The way in which medical and healthcare is delivered is changing. Technology is advanced to the extent that intensive-care unit (ICU) capabilities can be combined with home monitoring facilities; telehealth centres can receive multiple sources of data from large numbers of patients based in their homes and prioritise who needs care – instantly. And with video conferencing and online tools, it is no longer wholly necessary for people to attend appointments at surgeries and hospitals.

Philips HealthSuite, for example, is a digital platform that collects, compiles and analyses clinical and other data from multiple devices and sources. Representing a new era in personalised and connected care for both the public and professionals, it allows patients and their health-care providers to access all manner of data, from the state of an individual’s health through to population trends – all from their PC, tablet or smartphone.

Even without complex technology, data is being collected and analysed to address key challenges. Ian Ireland, chair of the Royal College of Nursing’s e-health group, gives the example of a care home that had a higher-than-average rate of falls. “A graph plotting the time and location of the falls compared to the staff rotas was created,” he says. “What became apparent was that after the evening meal some residents wanted to go to bed. While the nursing staff were busy taking them upstairs, other residents would attempt to go to the toilet by themselves but fall over. Staffing was subsequently rearranged and the number of falls reduced by 50 per cent,” he says.

Many of the skills required by health-care professionals are changing as new technologies come on the market. Indeed, Jeremy Hunt, the Secretary of State for Health, believes that increasingly powerful diagnostic tools will remove the need for GPs (that’s to say, human beings) to diagnose medical conditions.

The idea that technology will render diagnostic skills obsolete is perhaps a step too far. As Dr Taylor, a GP based in the Midlands, observes, doctors frequently don’t make “diagnoses” but “non-diagnoses”, and they do so by applying local context to their decisions – something a computer program can’t necessarily offer.

“Of course technology can be very clever, but there is much more to healthcare than just diagnosis,” Taylor says. “The benefit of visiting your GP is that they can consider the whole clinical picture in relation to family and social set-up. For example, recently I saw a woman who was experiencing knee pain. When I suggested that she have an MRI and arrange an appointment to see an orthopaedic surgeon, she burst into tears. Her husband had left her, her child had been taken into care and to have an operation would have made life even more difficult for her – all of which meant that I had to change my recommendations. A computer program couldn’t have responded to the social context in the same way.”

Equally, not all areas of the country are fully up to date yet when it comes to technology and high-speed broadband, and so many people simply could not access telehealth services even if they wanted to. As such, they will remain dependent on conventional forms of healthcare – at least for now.

All said and done, the digital revolution and the swaths of data that come with it clearly offer many opportunities for the NHS – as long as health-care professionals know how to use them. And there’s the rub, says Neil Mesher, managing director of healthcare at Philips UK & Ireland.

“If you look at how GPs are trained today versus what they will need to be trained in in ten or 20 years from now, it is a very different space. There is so much potential to be found in the data, but GPs need to know how to sift through it, manage it and interpret it,” he says.

The picture for UK medical training in relation to technological advances is currently a little confused. While it has been acknowledged that patients’ needs are changing fast, there doesn’t appear to have been as much discussion of the role of tech skills in helping address this. The 2013 Shape of Training Review by Professor David Greenaway aimed to offer an “approach that will ensure doctors are trained to the highest standards and are prepared to meet changing patient needs. It also offers an approach that will be fit for purpose for many years to come.”

However, only two paragraphs of the 57-page report were dedicated to technological advances. “We considered this review against the backdrop of rapidly changing medical and scientific advances, evolving health-care and population needs, changes to health-care systems and the information and communications technology (ICT) revolution,” the report stated, and then recommended that “a flexible training pathway” be introduced, to enable doctors to take advantage of developments.

In October this year, the British Medical Association (BMA) followed the Shape of Training review with its own publication, Pre and Post Qualification Training and Development of Doctors: a British Medical Association Vision. Referring to challenges such as the UK’s ageing population, expectationsof more personalised and joined-up healthcare; as well as rapid advancements in medical and science, it called for training that better reflected the needs of patients, allowing for continuous learning and improved flexibility to accommodate the needs of doctors.

“Crucially, change in medical training should be evolutionary and evidence-based. It should learn from and build upon current and past experience. Training and development must again become integral to services and service planning, specifically and explicitly resourced and based on quality and need rather than convenience,” the report said.

Some medical courses are adapting their curriculum accordingly. The University of Surrey, for example, is one of a handful that are looking to launch an integrated “engineering for health” degree promoting the use of technology in medicine. However, currently such courses are few and far between, although technology and engineering were recognised as important for certain areas of the medical profession. “I think it’s safe to say that big data is not currently driving changes to medical education in the UK,” said the head of clinical studies at the University of Oxford.

Lessons from the US

The United States is one country that is leading the charge on this front. The American Medical Association has launched a $1m initiative,designed specifically to encourage medical schools to change their curriculum. Called Accelerating Change in Medical Education, it is teaching the use of electronic health records, management of patient panels to improve health outcomes, and interpretation of big data on health-care costs and health-care utilisation in order to learn how best to use resources.

“We know it's time to change. Schools want to change, and we’ve gathered together people who are doing projects that are really making a difference in the way physicians are trained for the future,” saysDr Susan Skochelak, MPH, group vice-president of medical education at the AMA. “Together, the 31 [member] schools will collectively work to quickly identify and widely share the best models for educational change to ensure future physicians are prepared for a lifetime of learning, to lead a team of professionals in delivering care and to explore innovative ways to care for patients, populations and communities in the evolving health-care system.

“By working together, we believe that during the next several years this effort will produce physicians who are not just skilled clinicians, but system-based thinkers, change agents, technology champions and inter-professional team players.”

This is beginning to have an impact across other areas of the medical education community, too. Early this month, the Accreditation Council for Graduate Medical Education (ACGME) announced an initiative called Pursuing Excellence in Clinical Learning Environments, which will be delivered in partnership with the AMA, to facilitate improvement in the graduate medical education system.

We wait to see if the UK will follow suit. Until then, the take-up of tech and data skills is more likely to be driven by health-care professionals themselves.

“Nurses expect timely and accurate information on their patients and yet they don’t always receive this. They also expect access to the technology and training that allows them to use this information correctly,” says the RCN’s Ian Ireland. “I suspect that frustration at not being given the tools they need will help drive more universities and educational institutions to introduce more courses of this nature.”

He adds: “Of course, many nurses are already far more up-to-date with digital and data skills than they think they are, due to the fact they shop and bank online, and use many different apps via their mobile phones”.

Indeed, using in-house skills has already been identified as an important part of the NHS’s tech strategy. Code4Health, for example, is a UK government programme under which doctors, other health-care professionals and even patients are being given training to write basic computer code. They will then be given responsibility fordesigning simple prototypes for tools they think could make the NHS work better.

Members of Code4Health join a growing number of people taking NHS IT into their own hands. “Geeks who love the NHS” is another group of doctors and nurses, together with computer programers and web designers, who organise informal “hack days” when they come up with new apps and other programs. Examples of apps that the group has developed are CellCountr, an app that provides haemotology cell counts, and PatientList, a clinical task list app.

It can be easy to get caught up in all the excitement of new technology. However, if appropriate skills are not delivered to those who need them to use the new tools, then the opportunity to realise the potential of these developments could be lost. As Philips’s Neil Mesher, says: “Over the next ten to 20 years, IT and digital technologies will be providing more and more value to the health service. Having the right information available at the right time is central to allowing clinicians to make better, more accurate diagnosis.” Tech and data analysis skills therefore need to become a priority item on the agenda if the NHS is to remain relevant in the modern world. 

Marwa, which is not her real name, dated her husband in secret for over a year before they got engaged. They didn’t have a lot to hide – they didn’t kiss until after their legal marriage contract was signed in September – but her father would not have seen it that way. Marwa is 27, and until recently worked for a large international company in Cairo. Her husband, who we’ll call Amr, is 30 and works as a teacher in Saudi Arabia. They met through mutual friends, and grew close through Facebook messenger. In June, Amr returned to Cairo to meet Marwa’s father. He posed as a stranger, and said he’d been tipped off by family friends that Marwa might make a good wife for him. Getting Marwa’s father to agree in principle to the match was the easy part. The financial negotiations that followed were fierce and protracted.

Her father was adamant that Amr provide her with a rented apartment in Saudi, which would cost 40,000 Riyals (£7,000) a year, as well as a condo in Cairo costing half a million Egyptian pounds (LE) (£42,000). He drew up a list of household goods Amr must purchase for a minimum price of 35,000 LE (£3,000). Four days before their legal marriage, Marwa’s father and Amr shouted at each other for around seven hours over the purchase of two large diamond rings.

“If it was anyone other than my husband, I don’t think they would accept the way my father treated him and argued with him, and the expensive things he asked for. But my husband agreed, just because he loves me,” Marwa told me when we met for coffee in the upmarket Cairo district of Zamalek. She feels lucky; many of her friends have had to break off engagements over money problems. Marwa said she didn’t really want any of the things her father had bargained so hard for: not the diamond rings, and certainly not the condo. So why did he do it? “It’s the community,” she replied; in Egypt expensive marriage arrangements are still seen by many as a measure of a woman’s worth. As one cash-strapped groom put it to me, “the family want to show the daughter is valuable”.

