in which they were asked to write down the thoughts they have during hot flushes, for instance, and then challenge these beliefs.

“If a woman has a hot flush half the anxiety is about how people see her,” said Hunter. “There’s embarrassment and anxiety about being joked about and a big concept is hiding symptoms in fear of being ridiculed.”

“Really, we shouldn’t feel like that and when women verbalise it, it does appear ridiculous,” she added.

Women who were given the booklet reported a noticeable reduction in both their symptoms and how problematic they were. When they were followed up after five months, the number of hot flushes they experienced was reduced by one third, they reported better quality sleep and viewed their symptoms more neutrally. In interviews after the trial, 82% said the intervention had reduced the impact of their symptoms and 37% had spoken about their menopause to their line manager.

Kathy Abernethy, chair of the British Menopause Society and a specialist nurse, welcomed the work, saying that a social shift was underway with people generally becoming more open about discussing the menopause.

This trend, she said, has been partly driven by celebrities who “have decided that it’s not something embarrassing to talk about”. Far more women in their 50s are also in work than in the past. According to the Department for Work and Pensions, the proportion of women aged 50 to 64 with jobs has risen by more than 50% in the past 30 years.

“Women simply want to know workplaces are taking it seriously,” Abernethy added. “Awareness is a key thing. If managers are aware of the menopause it means the whole thing becomes a non-issue, like pregnancy.”

Tina Weaver, CEO of the charity Wellbeing of Women, which funded the research, said the study offered practical and accessible interventions to help women. “It’s alarming so many women suffer from these debilitating symptoms and feel so unsupported during the menopause that they drop out of the work force,” she said. “This natural process has been overlooked and considered a taboo for too long.”

The findings are published in the journal Menopause.

‘Some days I felt like I needed a badge saying “Stand clear: menopausal woman approaching!”’

Angela Bonnett


Angela Bonnett found professional skills that she’d come to take for granted suddenly foundering during the menopause. Photograph: Murdo Macleod for the Guardian

Angela Bonnett, 57, had a successful career in finance and by her early 50s was a senior project manager at a well-known financial institution in the City. “I’d spent 30 years being an excellent performer at the top of my tree,” she said.

Five years ago, she entered the menopause and found professional skills that she’d come to take for granted – her razor sharp memory and a cool disposition – suddenly foundering. “I felt all those things were falling away,” Bonnett said.

She experienced hot flushes in meetings, night sweats that disturbed her sleep, sudden mood swings, problems concentrating and irritation. “Everything that you’ve ever read about the menopause seemed to happen to some degree,” she said. “Some days I felt like I needed a badge saying ‘Stand clear: menopausal woman approaching!’”

In work, she noticed herself making careless mistakes, struggling to recall names or conversations she’d had a day earlier – “things that were just alien to me”.

She took detailed notes to prompt her memory and worked harder to compensate for tiredness. She began wearing layered clothes so she could “quickly disrobe” when she was hit by a hot flush in a meeting and took to carrying a fan she had picked up on holiday in Spain.

“Initially I had some reservations that people would know why I’m doing this,” she said. “But in the end I thought, either I’m going to explode or I need to cool down.”

As a rule, Bonnett did not share personal problems at work. “I prefer to keep the two separate,” she said. And the menopause felt like a particularly personal experience. “Whether you want someone to know your periods have stopped – it’s quite core to who you are.”

Angela Bonnett


Bonnett said that having support at work made dealing with the menopause easier. Photograph: Murdo Macleod for the Guardian

However, when she found herself snapping at a colleague – a reaction that was completely out of character – she decided she needed to raise the issue with her manager.

“Previously I’d been quite sensitive in situations at work, but from nowhere there would come a really sharp, nasty response to people that made the whole room gasp,” she recalled.

The lack of an established protocol made raising the issue at work feel potentially awkward. Eventually she emailed her line manager, a man in his mid-30s, with a newspaper article in which a high level lawyer described the challenges she’d faced at work due to menopausal symptoms. “This allowed me to introduce the subject using outside information and explain what I was going through,” she said.

