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.


Saturday, 19 December 2015

When you feel it’s all too much – remember these things and don't give up

Do you ever feel like it’s all too much? That the Christian life is too hard? That the obstacles are too overwhelming?

The devil knows that as Christians we are secure in Christ; that nothing can separate us from his love (Romans 8:38-39), that he will never leave us nor forsake us (Hebrews 13:5) and that nothing can snatch us out of his hand (John 10:28).

But he can render us ineffective through immobilising and discouraging us; by tempting us to throw in the towel and to give up.

The battle is primarily in our minds. It starts with the thoughts we accept and believe. Once we get seduced by a self-destructive and immobilising thought the trajectory is all downhill.

Nehemiah was a man who did not allow himself to be disempowered by unhelpful thoughts – even if there was more than an element of truth in them.

He was the key figure, along with Ezra, who was used by God in the fifth century BC to help bring about one of the most profound revivals in biblical history. 

Nehemiah was a skilful politician, a clever strategist, a brilliant manager, a social reformer who championed the rights of the poor and an intransigent visionary who never gave up despite threats and opposition from those in high places.

His achievements were monumental. He re-established full employment in a climate of economic recession. He reconstructed an effective social welfare system for the marginalised and reintroduced Bible exposition resulting in nationwide repentance and revival. He reinstated public worship and rooted out heresy and idolatry.

He was used by God to put a whole nation back on its feet. 

But a key part of Nehemiah’s armoury was the ability to recognise and deal effectively with disempowering thoughts and accusations.

One of his major opponents – his bĂȘte noire as it were – was a local administrator called Sanballat who sought to distract him from his task of rebuilding the wall of Jerusalem.

Sanballat threw five immobilising thoughts at Nehemiah; the very same thoughts that the evil one uses with every Christian in order to dissuade him or her from pressing on with the task in hand. We read about his methods in Nehemiah 4.

First, he pointed out the weakness of Nehemiah and his Jewish brothers, ‘What are these feeble Jews doing?’ (Nehemiah 4:2). Of course the reality is that there was more than an element of truth in this. The Jews were weak and had few resources. But Sanballat had forgotten that God’s strength is made perfect in weakness (2 Corinthians 12:9) Nehemiah remembered and asked God to ‘Strengthen my hands’ (6:9).

Second Sanballat reminded Nehemiah of the immensity of the task, ‘Will they finish it in a day?’ The task of rebuilding the wall of Jerusalem was indeed immense, way beyond a day’s work. But this did not mean it was unachievable. Plenty of hands, good organisation and steady progress meant that a wall that had laid in ruins for 150 years was rebuilt in 52 days. It just required time and effort.

Sanballat’s third tactic was to point out the Jews’ record of past failures, ‘Will they revive the stones out of the heaps of rubbish, and burned ones at that?’ Again, it was true that they had failed God in the past. In fact, this was precisely why the wall lay in ruins now. But God is the one who promises to give us back the years that the locust has eaten (Joel 2:25), who gives us beauty for ashes (Isaiah 61:3), who specialises in building something great on the foundations of past failures.

Fourth, Sanballat mocked Nehemiah’s small amount of progress thus far, ‘if a fox goes up on it he will break down their stone wall’ (4:3). It was true that the beginnings of the project were unimpressive. But God is the champion in constructing great things from small beginnings; mighty oaks from tiny acorns; the leaven in the parable which spreads through the whole loaf.

Finally there was the strength of the opposition, ‘they all plotted together to come and fight against Jerusalem and to cause confusion in it’ (4:8). But Nehemiah ‘prayed to our God and set a guard as a protection against them day and night’ (4:9). And through it all the Jews just kept on building, with a sword in one hand and a trowel in the other; brick by brick, stone by stone until the job was finished.

I don’t know what particular project – large or small – that you are currently attempting for God and how discouraged you feel.

But let me remind you of this. However weak you are, however immense the task, however little you have achieved so far, whatever your record of past failure or the strength of the opposition you face, you can rejoice that you serve a God who uses weak people to do mighty things.

Put on his armour (Ephesians 6:10-20). Take the shield of faith to protect yourself from the enemy’s accusations and threats. Take the sword of the sprit - his word, the Bible - with its wonderful promises - and keep on building stone by stone, brick by brick. And never ever give up. For he who has called us is faithful and he will do it (1 Thessalonians 5:24).  




Monday, 16 November 2015

Why is the government giving preferential treatment to those backing compulsory sex education in schools?

Campaigners are pushing for sex and relationship education (SRE) to be made compulsory in all English schools (see here, here and here).

Currently local authority maintained schools in England are obliged (See House of Commons briefing) to teach SRE from age 11 (year 7) upwards, and must have regard to the Government’s SRE guidance.

Academies and free schools, the majority in secondary education in England, do not have to follow the National Curriculum and so are not under this obligation. But if they do decide to teach SRE, they must also have regard to the guidance.

Parents are free to withdraw their children from SRE if they wish to do so, although few do so in practice. The only exceptions to this are the biological aspects of human growth and reproduction that are essential elements of National Curriculum Science.

But this could all soon change if government-funded campaigners have their way.

During the 2010 Parliament concerns were frequently raised about the content, status and quality of SRE. 

Private Member’s Bills have been tabled during both the 2010 and 2015 Parliaments to introduce compulsory SRE (sometimes within proposed statutory PSHE) and both Labour and Green Party MPs tabled amendments with this aim during the passage of the Children and Families Act 2014.

However these measures have all so far failed.

There have also been calls from across parties for the Government’s SRE guidance, which has been in place since 2000, to be updated to equip teachers better.

In February 2015 (before the general election) the Commons Education Select Committee recommended that ‘age-appropriate SRE’ should become a statutory subject in primary and secondary schools, albeit with parents retaining their right to withdraw children.