The price of marriage has been steadily increasing in Egypt. This cost falls largely on would-be grooms, who are expected to pay for the family home, most of its furnishings and the bride’s wedding jewellery, known as shabka. According to a survey by UNFPA the average cost of shabka has almost doubled in the past decade to reach 7,000 LE (£590), as has the average cost of getting married which, excluding the shabka and property, is now 40,000 LE (£3,400).

This is a lot to spend in a country where 14 per cent live on less than a $2 a day, and a quarter of young people are unemployed. It’s also a considerable investment to make while Egypt’s economic prospects are so uncertain. High youth unemployment and poverty contributed to the 2011 uprising against Hosni Mubarak, Egypt’s dictator for almost thirty years, and the political instability and social unrest that followed have done little to improve the country’s finances. Tourism accounts for 13 per cent of GDP, and so events such as the Russian plane crash over Sinai and the killing of Mexican tourists in the Western desert could deal a heavy blow to the economy. These economic problems have romantic implications.

For some men, marriage is prohibitively expensive. A quarter of Egyptian men aged 35 are unmarried, as are 12 per cent of women. Marriage is a life-changing transition for Egyptians. Unmarried people are expected to live with their parents and relationships outside of marriage are frowned upon – particularly for women. To put it bluntly, for many Egyptians, to be priced out of marriage can mean being priced out of sex. Unexpectedly, given Egypt’s social conservatism, a recent article in a local newspaper made a case for legalising prostitution to protect women and accept that in a “repressed and simultaneously sexually obsessed society” people will look for less “economically troublesome” options for meeting their sexual needs. But the problem is bigger than this. While many young men feel worn down by economic pressure, women suffer most under marital norms that reflect and reinforce Egypt’s patriarchal social structure.

In 2011, when men and women went out onto the streets en masse to protest against their government, a number of sexual assaults – including against the US TV anchor Lara Logan – drew renewed public attention to Egypt’s sexual harassment problem. A 2013 UN Women survey found that 99.3 per cent of Egyptian women reported being harassed, often in the streets. This makes Egypt the second worse place for harassment, after Afghanistan. Soraya Bahgat, a women’s rights activist and founder of Tahrir Bodyguard – which deployed teams of people to protect women against assaults at protests – told me she was struck by the anger expressed by many men. The attacks were “very vicious, they went beyond sexual frustration to express real violence”. The causes of this resentment are complex, she added, but economics could play a part. “If you can’t get married because of economic and social structures, you take your anger out on women: it’s easier sometimes to get upset at the woman, because who else can you blame?”

Marwa, who says she is harassed often and has been groped several times while walking around Cairo, believes sexual harassment is more directly linked to marriage. “Making love before marriage is not allowed in Egypt, and they cannot get married so they find another way to satisfy their needs,” she told me. She said she couldn’t wait to move to Saudi Arabia, which surprised me. She was wearing bright pink lipstick and a patterned headscarf, so I asked her how she felt about being forced to wear a black abaya in Saudi Arabia, and being banned from driving. Those were downsides, Marwa acknowledged. But, “in Egypt, men bother me all the time...in Saudi I can walk safely at 2am.”

If you want to know why Ukraine had a revolution, consider this: it has one of the world’s fastest-growing HIV epidemics, and yet officials deliberately overcharged their own health ministry for anti-retrovirals to make money for themselves. In 2013, about a quarter of the money intended for HIV medicines was embezzled, while more than half the Ukrainians who died of Aids-related conditions lacked access to drugs.

And that was not an isolated example: children lacked vaccines, haemophiliacs lacked clotting factor, diabetics lacked insulin. Patients had to bribe doctors to obtain the drugs the state was supposed to provide for free, while officials and intermediaries secretly got rich via Cyprus-registered shell companies.

Ukraine has finally moved to break the pharmaceutical mafia. Under three deals signed this month, the health ministry has outsourced drugs procurement to two UN agencies and to Britain’s Crown Agents. The drugs available should be better and cheaper – by between 10 and 25 per cent – so more can be bought for people who need them, and those that are bought will be more effective. Meanwhile, the criminals will lose out: it’s a win/win/win.

“We are drastically changing the rules of the game, we are changing a system that has been around for years and years, and which has proven to be inefficient, corrupted, non-transparent,” Deputy Health Minister Ihor Perehinets told me.

Ukraine’s revolution happened almost two years ago. Those have been years of war and economic collapse and the healthcare situation has deteriorated still further. This summer, polio paralysed two Ukrainian children after vaccination rates dropped to just 14 per cent. The only other countries in the world with polio outbreaks are Pakistan, Afghanistan, Madagascar and Guinea. Ukraine’s revolutionaries wanted to move closer to Europe, but instead got a disease found in the poorest parts of the developing world.

Anti-corruption activists have been highly critical of the health ministry for taking so long to act, but Alexandra Ustinova of the Anti-Corruption Action Centre was delighted it had finally done so.

“Of all the years of healthcare in independent Ukraine, this is the first real reform,” she said. “We have taken 2.3 billion hryvnias ($100m) from the oligarchs and given them to international organisations. It is massive.”

It is of course heartening that officials in Kiev have finally taken a step to fight the endemic corruption that has plagued Ukraine since independence, but it is depressing too. The post-revolutionary government should have been passing much more significant milestones than this long ago. This reform affects just one-third of one part of one ministry’s procurement budget. Other ministries and agencies – among them: the judiciary, the prosecutor’s office, the customs service – are not only unreformed, but are still staffed by officials appointed under the old regime. These people are not just delaying reforms, but actively opposing them.

“Corrupt actors within the Prosecutor General’s office are making things worse by openly and aggressively undermining reform,” said US Ambassador Geoffrey Pyatt in an unusually outspoken assault in September. “These bad actors regularly hinder efforts to investigate and prosecute corrupt officials within the prosecutor general’s office.  They intimidate and obstruct the efforts of those working honestly on reform initiatives within that same office.”

As the second anniversary of the revolution approaches, Ukrainians are increasingly wondering if these saboteurs are winning. Prosecutors have failed to bring any of the corrupt officials of the previous regime to trial, or to persuade foreign states to repatriate their stolen money. And they have the connivance of others. Earlier this month, Justice Minister Pavlo Petrenko accused parliament of deliberately neutering a new law intended to help bring stolen money home.

During the revolution, Sergei Leshchenko was a journalist who specialised in revealing Ukraine’s rulers’ corruption. While the president was amassing a fortune, parliamentarians cut side deals in what Ukrainians referred to as “the biggest business club in Europe”. Leshchenko decided to run for parliament and to try to improve the system from the inside, and won a seat in October last year.

“The direction of travel is correct, but it is too slow. This is a parliamentary republic, and you need consensus,” he says. We were eating lunch in parliament’s canteen, and he indicated his fellow deputies with a sweep of his head. “There are a lot of politicians here who are not motivated. Being optimistic, maybe 25 per cent of us want proper reform. In reality, it’s probably less.”

Although many Ukrainians still back President Petro Poroshenko, at least partly thanks to his response to the Russian destabilisation of Ukraine’s east, support for Prime Minister Arseny Yatsenyuk has collapsed so completely that his Popular Front party did not even stand in local elections last month. Both president and premier insist they are committed to transforming Ukraine into a European country but, when speaking privately, officials often despair of the muddle they have created. There is still no truly independent judiciary, the tax system is a mess, officials remain under-paid, and there has been no purge of the old regime’s corrupt officials.

“I am angry all the time, I feel ready to make a public statement and quit. About 90 percent of the time I think it’s all a disaster,” said one senior official, who asked to remain anonymous so he could speak his mind. “Every day I get approached through friends, through relatives, with offers of money. Any ordinary man would take it, and I’m beginning to think I’m acting like a Greek philosopher, like Diogenes in his barrel or someone. My wife thinks I’m an idiot.”

He was angry as well that European countries haven’t done more to return the money stolen from Ukraine and stashed in Western bank accounts. “They seem to prefer to have people in London buying property, or in Monaco, Austria or Slovenia or wherever, than to help us,” he said. “But then, if nothing is being done in Ukraine, it’s stupid to expect other countries to do it for us.”

Is he worried that the people will take to the streets once more?

“I would love to see that. I would join them in a second,” he said.

In 2011, David Cameron wrote in The Telegraph:  “In the years to come, people will look back at the days when government kept all its data – your data – in vaults and think how strange it was that the taxpayers – the people who actually own all this – were locked out. […] Use this information, exploit it, hold your public services to account.”

The Prime Minister’s words hit the nail on the head: data held by authorities is our data. We have a right to know how our institutions are run and our money spent – and if they’re failing to meet the standards we expect and deserve.

Alongside our threatened Human Rights Act, one of the most powerful tools for this is the Freedom of Information Act (FOIA). Since 2005, it’s proven an unparalleled mechanism for dragging stories of monumental public interest kicking and screaming into the light.

Without it, we’d still be in the dark about police use of tasers on children, the incineration of foetuses as clinical waste, Cyril Smith’s attempts to threaten police investigating claims he had molested young boys and hundreds of care home residents dying of thirst. We wouldn’t have had the seismic MPs’ expenses scandal– not to mention countless local and regional stories of vital importance in holding councils to account.

All revelations of unquestionable public interest, which led to – or should lead to – positive changes in the way our bodies are run. All stories it would have suited the powerful to keep under lock and key.

Given his barnstorming defence of the value of transparency and accountability, you’d think Mr Cameron would be a fan – but, an election on, it seems his strength of feeling has dulled.