Bonnett says her boss was not unwilling to help, he was simply oblivious. “It was an education for him. He said ‘I had no idea you were going through this’. I said ‘It’s because I’ve been working extra hard to make sure I carry on performing’.”

Once aware of her situation, Bonnett’s manager was understanding and reassured her that she should feel free to come in late or leave earlier, if she needed to. The message was: whatever you need to do to cope, that’s fine.

“Just having that reassurance made it a lot easier,” Bonnett said. “I didn’t need to do any of those things, but knowing he knew was sufficient and removed a lot of the anxiety.”

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Size does matter: wine glasses are seven times larger than they used to be

Our Georgian and Victorian ancestors may have enjoyed a Christmas tipple but judging by the size of the glasses they used they probably drank less wine than we do today.

Scientists at the University of Cambridge have found that the capacity of wine glasses has ballooned nearly seven-fold over the past 300 years, rising most sharply in the last two decades in line with a surge in wine consumption.

Wine glasses have swelled in size from an average capacity of 66ml in the early 1700s to 449ml today, the study reveals – a change that may have encouraged us to drink far more than is healthy. Indeed, a typical wine glass 300 years ago would only have held about a half of today’s smallest “official” measure of 125ml.

In the first UK analysis of its kind, the university’s behaviour and health research unit quizzed antique experts and examined 18th-century glasses held at the Ashmolean museum in Oxford, glassware used at Buckingham Palace, and more recent glasses in John Lewis catalogues. The evidence was clear: the newer glasses were bigger.

wine glass sizes

The study, published on Wednesday in the BMJ, measured wine glass capacity from 1700 to the present day to help understand whether any changes in their size might have contributed to the rise in wine consumption.

“Wine will no doubt be a feature of some merry Christmas nights, but when it comes to how much we drink, wine glass size probably does matter,” said Prof Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, who led the research.

In 2016, Marteau and her colleagues carried out an experiment at the Pint Shop in Cambridge, altering the size of wine glasses while keeping the serving sizes the same. They found this led to an almost 10% increase in sales.

For the new study, the researchers obtained measurements of 411 glasses from 1700 to the modern day. They found wine glass capacity increased from 66ml in the 1700s to 417ml in the 2000s, with the mean wine glass size in 2016-17 even higher at 449ml.

Wine glasses graphic

“Wine glasses became a common receptacle from which wine was drunk around 1700,” says first author Dr Zorana Zupan. “This followed the development of lead crystal glassware by George Ravenscroft in the late 17th century, which led to the manufacture of less fragile and larger glasses than was previously possible.”

The paper points out that alcohol is the fifth largest risk factor for premature mortality and disability in high income countries. In England, the type of alcohol and volume consumed has fluctuated over the last 300 years, in response to economic, legislative and social factors. Significantly, wine consumption increased almost fourfold between 1960 and 1980, and almost doubled again between 1980 and 2004, a trend attributed to better marketing and licensing liberalisation which allowed supermarkets to compete in the lucrative drinks retail business.

“Our findings suggest that the capacity of wine glasses in England increased significantly over the past 300 years,” added Zupan. “Since the 1990s, the size has increased rapidly. Whether this led to the rise in wine consumption in England, we can’t say for certain, but a wine glass 300 years ago would only have held about a half of today’s small measure.”

The strength of wine sold in the UK has also increased since the 1990s, adding to the amount of pure alcohol being consumed by wine drinkers.

Q&A

Large wine glasses: fashion or marketing ploy?

It’s the pubs’ and bars’ equivalent of supermarkets putting sweets by the checkout. The fashion for larger glasses – whether they are filled to the top or not – simply encourages people to drink (and spend) more than they need. Larger, stylish wine glasses can also increase the pleasure from drinking wine, which may also increase the desire to drink more.

In England, the type of alcohol and volume consumed has fluctuated over the last 300 years, largely in response to economic, legislative and social factors. Until the second half of the 20th century, beer and spirits (often watered down) were the most common forms of alcohol consumed, with wine generally the tipple of the upper classes.

In the 1930s and 1940s fortified wines were popular but wine took off when package holidays introduced Britons to exotic European tastes and law changes allowed UK supermarkets to compete in the sector.

