His aim is to establish a long-term political direction—one centered on a more activist government that shapes and polices the market to strengthen the foundation for sustainable, broadly shared growth. Everything else—the legislative tactics, even most individual policies—is negotiable. He wants to chart the course for the supertanker, not to steer it around each wave or decide which crates are loaded into its hull.

To the legislation itself, the Economist gives two reasons to back it: one, decency; and two cost control. The second first:

America’s health-care system is a nightmare of perverse incentives. Because employer-provided health insurance is not considered to be a taxable benefit, people feel insulated from the real cost of their coverage and consequently over-consume. Because hospitals and medical practices in many areas face too little competition, they charge absurdly too much even for simple procedures. Because of the rapacity of America’s lawyers, the fear of lawsuits encourages doctors to practise “defensive” medicine, again driving up costs.

This is the libertarian trap that prefers to let freedom reign which encourage the country to consume resources simply to game the system. Thus the cost of the UK’s universal system come in at around 8% of its GDP, whereas the US system which currently excludes 45 million of its population, eats up 16% of its gross domestic product.

Even ‘Obamacare’ will leave a significant number of people outside the system. And there will be no ‘public option’ (a government-run insurance option). Medicine will remain private, but it will be regulated into ‘exchanges’ or government regulated markets in which competition will exert a downward pressure on costs, with a tax being implemented on high-cost insurance plans.

And on the decency thing, for the Economist it is simply about closing an obvious gap between the US and the rest of the developed world. And it is not about covering those currently excluded, but those wage earners whom the insurance companies consider too bad a risk to make money on:

...the much larger number of people who fear falling into that position through losing their jobs; and the larger number again who cannot get affordable insurance because they have an existing medical condition, or because they are too old, or because they have exhausted the “lifetime caps” imposed by insurance companies.

That said, it is still no done thing. House Democrats have - in the words of one Congressman we met last week - ‘lost the narrative’ to outlying rumours like Sarah Palin’s Death Panel story... And the Republicans are counting on fears that these reforms will play into their hands come the mid term elections in November…

That is still a long way away. Obama’s pitch to his party’s Congress caucus yesterday was that this was a straight down the middle bill, which balances fairness with an attempt to bring down America’s sky high healthcare costs… Turning the US Supertaker will take a lot longer than 7 or 8 months…

And there are a dozen other reasons to kick the government party (not least the stubbornly persistent 10% unemployment rate)... Some of those waverers must now be calculating that it is as better to be hung for stealing the proverbial sheep than a lamb…

The Senate bill isn’t a “starter home,” it’s a sink hole.  It needs to die so something else can take its place. It doesn’t matter whether people are on the right or the left — once they understand the con job that’s about to be foist upon them, they agree.

That might be the sensible thing to do. Except, that US politics seems to be even more locked down than our own little regional affair in Stormont.

If and when Congress clears healthcare out of its inbox, the mid term elections will dominate the minds of the mainstream press and the US’s vast army of voluble bloggers. Yep, just over a year after the Obama ‘audacity of change’ election, the Democrats in the House (along with a third of the Senate, and a collection of Mayoral and gubernatorial contests now face a ‘throw the bums out’ election (in a poll released by NBC last night, 50% of US voters said they would vote out their congressman) in November.

Back in 1993, when Bill (and Hillary) Clinton tried and failed to get medicare reform through Congress had a trust rating of 70%. Now, according to the NBC poll (PDF copy), it is down to 17%.

The vicious culture wars that has slowly asserted its grip on US politics (and which once Obama promised he would bring to an end) seems to have trashed the bipartisanship that once allowed the US federal government to actually pass some law. Although getting a majority in the House works, it is not good enough to pass a bill in the Senate. When the Democrats lost Ted Kennedy’s old Massachusetts seat to Scott Brown, they definitively lost their filibuster-proofing.

In Washington, it seems, it is the game that counts, not the policy. A few weeks back (before he declared himself a candidate in the Democratic primary in California, Mickey Kaus argued that:

For months, both GOP and Fox hosts have been talking about socialized medicine and death panels and vicious Medicare cuts and the government coming between you and your doctor, etc. If Democrats pass the bill and none of this happens, Republican opponents will be more than defeated. They’ll be discredited.

But as PoliticsDaily notes:

Where the quandary comes in for Democrats is that the [NBC] survey found 67 percent of Republican respondents said they were very interested in the November elections compared to 46 percent of Democrats.

Moral appears low amongst Democrats on Capitol Hill. Some suggest that’s a lot to do with the Obama White House’s aloofness from their team in Congress. They cite poor engagement both with Congress and their external support base. The conventional wisdom, from bloggers to mainstream media insiders, at this moment is that it is the Dems are going to get caned in November. The degree to which they lose seats will depend on whether they can bed in their change and begin selling it.

The buzz now is that despite huge pressure being applied by a very targeted ad campaign at wavering Democrat congressmen, the party is confident of passing the bill. Confident even though the word goes the bill may only pass by one vote. Why? Because although they can pass it with more than one vote, they won’t because voting yes to health care for these guys is almost instant death in November’s mid term elections. 

