Wednesday, 18 May 2016

Serbian vets advocate free for all pet euthanasia

A decision by the Serbian Veterinary Association (SVA) to support the decriminalisation of pet euthanasia in any and all circumstances has generated huge controversy.

Pet advocate groups have expressed concern about how such a change in the law might be abused by those who feel that having a pet is no longer convenient for them, or who have simply grown tired of their pets or can’t be bothered looking after them.  

Critics say that vets should be concerned about the rights of pets and not just go with pet owners’ personal preferences. Pets, they argue, are vulnerable animals and deserve stronger legal protection from those who may have a financial or emotional interest in their deaths.

Ilena Berovic, CEO of the animal charity ‘Pet Protection’ said, ‘Vets should protect the rights of pets as well as proving services to pet owners. There should be strong protection in law to safeguard against the exploitation, neglect or abuse of pets. Pets cannot speak for themselves or defend themselves so vets need to be their voice and defence.’

The SVA does not agree and has today defended its new policy. I reproduce here a statement (translated from Serbian) from the SVA president justifying the move.

‘Let me put the record straight about what the SVA is actually supporting. It is in favour of decriminalising pet euthanasia. In keeping with this position, the SVA does not believe it is right that in the 21st century those pet owners who choose to have their pets euthanized can be criminalised. 

Put simply, this means they can be sent to jail for pet euthanasia, unless it is within the parameters of the Pet Euthanasia Act, which effectively gives other people control over pet owners’ decision-making.

The Pet Euthanasia Act requires that two vets approve every case of pet euthanasia, which can cause delays in and prolong this very difficult time for pet owners. Provisions in the Act are also used to prevent pet owners using the ‘pet euthanasia pill’ at home in their own time, requiring instead that they attend multiple appointments at a clinic, denying them choice over when the euthanasia is carried out.

If we are to be advocates for pet owners, then we must advocate for choice on all aspects of their care.

Accordingly, the SVA believes that pet euthanasia should be removed from the criminal law. That is why we took the decision to back the campaign calling for the decriminalisation of pet euthanasia across Serbia. The campaign calls for every pet owner to be given the necessary information to make their own informed choice as to whether or not to continue with a pet. The SVA is not advocating for or against pet euthanasia.

Nor is the SVA arguing for a complete free-for-all, with no controls. Rather, we are recommending that pet euthanasia procedures be regulated in the same way as all other procedures relating to pet healthcare. This would mean that decisions on pet euthanasia would occur in the same way that any other treatment decisions are reached, through discussion between the owner, their vets and other veterinary staff.

The SVA believes that if we are to be advocates for pet owners then we must advocate for choice on all aspects of pet care. Being a vet involves being for pet owners and about respecting their choices regarding their pets. It is about supporting them through the good times and the bad.

Decriminalisation is not the outrageous idea that some sections of the press suggest. It is already a reality in other countries and the pet euthanasia rate has not gone up as a result.

This is not about what we personally believe. This is about the pet owners we care for; it is about their lives and the choices they make. We will not have to live their lives once their decision is made.

I would urge people to read and consider the arguments that we set out in our position statement, and those set out by the ‘We trust pet owners’ campaign. It is in favour of people having a choice over their pet’s care, including whether to continue having a pet or not. We are not coming out either for or against pet euthanasia; we are for pet owners.’

As I’m sure you will have realised this article and statement is a spoof. The Serbian Veterinary Association (SVA) does not actually exist. There is in fact a Serbian Association of Small Animal Practitioners (SASAP) but it has made no such statement.

The statement above was instead produced by taking the statement by the CEO of the Royal College of Midwives (RCM) in the Guardian today on the decriminalisation of abortion and making the following changes throughout: RCM becomes SVA, abortion becomes pet euthanasia, doctor becomes vet, woman becomes person or pet owner.

Letter from BMA Council Chair Mark Porter on deal agreed today with government

     
A deal on the Junior doctors contract has been agreed today by the BMA and government.

It is still subject to referendum but this is a fantastic step forward and a wonderful answer to prayer.

      BBC coverage here and Twitter here

Congratulations to all those who worked together so hard over so many weeks to make it possible

Deo Gloria!

Letter from BMA Council Chair Mark Porter

Dear Dr Saunders,

Today, an agreement has been reached between the BMA and the government on a new contract for junior doctors in England.