Advocates argued that such a move would help address ‘problems’ in society including ‘teenage pregnancy, STI rates, drug and alcohol abuse, cyberbullying, and child sexual exploitation’.

However, the Government response published in July 2015 did not take forward this recommendation, although it stated that it would be giving further consideration to the Committee’s arguments.

In answer to a parliamentary question earlier this month, Edward Timpson MP said that the government was ‘currently working with a group of leading head teachers’ on this and would ‘provide a progress update later this year’.

The Commons Education Select Committee, in compiling its report (Life lessons: PSHE and SRE in schools), received 431 written submissions including one from Christian Medical Fellowship.

But in coming to its conclusions it appears to have drawn very heavily on three specific groups, which appear to have the privileged ear of government and also receive a not inconsiderable sum of regular government funding: Brook, the PSHE Association (PSHEA) and the Sex Education Forum (SEF). 

Brook is itself a member of SEF and almost certainly of PSHEA (although the latter seems to keep its membership list secret).

SEF seems to be neither a registered company nor a registered charity and it is difficult to find out much about either its governance structure or funding from its website.

But PSHEA and Brook are both registered charities.

In 2014 PSHEA received a grant of £100,000 from the (government) Department of Children Schools and Families, just under a third of its annual running costs. This is of particular interest, given that this department, as I understand, ceased to exist in 2010. I wonder where that money actually came from: probably worth a parliamentary question, especially in the light of the recent controversy over Kid’s Company.

In the same year, Brook’s funding sources included ‘government’ (£143,227), ‘PCT’ (£1,585,833) and ‘local authority’ (£7,854,702) – mainly central government funding – towards its annual turnover of £14,326,431. So well in excess of £9million annually – going back it seems over many years – quite a lot more even than Kid’s Company!

Not surprisingly Brook, PSHEA and SEF all back compulsory sex education in all English schools and seem to receive a large amount of government funding to help them make their case. 

But why should we be concerned about SRE being made statutory and thereby compulsory?

Primarily it would mean an imposed national curriculum – but specifically one based on the recommendations of Brook, PSHEA and SEF. And it is precisely concerns about the kind of material that teachers would be required to teach that has raised concerns.

The House of Lords voted down Labour’s proposals to introduce compulsory SRE by 209 votes to 142 in 2014 on the basis that it would increase the likelihood of children being exposed to unsuitable materials (See this booklet produced by the Christian Institute to see what I mean).

A quick browse through the membership list of SEF does not reassure – it reads like a who’s who of groups espousing liberal secular humanist values – IPPF, BPAS, Marie Stopes, Brook, British Humanist Association, National Secular Society, Diversity Role Models, FPA etc .

Britain is, of course, a free democratic society and such groups have every right to make their contribution to debates about public policy and to collaborate in doing so – but should they receive government funding and be given privileged input into the ear of government? That is the key question.

It might be objected that SEF also includes amongst its members faith-linked groups like Childnet, Romance Academy, the Methodist  Church and the Church of England. And it does. But my point is that SEF also explicitly campaigns for compulsory sex education in primary schools, so unless these groups have already bought into that agenda, they have little influence over what the wider body is campaigning for and have effectively been implicated in its stance. 

CMF’s submission, amongst the majority expressing similar views which were effectively side-lined by the Commons Education Select Committee, made points that need to be given equal consideration in this whole debate. We supported this principle from the previous DfEE SRE Guidance (See Para 5.3, page 25).  

Parents are the key people in: teaching their children about sex and relationships, maintaining the culture and ethos of the family, helping their children cope with the emotional and physical aspects of growing up; and preparing them for the challenges and responsibilities that sexual maturity brings.

Some of our principal concerns were as follows:

  • Parents are ultimately responsible for their children’s moral maturity and, within broad limits, should be free to educate their children on moral matters, as they judge best.
  • Personal, social, health and economic education should not be made a statutory part of the school curriculum. Primary school governing bodies should remain free to decide whether or not to provide sex and relationships education and secondary school governing bodies should remain free to formulate their own policies, in consultation with parents
  • Many of the topics covered in PSHE, in particular SRE, are not morally neutral. We support the continued right of parents to withdraw their child(ren) from sex education lessons that they consider inappropriate for their child(ren).
  • Schools should remain accountable to parents with regard to their PSHE and sex and relationships education provision
  • A significant proportion of the UK population has a faith background, therefore adopting a faith sensitive approach will increase relevance, promote understanding and capitalise on common ground and common goals.
  • Government should make funding available to organisations, both religious and non-religious, to produce materials which support parents, and faith groups, and do not expose children and teenagers to explicit sexual images and messages.

The education of our children is a crucial issue. This is why it is so important that a wide range of groups and individuals – and not just a few representing a specific ideological agenda – should be able to input into government policy in this key area.

Let’s try to ensure that government considers its sex education policy in an atmosphere which offers a level financial and ideological playing field to all stakeholders, rather than giving privileged place and financial help (with taxpayers’ money!) to a minority selected in a clandestine fashion on seemingly ideological grounds.

Currently it’s all a bit too Kid’s Company-esque. 

Wednesday, 28 October 2015

Amnesty International should stop pressurising Ireland and Northern Ireland to legalise abortion

The national charities LIFE and Right To Life are marking the 48th anniversary of the Abortion Act by calling attention to the 8 million lives lost since 1967, and urging lawmakers in Ireland and Northern Ireland not to compromise their laws and society by bowing to the pressure of the abortion industry and its lobbyists.

They sound a warning of the consequences of such a compromise, following the launch of an expensive campaign by Amnesty International that uses celebrities to attempt to convince Ireland and Northern Ireland to abolish their legal and constitutional protections for unborn children.

