Tag Archives: well

Arts can help recovery from illness and keep people well, report says

GPs prescribing arts activities to some ill patients could lead to a dramatic fall in hospital admissions and save the NHS money, according to a new report into the subject of arts, health and wellbeing published after two years of evidence-gathering.

The inquiry report was published on Wednesday; a huge document that includes hundreds of interviews and dozens of case studies showing how powerfully the arts can contribute to people’s health and wellbeing.

David Shrigley illustration


Illustration: David Shrigley

Co-chaired by former arts ministers Alan Howarth and Ed Vaizey, the all-party inquiry contends that the arts can keep people well, aid recovery from illness, help people to live longer, better lives and save money in health and social services.

Lord Howarth said it was a comprehensive review of evidence that had never been produced before. “Sceptics say where is the evidence of the efficacy of the arts in health? Where is the evidence of the value for money it can provide? We show it in this report.

“The arts can help people take responsibility for their own health and wellbeing in ways that will be crucial to the health of the nation.”

Art helps you see


Illustration: David Shrigley

The report was welcomed by the current arts minister, John Glen, appointed five weeks ago. He pledged to act on its recommendations, saying: “This sort of work isn’t window-dressing, please don’t be cynical about it. It gives a dataset and some real stories that we can use as we go through the treacle of Whitehall.”

The case studies include an Artlift arts-on-prescription project in Gloucestershire where patients with a wide range of conditions, from depression to chronic pain to stroke, were referred to an eight-week course involving poetry, ceramics, drawing, mosaic or painting.

A cost-benefit analysis showed a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. That represents an NHS saving of £216 per patient.

The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients


The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients.

Strokestra, a collaboration between the Royal Philharmonic Orchestra and Hull stroke service, found that 86% of patients felt music-making sessions – which included percussion and conducting – relieved their symptoms and improved their sleep.

The report also includes contributions from artists including David Shrigley, who has provided illustrations, and Grayson Perry, who writes: “Making and consuming art lifts our spirits and keeps us sane. Art, like science and religion, helps us make meaning from our lives, and to make meaning is to make us feel better.”

Howarth said there were many examples of good practice and innovation around the UK, but also areas where little was going on.

'The arts' sun shining on a sunflower


Illustration: David Shrigley

“We are calling for an informed and open-minded willingness to accept that the arts can make a significant contribution to addressing a number of the pressing issues faced by our health and social care systems.”

The report makes 10 “modest and feasible” recommendations that would not need additional public spending or require new legislation, the report authors said.

They include setting up a philanthropically funded strategic centre to support good practice, promote collaboration and coordinate research.

There are also recommendations about politicians and policymakers from different areas working better together, something Vaizey acknowledged was an issue.

Arts minister for six years until being sacked by Theresa May, Vaizey added: “I was very conscious as a minister that I worked in a silo and it was incredibly hard to break out of that silo, incredibly hard to engage with ministers from other government departments. The arts, almost more than any sector, is a classic example where silo working does not work.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing report is available here.

Arts can help recovery from illness and keep people well, report says

GPs prescribing arts activities to some ill patients could lead to a dramatic fall in hospital admissions and save the NHS money, according to a new report into the subject of arts, health and wellbeing published after two years of evidence-gathering.

The inquiry report was published on Wednesday; a huge document that includes hundreds of interviews and dozens of case studies showing how powerfully the arts can contribute to people’s health and wellbeing.

David Shrigley illustration


Illustration: David Shrigley

Co-chaired by former arts ministers Alan Howarth and Ed Vaizey, the all-party inquiry contends that the arts can keep people well, aid recovery from illness, help people to live longer, better lives and save money in health and social services.

Lord Howarth said it was a comprehensive review of evidence that had never been produced before. “Sceptics say where is the evidence of the efficacy of the arts in health? Where is the evidence of the value for money it can provide? We show it in this report.

“The arts can help people take responsibility for their own health and wellbeing in ways that will be crucial to the health of the nation.”

Art helps you see


Illustration: David Shrigley

The report was welcomed by the current arts minister, John Glen, appointed five weeks ago. He pledged to act on its recommendations, saying: “This sort of work isn’t window-dressing, please don’t be cynical about it. It gives a dataset and some real stories that we can use as we go through the treacle of Whitehall.”