So one will get to take the poison chalice, whilst the other four (it’s rumoured) get to run with the opposition herd.

We should get a result by midnight Eastern Time on Saturday night.

29. The Committee heard the phrase “with hindsight” on a number of occasions throughout the course of the inquiry. It is essential that those central to this incident take the opportunity to look back at their roles, and those that they interacted with, and critically assess their performance. It is equally a necessity that changes will be identified and that these changes need to be implemented with all urgency. Paramount, in the view of the Committee, is the streamlining of the process, including the number of statutory bodies and other agencies involved in the process. The Committee believes that this can be achieved through the establishment of an Incident Management Team.

30. The Committee heard from most of the organisations that they were content that their individual processes, on the whole, were successful and that the main objective, that is protecting the public health, was achieved. The Committee acknowledges this as being important. However, the Committee would draw attention to the fact that this incident did not have a “happy ending” and that the Northern Ireland industry is still struggling with the ramifications of the incident, primarily the financial consequences that have to be absorbed. If such an incident occurs in the future, it is essential that these are considered and that a proportionate response that protects both the public health and the local and wider economies is taken. It is equally important that the industry is kept informed through a single communication source, such as the Incident Management Team.

31. The events leading up to and beyond 6 December 2008 have placed the Northern Ireland agricultural sector in a precarious position at a time whenever the pressures of the global economy are being widely felt by the industry. Whilst an aid package was eventually provided by the Northern Ireland Executive to the Northern Ireland industry, the Committee does not believe this to be sufficient, as the aid package was restricted to a very precise part of the industry. The Committee calls on the authorities in both jurisdictions to revisit their respective schemes, given the benefit of hindsight and assess how aid can be provided to those currently considered ineligible to ensure that the financial risks being faced by these businesses disposing of slurry, milk and retail materials are negated.

And specifically on the lack of communication between the Irish Minister and the Northern Irish Minister

Communication

16. The Committee considers the absence of appropriate communication to be the most significant weakness identified during the course of the inquiry and that this was the single most critical contributory factor to the near-collapse of our industry in Northern Ireland.

17. The Committee believes that it is totally unacceptable for the Minister for Agriculture and Rural Development to learn of the total recall of Irish pork and pork products by chance whilst watching a news programme in the late evening of Saturday, 6 December 2009. This is despite a meeting having been held earlier that day between the Taoiseach, the Minister for Agriculture, Fisheries and Food, the Minister for Health and Children, the Chief Medical Officer, the FSAI and officials from the relevant statutory bodies in the Republic of Ireland.[5] The Committee believes that it should have been incumbent on the Minister for Agriculture, Fisheries and Food in the Republic of Ireland to have contacted the Minister for Agriculture and Rural Development in Northern Ireland immediately following this meeting. [added emphasis]

18. The Committee is particularly alarmed as this failure to communicate the seriousness of the situation and the unilateral decision to recall these products by the Irish authorities was taken despite being aware that a number of farms in Northern Ireland had received this bread and that some 9,000 live pigs are exported to Northern Ireland per week, representing approximately 18% of the total pigs slaughtered in the Republic of Ireland.[6]

19. The Committee has noted the very positive work that had previously been taken by officials in Northern Ireland and the Republic of Ireland in respect of, for example, the All-Island Animal Health Strategy. However, the Committee remains concerned at the vast difference between the principles expressed in such strategies and processes against the practical outworkings that presented themselves during the first real test of these principles.

20. The Committee has also identified a number of other breakdowns in the communication processes and these are detailed as follows:

(a) The period between the confirmation of the test results and the initial contact with DARD;

(b) The identification of the Northern Ireland farms that had received the bread (Thursday, 4 December 2008) and communication of this to DARD (Friday, 5 December 2008). This presented a number of problems, including the fact that the contact was at too low a level, the initial contact did not contain any relevant details and that DARD were required to chase DAFF late into Friday afternoon for information regarding the incident;

(c) The FSAI contacted FSA UK in the first instance on Thursday 4 December 2008 but did not contact the FSANI directly. The FSANI was formally contacted by FSA UK two days later;

(d) The Minister for Agriculture and Rural Development contacting her counterpart in the Republic of Ireland on 17 December 2008 regarding the eligibility of processors in Northern Ireland for compensation and the formal communication from Ministers at a North South Ministerial Council meeting on 23 January 2009 stating that they were unable to do so; and

(e) Because the recall was ordered (but not communicated to DARD) on Saturday 6 December, there was a dearth of information available to producers, processors and consumers on Monday 8 December 2008. This affected the ability of DARD and other agencies to provide clear decisions to industry stakeholders at what was a critical time in the process;

21. The Committee has previously commented in respect of the numbers of organisations that were (or should have been) involved through this process. The Committee is of the view that this also contributed to the poor communication witnessed because, as has been proven during this incident, the more elaborate the means of communication, inevitably the more ineffective it becomes. This can be evidenced by the number of Northern Ireland beef producers presenting cattle at abattoirs on Monday 8 December only to be advised that these animals were not permitted to enter the food chain and by farm businesses unable to access accurate information from a number of DARD offices.

