Avastin or not.

Sometimes personal experience makes logic difficult to accept. This is how I feel about last week's decision by NICE (National Institute of Clinical Excellence) to recommend that the NHS should not make the drug, Avastin available to bowel cancer sufferers. If I'd not been away on holiday in the US, I would have done some media interview work on this decision, accepting that it would not have been easy to challenge the NICE judgement. But I would have tried. Dr. Spock wasn't always right.

I've always thought of NICE as standing for 'national institute of control of expenditure'. And actually, there's nothing wrong with that. When Professor Mike Rawlins, Chair of NICE says "The question is not whether care is rationed, but how" he is being no more than honest and logical - unless you happen to be a bowel cancer sufferer or know someone whose life has been extended by years as a consequence of using Avastin.

Anyway, the purpose of this post is to highlight Alastair Palmer's article in yesterday's Sunday Telegraph which is more about the 'supposed' freedom of people to buy Avastin with money from their own wallets (£21,000 for a year's course of treatment) to 'top up' the care that the NHS will pay for. Until last year the rule was that patients who 'topped up' NHS care from their own pockets sacrificed the right to any NHS care at all. There was a ban on what were referred to as co-payments. Following some high profile cases the then Labour Government supposedly changed the position to allow co-payments. Palmer's article suggests that this change might not have taken place in practice - because of a rule that the private treatment must be carried out separately from the NHS treatment. This is not always practically possible. It depends whether the particular hospital has 'separate facilities'. In my opinion, any ban on co-payments, or any device to make co-payments more difficult is egalitarian stupidity. If an NHS patient decides to enhance treatment by paying for Avastin, it makes not a jot of difference to anyone else, or to the NHS's finances. Its just cruel and spiteful. I shall be writing to the hospitals that serve Montgomeryshire tomorrow to ask what the position is on this issue.

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The 1000 cow dairy unit

Montgomeryshire is a farming county. Its a whole lot more as well, but agriculture has always been at the heart of the local economy. And its quite true that as farming has changed over time, conflicts have arisen about how the industry should develop. Just such a conflict hit the headlines while I've been away on a family holiday - though the young farmer concerned had already discussed his plans with me before I left. A new proposal for a 1000 cow dairy unit near Welshpool has been submitted by local farmer, Fraser Jones.

There are two reasons why I start, instinctively from a position of supporting this dramatic proposal - subject to assurance that it satisfies proper environmental concerns. Firstly, my own background in 'farming' leads me to be aware that Montgomeryshire farmers must keep up with commercial developments to remain competitive. And secondly, I always start from a position of supporting planning proposals, unless I can see a good planning reason to refuse them - a basic principle that, in my opinion should always be applied to planning applications.

Now, I accept that there may be solid planning reasons to refuse Fraser Jones' 1,000 cow dairy unit on Lower Leighton Farm, (about one mile from the edge of Welshpool) - but not some of those I've heard being put forward so far. There is no logical reason to believe that a 1000 cow herd should have lower welfare standards than any other sized unit. And there is no reason to oppose dairy cows being indoors for about 250 days per year. Many farmers keep cows indoors for 250 days now, and some even zero graze. Almost all pigs and poultry are kept indoors. What always matters is that the animals are looked properly cared for, whether indoors or out.

Its interesting that a proposal taking dairying into a new dimension should have been proposed at Leighton, which has a glorious history in the field of agricultural pioneering. There are a host of conservation orders all over the Leighton Farm Estate that stand as monuments to the initiative and entrepreneurship of the Fraser Jones of previous centuries.

And while I'm about it, lets consider poultry houses. Several local farmers are deeply frustrated at present because local planners seem to have developed an antipathy to expansion of poultry units. Again, there may be strong reasons to refuse individual applications, but an attitude of being anti-expansion will simply drive the industry elsewhere. I've lost count of the times farmers have contacted me about this. At least one Montgomeryshire based agent will no longer deal with applications in Powys, because the whole process is so much easier in Shropshire. I really find it difficult to get my head around how a planning department can approve wind farms all over our beautiful mountains, and refuse jobs-providing farming enterprises in locations that can be landscaped.

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Health and Social Care in Powys

There are big changes afoot in how health care is delivered in Powys. Don't suppose they will receive the media coverage that they warrant, because the issue doesn't lend itself to an easy headline. But its so important to the people I represent that I want to post about it.

On my last working day before flying out of Manchester last week, I spent an hour speaking to both the Chief Executive of Powys County Council, and the Chief Executive of the Powys Local Health Board about the structure by which health and social services are to be delivered in Powys. Must admit that I've never thought a Powys Local Health Board to be viable - and that's how its beginning to appear. Mental health has already been transferred to other health boards, and the proposed renal dialysis unit in Welshpool is now being managed by the North Wales LHB.