The case studies include an Artlift arts-on-prescription project in Gloucestershire where patients with a wide range of conditions, from depression to chronic pain to stroke, were referred to an eight-week course involving poetry, ceramics, drawing, mosaic or painting.

A cost-benefit analysis showed a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. That represents an NHS saving of £216 per patient.

The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients


The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients.

Strokestra, a collaboration between the Royal Philharmonic Orchestra and Hull stroke service, found that 86% of patients felt music-making sessions – which included percussion and conducting – relieved their symptoms and improved their sleep.

The report also includes contributions from artists including David Shrigley, who has provided illustrations, and Grayson Perry, who writes: “Making and consuming art lifts our spirits and keeps us sane. Art, like science and religion, helps us make meaning from our lives, and to make meaning is to make us feel better.”

Howarth said there were many examples of good practice and innovation around the UK, but also areas where little was going on.

'The arts' sun shining on a sunflower


Illustration: David Shrigley

“We are calling for an informed and open-minded willingness to accept that the arts can make a significant contribution to addressing a number of the pressing issues faced by our health and social care systems.”

The report makes 10 “modest and feasible” recommendations that would not need additional public spending or require new legislation, the report authors said.

They include setting up a philanthropically funded strategic centre to support good practice, promote collaboration and coordinate research.

There are also recommendations about politicians and policymakers from different areas working better together, something Vaizey acknowledged was an issue.

Arts minister for six years until being sacked by Theresa May, Vaizey added: “I was very conscious as a minister that I worked in a silo and it was incredibly hard to break out of that silo, incredibly hard to engage with ministers from other government departments. The arts, almost more than any sector, is a classic example where silo working does not work.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing report is available here.

Men are affected by the biological clock as well, researchers find

For men who are reluctant to start a family, it is an age-old defence: there is no need to rush into fatherhood, as Des O’Connor, Luciano Pavarotti and countless rock stars have proved when they had children well after they qualified for their bus passes.

But men, just like women, can wait too long, doctors warn. A new study reveals that a couple’s chances of having a baby fall with the man’s age, to the point that it can have a substantial impact on their ability to start a family.

Laura Dodge, who led the research at the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, said that couples should bear the findings in mind when planning a family. “When making this decision, they should also be considering the man’s age,” she said.

Scientists have long known that a woman’s chances of conceiving naturally drop sharply from the age of 35, but fertility research has focused so much on women that male factors are less well understood. “The impact of age seems to focus almost exclusively on the female partner’s biological clock,” Dodge said.

To investigate the impact of a man’s age on a couple’s chances of having a baby, Dodge and her colleagues studied records of nearly 19,000 IVF treatment cycles in the Boston area between 2000 and 2014. The women were divided into four age bands: those under 30, 30-35 year-olds, 35-40 year-olds, and those aged 40-42. The men were divided into the same age brackets with an extra band for the over 42s. Some of the couples had received up to six cycles of IVF.

Dodge then looked at how age affected couples’ chances of having a live birth. As expected, women in the 40-42 age bracket had the lowest birth rates, and for these women the male partner’s age had no impact.

But for younger women the man’s age mattered. Women aged under 30 with a male partner aged 30 to 35 had a 73% chance of a live birth after IVF. But that impressive success rate fell to 46% when the man was aged 40 to 42. Whether they can hear it or not, the biological clock ticks for men too.

The study, to be reported at the European Society of Human Reproduction and Embryology meeting in Geneva on Tuesday, found that male age had no real impact on birth rate when his partner was the same age. But some women did benefit from being with younger men. When women aged 35-40 partnered with men aged 30-35, their chances of having a baby stood at 54%, a figure that rose to 70% when the man was under 30. On average, women aged 30 to 35 who had older male partners had live birth rates of 64% compared with 70% if the man was in the same age bracket.

“The value of this is not only in counselling couples,” said Nick Macklon, professor of obstetrics and gynaecology at the University of Southampton, who was not involved in the study. “It may help women to encourage their male partners to get a move on. We know from a number of studies that one of the reasons why women are having babies later is because men are sometimes slow to support the idea.

“This reminds us that it takes two to tango and it’s not just down to the age of the woman.” The research comes a year after scientists at the University of Copenhagen found that children born to older fathers had a greater risk of developing autism.

