Publish and (don’t) be damned – just don’t do anything illegal

Stuart Baldock 12.55pm
Lord Justice Leveson, at the beginning of his inquiry into the culture, practice and ethics of the press, stated:
The press provides an essential check on all aspects of public life. That is why any failure within the media affects all of us. At the heart of this Inquiry, therefore, may be one simple question: who guards the guardians?”
The answer is definitely not Government regulation and thankfully the Government appears to agree. Jeremy Hunt, the Culture Secretary, talking to Andrew Marr, stated:
“I think everyone recognises we don’t want the state regulating content. We have one of the most lively free presses in the world, they make life for me and my colleagues extremely uncomfortable and it is part of keeping us on the straight and narrow”.
Imagine a nightmare scenario: a future Government may disapprove of a line of enquiry been undertaken by the press and simply decrees the topic to be ‘out of bounds’. For example, reporting on inadequate military equipment prior to a military campaign could be blocked on flimsy ‘national security’ grounds. This may seem farfetched - even absurd - but if Government regulation of the press is allowed there is no telling where it may end.

The answer to ‘who guards the guardians’ is simple. Who are supposed to be the ‘guardians’ of society’s rules – the police? The police have been complicit in these scandals too, something we are not reminded of enough.
There are already enough laws on the statute book to govern the conduct of the press – transgressions simply need to be investigated and punished.
  • The Prevention of Corruption Act (1906) means it is illegal to bribe a Crown agent (Police Officers and other Government employees are classed as Crown agents) in order to obtain confidential information.
  • The Computer Misuse Act (1990) amended by Part 5 of the Police and Justice Act (2006) forbids unauthorised access to computer material. This Act forbids hacking an individual’s email account for instance.
  • The Data Protection Act (1998) made it illegal to gain unauthorised access to confidential databases, such as telephone records and bank accounts.
  • The Regulation of Investigatory Powers Act (2000) makes intercepting someone’s voicemail (unless you are the Police or Security Service with a warrant) illegal.
While there is a possible public interest defence if journalists violate the Data Protection Act, there is not a public interest defence if the Regulation of Investigatory Powers Act, the Prevention of Corruption Act, or the Computer Misuse Act are broken.

Granted, none of these laws specifically target the press – but journalists are bound by them like the rest of society.

The question has to be asked – do we need further legislation? I would argue no. Further legislation risks the press not being able to be an ‘essential check on all aspects of public life’ and may seriously hamper investigative journalism.

The UK is only twenty-eighth on the Reporters Without Boarders (RWB) Press Freedom Index – behind countries such as Namibia, Mali, and Costa Rica. The UK is so low on the list in part due to our anarchic libel laws which allow rich ‘libel tourists’, both individuals and corporations, to sue for damages in the UK, even if comparatively miniscule number of people read the ‘offending’ article in the UK.

The UK is also low on that list because of the number of ‘super-injunctions’ issued by our courts. Most of these are the consequence of the rather generous interpretation of Article 8 of the European Convention on Human Rights: “Everyone has the right to respect for his private life, his home and his correspondence”.
When drafted in 1950 in the aftermath of the Second World War, its intention was so that your children could not be co-opted into a Hitler Youth type organisation, or that you would not be dragged out of your bed by a Gestapo-like entity. Article 8 was not drafted to protect people who have a predilection for sex with someone other than their established partner.
What if a newspaper is wrong? Lord Leveson could set-up a reconciliation service to quickly resolve disputes with a back-up of penalties if either side acts unreasonably.
Rather than punishing newspapers financially, the service should punish errant newspapers in column inches. An apology should be published in the same font as the incorrect article and on the same page, even if that happens to be on the front page, and damages should be paid. If the article is true, newspapers should be able to publish it all over again.
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Transport problems: Heathrow is the solution that dare not rear its head

Stuart Baldock 9.38am

The Government has put itself in a difficult spot with regards to solving the South East’s airport capacity problem - or more accurately the capacity issue at Heathrow.

