Dr Liam Research Articles

Devolution and Post-Brexit Trade Agreements: Towards a Joint Trade Policy Committee?

In October 2017 when presenting the Policy Paper, Preparing for our Future UK Trade Policy, the Secretary of State for International Trade, Dr Liam Fox, recognised that for the first time since the 1970s, the United Kingdom (UK) would have its own independent trade policy.1 Since the last time the UK had an independent trade policy, there have been notable constitutional changes within the UK, notably the creation of devolved administrations in Scotland, Wales and Northern Ireland. All parts of the UK will be differently affected by the decision to leave the European Union (EU) (i.e. Brexit) after 29 March 2019, particularly by the creation of an independent trade policy. As a member of the EU customs union and of the single market, the UK does not at present have an independent trade policy. Instead, trade policy is “largely determined by the EU”2, a position that will change upon the UK’s departure from the EU. While trade is a reserved matter, areas of devolved competence such as agriculture will need to be taken account of in any future UK trade policy. The devolved administrations will require to be involved in what Dr Fox identified as “a once in a lifetime opportunity to build a stronger, fairer and more prosperous United Kingdom that is more open and outward-looking than ever before.”3 Indeed, the Policy Paper mentioned above further recognised that, “(t)he devolved administrations will have a direct interest in our future trade agreements,”4 with this recognition accompanied by a commitment, “to seek the input of the devolved administrations to ensure they influence the UK’s future trade policy, recognising the role they will have in developing and delivering it.”5 In this present paper, we critically review the UK government’s current approach to involving the devolved administrations in post-Brexit trade policy development. We demonstrate that there is a significant lack of clarity on the future role of the devolved administrations in the development of trade policy. The Scottish government is particularly concerned in this respect given that its extensive devolution settlement includes areas with significant trade dimensions such as agriculture, fisheries and environmental policy. We argue that greater clarity on such involvement is very much needed and in response, propose the creation of a Trade Policy Committee through an amendment to the Trade Bill.

Devolution and Post-Brexit Trade Agreements: Towards a Joint Trade Policy Committee

In October 2017 when presenting the Policy Paper, Preparing for our Future UK Trade Policy, the Secretary of State for International Trade, Dr Liam Fox, recognised that for the first time since the 1970s, the United Kingdom (UK) would have its own independent trade policy. Since the last time the UK had an independent trade policy, there have been notable constitutional changes within the UK, notably the creation of devolved administrations in Scotland, Wales and Northern Ireland. All parts of the UK will be differently affected by the decision to leave the European Union (EU) (i.e. Brexit) after 29 March 2019, particularly by the creation of an independent trade policy. As a member of the EU customs union and of the single market, the UK does not at present have an independent trade policy. Instead, trade policy is “largely determined by the EU”, a position that will change upon the UK’s departure from the EU. While trade is a reserved matter, areas of devolved competence such as agriculture will need to be taken account of in any future UK trade policy. The devolved administrations will require to be involved in what Dr Fox identified as “a once in a lifetime opportunity to build a stronger, fairer and more prosperous United Kingdom that is more open and outward-looking than ever before.” Indeed, the Policy Paper mentioned above further recognised that, “(t)he devolved administrations will have a direct interest in our future trade agreements,” with this recognition accompanied by a commitment, “to seek the input of the devolved administrations to ensure they influence the UK’s future trade policy, recognising the role they will have in developing and delivering it.” In this present paper, we critically review the UK government’s current approach to involving the devolved administrations in post-Brexit trade policy development. We demonstrate that there is a significant lack of clarity on the future role of the devolved administrations in the development of trade policy. The Scottish government is particularly concerned in this respect given that its extensive devolution settlement includes areas with significant trade dimensions such as agriculture, fisheries and environmental policy. We argue that greater clarity on such involvement is very much needed and in response, propose the creation of a Trade Policy Committee through an amendment to the Trade Bill.

