Tag Archives: well

In my role as chaplain, I have seen joy in hospital at Christmas as well as sadness

Enid* had become the granny of the ward. She had been in the hospital for some time. The staff loved her; she knew them all by name and they would seek her advice. The ward was the place where she felt loved and wanted. She had attended services I led in the hospital chapel when she could – and this had become her church.

I went to visit Enid a week before Christmas and this time she was miserable. It was so unlike her: she was usually such a cheerful person and always had a tale or two of her childhood to tell. I asked her what the matter was and she told me that the decision had been made to discharge her. She knew that she did not need to be in an acute hospital any more – but she was going to miss what she saw as her community and ward family.

She would have community support at home, but she would be on her own for most of the time. We sent her home with a food parcel as we have links with a local food and clothes bank.

That day I was interviewed by the local BBC TV news for a short piece about being in hospital at Christmas. I talked about the difficulties of people being separated from families and friends at a time when everyone else seemed to be having a good time. Although Enid was not going to be in hospital, I was thinking about her distress and anxiety. It was due for broadcast in the following day or two, but got bumped as there was a snowstorm that filled the news.

I was working on Christmas Eve – and there is always a lot to do, such as catching up with people who were being discharged for Christmas Day. Most, unlike Enid, were very happy to go home, even if it was only for a day or two. I also wanted to see those people who were staying in.

There were the families waiting by their loved ones’ bedsides for their lives to come to an end: the family of a young man who had come off his motorbike, and the relatives of a 40-year-old woman with cancer who was not going to see another Christmas. There were people, too, from long distances away, whose families would not be able to visit over Christmas. I guess this is what I had reflected in the TV interview.

We have an army of volunteers who come in on Christmas Eve to go around every ward and sing carols. I tell the teams, “If you make the nurses cry, you are doing your job properly!” They, and the patients and their families, are so touched that people care enough to come in on such a busy day to sing to them.

As we worked our way around the wards, I was surprised to see Enid back on the ward she had been in before. She looked very happy indeed. I was concerned that she had had to be admitted again. Enid told me afterwards that this was the best Christmas she had had for years. The ward manager had sat with her as she had her Christmas dinner and all the staff made a great fuss of her.

We talk a lot about holistic care in the NHS and this seemed to me a fine example of it. As it turned out, it was Enid’s last Christmas: what a wonderful gift.

I got home at about 9.30pm with a sore throat – and heartily fed up with carols. My family and I caught the news before going out again to the midnight service. There I was on the TV talking about what it was like to be in hospital over Christmas. I had forgotten about it completely. I realised that Enid’s experience had altered my thinking and that, if asked again, I would say something different about being in hospital over Christmas. I would say that I have seen joy in hospital at Christmas as well as sadness. Joy and hope can arise in the most unpromising circumstances.

*Name and some details have been changed

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Surgery that made its mark on patients’ lives as well as livers | Letters

I was operated on by Simon Bramhall and team at the liver unit of the Queen Elizabeth hospital, Birmingham, in 2006 (Surgeon admits leaving his initials on livers of patients, 14 December). Following colorectal surgery the previous year the cancer had spread – which entailed a resection of 75% of my liver. Following the operation, I was informed by one of his colleagues that on the balance of probability I had about five years to live.

I had regular post-operative checks with Bramhall for four years. My treatment was professional, patient-focused and friendly. He always had a welcoming smile. I am horrified to read phrases like “assault by beating” applied to a thoroughly decent professional.

Thanks to Bramhall I am still alive and very active long after my projected demise. It does not bug me one bit whether or not I have his initials on my liver.Emeritus Professor Jim S SandhuUniversity of Northumbria

Henry Marsh wonders why the surgeon who discovered that Simon Bramhall had marked his name on a patient’s liver felt obliged to report this to hospital authorities (Surgeons walk a tightrope. Some fall off, 16 December). I would be far more concerned if a surgeon found something like this and did not report it, therefore colluding in what Marsh acknowledges in his article is a wrongful action. (Marsh says that signing of the skulls of any of his own patients would have been “wholly inappropriate”.)