Millions of unborn lives have been lost and thousands of women have been psychologically harmed in Great Britain because of the 1967 Act. It paved the way for the emergence of a multi-million pound industry costing the taxpayer over £100 million a year. Since its inception, abortion providers have consistently misinterpreted, abused and broken the law with impunity. The safeguards built into the law have been rendered ineffective, with the CPS refusing to prosecute doctors in some cases.

Those who voted for the Abortion Act could never have envisaged a day when abortions would be performed at the rate of one every three minutes, when nine out of ten babies with Down’s Syndrome would be aborted, when babies would be terminated because they were the ‘wrong’ gender, and when the bodies of aborted babies would be burnt to heat hospitals. This is certainly not a situation that we should want Ireland or indeed any other country to move towards.

Amnesty International, which was born out of the conviction that the human rights of the oppressed and vulnerable should be vocally supported by those who believed in the dignity of all human beings, now perversely campaigns for a human right to end human lives. Specifically the most vulnerable of all: unborn children. Where nations have chosen to resist abortion, Amnesty is spending significant sums of charity funds to pressure them to ensure the platform exists for the termination of babies in the womb. It is ironic that an organisation which in 1977 received the Nobel Peace Prize for its lifesaving work would today be championing ending the very lives that most need the humane advocacy it is meant to provide.

All people of good will, who wish to call Amnesty back to the humane founding principles of their organisation under the late Peter Benenson, can visit the new website of our Amnesty Travesty campaign and sign the open letter calling on them to stop pressuring countries into accepting the inhumanity of abortion.

As friends from across the Irish sea, LIFE and Right To Life are calling on the people and lawmakers of Ireland and Northern Ireland to avoid the tragedy that Great Britain’s abortion laws have engendered, and stand firm against the pressure by Amnesty and similar organisations to compromise their legal safeguards for the most vulnerable of their fellow citizens. In doing so they will protect women, prevent the horrific loss of life experienced in the United Kingdom since 1967, and affirm the dignity and right to life of all members of the human family.

Friday, 18 September 2015

The Battin study does not prove that vulnerable people are not at risk from legalised assisted suicide

This report has been reproduced with permission from the Euthanasia-Free New Zealand Website

The Battin study is often quoted by pro-euthanasia advocates to support their claim that legal assisted suicide does not pose a risk to vulnerable people. The absolute claim that “vulnerable people are not at risk” is not supported by this study, because it identified a heightened risk to one vulnerable group: people with AIDS.

Subsequent research has also invalidated the study’s conclusion that other vulnerable groups are not at risk. 

For example, studies published in 2009 and 2010 show that vulnerable groups, such as the elderly and mentally incompetent, are indeed at a higher risk of being killed by euthanasia without their consent.

The Battin study was based on wrong assumptions and there are several issues with its scope and methodology. The case is not proven.

What is the Battin study about?

Margaret Battin and others analysed data up to 2005 from Oregon and The Netherlands to find out whether there is evidence that the lives of people identified as vulnerable are more frequently ended with assistance from a physician than those of the background population.

“These groups were analysed and compared with background populations: the elderly, women, the uninsured (Oregon only), people with low educational status, the poor, the physically disabled or chronically ill, people with sometimes stigmatised illnesses like AIDS, minors, people with psychiatric illnesses including depression, and racial or ethnic minorities.

“The study found that the only group with a heightened risk was people with AIDS. Where assisted dying is already legal, there is no current evidence [emphasis ours] for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician‐assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.”

The Battin study is based on wrong assumptions

  • It assumed the elderly consist only of people aged 85 and older. No mention was made of people aged 65 to 84.
  • It assumed women are more vulnerable than men when it comes to suicide and assisted suicide.
  • It assumed depressed people are not vulnerable to assisted suicide.
  • It assumed vulnerability is limited to physical characteristics and conditions.
  • It assumed the poor are more vulnerable to physician-assisted suicide than the rich.
  • It assumed only terminally ill people receive physician-assisted suicide in Oregon.
  • It assumed a person cannot belong to more than one vulnerable group, i.e. be both elderly and disabled.  Battin et al treated vulnerable groups as separate and mutually exclusive.
Other limitations and issues with the Battin study

  • Three vulnerable groups, who feature in statistics and studies on assisted suicide and euthanasia, were ignored in the Battin study: Those who suffer from depression, the mentally incompetent, and the unconscious or comatose.
  • The study is based on data only up to 2005, when the Dutch euthanasia situation was relatively stable. According to Prof Theo Boer, a former member of a Dutch Regional Euthanasia Committee who has reviewed 4000 cases over 9 years, there has been a dramatic increase in euthanasia deaths since 2008. He recommends that the cause of this surge be investigated.  He was in favour of euthanasia, but has changed his mind. 

“I was wrong, terribly wrong in fact, to believe that regulated euthanasia would work.”

“In hindsight, the stabilization in the numbers was just a temporary pause. Beginning in 2008, the numbers of these deaths show an increase of 15% annually, year after year.”

“Other developments include a shift in the type of patients who receive these treatments. Whereas in the first years after 2002 hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. Some of these patients could have lived for years or decades.

  • It’s limited to data from only two jurisdictions, and jurisdictions with very different social, cultural and legal environments as well as assisted-suicide reporting requirements. The study should not be used to make generalisations about the effect of legal euthanasia and assisted suicide in other parts of the world.

“We recognize that substantial differences in the methodologies of the source studies make it impossible to determine with certainty [emphasis ours] the actual incidence of assisted dying in several of the vulnerable groups studied. Our question is whether the available data show evidence of heightened risk to persons in vulnerable groups.”

  • The source data didn’t include data on disability.
In reference to the group “people with chronic physical or mental disabilities or chronic non-terminal illnesses”, the authors stated “no data to calculate denominator; probably 10 cases or fewer per year.”  The word “probably” is hardly conclusive!

Expert critiques of the Battin study

The Battin study has been criticized by Prof Ilora G. Finlay and Rob George in the Journal of Medical Ethics, as well as by Dr George Seber, a statistician and counsellor.