#IrishMed; let's talk, and break down the barriers

A tweetchat is a live Twitter event, moderated and focused around a specific topic. To filter all the chatter on Twitter into a single conversation, a hashtag e.g #IrishMed, is used. A moderator or host sets the agenda and leads the discussion. #IrishMed https://irishmed.wordpress.com/ is a live twitter-driven event which takes place every Wednesday at 10 pm Irish time, 5 pm ET, lasting for one hour, on all things relating to medicine. Tweets are welcome from everyone, healthcare professionals (HCPs), patients, carers, advocates, general public; all perspectives are valuable, as #IrishMed is non-hierarchical, and a core objective is to break down the artificial barriers between HCP and patients; after all every HCP will be a patient one day. And the dialogue goes both ways; HCPs learn about patient frustrations, patients can more appreciate the difficulties and limitations of medical care. Founded over 2 years ago and curated by Dr Liam Farrell (@drlfarrell) #IrishMed has grown into a global network with regular participants from Europe, North America, Africa + Asia. Connecting with people and making friends from all across the globe has been a wonderful experience, all generous with their time and their wisdom, all trying to make the world a better place, as health issues are global. We usually have over 100 participants, and trend both in Ireland and in worldwide healthchats. The topics are wide-ranging and the opinions diverse, and the format enables and encourages engagement around a number of strategic issues, such as research, ehealth, integrated care, expert patients, management of rare diseases etc. Each discussion is facilitated by ann expert co-host. To demonstrate the complexity and the outreach of the interactions, this is a transcript and the analytics of a recent chat on Integrated care; in which there were 227 participants, 2,216 tweets, and 6,394,372 impressions; https://irishmed.wordpress.com/2016/10/02/integrated-care/ SoMe is soft power; words are cheap, and as we screen-writers say, “action reveals character.” but you never know when a message will have an effect, and someone, somewhere will be helped because of it. Twitter is the perfect platform for this kind of interactive and participative forum, easily accessible to everyone and enabling rapid exchange of ideas. At it’s best, as with #IrishMed, the concise format demands careful thought; as Samuel Johnson said, ”I'm too busy to be brief.”

JSCSC, Shrivenham: Society of Tri-Service Anaesthetists in Training annual meeting

The prestigious Joint Services Command and Staff College (JSCSC) once again hosted this year’s meeting of the Society of Tri-Service Anaesthetists in Training. This conference, welcoming both regular and reserve anaesthetists as well as those General Duties Medical Officers (GDMOs) contemplating a career in Defence anaesthesia, aims to bring together anaesthetic trainees from across all three services and provides a platform for specialty specific updates and presentation of work done by the cadre. The first day was started with the Defence Professor of Anaesthesia, Colonel Mahoney, updating the cadre on recent research emanating from the Department of Military Anaesthesia, Pain & Critical Care, in view of the changing patterns of injuries encountered in recent conflicts. With current conflicts occurring more in closed environments with greater usage of formed explosive devices, research has included examination of the microvascular effects of blast injury, long term cardiorespiratory changes following multiple amputations, and the chronic pain burden of these injuries. The Major Claim Ackroyd Memorial Lecture was given by Professor Mike Grocott, lead investigator of Caudwell Xtreme Everest, who presented findings of his expeditions to the summit of the world’s highest peak. Interestingly this may have significant implications for the future with liberal oxygen therapy possibly leading to a poorer outcome, the clinical implications of which may mean a strategy of ‘permissive hypoxaemia’ is adopted in critically-ill patients in intensive care. The Commanding Officer of 3 Medical Regiment, Lt Col De Rouffignac, gave an enlightening talk on the non-clinical challenges of deployed care outlining the logistical, equipment, maintenance, manning and the environmental health burdens of deployed operations, all of which are essential contributors to an effective mission and can be all too often forgotten unless the resource required is notable by its absence. The first day closed with a presentation from Dr Liam Brennan, Chair of the Royal College of Anaesthetists (RCOA) training committee, who gave a talk relevant to many on making the most of the final few years of training and highlighted the value that military personnel brought to the NHS in terms of leadership and management of personnel. These key non-clinical skills are now more than ever required in the light of national press reports on the poor management of some hospitals. There was also discussion on the future of fellowships and post-Certificate of Completion of Training (CCT) fellowships in particular, with the feeling that an ‘expert’ requires 100+ cases in their chosen field of subspecialisation. These fellowships are felt to provide valuable experience, and the RCOA is looking to ensure their high quality by examining the possibility of accrediting them. The first day ended with the Society’s annual dinner held in the JSCSC Officers’ Mess, an evening thoroughly enjoyed by all, which allowed the cadre to chat informally not only amongst themselves but also with their single-Service Consultant Advisors and the Defence Consultant Advisor (DCA). The second day saw trainees compete for the David Hughes Prize, presenting audits performed during the course of training. The winner of this year’s prize was Capt Kumar with his presentation entitled “Laryngoscope light failure: The importance of incident reporting”. The runner-up prize was awarded to Surg Lt Cdr Mellor for his presentation “Revisiting the Acute Surgical Patient: The view from the patient’s end”. This was followed by updates from the Regional Advisor, Surg Cdr Birt, as well as updates from each single-Service Advisor on the current situation within their Service. With a return to contingency, on the cessation of combat operations on Op HERRICK, the focus of Defence anaesthesia is likely to alter from that seen at present. There were also specific updates relating to critical care training in light of the alteration of the training scheme and the extended time required to dual-CCT in anaesthesia and critical care. The session also included an update from the DCA, Surg Capt Burgess, on the challenges facing the cadre as a whole, echoing the change in focus from current operations, returning to core business for each Service, and delivering this in light of the recent DMS 20 report. The meeting closed with the Society’s Annual General Meeting, with the reins handed over from the RAF to the Army for the running of next year’s meeting.