Prior to the election, the Conservative party - it could be said foolishly - ruled out building a third runway at Heathrow. The Liberal Democrats - perhaps even more foolishly - have ruled out any capacity increase in the South East, including a new airport or additional runways at Stansted or Gatwick. Both policies are enshrined in the Coalition Agreement. Both Parties should reconsider.

Airports are as important to the modern UK economy as maritime ports were between the 18th and 20th centuries. At a time when growth in the economy is desperately needed, ignoring this fact is misguided at best, or reckless and incompetent at worst.

Success in this globalised world depends on one’s links to current and potential markets.

No matter how good teleconferencing has become, business is still done in person. Indeed, a report by Frontier Economics, an economic consultancy, found that UK businesses trade by as much as twenty times more with economies that have direct daily flights to the UK compared with those that have fewer or no services.

Lack of capacity is already estimated to cost the UK economy £1.2 billion each year. Heathrow is operating at nearly 100 per cent capacity.

The UK is far behind competitors when it comes to direct flights China. As shown below, the UK has significantly less flights to the main Chinese cities than Frankfurt and Paris. In the case of Guangzhou, the leading manufacturing region in China, there are no direct flights from Heathrow.


Frankfurt – 1032 


Heathrow – 698


Frankfurt – 1110

Paris – 1323

Heathrow – 621


Frankfurt – 211

Paris – 290

Heathrow – 0


There have been a number of solutions put forward to rectify London’s airport capacity problem:

  • Build extra runways at Gatwick and/or Stansted. Both schemes would be relatively cheap – at around £2.5 billion. But Stanstead is unlikely to attract a significant number of airlines due to its distance from London. The Stansted Express train connection could be up-graded but at significant cost. Also linking it with HS2 would be prohibitively expensive due to its distance from the intended high-speed route. The main issue with expanding Gatwick is a planning agreement with West Sussex County Council prohibits the building of a second runway until after 2019. Not ideal when the Heathrow is already operating at capacity.

  • Build a ‘Thames Estuary Airport’Lord Foster’s Isle of Grain scheme, the so called ‘Boris Island’, or an airport at Cliffe in Kent. The main issue with these schemes is the cost. The cheapest proposal is Cliffe at £14 billion. The other schemes are estimated in excess of £20 billion just for the airports, while another £30 billion may be necessary for associated transport infrastructure. There are also environmental and safety issues to consider: birds and airliners are not compatible. A 2003 report found that the risk of losing an aircraft to bird strike around a ‘Thames Estuary’ was between one in 100 or 300 years – significantly more than any other UK airport.

Heathrow is the best option from a point of view of speed, cost, and environmental sustainability.

An additional runway could be built relatively quickly and could cost around £9 billion - a substantial investment, but not as much as other schemes.

The question has to be asked, is it really ‘sustainable’ to close one airport in a suburb (which is what it would take to make many airlines leave Heathrow) and move it to ecologically important marshland? No.

Heathrow can - as indeed is planned - be easily linked with HS2 so that the benefits of a world class airport can be shared with the rest of the UK, not just the South East. A third runway may not be the most staightforward option politically, but it is the best option.

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Railways should be seen as a public good like education or health

Stuart Baldock 11.28am

The average the cost of a rail journey has increased by 5.9 per cent. The price of some tickets has increased by as much as 11 per cent.

The Government allows train companies to raise ticket prices by Retail Price Index (RPI) +1% but it could have been more drastic still.

In the autumn statement, the Chancellor, George Osborne, scrapped plans to increase fares by RPI +3 per cent. Had this decision not been taken, ticket prices could have increased by an average of 8 per cent.

The ‘relief’ may only be short lived - unbeknown to many passengers, rail companies also have the opportunity to increase ‘non-regulated’ fares, e.g. off-peak tickets, in both May and September.  Additionally, in January 2013 and January 2014, it is anticipated that the Government will revert to the RPI +3 per cent formula to calculate fare increases.   

