CentreRight

My son has been in tears and I’ve got my perspective back. Both were achieved last week by taking my family to join two others to play on the other side of the EU in a Bulgarian orphanage. The EU, but not as we know it. No rule of law, so precious little infrastructure capable of receiving EU funding  (let alone implementing directives!) and social security here lasts for 3 months, after which the options are family and friend’s support, begging or crime. The children we visited aren’t strictly orphans; these are children abandoned by their parents due to poverty, neglect or both and handed over to State institutional care.

Like other eastern bloc countries Bulgaria has been an independent republic for nearly 20 years since the fall of communism. But with the average monthly salary still only €200, these years have seen a huge brain drain with 800,000 choosing to emigrate rather than struggle on against corruption and pitiful pay.

The orphanage we visited was two hours outside of Sophia and situated on a beautiful hillside, this week framed by stunning autumn foliage. Inside, forty-three 3-7 year olds eat, sleep and play. None of them were disabled though several showed signs of mental retardation and a significant number had eye defects. After the first day I walked away happy to have been there, but by the end of day two I was in meltdown. My teenage daughter asked me to save my big cry and resulting red eyes until after dinner. It wasn’t the cockroaches that appeared out of the breadbasket at lunch time in our restaurant. It wasn’t the bare surroundings. It wasn’t the cries of ‘Mama’ that they insisted on calling me. It wasn’t noticing that all clothes were shared not owned. It wasn’t having to peel apart the fingers from behind my neck as it came to unlocking their embrace when our sessions were over. It was the knowledge of their future. 

Their future is currently utterly bleak. Most are abandoned but not disowned, so they can’t be adopted. The spectre of a returning parent can be a threat to their stability, because whether they are reclaimed or whether they go on to the next orphanage when they are 7, the same fate of begging, crime or prostitution is the usual outcome – and at a younger age if the family request their return. Rejected at birth they are usually rejected at school by their peers and few make it into work.

The Independent Safeguarding Authority. What can we say?

Bureaucratic, divisive, corrosive, duplicated, wasteful, negative nonsense. How about ensuring existing systems actually work instead of inventing another?

My premise is this: the Daily Mail has got its health headline priorities the wrong was around today (ok - no big shock - but it's significant). It's put the long-term-maybe ahead of the immediate-for-certain. Genes trump Geriatrics. But whilst I am passionate about greater engagement of the public with science and want more mainstream coverage of research, I am also horrified about the way we are treating our elderly.

The main splash is about a 'Giant leap in Alzheimers fight that COULD spare 100,000 sufferers every year'. Three new genes have been identified with Alzheimers, which is great, but without going into detail, this still means practically that there are (probably) many more genes to find and even when we do, genetic based testing, prevention and /or treating are still decades away. I am a sincere advocate of much more research into dementia, it's been grossly underfunded considering the rising prevalence.

But the subheading is about the certainty that home care that WILL be withdrawn from the elderly this winter. By next year the percentage of elderly classified as having 'moderate' homecare needs and getting free help from social services will have dropped from 31% to 14%. I have sat in the lounge of elderly people who have wept openly before me as they show me letters of having care withdrawn. Practically for them this could mean less fresh food or no bath or sitting in the same chair all day (and being forced to wear incontinence pads). They seem to always be the easy target for cuts, behind closed doors and loathe to complain.

What is a possible breakthrough of science has trumped in our headlines a certain, tragic breakdown of society. It reflects a shocking lack of compassion for those who have gone before us. The solutions are multiple - everything from encouraging through our culture a higher regard for the elderly to ensuring social service resources are prioritised on the most vulnerable (children and elderly) first. Think of the irony - we find a cure for dementia but have meanwhile abandoned the elderly to isolation and neglect.

The smear-a-peer reached new depths today with the Times allegations of embarrassment against the Tory shadow health minister Lord McColl. Iain Dale has already blogged as someone who doesn't know him, but having known Ian McColl for 17 years I wanted to add some more perspective.