Last September, both Powys County Council and the Powys tLHB decided to explore a merger of the two organisations by 2012. I was supportive of the principle, but sceptical of whether an acceptable agreement could be reached. Well it seems that the scepticism was justified. The sheer scale of the LHB's annual deficit, the costs of merger, restrictions arising from a policy of 'No compulsory redundancies' in the Wales NHS, and what are referred to as 'governance' issues have scuppered the idea of merger. But something must be done, and its being done tomorrow.

The proposal going to Councillors this week is that the Chief Executive of the Powys tLHB is going to also take the role of the Council's Director of Social Care and Well Being (answerable to the Powys Chief Executive). The idea is that such a merger at the highest level will lead to closer working arrangements at all levels of service delivery. If its approved and implemented this week, it will be reviewed in 9 months time. The aim is that the benefits of 'merger' can be achieved without the disbenefits. I accept that something must be done, and support what is being proposed. For the sake of the people of Powys, I hope it works.

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The Wrong Question

Starting to take note of what's in the UK media again, in readiness for re-entry into things political. We're back in the House of Commons two weeks tomorrow. And the story that's caught my eye today has been the re-emergence of the suicide of Dr David Kelly, the scientist who was thought to have leaked sensitive information to the BBC during the build-up to the Iraq War. But the reports are about the wrong aspect of the issue. I suspect that Tony Blair will be quite pleased with today's coverage, which seems to be about whether Dr Kelly committed suicide or was murdered.

Well yes, if there is some doubt about how this quiet family man died, there ought to be an inquiry, but its not the biggest question relating to his death. There's never been any reason to think that Dr Kelly did not commit suicide - but there's been plenty of speculation about the direct role that the then Prime Minister of Britain, Tony Blair played in the release of his name to the press pack and to the Committee of MPs who tore this rather shy man to shreds. This is far and away the most likely cause of death. Over the last few days, I've read Andrew Rawnsley's book, The End of the Party, which has catapulted this question back into my mind. I do not think we should ever forget the 'dodgy dossier' or the vile way Dr Kelly's name was made public. We should not forget when our Government behaves disgracefully. It helps to stop such things happening again.

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Deadly eyes above the water

Was interested to read on BBC Online today that a crocodile has been spotted off Bologne-sur-Mer in the English Channel. It seems that the spot was also made by coastguards at Dover. I can imagine the excitement - and the disappointment when it turned out to be a piece of wood.

Well the one I saw today on the 9th at Kissimmee Oaks was no piece of wood. Karen had hit her tee shot near to the water, and the four of us were gathering around to watch her recovery shot when we noticed a pair of cold silent eyes watching every move from a few yards away. And the eyes moved in for a closer look. First time I've ever seen an alligator in its natural environment. Apparently they are common around the golf courses of Florida - but it was my first time.

Those cold unblinking eyes exuding such silent threat. Reminded me of the Chief Whip (only joking). The alligator moved not a muscle, but we got out of there fast. And I didn't look for lost balls anywhere near water after that.

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Heaven and Hell

Berkley Lake is an extremely nice place. Sunshine, swimming pool and all we could possibly wish for. Even the wireless provider I'm connected to is named Holiday Dream. But just 400 yards away is an experience as near to Hell as its possible to achieve on earth. Its preparation for what awaits those who, in their lives, have done too many of the things that they should not have done - and who in due course will be barred from passage through the Pearly Gates. Worse than that time at Twickenham, sitting amongst tribal Englishmen, when Wales were stuffed out of sight to the sound of triumphant loudspeaker music. Even worse than being forced to listen to an unabridged omnibus of all of Gordon Brown's budget speeches. Yes, just 400 yards away is the Kissimmee Walmart hypermarket.

Made the mistake of accompanying Mrs D there yesterday on a shopping expedition. After a while I began to feel lost. A bit what it must be like to find oneself alone in a desert. I needed a rest, and said I'd meet her in the coffee area. The Kissimmee Walmart is so huge that there is not a word in the English language that does it justice. Almost as big as one of National Grid's 400kv substations (which for those that don't know is about 13 football pitches). OK, so I'm not great at supermarkets, finding the Welshpool Morrison's a testing experience. But Walmart is something else. Its like being lost in Tokyo (which I've been). Whatever, I eventually found my way to the coffee area, where everyone there was grossly fat. Too many cookies I thought. I ate three myself. Only ordered one, but I was given three, which I suppose is how everyone became so fat.