Also, the seriousness of this action from a criminal point of view should be reflected in the outcome of Bramhall’s trial, which will provide a legal precedent for what I believe is a unique case. The court is the right place for an alleged offence of assault to be tested and it should not be left for the person who discovered it to be judge and jury.Alexis LivadeasKidlington, Oxfordshire

Henry Marsh says that as patients we must trust our doctors and that it is not always easy. It is made much harder when they, including Marsh, see nothing criminal in a surgeon who behaves like a spoilt teenager and engraves his initials in his patients’ liver. He says it causes no physical harm, but it is indicative of the arrogance and contempt in which some members of the profession hold their patients.Nick CrookBatheaston, Somerset

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Surgery that made its mark on patients’ lives as well as livers | Letters

I was operated on by Simon Bramhall and team at the liver unit of the Queen Elizabeth hospital, Birmingham, in 2006 (Surgeon admits leaving his initials on livers of patients, 14 December). Following colorectal surgery the previous year the cancer had spread – which entailed a resection of 75% of my liver. Following the operation, I was informed by one of his colleagues that on the balance of probability I had about five years to live.

I had regular post-operative checks with Bramhall for four years. My treatment was professional, patient-focused and friendly. He always had a welcoming smile. I am horrified to read phrases like “assault by beating” applied to a thoroughly decent professional.

Thanks to Bramhall I am still alive and very active long after my projected demise. It does not bug me one bit whether or not I have his initials on my liver.Emeritus Professor Jim S SandhuUniversity of Northumbria

Henry Marsh wonders why the surgeon who discovered that Simon Bramhall had marked his name on a patient’s liver felt obliged to report this to hospital authorities (Surgeons walk a tightrope. Some fall off, 16 December). I would be far more concerned if a surgeon found something like this and did not report it, therefore colluding in what Marsh acknowledges in his article is a wrongful action. (Marsh says that signing of the skulls of any of his own patients would have been “wholly inappropriate”.)

Also, the seriousness of this action from a criminal point of view should be reflected in the outcome of Bramhall’s trial, which will provide a legal precedent for what I believe is a unique case. The court is the right place for an alleged offence of assault to be tested and it should not be left for the person who discovered it to be judge and jury.Alexis LivadeasKidlington, Oxfordshire

Henry Marsh says that as patients we must trust our doctors and that it is not always easy. It is made much harder when they, including Marsh, see nothing criminal in a surgeon who behaves like a spoilt teenager and engraves his initials in his patients’ liver. He says it causes no physical harm, but it is indicative of the arrogance and contempt in which some members of the profession hold their patients.Nick CrookBatheaston, Somerset

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Budget boost for NHS to fall well short of management demands

Philip Hammond is to give the NHS an emergency cash injection in the budget, though the chancellor will disappoint health service bosses by increasing funding by far less than they believe is needed.

Hammond is understood to be preparing to unveil a plan to give the NHS up to £6bn by 2022 for three different purposes.

Despite already rejecting a plea by the NHS chief executive, Simon Stevens, for £4bn extra for next year, Hammond is thought to nevertheless be ready to give the NHS approaching, but less than, £1bn more than previously planned in 2018-19 to meet its running costs and to maintain care standards.

He is also expected to announce that the NHS in England will receive an extra £1bn for each of the next four years in capital funding, which is used to build new NHS premises, undertake repairs and buy new equipment. However, that is £6bn less than the £10bn extra capital funding Theresa May promised during the election campaign earlier this year. Hammond may indicate that selloffs of NHS land and property can plug most or all of that gap.

Sources say that Hammond is also likely to indicate that the government will give the NHS some further money to help cover the cost of the pay rise its 1.4m staff receive next year now that ministers have decided to end the 1% pay cap.

He is likely to say that the exact sum the Treasury will provide will depend on what the two NHS pay review bodies recommend. But sources estimate that Hammond’s pledge could ultimately yield several hundred million pounds for the NHS as each 1% rise in staff pay would cost £500m.