Researchers are not entirely sure why male fertility decreases with age. Women are born with their life’s store of eggs which accumulate mutations as they age. As a result, the overwhelming cause of infertility in older women is a rise in abnormal chromosomes in their eggs. In men, the ageing process affects sperm quality, making it harder to achieve a pregnancy and increasing the risk of miscarriage.

“Declining sperm quality certainly plays some role, but our work shows that this is not the whole picture,” Dodge said. “We found similar results among couples with no documented male infertility, so something else is happening.” Even though men produce fresh sperm every day, the cells the sperm are made from gather their own mutations, and older sperm carries more DNA damage. Dodge now plans more studies to investigate the causes.

“This is something we’ve suspected is the case, that male age probably has an effect on the success rate of fertility treatment,” said Raj Mathur, clinical lead for reproductive medicine at Manchester Fertility. “It is important and perhaps clinicians should start, when they are counselling couples, to take into account the age of the man as well.” He added that scientists should now study data held by the UK fertility regulator, the Human Fertilisation and Embryology Authority, to confirm the effect in a larger number of people. “It would answer this question more definitively,” he said.

Sugar tax must apply to sweets as well as drinks, say campaigners

The sugar tax should be extended to cover sweets, not just soft drinks, according to public health campaigners. The charity Action on Sugar said it wanted ministers to get tough on childhood obesity by forcing confectionery manufacturers to reduce the sugar in their products.

Chocolates and sweet confectionery account for 9% of all the sugar eaten by children aged between four and 10 and for 11% by those aged between 11 and 18.

The levy, which is due to come into force in the UK affecting heavily sugared fizzy drinks from next year, should also be applied to sweet treats sold in coffee shops and restaurants because those often contained a lot of sugar and calories, the campaign group said.

Under the new rules, producers or importers of soft drinks will have to pay a sugar tax of 18p per litre on drinks containing five grams or more of sugar per 100 millilitres and 24p per litre more if their products contain eight grams or more per 100 millilitres. The Treasury expects the levy to raise £520m a year.

“Action on Sugar is urging the next government to implement a mandatory sugar levy on all confectionery products that contain high levels of sugar to ensure maximum impact to help tackle the obesity and type 2 diabetes crisis,” said Graham McGregor, Action on Sugar’s chairman, who is professor of cardiovascular medicine at Queen Mary University of London.

“The levy should be structured by the Treasury as per the soft drinks industry levy, whereby it is aimed at manufacturers to encourage them to reduce sugar in their overall product ranges. The next government needs to bring in tough measures to ensure compliance and put public health before the profits of the food industry.”

Dentists in Britain backed the move as a way of tackling tooth decay. “When the sugar levy is already showing that progress is possible, it makes no sense to draw an arbitrary line and ignore the likes of sweets or energy drinks that are so aggressively marketed at children,” said Mick Armstrong, chair of the British Dental Association. “Ministers keep giving the impression that it’s ‘mission accomplished’ on sugar controls. Dentists are confronting an epidemic of tooth decay and government must show it is prepared to go further on advertising, reformulation targets and through the tax system.”

A sugar tax on sweets had to be mandatory because “voluntary sugar reduction vis reformulation alone will not combat obesity”, said McGregor.

Conservative sources said they would not be extending the sugar tax. “Reducing childhood obesity is vital, and we’re pleased that Public Health England says that our plan to address it is the most ambitious in the world,” a source said.

The Food and Drink Federation, which represents manufacturers, recently warned that the 20% cut in sugar content of most types of foodstuffs being sought by Public Health England by 2020 was highly unlikely to happen because it would not be “technically possible, or acceptable to UK consumers”.

Fact check: how well does your birth control work?

Hello, how are you today? If you’ve got a uterus, maybe the answer is “not so great” – especially if you’ve heard reports about Donald Trump’s latest appointee. The woman tipped for a key family planning role, Teresa Manning, has previously worked with an anti-abortion group as well as an anti-LGBT rights lobbying group.

If Manning is appointed as deputy assistant secretary for population affairs at the Department of Health and Human Services, she would have oversight of the federal program that provides contraceptive services to low-income and uninsured women and men.