In brief, this is a man whose Christian faith has driven a career which has been dedicated to not just to 50 odd years of NHS surgery but to human rights and social justice. He spends up to 3 months a year unpaid on board a Mercy Ship undertaking life-saving and sight-saving operations off the coast of Africa, often accompanied by his GP wife; a man who promoted compassion for Aids victims through his involvement in setting up Europe's first palliative care centre in 1988, the Mildmay Hospice; who then continued this work in Uganda; who was awarded his life peerage for services to the disabled and to medicine; who has supported the work of the Leprosy Mission (he may still be its president). I could go on with stories of his incredible generosity and philanthropy, but he would be mortified if I did.

The only embarrassment that should be felt today is that of the Times journalists who cannot have failed to discover some of the above compassionate activity as they scraped around in no-news-season, like urban foxes in your dustbins, to deliver a summer shocker: that Lord McColl believes in freedom of choice in healthcare.

While we debate how to sustain our universal, free healthcare (see ConHome yesterday), Obama is burdened with how to obtain universal healthcare. As the Times says today, it defeated Clinton and the people and professionals are not liking what they are being offered this time either. An article in the New York Post today sets out the reasons why.

NHS IT - what can I say? Well in the light of today's Times headlines "Google or Microsoft could hold NHS patient records say Tories" quite a lot. The Times totally conflate minor and major objectives and call the entire NHS IT 'Connecting for Health' programme 'the electronic patients records programme' and imply the latter will cost £12.4Bn.

The reality is that the use of Microsoft, Google or any other electronic record system would only apply to the summary care record of the 'NHS spine' which has a contract value of £600m. The NHS spine has many other elements which are valuable and would need retaining under any model. For instance the personal demographics service, all the national security and confidentiality provisions as well as the means to support valuable national applications such as 'Choose and Book' and Electronic Transfer of Prescriptions. Both the latter are up and running but need developing further - the former particularly with respect to long term conditions.

Granted there were two major problems with this project right from the start. Firstly the Government took a command and control approach that prevented hospitals finding their own providers and IT solutions. Result - chaos and wasted millions. Secondly calling the whole project an 'IT' programme. Not only was the name the kiss of death but the goal wasn't 'IT' in itself, and the approach alienated clinicians right from the start instead of involving them. The project is about (amazingly) improving patient care [remember that?] through enabling technology. The 2020health-EDS/Hewlett Packard conference on Improving patient outcomes with IT in May (written up here in e-health insider) had superb examples of how technology has transformed patient care in the USA, Spain and Norway (publication to follow).

The major challenge for the Conservatives is how they will support the complex major areas of the project - the local Care Records Service which are the new hospital systems to support clinical functionality needed within hospitals for patient care. Google and Microsoft have no relevance here.

There is an interesting dialogue going on over at ConHome about Welsh Tories wanting to bring back prescription charges. It is I believe however missing the main point.  

Prescription charges for some people [low paid, diabetics, pensioners] should not be brought back in order to raise money. They should be brought back for everyone to help reverse our dependency culture and reinforce the message that we need to be in more control of our own healthcare, including being responsible when obtaining medication.

We argued for a nominal charge of £1 in 2020health's report last year: 'Our health, our money, our say' (sorry image slightly blurry, it's not your eyes!)
To summarise the argument for this:

• Unused medication in our bathroom cabinets cost the taxpayer (a conservative estimate) about £800m a year - 10% of the annual medicine budget.
• Even for the average pensioner on 38 prescriptions a year, the weekly cost would work out at an affordable 70p per week. Judging from the mountains of repeat medications piled up in the homes of patients I have visited, it wouldn't even come to that.
• A small charge would encourage forethought about for example genuine need, stockpiling of medication, whether the GP should be consulted for a minor ailment that could be dealt with by a pharmacist or self-care etc. 
• The current situation in England is unfair - if you have Aids you have to pay for your meds; if you have diabetes you don't. Where's the logic?

If we are starting afresh and being honest about healthcare, this is a move to level the playing field. We've had means tested prescription charges since 1951. A responsible way forward is to encourage each of us to think about what meds we need and the most appropriate place to get them. A free-for-all system would result in just that, and the wastage bill would soar.