This relationship between Heaven and Hell reminds me of an old fable. A soul arrives at the Pearly Gates and is asked to which he seeks entry. He asks what's the difference, and is offered a day trip to each place before making his decision. In Hell he finds an unlimited supply of beautiful women, glorious sunshine, beutiful music, the best wines and more indulgences than are available at Walmart. In Heaven he finds a gentle quietness, no alcohol, harp music (which he'd never liked) and no excess. So he chooses Hell. But on his return he finds hideous women, garbage to eat, non stop Cliff Richard background music and only filthy water to drink. It seems that on his exploratory visit, he was treated as a tourist, but on moving in he was treated as an immigrant. Never trust first impressions.

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Russell George

Our Assembly candidate's website and blog is now up and running. Take a look here.

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Images of Macroom

Last week, we spent two days in Macroom, where Baby Darragh's christening took place. This fine example of Irish livestock art welcomes you to the town, which you will pass through if you are travelling from Cork to Killarny. Its life size, and very impressive. Its purpose is to recognise the regard the people of Macroom have for rural life and the importance of the livestock industry. It was this piece of artwork which inspired the similar statue (not an exact copy) which is to be seen at Builth Wells. We have a 'limited edition' replica of him at home. I think there were 300 made.
Surprisingly there is no by-pass of Macroom, which result in the most dreadful traffic problems (even worse than Newtown). The people of Macroom came up with this novel way of making their feelings known. Perhaps this is an idea we should copy. Bearing in mind the massive investment that there has been in the roads of Ireland, the people of Macroom must have done something awful to have been ignored. Its possible today to travel from Dublin to Cork in not much over two hours, around half the time it would have taken twenty years ago.

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Darragh's big day

Just returned from Ireland, where the youngest member of the Davies family has just been christened. Baby Darragh is also the first of us who has joined the Catholic Church. He is a beautifully behaved little boy, who is blessed with a ready smile for everyone. The second photograph is of Baby Darragh actually being done, watched over by proud parents, Tim and Adrienne. He behaved like a little angel throughout the proceedings.

Now speaking of little angels, no-one would accuse his cousin, Ffion of being one of those. There never was such a lovable bundle of mischief. She just never stops - either talking or racing around. For most of my life I didn't know what tiredness was - and Ffi has inherited that gene. Mrs D and I are truly blessed with two of the most gorgeous little grandchildren. Sorry to be so 'female side' but I've had a couple of glasses of wine tonight. Always makes me that way.

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Montgomeryshire's Political Future

This blog reported on the selection of County Councillor Russell George as Montgomeryshire's Conservative Candidate to fight the National Assembly election next May 5th here. Today Russell's first campaign election meeting was held in the Welshpool Conservative Association office. I happened to call in, and everyone was so engrossed in the task in hand that my presence was not noticed - exactly as it should be. This young man means business. What's really great for me is that he is 'organised' - which I'm not. We could prove to be a winning team. Only thing that bugs me is that he's half an inch taller than I am - which is obvious from this photograph taken on the evening of his selection. Russ is even less politically tribal than I am. He just wants to be a good representative for Montgomeryshire. Why not come and join our team.

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Allison John - Doctor Amazing.

Lots of coverage in today's media about what the amazing Cardiff woman, Allison John has achieved. Have met Allison at least a couple of times at Kidney Wales Foundation meetings - when she has always been unfailingly cheerful. During her 32 years, Allison's life has been blighted by ill health, and she has become the first British person to have all her major organs transplanted - heart, liver, kidney and lungs.

The reason today's media has gone big over Allison is that she has graduated from medical college and begins work shortly at the Neville Hall Hospital in Abergavenny. Its great to read her being quoted so positively - "At the moment I feel that I'm in the best shape physically that I've ever been and I'm so excited about the future". Inspirational.

People like Allison are a great example for us all - dealt a poor hand in terms of health, but still really making something of her life. I know others who fall into the same inspiring catagory, including my good friend, Trudy who lives in Montgomeryshire, and chairs the local Powys branch of Kidney Foundation Wales. I hope that Dr. Allison John enjoys a long and successful career.

UPDATE - My friend, Trudy tells us (on my facebook site) that the first person to have all major organs replaced was Mark from the Midlands a few years ago.

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'Gerrymandering' - or protecting an unfair bias?

Must admit that I'm not keen on the proposals to equalise the size of Parliamentary constituencies at the same time as reducing the total number of MPs from 650 to 600. I'm just not sure its worth the rumpus. But I really cannot see how it can be called 'gerrymandering' as some pseudo-apoplectic Labour MPs are claiming. The protests seem to be loudest in Wales. Lets consider what's actually being proposed here.