Based on these expert opinions, as well as subsequent studies, Euthanasia-Free NZ concludes that the Battin study is unreliable and inconclusive.

Discredited by a statistician

Prof George Seber, an internationally-respected statistician, as well as an experienced counsellor, is of the opinion that “the case is not proven”.

He wrote an email to Euthanasia-Free NZ stating,

“The Battin et al. paper has some unresolved problems that may invalidate its findings.

“In endeavouring to look for differences between pairs of groups it is important to look at the numbers in overlapping groups, for example the numbers in two-group overlaps like gender and age, and those in three-group overlaps like gender, age, and vulnerability (e.g. with disabilities), etc. If there is “interaction” between groups it is not valid to compare groups in pairs without taking into account any interactions. Are there interactions? It seems likely that  the following might have an effect: (1) women live longer than men, (2) men may be more disabled than women in a certain age groups, (3) women network better than men and networks of friends are very important when it comes to psychological health.

“A major problem is how to compare suicide-assisted deaths with deaths in the population at large. It could be a case of comparing apples and oranges! For example, some people may die by accident or after a short illness and are not relevant to the comparison. We need to compare the numbers of people in both populations who have similar ages and are in similar situations (e.g. similar vulnerability).

“Another concern I have is about the fact that there is no mention of the  methods used to compare proportions. Some methods are still commonly used these days that are not  appropriate (cf. Seber , 2013a).

“Another worrying feature is the confusion over the role of depression and the so-called right of euthanasia. As a trained counsellor I can say  that depression is the most treatable of all mental illnesses and it is strongly linked to suicide without assistance (Seber, 2013b). I don’t believe it is grounds for assisted suicide or euthanasia.  It is known, for example, that women seem to be about twice as prone to depression than men, and the elderly are more prone as the life-span has been significantly increased so there is an age factor relating to depression as well.

“In summary, the case is not proven. Further research and statistical analysis is needed.”

George  A. F.  Seber, PhD, FRSNZ, Dip. Counsel., MNZCCA.
Emeritus Professor of Statistics, University of Auckland, New Zealand

Discredited by peers in the same journal

  • Battin limits vulnerability to physical characteristics such as race, gender and socioeconomic status only. Finlay and George argue,
“Vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. Contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et alreported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.”

  • Battin defines the elderly as people over 85 and finds that those people are not at heightened risk as compared to people aged 18-64.  Finley and George point out that people over 65 are generally defined as elderly in our society and note that Battin’s study does not mention at all the age group between 65 and 85.  Finlay and George also quarrel with Battin’s comparison of natural death rates of people 85 and older with assisted suicide rates in that age cohort, pointing out that, “Since the death rates from non-PAS causes among persons aged 85 years or over are naturally very high, it follows that almost any rate of PAS in this age bracket is likely to show up as proportionately less than the rate of death from other causes.”  In fact, they write, 68% of PAS deaths are among people over 65.  The elderly do seem to be vulnerable to PAS.
  • Finlay and George quarrel with Battin’s choice of which groups to investigate for vulnerability.  For example, she investigates whether women are more vulnerable to PAS than men and finds that they are not.  Finlay and George find her discovery unimpressive, since studies done all over the world have shown men are more likely to commit suicide than women.   Battin cites the affluence and high educational level of PAS users as proof that the poor are not vulnerable. Finlay and George ask whether Battin has overlooked the possibility that there is a particular vulnerability among the affluent and educated, a vulnerability marked by an aversion to suffering, an isolating individualism seen as “dignity”, and a need for control.  They believe Battin’s work may have been distorted by her seeing “the concept of vulnerability from one perspective only, as something to which only less educated or less wealthy persons might succumb.”  They also suggest the possibility that Compassion and Dying, now Compassion and Choices, represented at the hearings by George Eighmey, may exert an unintended coercion on individuals they guide through the PAS process.  Finally, they point to the coercive influence among the affluent of fashion and political correctness.
  • Finlay and George question Battin’s conclusion that only the terminally ill are receiving PAS in Oregon, pointing out, as Dr. Bentz did in his testimony to Health and Welfare, that the Oregon reports are based on “voluntary” reporting by doctors who are motivated to state that they acted within the law; those same doctors label their patients as terminal.  They note that one patient lived for three years after getting a PAS prescription; he was clearly not terminally ill when he got it.  They point to the difficulty of prognosticating and also to the blurring, purposeful or not, of the boundaries between chronic illness and terminal illness; for example they note that “…illnesses such as multiple sclerosis, Parkinson’s disease and cardiopulmonary disease pretty well universally have a chronic and disabling prelude before they become predictably terminal as defined by less than 6 months to live.”  Battin , they point out, discusses chronic and disabling terminal illness in a way that blurs the lines, if they can be drawn at all.
  • Lastly, Finlay and George do point out, as Battin said, that some depressed patients seem to have received PAS.

References

Battin, M. P., Van der Heide, A. and Ganzini, L.  et al. Legal physician-assisted dying in Oregon and The Netherlands: Evidence concerning the impact on patients in ‘vulnerable’ groups. J Med Ethics 2007(37):591-97.

Finlay, I. G. and George, R. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups – another perspective on Oregon’s data. J Med Ethics 2011(37):171-174   doi:10.1136/jme.2010.037044  http://jme.bmj.com/content/37/3/171.abstract

Seber, G. A. F. (2013a). Statistical models for proportions and probabilities. Springer Briefs in Statistics: Berlin.

Seber, G. A. F.  (2013b). Counseling Issues: A handbook for counselors and psychotherapists. Xlibris Publishing.


Saturday, 12 September 2015

Defeat of the Marris Assisted Dying Bill – some reflections on how MPs voted


The Assisted Dying (No 2) Bill of Labour MP Rob Marris was the eleventh attempt in twelve years to legalise assisted suicide through British Parliaments.