Hammond angered NHS leaders by making clear on BBC1’s Andrew Marr Show on Sunday that he would not bow to the demands by Stevens to raise the NHS budget by £4bn next year. He said he was not persuaded that “armageddon will arrive” without that level of extra investment.

Informed sources say that Hammond and May accept that they have to give the NHS more than the £124.4bn planned in 2018-19 in order to avoid breaking the Conservative manifesto pledge that health spending per head would grow every year of this parliament. Funding needs to grow by at least £310m to avoid that promise being broken.

Chris Ham, the chief executive of the King’s Fund health thinktank, said: “If these numbers are confirmed, they will provide some relief to an NHS struggling to meet rising patient demands with budgets that have been constrained for eight years. However, they fall well short of the £4bn increase we estimate is needed in 2018-19 to prevent standards of care falling further.”

Chris Hopson, the chief executive of NHS Providers, which represents hospital trusts, claimed ministers were expecting the NHS to make unrealistically ambitious improvements to productivity to meet the shortfall in the cost of covering the staff pay rise.

He said: “The economy as a whole has seen average productivity gains of 0.2% a year over the last five years. The historical NHS average has been 1% a year. Thanks to the hard work of trusts, we’ve significantly exceeded both these – realising an average productivity gain of 1.7% a year between 2009-10 and 2014-15.

“And we mustn’t forget that the spending review plans already assume productivity gains of 2-3% a year between now and 2021. Is it really credible to argue that a significant level of further gain can be realised? Or is this a way of justifying a decision not to make the extra investment in the NHS that is needed?”

Budget boost for NHS to fall well short of management demands

Philip Hammond is to give the NHS an emergency cash injection in the budget, though the chancellor will disappoint health service bosses by increasing funding by far less than they believe is needed.

Hammond is understood to be preparing to unveil a plan to give the NHS up to £6bn by 2022 for three different purposes.

Despite already rejecting a plea by the NHS chief executive, Simon Stevens, for £4bn extra for next year, Hammond is thought to nevertheless be ready to give the NHS approaching, but less than, £1bn more than previously planned in 2018-19 to meet its running costs and to maintain care standards.

He is also expected to announce that the NHS in England will receive an extra £1bn for each of the next four years in capital funding, which is used to build new NHS premises, undertake repairs and buy new equipment. However, that is £6bn less than the £10bn extra capital funding Theresa May promised during the election campaign earlier this year. Hammond may indicate that selloffs of NHS land and property can plug most or all of that gap.

Sources say that Hammond is also likely to indicate that the government will give the NHS some further money to help cover the cost of the pay rise its 1.4m staff receive next year now that ministers have decided to end the 1% pay cap.

He is likely to say that the exact sum the Treasury will provide will depend on what the two NHS pay review bodies recommend. But sources estimate that Hammond’s pledge could ultimately yield several hundred million pounds for the NHS as each 1% rise in staff pay would cost £500m.

Hammond angered NHS leaders by making clear on BBC1’s Andrew Marr Show on Sunday that he would not bow to the demands by Stevens to raise the NHS budget by £4bn next year. He said he was not persuaded that “armageddon will arrive” without that level of extra investment.

Informed sources say that Hammond and May accept that they have to give the NHS more than the £124.4bn planned in 2018-19 in order to avoid breaking the Conservative manifesto pledge that health spending per head would grow every year of this parliament. Funding needs to grow by at least £310m to avoid that promise being broken.

Chris Ham, the chief executive of the King’s Fund health thinktank, said: “If these numbers are confirmed, they will provide some relief to an NHS struggling to meet rising patient demands with budgets that have been constrained for eight years. However, they fall well short of the £4bn increase we estimate is needed in 2018-19 to prevent standards of care falling further.”

Chris Hopson, the chief executive of NHS Providers, which represents hospital trusts, claimed ministers were expecting the NHS to make unrealistically ambitious improvements to productivity to meet the shortfall in the cost of covering the staff pay rise.