The agreement, after many months of negotiation, also addresses wider issues about safe working conditions, recruitment, and the maintenance of high-quality care.

It comes after an extraordinary year. Junior doctors have been forced to take industrial action five times. On each occasion, they have looked to, and received, the strong support of consultants, SAS doctors, GPs and medical students. We have demonstrated beyond doubt that we are one profession.

Junior doctors across the country have inspired us with their passion and resilience in defending high-quality patient care. There have been many times when their right to a safe and fair contract has gone unheeded. But now, after talks in which all parties took a positive and constructive approach, we have the basis of a new contract.

The considerable progress made in recent week's means we now have: 

− recognition of junior doctors’ work and contribution across every day of the week

− proper consideration of and provision for equality in the contract, including the chance for accelerated training for those who take time out for caring responsibilities

− improved flexible pay premia for specialties such as emergency medicine and psychiatry to address the recruitment and retention crisis in these areas 

− more rigorous oversight of the new guardian role to ensure safe working.

The new contract will be published at the end of May. During June, it will be explained in a series of roadshows, and then put to a referendum of junior doctors. We will be publishing more details of the agreement as soon as possible on the BMA website.

We have come a very long way since the original proposals were made last July. None of the progress made in negotiations would have been possible without the consistent and inspiring support of all doctors. The support of our patients has also been critical. They knew we had common cause in protecting and improving the quality of patient care.

No-one would have chosen the situation we have had to face over the last 10 months. But in adversity we have seen doctor after doctor stand up with passion and integrity for the quality of patient care. The NHS faces some profoundly difficult challenges, but with such commitment from doctors, and a spirit of engagement from employers, we can make progress in other areas too.

Thank you. What we have achieved for the profession, we have achieved with the unity of support of the profession.

Yours sincerely

Mark Porter
BMA council chair


Monday, 16 May 2016

The CEO of the Royal College of Midwives must step down over this abortion scandal

See also my interview with Premier Radio calling on Cathy Warwick to resign.

The Royal College of Midwives (RCM) has come under fire for backing the BPAS ‘We Trust Women’ Campaign, which advocates the decriminalisation of abortion up until birth.

RCM CEO Cathy Warwick gave her backing to the controversial campaign back in February, when she said that the campaign had the College’s ‘full support’.

This will surprise the 30,000 midwives who belong to RCM as they were not consulted at any point. Nor it seems was the RCM board.

98% of women in a 2012 survey said they opposed any rise in the abortion limit above 24 weeks so it seems that women in general are strongly opposed to Warwick's position.

Furthermore, the RCM itself in the 1980s actually supported a lowering of the upper limit for abortion from 28 weeks to 24 weeks.

So how did an organisation, devoted to the safety through childbirth of both mother and baby, and with the motto ‘Life is the gift of God’ come to such a place?

The answer it seems lies in its current leadership. Its CEO, who also chairs the abortion ‘provider’ BPAS, responsible for 65,000 abortions per year in Britain, is apparently waging something of a personal crusade.

Warwick’s proposal is to remove legal protection from babies between 24 and 40 weeks, allowing viable babies in the womb to be aborted for each and every reason.

In the UK about 8% of babies are born before 37 weeks (a normal pregnancy lasts 40 weeks), nearly 60,000 premature births every year. The vast majority of these survive and thrive, and in the best units like University College London, about 80% of those born at 24 weeks, the accepted threshold of viability, will live with good postnatal care.

How does one abort a baby at an age at which it would be born alive and almost certainly survive?

One has to kill it first in utero, normally with a lethal injection, or alternatively, remove it manually piece by piece. Chilling to think that midwives, trained safely to deliver babies and place them tenderly in their mothers’ arms, are now supporting their destruction at the very same age.
   
Abortion is contrary to every historic code of medical ethics. It is against the Hippocratic Oath, the Declaration of Geneva and the International Code of Medical Ethics. In 1947 the British Medical Association called abortion ‘the greatest crime’.

Two hundred midwives have already signed a letter ‘not in our name’ dissociating themselves from the RCM’s position and thousands more citizens have called on the College to abandon its policy.

Thus far the RCM has shown no sign of turning. It has published a statement on its website today replete with specious euphemisms claiming that it is the victim of ‘distorted and sensationalist accounts’.

But the legal position it is advocating is one where all legal protection for unborn children will be removed – a law like that of China and North Korea.

The RCM used to stand for women’s and children’s health. Now it seems to deny the humanity of the preborn baby altogether.