But its overwhelming defeat yesterday (11 September 2015) by a margin of 212 votes (330 to 118) should settle this matter for a decade.

It is striking (and indeed fitting) that this happened the very day after World Suicide Prevention Day. The bill now cannot proceed further. It is dead.

There is clearly no chance at all of a similar bill passing through the Commons in the current parliament and even in the (now) unlikely event of a Labour victory in 2020 it is virtually inconceivable that the views of MPs will change enough to make it likely in the next parliament either.

MPs dealt the bill a resounding defeat largely driven by concerns about the risks it posed to vulnerable people who would have felt under pressure to end their lives so as not to be a burden to family, relatives, caregivers or a society short of resources. Six in ten who die under a similar law in Washington State US give this reason.

Overall 74% of MPs voted against the bill, a proportion almost identical to the 72% who opposed the last bill of its kind in the House of Commons in 1997. So there has been essentially no shift in parliamentary opinion in the last 20 years.

Rob Marris conceded in a BBC interview after the debate that he did not foresee another attempt in the Commons in this parliament and in fact called on the government to invest more in palliative care, a move which I would strongly support. Patients whose symptoms are properly controlled do not generally want help to kill themselves. 

You can read the full four hour parliamentary debate on Hansard and see reaction to the result on you tube along with my comments on what it means.

The Daily Mail has also given a full list of how MPs voted by party which I have reproduced below.

Overall out of 650 MPs, a total of 448 took part in the vote.

118 MPs supported the bill (27 Conservative, 72 Labour, 14 SNP, 3 Lib Dem and 1 Green).

330 voted against it (210 Conservative, 91 Labour, 11 SNP, 3 Lib Dem, 1 UKIP, 8 DUP, 3 SDLP, 1 Independent).

Here are some preliminary quick reflections on how people voted.

1. This was a huge (almost unprecedented) turnout considering this was a private member’s bill debate on a Friday when most MPs would be expected to be in their local constituencies. It is a measure of how important they considered the issue to be. 

2. Over half of all MPs (330) voted against it meaning that it would have been defeated even if all 650 MPs had been present.

3. More Labour MPs (91) voted against the bill than supported it (72) and the SNP and Lib Dems were more or less evenly split. This is hugely significant as it signals that assisted suicide is not a simple left/right political issue. In fact suicide prevention and protection of vulnerable people from exploitation and abuse resonate strongly with left wing politicians.

4. Most party leaders did not vote. Prime Minister David Cameron (Conservative) was not present. Nor was Tim Farron (Lib Dem), Angus Robertson (SNP) or Jeremy Corbyn (Labour). However all four had previously signalled their opposition to the bill.

5. Former Labour leaders and Blairites generally supported the bill. These included former Labour leader Ed Miliband and Deputy Leader (and recently acting Leader) Harriet Harman.

6. Medically qualified MPs were generally strongly opposed, notably former cabinet minister Liam Fox (Conservative), Sarah Woollaston (Conservative) and SNP health spokesperson Philippa Whitford.

7. Many current cabinet ministers opposed the Bill including Theresa May (Home Secretary), Michael Fallon (Defence), Michael Gove (Lord Chancellor), Iain Duncan Smith (Work and Pensions), Jeremy Hunt (Health), Chris Grayling (Leader of the House of Commons), Justine Greening (International Development), Patrick McLoughlin (Transport), Theresa Villiers (Northern Ireland), Stephen Crabb (Wales), Oliver Letwin (Duchy of Lancaster), David Mundell (Scotland), Robert Halfon (without portfolio), Greg Hands (Treasury),  Mark Harper (Chief Whip) and Jeremy Wright (Attorney General).

8. Other prominent MPs who opposed the bill included former London Mayor Boris Johnson, former Lib Dem leader Nick Clegg, former Attorney General Dominic Grieve, former Conservative cabinet ministers Eric Pickles and Peter Bottomley and former Labour Cabinet ministers Alan Johnson and David Lammy.

9. Former Director of Public Prosecutions (DPP) Keir Starmer, now a Labour MP, voted in favour of the bill. Perhaps this explains his apparent reluctance to prosecute people whilst in office. It will certainly raise further discussion about whether or not his published prosecution criteria amounted to stealth legalisation.

How did you MP vote? Full list of the politicians who took part

Out of 650 MPs, a total of 448 took part in the free vote on assisted dying. It was a free vote, which meant they could support either side or none, without being told to toe a party line. This is how they voted.

VOTED IN FAVOUR OF ASSISTED DYING

Conservatives (27)

Lucy Allan (Telford), Gavin Barwell (Croydon Central), Andrew Bingham (High Peak), Crispin Blunt (Reigate), Greg Clark (Tunbridge Wells), Tracey Crouch (Chatham and Aylesford), Lucy Frazer (Cambridgeshire South East), Nick Gibb (Bognor Regis & Littlehampton), Zac Goldsmith (Richmond Park), Peter Heaton-Jones (Devon North), Kevin Hollinrake (Thirsk & Malton), Robert Jenrick (Newark), Joseph Johnson (Orpington), Kit Malthouse (Hampshire North West), Scott Mann (Cornwall North), Tania Mathias (Twickenham), Huw Merriman (Bexhill & Battle), Nigel Mills (Amber Valley), Andrew Mitchell (Sutton Coldfield), Guy Opperman (Hexham), Claire Perry (Devizes), Chris Philp (Croydon South), Paul Scully (Sutton & Cheam), Chloe Smith (Norwich North), Anna Soubry (Broxtowe), Mel Stride (Devon Central) and Matt Warman (Boston & Skegness).