In July, the government announced a new Commission on Freedom of Information – required, they claim, to scrutinise the balance between transparency, accountability and the need for “robust protection” of sensitive information; consider the need for a “safe space” and “frank advice”; and look at the “burden of the Act” on authorities. Launching the review, Cabinet Office Secretary Lord Bridges insisted the Government supported the FOIA – but added: “after more than a decade in operation it is time that the process is reviewed, to make sure it’s working effectively”.

Perhaps this government has an unnervingly short collective memory. Or perhaps it just wants us to forget that the FOIA was subject to a thorough scrutiny process by the cross-party parliamentary Justice Select Committee just three years ago. That Committee considered expert evidence from senior politicians, academics, civil servants, journalists and organisations including Liberty.

Its conclusion? The FOIA had been a success and its scope should not be diminished. It had “enhanced the UK’s democratic system”, making our public bodies “more open, accountable and transparent”. The comprehensive report remains available online.

Regarding the “safe space”, Committee Chairman Sir Alan Beith was clear: “The Act was never intended to prevent, limit, or stop the recording of policy discussions in Cabinet or at the highest levels of government, and we believe that its existing provisions, properly used, are sufficient to maintain the ‘safe space’ for such discussions”.

He also dismissed concerns about the “burden”, saying: “Complaints about the cost of FOI will ring hollow when made by public authorities which have failed to invest the time and effort needed to create an efficient freedom of information scheme”. The right to access information under the FOIA is already subject to restrictions, including an exemption if the cost of complying would exceed an ‘appropriate limit’.

The Justice Committee also heard evidence about savings made to the public purse following FOI disclosures about systemic inefficiencies and serious mismanagement of public funds. And let’s put the cost “burden” in context. government spent £150.7m on press, communications and marketing in 2014/5. Almost five times more than it spent on maintaining a healthy system of access to information under the Act. And we know of this staggering disparity thanks to… an FOI request.

In short, the Committee addressed everything this new review has ostensibly been set up to consider. Why then – at a time of massive cuts to Whitehall budgets – the sudden pressing need for another one?

When it comes to the Committee line-up, the deck has been brazenly stacked. Among its five members are Jack Straw, already all over the public record saying the FOIA should be entirely rewritten. When asked by the Justice Committee whether he would have “killed” the legislation “at birth”, he responded: “I do not know the answer”.

Alongside him are Lord Howard (who felt the full force of the FOIA during the expenses scandal) and Lib Dem Lord Carlile (whose views on the supreme importance of government secrecy are well-known). Nobody on the Commission has a record of having previously used or benefitted from the Act.

Announcing the Commission, Lord Bridges declared the government’s commitment to being the “most transparent” in the world, pointing to data.gov.uk as proof. Of course, authorities can promote greater transparency by proactively publishing information. But, as Information Commissioner Christopher Graham puts it: “Sometimes the full story is in the background papers and minutes of meetings rather than just raw data.”

Politicians, senior civil servants and advisers instinctively hoard power because they think that’s the way to get things done – once again, the words of David Cameron. Without FOI requests, decisions on what to publish will lie with those in power – those with a vested interest in keeping politically embarrassing, contentious or damning information out of public hands.

Fine words extolling the virtues of transparency are one thing. But, just as common law can’t provide the rights protections our equally beleaguered Human Rights Act can, fine words can’t guarantee our right to access information of profound public interest held by our authorities – the FOIA can.

This is a clear attempt to crack down on Freedom of Information – and it’s darkly hypocritical from such a surveillance-obsessed government, taking “no privacy for you, no scrutiny for us” to a whole new level. Perhaps it should come as no surprise, given the very public bruising many senior politicians have suffered at its hands in recent years. But to seek so shamelessly to curtail the FOIA in the face of such recent evidence that it is working well betrays a staggering disdain for accountability and transparency – the pillars that shore up good democracy.

The FOIA’s impact in just a decade has been inestimable. At Liberty, we’ve used information obtained under it to challenge human rights breaches, end discriminatory policy and advocate for the most vulnerable. It’s been critical to some of our most successful legal cases and policy reforms, including curtailing discriminatory stop and search and the degrading treatment of detained immigrants, and exposing dangerous deportation practices. It has helped us force disclosure of statistics about incidents of sexual assault in the armed forces and controversial powers to detain people without suspicion at ports and borders.

We have very few pieces of legislation which let ordinary people hold our public bodies to account. The Freedom of Information Act is one. The Human Rights Act is another. The government is intent on curbing both. If we don’t speak up in their defence, people will look back in years to come – to echo the Prime Minister – and question why we let them get away with such a barefaced attempt to hand power back to the few.

Bella Sankey is policy director for Liberty

Refusing to sing the national anthem

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Just a few days after being elected Labour leader, Corbyn was felled by a toxic combination of pomp and circumstance. His first appointment after being elected was attending a Battle of Britain memorial service. The famously republican Labour MP decided not to sing the national anthem during the service.

He’s sticking to his principles, and who cares anyway, his supporters argued. The newspapers were just trying to catch him out.

But with polling showing 68 per cent of Britain think the monarchy is good for the country, it would have been pragmatic to sing. Something he clearly got wise to, later commenting: “I will show my respect in the proper way at all future events. The proper way is to take a full part in it and I will take a full part.” (A hassled Labour spokesperson clarified: “taking part fully includes singing”).

Ruling: GAFFE

Stealing sandwiches from veterans

Screengrab from The Independent

Erm. He didn’t. The sandwiches were freely offered.

Ruling: GUFF

Assaulting a BBC cameraman

Pixabay

A BBC cameraman was injured and had to go to hospital during a media scrum outside Corbyn’s house. It’s unfortunate that it was Corbyn’s driver who hit the cameraman, and it sounds like it was quite an aggressive situation. But just as it wasn’t the media’s fault, it wasn’t the new Labour leader’s fault.

Ruling: GUFF

Wearing a tie/not wearing a tie

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Will he wear a tie? Has he sold out by wearing a tie? Will he confirm whether he will wear white tie to a white tie dinner?

Who cares? Tony Blair’s open-necked ease may have attracted a bit of mockery, but it made him distinctive.

Ruling: GUFF

Socks ‘n’ Crocs

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Mischievous from the photographer, bold from Corbs. There's nothing wrong with a man showing a little sartorial flair.

Ruling: GUFF

Giving top shadow cabinet positions to men

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Soon after he was elected, Corbyn picked his shadow cabinet. Shadow chancellor, shadow foreign secretary, and shadow home secretary – all the great offices of state are shadowed by male politicians.

His defence: this is the first majority female shadow cabinet.

But it doesn’t really count when the women are mainly in more junior positions.

His next defence: your view of which positions are most senior is old-fashioned and arbitrary.

Why appoint and announce the shadow great offices of state first then? And why make your closest ally shadow chancellor if being minister for tiddlywinks is just as important?

Ruling: GAFFE

Skipping the first Privy Council meeting

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He SNUBBED the Queen, wailed The Sun. But he didn’t, did he? He missed the first Privy Council meeting because he was on holiday. A break he had planned to take after an exhausting leadership election campaign.

Besides, it’s normal to miss the first opportunity to swear in. David Cameron kept Her Maj waiting twice as long when he became opposition leader.

Ruling: GUFF

Plagiarising his party conference speech

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There’s nothing legally wrong with it, but Corbyn should have avoided reciting a large chunk of a speech available for all to read online since August 2011, and previously offered to Ed Miliband and other Labour leaders by the author (They all declined.). This wasn’t a good look under the banner intended to convey Corbyn’s authenticity: “Straight-talking, honest politics”. Unforced error.

Ruling: GAFFE

Using a question from a former BNP organiser at PMQs

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Nothing wrong with crowdsourcing, but probably best to check who your questions are from...

Ruling: GAFFE

Making Seumas Milne spin doctor

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The press balked at this appointment of the Guardian journalist as head of strategy and communications. Milne, whose lefty columns and opinions have caused controversy, was thought of as a toxic addition to Corbyn’s team.

Come on. No one outside the media really cares about a leader’s backroom team. Not even when the Prime Minister’s former communications chief, Andy Coulson, was sent to prison.

Ruling: GUFF

Supporting the scary Momentum conspiracy

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Momentum, the campaign network that has sprung out of Corbyn’s leadership campaign, is scaring MPs and the press alike. It’s all a big conspiracy to take over and hollow out the Labour party!

But it’s not really, is it? It’s run and peopled by those who voted for Corbyn – who won nearly 59.5 per cent of votes in a historic first-round victory. Probably makes sense that members and supporters who voted for him are a significant voice in the party.

Ruling: GUFF

Not bowing at the Cenotaph

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He did bow.

Ruling: GUFF

"Going soft on Jihadi John"

“It would have been far better for us all if he had been held to account in a court of law,” was Corbyn’s take on killing Jihadi John with a drone strike. Shock! Horror! Politician stresses due process and the rule of law. Incidentally, the relatives of beheaded hostages also had mixed feelings about killing the murderer in an air strike.

Plus, as my colleague George points out, Corbyn has more in common with David Cameron’s stance on Syria than you might expect.

Ruling: GUFF

The shoot-to-kill U-turn

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Following the events in Paris, Corbyn gave an interview saying he was “not happy” with UK police operating a shoot-to-kill policy. A big mistake, considering the context of a deadly terrorist attack and the almost universal opposition among his own shadow cabinet.

He soon watered down his remarks: “Of course I support the use of whatever proportionate and strictly necessary force is required to save life in response to attacks of the kind we saw in Paris.”