These are extraordinary times! The revolving door at Westminster has been spinning so fast, there hasn't been time to even start spreading rumours. Apart from Flint at health, as suggested by Benedict Brogan that is. Luckily that was proved to be false (I have the Nation's health and well-being at heart), but not before (I am sure) they had started having kittens at the Department of Health. I remember one civil servant rolling her eyes at the memory of the time when Caroline was there and they had to repeat briefings in two syllable words. It was not her forte. (I've just read her letter to Gordon; must have been a joke rumour :)

I wondered too about Shaun Woodward, who sat loyally beside Gordon at PMQs this week, nodding, smiling in all the right places. He'll be really cross, as will Hoon, who has never hidden his high flying ambitions. But in beefing up roles for Mandelson and Balls and getting rid of DIUS, one interesting question is how will Cameron now use David Willetts' skills now? ......The best news however is in the Council Elections and that my childhood county of Derbyshire has gone blue! Yeah! Fabulous news! Now, back to the net to see what MORE has happened in the last few minutes... 

This has to be one of the saddest weeks of my 9 years involvement in British politics.
Distressed for the honourable MPs who have always kept their expenses within the spirit of the regulations and are now smeared either by false allegations or by association with their greedy colleagues.
Despairing at the damage done by the Chancellor of ALL people who flips his homes 4 times to avoid paying tax!!! Is he so cocooned that he doesn't understand that this is carte blanche for all those considering other forms of tax evasion?
Outraged for the sense of betrayal felt by the Conservative Party at large, that is made up of wonderful, ordinary people who for no personal gain give time, money and energy to further the freedom and democracy that they care so passionately about. 
Miserable that our precious democracy is jeopardised by the deepening apathy and disengagement that this scandal has engendered amongst the electorate.
I previously called for radical, immediate action - a Zacchaeus moment - in British politics. There is no more time to lose. As well as previous suggestions I would add another. The MP's main home in the constituency or in London should be bought, owned and maintained by an arms-length organisation that is wholly owned by the State so the asset remains with the taxpayer. Just as vicarages up and down the country are established in the parish for successive incumbents and owned by the Church of England [roughly - I'll spare you the details], a house from which the MP serves his or her community should be made available. This wouldn't stop those with the means to buy their own place or live out of two homes, but it would put an end to the practice and perception of profiteering from home allowances.
Some will say that this will deter good people from entering politics. I would say that the first time I heard David Cameron speak he talked of service and sacrifice. Now, with depression on one side and scandal on another, more than ever we need to rebuild the reputation of the British politician - and this has to be demonstrably based on the virtues of frugality, integrity and good stewardship.

Following my 'flu forecast on Thursday in which I raised the socio-economic angle to the pandemic, yesterday in the NYT the significance of Mexican culture is highlighted further. Dr Andrew Paxman, an expert in all things Mexican [I can say that as his sister] clarifies as well that it is the loss of wages posed by a day spent queuing in hospital that is one significant deterrent for people seeking help. Culturally he also says that Mexicans are 'stoical' about illness and fond of self-medicating as far as possible, a point also made in the NYT article. Going to the doctor or hospital is the last resort, when all else has failed. And tragically as we have seen, it has been too late in many cases already.

While there are still many unanswered questions about the virus, which the evidence shows is highly contagious, it is right that the government takes precautions. But in order to maintain a realistic perspective we need to be aware of the history and cultural circumstances of the deaths now being found to be caused by swine 'flu [or H1N1 influenza A as WHO now call it]. Maybe it's people of working age who have died because they were the ones who didn't want to take a day off work? With a reported 20% rise in 'sickies' in the UK in the past few days already, and a freely available NHS, that is never going to happen here! Tomorrow my cousin returns from 2 weeks in Mexico with a group of fellow doctors; I wonder if they will find themselves on extended leave...

The current evidence backs up Ryan Air boss Michael O'Leary's assertion in today's Times that swine 'flu is only a real threat to slum dwellers. Speaking to my brother yesterday, a professor of Mexican studies, he too pointed out that it was poor Mexicans who can't afford the doctor's fees who have died.

I don't want to diminish the global significance of a new, rapidly transmitted virus - especially one like 'flu that could mutate and get worse over time. But will the unfolding tragedy really be that there is another new form of disease, like diarrhoea, like pneumonia, that is entirely treatable and which is an inconvenience to the rich in the west, but a death sentence for the poor? If so, what are we going to do about it?