He said: “The economy as a whole has seen average productivity gains of 0.2% a year over the last five years. The historical NHS average has been 1% a year. Thanks to the hard work of trusts, we’ve significantly exceeded both these – realising an average productivity gain of 1.7% a year between 2009-10 and 2014-15.

“And we mustn’t forget that the spending review plans already assume productivity gains of 2-3% a year between now and 2021. Is it really credible to argue that a significant level of further gain can be realised? Or is this a way of justifying a decision not to make the extra investment in the NHS that is needed?”

The Guardian view on gene therapy: money well spent | Editorial

The NHS is to fund a very expensive treatment for a very rare but terrible childhood disorder that leaves babies condemned to life in a sterile bubble. This is a triumph for medical science but it should also provoke some deep and careful thought. The treatment in question, strimvelis, qualifies as the second most expensive drug ever put on the market (the only one more expensive was withdrawn due to lack of demand). A single dose costs nearly £500,000 plus VAT, and can only be administered in Milan, where the preparation is made. On the other hand, that one dose is literally life-saving, and as far as we now know, is the only treatment the disorder will ever need. At the rate that the National Institute for Health and Care Excellence (Nice), is prepared to pay for treatments of rare diseases – £100,000 a year of good life – this represents good value. The calculation may seem heartless, but it is unavoidable. Money spent on one patient is unavailable for all others. Someone, somehow, must decide who benefits.

Looked at purely as a medical advance, this is great. The babies born with this syndrome have two defective copies of a gene essential to the functioning of white blood cells. They are therefore unable to defend themselves against infection and unless kept in wholly sterile surroundings will die of a variety of horrible diseases and developmental disorders before they reach school age. Until now the only treatment was with a stem cell transplant, which was only effective in about three quarters of the cases, and relied on finding matched donors, who are rare. The new treatment removes defective stem cells and replaces their genes with properly functioning versions before returning these to the patients. Once these are incorporated into the bone marrow, they produce healthy white blood cells and the immune system functions as it should. This is how genetic medicine is supposed to work, but has not done reliably until now.

The decision to make the treatment available is clearly correct. But it is also irrelevant to the deeper and more urgent problems of the NHS, which are not caused by a shortage of miracle cures for rare and dramatic diseases. It is the common ills that almost all flesh is heir to that cost most when you add them up. Sorting out social care, making things work away from the headlines: those are the measures that will relieve the most suffering, but compared with medical miracles, political ones are harder.

The Guardian view on gene therapy: money well spent | Editorial

The NHS is to fund a very expensive treatment for a very rare but terrible childhood disorder that leaves babies condemned to life in a sterile bubble. This is a triumph for medical science but it should also provoke some deep and careful thought. The treatment in question, strimvelis, qualifies as the second most expensive drug ever put on the market (the only one more expensive was withdrawn due to lack of demand). A single dose costs nearly £500,000 plus VAT, and can only be administered in Milan, where the preparation is made. On the other hand, that one dose is literally life-saving, and as far as we now know, is the only treatment the disorder will ever need. At the rate that the National Institute for Health and Care Excellence (Nice), is prepared to pay for treatments of rare diseases – £100,000 a year of good life – this represents good value. The calculation may seem heartless, but it is unavoidable. Money spent on one patient is unavailable for all others. Someone, somehow, must decide who benefits.

Looked at purely as a medical advance, this is great. The babies born with this syndrome have two defective copies of a gene essential to the functioning of white blood cells. They are therefore unable to defend themselves against infection and unless kept in wholly sterile surroundings will die of a variety of horrible diseases and developmental disorders before they reach school age. Until now the only treatment was with a stem cell transplant, which was only effective in about three quarters of the cases, and relied on finding matched donors, who are rare. The new treatment removes defective stem cells and replaces their genes with properly functioning versions before returning these to the patients. Once these are incorporated into the bone marrow, they produce healthy white blood cells and the immune system functions as it should. This is how genetic medicine is supposed to work, but has not done reliably until now.