Ruling: GAFFE

Appointing Ken Livingstone to co-chair the defence policy review (without telling the other convenor first)

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An unnecessary error. Livingstone, a divisive figure, is anti-nuclear, whereas Maria Eagle, the shadow defence secretary who Corbyn appointed, supports the renewal of Trident. And Eagle only found out about the appointment on Twitter.

Undermining your own defence spokesperson, and putting a controversial character in such a public position, was never going to end well. And sure enough, Livingstone somehow managed to make insulting remarks about mental ill health all day long following his appointment.

Ruling: GAFFE

Growing up in a seven-bed manor house

Screengrab from Daily Mail

I had to put this one in, because I’m an evil member of the mainstream media who enjoys a pun. Are you ready for it? Here goes . . .

Ruling: GAFF

It’s funny how small moments from films can stick in your mind. Ever since I saw Five Easy Pieces about thirty years ago, I’ve carried around in my head the scene at the dinner table where Karen Black, playing Jack Nicholson’s girlfriend, defends her love of TV to his snobby patrician family. “There’s some good things on it, though,” she says quietly, after she has been patronised. “The TV. There’s some good things on it sometimes.” I usually assume that nowadays it’s taken for granted that we all agree with her – it’s fine to love the telly, and only idiotic dinosaurs disagree.

But here we are in 2015 and people still use it as an arena for one-upmanship, disguising their snobbery now by taking against particular programmes, or types of programme, instead of the medium in general. I’ve written before about how much trouble I get into when I tweet about The X Factor, and one result has been that I just don’t bother much any more. On a Saturday afternoon my timeline fills up with tweets about the football. I’m no footie fan, but I smile fondly at these tweets – some of which are from my husband – as I enjoy the sight of other people enjoying themselves.

On a Saturday evening, though, woe betide me if I mention what I’m now watching. I get lectured about its awfulness. Blocking sanctimonious bores isn’t as much fun as it sounds, so I’ve mostly stopped telly tweeting, but the other weekend I did have a joyful hour of sharing X Factor comments with Stella Creasy and it was almost like the good old days. Not for long, though. This time it was someone I actually follow who went to the trouble of telling me, and their many, many followers, that I should stop watching it. As they had done – hurrah for them.

It astonishes me that anyone can still be this puritanical. Maybe it’s partly Roald Dahl’s fault. I loved his books as a kid and read them to all mine, but Charlie and the Chocolate Factory does come with a pretty clear message that telly is a lowering, corrupting influence. Mike Teavee is obsessed with it and so gets shrunk and sucked into a television. That sinister box will take over your life, diminish and then consume you.

But come on, that was written in 1964. We’ve moved on a bit since then, haven’t we, broken free of our imprisoning ideas about high and low culture? For proof, just look at Gogglebox, another one of my favourite programmes, where we watch, on our tellies, people watching things on their tellies, while the ghost of Roald Dahl shakes a futile fist at us and he rolls in his grave.

TV has triumphed, and given that it now has to fight off competition from so many newer forms of entertainment, it’s perhaps a miracle that it has survived. Gogglebox– which celebrates the communal, family-based, shared viewing experience – is heart-warming precisely for being ever so slightly nostalgic. What it shows above all is that no one watches passively. We take part, we interpret, we judge, we react. You don’t switch off the second you dislike something. What, you thought it was just you who hurled witty comments from your sofa, happily slagging things off? We all do; that’s the whole point.

The Gogglebox crowd are a particularly warm and lovely bunch (even when they’re being bitchy). On that programme, we see things we hardly ever see in fictionalised drama – families that love each other, parents who think their kids are funny, kids who think their parents are smart, ex-lovers who are still mates. All together, keeping company in front of the glowing box.

And in their reactions, they prove to us that there is no need to love every moment of what you’re viewing in order to love the experience. They shout with laughter at the awfulness, they are moved to tears by the plight of others, they roar their disapproval at the screen, they sigh with pleasure. I love them all, because they understand that essential truth – that there are some good things on the telly sometimes, and even when there aren’t, it’s still fun to watch. 

August 2013: the heatwave. Ice was my pregnancy food, which I ate out of buckets; my body was a stranger. Apart from a column in the Guardian, in which I pondered my own death in childbirth, I made no plans, read no books.

I went to be induced. I took my laptop because I thought I might write a column. But I did not feel like writing a column.

In the high-dependency ward (for women too column-dependent to have children before 39, and too fat to do it safely) I realised I could get morphine if I made sad faces and lied about the pain.

I have not had a drink for 13 years, for reasons that will soon become obvious. I did so much morphine, I almost forgot I was pregnant until people reminded me. This annoyed me. It contaminated my drug dream. I wanted to do morphine and never come back.

I got an epidural. It failed. I got a spinal block. I couldn’t feel anything below my tits and I seriously feared I would never feel my legs again. They told me to push but I couldn’t feel my body. So I made faces designed to make people think I was pushing.

I was so high that when two hot doctors came in, and I was in the stirrups pretending to push, I screamed: “Hi!” I wasn’t quite high enough to attempt to seduce them – what would be the point, during childbirth? – but I could have. They could have been mine.

When the emergency C-section came, they were on to me. “You will tell me when you can’t feel the pain, won’t you?” the anaesthetist asked. Ha! Bollocks I will. When my child was born – I mean removed – I was so high I was talking about risotto. I looked at the baby, recited some Auden at him, decided he could look after himself, and asked for a book. I was chasing my high across the sky.

The crash: the next day, a nurse asked me if, when in labour, I had told my husband I didn’t love him. No, I said, I told him I’d never loved him. Then I began to vomit shit. This is called paralytic ileus; my bowel had stopped working, possibly as a result of the C-section, but probably because of the morphine. The doctor did not believe in the pain at first; she offered me Gaviscon, which I vomited, cinematically, over myself.

Then she did believe me, and consoled me by saying Caitlin Moran had also had paralytic ileus, and written very wittily about it. I hope you’re a better doctor than literary critic, I wanted to say, but didn’t.

She didn’t return, so I took my shit vomit to the desk. They put me in a high-dependency ward. The chief surgeon called with his crocodile of students to gawp at my shit vomit. There, after I had done a fart, which meant I would live, I became delighted with my condition. I am a hack, and my body had produced a column!

Suzanne Moore is away

This week, we talk about Corbyn's media gaffes, and explain how cities will save the world. (Helen Lewis, Anoosh Chakelian, George Eaton, Jonn Elledge, Barbara Speed)

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When Labour fought the general election in May it had around 200,000 full members. It now has more than 380,000, close to the 400,000 reached in 1997 and an increase of around 90,000 since Jeremy Corbyn became leader. 

But what is rarely noted is that these are net figures: the number who have joined minus the number who have left. Two months after Corbyn's election, MPs are struck by those exiting as well as those entering. Peep Show actor Robert Webb, who endorsed Yvette Cooper in the Labour leadership election, revealed yesterday that he had left the party - and he is far from the only one. One senior MP estimated that for every 75 members who joined, around 25 left. The majority of those departing are likely, as in Webb's case, to have voted fo non-Corbyn candidates. 

The net result is that the party has moved leftwards since the Labour leadership election. Were Corbyn to be challenged and defend his position, many believe he would win an even larger victory. As both supporters and opponents of the Labour leader emphasise, the increasing discontent among MPs is not shared by the membership.

For this reason, as I write in my column this week, the question of deselection, be it of Corbyn or of recalcitrant MPs, will persist. True unity will not be achieved until the PLP reflects the leader, or the leader reflects the PLP. As Labour's divisions grow, MPs fear that left-wing members will increasingly turn on them. One told me that Corbyn's refusal to grant a free vote on air strikes in Syria was "an attempt to pick a fight, isolate colleagues and pave the way for deselection". The list of the 21 MPs who abstained on George Osborne's fiscal charter, while the leadership voted against, was widely shared by Corbyn supporters. At a recent meeting of Momentum in Nottingham, former shadow chancellor and local MP Chris Leslie was mentioned as a target for deselection. 

A more left-wing membership will make it easier for Corbyn to win conference policy votes and for his supporters to become parliamentary candidates. As the Labour leader's opponents privately acknowlege, it will also make it far harder for any candidate significantly to his right to win in any future contest. 

Labour's postwar history is inescapably linked with the nuclear deterrent.If it weren't for Labour, Britain wouldn't have the Bomb. But it is Labour, more than any other party, that has been split and disfigured by battles over the deterrent. 

It was Attlee’s government, in 1946, that took the decision to make Britain a nuclear power at all. The cost – coupled with the wounds of war, and a programme of tight fiscal retrenchment – meant that the two economic ministers, Hugh Dalton at the Treasury and Stafford Cripps at the Board of Trade – now BIS – both believed the cost was too high, and that Britain simply couldn’t afford it.

Years later, Diane Abbott, Labour’s shadow international development secretary, made a similar argument to me, saying: “If you put the same money into building houses and roads it creates jobs and prosperity, but Trident is just dead money. That is the last thing we need when the world is teetering on the brink of another recession.”

But the intervention of Attlee’s Foreign Secretary, Ernest Bevin, ensured that Britain would become a nuclear power. Bevin, in many ways, is the original on which so many of the Labour right’s politicians are mere echoes of: physically imposing, virulently anti-Communist, and reliant upon his political success for his relationship with the trades union right, then as for much of its history based around the Transport and General Workers Union (TGWU), of which Bevin was not only a former general secretary but one of the founders. It was Bevin who as general secretary of the TGWU forced out the pacifist and leftwinger George Lansbury from the party leadership, and his intervention around the Cabinet table was just as vital to the direction of British foreign policy as his earlier move against Lansbury.