If we are lucky, this new swine H1N1 strain of 'flu will fizzle out and we will merely be sending heartfelt condolences to the people of Mexico. However we can't simply wait for that 'if' to materialise and the government needs to show leadership today including:

• Acting to reassure the nation that they have systems in place to cope with an influenza pandemic, even though swine ‘flu that is being spread out from Mexico by global travellers has so far proved less virulent in the countries to which it has spread.
• Willing to be honest: there is no way of containing a virus like this even if borders are closed. So clear information and instructions should be immediately issued to all international arrivals at our airports and ports.
• Publicising our position re stockpiles of the two ‘flu drugs that seem to be effective against it – Tamiflu and Relenza. The risks and benefits should be clearly publicised by the independent Health Protection Agency to avoid scaremongering by the anti-jabs brigade.
• Reviewing all the literature around the 1976 outbreak of the same H1N1 virus [though we are probably dealing with a different strain] which caused major alarm in the USA but which never developed into the feared pandemic. Why – was it just luck or did certain measures make all the difference?
• Considering how we can support our less-developed Commonwealth partners if they should need our help.
  

A pandemic is not inevitable, neither is panic. We're not immune but we can be prepared - time will tell if this is something this government was ready for.

Having been either away or submerged in family illness, I'm just venturing forth again with a few questions.  Firstly, am intrigued to know what CR readers think of their money being spent on a BBC Indian Election Train? I know we paid for a bus to follow the US elections, but that was about the next leader of the world's greatest super power. India is a developing nation, granted has a significant geo-strategic position and I'm a fan of the World Service, but is this train a good use of our licence fee?

If MPs were subject to the European Working Time directive limit that is coming in for junior doctors of 48 hours, half of all parliamentary activity would grind to a halt. The majority of MPs work long and hard hours representing, scrutinising, legislating and campaigning on behalf of their constituents. The majority have gone into politics wanting to improve the quality of life for those they represent. And most of them earn less than the average salary of a mere director of an NHS  Trust.

The headlines of fraud, failure and foolishness must grieve the many honourable MPs who are all tarred with the same brush. But today we face an unprecedented situation: seismic national economic meltdown combined with extensive individual fiscal suspicion. Whilst politicians are always towards the bottom of trustability league tables, unfolding revelations of individual greed are grating against a backdrop of developing personal hardship and the public are left feeing angry and betrayed.

Brown’s current position is untenable.  To do nothing (yet) and allow the Standards watchdog to follow up the trail of successive media exposés is allowing a crisis of trust to deepen. Sleaze will continue to flow and the damage will be to local confidence, national democracy and international reputation.

Or Brown could change his mind and authorise an immediate investigation into the expenses of all 646 UK MPs. An expensive exercise that will exonerate some, condemn others but satisfy no one as no resignations will accompany the findings. In any other walk of life there would already have been legal proceedings and firings. But whether through ignorance, weakness or their own deliberate fault the rules on expenses have been abused and what is right and appropriate has got lost in the muddy waters of allowance guidelines.

But there is another option which I call the Zacchaeus opportunity.

The hospital I am sitting in has had had multi-millions spent on it in the past 10 years. There are shiny new wards and smart new beds, flat screen tv for my daughter to watch and impressive portable technology that can scan, monitor and measure [but not weigh - that one is broken] at the flick of a switch.

So can someone tell me why it took 3 hours for notes to follow her from A&E to the ward which meant tests were delayed until the next day; why the Consultant couldn't access previous blood test results processed by the in-house lab; and why I've had to fill in her details 4 times?  Ok, so I know the answer. IT. Lack of. It's just so incredible that we are still relying on paper records and the IT records that are in place are either partial or inaccessible to different departments all or some of the time.

Not only would electronic records improve efficiency all round, they are an essential component of affordable healthcare in the developing world. This is one of the key recommendations of the Rockefeller Foundation's ehealth 'Call to Action'. But while they focus on international development, we need to make rapid progress here because IT is one of the answers to the squeeze that will come on public sector spending in the years ahead. I could plug 2020health's Transformational IT Seminar on May 19th at the Royal College of Medicine with our emphasis on patient-controlled electronic records, or our international speakers including one coming from a Spanish paperless hospital. But I'll do that another time. Right now I just want the test results to come through, even on paper.