Any society will be judged by the way it treats its most vulnerable members and there is nothing more innocent and vulnerable than a baby in its mother’s womb.

Warwick is guilty of a blatant conflict of interests. She needs to step down either from the RCM, or BPAS but cannot continue in both positions.

Wednesday, 27 January 2016

Holocaust Memorial Day – let’s not forget the leading role doctors played

Today is Holocaust Memorial Day when Britain marks the 71st anniversary of the liberation of Auschwitz-Birkenau, the largest of the Nazi death camps. This year’s theme is ‘Don’t stand by’.

More than one million people, mostly Jews, died at the Nazi camp (pictured) before it was liberated by allied troops on 27 January 1945. Overall, six million Jews were murdered in a systematic attempt to erase all traces of the Jewish race from Europe. 

But the horrific genocide of six million Jews was in fact only the final chapter in the Nazi holocaust story.

The detail of how it happened, and particularly the role of doctors in the process, is not at all well known.

What ended in the 1940s in the gas chambers of Auschwitz, Dachau and Treblinka had much more subtle beginnings in the 1930s in nursing homes, geriatric hospitals and psychiatric institutions all over Germany.

When the Nazis arrived, the medical profession was ready and waiting.

Twenty three physicians (see below) were tried at the so-called Nuremberg Doctors' Trial in 1946, which gave birth to the Nuremberg Code of ethics regarding medical experiments. 

Many others including some of the very worst offenders never came to trial (see list of main perpetrators here and full list here)

How did it actually happen?

Our story begins with Germany emerging from the First World War defeated, impoverished and demoralised.

Into this vacuum in 1920 Karl Binding, a distinguished lawyer, and Alfred Hoche, a psychiatrist, published a book titled ‘The granting of permission for the destruction of worthless life. Its extent and form'.

In it they coined the term ‘life unworthy of life’ and argued that in certain cases it was legally justified to kill those suffering from incurable and severely crippling handicaps and injuries. Hoche used the term ballastexistenzen (‘human ballast’) to describe people suffering from various forms of psychiatric disturbance, brain damage and retardation.

By the early 1930s a propaganda barrage had been launched against traditional compassionate 19th century attitudes to the terminally ill and when the Nazi Party came to power in 1933, 6% of doctors were already members of the Nazi Physicians League.

In June of that year Deutsches Arzteblatt, today still the most respected and widely read platform for medical education and professional politics in Germany, declared on its title page that the medical profession had ‘unselfishly devoted its services and resources to the goal of protecting the German nation from biogenetic degeneration’.

From this eugenic platform, Professor Dr Ernst Rudin, Director of the Kaiser Wilhelm Institute of Psychiatry of Munich, became the principle architect of enforced sterilisation. The profession embarked on the campaign with such enthusiasm, that within four years almost 300,000 patients had been sterilised, at least 50% for failing scientifically designed ‘intelligence tests’.

By 1939 (the year the war started), the sterilisation programme was halted and the killing of adult and paediatric patients began. The Nazi regime had received requests for ‘mercy killing’ from the relatives of severely handicapped children, and in that year an infant with limb abnormalities and congenital blindness (named Knauer) became the first to be put to death, with Hitler’s personal authorisation and parental consent.

This ‘test-case’ paved the way for the registration of all children under three years of age with ‘serious hereditary diseases’. This information was then used by a panel of ‘experts’, including three medical professors (who never saw the patients), to authorise death by injection or starvation of some 6,000 children by the end of the war.

Adult euthanasia began in September 1939 when an organisation headed by Dr Karl Brandt and Philip Bouhler was set up at Tiergartenstrasse 4 (T4). The aim was to create 70,000 beds for war casualties and ethnic German repatriates by mid-1941.

All state institutions were required to report on patients who had been ill for five years or more and were unable to work, by filling out questionnaires and chosen patients were gassed and incinerated at one of six institutions (Hadamar being the most famous).

False death certificates were issued with diagnoses appropriate for age and previous symptoms, and payment for ‘treatment and burial’ was collected from surviving relatives.

The programme was stopped in 1941 when the necessary number of beds had been created. By this time the covert operation had become public knowledge.

The staff from T4 and the six killing centres was then redeployed for the killing of Jews, Gypsies, Poles, Russians and disloyal Germans. By 1943 there were 24 main death camps (and 350 smaller ones) in operation.