Labour (72)

Graham Allen (Nottingham North), Adrian Bailey (West Bromwich West), Kevin Barron (Rother Valley), Hilary Benn (Leeds Central), Clive Betts (Sheffield South East), Paul Blomfield (Sheffield Central), Nick Brown (Newcastle upon Tyne East), Karen Buck (Westminster North), Richard Burden (Birmingham Northfield), Ruth Cadbury (Brentford & Isleworth), Sarah Champion (Rotherham), Ann Coffey (Stockport), Jo Cox (Batley & Spen), Stella Creasy (Walthamstow), Wayne David (Caerphilly), Geraint Davies (Swansea West), Angela Eagle (Wallasey), Maria Eagle (Garston & Halewood), Jim Fitzpatrick (Poplar & Limehouse), Caroline Flint (Don Valley), Paul Flynn (Newport West), Vicky Foxcroft (Lewisham Deptford), Roger Godsiff (Birmingham Hall Green), Helen Goodman (Bishop Auckland), Kate Green (Stretford & Urmston), Lilian Greenwood (Nottingham South), Louise Haigh (Sheffield Heeley), Harriet Harman (Camberwell & Peckham), Carolyn Harris (Swansea East), Margaret Hodge (Barking), Kelvin Hopkins (Luton North), George Howarth (Knowsley), Liz Kendall (Leicester West), Stephen Kinnock (Aberavon), Dr Peter Kyle (Hove), Clive Lewis (Norwich South), Holly Lynch (Halifax), Kerry McCarthy (Bristol East), Pat McFadden (Wolverhampton South East), John Mann (Bassetlaw), Rob Marris (Wolverhampton South West), Ed Miliband (Doncaster North), Madeleine Moon (Bridgend), Ian Murray (Edinburgh South), Melanie Onn (Great Grimsby), Matthew Pennycook (Greenwich & Woolwich), Jess Phillips (Birmingham Yardley), Lucy Powell (Manchester Central) Jamie Reed (Copeland), Christina Rees (Neath), Emma Reynolds (Wolverhampton North East), Geoffrey Robinson (Coventry North West), Paula Sherriff (Dewsbury), Tulip Siddiq (Hampstead & Kilburn), Andy Slaughter (Hammersmith), Cat Smith (Lancaster & Fleetwood), Jeff Smith (Manchester Withington), Owen Smith (Pontypridd), Karin Smyth (Bristol South), Keir Starmer (Holborn & St Pancras), Jo Stevens (Cardiff Central), Wes Streeting (Ilford North), Anna Turley (Redcar), Karl Turner (Hull East), Stephen Twigg (Liverpool West Derby), Chuka Umunna (Streatham), Catherine West (Hornsey & Wood Green), Phil Wilson (Sedgefield), David Winnick (Walsall North), Rosie Winterton (Doncaster Central), Iain Wright (Hartlepool) and Daniel Zeichner (Cambridge).

Scottish National Party (14)

Kirsty Blackman (Aberdeen North), Alan Brown (Kilmarnock & Loudoun), Ronnie Cowan (Inverclyde), Stuart Donaldson (Aberdeenshire West & Kincardine), George Kerevan (East Lothian), Calum Kerr (Berwickshire, Roxburgh & Selkirk), Chris Law (Dundee West), Callum McCaig (Aberdeen South), Stewart McDonald (Glasgow South), Dr Paul Monaghan (Caithness, Sutherland & Easter Ross), Roger Mullin (Kirkcaldy & Cowdenbeath), John Nicolson (Dunbartonshire East), Tommy Sheppard (Edinburgh East) and Corri Wilson (Ayr, Carrick & Cumnock).

Liberal Democrats 

Tom Brake (Carshalton & Wallington), Alistair Carmichael (Orkney & Shetland), Norman Lamb (Norfolk North)

Green 

Caroline Lucas (Brighton Pavilion)

VOTED AGAINST ASSISTED DYING 

Conservatives (210)