And DC’s Improbable blog lists the culprits

Here is the roll of shame, updated on 12 March (the last six signed in the last 24 hours)

Tredinnick, David Con
Simpson, Alan Lab
Russell, Bob LibDem
Pound, Stephen Lab
Dismore, Andrew Lab
Simpson, David Democratic unionist
McDonnell, John Lab
Campbell, Gregory Democratic unionist
Cohen, Harry Lab
Corbyn, Jeremy Lab
Drew, David Lab
Gray, James Con
Hancock, Mike LibDem
Hermon, Lady Ulster unionist
Key, Robert Con
Hemming, John LibDem
Bone, Peter Con
Davies, Dai Independent
Mates, Michael Con
Dodds, Nigel Democratic unionist
Wyatt, Derek Lab
Sarwar, Mohammad Lab
Hamilton, Fabian Lab
Winterton, Nicholas Con
Davies, Philip Con
Leigh, Edward Con
Barlow, Celia Lab
Ellwood, Tobias Con
Leech, John Lib Dem
Main, Anne Lab
Robinson, Peter Democratic unionist
McCrea, Dr William Democratic unionist
Paisley, Ian Democratic unionist
Brady, Graham Con
Cook, Frank Lab
Hall, Patrick Lab
Binley, Brian Con
Pugh, John Lib dem
Davey, Edward Lib dem
Weir, Mike Scottish Nationalist
Sharma, Virendra Kumar Lab
Abbott, Diane Lab
Williams, Mark Lib dem
Horam, John Con
Widdecombe, Ann Con
Browne, Jeremy Lib dem
Spicer, Michael Con
Maclean, David Con
McCafferty, Chris Lab
Buck, Karen Lab
George, Andrew Lib Dem
Vis, Rudi Lab
Walter, Robert Lab
Whittingdale, John Con
Farron, Timothy Lib Dem

And, as Edzard Ernst points out

But what about patients’ experience? What about my own experience as a patient and later as a clinician? In fact, tonnes of data shows that people get better after seeing a homeopath. This is why homeopaths are adamant that their treatments work. Can this wealth of experience be overruled by scientific evidence?

When one begins to analyse this contradiction rationally it very quickly dissolves into thin air. The empathic encounter with a homeopath, the expectation of the patient, the natural history of the disease and many other factors all provide ample explanation for the fact that patients can improve even when they receive placebos.

This leads to the vexatious question: what is wrong with giving placebos to patients as long as they help? The answer, I’m afraid, is a lot. This strategy would mean not telling the truth to patients and thus depriving them of fully informed consent. This paternalistic approach of years gone by is now considered unethical.

From the report’s Conclusions and Recommendations [some added emphasis throughout]

13.  We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base as this risks confusing or misleading the public, the media and policy-makers. (Paragraph 73)

14.  There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities. (Paragraph 77)

15.  It is also unethical to enter patients into trials to answer questions that have been settled already. Given the different position on this important question between the Minister and his Chief Scientist, we recommend that the Government Chief Scientific Adviser, Professor John Beddington, investigate whether ministers are receiving effective advice and publish his own advice on this question. (Paragraph 78)

16.  We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect alone and therefore does not prove the efficacy of homeopathic interventions. (Paragraph 82)

17.  We recommend that the Department of Health circulate NHS West Kent’s review of the commissioning of homeopathy to those PCTs with homeopathic hospitals within their areas. It should recommend that they also conduct reviews as a matter of urgency, to determine whether spending money on homeopathy is cost effective in the context of competing priorities. (Paragraph 86)

Should NICE evaluate homeopathy?

18.  We accept that NICE has a large queue of drugs to evaluate and that it may have greater priorities than evaluating homeopathy. However, we cannot understand why the lack of an evidence base for homeopathy might prevent NICE evaluating it but not prevent the NHS spending money on it. This position is not logical. (Paragraph 90)

Homeopathy on the NHS

19.  When doctors prescribe placebos, they risk damaging the trust that exists between them and their patients. (Paragraph 97)

20.  For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice. (Paragraph 101)

21.  We recommend that if personal health budgets proceed beyond the pilot stage the Government should not allow patients to buy non-evidence-based treatments such as homeopathy with public money. (Paragraph 104)

22.  When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made “following a proper consideration of the evidence”, patients may reasonably form the view that homeopathy is an evidence-based treatment. (Paragraph 109)

23.  The Government should stop allowing the funding of homeopathy on the NHS. (Paragraph 110)

24.  We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals—hospitals that specialise in the administration of placebos—should not continue, and NHS doctors should not refer patients to homeopaths. (Paragraph 111)