Cutting across Cripps, who was midway through a lengthy disposition on the costs of the deterrent, Bevin roared: “That won’t do at all...we’ve got to have this thing, whatever it costs. We’ve got to have a bloody Union Jack on top of it.”

“I don’t mind for myself,” Bevin, who had just finished a telephone call with his American opposite number, said: “but I don’t want any other Foreign Secretary of this country to be talked to or at by a Secretary of State in the United States as I have just had in my discussions with Mr Byrnes.”

And that was pretty much that, with that inner quartet informing the Cabinet of the decision – Parliament wasn’t involved until 1948, two years into the nuclear programme. Bevin and Attlee believed that Britain’s nuclear capability would keep the United Kingdom in the game. They saw it, in the words that Winston Churchill would use a few years later when he was back in Downing Street, as “the price we pay to sit at the top table”.

Judged on those early conversations, Britain’s nuclear deterrent has been a catastrophic failure. British Foreign Secretaries are “talked to or at by a Secretary of State in the United States” in a manner far more condescending and dismissive than anything endured by Bevin.  The United Kingdom no longer sits at the top table or anywhere like it. But its capacity to divide Labour remains just as strong.

Labour went into opposition in 1951, and the party faithful almost immediately decided that it was because the Labour government had been insufficiently leftwing. Internal opposition to Attlee coalesced around Aneurin Bevan - “Nye” for short - who had resigned from the government in its dying days over the programme of rearmament.  Attlee and his former ministers were criticised for spending too much on defence in general and the nuclear deterrent in particular.

Splits over defence – with Attlee and his eventual successor, Hugh Gaitskell, on one side, and Bevan and his followers on the other – scarred Labour’s years in the wilderness. Writing in 1989, Denis Healey reflected:

“We use to describe the period of Conservative Government from 1951 to 1964 as ‘thirteen wasted years’. The first eleven of those years were wasted by the Labour Party. Our bitter internal wrangling at the time gave us a reputation for division and extremism from which we have not yet recovered.”

But by 1964, with both Bevan and Gaitskell dead, Labour returned to power – and its first major division was on the issue of whether to scrap the Polaris nuclear submarines, the predecessor to Trident.

Just as in 1946, the new Labour government had the opportunity to kill off Britain’s nuclear programme. Harold Wilson, the Prime Minister, colluded with Denis Healey – a Bevinesque bruiser from the party’s right, then at Defence – telling him to tell the Cabinet that the programme was already too advanced to be mothballed. (In reality, the new government could easily have cancelled the submarines.  Healey recalled the Cabinet meeting that followed:

“Jim [Callaghan, the Chancellor of the Exchequer] wanted it down to three, just to save money, of course. But George Brown wanted it down to three on the grounds that with three boats we couldn’t be sure of always having one on patrol, and therefore it couldn’t be regarded as capable of being used independently. I remember Michael Stewart saying at the time that it reminded him very much of when he was on the committee of the Fulham Co-op in the 1930s and they were discussing, being good Methodists all, whether, for the first time, they should stock wine. And they finally decided they would stock wine, but only very poor wine.”

In many ways, Polaris – and Trident, the like-for-like replacement which came in 1996 – is the “very poor wine” of nuclear deterrence. By 1964, the Attlee government’s ambitions that Britain could maintain “Great Power” status had been shattered. Hopes of a ground-to-air nuclear missile, or a bomber fleet had both been scrapped, while instead of building its own deterrent, the missiles themselves were bought “off the shelf” from the United States. (The submarines are made in Barrow, however.) The United Kingdom is a nuclear state – but only just - .

Poor wine drank in large amounts can still cause family feuds, and the deterrent still retains its capacity to split Labour, not just during its period of opposition in the 1980s but even in the New Labour years. 95 Labour MPs, including Charles Clarke, the former Home Secretary, rebelled over Trident in 2007. Stephen Pound resigned from the government to vote against Trident, although he returned to the frontbench a year later and is still there now. This latest bout of in-fighting, in many ways, is just a case of history repeating

Whether the nuclear issue will remain as potent an electoral asset for the Conservatives as it was in the 1980s remains up for debate – but just as it has throughout the party’s history, the Bomb has lost none of its power to divide Labour. 

The image is Instagram-worthy: handsome young men throw their arms around each other’s shoulders in an unselfconscious, brotherly gesture. There’s even that distinctive blur at the edges of the photo, drawing the eye more strongly to the men’s smiling faces.

Any echoes of the popular photo app are not accidental, because this is indeed an image designed to go viral. It appeared in Dabiq, a glossy magazine distributed by Isis, the terror group that has claimed responsibility for recent attacks in Paris and on a Russian plane.

For years, journalists have been bemused by the existence of Inspire, a forerunner of Dabiq distributed by al-Qaeda. It’s hard to imagine the nitty-gritty of magazine production being undertaken by terrorists, and there is something darkly comic about the idea of a “jihadi sub-editor” (that said, most subs do have deeply held beliefs, even if they are usually about the correct placement of commas). But there is a thriving tradition of jihadi magazines, including several targeted at women, published as PDF files to allow decentralised distribution across the globe.

The image, printed in an edition of Dabiq, is typically idealistic. Photo: Dabiq

The Dabiq picture is captioned “Wala’ and bara’ [loyalty and disavowal] versus American racism”, a reference to an Islamic concept of friendship between Muslims. Professor Shahira Fahmy of the University of Arizona came across it during a year-long secondment to study Isis propaganda for Nato. Looking at Dabiq, she found that images promoting the idea of an “idealistic caliphate” far outnumbered photographs of killings and torture. Overall, she estimates that only 5 per cent of imagery produced and distributed by Isis is violent.

“What gets disseminated in media organisations could be considered a misrepresentation of the volume of the visual content that gets produced and disseminated by the organisation on a daily basis,” she told me by email from Riga in Latvia, where she is currently based. “These [idealistic] images might be more important in terms of branding the organisation and recruitment purposes than the images of violence that we regularly see in the news.”

Research by the Quilliam Foundation, an anti-extremism think tank, supports this view. A recent report found that the propaganda Isis distributes in the Middle East often shows the group “administering its civilian population, cleaning the streets, fitting electricity pylons, fixing sewage systems, purifying water, collecting blood donations, providing health care and education”.
In other words, the same kind of thing your local council probably pushes through your letter box on a leaflet – and with the same aim: reassuring people that they are living under a plausible, functional authority. Don’t worry, Isis will unclog your drains. Isis will collect your rubbish.

Like the concept of jihadi sub-editors, this all seems very incongruous to us in the West. Our media depictions of terrorists almost always depict them as inhuman monsters, as nihilists, as members of a death cult; not the kind of people who would be interested in civil infrastructure. But part of the modernity of Isis is its high level of media literacy. Terror is only part of the movement’s communications strategy: it knows it must offer hope, too. Fahmy points to images showing serenity and repentance – “suggesting that any individual will always be embraced by the organisation and forgiven for past affiliations upon joining the ‘caliphate’” – alongside others promoting the idea of victimisation by the West, such as graphic photographs of children killed by drone strikes. Like British newspapers, the group also seized on the image of Aylan Kurdi, the Syrian boy on the beach – as an illustration of the dangers of emigrating.

Fahmy notes that very little utopian Isis propaganda is seen in the West. Might we understand the group better if it was? The past few days have been filled with questions over Western media bias – for instance, the relative lack of attention given to bombings in Beirut – predicated on an acknowledgement of how much the media shape and reinforce public opinion.

Isis certainly believes in the power of the press. A recent blog boasted of having 15 media centres in a single province which disseminate CDs and audio files, and it has a large internet presence, too. It runs hashtag campaigns (such as #amessagefromIsistoUS) and an Arabic-language news app called The Dawn of Glad Tidings, which posts pro-Isis messages to users’ Twitter feeds. There is something oddly fitting that one of the very few foreign media organisations given access to Isis is Vice, the self-consciously edgy, gonzo, youth-focused online media giant. Vice’s 2014 documentary captured footage of jihadis snapping pictures of each other with smartphones – opening another front in the Isis propaganda war.

It’s obviously been a grim week for Europe, and Gibraltar’s security has come under scrutiny from a number of sources. Here’s CIMSEC on the subject, and on the subject of terrorism the Gibraltar Chronicle reports on the Rock’s respectful tributes to the French tragedy of a week ago.

December, meanwhile, is only a heartbeat away and it brings with it the inevitable “C” word – so here’s the Olive Press on Gibraltarian Christmas shopping. It also reports on Ocean Village’s lights going on at the end of this month.

And of course the election is just over two weeks away; GBC reports on tourism promises at the GSD’s policy launch, and Euro Weekly News points to the debate livening up.

We’ll know the result pretty soon.

Whose responsibility is our health? Government? Employers? The food and drink industry? Ourselves? Whereas one person might be comfortable to hand over control of his well-being to others, the next person may not.

Whatever New Statesman readers may think, there is one fact that cannot be ignored: too many of us are eating too much, drinking too much, smoking and not doing enough physical activity – and that is beginning to take its toll on our health and our health-care system.