MPs were: Peter Aldous (Waveney), Sir David Amess (Southend West), Stuart Andrew (Pudsey), Caroline Ansell (Eastbourne), Edward Argar (Charnwood), Richard Bacon (Norfolk South), Steven Baker (Wycombe), Harriett Baldwin (Worcestershire West), Stephen Barclay (Cambridgeshire North East), Guto Bebb (Aberconwy), Henry Bellingham (Norfolk North West), Richard Benyon (Newbury), Jake Berry (Rossendale & Darwen), James Berry (Kingston & Surbiton), Bob Blackman (Harrow East), Nicola Blackwood (Oxford West & Abingdon), Peter Bone (Wellingborough), Victoria Borwick (Kensington), Peter Bottomley (Worthing West), Karen Bradley (Staffordshire Moorlands), Graham Brady (Altrincham & Sale West), Julian Brazier (Canterbury), Andrew Bridgen (Leicestershire North West), Steve Brine (Winchester), James Brokenshire (Old Bexley & Sidcup), Fiona Bruce (Congleton), Robert Buckland (Swindon South), Conor Burns (Bournemouth West), Simon Burns (Chelmsford), David Burrowes (Enfield Southgate), Alun Cairns (Vale of Glamorgan), Neil Carmichael (Stroud), James Cartlidge (Suffolk South), Bill Cash (Stone), Maria Caulfield (Lewes), Alex Chalk (Cheltenham), Rehman Chishti (Gillingham & Rainham), Christopher Chope (Christchurch), Jo Churchill (Bury St Edmunds), Kenneth Clarke (Rushcliffe), James Cleverly (Braintree), Geoffrey Clifton-Brown (Cotswolds, The), Therese Coffey (Suffolk Coastal), Oliver Colvile (Plymouth Sutton & Devonport), Alberto Costa (Leicestershire South), Geoffrey Cox (Devon West & Torridge), Stephen Crabb (Preseli Pembrokeshire), Byron Davies (Gower), Chris Davies (Brecon & Radnorshire), David Davies (Monmouth), Glyn Davies (Montgomeryshire), James Davies (Vale of Clwyd), Mims Davies (Eastleigh), Philip Davies (Shipley), Michelle Donelan (Chippenham), Nadine Dorries (Bedfordshire Mid), Stephen Double (St Austell & Newquay), Jackie Doyle-Price (Thurrock), Flick Drummond (Portsmouth South), Iain Duncan Smith (Chingford & Woodford Green), Michael Ellis (Northampton North), Jane Ellison (Battersea), Charlie Elphicke (Dover), George Eustice (Camborne & Redruth), Graham Evans (Weaver Vale), Nigel Evans (Ribble Valley), David Evennett (Bexleyheath & Crayford), Michael Fallon (Sevenoaks), Suella Fernandes (Fareham), Mark Field (Cities of London & Westminster), Kevin Foster (Torbay), Dr Liam Fox (Somerset North), Mark Francois (Rayleigh & Wickford), George Freeman (Norfolk Mid), Richard Fuller (Bedford), Marcus Fysh (Yeovil), Roger Gale (Thanet North), Edward Garnier (Harborough), Cheryl Gillan (Chesham & Amersham), John Glen (Salisbury), Robert Goodwill (Scarborough & Whitby), Michael Gove (Surrey Heath), James Gray (Wiltshire North), Chris Grayling (Epsom & Ewell), Chris Green (Bolton West), Damian Green (Ashford), Justine Greening (Putney), Dominic Grieve (Beaconsfield), Andrew Griffiths (Burton), Ben Gummer (Ipswich), Sam Gyimah (Surrey East), Robert Halfon (Harlow), Luke Hall (Thornbury & Yate), Stephen Hammond (Wimbledon), Greg Hands (Chelsea & Fulham), Mark Harper (Forest of Dean), Sir Alan Haselhurst (Saffron Walden), John Hayes (South Holland & The Deepings), Sir Oliver Heald (Hertfordshire North East), James Heappey (Wells), Nick Herbert (Arundel & South Downs), Damian Hinds (Hampshire East), Simon Hoare (Dorset North), Philip Hollobone (Kettering), Adam Holloway (Gravesham), Kris Hopkins (Keighley), Ben Howlett (Bath), Jeremy Hunt (Surrey South West), Stewart Jackson (Peterborough), Margot James (Stourbridge), Ranil Jayawardena (Hampshire North East), Bernard Jenkin (Harwich & Essex North), Andrea Jenkyns (Morley & Outwood), Boris Johnson (Uxbridge & Ruislip South), Gareth Johnson (Dartford), Andrew Jones (Harrogate & Knaresborough), David Jones (Clwyd West), Marcus Jones (Nuneaton), Seema Kennedy (South Ribble), Simon Kirby (Brighton Kemptown), Greg Knight (Yorkshire East), Julian Knight (Solihull), Mark Lancaster (Milton Keynes North), Andrea Leadsom (Northamptonshire South), Phillip Lee (Bracknell), Jeremy Lefroy (Stafford), Sir Edward Leigh (Gainsborough), Oliver Letwin (Dorset West), Julian Lewis (New Forest East), David Lidington (Aylesbury), Tim Loughton (Worthing East & Shoreham), Karl McCartney (Lincoln), David Mackintosh (Northampton South), Patrick McLoughlin (Derbyshire Dales), Stephen McPartland (Stevenage), Anne Main (St Albans), Alan Mak (Havant), Theresa May (Maidenhead), Paul Maynard (Blackpool North & Cleveleys), Mark Menzies (Fylde), Johnny Mercer (Plymouth Moor View), Stephen Metcalfe (Basildon South & Thurrock East), Maria Miller (Basingstoke), Amanda Milling (Cannock Chase), Anne Milton (Guildford), James Morris (Halesowen & Rowley Regis), Wendy Morton (Aldridge-Brownhills), David Mundell (Dumfriesshire, Clydesdale & Tweeddale), Sarah Newton (Truro & Falmouth), Caroline Nokes (Romsey & Southampton North), David Nuttall (Bury North), Matthew Offord (Hendon), Neil Parish (Tiverton & Honiton), Owen Paterson (Shropshire North), Mark Pawsey (Rugby), Mike Penning (Hemel Hempstead), Andrew Percy (Brigg & Goole), Stephen Phillips (Sleaford & North Hykeham), Eric Pickles (Brentwood & Ongar), Christopher Pincher (Tamworth), Rebecca Pow (Taunton Deane), Victoria Prentis (Banbury), Mark Prisk (Hertford & Stortford), Tom Pursglove (Corby), Jeremy Quin (Horsham), Will Quince (Colchester), John Redwood (Wokingham), Jacob Rees-Mogg (Somerset North East), Laurence Robertson (Tewkesbury), Mary Robinson (Cheadle), David Rutley (Macclesfield), Antoinette Sandbach (Eddisbury), Andrew Selous (Bedfordshire South West), Alok Sharma (Reading West), Alec Shelbrooke (Elmet & Rothwell), Keith Simpson (Broadland), Julian Smith (Skipton & Ripon), Royston Smith (Southampton Itchen), Nicholas Soames (Sussex Mid), Amanda Solloway (Derby North), Caroline Spelman (Meriden), Bob Stewart (Beckenham), Iain Stewart (Milton Keynes South), Gary Streeter (Devon South West), Desmond Swayne (New Forest West), Robert Syms (Poole), Derek Thomas (St Ives), Maggie Throup (Erewash), Kelly Tolhurst (Rochester & Strood), Michael Tomlinson (Dorset Mid & Poole North), Craig Tracey (Warwickshire North), Anne-Marie Trevelyan (Berwick-upon-Tweed), Thomas Tugendhat (Tonbridge & Malling), Andrew Turner (Isle of Wight), Ed Vaizey (Wantage), Shailesh Vara (Cambridgeshire North West), Martin Vickers (Cleethorpes), Theresa Villiers (Chipping Barnet), Robin Walker (Worcester), Ben Wallace (Wyre & Preston North), David Warburton (Somerton & Frome), James Wharton (Stockton South), Helen Whately (Faversham & Kent Mid), Craig Williams (Cardiff North), Gavin Williamson (Staffordshire South), Rob Wilson (Reading East), Dr Sarah Wollaston (Totnes), Mike Wood (Dudley South), William Wragg (Hazel Grove) and Jeremy Wright (Kenilworth & Southam)