Product Licences of Right

25.  We are concerned that homeopathic products were, and continued to be, exempted from the requirement for evidence of efficacy and have been allowed to continue holding Product Licences of Right. We recommend that no PLRs for homeopathic products are renewed beyond 2013. (Paragraph 121)

The evidence check: licensing

26.  We conclude that the MHRA should seek evidence of efficacy to the same standard for all the products examined for licensing which make medical claims and we recommend that the MHRA remove all references to homeopathic provings from its guidance other than to make it clear that they are not evidence of efficacy. (Paragraph 128)

27.  We consider that the MHRA’s consultation, which led to the introduction of the NRS, was flawed and we remain unconvinced that the NRS was designed with a public health rationale. (Paragraph 135)

28.  We fail to see why the label test design should be acceptable to the MHRA given that, first, it considers that homeopathic products have no effect beyond placebo and, second, Arnica Montana 30C contains no active ingredient and there is no scientific evidence that it has been demonstrated to be efficacious. We conclude that the user-testing of the Arnica Montana 30C label was poorly designed with parts of the test actively misleading participants. In our view the MHRA’s testing of the public’s understanding of the labelling of homeopathic products is defective. (Paragraph 140)

29.  If the MHRA is to continue to regulate the labelling of homeopathic products, which we do not support, we recommend that the tests are redesigned to ensure and demonstrate through user testing that participants clearly understand that the products contain no active ingredients and are unsupported by evidence of efficacy, and the labelling should not mention symptoms, unless the same standard of evidence of efficacy used to assess conventional medicines has been met. (Paragraph 141)

And

Conclusions on the licensing regimes

32.  It is unacceptable for the MHRA to license placebo products—in this case sugar pills—conferring upon them some of the status of medicines. Even if medical claims on labels are prohibited, the MHRA’s licensing itself lends direct credibility to a product. Licensing paves the way for retail in pharmacies and consequently the patient’s view of the credibility of homeopathy may be further enhanced. We conclude that it is time to break this chain and, as the licensing regimes operated by the MHRA fail the Evidence Check, the MHRA should withdraw its discrete licensing schemes for homeopathic products. (Paragraph 152)

Overall conclusion

33.  By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products. (Paragraph 157) [added emphasis]

Some specifics from the ruling

Conclusions on the issue

[44]    Section 4.1 of the Guidance clearly requires amendment to deal with the words “although there is no legal right to refuse to take part in the termination of pregnancy.”  A member of staff may have a legal right to refuse to take part in a procedure. This may arise in at least the following circumstances. Firstly, this can arise if the member of staff considers reasonably and in good faith that an abortion procedure is illegal because the continuation of the pregnancy does not present a risk to the life or long term health of the mother.  Secondly, it can arise if under the express terms of his or her contract he or she is entitled to refuse to participate a contract of employment could be so drawn to cover the question.  Thirdly, it may be that a member of staff could succeed in a particular case in establishing that to require him to assist in the procedure would infringe his Article 9 rights.  This may depend on the express terms of his contract which may require him to participate.  If it does a question may arise as to whether the imposition of such an obligation itself infringes the Article 9 rights of the member of staff. 

[45]    Section 4.1 recognises the right to object on grounds of conscience to be recognised and respected “except in circumstances where the woman’s life is in immediate danger and emergency action needs to be taken”.  It is not clear whether this relates only to a situation in which the actual life of the mother is at stake or whether it extends to the situation where, in the absence of an abortion, there will be serious adverse effects of a permanent or long term nature in relation to her physical or mental health.  If the Guidance is to be clear this requires to be spelt out.  There are those who in conscience object to the abortion of an unborn child where the mother’s actual life is not at stake.  They take the view that in weighing up the ethical and religious dilemmas of destroying the life of the unborn child or destroying not the life but the long term health of the mother the decision should be in favour of the unborn child.  It is not clear what guidance paragraph 4.1 is purporting to give on this question.  Restricting the conscientious objection exception to a situation where the mother’s actual life is at stake would protect the right of conscientious objection in relation to an abortion causing the death of the unborn baby where the mother’s long term health is at danger but not her life. 

[46]    Section 4.2 as worded is open to the interpretation that if a woman presents to a general practitioner asking for advice about a termination even where there is no question of a danger to her long term health or life a general practitioner with a conscientious objection to abortion should have in place arrangements for onward referral.  This links into the problem identified in relation to the counselling provisions of the Guidance and it requires reconsideration.  The Guidance does not grapple with the problem of a woman wanting an abortion in a situation which is not permissible under Northern Ireland law.  It uses language much too ambiguous and leaves GPs unclear as to what is expected of them.  While Mr Hanna’s argument as to how it should be read may have some force, a GP should not be expected to have a legal training in construing documents.  The Guidance should speak to health care workers not to trained lawyers.  Nor does it fall to be construed like a legal contract.  It falls to be construed as guidance.  Hence it should be absolutely clear.  Otherwise it is not guidance but a trap to the unwary.