Passengers are entitled to feel aggrieved. Travelling at peak time is often an unpleasant experience. Even if the service they plan to join is not too overcrowded to board – there is unlikely to be the ‘luxury’ of a seat.  

It is not hyperbole when rail passenger advocacy groups note that for many commuters such increases are unaffordable - particularly at a time of stagnating wages. Research by the Hay Group has highlighted that for many workers the cost of commuting by rail already accounts for around one-fifth of yearly earnings.   

The rationale for increasing fares is a simple one. Taxpayers who do not use the rail network should not have to shoulder the burden of financing the much needed investment in the UK’s rail infrastructure. But everyone can benefit from a good rail network.

Every commuter on a train is one less person driving a car on the UK’s already heavily congested roads. A recent report by Churchill Car Insurance calculated the per annum cost to the UK economy of lost working hours due to traffic congestion at £752 million. Why allow unsustainable increases in rail fares and possibly make this worse?

Additionally, there are environmental benefits that rail travel has over other means of transportation – particularly cars. For example, if we take an average journey in the UK to be approximately 10 miles or around 600 miles per month, one person commuting by car will emit 3.96 tons of CO2 per annum. The same journey undertaken by train would emit only 1.62 tons of CO2 per annum.

It is time we started viewing our trains very much like we view education, health, or defence. The railway is a public service that all taxpayers can benefit from. Passengers directly contribute £6.5 billion to the running of the railways. Taxpayers contribute £4 billion. There should be a rebalancing.

Research by the Campaign for Better Transport (CBT), has found that in some instances rail passengers in the UK pay up to ten times more for their tickets than on the continent. The CBT compared the cost of travel between Woking, Surrey and London Waterloo with similar commutes on the continent.

  • A season ticket between Woking and Waterloo costs £3,268 per year.
  • Between Ballancourt-sur-Essone and Paris the cost of a season ticket is £924.
  • Between Strausberg and Berlin the cost of a season ticket is £705.
  • Between Collado-Villalba and Madrid the cost of a season ticket is £653.
  • Velletri and Rome, the cost of a season ticket is £336.            

In response to the CBT’s research, the Association of Train Operating Companies notes accurately:

“In many other countries, the state chooses to subsidies the railways more heavily than in Britain.”   

If we want to stimulate the UK economy and help lower paid workers we need to increase state rail subsidies.

If ticket prices increase along the current trajectory then we risk reducing our workforce mobility; particularly for the lowest paid.

Rail fares as a proportion of salary for a Senior Manager, based on a 17-30 minute commute, are between 1-2 per cent; for a Production Operative it is 8-11 per cent. Based on a 50 minute commute the figures are an even more disparate 2-3 per cent and 16-20 per cent respectively.

When the economic situation improves, the cost of commuting to jobs should not be an impediment to taking work.

Mary Portas shopping list should get Government thinking

Stuart Baldock 7.40am

Mary Portas’s Review into the Future of our High Streets contains some depressing statistics:

  • The number of town centre stores fell by almost 15,000 between 2000 and 2009, with an estimated 10,000 losses over the past couple of years.

  • Nearly one in six shops stands vacant.

  • Excluding central London, high street foot-fall has fallen around 10 per cent in the past three years.

The review does propose policy changes that central and local government could implement to improve the fortunes of our high streets.

One of Ms Portas’ most important arguments is that in future high streets should not be viewed solely as commercial centres but as ‘spaces’ that belong to the whole community.  

She states:

“High streets [should be] re-imagined as destinations for socialising, culture, health, wellbeing, creativity and learning…high streets won’t just be about selling goods. The mix will include shops but could also include housing, offices, sport, schools or other social, commercial and cultural enterprises and meeting places. They should become places where we go to engage with other people in our communities, where shopping is just one small part of a rich mix of activities.”