The front pages quite rightly today detail the desperate case of Mid Staffordshire NHS Foundation Trust. The Guardian lists some of the failings.

I doubt there is a clinician alive in the NHS today who has not seen how targets have distorted clinical priorities. Are we shocked by this story? No. Because we have seen these distortions for years and have we complained? Yes. And what has been the outcome? Put-downs by managers who have been put in the invidious position of enforce or be punished by this Labour Government. Clinical need and quality of care have been trumped by clockwatching and fear.

Reviews have been launched into quality of care and A&E but there are fundamental procedural questions to be answered.

1. Why on earth didn't Monitor, the independent regulator of foundation trusts know that the HealthCare Commission had serious concerns about the Trust?
2. Why is there no red alert system when there is a rising number of deaths?
3. And why are the Trust's minutes so inadequate? 

I might have an answer to the last one - because the Trust I used to work in had a chairman who edited the minutes for anything she didn't want to be recorded including for meetings where she wasn't present.

If this can happen, then records of complaints from staff, clinicians and family can all be altered / changed / lost too can't they? Most people whether managers or clinicians or ancillary staff go into the NHS to care and to serve. What has happened to us when external pressures drive out this noble aim and integrity is thrown out with the hospital waste?

News of a minimum price for alcohol broke last week and it's still the subject of many column inches today although timesonline is now reporting that Gordon Brown has rejected the idea. The Conservative's ideas of targeted rises on both loss-leader promotions and high-alcohol drinks is laudable, but it's not enough in isolation.

And Simon Carr in the Independent illustrates perfectly a significant part of the problem - parental disengagement. I don't know how old his children are, but he expects everyone else to keep them occupied and out of trouble and unashamedly dismisses his own 'guzzling' with the fact that 'role models don't always work'. No they don't always, but often they do. And this includes not just how we drink in the home but how we handle our money. The fact that one in ten admissions to hospital for alcohol abuse is for a minor with no personal income should be shocking us here. Let me ask the obvious - where do most teens get their money from? Answer, their parents. How many parents are teaching their kids how use this money sensibly? Anecdotally I would say the minority. I know many who seem to 'demand supply' their kids with cash. So isn't this ready supply part of the problem?

Teaching your teenagers how to budget on an 'allowance' seems to be out of fashion big time, but it is a crucial parental role. My daughter has had her monthly allowance since she was 12 - she has to cover her phone, pet supplies, stationary, travel, gifts and other specified items. When the money runs out, no more is forthcoming until the 1st of the next month. Hard lessons are learned - but that's the point - they are learned. And where did I get my model from? From my parents.

You can't legislate for this but it is part of the bigger picture of the need for Government to raise the status of parenting. And not only do more confident, more involved parents who nurture and teach their children good habits save the NHS Public and Mental Health budget millions, but they are an investment for the future of civil society.

A Scottish family doctor will today call for a tax on chocolate at a medical conference north of the border. Without getting distracted by the cultural anomaly of a Scot asking to pay more, isn't this a gimmicky suggestion instead of answers to three far more fundamental questions?

One is that many people have no idea of the nutritional value of food and there is a dearth of knowledge about what constitutes a balanced diet. One of my patients once proudly told me about all the fruit she ate, but that was in between her main meals and on top of rich puddings! There's been talk of more 'food technology' in schools to educate kids - but how many of the new school builds have allowed for this.....?  And isn't it the parents who supply the fizzipops and crisps that they eat for breakfast as they walk to school?

Two is that we don't realise how many calories there are in the portions we have - and this is where he does have a point about chocolate, but check out pizza and wine and pies too - are we going to tax all of these [more?]. Surely it's about size of portion as there has been an American drift in the sizes of portions that we eat and a concurrent reduction in the distances we walk. Maybe there is too much public transport?

And thirdly, there has to be an incentive to eat less. It used to partly be the shame at being obese, being thought of as being greedy. Can we regain a sense of shame in a society that embraces relativism? What other incentives are there?

The Scottish doctor's suggestion is really a plea for help; chocolate tax isn't the answer but we have to come up with others.