[47]    Clearly if a patient presents with a medical problem that indicates a risk to life or long term health from continued pregnancy a general practitioner who objects to abortion on conscientious grounds remains obliged to take steps to ensure that her medical condition is properly catered for.  It would appear obviously necessary for her to be referred to the appropriate clinicians.  The general practitioner who failed to take steps to ensure her proper treatment would be in breach of his duties of care and his duty to act consistently with the GMC’s Guidance on proper practice.  There may be situations where, for example, a patient has been advised by her obstetrician to have a termination and in considering whether to consent she seeks advice from her GP.  In such a situation the GP’s conscientious objection to abortion may be such that he could not give her dispassionate advice.  The GMC’s advice on good medical practice accurately reflects his obligations as set out in Section 4.3 of the Guidance.

The failure of our major parties to mount a full-blooded referendum campaign is a symptom of an ailing political system.

For so many TDs, the only thing that matters is their own seats. Most party organisations are now based around the election of individuals and lack any wider concept of what they are in politics to achieve.

This personalised, issue-free concept of politics is precisely what has brought the country to its current sorry pass. The absence of real political debate in the 1997 to 2007 period facilitated government decisions that led inexorably to the collapse of the public finances. It also allowed our planning system to spin out of control, taking the banking system and the whole economy with it.

In government, Fianna Fáil ratcheted up public spending at a much higher rate than economic growth year after year – without providing the tax base to underpin it – while the Progressive Democrats and Charlie McCreevy slashed income tax without regard to public spending commitments.

And then the Opposition:

...mock indignation and constant, mindless heckling of government speakers in the Dáil took the place of reasoned, robust debate.

One of the reasons Fine Gael and Labour did not win the last election was that they avoided challenging the Government’s fundamentally flawed economic policies. Instead they concentrated on the soft option of health, which can be so easily manipulated to achieve scare headlines in the media. In the event, health didn’t pay the political dividends on which the opposition had counted.

The debasement of political debate has now become a really serious problem that is threatening the country’s viability. It has brought about a situation whereby not only the voters but most of the TDs seem to have no grasp of how precarious the state of the public finances really is and what the options are.

He picks out last week’s full frontal assault on Colm McCarthy on last week’s Frontline as indicative of the malaise in Irish politics… In any other modern democracy the public advocacy role currently being played by Dr McCarthy would be played by a professional politician.  As he points out himself, his work is advisory.

Yet is the ‘expert’ whose work will not to be implemented who’s taking the brunt of the public anger (‘anger is not a policy’, ‘you’re talking through your hat’, ‘be emotional if you want then’ are all wonk’s statement not a politician)... The government is effectively buying in a consultant to give them advice and then sending them out to tell a teacher that the 20% they’ve already lost in ‘levies’ is necessary and that there is probably much worse to come…

For just example, it is not Dr McCarthy’s job to do a risk assessment on the cuts he’s earmarked in the HSE… However it would be the Health Minister’s job to do that…

By Eamon Gilmore TD

First, let’s get one thing straight: this treaty is not about transferring powers from national governments to “Brussels”. Rather, it changes the way the European Union exercises its existing responsibilities while adding extra checks and balances - both in terms of democratic accountability and in terms of social protection.

Let’s start with the democratic accountability. Under Lisbon, no EU legislation can be adopted without, first, prior examination of proposals by national parliaments, second, approval by the EU Council of Ministers (composed of national ministers accountable to those national parliaments) and third, approval of the European Parliament (composed of our directly elected MEPs).

This is a level of scrutiny that exists in no other international organisation. Anyone genuinely worried about accountability should focus on the IMF, the WTO, the World Bank, the OECD and so on, which lack such accountability.

The treaty will also require the Council of Ministers to meet in public when discussing legislation - entrenching a long overdue reform.

Lisbon also provides for the President of the Commission to be elected by the European Parliament. The European Council must make a nomination taking account of the European election results and the majorities that are possible in the European Parliament. At the very least, this (and the need for a vote of confidence by Parliament in the whole Commission) will make it clear that the Commission is not a group of unaccountable bureaucrats, but is a political executive dependant on the confidence of the elected parliament.

As an extra safeguard, the treaty obliges the EU institutions to respect a Charter of Rights, failing which its decisions can be struck down by the courts. This will ensure the EU cannot undermine rights commonly accepted across Europe, including key workers’ rights.

With these democratic reforms come some practical changes to help the institutions function better in an enlarged Union: merging the two EU foreign affairs positions into one role of High Representative and replacing the 6-month rotating European Council presidency (changing chairman every second meeting) with a longer 30-month term.

Equally important are the changes on the social front.

The Lisbon Treaty will strengthen the European Social Model. It will enshrine the values of social justice, full employment and solidarity in the EU’s mission statement and commit the EU to “a social market economy, aiming at full employment and social progress”. The Treaty emphasises that the EU must work to “combat social exclusion and discrimination”, and will be legally required to promote social justice, gender equality and solidarity between generations. It is values such as these that clearly differentiate the EU from the American model of capitalism that allows private wealth and public squalor.