To achieve this Portas makes what are arguably the most important and substantive recommendations in the review – specifically, those concerning Business Improvement Districts (BIDs), ‘Use Class’, and vacant properties:

  • Empower successful Business Improvement Districts to take on more responsibility and powers and become “Super-BIDS”.

  • Legislate to allow landlords to become high street investors by contributing to their Business Improvement District.

  • Address the restrictive aspects of the ‘Use Class’ system to make it easier to change the uses of key properties on the high street.

  • Banks who own empty property on the high street should either administer these assets well or be required to sell them.

  • Empower local authorities to step in when landlords are negligent with new “Empty Shop Management Orders”.

  • Support imaginative community use of properties through Community Right to Buy, Meanwhile Use and a new “Community Right to Try”.

For those unfamiliar, a Business Improvement District (BID) is an area in which businesses vote in a referendum to levy a fee, in addition to business rates, to be used as the BID sees fit.

As noted by Portas, BIDs tend to focus solely on ‘crime and grime’ issues, rather than investing in long-term improvement. Enabling landlords, rather than just business tenants, to be members of BIDs may address this issue.

The only caveat to a greater involvement of landlords in BIDs is that as decisions are often made by majority voting there may be times due to lack of occupancy when landlords could ‘out-vote’ businesses to raise the BID levy unfairly and disproportionately. Legal avenues for business owners to challenge such a situation must be included in any future BIDs legislation.

Another important recommendation is to speed up the time, and make it easier to change, the ‘Use Class’ from retail to a leisure class etc. If a property is not attracting a tenant for retail, there should be the potential to change the class from retail to another use.

The ability easily and speedily to change the ‘Use Class’ is an important prerequisite of the other recommendations that seek to occupy vacant units. A bank is not going to be able to sell a vacant property for a reasonable sum - it should be remembered that the taxpayer owns the majority of UK banks and by default the repossessed property on their books - if the original ‘Use Class’, the inappropriateness of which may have contributed to the repossession cannot be quickly changed.

Perhaps the most interesting recommendations, and priorities for implementation, are Community Right to Buy, Meanwhile Use and a new “Community Right to Try”. This would apply to council owned and properties the council has taken control of due to negligent landlords. This would allow communities to trial co-op shops selling local produce, set-up a community gym, or a youth group etc.  

A sobering note in the Portas Review is that this is not the first report that has looked at revitalising the UK’s high streets; many others have simply ‘sat on the shelf’. Let’s hope this one with its radical ideas does not.

Britain must choose higher urban density instead of suburban sprawl

Stuart Baldock 6.03am

Demographers estimate that the UK population will increase to approximately 75 million by 2051. If this is true, the increase equals the population of two cities the size of London.

Therefore the UK is going to have to build many more houses. Even if demographers have over-calculated, life expectancy is increasing and there more households with single occupancy - both factors increase the demand for housing.

There is also the pressing need to enable first time buyers (FTBs) to get onto the property ladder. The typical FTB is now looking at having to pay over £150,000 for their first property - in London the average is more than £250,000. The average age for a FTB is now 35, and in London it is 43. This is partly a result of the lack of affordable credit, but the lack of suitable housing stock is critical.

The UK will soon be forced to answer the question nobody wants to confront: Are we favour of higher urban density or suburban sprawl?

The NIMBY argument that the UK is already developed enough is not one any political party can afford to entertain. Only 10 per cent of the UK is actually developed and this figure includes garden land - there is plenty of space to build more houses should we want to expand suburbs.

However, our preference ought emphatically to be in favour of higher-density development. Higher-density urban areas are more environmentally sustainable than suburban areas in the medium to long term (something that Nik wrote about recently). Whilst this assertion may seem counter intuitive, it is a popular misconception that because a suburban area is aesthetically ‘green’ - with grass, open spaces, trees etc - it is environmentally sustainable. The diametric opposite is true.