Labour (91)

Debbie Abrahams (Oldham East & Saddleworth), Rushanara Ali (Bethnal Green & Bow), David Anderson (Blaydon), Jon Ashworth (Leicester South), Tom Blenkinsop (Middlesbrough South & Cleveland East), Lyn Brown (West Ham), Chris Bryant (Rhondda), Richard Burgon (Leeds East), Dawn Butler (Brent Central), Alan Campbell (Tynemouth), Ann Clwyd (Cynon Valley), Rosie Cooper (Lancashire West), Neil Coyle (Bermondsey & Old Southwark), David Crausby (Bolton North East), Mary Creagh (Wakefield), Jon Cruddas (Dagenham & Rainham), Judith Cummins (Bradford South), Jim Cunningham (Coventry South), Stephen Doughty (Cardiff South & Penarth), Jim Dowd (Lewisham West & Penge), Peter Dowd (Bootle), Clive Efford (Eltham), Julie Elliott (Sunderland Central), Bill Esterson (Sefton Central), Chris Evans (Islwyn), Frank Field (Birkenhead), Rob Flello (Stoke-on-Trent South), Colleen Fletcher (Coventry North East), Barry Gardiner (Brent North), Pat Glass (Durham North West), Mary Glindon (Tyneside North), Margaret Greenwood (Wirral West), Nia Griffith (Llanelli), David Hanson (Delyn), Helen Hayes (Dulwich & West Norwood), Sue Hayman (Workington), Stephen Hepburn (Jarrow), Meg Hillier (Hackney South & Shoreditch), Sharon Hodgson (Washington & Sunderland West), Kate Hoey (Vauxhall), Imran Hussain (Bradford East), Alan Johnson (Hull West & Hessle), Gerald Jones (Merthyr Tydfil & Rhymney), Helen Jones (Warrington North), Susan Elan Jones (Clwyd South), Mike Kane (Wythenshawe & Sale East), Sir Gerald Kaufman (Manchester Gorton), Barbara Keeley (Worsley & Eccles South), David Lammy (Tottenham), Emma Lewell-Buck (South Shields), Ivan Lewis (Bury South), Ian Lucas (Wrexham), Rebecca Long-Bailey (Salford), Steve McCabe (Birmingham Selly Oak), Siobhain McDonagh (Mitcham & Morden), Andy McDonald (Middlesbrough), Conor McGinn (St Helens North), Liz McInnes (Heywood & Middleton), Catherine McKinnell (Newcastle upon Tyne North), Justin Madders (Ellesmere Port & Neston), Shabana Mahmood (Birmingham Ladywood), Seema Malhotra (Feltham & Heston), Gordon Marsden (Blackpool South), Rachael Maskell (York Central), Chris Matheson (Chester, City of), Grahame Morris (Easington), Albert Owen (Ynys Mon), Teresa Pearce (Erith & Thamesmead), Toby Perkins (Chesterfield), Bridget Phillipson (Houghton & Sunderland South), Stephen Pound (Ealing North), Yasmin Qureshi (Bolton South East), Kate Osamor (Edmonton), Angela Rayner (Ashton Under Lyne), Jonathan Reynolds (Stalybridge & Hyde), Marie Rimmer (St Helens South & Whiston), Virendra Sharma (Ealing Southall), Barry Sheerman(Huddersfield), Dennis Skinner (Bolsover), Gavin Shuker (Luton South), Andrew Smith (Oxford East), John Spellar (Warley), Graham Stringer (Blackley & Broughton), Gisela Stuart (Birmingham Edgbaston), Mark Tami (Alyn & Deeside), Nick Thomas-Symonds (Torfaen), Stephen Timms (East Ham), Derek Twigg (Halton), Keith Vaz (Leicester East), Valerie Vaz (Walsall South) and John Woodcock (Barrow & Furness).

Scottish National Party (11)

Richard Arkless (Dumfries & Galloway),Ian Blackford (Ross, Skye & Lochaber), Dr Lisa Cameron (East Kilbride, Strathaven & Lesmahagow), Marion Fellows (Motherwell & Wishaw), Margaret Ferrier (Rutherglen & Hamilton West), Patrick Grady (Glasgow North), Carol Monaghan (Glasgow North West), Gavin Newlands (Paisley & Renfrewshire North), Brendan O'Hara (Argyll & Bute), Christopher Stephens (Glasgow South West) and Dr Philippa Whitford (Ayrshire Central).

Liberal Democrats (3)

Nick Clegg (Sheffield Hallam), John Pugh (Southport) and Mark Williams (Ceredigion).

Ukip

Ukip MP Douglas Carswell

Democratic Unionist Party (8)

Gregory Campbell (Londonderry East), Nigel Dodds (Belfast North), Jeffrey Donaldson (Lagan Valley), Ian Paisley (Antrim North), Gavin Robinson (Belfast East), Jim Shannon (Strangford), David Simpson (Upper Bann) and Sammy Wilson (Antrim East).

SDLP (3)

Mark Durkan (Foyle), Dr Alasdair McDonnell (Belfast South) and Margaret Ritchie (Down South), one from the UUP, Tom Elliott (Fermanagh & South Tyrone)

Independent 

Lady Syvia Hermon (Down North). 

Labour's Rupa Huq (Ealing Central and Acton) is excluded after voting in both lobbies.