There are an estimated 3.2 million people with diabetes in the UK, already one million more than ten years ago, and the figure is predicted to reach four million by 2025. There are now more than 3,000 alcohol-related admissions to A&E every day. One in five adults still smokes. Almost two-thirds of adults are overweight or obese, and, shockingly, so, too, are a growing number of children. Fewer than one in ten children are obese when they enter reception class, but by the time they’re in year six, that figure is nearly one in five.

The NHS is bearing the brunt of this. As it states in the Five Year Forward Review:  “As the ‘stock’ of population health risk gets worse, the ‘flow’ of costly NHS treatments increases as a consequence . . . Put bluntly, as the nation’s waistline keeps piling on the pounds, we’re piling on billions of pounds in future taxes just to pay for preventable illnesses.”

Quite rightly, the NHS strategy places considerable focus on prevention. It makes more sense to roll out a national programme of intensive lifestyle intervention programmes than it does to spend more money on dealing with the health complications stemming from an unhealthy lifestyle. A key ambition of the NHS, therefore, is to “become the first country to implement at scale a national evidence-based diabetes prevention programme modelled on proven UK and international models, and linked where appropriate to the new Health Check. NHS England and Public Health England will establish a preventative services programme that will then expand evidence-based action to other conditions”.

But does the public understand its own role in this prevention strategy? Research shows there are contradictions at play that need to be addressed if significant results are to be achieved. For example, a recent report published by Philips, Picture of Health, shows that UK adults and health-care professionals both agree that preventing poor health is the responsibility of the person in question. However, only 38 per cent of professionals believe patients understand that prevention is better than cure, despite patients reporting the opposite. Indeed, at present, less than half of UK adults are actively managing their health. All of this shows there is a clear disconnect between what they think they should do and what they actually do, and that it is time for people to engage actively with their health.

“If you look at the different age groups, millennials are very actively monitoring their own health but they’re a bit confused as to what they can do with the data [that their apps and health trackers provide]. Conversely, the 55-to-65-year-old cohort are very confident that they’re managing their health in a big way but when you actually ask them what they’re doing, they say that they weigh themselves, brush their teeth and visit their doctor occasionally, which is not particularly active engagement when it comes to managing your health,” said Sean Hughes, vice-president of design at Philips, speaking at a recent event hosted by the RSA called “Our Health: Who Cares?”.

Overall, less than half (45 per cent) of British adults say they are actively managing their health. Of those who aren’t, a quarter (26 per cent) know they should be more active but don’t have a strong desire to be so, and 8 per cent admit they just don’t do it.

Of course, all sections of our society have a responsibility for our health in one way or another, be it food manufacturers reducing salt and sugar in our food, local authorities seeking to limit junk-food outlets near schools, or employers ensuring positive well-being in the workplace – and this was reflected in the Philips research. About half (48 per cent) of respondents felt that corporations, such as the food and drink industry, should bear responsibility for our health, closely followed by the NHS (46 per cent) and educators (39 per cent). One in three (32 per cent) believe the onus lies on the media, while (22 per cent) think it is their employers’ responsibility.

Again, age influenced opinion. Millennials were much more likely to see other actors playing an active role in public health, half (50 per cent) of them believing that legislation could be a positive move. This was in contrast to most adults, of whom only a third (37 per cent) felt that the government should legislate. Meanwhile, many more health-care professionals were in favour of legislation – some 64 per cent of primary and 55 per cent of secondary health-care professionals would support new laws.

In general, British adults have a reactive outlook on making meaningful lifestyle changes. Most (71 per cent) waited until they had physical symptoms or were given a warning by their doctor (69 per cent). Very few are motivated by others; only 22 per cent said seeing a friend or family member experience a health problem would prompt them to change their behaviour and just 11 per cent would be inspired to change after seeing a friend or family member take charge of their own health.

“There is an interesting aspect in the report in terms of who’s responsible for prompting people to actually think [about their health]. We probably all believe that it’s everybody – individual, community, industry, third sector, local and national government – but it really has to be a whole system change,” said Tim Chadborn, behavioural insights lead researcher at Public Health England, who also spoke at the RSA event. He gave examples from within the NHS of initiatives such as the NHS Health Check programme, which invites people to talk to a trained health-care worker about their diet and physical activity, and Making Every Contact Count, which encourages health-care workers to stress the importance of prevention when they see members of the public. “For instance, we know that if someone is a smoker and goes to see a doctor and the doctor doesn’t ask about their smoking, they’re actually less likely to quit,” he said.

Knowledge is power

Individuals can be greatly helped by knowing what options they have, what these cost the taxpayer in terms of time and money, and how they may affect their ability to work and play. Better education clearly should play a part in the strategy.

Brits have already indicated they are hungry for information: three-quarters have gathered information about health and wellness from more than one source in the past year (primarily health-related websites). Seventy-one per cent of those who use connected devices and apps to track their health believe technology has empowered them to take control of their well-being. In addition, younger adults feel that their ability to manage their health would be boosted by support from professionals, such as a health, nutrition or fitness expert (36 per cent); by consistent information and advice from experts (33 per cent); by guidance on how to put information into practice (30 per cent); and by personalised consultations and treatments from their doctor (28 per cent).

Providing people with the tools they need to take control is vital, says Tim Kelsey, NHS national director for patients and information, who believes access to data is at the heart of this.

“From this April we've become the first country in the world to offer all our citizens access to GP records, online bookings, repeat prescriptions . . . The public is ready and willing: we just need to get ready to give them more control when they want it,” he said at the RSA event.

Philips’s Hughes concurs: “We believe we can break free from the inertia of inaction by connecting people and professionals with accurate and personalised health data. This, combined with solutions that keep healthy people well longer and aiding people to manage health at home, is the key to a hearty and better future for us all.”

A similar sentiment comes from within the NHS itself. Some 62 per cent of primary and 69 per cent of secondary health-care professionals believe that access to health data is a patient’s right and that individuals should have access to more of it. Indeed, 55 per cent felt that being given such access would increase patients’ sense of responsibility for their health.

A problem shared is a problem halved

It seems obvious that the job of clinicians and the health-care system is to take care of people when they are sick, but when the impact of every individual patient case is considered as a whole – and we see the implications this has for budgets, staffing, volume of services and so on – it becomes clear that responsibility for our nation’s health has to be shared, so that the NHS is not required to shoulder the whole burden alone.

Creating the type of environment that empowers and supports people to make informed, balanced choices will help them lead healthier lives, and will go a long way towards maintaining the health of the NHS itself.

This article is part of a thought-provoking series on living health, brought to you by New Statesman in association with Philips, that looks at how technology, innovation and big data are helping to improve your health and our health-care system.

Gunmen have entered the Radisson Blu hotel in Bamako, Mali's capital, and are holding 170 hostages inside the hotel. 

According to a statement from the hotel's manager, the attackers have barred the hotel's doors and are keeping 140 guests and 30 employees inside the hotel, which is near the city's centre and is popular among tourists and expats.

A security source told Reuters that the gunmen shouted "Allahu Akbar" ("God is Great" in Arabic) on entering the hotel, and have released some hostages, including those able to recite verses from the Koran. 

Thirteen people were killed in another attack in Sevare, another Malian town, in August.

We will update this story as more information is released.

For most of his lifetime T S Eliot appeared an austere and reticent figure. During the long breakdown of his first marriage, to Vivienne Haigh-Wood, he took a vow of celibacy in 1928, controlled his relations with other women, and in 1953 planned to retire to an abbey. So some may be surprised by the sexual content of two sets of poems published in full for the first time in a complete edition of his Poems.

The editors politely call the earlier set “Improper Rhymes”; in truth, it’s a smutty romp. The later set contains poems of marital love, written for his second wife, Valerie Fletcher. Neither set remotely approaches the greatness of the 1963 Collected Poems, Eliot’s last volume before he died in 1965, and we may wonder how to place erotic exploits in our sense of his life and character.

As a student at Harvard, he began circulating his Columbo and Bolo jingles between about 1908 and 1914. For men only, and degrading women, Jews and blacks, they offer
the spectacle of a penis so mighty it can rip a “whore” “from cunt to navel”. This revel in violence is varied by the antics of the sex-mad King Bolo and his Big Black Kween, whose bum is as big as a soup tureen.

After Eliot settled in London in 1915 he was prepared to publish the verses, but Wyndham Lewis, to whom they were offered for his avant-garde magazine Blast, declined to print words “ending in -Uck, -Unt and -Ugger”.

At first, when I came upon the Bolovian Court and Columbo and his crew, I assumed that they were a juvenile aberration. The third volume of Letters (covering the period of Eliot’s conversion to the Anglican faith in June 1927) presents a challenge to this. For the obscene verse that Eliot continued to write and disseminate as late as the age of 44 is not, in his own post-conversion view, an aberration. In an exchange with his fellow publisher Geoffrey Faber in August 1927 he commends obscenity, in the manner of Swift, as an eye for evil.

Here is an elevated justification, and I have tried to accept it. All the same, hesitation has lingered. For one thing, an eye for evil is dangerously godlike, a danger acknowledged by Eliot’s Puritan forebear Andrew Eliott, who condemned innocents to death at the Salem witch trials. In 1692 Eliott confessed that he and his co-jurors had been unable to withstand the delusions of the powers of darkness. Can Tom Eliot be something of a throwback to the punitive temper of those old New England Puritans, and foreign, after all, to the mild-mannered Anglicans whose faith he adopted? Conceivably he was testing and judging the morality of the recipients of his smut, among them his Harvard buddy Conrad Aiken, Ezra Pound and a Criterion board member called Bonamy Dobrée.