Throughout this process doctors were involved from the earliest stage in reporting, selection, authorisation, execution, certification and research. They were not ordered, but rather empowered to participate. 

Leo Alexander, a psychiatrist with the Office of the Chief of Counsel for War Crimes at Nuremberg, described the process in his classic article 'Medical Science under Dictatorship' which was published in the New England Medical Journal in July 1949.

‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in the euthanasia movement that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.’ 

The War Crimes Tribunal reported that ‘part of the medical profession co-operated consciously and even willingly’ with the ‘mass killing of sick Germans’.

Among their numbers were some of the leading academics and scientists of the day; including professors of the stature of Hallervorden (neuropathology), Pernkopf (anatomy), Rudin (psychiatry/genetics), Schneider (psychiatry), von Verschuer (genetics) and Voss (anatomy). None of these men were ever prosecuted while of the 23 defendants at Nuremberg, only two were internationally recognised academics.

It is easy to distance ourselves from the holocaust and those doctors who were involved. However, images of SS butchers engaged in lethal experiments in prison camps don’t fit the historical facts; the whole process was orchestrated through the collaboration of internationally respected doctors and the State.

With the advantage of hindsight we are understandably amazed that the German people and especially the German medical profession were fooled into accepting it. The judgement of the War Crimes Tribunal in 1949 as to how they were fooled was as follows. 

'Had the profession taken a strong stand against the mass killing of sick Germans before the war, it is conceivable that the entire idea and technique of death factories for genocide would not have materialized...but far from opposing the Nazi state militantly, part of the medical profession co-operated consciously and even willingly, while the remainder acquiesced in silence. Therefore our regretful but inevitable judgement must be that the responsibility for the inhumane perpetrations of Dr Brandt (pictured left)...and others, rests in large measure upon the bulk of the medical profession; because the profession without vigorous protest, permitted itself to be ruled by such men.' (War Crimes Tribunal. 'Doctors of Infamy'. 1948)

The lessons of history must never be forgotten and every new generation needs  re-educating about what really happened, not least the medical profession itself. 

Sunday, 17 January 2016

Claims that DNA editing of human embryos will help infertile couples lack any evidence base

A scientist made her case last week to be the first in the UK to be allowed to genetically modify human embryos. 

The regulator, the Human Fertilisation and Embryology Authority (HFEA), considered her application last Thursday and will give a ruling later this month (Nature, Guardian, Mail, Telegraph). If approved the research could begin as early as March this year.

Dr Kathy Niakan (pictured), from the Francis Crick Institute in London, wants to use a new technique called CRISPR/Cas9 to ‘edit’ genes in day-old human embryos left over from IVF in order to discover what role they play in normal embryo development.

She plans to start with a gene called Oct4, which is thought to have a critical role in embryo development, using 20-30 donated embryos. If this is successful she plans to move on to testing 3-4 other genes, each again using a further 20-30 embryos.

The research is highly controversial, and not just because it results in the destruction of the embryos being studied (each will be destroyed and examined at seven days).

Although gene editing to treat some genetic disease in fully developed human beings appears to have huge promise (such as in the case of Layla Richards who was saved from terminal leukaemia in London last year), gene editing in embryos (germline gene editing) has come in for huge criticism internationally (see also here) and has so far only been attempted (unsuccessfully) in China.

This international criticism is mainly driven by concerns about safety and unforeseen consequences – introducing genetic changes into a day old embryo will mean that any genetic change will be expressed in every cell of the developing human being, including reproductive cells (sperm and egg), and will therefore be passed on down the generations.

CRISPR, however, can be applied with great precision and there is the very real possibility that it might be used in the future to treat – or perhaps even prevent – some genetic diseases by correcting genetic defects in embryos or foetuses. However it is still very early days.

Usually research like this needs to be conducted exhaustively using animals before it is attempted in humans. However Niakan argues that the genes she wishes to study are sufficiently different from their equivalents in animals to justify doing the research on human embryos.

Whenever scientists seek approval for controversial techniques, they tend to emphasise their potential therapeutic benefit in order to get regulators, parliamentarians and the general public on side.  This case is no exception.

Niakan is arguing that her research will provide a deeper understanding of the earliest moments of human life and could reduce miscarriages: ‘The reason why it is so important is because miscarriages and infertility are extremely common, but they're not very well understood. We believe that this research could really lead to improvements in infertility treatment and ultimately provide us with a deeper understanding of the earliest stages of human life.’