The decision to make the treatment available is clearly correct. But it is also irrelevant to the deeper and more urgent problems of the NHS, which are not caused by a shortage of miracle cures for rare and dramatic diseases. It is the common ills that almost all flesh is heir to that cost most when you add them up. Sorting out social care, making things work away from the headlines: those are the measures that will relieve the most suffering, but compared with medical miracles, political ones are harder.

Children raised by same-sex parents do as well as their peers, study shows

As the marriage equality vote draws toward its close, a comprehensive study published in the Medical Journal of Australia shows children raised in same-sex-parented families do as well as children raised by heterosexual couple parents.

The review of three decades of peer-reviewed research by Melbourne Children’s found children raised in same-sex-parented families did as well emotionally, socially and educationally as their peers.

The study’s findings will undercut one of the arguments that have been used by the No campaign: that children need both a mother and a father to flourish.

The study’s authors said their work aimed to put an end to the misinformation about children of same-sex couples and pointed out that the results had been replicated across independent studies in Australia and internationally.

Titled The Kids are OK: it is Discrimination Not Same-Sex Parents that Harms Children, the report comes as the postal survey voting period enters its final days. Votes must be received by the Australian Bureau of Statistics by November 7 and outcome will be announced on November 15. So far polling has indicated that the Yes campaign is headed for a convincing win.

Among the studies reviewed were the 2017 public policy research portal at Columbia Law School, which reviewed 79 studies investigating the wellbeing of children raised by gay or lesbian parents; a 2014 American Sociological Association review of more than 40 studies, which concluded that children raised by same-sex couples fared as well as other children across a number of wellbeing measures; and the Australian Institute of Family Studies’ 2013 review of the Australian and international research, which showed there was no evidence of harm.

“The findings of these reviews reflect a broader consensus within the fields of family studies and psychology. It is family processes – parenting quality, parental wellbeing, the quality of and satisfaction with relationships within the family) – rather than family structures that make a more meaningful difference to children’s wellbeing and positive development,” the researchers said.

The researchers said that studies reporting poor outcomes had been widely criticised for their methodological limitations. For example the widely quoted Regnerus study compared adults raised by a gay or lesbian parent in any family configuration with adults who were raised in stable, heterosexual, two-parent family environments, which may have distorted the outcomes.

However, the study did find that young people who expressed diversity in their sexual orientation or gender identity experienced some of the highest rates of psychological distress in Australia, said the study’s senior author, Prof Frank Oberklaid.

“Young LGBTIQ+ people are much more likely to experience poor mental health, self-harm and suicide than other young people, “ he said.

“Sadly, this is largely attributed to the harassment, stigma and discrimination they and other LGBTIQ+ individuals and communities face in our society,” Oberklaid said.

Children from Rainbow Families discuss marriage equality plebiscite

He warned that the debate itself had been harmful.

“The negative and discriminatory rhetoric of the current marriage equality debate is damaging the most vulnerable members of our community – children and adolescents. It’s essential that we recognise the potential for the debate about marriage equality to cause harm for our children and young people,” Oberklaid said.

He said there was solid evidence in countries that had legalised same-sex marriage that it had a positive impact on the mental health and wellbeing of same-sex-parented families and LGBTIQ+ young people.

“As part of the medical community we feel a duty of care to all groups in our society, particularly to those who are vulnerable. Our duty extends to making sure that accurate, objective interpretations of the best available evidence are available and inaccuracies are corrected in an effort to reduce the destructiveness of public debate,” Oberklaid said.

He called for an end to the negative messages that could harm children in the final weeks of the voting period.

Melbourne Children’s is made of up of four child health organisations – the Murdoch Children’s Research Institute, the Royal Children’s hospital, the University of Melbourne, department of paediatrics and the Royal Children’s Hospital Foundation.

Will a sugar tax work? Well, it did at Jamie Oliver’s Italian restaurants

Jamie Oliver’s 10p tax on sugary drinks sold in his Italian restaurants has resulted in a significant drop in sales, a study has found.

The Jamie’s Italian chain introduced the sugary drinks tax to set an example as part of a campaign to persuade the government to take action. In June 2015, Oliver announced that every drink containing added sugar would cost 10p extra and that the money would help pay for food education and water fountains in schools.