Alcohol strength has also gone up significantly due to the public’s taste for riper, softer wines that are ready to drink. Wines like Bordeaux and Rioja that used to be about 12.5%-13% abv are often now 14% or more.

In England, wine is increasingly served in pubs and bars in 250ml servings, with smaller measures of 125ml often absent from wine lists or menus despite a regulatory requirement that licensees make customers aware of them.

The Wine and Spirits Trade Association said sociological trends were probably part of the reason for the growing wine glasses.

“The size of a wine glass reflects the trend and fashions of the time and is often larger for practical reasons” said the WSTA chief executive Miles Beale. “Red wine, for example, is served in a larger glass to allow it to breathe, something which perhaps wasn’t a priority 300 years ago.”

The Grenfell survivors don’t need our pity – they need homes | Deborah Orr

John Green, the psychologist who leads the mental health response to the Grenfell fire, says the disaster has transformed the local NHS trust into “the largest trauma service in the UK”. It’s not just the survivors of the fire who are affected. Many people in the community are haunted by what they saw, smelled, felt, heard, learned and imagined that appalling night and in those dreadful following days.

The singularity of Grenfell is that those affected are concentrated in a stable community. It’s not like the typical terror attack, which will usually strike many people from disparate places just visiting or passing through. Grenfell is tightly knit – a dense site of shared trauma.

There are some advantages to this. Rather as with people who have been in a war, who can support one another in a way no one else can, there is no shortage of others who understand. Yet the disadvantages are very great. These people are still in the heart of the site of the trauma. There are daily reminders of unspeakable horror and loss.

“Trigger warnings” are discussed a great deal in the contemporary world. For a lot of traumatised people, that blackened tower remains a trigger. Any trauma expert – and many of them have offered their services to the Grenfell community – will tell you that the first thing to do when helping people to recover is to attend to their immediate safety and security, so that they can feel some agency over their lives. Yet being in temporary accommodation is the opposite of that. Six months after the fire, as Pilgrim Tucker reported here on Thursday, the vast majority of survivors have not been rehoused.

This too is a major disadvantage of a concentrated disaster. Social housing is hard to come by in Britain, harder to come by in London, and almost impossible to come by in a wealthy area of the city such as Kensington and Chelsea. This does not mean the problem with rehousing survivors is insurmountable. It means that it was eminently predictable. Again, British engineering has so far failed to rise to the challenge.

You wouldn’t imagine it from nearly 50 years of bellyaching by the UK government and most local authorities, but cheap, quick, decent housing is not hard to supply. Many options for off-site prefabricated homes are available. Creekside Wharf, a modular development going up fast on a small piece of land in Greenwich, south-east London, is designed to provide 249 homes. It’s a tall building, at 23 storeys, and one can understand why Grenfell survivors might shrink from living that way again.

But other people in flats and flatshares in the borough would have been glad to move, to help survivors of the disaster. In a whole community that has suffered an extraordinary blow, there is no shortage of people willing to muck in. That goodwill was never tapped as enthusiastically as it could have been.

The problem all along has been a lack of vision, imagination and simple belief from central and local government in the idea that solutions at scale are possible. Grenfell’s survivors are being treated simply as people on the housing list who have to be patient like everyone else, not people who could be vulnerable to continuing or exploding trauma with every day of waiting in limbo.

What must it be like, for month after month, as the temporary hardens around you – and summer, autumn and winter pass without any tangible idea of what the future might look like? Meanwhile, all around are tangible reminders of the horror you lived through. At one point there was some sort of target for every Grenfell survivor who wanted to move into a new home to be rehoused by Christmas. Instead, the dead have been counted and the living left to ponder the notion that they don’t count very much at all.

Even now, it doesn’t have to be that way. Sure, a lot of time has been lost, and that’s shameful. But there’s no better moment than now to decide that the next six months should demonstrate how much can be done, as the last have shown how little can be. Things felt urgent in the days and weeks after the fire. The truth is that they are more urgent now than ever.

There’s a growing understanding, especially in the United States, that simply being disadvantaged in cities (even without a seismic event such as Grenfell) can be distressing enough to induce post-traumatic stress disorder – which, untreated, helps to perpetuate a cycle of misery, violence, failure and shame.