Manning, who is a law professor, has said “family planning is something that occurs between a husband and a wife and God, and it doesn’t really involve the federal government”. I won’t be fact-checking that statement (because it’s tricky to prove who does and who does not have a direct line to chat to God), but rather Manning’s claim that contraception doesn’t work well.

Here’s Manning’s statement in full which she gave in full during a radio interview:

Its efficacy is very low, especially when you consider over years – which, a lot of contraception health advocates want to start women in their adolescent years, when they’re extremely fertile, incidentally, and continue for 10, 20, 30 years. The prospect that contraception would always prevent the conception of a child is preposterous.

Let’s fact-check this.

Step 1: Do an internet search for “contraception efficacy rates”. You’ll very quickly land at this summary published by the Centers for Disease Control and Prevention (CDC). It shows that the effectiveness of contraception varies depending on which method is being used.

They range from spermicide (which is the least effective, with about 28 out of every 100 women who use it becoming pregnant on average within the first year of typical use) to the hormonal implant (which is the most effective, with one out of every 200 women becoming pregnant in the first year of typical use).

Step 2: Check the reliability of your source. While Wikipedia is certainly not the most accurate site on the internet, the thousands of editors who regularly work there can be more inclined to dig up criticism than the standard “about” page on a website.

The Wikipedia page on the CDC offers few leads about a corrupt, biased organization – rather, the CDC is simply described as a federal agency whose “main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally”. The organization doesn’t seem to have an interest in overstating the effectiveness of contraception.

Step 3: Understand the terms used. The CDC talks about “typical use” and that seems kind of important, so I repeat the same internet search but this time with those two words added in there.

I land at this New York Times page, which has been built using data compiled by James Trussell from the Office of Population Research at Princeton University and also the Brookings Institution. Here’s how they define typical use:

“This is the norm, reflecting the effectiveness of each method for the average couple who do not always use it correctly or consistently.”

That makes sense. It is part of the reason why methods that require planning (eg “Babe, do you have the spermicide?”) or some other action before or during sex (“Don’t worry, I’ll pull out in time”) are much less effective than those that don’t (hormonal implants, intra-uterine devices and sterilization require much less upkeep).

Perfect use, by the way, is defined as:

“A measure of the technical effectiveness of each method, but only when used exactly as specified and consistently followed. Few couples, if any, achieve flawless contraceptive use, especially over long time periods.”

If 100 women were to use the pull-out or withdrawal method “perfectly”, 34 of them would wind up pregnant within 10 years (yep, that’s the 10-year use period Manning mentioned). But even with perfect use, there’s still a significant gap between different contraceptive methods. If those same women were to use a hormonal implant, chances are only one would be pregnant at the end of 10 years.

By appointing Manning, an opponent of Planned Parenthood, Trump takes another step towards his goal: defunding it. As a result, the availability of contraception such as the hormonal implant will be curtailed.

Step 4: Find a sexually active woman and listen to what she has to say. Ask her whether she wants to have the freedom to choose.

Would you like to see something fact-checked? Send me your questions! mona.chalabi@theguardian.com / @MonaChalabi

How Well Do You Know Your Medicine Cabinet?

We live in a self-prescribing society where many of us like to self-diagnose our symptoms and treat them with over-the-counter (OTC) medications. According to the Consumer Healthcare Products Association (CHPA), without OTC drugs, approximately 60 million Americans would not seek treatment for their illness.

The CHPA also estimates that U.S. households spend about $ 338 a year on OTC products.  Although OTC medicine is convenient and easy to use, many people may not know about the potentially dangerous side effects that can result in using such medicines.

How well do you know the OTC products in your medicine cabinet?

  1. Pain Relievers

If you check out any “must have in your medicine cabinet” list, pain relievers usually make the top of the list. An OTC pain reliever is either ibuprofen (Advil), acetaminophen (Tylenol), or naproxen (Aleve).

Although these types of pain relievers seem less dangerous than pain medication prescribed by a doctor, they can cause an increase in blood pressure, kidney damage, and gastrointestinal issues. Always talk with your doctor before taking a seemingly harmless pain reliever.

  1. Cold Medicine

Although there’s no tried and true cure to getting rid of a cold, many people rely on cold medicine that often contains acetaminophen, dextromethorphan, doxylamine, and pseudoephedrine.