A study of the effects of the levy, published in the Journal of Epidemiology & Community Health, has found that sales of sugar-sweetened drinks such as colas and lemonades fell by 11% in the first 12 weeks. At the end of six months, sales were 9.3% lower than they had been before the levy was introduced.

Prof Steven Cummins of the department of social and environmental health research at the London School of Hygiene and Tropical Medicine, who carried out the study, acknowledged that the clientele of Oliver’s restaurants tended to be affluent, and that the price hike on a drink costing between £2.60 and £3.25 might not make a lot of difference to them.


We can’t be sure that the fall in consumption of sugary drinks was entirely, or even mainly, caused by the extra 10p

“I don’t think the financial element of it is a massive disincentive,” he said. But he likened it to the plastic bag charge, which prompts people to think about having one.

The menu explains the purpose of the levy and, at the time of the launch, Oliver was fronting a television documentary on the potential damage of sugary drinks to children’s health, called Jamie’s Sugar Rush.

When it came to the government tax on drinks containing added sugar, which begins in April 2018 – assuming it is passed on to the consumer and not absorbed by some of the multinational companies making popular drinks – the impact would likely depend on how much educational messaging accompanied the price rise, said Cummins.

“If you want to optimise the effect at point-of-sale [in shops], perhaps signage or other elements that could be put on the shelves themselves might have an impact over and above the financial incentive,” he said.

In the 12 months leading up to the introduction of the levy, more than 2m non-alcoholic drinks were sold in the 37 Jamie’s Italian restaurants, of which 38% (773,230) were sugar sweetened.

The drop in sales at six months of 9.3% was only in the restaurants that previously had higher levels of sales of sweetened drinks. There was a general drop in sales on non-alcoholic beverages, except for fruit juices, which went up. There is no evidence as yet on whether alcohol sales also went up. Cummins said it was possible that more people were drinking tap water, which is not billed and therefore did not appear in the sales figures.

He said he thought the effect was “entirely transferable” to other less expensive chains. “There is no reason why other restaurants couldn’t do exactly the same,” he said. Those that have the highest sales of sweetened drinks would be likely to have the biggest falls.

Susan Jebb, professor of diet and population health at the University of Oxford said this was the first evidence of the effects of a price rise in a restaurant setting and could not be considered conclusive.

“Nonetheless this is a careful analysis and shows a greater than anticipated fall in sales, which is encouraging news for public health ahead of the introduction of the soft drink industry levy next year,” she said.

“Surprisingly, and unlike the experience in some other countries, there was also a decline in low- and no-sugar drinks, which is harder to explain. The gap in the paper is data on alcohol sales, since any compensatory increase (which may or may not have occurred) would be of considerable concern given the potential contribution to energy intake and health harms. Businesses will also want to understand more about the likely impact on turnover.”

Kevin McConway, emeritus professor of applied statistics at the Open University, said there was a lot more going on than just the price increase. “The menu was redesigned: it explained that the proceeds of the levy would go to the Children’s Health Fund, new drink products were introduced, and Jamie himself appeared in a television programme about sugar. So we certainly can’t be sure that the fall in consumption of sugary drinks was entirely, or even mainly, caused by the extra 10p.

“The researchers do provide some circumstantial evidence that the 10p played a role in the reduction in consumption, but they (rightly) make it clear that a study like this can’t prove what caused what. Actually, it doesn’t even establish that any of the specific changes at Jamie’s Italian restaurants had anything to do with the lower consumption – for instance, the researchers had no data from any other restaurants, and maybe consumption fell there as well.

“Jamie Oliver isn’t the only person to have been on TV pointing out the health consequences of too much sugar, and the general publicity that sugary drinks are bad for health is likely to have had some general effect on consumption,” McConway said.

Will a sugar tax work? Well, it did at Jamie Oliver’s Italian restaurants

Jamie Oliver’s 10p tax on sugary drinks sold in his Italian restaurants has resulted in a significant drop in sales, a study has found.