One of the worst things about society today is that insight into the human condition abounds, yet when it matters those insights are dismissed in favour of wilful ignorance. It is sometimes too late for healing to start; it was for the victims of the fire. But it is not too late for the survivors.

The Grenfell survivors don’t need our pity – they need homes | Deborah Orr

John Green, the psychologist who leads the mental health response to the Grenfell fire, says the disaster has transformed the local NHS trust into “the largest trauma service in the UK”. It’s not just the survivors of the fire who are affected. Many people in the community are haunted by what they saw, smelled, felt, heard, learned and imagined that appalling night and in those dreadful following days.

The singularity of Grenfell is that those affected are concentrated in a stable community. It’s not like the typical terror attack, which will usually strike many people from disparate places just visiting or passing through. Grenfell is tightly knit – a dense site of shared trauma.

There are some advantages to this. Rather as with people who have been in a war, who can support one another in a way no one else can, there is no shortage of others who understand. Yet the disadvantages are very great. These people are still in the heart of the site of the trauma. There are daily reminders of unspeakable horror and loss.

“Trigger warnings” are discussed a great deal in the contemporary world. For a lot of traumatised people, that blackened tower remains a trigger. Any trauma expert – and many of them have offered their services to the Grenfell community – will tell you that the first thing to do when helping people to recover is to attend to their immediate safety and security, so that they can feel some agency over their lives. Yet being in temporary accommodation is the opposite of that. Six months after the fire, as Pilgrim Tucker reported here on Thursday, the vast majority of survivors have not been rehoused.

This too is a major disadvantage of a concentrated disaster. Social housing is hard to come by in Britain, harder to come by in London, and almost impossible to come by in a wealthy area of the city such as Kensington and Chelsea. This does not mean the problem with rehousing survivors is insurmountable. It means that it was eminently predictable. Again, British engineering has so far failed to rise to the challenge.

You wouldn’t imagine it from nearly 50 years of bellyaching by the UK government and most local authorities, but cheap, quick, decent housing is not hard to supply. Many options for off-site prefabricated homes are available. Creekside Wharf, a modular development going up fast on a small piece of land in Greenwich, south-east London, is designed to provide 249 homes. It’s a tall building, at 23 storeys, and one can understand why Grenfell survivors might shrink from living that way again.

But other people in flats and flatshares in the borough would have been glad to move, to help survivors of the disaster. In a whole community that has suffered an extraordinary blow, there is no shortage of people willing to muck in. That goodwill was never tapped as enthusiastically as it could have been.

The problem all along has been a lack of vision, imagination and simple belief from central and local government in the idea that solutions at scale are possible. Grenfell’s survivors are being treated simply as people on the housing list who have to be patient like everyone else, not people who could be vulnerable to continuing or exploding trauma with every day of waiting in limbo.

What must it be like, for month after month, as the temporary hardens around you – and summer, autumn and winter pass without any tangible idea of what the future might look like? Meanwhile, all around are tangible reminders of the horror you lived through. At one point there was some sort of target for every Grenfell survivor who wanted to move into a new home to be rehoused by Christmas. Instead, the dead have been counted and the living left to ponder the notion that they don’t count very much at all.

Even now, it doesn’t have to be that way. Sure, a lot of time has been lost, and that’s shameful. But there’s no better moment than now to decide that the next six months should demonstrate how much can be done, as the last have shown how little can be. Things felt urgent in the days and weeks after the fire. The truth is that they are more urgent now than ever.

There’s a growing understanding, especially in the United States, that simply being disadvantaged in cities (even without a seismic event such as Grenfell) can be distressing enough to induce post-traumatic stress disorder – which, untreated, helps to perpetuate a cycle of misery, violence, failure and shame.

One of the worst things about society today is that insight into the human condition abounds, yet when it matters those insights are dismissed in favour of wilful ignorance. It is sometimes too late for healing to start; it was for the victims of the fire. But it is not too late for the survivors.

The Grenfell survivors don’t need our pity – they need homes | Deborah Orr

John Green, the psychologist who leads the mental health response to the Grenfell fire, says the disaster has transformed the local NHS trust into “the largest trauma service in the UK”. It’s not just the survivors of the fire who are affected. Many people in the community are haunted by what they saw, smelled, felt, heard, learned and imagined that appalling night and in those dreadful following days.