Compare emissions of climate altering greenhouse gases. As noted in a UN Population Fund paper published in 2009 “low-density suburban development is 2.0-2.5 times more energy and greenhouse gas intensive than high-density urban core development on a per capita basis”.

The typical Londoner produces in an average year only a little over half the UK average per capita of CO2. The per capita CO2 emissions of a London resident are approximately 6.18 tons - the UK average is approximately 11 tons.

This impressive statistic could be better still and the results emulated by other UK cities. It could be achieved by abandoning the very British fascination with suburbs and embracing high-rise / high-density city centre living such as has taken place on the continent.

The reason the average London resident produces less CO2 than the UK average is due to the proximity of their house to their place of work. Reduced travel distance = reduced CO2 emissions. Even suburban trains and metro’s emit CO2, a 5 mile journey by train emits 0.4kg of CO2 per person. The ultimate goal of urban development should be to make cities as compact as possible with as many people as possible living within walking or cycling distance to work. Not only will this have positive environmental benefits – it will have positive health benefits. An advantage urban dwellers have over their suburban counterparts is significantly lower rates of obesity and associated diseases.

It is true that the UK has not a comfortable history with high-rise / high-density developments. Many of the post-WW2 experiments in municipal housing have blighted the views of entire generations to high-rise living. Perhaps the most infamous example is the Aylesbury Estate in South-East London. It was described by the press in the 1980s and 1990s as “Hell’s Waiting Room”.

Other high-rise estates around the country have had similarly bad reputations. Many became known as areas of high crime, social depravation and depressive environments. Therefore it probably came as a shock to many residents and Ladbrooke Grove locals when in 1998, the Department of Culture Media and Sport, gave Erno Goldfinger’s Trellick Tower a Grade-II* listing. This was due to the building being an early example of the ‘New Brutalist’ school of architecture.

We should not let past mistakes cloud our judgement about the kind of city we need to build for the future. It should not be beyond the skills of architects to design buildings in which people today want to reside. It may though necessitate some rather draconian restrictions on building in the urban fringe, as well as some imaginative use of Section 106 agreements to get developers to construct mixed use high-density buildings.

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Are Conservatives going BANANAs over High Speed Rail?

Stuart Baldock 11.12am

A recent poll by ConservativeHome showed that a majority of Conservative party members oppose the construction of HS2.

Not comfortable reading for the Prime Minister, David Cameron, and his Transport Secretary, Philip Hammond. The Government has been steadfast in its support for High Speed Rail, much to the consternation of Conservative MPs whose constituencies sit along the proposed route.

Cheryl Gillan, the Secretary of State for Wales and MP for Chesham & Amersham, said this summer in the Sunday Times (£):

If the proposals go through as they are, I cannot vote for them… If that happens the Prime Minister must decide whether he wants me or not… If the project goes ahead, I would resign the Whip unless the Prime Minister tells me he would allow me to vote against it.

Philip Hammond has gone as far as to call opponents of HS2 “nimbys”, which is perhaps not the most sensitive way to aid party unity.

The fact that a majority of Conservative party members oppose the scheme leaves the party looking not just collectively “nimby”, but looking BANANAs! For readers not familiar with this planning acronym it stands for “Build Absolutely Nothing Anywhere Near Anything (or Anyone)”.

Nimbyism is a perfectly understandable emotion for local residents and affected Conservative MPs. The inescapable fact, however, is that railway passenger numbers in the UK are forecast to more than double over the next 30 years. Between 1994 and 2005, passenger numbers increased by 60 per cent. This trend is set to continue.

Merely adding more rolling stock will do little to ease the chronic overcrowding. On many routes this isn’t even an option, as lines are already operating at capacity. This is particularly true for the West Coast Mainline, which HS2 is due most closely to follow. The only option available is to lay extra line. If new railways are required, it follows that in the 21st century the UK should follow everyone else and build High Speed Rail. So the argument goes.