First thing worthy of note is that what's proposed is exactly what David Cameron made clear he would do before he became Prime Minister. In fact the proposal is not quite so radical. The cull of MPs is 50 rather than the 65 previously proposed. Secondly, I cannot see how anyone can dispute the fairness of expecting all MPs to represent a roughly similar number of constituents. Its possible to argue that greater note should be made of historic boundaries, or that sparsity should be a factor - but not 'gerrymandering'.

Lets consider how these proposals apply to Wales, which currently sends 40 MPs to Westminster. It seems that this number will fall to 30 (or thereabouts) - a bigger reduction than will happen anywhere else in the UK. All this tells us is that Welsh MPs must be currently representing fewer constituents than other parts of the UK. What's being proposed is an end to this imbalance. If the Bill is approved, the arithmetical calculations can produce no other result. "Its logic Captain". And contrary to some of the devious comments I've heard used, its nothing whatsoever to do with devolution. The 600 figure does not take any account at all of the fact that MPs in England will have wider responsibilities. Several areas of policy have been devolved to the National Assembly. The worst aspect of this is that those who squeal 'gerrymandering' must know that there is no justification for their desperate cries as they pursue retention of their unjustified self-interest.

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Tuffin' s lessons for the society.

Who would have thought that a morning visit to Tuffin's Annual Fun Day at Churchstoke in Montgomeryshire would promote understanding of the mightily complex subject, international relations. But that is what happened to me this morning. When I first arrived, I saw only total chaos. Thousands of people, wandering around aimlessly. When I left, I grasped what Hedley Bull was going on about when he wrote 'The Anarchical Society', and even what Edmund Burke was talking about when he was wittering on about 'little platoons' (but that's a different story). After Sallie, one of the family firm that run the whole Tuffin's enterprise, had taken me on tour, explaining what was actually happening, I grasped that what I'd seen as chaos was an organised anarchy - a wonderful example of the realist's view of how the world functions.

I don't remember much about Bull's theories. Too long ago. But I can recall that it was something to do with world society being apparently anarchical, but actually being divided into states which interrelated with each other, each conscious of the limits imposed by an international society. Despite all the individual states seemingly pursuing their own individual interests, the whole works successfully as a society - even without the help of international law as an enforcing mechanism. This morning the more I looked, the more everything was working in perfect harmony - and the more I understood Hedley Bull's theory.

Another lesson of this morning was the value of data - or not. As leaving I asked, quite casually, how many people attended the fun day. Its a massive event, and many thousands must attend. Incredibly (for me anyway) no-one knew - because no-one counted them. Brilliant. When you think about it, knowing how many people attend is a useless statistic. If there's a need to react because there are too many or too few people, changes will be made for next year - but knowing the actual attendance is useless data. The clarity and logic of this approach is stunning in its simplicity. Government can learn so much from Tuffin's. The principle is that if there is no clear use for the data, don't collect it. The nation could save billions that way.

Tuffin's Fun Day is an annual event, so you'll have to wait until next year until you can benefit from one of the best lessons in international relations available anywhere in the world. Its a fabulous day out as well.

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Montgomeryshire's National Assembly for Wales Candidate.

Been an important week for the Montgomeryshire Conservatives. On Thursday night we selected our candidate to contest the Assembly election on May 5th 2011. Almost 300 of us turned up at Welshpool Town Hall to elect Powys County Councillor, Russell George to carry our banner. Here's Jonathon Isaby's report.

Since the National Assembly was established in 1999, Montgomeryshire has always been held by the Liberal Democrats, in the person of Mick Bates. Mick is standing down in 2011, midst a bit of turmoil, and the new Lib Dem candidate will be a Llanfair Caereinion lamb buyer named Wyn Williams. Must admit that I really fancy Russell's chances of winning. It's going to be a full blooded battle, and I hope to play my part as one of the seconds in the 'blue corner' - in the nicest possible way of course, since the Lib Dems are now my honourable allies at Westminster.

Montgomeryshire's selection of a well-known, young, dynamic, local businessman from Newtown has injected some real interest into the whole Mid and West Wales position. Because of the way the Assembly election voting system works, its likely that three Conservative candidates will be elected to represent Mid and West Wales - either directly elected to represent one of the eight constituencies or indirectly elected to represent the whole region. If no Conservatives win constituency seats, (as happened in 1999 and 2003) either two or three 'list' members are likely to be elected. If only one Conservative wins, two list members are likely to be elected. If two Conservatives win (as happened in 2007 - Paul Davies and Angela Burns) just one list member is likely to be elected (which is how I came to lose my position as an AM). And of course, if three Conservatives win seats, its likely that no list members at all will be elected. At the last Assembly election, Conservative group leader, Nick Bourne was elected as a 'list' member. I daresay you can work out the permutations and consequences for yourself. Whatever, Russ has been selected, and I seriously fancy his chances - but its an election, and anything can happen.

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