The singularity of Grenfell is that those affected are concentrated in a stable community. It’s not like the typical terror attack, which will usually strike many people from disparate places just visiting or passing though. Grenfell is tightly knit – a dense site of shared trauma.

There are some advantages to this. Rather as with people who have been in a war, who can support one another in a way no one else can, there is no shortage of others who understand. Yet the disadvantages are very great. These people are still in the heart of the site of the trauma. There are daily reminders of unspeakable horror and loss.

“Trigger warnings” are discussed a great deal in the contemporary world. For a lot of traumatised people, that blackened tower remains a trigger. Any trauma expert – and many of them have offered their services to the Grenfell community – will tell you that the first thing to do when helping people to recover is to attend to their immediate safety and security, so that they can feel some agency over their lives. Yet being in temporary accommodation is the opposite of that. Six months after the fire, as Pilgrim Tucker reported here on Thursday, the vast majority of survivors have not been rehoused.

This too is a major disadvantage of a concentrated disaster. Social housing is hard to come by in Britain, harder to come by in London, and almost impossible to come by in a wealthy area of the city such as Kensington and Chelsea. This does not mean the problem with rehousing survivors is insurmountable. It means that it was eminently predictable. Again, British engineering has so far failed to rise to the challenge.

You wouldn’t imagine it from nearly 50 years of bellyaching by the UK government and most local authorities, but cheap, quick, decent housing is not hard to supply. Many options for off-site prefabricated homes are available. Creekside Wharf, a modular development going up fast on a small piece of land in Greenwich, south-east London, is designed to provide 249 homes. It’s a tall building, at 23 storeys, and one can understand why Grenfell survivors might shrink from living that way again.

But other people in flats and flatshares in the borough would have been glad to move, to help survivors of the disaster. In a whole community that has suffered an extraordinary blow, there is no shortage of people willing to muck in. That goodwill was never tapped as enthusiastically as it could have been.

The problem all along has been a lack of vision, imagination and simple belief from central and local government in the idea that solutions at scale are possible. Grenfell’s survivors are being treated simply as people on the housing list who have to be patient like everyone else, not people who could be vulnerable to continuing or exploding trauma with every day of waiting in limbo.

What must it be like, for month after month, as the temporary hardens around you – and summer, autumn and winter pass without any tangible idea of what the future might look like? Meanwhile, all around are tangible reminders of the horror you lived through. At one point there was some sort of target for every Grenfell survivor who wanted to move into a new home to be rehoused by Christmas. Instead, the dead have been counted and the living left to ponder the notion that they don’t count very much at all.

Even now, it doesn’t have to be that way. Sure, a lot of time has been lost, and that’s shameful. But there’s no better moment than now to decide that the next six months should demonstrate how much can be done, as the last have shown how little can be. Things felt urgent in the days and weeks after the fire. The truth is that they are more urgent now than ever.

There’s a growing understanding, especially in the United States, that simply being disadvantaged in cities (even without a seismic event such as Grenfell) can be distressing enough to induce post-traumatic stress disorder – which, untreated, helps to perpetuate a cycle of misery, violence, failure and shame.

One of the worst things about society today is that insight into the human condition abounds, yet when it matters those insights are dismissed in favour of wilful ignorance. It is sometimes too late for healing to start; it was for the victims of the fire. But it is not too late for the survivors.

UK patients ‘suffering as they cannot afford assisted dying overseas’

Thousands of terminally ill people who want to travel abroad to end their life in specialist clinics can not afford the costs of doing so, leaving them to face often “painful and traumatic deaths at home”, according to a new report.

The study by the campaign group Dignity in Dying says the UK is outsourcing death to Dignitas – the assisted dying organisation in Switzerland – which only the better off can afford.

The study found that while more than half of Britons would consider travelling to abroad for an assisted death, only a quarter said they could afford the average £10,000 cost.

Sarah Wootton, the chief executive of Dignity in Dying, said the study “exposes the unacceptable reality that is faced by so many dying people in this country.