Everyone who reads these words has benefitted from the top two Public Health measures of all time: clean water and vaccination. While clean water is still de riguer, vaccine conspiracy theorists continue to threaten the health of the nation with spurious stories that simply reflect the need to blame something for poorly understood diseases. Yet the truth remains - millions of lives are saved every year through immunisation.

In 2020health's new report out today Not Immune: UK vaccination policy in a changing world we make the case for strengthening the role of the vaccine decision making body in the UK, the JCVI (Joint Committee on Vaccination and Immunisation). Although the high profile that Andrew Lansley, shadow health secretary, has given to Public Health is superb, we disagree with the Conservative Party's suggestion that vaccine decisions should be moved to NICE [which assesses medicines and medical devices]. The complexity of decision making about vaccines, the fact that the JCVI covers the whole of the UK [whereas NICE just covers England and Wales] and the controversy surrounding some of NICE's decisions would, we felt, jeopardize the UK's successful immunisation programme.

However there is considerable room for improvement in the way the JCVI works regarding horizon scanning, speed, transparency, industry relations and cost-effective analysis. One of the most important changes would be to make the JCVI meetings public. Openness in health and science policy making, as well as the involvement of patient groups could only boost confidence in the decision making process. They shouldn't be immune from public scrutiny and we should for ever be grateful to Jenner and his milkmaids.

The Mail today claims that facebook and twitter 'fuel' cyberbullying. While cyberbullying is a serious problem and sad reality [apart from when Guido does it!], I would argue that these sites do not fuel it. Yes they offer the cowardly bully a medium through which they can torment, but to accuse them of promoting it is simply to shoot the messenger.

The much more serious point here is that 50% of mental health problems begin in children under the age of 14 years and that will certainly rise if we don't take responsibility for protecting children while using this great software. There have already been tragic cases of suicide after experiences of cyberbullying. I would suggest there are three significant contributors to this neglect of responsibility.

Firstly many [most?] parents don't or don't know how to set security & privacy settings for their children's computers, mobiles or social networking sites [which have an age limit of 13 years anyway]. The recent cybersurvey undertaken by Mr Manning at his school revealed a scandalous level of neglect by parents in this domain, both in the unlimited terms of access and time [more on that another post - and there is another clue to obesity in there too]. Whether through ignorance, weakness or deliberate some of this is another consequence of the undermining of parenting by Labour.

Secondly, children are not taught how to be safe online when they use IT - surely this should a basic priority for teachers in the primary school PHSE curriculum. And lastly kids themselves need to behave responsibly, although a large part of this is having the emotional intelligence to be able to block unwanted calls and 'friends', and that often depends on whether their parents have bothered to instil it.

Picking up the pieces is unsustainable - psychiatry colleagues are currently being told to find cuts in their mental health service provisions. We need to start somewhere, so how about a high profile campaign led by the likes of the Sun, Mirror and Mail with cut-out 20 things to make your home pc safe along with a school-centred awareness campaign that kid's mental wellbeing is at stake paid for by the software/networking companies. What a great chance to demonstrate their CSR! Now, who's ready to get this one going?

Lance Corporal Johnson Beharry has been brave again, highlighting the disgraceful inadequacies in the help available for veterans with post traumatic stress disorder [PTSD]. [It's worth looking at the comments on the impact of PTSD posted in the Independent online to get a glimpse of what families suffer]. Although he is still a serving soldier, he was talking about ex-service personnel, and it seems that nothing has substantially changed since the early 2008 publication of the Seventh Report of the Commons Select Defence Committee in which one psychiatrist was particularly critical of the lack of proactive provision of mental healthcare for veterans, saying that the NHS "hardly deals with them at all"

The Chief Executive of the charity Combat Stress also said at the time: "A veteran who has undergone a traumatic experience in battle could find himself referred to a PTSD support group with people who had been in car accidents or had suffered traumatic childbirths". It beggars belief that anyone could think this appropriate.

  He also reported a 27% increase in referrals for help in the previous year - now standing at 53% over 3 years.

Meanwhile the Government think that their six 2 year community mental health pilots for veterans are adequate. But hang on, the Tories launched a successful pilot in 1996 in Yorkshire - it proved a success - and is now a mainstream service. What's to pilot? That's no commitment, that's a cop out.