Opponents of HS2 have put forward many counter-arguments. One of the most widely cited is that HS2 will have a negative environmental impact. Recently in The Times (£), the Chilterns Conservation Board asserted that HS2 would “have a huge and irreversible damage to the area and represent a Berlin Wall for wildlife”.

Whilst any development will have an impact on wildlife, calling it a “Berlin Wall” maybe adds too much pathos. There are methods that can mitigate the impact. For instance, ‘habitat linking’ has been used worldwide to connect areas of particular environmental importance. Corridors of unaffected land are incorporated into development projects. As the proposed HS2 route already includes a large number of tunnel sections that will leave the surface unaffected, ‘habitat linking’ is in effect already going to happen.

Another argument is that it is a waste of money to spend £17 billion on the first stage only to reduce the travel time from London to Birmingham by 35 minutes. There is no denying that £17 billion is a considerable sum but when you take into account that HS2 is alleged to have a benefit ratio of 2.0, the investment looks more sound. If the second leg is completed (to Manchester and Leeds), the benefit to the national economy could total more than £64 billion.

Moreover, it is argued that the benefits of HS2 will be drawn to London and not the Midlands or the North as hoped. Some commentators argue as much as 75 per cent of the benefits will concentrate on the capital. Yet would this truly be a bad thing? London contributes nearly 20 per cent of the UK’s output. What benefits London benefits Britain.

It ought to be hoped that the Conservative party collectively will be a little less BANANAs about High Speed Rail.

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Libya is becoming a stalemate - is it time to arm the rebels?

Stuart Baldock 12.01pm

Last week the Defence Secretary, Dr Liam Fox, said military action in Libya would continue "until we have achieved militarily and politically what [we] set out to do". While the Government’s commitment is to be welcomed, the regrettable question mark remains over what exactly those military and political aims are. This ambiguity must end.

The situation on the ground in Libya is still much the same as it was prior to the start of military operations on 19th March. With the exception of Misrata, the western part of Libya is still under Colonel Ghaddafi’s control and the rebels hold the east. Forces loyal to Ghaddafi may have lost many of their tanks and heavy weaponry from coalition airstrikes but as reports from Misrata demonstrate, they have lost none of their ruthlessness or propensity for violence. Both Dr Fox and Robert Gates, the US Defence Secretary, have dismissed suggestions of a stalemate forming. However, what is becoming clearer is that unless support for the rebels is bolstered this is likely to be a long war.

British support for the rebels has taken the form of ‘non-lethal’ equipment such as body armour and communications devices. In a recent interview, the Prime Minister hinted that arming the rebels is still an option. General Abdul Fatah Younis, a former Interior Minister for the Ghaddafi regime and now a senior member of the Transitional National Council, has on a number of occasions requested advanced weaponry for the rebel forces. The requests for attack helicopters and torpedo boats might be unfeasible. Advanced anti-tank missiles could be provided though, as they would give the rebels the ability to destroy Ghaddafi’s tanks in urban areas, which are less vulnerable to coalition aircraft.

Other contributors to these pages have cautioned against the deployment of military advisers (Alexander Pannett drew parallels with Vietnam last month) but many more advisers will be needed to help the rebels to defend themselves and to topple Ghaddafi. It is hard to find a link between Vietnam and what is happening in Libya. Ghaddafi, unlike the North Vietnamese, is not backed militarily or ideologically by another superpower. In fact he has very few allies in the region following the departures of Presidents Ben-Ali and Mubarak.

There is the question of legality. UN resolution 1973 authorises member states to undertake all necessary measures - excluding an occupation force - to protect civilians on the ground. ‘Occupation’ is defined under international law by the 1907 Hague Convention:

Territory is considered occupied when it is actually placed under the authority of the hostile army. The occupation extends only to the territory where such authority has been established and can be exercised.