A new protocol will require the Union to safeguard public services, including the way they are organised and financed in each country. The treaty also requires the Union, in all policy areas, to take account of “the promotion of a high level of employment, the guarantee of adequate social protection, the fight against social exclusion, and a high level of education, training and protection of human health”.

Lisbon reaffirms the existing obligation on the Commission to “promote the consultation of management and labour at Union level”, to “facilitate their dialogue by ensuring balanced support for the parties”, and to “consult the social partners before submitting proposals on social policy”.

The Charter of Rights, approved by every Member State government in 2000, but which will with Lisbon become legally binding on the EU institutions, sets out the civil, economic and social rights that the EU will be obliged to respect. These include the right to fair and just working conditions, to collective bargaining and collective action, including strike action, equal pay for men and women, the right to social security and freedom from discrimination.

The Lisbon treaty is, of course, a compromise and, indeed, falls short of some aspirations. However, it provides a base to protect and develop a social vision of Europe. The overwhelming majority of socialist parties and of trade unions across Europe support the Lisbon Treaty, despite some reservations, precisely because it will enshrine the European Social Model.

Moreover,  a rejection of the treaty would further galvanize those who are bitterly opposed to the values of social inclusion and solidarity that are enshrined in the EU, and who instead call for unrestricted free-market capitalism. It is no coincidence that the treaty’s strongest opponents are the British Conservative and UKIP parties and the Czech President Vaclav Klaus. This would be a disaster - the social model is central to the European project and is too important not to be fought for.

For those of us who believe in a European Union that is fit for purpose, this treaty is a result to be welcomed - a set of useful reforms that should put an end to years of institutional wrangling and will make the EU institutions more responsive to citizens, to Member States, their parliaments and their peoples.

In other words, it will deliver a more focused EU, better capable of delivering in those policy areas where we benefit from common European action, not least the social, environmental and consumer protection legislation that tames market forces. At the same time, it subjects the EU to stronger safeguards and more scrutiny. This, surely, deserves our support.

Eamon Gilmore TD is Leader of the Irish Labour Party…

“The current efficiency targets set in the last budget are already not being met. Evidence from official sources indicates that for the period covering 2008/09 47.7% of the planned savings are marked at being “at significant risk.” The figure for 2010/11 is worse, with 51.6% of these savings assessed as being at significant risk. This is a trend already showing in 2008/09 - when £273 million was to have been saved only £174 million was actually saved – a shortfall of £99 million on the savings target. So now we have a mini black hole appearing in the middle of Sammy’s rescue package for the even bigger black hole.”

“What we now have since Sammy admitted to a £400 million black hole, in one of the biggest ministerial climb-downs in recent history, is that once again Sammy is doing too little too late.  With new black holes appearing all over the place, it is clear Sammy’s efficiencies will not work – in fact, they are failing already.”

There is a story on page 15 in one of today’s newspapers which contains significant inaccuracies, including with regard to conjecture about my political future.

I will be speaking at the NI launch of the independent thinktank referred to at the Richview Regeneration Centre (339 Donegall Road) at 11am on Wednesday, 16 September. This is a very exciting project which will, I trust, be of significant benefit to the promotion of a “Shared Future” for the entire community. Media will be welcome.

...drug use in Portugal has not risen in the last 8 years. In fact it has fallen, by around 10%. This might seem counter-intuitive but proponents of reform of drug laws have been saying for years that rise and fall in the use of drugs is largely independent of the legislative situation.

Not only that, but also:

...use by teenagers of every type of drug measured has also fallen (see here). This is remarkable as usually when one type of drug use falls, another increases as they are affected by societal trends.

Finally:

Perhaps the most important result of this trial though is how HIV infections and drug deaths have been reduced. The following quote from Mark Easton’s report is by Paula Vale de Andrade who is involved with an organisation who try to help heroin addicts:

When drug use was a crime, people were afraid to engage with the teams. But since decriminalisation, they know the police won’t be involved and they come forward. It has been a great improvement.

Portugal is a strange mix of ultra conservative Catholicism, and what remains of the radicalism of the Carnation revolution of 1974, which oversaw a significant re-purposing of the Salazar built educational system…  Yet it is the only EU member state with a law explicitly declaring drugs to be “decriminalised.”

Could it happen here? Well, attempts to liberalise the alcohol laws along more liberal, southern European lines regularly meets with a huge critical backlash. It also would not do to expect that UK (or Irish) health and criminal policies are routinely formed on the basis of strong empircal data.

One cannot but feel for the plight of Gareth Anderson who is seriously ill in a London Hospital, nor in any way criticise his father, who is considering legal action to try to help save his son.

There seems to be considerable political interest, although Michael McGimpey is surely right in his assertion that he cannot force change to organ transplant rules.

Some of the political interest seems to focus on the fact that normally a six month period of abstinence from alcohol is required prior to accepting a patient onto the transplant waiting list: this length of time appears to be unavailable to Mr. Anderson. Whether or not he will be assessed or accepted remains to be seen.