We need a military health service in the UK that communicates the deep appreciation and respect that most of us have for our veterans. The price paid by our forces in the daily sacrifices of duty should be credited to them in the specialised care they receive when their losses later extend to their mental health.

I'm just coming to the end of a fabulous week in the USA and vote Washington DC the most friendly city I have ever been to. London would be transformed if we could be as polite and helpful and spontaneous as our Washingtonian cousins. Now in New York I got the Wall Street Journal this morning and came across the full page spread advert paid for by the Cato Institute which has over 260 economists including Nobel laureates [though not Jed Bartlett] disagreeing with Obama's quote from Jan 9th when he said that "economists from across the political spectrum agree" on the need for massive government spending.

It's worth reproducing their succinct argument here:

"Notwithstanding reports that all economists are now Keynesians and that we all support a big increase in the burden of government, we the undersigned do not believe that more government spending is a way to improve economic performance. More government spending by Hoover and Roosevelt did not pull the United States economy out of the Great Depression in the 1930's. More government spending did not solve Japan's 'lost decade' in the 1990s. As such, it is a triumph of hope over experience to believe that more government spending will help the US today. To improve the economy, policymakers should focus on reforms that remove the impediments to work, saving, investment and production. Lower tax rates and a reduction in the burden of government are the best ways of using fiscal policy to boost growth."

So Cameron-Osborne are not so lonely now, but the grim reality is that they will have to become salvage experts between now and the next election.

The Children's Society 'The Good Childhood Inquiry' to be published on Wednesday was previewed in the weekend papers, and we are told, will contain 'controversial' findings. 'Controversial' implies the findings might not be true or valid, when what they probably mean is 1) the findings are true and therefore exclusive [all truth excludes] but 2) they apply them universally, which, as I have recently been reminded, makes too many presumptions and ignores individual circumstances. Being a working mother has not meant I have neglected kids or have left my husband through my economic independence.

But the overall theme - the 'excessive individualism' of adults today is totally valid and key to changing this as I have said before, is how the Tory Party raises the status of being a parent, which is the most important job I will ever do. I hope that they will adopt some of the really positive suggestions made by this report such as civic ceremonies for the public acceptance of parental responsibilities [booked at the Registrars office?!] and free parenting classes and 'normalise' family support access [more here]. NuLab in all their PC glory have contributed massively to this mess by withdrawing funding from many organisations that supported families and marriage in the late 90's.

Churchill said of Asquith 'His children are his best memorial, and their lives recount and revive his (great) qualities.' Imagine that becoming the maxim for all parents in this country... anyhow, must go, have just committed myself to a snowball fight which, bearing in mind the bowling ability of my 10 year old, demonstrates total commitment!

We may not have all the facts, but if the headlines in the Daily Mail are true, the grandparents aged 46 and 59 who have been told they are too old to adopt their grandchildren are victims of the most ludicrous and detrimental application of social services regulations [please tell me it's not the law!]. The list of common sense objections to this decision should be too obvious to state.... many natural mothers have babies in their 40's [Cherie Blair at 45]....the grandmother's diabetes is chronic condition handled by thousands of mothers alongside child-rearing....housing children with extended family should be the priority....the children need security and the vast majority of gay couples split within 6 years [a fact not a prejudice] ....grandparents across the UK are routinely involved in grandchild care.... etc etc etc

Having had a heroin-addict mother [according to the 6am BBC news but not yet on website] these children will already have had a hugely traumatic start to their lives. All the evidence points to the grandparents wanting the best for their grandchildren, their being the best source of love and continuity yet having been persuaded by the authorities that they weren't good enough. Chaos theory seems to have taken over Edinburgh Social Services.

Turned on my browser this morning to find a bunch of scribble instead of the Google logo on my home page. Obviously someone at the search engine likes Jackson Pollock who was born this day in 1912 - but after logo changes for the Queen and Chinese New Year, is this now going to be a daily feature and if so, can we nominate changes? If so mine are WC Fields [a bat for the L?] for tomorrow and FDR for the 30th [head and shoulders for the G?]!