One of the biggest dangers of OTC cold medicine is simply failing to read or follow the directions. Cold medicines should never be mixed with other pain relievers, like acetaminophen, because one could end up taking more than the daily dose without knowing.

  1. Vitamins and Herbal Supplements

Vitamins and herbal supplements are a great way to fill in any “gaps” that may be missing from your diet. Some supplements are designed to be a “safer” remedy for similar medications. It’s important to note that most vitamins and herbal supplements are not regulated by the FDA.

Many people who take these kinds of OTC products have little knowledge on the ingredients and may mix them with other OTC medications; the results can be dangerous. Take the supplement St. John’s Wort (for anxiety) and cold medicine. Mixing the two have been known to have a fatal outcome.

  1. Laxatives

Some individuals take laxatives to help stay regular, and while this seemingly safe OTC drug is used by young and old alike, it can cause dehydration and kidney issues due to improper dosing.

Considerations Before Taking

While there are hundreds of OTC drugs that are safe and effective, it’s always important to know what you are taking before you try to treat any symptoms. Dangerous side effects are more likely to occur when people don’t read the directions and don’t give or take the proper dosage.

Additionally, some adverse effects happen because people don’t know enough about their health, such as allergies, blood pressure, or any underlying issues. Even if you would rather take OTC drugs than prescription medications, it’s a good idea to have a check-up with your doctor and always tell him or her what OTC medicines you take.

Boys as well as girls should be told about the evils of FGM

Lynne Featherstone, the Liberal Democrat parliamentarian who was once a home office minister, and Justine Greening, the education secretary, have written to Theresa May asking that she will allow girls’ schools to teach pupils what a bad idea female genital mutilation (FGM) is, so that the poor things will know how they can avoid being so tortured.

I can’t remember when I first heard of FGM – presumably when being told all about strange foreign places and habits, while absorbing the oddities of geography at school or later. The tiresome fact is that while the clitoris exists to make reproduction agreeable so that the species will continue, FGM makes reproduction the exact opposite when its painful removal is deemed necessary by any tribe or group.


I know that it is often older women who do the actual chopping

So there is no harm in warning young girls, but you would think the males ought to be the ones to be lectured on the subject. (I know that in the hot places where the habit comes from, it is often other women, older women, who do the actual chopping – perhaps partly to be sure that lush young girls are not keen to attract all the older chaps.)

I do think that it should be the boys’ schools that make sure the pupils are aware of the awfulness of FGM, so that girls and women will not be in for a bad time at the mercy of boys and men who don’t see the usefulness of the clitoris at all.

There’s no harm in sensible information being available for all, but surely it’s the males that need educating.

What do you think? Have your say below

Soon we’ll be able to spot diseases like cancer before we even feel sick

The sooner a disease is diagnosed, the more likely it is to be well managed or cured. The challenge to finding a disease early is that most of us don’t seek treatment until we have symptoms, which means the disease has already progressed.

But breakthroughs in nanobiotechnology techniques mean that in five years we will be able to examine and filter bodily fluids for tiny bioparticles that reveal signs of disease like cancer before we have any symptoms, letting us know immediately if we should consult a doctor.

Information about the state of our health can be extracted from tiny bioparticles in bodily fluids such as saliva, tears, blood, urine and sweat called exosomes. These particles were first discovered in the 1980s as vesicles secreted by immature red blood cells, but later they were found to be secreted in all cell types. Scientists discovered that exosomes carry information from the cell they originated from, including proteins, RNA (ribonucleic acid) and DNA. Because the state of the originating cell can be inferred from these exosomes, they have been considered as potential biomarkers of disease for more than a decade. Besides cancer, exosomes are being considered as insightful for central nervous system diseases (Alzheimer’s, multiple sclerosis and stroke), renal fibrosis and cardiovascular disease.

At the moment it’s difficult to capture and analyse these bioparticles as they are thousands of times smaller than the diameter of a strand of human hair. But at IBM Research we are developing lab-on-a-chip nanotechnology that can separate and isolate bioparticles down to 20 nanometres in diameter, a scale that gives access to DNA, viruses and exosomes. These particles could be analysed to potentially reveal signs of disease even before we have symptoms.