The current guidelines are here and although the six month abstinence period may not always be required it seems to have been a significant factor in a recent decision not to transplant a young patient.

It must be remembered, however, that whatever happens if he is to receive a liver transplant someone will have to die (to be a donor) and someone else will receive a liver later and hence, they may die. Although there has been some progress in terms of living liver donation this is still a very small minority and is unlikely to be possible in the vast majority of adults in the foreseeable future.

Transplantation units are of course used to making these sorts of judgements which make Solomon’s look easy and they have to make them extremely frequently. According to Prof Gilmore people with a short history seem to do less well when transplanted (see audio piece here). It is also important to mention that even if a patient has had a successful liver transplant, that does not offer a normal life expectancy and maintenance of the donated liver requires long term immunosupression (albeit less potent than for many other donated organs).

Sadly there is currently no equivalent of renal dialysis for liver disease patients and as such the non transplant options for patients with severe liver failure are extremely limited.

The effect of any judicial review or political pressure is of course difficult to gauge though any sudden change in transplantation guidelines forced by putative legal action would undoubtedly throw the whole system into chaos. Although an increase in organ donation would no doubt help in these dreadful situations (50% of families still refuse transplant donation) there is a grim fact that the improvements in trauma and intensive care services have actually resulted in a reduced number of organs available for transplantation.

Of course, sadly, no discussion of liver disease would be complete without noting that it is rising in incidence and this is largely caused by increasing consumption of alcohol and from an earlier age. Very recent data have suggested some decrease in alcohol consumption in the 16-24 year age group but an increase in excessive drinking in Northern Ireland. The causes of increasing alcohol consumption are of course multiple and varied: however, a very major factor is the increasing relative affordability of alcohol.

The Scottish government (Scotland’s problems are worse than any other part of the UK) has begun to attempt to address this issue with the possibility of minimum prices for alcohol though Gordon Brown has rejected this approach for the rest of the UK.

One final point worth making on liver disease has nothing to do with alcohol: paracetamol is an extremely safe and effective medicine used by countless people every day at the appropriate dose. However, in overdose it is can be fatal (again from liver failure) causing about 100 deaths in England and Wales each year and about in Northern Ireland (page 10).

The story of Gareth Anderson is a very real and a very human tragedy. It will no doubt be suggested that whatever the outcome people (especially young people) will stop and think about the dangers of excess alcohol. That is of course a completely naïve hope: in reality young people will continue to get drunk and get themselves into fights and end up in the A+E departments of our hospitals either drunk or injured and every now and again someone will die from the effects of excess alcohol whether acute or chronic, direct or indirect. However, the vast majority of people (even young people) will either by good luck or by a degree of personal responsibility drink alcohol without suffering any major ill effects.

There is a place for legislation and there is also a place for personal responsibility. In addition there is also bad luck, and Gareth seems to have suffered extraordinarily from this.

It’s not clear how early that warning came, but according to the report the Committee on Ethical Aspects of Pandemic Influenza last met in May.  And the report also notes calls to stop the national flu pandemic service.

The concern was seconded by flu expert Hugh Pennington, emeritus professor at Aberdeen University, who called for the national flu line to be shut down.

“I am concerned about the vast amount of Tamiflu that is going out almost unregulated,” he told the Guardian. “We are increasing the possibility that the flu will become resistant sooner or later. At the moment there is no desperate need for Tamiflu. We should be reconsidering its issue, rather than encouraging its use.

“I think we should stop the national pandemic flu service. It was put there for an outbreak of far higher mortality than we have. If you get a resistant strain that becomes dominant in the autumn, Tamiflu will then be useless.”

It’s worth noting that there appears to have been a divergence in policy here when compared to elsewhere in the UK. [added link]

In his earliest statement to the Assembly on 27 April, NI Health Minister, the UUP’s Michael McGimpsey, set out the initial response

“Testing has shown that the human swine influenza can be treated with antiviral drugs, which I am pleased to say that we have already stockpiled in Northern Ireland.”

Anti-virals, such as Tamiflu, were still the main focus of the NI Health Minister on 5 May

Given that it will take several months before a vaccine becomes available, we will in the interim need to ensure we have adequate supplies of antiviral medication, which is proving effective in treating this virus.

We currently have a stock of antiviral drugs which will cover half of the population.  Steps are in place to increase this so that there will be sufficient antivirals to treat up to 80% of the population.  No previous global pandemic has been known to affect more than a third of the population. 

We have placed supplies of the antiviral medications in hospitals and in GP out of hours centres.  In addition, measures are in place to ensure that an adequate supply of antiviral medication will also be available to community pharmacies.

And on 18 May, although a note of caution had emerged

We must be prepared for a potential further wave of the swine flu virus in the autumn, which may be more widespread. In light of this, it is essential, that we use our stock of antivirals carefully so that the public will be protected during the winter months.

That position was largely unchanged on 9 June but the focus on anti-virals remained and, arguably, intensified.