The media has picked up strongly on this theme with The Times (£) running the headline ‘GM embryos set to give massive boost to IVF success rates’:  ‘Britain’s first genetically engineered human embryos could lead to dramatic improvements in IVF and help to explain why so many women suffer miscarriages, according to the scientist leading the project.’

There are strong advocates for the research in Britain (see here and here) and an international collaboration (the Hinxton group) has made an earlier call for bans on germline gene editing to be lifted (see critique here).

Other voices have been raised in support. Hugh Whittall (£), the director of the Nuffield Council on Bioethics, said that there are ‘possible future scenarios in which a modification made in a research context — for example, to correct a disease-causing genetic mutation — could, if this were to become permissible, result in the birth of a child.’  


Sarah Norcross, Director of the Progress Educational Trust, has also jumped on the bandwagon saying: 'This is an important piece of basic scientific research. Recurrent miscarriage affects a huge number of people and it isn't greatly understood. People are just told to go away and try again. To improve our understanding of something like that, which has a huge impact on people, is really valuable.'

Professor Robin Lovell-Badge of the Crick Institute was a little more guarded, ‘If you found that there were people carrying a specific mutation which meant that their embryos would never implant [in the womb], then you could contemplate using the genome-editing technique to make germ-line changes which would then allow the offspring of that woman to be able to reproduce without having a problem.’

The clear implication is that some genetic defects which lead to embryo death or miscarriage are those that could be 'corrected' by CRISPR (ie single gene defects).

But is there any real evidence that embryo death or miscarriage is actually caused these sorts of genetic problems? Actually no.

If CRISPR could be made to work safely in embryos then it might conceivably have a role in correcting genes responsible for single gene disorders like cystic fibrosis, sickle cell disease, Fragile X syndrome, muscular dystrophy or Huntington disease. But again, is there any evidence that single gene disorders are responsible for failure of embryo implantation or miscarriage?

Very little, if any. It is mere speculation.

According to the American College of Obstetricians and Gynaecologists (ACOG), most miscarriages (about 60%) occur when an embryo receives an abnormal number of chromosomes during fertilisation (see also here). This is called aneuploidy. This type of genetic condition occurs by chance – there is no medical condition that causes it. However it becomes more common in women of increased reproductive age.

Down’s syndrome, Edward’s syndrome and Patau’s syndrome are the best known forms of aneuploidy. In each condition there is an additional chromosome – numbers 21, 18 and 13 respectively. Babies with these conditions are usually born alive but most other aneuploidies are lethal in utero – causing miscarriages or failed implantation.

The commonest cause of miscarriages are trisomy 16 and 22. In a 2015 study of 832 early miscarriages, 368 (44.23%) were found to be abnormal. 84.24% (310/368) of these were aneuploidies and 15.76% (58/368) were polyploidies. The first was trisomy 16 (121/310), followed by trisomy 22, and X monosomy. It may well be that trisomies of chromosomes other than 13, 18, 16, 21 and 22 (there are 23 chromosomes in each egg and sperm) prove lethal earlier in pregnancy or before implantation. It makes good sense.

According to the ACOG, in a small number of couples who have repeated miscarriages, one partner has a translocation, involving the abnormal transfer of one part of a chromosome to another  chromosome. Deletions and inversions may also play a role.

All of these chromosomal abnormalities (aneuploidy, translocations, deletions and inversions) may be present in sperm and/or eggs or may occur after fertilisation. Either way they end up in the embryo and fetus.

So what about failure of an early embryo to implant in the uterus? Implantation failure is related to either maternal factors or embryonic causes. Maternal factors include uterine anatomic abnormalities, thrombophilia, non-receptive endometrium and immunological factors. Failure of implantation due to embryonic causes is associated with either genetic abnormalities or other factors intrinsic to the embryo that impair its ability to develop in utero, to hatch and to implant.

The average implantation rate in IVF is about 25 %. Inadequate uterine receptivity is responsible for approximately two-thirds of implantation failures, whereas the embryo itself is responsible for only one-third of these failures. Again, aneuploidy and translocations are major reasons for embryo-related failure.

The key point to grasp here is that the genetic abnormalities which result in implantation failure (either in IVF or naturally) or miscarriage are chromosomal abnormalities, not abnormalities in single genes. But only abnormalities in single genes can be fixed with gene editing of the sort that the Crick Institute is proposing. Gene editing does not fix chromosomal abnormalities.