“By denying terminally ill people the option of an assisted death at home, we are not solving the problem, just outsourcing it to Switzerland – and dying people and their families are the ones paying the price.”

Assisted dying is illegal in the UK and Wootton said terminally ill people are spending their final months “overwhelmed by paperwork [and] being made to feel like criminals”.

She added: “Those that are unable to obtain an assisted death overseas can end up suffering painful and traumatic deaths at home or taking drastic measures to end their own lives. This is not how a civilised country should treat its dying citizens.”

The report is based on polling and in-depth interviews with three groups of people: those with a terminal illness who are considering an assisted death in Switzerland; those who have helped a loved one to have an assisted death in Switzerland; and those whose loved one considered an assisted death in Switzerland but died in the UK.

It found that those without enough money or family and friends to support them were unable to make the tip to assisted dying clinics.

Emil Prysak, 30, from London, said his mother was diagnosed with thyroid cancer, which spread throughout her body. She initially ruled out Dignitas because of the cost involved, but later regretted it due to the pain and suffering she experienced at the end of her life.

Prysak said: “Because of the complexity of her illness, my mum was suffering all the way to the end … She was looking at us, saying ‘Why can I not die? If I had known it was going to be like this I would have gone to Switzerland’ … My mum didn’t want that suffering and that’s haunting me. It will haunt me to the end of my life.”

Caroline Villar, 39 from County Down, was also interviewed. She said when her mother, Margaret, received a terminal diagnosis of cancer, she considered an assisted death in Switzerland but feared the legal implications for her family if they helped her. She ended up dying in pain at home in Northern Ireland.

Villar said: “I think most people believe that modern medicine will stop you suffering, but my mum was crying out for painkillers at the end, and they couldn’t increase the dose because they said if they gave her any more, it would push her over into death. We were all happy for that to happen, to finally end her suffering, but they couldn’t do it.”

Kit Malthouse, the Conservative MP for North West Hampshire, wrote in a foreword for the report that it “shines a light where too few policy makers are willing to look.”

“We must ask whether these terrible experiences can truly be justified by a false dichotomy between dominion over our lives and protection of the vulnerable, a premise long-disproved,” he said.

“The evidence that we need change is overwhelming. It’s time that the UK stopped outsourcing its compassion and began listening to dying people who want and need the most basic choice they will ever face.”

UK patients ‘suffering as they cannot afford assisted dying overseas’

Thousands of terminally ill people who want to travel abroad to end their life in specialist clinics can not afford the costs of doing so, leaving them to face often “painful and traumatic deaths at home”, according to a new report.

The study by the campaign group Dignity in Dying says the UK is outsourcing death to Dignitas – the assisted dying organisation in Switzerland – which only the better off can afford.

The study found that while more than half of Britons would consider travelling to abroad for an assisted death, only a quarter said they could afford the average £10,000 cost.

Sarah Wootton, the chief executive of Dignity in Dying, said the study “exposes the unacceptable reality that is faced by so many dying people in this country.

“By denying terminally ill people the option of an assisted death at home, we are not solving the problem, just outsourcing it to Switzerland – and dying people and their families are the ones paying the price.”

Assisted dying is illegal in the UK and Wootton said terminally ill people are spending their final months “overwhelmed by paperwork [and] being made to feel like criminals”.

She added: “Those that are unable to obtain an assisted death overseas can end up suffering painful and traumatic deaths at home or taking drastic measures to end their own lives. This is not how a civilised country should treat its dying citizens.”

The report is based on polling and in-depth interviews with three groups of people: those with a terminal illness who are considering an assisted death in Switzerland; those who have helped a loved one to have an assisted death in Switzerland; and those whose loved one considered an assisted death in Switzerland but died in the UK.

It found that those without enough money or family and friends to support them were unable to make the tip to assisted dying clinics.

Emil Prysak, 30, from London, said his mother was diagnosed with thyroid cancer, which spread throughout her body. She initially ruled out Dignitas because of the cost involved, but later regretted it due to the pain and suffering she experienced at the end of her life.