Hesitation lingers also because the pervasive history of violence against women makes it impossible to be amused by the incitement to sexual violence that accompanies Eliot’s obscenity. This is not imaginative. It’s as banal as Eliot’s stabs at anti-Semitism – as banal as evil.

Eliot concealed his extremes with a normative mask: the City uniform of his bowler hat, rolled umbrella and what his first editor, Virginia Woolf, called his “four-piece suit”. Eliot himself caricatures propriety in the figure of J Alfred Prufrock at a Boston tea party, too prudish, too buttoned-up for love, recoiling from a woman whose arm, moving to wrap a shawl, is “downed with light brown hair”.

This shudder precedes Eliot’s doomed first marriage and intensifies over the years as a counter to what he termed “the wind beyond the world” – an evanescent vision that came but rarely. There is disgust with the flesh in “Sweeney Erect”, where sex is associated with the jolts of an epileptic attack. In the drafts of The Waste Land, the clerk and the typist couple “like crawling bugs”.

Three of the marital poems belong neither with the degraded flesh nor with the poet’s purified feeling for a “Lady of silences”, a Beatrice figure whom Eliot’s imagination wrought out of his long tie to a Bostonian speech teacher, Emily Hale. The marital poems are of a piece with the final poem in the 1963 Collected Poems, a dedication to Eliot’s second wife which speaks of sleeping lovers whose bodies smell of each other. In the same way, “Sleeping Together”, “How the Tall Girl and I Play Together” and “How the Tall Girl’s Breasts Are” affirm physical love based on trust and commitment. Fair copies survive in “Valerie’s Own Book”.

When Eliot married Valerie Fletcher he was nearly 70 and she aged 30, his trusted secretary at Faber. We are invited to witness how they “play together” when they have nothing on. Because she’s so tall, her nipples touch his and their tongues meet head-on.

The stimulus is as much in the looking as in touch: we are invited to see the tall girl’s breasts from below, from above and from the side where the cleavage invites the lover’s hand. Eliot’s poems have an awakened freshness, as though for the first time he observes a woman’s body as a thing of beauty. But as poetry this can’t compare with the eloquence of Donne’s lover whose roving hands, licensed to “go/Before, behind, between, above, below”, are likened to voyages of discovery: “O my America! my new-found-land”.

Eliot’s simplicity is charming when he repeats, “I love a tall girl”; also the tenderness when he strokes her back and long white legs as she “sits astraddle” on his lap. Explicitness, though, is less erotic than suggestion. It is no match for the overwhelming theatricality of Yeats’s lover, with his “mask of burning gold/With emerald eyes”.

Eliot’s words of love were designed to please his wife and to sustain her through her life without him, but for readers they are meant, I think, as a sign of sorts.

Crossing “a whole Thibet of broken stones/That lie, fang up, a lifetime’s march”, Eliot had looked to paradise as too unlikely: too undeserved. He could give credence to the perfect life, “burning in every moment”, but had remained imperfect himself, unfit for divine love – and out of this disjunction had come the great poems we know. But then, in 1956, when he conceived his last play, The Elder Statesman, he began to imagine the possibility of forgiveness. It comes to a hollow-hearted old man through the love of his daughter.

At that turning point in 1956, when Eliot’s health was failing and he asked himself how to prepare for death, he found “a peach of a girl” ready in the wings, awaiting his cue. As always, there were moral issues: the shift to human love led him to cast off two others, Emily Hale and Mary Trevelyan, who had devoted themselves to him in different ways over decades. Fury with Emily in 1956 may, in fact, have prompted his embrace of Valerie, because in that year Emily gave Princeton the thousand letters that he had written to her from the time of his break-up with Vivienne. For once, Eliot had lost control of what he would leave to posterity. My guess is that this burst of fury and need for a long-term guardian with Valerie’s absolute loyalty played some part in Eliot turning to her.

His love poems tell us nothing about Valerie as a person, except that she adores him and delights in seeing him aroused by her beauty as she stands naked in high heels. It’s easy to take in the enormity, from her point of view, of being chosen by an immortal and feeling it in her power to stir him. Even after her death in 2012, the scenes remain to tell us something, and there is a confirmatory clue in an obscure publication, the last work Eliot wrote.

The love poems are a sign of the grace that came to Eliot unexpectedly through human love in the final eight years of his life. He lays out the pattern for this finale in a British Council pamphlet on George Herbert (1962). It is a spiritual biography in which Eliot seems to speak in unison with the 17th-century poet, moody, snobbish, meticulous of dress, who turned aside from the world. Like Eliot, after suffering divine absence, Herbert had a happy marriage in his last years. Eliot closes by quoting in full the poem beginning “Love bade me welcome: yet my soul drew back,/Guiltie of dust and sinne.” Every part suggests a parallel with Eliot’s life, especially the grace of the last two lines: “You must sit down, sayes Love, and taste my meat:/So I did sit and eat.”

Eliot once remarked that however intimate a love poem may be, it is meant to be overheard. He compares this with what is said to the beloved in private, which must be “in prose”. It is said that Eliot wrote to his wife even when they were together. If so, we might look forward to further biographical revelations in the final volume of Eliot’s Letters.

Lyndall Gordon’s biography of Eliot is published in its most up-to-date edition, “The Imperfect Life of T S Eliot”, by Virago

A new blanket court fee was slipped into legislation by the last government in April, just before the election. It is called the criminal courts charge, and is applied without discretion or means-testing to all those convicted of a crime. It’s £150 if you plead guilty, and can reach £1,200 if you don’t.

The Justice Select Committee has scrutinised this new charge and expressed “grave misgivings” about its benefits, in a report out this week. Notoriously, the charge resulted in a starving woman who shoplifted a 75p packet of Mars Bars being fined £328.75 in August.

The Committee’s MPs are calling on Ministry of Justice ministers to scrap the charge, which it concludes is often a “grossly disproportionate” financial penalty in light of the crime committed and the defendant’s means:

“In particular we express concern about: the levels of the charge being grossly disproportionate to the means of many offenders and the gravity of the offences in relation to which it has been imposed; the lack of discretion enjoyed by sentencers on whether to impose the charge and if so at what level; the capacity of the charge to raise the revenue projected by the Government and the effect of levels of non-payment on respect for the legal process; the creation of perverse incentives affecting defendant and sentencer behaviour; and the detrimental impact on victims and the Crown Prosecution Service from sentencers reducing awards of compensation and prosecution costs . . .

“Our principal recommendation, in light of the evidence we have received and the grave misgivings about the operation of the charge which that evidence has prompted, is that legislation to repeal the charge should be brought forward by the Government.”

I investigated the effects of the charge on poor and vulnerable people earlier this year. A magistrate frustrated and feeling “absolutely rotten” about imposing the charge on those who couldn’t afford it spoke to me anonymously about his experience:

“It's not means-tested, so we can't take into account the circumstances of an individual defendant. Probably 90 per cent of the times that I sit in court, at least one – possible more – will be people who find themselves homeless, or living in shelters, with absolutely no income whatsoever. There are a lot of people not even claiming benefits, not working, living on the streets – that’s where the discretion should come in . . .

“Someone who’s stealing to survive, who’s not going out and stealing things to sell, someone who’s genuinely stealing because they’re hungry, and they’ve not got any food in the cupboards – that’s a completely different situation . . . . It [the charge] doesn't recognise each individual’s case, and that each individual case should be judged by its own merit, and it completely removes from the hands of members of the judiciary the ability to ensure that justice is fair.

“All it boils down to is that the government wants to use the courts as a way of swelling their coffers.”

Read the full piece here.

It takes a lot to unite doctors. Put ten of us in a room together, and we’ll all have a difference of opinion. We all think we’re right. Yet somehow, the Secretary of State for Health, Jeremy Hunt, has managed to bring doctors together in an unprecedented fashion.

Junior doctors have voted to go on strike.

In a ballot of junior doctors by the British Medical Association (BMA), almost all respondents voted to go on strike. This is a decision that may polarise opinion, but is a decision that was not taken lightly. As a doctor, we have a duty of care to our patients. As a trade union member, we have the right to take industrial action.

The battle of spin and counter-spin, fought between Jeremy Hunt and the BMA, has been waged on the pages of newspapers, magazines and above all on social media. There have been protest marches in London and cities across England. Protesting against the imposition of a contract that would see many junior doctors working longer hours, for less money. The BMA have argued that more unsociable hours means tired doctors, and tired doctors make mistakes.

This is a problem for doctors in the NHS in England alone. Scotland and Wales won’t see the imposition of a new contract, and Northern Ireland is yet to make up its mind.

Over the summer, doctors have been described as money grabbing, lacking vocation, and more recently militant. Jeremy Hunt has been spinning out the same half truths about the “weekend effect”, that you’re more likely to die in hospital over a weekend. This is true, but the difference is small, and there is no evidence that this is down to staffing levels. Sicker people come into hospital at weekends, and most of the work carried out is for emergencies. Routine operations and out patients clinics don’t tend to run at weekends, so those admitted are more likely to be seriously ill.

Rather than deal directly with the BMA, Hunt has decided to negotiate via the pages of the press. His offers to the profession have be as changeable as our weather. They are as easy to keep tabs of as the stairs at Hogwarts. Constantly changing and confusing for all. First came refusal to negotiate openly without preconditions, then the promise of a mixture of pay rise and pay cut, then direct negotiations without preconditions. The BMA have offered to negotiate via the conciliation service ACAS, and with trust of Hunt at an all time low, is there any wonder no one wants to be in the same room as him.