Provided that Libyans (i.e. the Transitional National Council) remain in political control of areas that advisers operate, it is arguably permissible under the terms of resolution 1973.

William Hague says that time is not on Colonel Ghaddafi’s side. We must ensure that his regime lasts no longer than necessary and do all that we can to help those fighting to end it.

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Time to abandon the NHS Bill: the real health costs lie elsewhere

Stuart Baldock 6.59am

The Royal College of Nursing (RCN) has passed an overwhelming motion of no confidence in the Health Secretary, Andrew Lansley. The RCN opposes the abolition of Primary Care Trusts (PCTs), which are set to be replaced by GP commissioning consortia. The NHS must make efficiency savings of £20 billion a year by 2014 and abolishing PCTs would go quite some way to achieving this. However, the RCN is not the only opponent. The Chairman of Council at the British Medical Association (BMA), Dr Hamish Meldrum, recently stated:

"While we share the objectives of improving services for patients and empowering staff, we believe the Bill as it is currently written is taking the NHS in England in the wrong direction. We have particular concerns about the emphasis on a statutory duty to promote competition in the NHS - with the accompanying risk of fragmentation of care, the proposed new model for the delivery of education and training, and the detail of how commissioning will work."

Andrew Lansley argues that the £20 billion of efficiency savings are necessary to face a number of long-term challenges, and he is completely correct - this country faces enormous structural health challenges.

When the NHS was founded in 1948, the average life expectancy was 66 years. It is now 77 years. Over the coming years, age-related conditions, such as dementia, will require an ever increasing share of NHS funding. Post-war Britain was relatively healthy: rationing made the country ‘fighting fit’, consequently the prevalence of ‘lifestyle’ diseases was significantly lower. If current trends in obesity rates continue then by 2025, 47 per cent of the male and 36 per cent of the female population will be classified as obese. Consider also the NHS drugs bill, which doubled from £4 billion to £8.2 billion between 1998 and 2008; it is likely to increase further as more drugs come onto the market and as the cost per course goes up.

Evidently, the structural problem facing the country cannot go unsolved but it is unclear how the Health and Social Care Bill, in its current form, is going to do so. The Bill should be abandoned in its entirety. The abolition of PCTs can be revisited at a later date. The Government is risking paying a very high political price - both for the stability of the Coalition, and the trust that the electorate placed in the Conservative party’s safe management of the NHS. Is this a price worth paying for a Bill that does not address the very real, long-term structural health challenges facing Britain?

A Health Bill should be produced that does address these health challenges, which matter more long-term than the structure of the NHS itself. Start by using the tax system to recoup the cost of unhealthy lifestyle choices. There is already punitive taxation on tobacco. Taxation should be extended to foods high in sugar and salt. Diabetes care costs the UK taxpayer £286 per second. The majority of this cost is for Type-2 diabetes, which is associated with obesity. In 2009, New York proposed a 'soda tax' on sugar sweetened drinks of 1 cent per ounce but it was abandoned in the face of drinks industry opposition; Mayor Bloomberg has tried to revive the idea and Oregon might follow suit. Washington State has taxed fizzy drinks by 2 cents per 12oz since 2007. Similar measures should be considered in the UK.

Additionally, serious thought must be given to an ‘insurance’ scheme for NHS procedures, particularly expensive drug therapies, or long-term elderly care. This should not mean the involvement of private health insurance companies, but instead a system similar to that in France. Andrew Lansley has announced a £200 million cancer drugs fund but it is only set to operate for three years. This fund could be topped up with ring-fenced funds from a health ‘insurance’ levy.

The proposals contained in the current Health and Social Care Bill are not necessarily wrong - indeed, the Bill includes some important and intelligent suggestions for a more efficient, more patient focused NHS. Yet the priority must be to tackle Britain’s long-term structural health challenges. That is where the serious costs are, and where they will be for many years to come.

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