However this simple fact has not been made clear to the media, to decision makers or the public. In fact researchers like Niakin and Lovell-Badge, who must be aware of it, seem to have gone out of their way to fuel the misconception that gene editing will help infertility.

This, it seems, is both negligent and disingenuous, as the key factor that is driving the call to approve this new research is the supposed benefit to infertile couples. 

In reality, it seems to be more about satisfying scientific curiosity about how genes work in the normal development of the human embryo with any therapeutic application a distant dream.

British scientists have form in making wild and rash promises about new therapies in order to get approval for controversial research – the hype around animal-human hybrids and three parent embryos (mtDNA) are cases in point.

With respect to the latter David King, who runs the watchdog group Human Genetics Watchremarked when the UK’s fertility agency, the Human Fertilisation and Embryology Authority (HFEA), approved mtDNA work: ‘The decision is very disappointing, but comes as no surprise, since the HFEA can never say no to scientists.  These experiments are scientifically useless and morally very problematic. The research lobby has distorted the scientific facts in order to defuse criticism.’

Gene editing, as I said at the beginning of this article, has great therapeutic promise for treating and perhaps even preventing some genetic disease. But gene editing of the embryo (germline editing) is extremely controversial and potentially very dangerous. Scientists around the world think that we are mad in Britain to be pursuing it. 

At very least much more work is needed in animal models before we contemplate using it on human embryos; and especially we need to establish first in animals whether or not it is likely to have any benefit at all in preventing infertility before we start making rash promises about humans.

I am not alone in remaining sceptical and unconvinced.

Here’s hoping that the HFEA will pour cold water on Niakan’s proposed research. However, based on past form I am not holding my breath.

Saturday, 26 December 2015

How health services are organised in Bedfordshire and Hertfordshire

This post will be of interest to very few people, as it is purely factual. I just wanted to get my head around how NHS services and parliamentary constituencies are organised in the county in which I live (Herts) and the county immediately north of us (Beds) and to post it for future reference. So if the subject doesn't interest you then feel free to invest your time elsewhere. If it does then it may be worth a scan. I'll add more links later.

The combined population of Beds and Herts (Bedfordshire and Hertfordshire) is 1,671,000 - 617,000 in Beds and 1,154,000 in Herts. Seven NHS Trusts and four CCGs (Clinical Commissioning Groups) serve this population.

Beds has two NHS Trusts – Bedford and Luton & Dunstable – and two CCGs - Bedfordshire and Luton.

Herts has four NHS Trusts – East and North Herts, West Herts, Herts Community and Herts Partnership – and two CCGs – East and North Herts and Herts valley.

One trust – The East of England Ambulance service – covers both counties.

The area also includes 17 parliamentary constituencies – 11 in Herts and 6 in Beds. Of these 15 MPs are Conservative and two are Labour, those in North and South Luton.

More detail is given below.

Hertfordshire

Hertfordshire (Herts) is a county in southern England, bordered by Bedfordshire to the north, Cambridgeshire to the north-east, Essex to the east, Buckinghamshire to the west and Greater London to the south.

Four towns have between 50,000 and 100,000 residents: Hemel Hempstead, Stevenage, Watford and St Albans. 

Ten railway lines and three motorways pass through or reach into the county. In 2014, the county had a population of 1,154,000 living in an area of 634 square miles (1,640 km2). 

Health facilities (4 trusts, 2 CCGs)

The Trust manages four hospitals: Hertford County (Hertford), the Lister (Stevenage), Mount Vernon Cancer Centre (Northwood) and the QEII (Welwyn Garden City).

The Trust manages three hospitals: Watford, Hemel Hempstead and St Albans. It provides general healthcare and some specialist services and has close links with specialist hospitals such as Harefield.

The Trust is one of a new generation of community health service Trusts in the NHS. It is responsible for delivering a wide range of community health services across Hertfordshire and serves the communities of Broxbourne, Dacorum, West Herts, Hertsmere, North Herts, St Albans, Stevenage, Three Rivers and Welywn/Hatfield. It also provides children's specialist community services in West Essex.

Hertfordshire Partnership University NHS Foundation Trust (HPFT) provides mental health and social care services for adults of working age, older adults, children and adolescents and specialist learning disabilities services. It also provides specialist learning disability services in Norfolk and North Essex.