The Jamie’s Italian chain introduced the sugary drinks tax to set an example as part of a campaign to persuade the government to take action. In June 2015, Oliver announced that every drink containing added sugar would cost 10p extra and that the money would help pay for food education and water fountains in schools.

A study of the effects of the levy, published in the Journal of Epidemiology & Community Health, has found that sales of sugar-sweetened drinks such as colas and lemonades fell by 11% in the first 12 weeks. At the end of six months, sales were 9.3% lower than they had been before the levy was introduced.

Prof Steven Cummins of the department of social and environmental health research at the London School of Hygiene and Tropical Medicine, who carried out the study, acknowledged that the clientele of Oliver’s restaurants tended to be affluent, and that the price hike on a drink costing between £2.60 and £3.25 might not make a lot of difference to them.


We can’t be sure that the fall in consumption of sugary drinks was entirely, or even mainly, caused by the extra 10p

“I don’t think the financial element of it is a massive disincentive,” he said. But he likened it to the plastic bag charge, which prompts people to think about having one.

The menu explains the purpose of the levy and, at the time of the launch, Oliver was fronting a television documentary on the potential damage of sugary drinks to children’s health, called Jamie’s Sugar Rush.

When it came to the government tax on drinks containing added sugar, which begins in April 2018 – assuming it is passed on to the consumer and not absorbed by some of the multinational companies making popular drinks – the impact would likely depend on how much educational messaging accompanied the price rise, said Cummins.

“If you want to optimise the effect at point-of-sale [in shops], perhaps signage or other elements that could be put on the shelves themselves might have an impact over and above the financial incentive,” he said.

In the 12 months leading up to the introduction of the levy, more than 2m non-alcoholic drinks were sold in the 37 Jamie’s Italian restaurants, of which 38% (773,230) were sugar sweetened.

The drop in sales at six months of 9.3% was only in the restaurants that previously had higher levels of sales of sweetened drinks. There was a general drop in sales on non-alcoholic beverages, except for fruit juices, which went up. There is no evidence as yet on whether alcohol sales also went up. Cummins said it was possible that more people were drinking tap water, which is not billed and therefore did not appear in the sales figures.

He said he thought the effect was “entirely transferable” to other less expensive chains. “There is no reason why other restaurants couldn’t do exactly the same,” he said. Those that have the highest sales of sweetened drinks would be likely to have the biggest falls.

Susan Jebb, professor of diet and population health at the University of Oxford said this was the first evidence of the effects of a price rise in a restaurant setting and could not be considered conclusive.

“Nonetheless this is a careful analysis and shows a greater than anticipated fall in sales, which is encouraging news for public health ahead of the introduction of the soft drink industry levy next year,” she said.

“Surprisingly, and unlike the experience in some other countries, there was also a decline in low- and no-sugar drinks, which is harder to explain. The gap in the paper is data on alcohol sales, since any compensatory increase (which may or may not have occurred) would be of considerable concern given the potential contribution to energy intake and health harms. Businesses will also want to understand more about the likely impact on turnover.”

Kevin McConway, emeritus professor of applied statistics at the Open University, said there was a lot more going on than just the price increase. “The menu was redesigned: it explained that the proceeds of the levy would go to the Children’s Health Fund, new drink products were introduced, and Jamie himself appeared in a television programme about sugar. So we certainly can’t be sure that the fall in consumption of sugary drinks was entirely, or even mainly, caused by the extra 10p.

“The researchers do provide some circumstantial evidence that the 10p played a role in the reduction in consumption, but they (rightly) make it clear that a study like this can’t prove what caused what. Actually, it doesn’t even establish that any of the specific changes at Jamie’s Italian restaurants had anything to do with the lower consumption – for instance, the researchers had no data from any other restaurants, and maybe consumption fell there as well.

“Jamie Oliver isn’t the only person to have been on TV pointing out the health consequences of too much sugar, and the general publicity that sugary drinks are bad for health is likely to have had some general effect on consumption,” McConway said.