This technique is known as liquid biopsy, designed to be more accessible, comfortable and convenient than the traditional tissue biopsy or cancer screening techniques many of us are familiar with. The goal is to shrink down to a single silicon chip all of the processes necessary to analyse a disease that would normally be carried out in a full-scale biochemistry lab.

In the future, the lab-on-a-chip technology could be packaged in a convenient handheld device to allow people to measure the presence of biomarkers found in small amounts of bodily fluids, streaming this information into the cloud from the convenience of their home. There it could be combined with health data from other IoT-enabled devices, like sleep monitors and smartwatches, and analysed by artificial intelligence systems for insights. When taken together, this dataset will give us an in-depth view of our health and alert us to the first signs of trouble, helping to stop disease before it progresses.

Young woman suffering from cancer


Treating a disease like cancer is expensive. According to Cancer Research UK, there was a 10% annual increase in cancer drugs prices from 1995-2013. Photograph: KatarzynaBialasiewicz/Getty Images/iStockphoto

The next five years will see significant advances in the application and development of this technology. Practically speaking, it’s difficult to say confidently that it will be in widespread use in our homes by 2022, but based on current developments and advances in research, this innovation will likely be used by physicians in some capacity by that time.

The vision for this technology is that it could be used anywhere in the world, from remote rural locations to developed urban areas. To reach the people who need it most, the technology must be affordable. Putting these capabilities on a regular silicon chip means they can be manufactured inexpensively. The challenge will be to do so at a scale that can reach people worldwide while also educating users and physicians on its benefits.

As we all know, treating a disease like cancer is expensive, and rising. According to Cancer Research UK, there was a 10% annual increase in cancer drugs prices from 1995-2013 and many new immunotherapies have price tags of over £100,000 per patient per year. When your doctor can diagnose cancer in its early stages, your odds of financial hardship – and death – decrease significantly. By making it nearly as easy to detect early stage cancer as taking a home pregnancy test, you could argue that we will change the economics of cancer. If all goes well, we may greatly diminish the physical and emotional toll of this terrible disease for future generations.

Gustavo Stolovitzky is program director of Translational Systems Biology and Nanobiotechnology at IBM Research

The Guardian view on social care: a crisis of politics as well as finance | Editorial

No one who has experienced adult social care – whether as patient or provider – will have been surprised by the Care Quality Commission’s verdict this week that cuts to local authority services had reached a “tipping point”, with grave consequences for the NHS. Council-run care services were not included in the Treasury “ringfence” around health spending. Since local authorities face cumulative budget cuts of up to 40%, much of the burden of looking after elderly people is transferred to hospitals. Elderly inpatients, many of whom should be discharged for treatment at home, then “block” beds on wards. There is nothing sustainable or conscionable about a system that treats the elderly as a liability to be shunted around an unfathomably complex system.

For that reason a consensus in policy circles has emerged around the idea that NHS and social care services should be merged. But there is no agreed method. One attempt to integrate a range of national services in eastern England failed last year in the ninth month of a five-year contract worth £800m. The National Audit Office blamed failure to anticipate demand on services, underestimated costs, and structures that meant patient accountability slipped through gaps between commissioners and outsourced providers of care. Many people do not realise that social care is a labyrinth of NHS, local government and private-sector provision until they are lost in the maze. And ministers have shied away from confronting voters with painful truths about cost. A cap on the amount any individual should expect to pay, originally due this year, has been deferred to 2020. Even then, the cap will not include bed and board, so residential care will quickly consume the savings of those who do not pass a stringent means test.

The government has tried to divert a few extra resources towards this cinderella service, but there has been nothing to match the scale of the challenge, which grows as society ages. The number of citizens over 85 will double within a generation. A first step towards grappling with the crisis involves setting aside tribal party hostilities. When the last Labour government considered a levy on inheritance to fund social care, the Tories cynically denounced the measure as a gruesome “death tax”. Labour’s preference in opposition for impugning the motives of Conservatives – as if they are incapable of compassion – hasn’t raised the tone of debate.