Covers both Hertfordshire and Bedfordshire

Hertfordshire Parliamentary constituencies (11)

1. Broxbourne – Charles Walker (Conservative)
2. Hemel Hempstead – Mike Penning (Conservative)
3. Hertford and Stortford – Mark Prisk (Conservative)
4. Hertsmere – Oliver Dowden (Conservative)
5. Hitchin and Harpenden – Peter Lilley (Conservative)
6. Hertfordshire North East – Oliver Heald (Conservative)
7. Hertfordshire South West – David Gauke (Conservative)
8. St Albans – Anne Main (Conservative)
9. Stevenage - Stephen McPartland (Conservative)
10.Watford – Richard Harrington (Conservative)
11.Welwyn Hatfield – Grant Shapps (Conservative)

Bedfordshire 

Bedfordshire (Beds) is a county in the East of England. It is a ceremonial county and a historic county, but not an administrative county, as it is divided into three unitary authorities: Bedford, Central Bedfordshire, and Luton.

Bedfordshire is bordered by Cambridgeshire to the northeast, Northamptonshire to the north, Buckinghamshire to the west and Hertfordshire to the southeast; it is sometimes described as being in the South Midlands.

Over half the population of the county lives in the two largest built-up areas: Luton (236,000) and the county town, Bedford (102,000). In 2014, the county had a population of 617,000 living in an area of 477 square miles (1,235 km2).

Health facilities (3 Trusts, 2 CCGs)


The Trust manages two hospitals: – Luton and Dunstable Hospital and Harpenden Memorial Hospital



Covers both Hertfordshire and Bedfordshire

Bedfordshire Parliamentary constituencies (6)

1. Bedford - Richard Fuller (Conservative)
2. Luton North – Kelvin Hopkins (Labour)
3. Luton South – Gavin Shuker (Labour)
4. Mid Bedfordshire -  Nadine Dorries (Conservative)
5. North East Bedfordshire – Alistair Burt  (Conservative)
6. South West Bedfordshire – Andrew Selous  (Conservative)

Now what am I going to do with all this information? I'm not quite sure yet but I'm sure it will come in handy. I'll keep you posted,

Thursday, 24 December 2015

The Cameron and Corbyn Christmas messages – full text and some brief reflections

Both Prime Minister David Cameron and Opposition Leader Jeremy Corbyn have issued Christmas messages today, although Corbyn is promising a fuller one for New Year.

You can read them in full in the Daily Mirror (here and here) and I have pasted them below for easy reference.

I was particularly interested in what they said about Jesus Christ and I’ve highlighted this in bold in the text of their messages below.

Each of them uses the refugee crisis and those struggling at home as major themes but in different ways.

David Cameron emphasises the importance of care and security asking us to ‘give thanks to those who are helping the vulnerable at home and protecting our freedoms abroad’.

He specifically praises health professionals for their care for the vulnerable and our armed forces for making sacrifices to protect us.

He hails Jesus Christ as ‘God’s only Son – The Prince of Peace’, says that his birth means ‘peace, mercy, good will and above all hope’ and refers to Britain as ‘a Christian country’.

He asks us to ‘reflect on the fact that it is because of these important religious roots and Christian values that Britain has been such a successful home to people of all faiths and none’.

Jeremy Corbyn praises those who will ‘not be getting a break’ over Christmas – hospital staff, firefighters, the police and the armed forces.

He then talks about refugees, the homeless and those on low wages, emphasising that the Nativity story is about ‘offering shelter to a family in need and to those who find themselves ­refugees - fleeing evil’.

He proceeds to quote two of Jesus’ most well-known teachings: ‘Do to others what you would have them do to you’ (Matthew 7:12) – which he says is ‘the essence of (his) socialism’ and ‘It is more blessed to give than to receive’ (Acts 20:35)

Corbyn closes by saying that ‘it is a similar maxim that inspired our party: “From each according to their means, to each according to their needs.”’

‘From each according to his ability, to each according to his needs’ is a slogan said to be first used by Louis Blanc in 1851 and popularised by Karl Marx in his 1875 Critique of the Gotha Program.

Ironically it describes an ideal which communism was never able to deliver – Communism, by contrast, has always meant inequality, oppression and the strong dominating the weak.

In fact the saying actually goes back far beyond the nineteenth century to the first and finds its origin – like Corbyn’s two quotes from Jesus above -  in the pages of the New Testament.