Prysak said: “Because of the complexity of her illness, my mum was suffering all the way to the end … She was looking at us, saying ‘Why can I not die? If I had known it was going to be like this I would have gone to Switzerland’ … My mum didn’t want that suffering and that’s haunting me. It will haunt me to the end of my life.”

Caroline Villar, 39 from County Down, was also interviewed. She said when her mother, Margaret, received a terminal diagnosis of cancer, she considered an assisted death in Switzerland but feared the legal implications for her family if they helped her. She ended up dying in pain at home in Northern Ireland.

Villar said: “I think most people believe that modern medicine will stop you suffering, but my mum was crying out for painkillers at the end, and they couldn’t increase the dose because they said if they gave her any more, it would push her over into death. We were all happy for that to happen, to finally end her suffering, but they couldn’t do it.”

Kit Malthouse, the Conservative MP for North West Hampshire, wrote in a foreword for the report that it “shines a light where too few policy makers are willing to look.”

“We must ask whether these terrible experiences can truly be justified by a false dichotomy between dominion over our lives and protection of the vulnerable, a premise long-disproved,” he said.

“The evidence that we need change is overwhelming. It’s time that the UK stopped outsourcing its compassion and began listening to dying people who want and need the most basic choice they will ever face.”

UK patients ‘suffering as they cannot afford assisted dying overseas’

Thousands of terminally ill people who want to travel abroad to end their life in specialist clinics can not afford the costs of doing so, leaving them to face often “painful and traumatic deaths at home”, according to a new report.

The study by the campaign group Dignity in Dying says the UK is outsourcing death to Dignitas – the assisted dying organisation in Switzerland – which only the better off can afford.

The study found that while more than half of Britons would consider travelling to abroad for an assisted death, only a quarter said they could afford the average £10,000 cost.

Sarah Wootton, the chief executive of Dignity in Dying, said the study “exposes the unacceptable reality that is faced by so many dying people in this country.

“By denying terminally ill people the option of an assisted death at home, we are not solving the problem, just outsourcing it to Switzerland – and dying people and their families are the ones paying the price.”

Assisted dying is illegal in the UK and Wootton said terminally ill people are spending their final months “overwhelmed by paperwork [and] being made to feel like criminals”.

She added: “Those that are unable to obtain an assisted death overseas can end up suffering painful and traumatic deaths at home or taking drastic measures to end their own lives. This is not how a civilised country should treat its dying citizens.”

The report is based on polling and in-depth interviews with three groups of people: those with a terminal illness who are considering an assisted death in Switzerland; those who have helped a loved one to have an assisted death in Switzerland; and those whose loved one considered an assisted death in Switzerland but died in the UK.

It found that those without enough money or family and friends to support them were unable to make the tip to assisted dying clinics.

Emil Prysak, 30, from London, said his mother was diagnosed with thyroid cancer, which spread throughout her body. She initially ruled out Dignitas because of the cost involved, but later regretted it due to the pain and suffering she experienced at the end of her life.

Prysak said: “Because of the complexity of her illness, my mum was suffering all the way to the end … She was looking at us, saying ‘Why can I not die? If I had known it was going to be like this I would have gone to Switzerland’ … My mum didn’t want that suffering and that’s haunting me. It will haunt me to the end of my life.”

Caroline Villar, 39 from County Down, was also interviewed. She said when her mother, Margaret, received a terminal diagnosis of cancer, she considered an assisted death in Switzerland but feared the legal implications for her family if they helped her. She ended up dying in pain at home in Northern Ireland.

Villar said: “I think most people believe that modern medicine will stop you suffering, but my mum was crying out for painkillers at the end, and they couldn’t increase the dose because they said if they gave her any more, it would push her over into death. We were all happy for that to happen, to finally end her suffering, but they couldn’t do it.”

Kit Malthouse, the Conservative MP for North West Hampshire, wrote in a foreword for the report that it “shines a light where too few policy makers are willing to look.”

“We must ask whether these terrible experiences can truly be justified by a false dichotomy between dominion over our lives and protection of the vulnerable, a premise long-disproved,” he said.

“The evidence that we need change is overwhelming. It’s time that the UK stopped outsourcing its compassion and began listening to dying people who want and need the most basic choice they will ever face.”