Politicians will have to decommission these old rhetorical weapons. The left will have to accept that Conservatives who see a role for the private sector in reforms are not driven by evil intent to denude the public realm of assets. The right must concede that Labour looks at taxes not because it relishes confiscation from the middle classes, but because taxation might be the best way for a society to pool resources in the collective interest. As Theresa May told the party faithful, tax is “the price we pay for living in a civilised society”. A crisis of this order transcends party allegiance. Social care and the NHS will have to be better integrated. Any feasible solution will involve a mix of public and private provision, coupled with public funding through higher taxes. Traditional divisions at Westminster make it difficult to build the kind of consensus required to design a solution along those lines. But without such a consensus, the prospects for a solution – and an ageing society – are bleak.

Free movement of doctors has served the NHS well | Letters

The government, the NHS and the public need to value and support all NHS staff, wherever they are from (Hunt promises to end NHS reliance on overseas doctors, 4 October). The recent announcement of 1,500 extra medical school places is welcome. But, as over a quarter of current NHS doctors are from overseas, the extra places will not in themselves produce a self-sufficient UK medical workforce, and we will still need our overseas doctors.

The announcement has led to our colleagues from overseas feeling that they may not be as valued as UK doctors and is affecting morale. We cannot let this happen.

Currently a quarter of NHS doctors are from overseas, and the NHS has benefited from their talents, their abilities and their will to work with us in the UK. We must continue to support them, despite the insecurity caused by the Brexit situation, and reassure them that they are valued and needed.

Diseases know no borders, and medicine has therefore developed as an international profession, with global cooperation in research, drug development, standards of patient care, and free movement of doctors around the world. This model has served the UK and the NHS well for decades. Moving away from it is a major risk to the success of the NHS.
Professor Jane Dacre
President, Royal College of Physicians
Clare Marx
President, Royal College of Surgeons

While the government’s proposed ban on UK-trained doctors working overseas may sound appealing, it is a tacit admission of failure.

As part of my training I benefited greatly from working in a rural African setting. Quite apart from what I hope I contributed, I returned to the UK with new skills, greater knowledge and full of enthusiasm for my chosen profession.

Ever since, I have encouraged my junior colleagues to embrace any opportunity to work in a developing country. Many choose to do so after two years of working – the logical time in the highly structured and inflexible (government-imposed) training structure.

I suspect the health secretary imagines doctors are rushing to work in Australia and New Zealand – and of course some do. But a thoughtless blanket four-year ban will have consequences for many developing countries that benefit from UK doctors. The proposed ban is necessary only because the failure to support the NHS has led to it becoming such a stressful place in which to work. People do not choose to go and live thousands of miles from their family and friends if they are enjoying their work.

Rather than yet another negative restriction on junior doctors’ working lives, can I suggest the health secretary reflect on a more carrot-oriented approach: that of making the NHS such a fulfilling and exciting place to work that anyone who chooses to spend some time overseas spends that year moaning about how great it is back in the UK and returns promptly.
Dr Ed Moran
Consultant in infectious disease, Heartlands Hospital, Birmingham

Jeremy Hunt has proposed that young doctors should be prevented from working overseas for a period of four years after qualifying in order to alleviate the staffing crisis in the NHS, or else face a fine by paying back some of their training costs. Perhaps I could propose that former cabinet ministers be prevented from taking up lucrative directorships or consultancies with private companies for four years after leaving office. After all, much of their expertise and their contacts would have been accrued at taxpayers’ expense while they were in post.
Dr John Nottingham
Ravensthorpe, Northamptonshire

Jeremy Hunt should also commit himself and his government to ending our reliance on bricklayers, plumbers, joiners and workers in many other trades and industries. How could they do this? By making employers offer decent pay and conditions. That would make such employment attractive to Britons who, justifiably, expect to be treated decently and are not as desperate as others.
David Hibbert
Chadderton, Greater Manchester

Theresa May’s statement “Our NHS” (Key points, 6 October) needs to be backed up by immediate real-term funding. Her quote is reminiscent of the phrase “the NHS is safe in our hands”. Yet under every Conservative prime minister since 1980 the proportion of the nation’s GDP going to health has fallen.

Who can disagree with Margaret Thatcher’s “we can only have the services we can afford”? But over the years we have not afforded as much as other western nations – currently running at 9.1% compared with Germany’s 10.3% and France’s 11.6%. Yet our research shows that the NHS is still one of the most effective and efficient in reducing feasible adult deaths.

Every prime minister should be held to account so we can test between rhetoric and delivery.
Professor Colin Pritchard
Southampton

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