“I have therefore been working with my counterparts from the other UK Health Departments in developing the National Pandemic Flu Service. This system will co-ordinate the distribution of antivirals and has the capacity to cope with any surges in demand that are likely if the virus becomes more widespread.

“The National Pandemic Flu Service will be the first of its kind in the world and will be available from October.

“The aim is to enable symptomatic patients across the whole of the UK to access antivirals through a single 0800 number, or a supporting website application. This will mean people can have their symptoms assessed against a list of the key symptoms and risk factors either over the phone or online.”

By the 15 June the NI Health Minister’s position was unchanged but he was looking towards a mitigation strategy

“The mitigation strategy will mean that when the number of cases increases beyond a certain level, we will have to keep under review to what extent we supply antivirals to contacts —in the first instance supplying them only to immediate close contacts rather than to all contacts. This may also require the use of clinical diagnosis rather than laboratory testing where there is a high probability that cases are positive. A reduction in the numbers of follow-up contacts may also be necessary so we only target those who are most at risk.”

Significantly on 30 June, for the first time the NI Health Minister publicly considered changing the strategy ahead of a meeting “chaired by Andy Burnham, Secretary of State for Health in England. Health Ministers from Wales and Scotland also participate in this meeting, along with scientists and other senior health professionals including the four Chief Medical Officers.”

“As with seasonal flu, most otherwise healthy people generally do not require antivirals. What is more, antivirals can produce side effects such as vomiting, diarrhoea and nausea. The continuation of widespread use of antivirals also runs the risk of the virus developing resistance and so reducing the level of protection this treatment gives.

“Emerging clinical experience of this virus suggests that for many people, the symptoms of swine flu can be treated in the same way as a normal cold or seasonal flu, by staying at home; taking paracetamol and cold remedies to reduce symptoms; drinking fluids and resting and only contacting your GP if your symptoms are not improving.

“If we were to adopt this approach, as with seasonal flu, it would mean that we would rely more on symptoms rather than swabs to diagnose the illness. It would mean that the use of antivirals as a preventative measure and the tracing of close contacts of a symptomatic patient, would be largely discontinued, although that would be based on the clinical judgement of local clinicians.

“This is in line with what is currently happening in the US, Canada and Australia where there are large numbers of cases.”

On 2 July the Minister announced the outcome of that meeting

“The Scientific Advisory Group in Emergencies (SAGE) has considered this question and reports that on balance the science points towards adopting a targeted approach, but acknowledges that this is a ‘finely balanced’ decision. Health Ministers are also conscious that, as this is a new virus, it cannot yet with confidence be directly compared to seasonal flu. Given this, we have decided to adopt a safety first, precautionary approach. Antivirals will continue to be offered to people who have contracted swine flu.”

And, perhaps with an eye on the possibility of adverse publicity, the first apparent divergence in strategy came not from the Health Minister, but on 24 July from the Acting Chief Medical Officer, Dr Elizabeth Mitchell whose statement notes that the National Pandemic Flu Service “is only available to people living in England or registered with a GP in England.”

“The current numbers of GP consultations in Northern Ireland for flu are still relatively low. The present arrangements remain the best and most appropriate way to get treatment to anyone who needs it. Northern Ireland will be able to use the National Pandemic Flu Service if the need arises at a later date. This situation is being kept under constant review.

“To avoid spreading the virus, people who think they have swine flu should stay at home and take simple measures to alleviate their symptoms such as rest, drinking plenty of fluids and taking paracetamol as required. If anyone is still concerned, and in particular, if they are in a higher risk group they should contact their GP.”

And on 30 July the Acting Chief Medical Officer, again, confirmed that change in strategy

“If you think you have swine flu stay at home, please do not visit your GP practice or A&E in person. For otherwise fit and healthy people, there is usually no need to take antivirals. Most people will recover at home by taking simple measures to alleviate symptoms such as resting, taking paracetamol and drinking plenty of fluids. If, however, your condition suddenly deteriorates or is getting worse after seven days (five for a child) then you should contact your GP or out-of-hours service.

“People with underlying health conditions who are at higher risk of complications if they develop influenza should call their GP for advice and assessment for antivirals.”

On 8 August the Health Minister made a statement assuring the public that Tamiflu remained available as a treatment, although the actual quotes don’t quite match the introduction.

Mr McGimpsey said: “The Public Health Agency in Northern Ireland is working closely with colleagues in the Republic of Ireland to ensure that all symptomatic children receive Tamiflu, if appropriate and, that parents are advised of the situation.” [added emphasis]

The new NI strategy remains in place as of 13 August.

And the vaccine, when available, will be similarly targeted.

Adds RTÉ reports that - “Drinks group Diageo has confirmed that it has offered its 2,000 Irish employees a free course of anti-viral medication [Tamiflu] to treat influenza.”

Free or subsidised anti-viral medication has also been offered to designated members of employees’ families, as part of the measure, which has also been introduced for its employees worldwide.

In a statement, Diageo Ireland, whose brands include Guinness and Budweiser, said that the most important priorities are ‘to protect our people, their families and our business operation’.