‘Each according to his ability’ comes from Acts 11;29: ‘So the disciples, each according to his ability, decided to send relief to the brothers living in Judea.’ (ESV)

It describes how Christians in Antioch (in modern day Syria) helped their brothers and sisters in Jerusalem (Israel) during a famine.

‘To each according to his need’ comes from Acts 4:34,35: ‘There was not a needy person among them, for as many as were owners of lands or houses sold them and brought the proceeds of what was sold and laid it at the apostles' feet, and it was distributed to each as any had need.’ (ESV)

It describes how the early Christian believers in Jerusalem provided for each other’s material needs.

Care for the vulnerable and making sacrifices for the weak are at the heart of the Christian ethic – and have their origin in Jesus Christ himself.

As the Apostle Paul tells us Jesus ‘did not count equality with God a thing to be grasped’ but ‘emptied himself’, ‘taking the form of a servant’ and ‘being born in the likeness of men’ (Philippians 2). While we were weak, ‘Christ died for the ungodly’ (Romans 5).

Christmas is when we remember, in Paul’s words to Titus, ‘our great God and Saviour Jesus Christ, who gave himself for us to redeem us from all lawlessness and to purify for himself a people for his own possession who are zealous for good works.’ (Titus 2:13-15)

Let’s live lives and speak words, by his strength, that point to and give glory to Jesus Christ this Christmas and this coming year.

David Cameron's Christmas message

If there is one thing people want at Christmas, it’s the security of having their family around them and a home that is safe.

But not everyone has that. Millions of families are spending this winter in refugee camps or makeshift shelters across Syria and the Middle East, driven from their homes by Daesh and Assad.

Christians from Africa to Asia will go to church on Christmas morning full of joy, but many in fear of persecution. Throughout the United Kingdom, some will spend the festive period ill, homeless or alone.

We must pay tribute to the thousands of doctors, nurses, carers and volunteers who give up their Christmas to help the vulnerable – and to those who are spending this season even further from home.

Right now, our brave armed forces are doing their duty, around the world: in the skies of Iraq and Syria, targeting the terrorists that threaten those countries and our security at home; on the seas of the Mediterranean, saving those who attempt the perilous crossing to Europe; and on the ground, helping to bring stability to countries from Afghanistan to South Sudan.

It is because they face danger that we have peace. And that is what we mark today as we celebrate the birth of God’s only son, Jesus Christ – the Prince of Peace.

As a Christian country, we must remember what his birth represents: peace, mercy, goodwill and, above all, hope.

I believe that we should also reflect on the fact that it is because of these important religious roots and Christian values that Britain has been such a successful home to people of all faiths and none.

So, as we come together with our loved ones, in safety and security, let’s think of those who cannot do the same.

Let’s give thanks to those who are helping the vulnerable at home and protecting our freedoms abroad.

And let me wish everyone in Britain and around the world a very happy and peaceful Christmas.

Jeremy Corbyn’s Christmas Message

For many people Christmas is a time for relaxation, for catching up with friends and family. But many won’t be getting a break.

Hospital staff for whom Christmas is as busy as any time of the year. The firefighters on call, including those who recently helped save people and homes in communities like ­Cockermouth and Carlisle.

The police and our armed forces too. And the many workers in low-paid industries who simply cannot afford to take leave over Christmas.

Christmas is also a time for reflection, and it is worth considering the ­poignancy of the Nativity story. It is about offering shelter to a family in need and to those who find themselves ­refugees fleeing evil.

Homelessness in Britain is rising, more children are in poverty and tens of thousands will spend this Christmas in temporary accommodation – a home that is not their own.

Globally there are more refugees today fleeing horror than at any time since the Second World War.
These are lives that are being held back, young people who are not getting the opportunities they should.

We should always be asking ourselves – all of us, not just politicians – whether we could do more for others.

In this way, the Christmas story holds up a mirror to us all. “Do unto others as you would have done to you” – that is the essence of my socialism, summed up in the word ­“solidarity”.

The concept of solidarity is about our unity – we succeed or fail together. Yet too often there are attempts to divide us, to scapegoat, rather than help, those in need.

Jesus said: “It is more blessed to give than to receive”.

It is a similar maxim that inspired our party: “From each according to their means, to each according to their needs.”

May you enjoy a merry Christmas as we all reflect on how we create a better world in 2016.