The plight of my junior colleagues has garnered support from a host of different angles. Prominent medical negligence lawyer Peter Serafinovic has spoken out strongly against Hunt’s contract threat. Celebrities such as J K Rowling, Rufus Hound and the cast of Eastenders have leant their support. I’d even heard rumours that the cast of Holby City would take a break from filming out of solidarity. Previously anonymous junior doctors have been thrust into the spotlight, taking to stage, television and radio to speak out against the imposition of an unjust, unfair and unsafe contract.

This isn’t the first time junior doctors have been on strike. Forty years ago, junior doctors took to the picket lines to protest, again about the imposition of a contract. This would have seen a cut in pay for the more unsociable part of the job.

It takes a lot to make a doctor angry. By definition we must be calm under pressure, and possess a compassionate desire to ease suffering. I suspect many of my colleagues are the same. The purulent environment of the NHS, underfunded and overstretched, makes this ever more challenging. Like many of the severely unwell patients we see, the NHS is in danger of dying.

At present, industrial action is set to take place of three days in December. 1 December  will see 24 hours of emergency cover only, with a full walk-out planned on 8 and 16 December. What effect might this have remains to be seen, but consultants across England have pledged support for industrial action, and have informed their juniors that they will cover the work. It is likely that routine, elective surgery and out-patients clinics will be cancelled. Emergency care will carry on as usual.

Jeremy Hunt still has time to sit down with the BMA and negotiate. Winter is a bad time for the NHS, and an even worse time for industrial action. Through wilful malevolence or political incompetence, Jeremy Hunt has driven doctors to strike. The first time in forty years. With an unprecedented turnout and a solid mandate.

Mr Hunt, it’s time to drop the bully boy posturing and get talking, for all our sakes.

Ladies, we've all been there. You fancy listening to something, and then, as you approach your laptop or phone, you become strangely paralysed. You can't think of a single artist or song you’d like to listen to. In fact, do you even know any artists? Can you name a single song? 

This was the strange phenomenon described by head of Apple Music, Jimmy Iovine, in an interview on a US breakfast show today. Apple Music’s streaming service offers pre-potted playlists and music suggestions chosen by experts, and Iovine took the opportunity to share his own experiences of women’s listening habits: 

I’ve always known that women find it very difficult at times—some women—to find music… And this helps makes it easier with playlists curated by real people.

Breaking news: this is, of course, rubbish. We all struggle to think of the right song sometimes, but research suggests women actually find decision-making easier than men. And that’s assuming it makes sense to analyse this by gender in the first plae - our ability to select music probably has a lot more to do with age, level of musical interest, and who we’re trying to impress with our choices.

Iovine went on to explain that women often have far more pressing concerns to attend to:

I just thought of a problem, you know, girls sitting around talking about boys, right, or complaining about boys when they’re heartbroken or whatever.

They need music for that, right? So it’s hard to find the right music. Not everyone has the right list or knows a DJ or something.

Iovine made the comments on the CBS This Morning show, where he was a guest alongside artist Mary J Blige (how does she make her own music despite her music paralysis? Incredible!) to discuss a new advert for the streaming service. In the ad, Blige and two friends make dinner and dance around to Apple Music playlists, and compare the playlists to old-school mixtapes. 

On first watch, it’s charming, if a little stilted: “Go onto my Apple Music playlist!” cries Blige. “Siri, what’s your favourite song?!” But it’s a shame to know it may well have been inspired by prehistoric ideas about women’s decision-making abilities. 

In a statement sent to various news outlets, Iovine apologised for the the slip-up:

We created Apple Music to make finding the right music easier for everyone — men and women, young and old.

Our new ad focuses on women, which is why I answered the way I did, but of course the same applies equally for men. I could have chosen my words better, and I apologise.

Gamers have had different ways to get their fix over the years. Either by sitting on the sofa playing traditional consoles, hosting a souped-up gaming rig at their desks, or tapping their fingers at a small (or large) screen a few inches away from their faces through smartphones and tablets.

But the definition of a traditional console is changing, as the size of computing devices continues to shrink and desktop cases continue to become more stylish. After all, nothing's stopping you from making your own powerful gaming PC that you can hook up to your TV, all for a price similar to a PS4 or Xbox One.

Here is where Alienware's new Steam Machine comes in. It's a compact computer stuffed with traditional computing bits – except for one thing: it doesn't run the usual Windows software you'd expect.

Although you can get a Windows version of this (known as the Alienware Alpha), the Steam Machine uses SteamOS software, created by gaming giant Valve, which is based on Linux – that weird, free, lightweight operating system anybody can download but most people haven't.

Now, let's get to the main course here: the games. Portal 2, Bioshock Infinite and Civilisation V all ran perfectly fine at high settings without pushing the Steam box too far.

Missing in action: the new Steam Machine doesn't offer the latest games, such as Metal Gear Solid V

Because SteamOS is a relatively new OS, it requires developers to tweak their Windows creations so they can run on this flavour of Linux. Although many games are available for SteamOS, the best A-rated titles are currently absent. Want to check out the latest Metal Gear? Sorry, not here. The new Call of Duty? Good luck even getting that on the Mac.

I love indie games, and they are primarily what fill the 1,500+ SteamOS library at present. However, indie games are often unique in their ideas or gameplay and not as graphically intense, which makes you wonder why you'd need a computer starting from £449 to play such games. If the Steam machine is going to compete with consoles, it needs to attract the heavyweight titles that go along with one.

One thing that deserves special attention is the dedicated Steam controller. Now, you can go ahead and plug in an Xbox controller, which has long been the preferred controller for PC gamers, but for the purpose of this review, I decided to jump into the unknown and see what it was like using the most interesting controller released since the original Wii remote:

Brave new world? The new Steam controller

I can understand the silent rage hardcore gamers may experience when facing the prospect of their memory muscle being challenged. It does look unusual after all. But I think Valve has done an impressive job of the daunting task of transferring the full functionality of the mouse and keyboard to our palms. The two concave circles are effectively trackpads, responsive and able to provide individual feedback.

After a relatively quick setup, I realised just how fast and hassle-free it is to get going with the Steam box, while users of the Xbox One have to install gigabytes and gigabytes of patches as soon as they're connected to the internet. Perhaps having a PC as a games console is easier than ever before, while traditional consoles have never been more complex. But despite Alienware’s excellent design and packaging, SteamOS still has a lot of work to do.

Towards the end of 1985, at the height of the worst famine in modern Ethiopian history, Margaret Thatcher contemplated helping to topple the Ethiopian government. The documents– marked Top Secret and Personal – have now been placed in the National Archive:

The British prime minister had long made no bones about how much she disliked the military regime led by Colonel Mengistu Haile Mariam. The British government was among the most generous donors to the Ethiopian famine appeal, but the regime itself – Marxist and pro-Soviet – was exactly the kind of authority Thatcher loathed.

By late 1985 the prime minister’s patience was wearing thin. Charles Powell, her private secretary, wrote to the Foreign Office asking what steps might be taken. The FCO, taking is normal, cautious approach wrote back on 27 November saying that: “Barring an assassin’s bullet, Mengistu looks secure, and the opposition movements inside and outside Ethiopia remain deeply divided. The choice is between seeking to influence the present regime, and a policy of containment.”

This did not satisfy Thatcher at all.

“The Prime Minister continues to believe that it is not enough just to jog along in our relations with the distasteful regime in Ethiopia,” came the reply from her private office, just two days later. “If the conclusion is that our present relations offer no serious scope for exercising beneficial and positive influence, she would like serious thought given to ways in which we could make life harder for the Ethiopian regime. These might, as examples, include:”

The letter then lists four options – the first two of which were explosive.

“i) support for the rebels in Eritrea and Tigray;

ii) a more active effort in conjunction with the Americans to identify and perhaps encourage opponents of Mengistu within Ethiopia”

The other two options were more conventional: asking other western powers to criticise the Ethiopian government and taking a “more robust line” when examples emerge of the abuse of aid.

The Foreign Office – and Geoffrey Howe as foreign secretary – must have found these suggestions very hard to digest. Certainly it took some more than a month for a suitable response to be drafted. “The Foreign Secretary agrees that jogging along with the Ethiopian regime would not be right,” came the reply on 10 January 1986.

But, noting that some progress was being made, the Foreign Office urged caution. Backing the rebels would – Sir Geoffrey believed – not work, driving Mengistu further into the arms of the Soviets and (a killer argument with Mrs T) it was also noted that the Eritrean and Tigrayan rebel leaders were “…as extreme in their broadly Marxist political attitudes as the Derg [the Ethiopian government].”

The letter concludes: “We do not believe that support for the rebels would work to our advantage.”

What is interesting to note is that the British government was – if this correspondence is to be believed – unaware that aid that international charities were providing through the Sudan based rebel movements was already being diverted to purchase weapons. A programme I produced for the BBC in 2010  detailed this evidence.

Bob Geldof objected – saying that none of Band Aid’s money had gone astray (a suggestion the programme never made). The BBC Trust apologised to Geldof for the apparent mistake.

I was subsequently contacted by the head of a major British aid agency who substantiated the claims that aid had gone astray, without commenting on which agency’s resources had been used to buy arms and ammunition.