An Unusual Cause of Transient Ischemic Attack

1Department of Cardiology, Royal Melbourne Hospital; 2Institute for Breathing and Sleep, Heidelberg; 3Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia Correspondence: Dr Liam Hannan, Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. Telephone 778-8361863, e-mail liam.hannan@austin.org.au In April 2011, a 57-year-old woman with a long smoking history presented with transient symptoms of left-hand incoordination and dysarthria. At the time of arrival to hospital, there had been complete resolution of neurological signs and symptoms. Computed tomography and subsequent magnetic resonance imaging of the brain demonstrated no evidence of cerebral infarction and no other intracranial pathology. A routine chest radiograph revealed right middle lobe collapse. Computed tomography of the chest demonstrated a large proximal obstructing mass within the right middle lobe in addition to multiple bilateral pulmonary nodules suggestive of an advanced primary bronchogenic carcinoma with pulmonary metastases. There appeared to be tumour extension into the lateral wall of the left atrium (Figures 1A and 1B). Standard bronchoscopy demonstrated an endobronchial tumour at the origin of the right middle lobe bronchus, and endobronchial biopsy and brush cytology confirmed an adenocarcinoma that was TTF-1 and cytokeratin positive, consistent with a primary lung malignancy. A transesophageal echocardiogram demonstrated tumour infiltration of the right lower pulmonary vein with extension into the left atrium (Figure 2). There was no evidence of vegetations on the aortic or mitral valves, effectively excluding the possibility of marantic endocarditis. No other alternative sources of emboli were identified to explain the transient ischemic attack. With the exception of atrial myxoma, embolic phenomena due to intracardiac tumours are uncommon. Previous case reports of intracardiac extension of primary lung tumours have generally described extension via the pulmonary vein, as was apparent in the present case (1). The patient was referred for palliative radiotherapy for the primary lesion in addition to systemic chemotherapy. imAges in RespiRAtoRy medicine

Comment from the Field

The Autumn 2012 meeting of Northern Renaissance Seminar was held at Leeds Trinity University College on 8 September 2012, with theme of Disability and Renaissance. The theme was intended to address a perceived lack of engagement thus far with critical theory by scholars of Renaissance literature and culture.The conference organizer, Dr Susan Anderson of Leeds Trinity, welcomed delegates and introduced keynote speaker, Dr Allison Hobgood from Willamette University, Oregon. Hobgood's talk, Modern Disability Studies: Beholding Milton, started with a discussion of ethical beholding as a way of avoiding excluding people from critical discourse, and as a way of combating normative encouragement to ignore difference. Hobgood argued that disabled was an operational identity category in English Renaissance and that representations of in period are not always merely metaphorical, but can also tell us something of lived experience of people. Indeed, she asserted that material conditions of illness, injury, and childbirth would have made impairment more rather than less visible than it is now.The second part of keynote speech was a round-up of state of field in USA, detailing current research on aspects of as diverse as dwarf aesthetics in The Faerie Queene, and autism and theory of mind in connection with Book of Common Prayer. Hobgood's vision for future of studies in early modern period necessitates resisting charges of anachronism in order to enable socially responsible dialogue anti-ableist politics and advocacy in scholarship and teaching.The final part of keynote speech was a Miltonic case study, critiquing traditional scholarly discourses surrounding Milton's blindness and instead positioning Paradise Lost as part of a disability aesthetic. In this paradigm Milton's God is the ultimate normate and his angels are ableist superhumans, while Satan stands against their definitions of what it means to be fit.Following keynote speech, first panel, chaired by Dr Liz Oakley-Brown (Lancaster University) was on Sexuality. Dr Amritesh Singh, from University of York, spoke on Masculinities in Mary Sidney's The Tragedie of Antonie, looking at links between compulsory able-bodiedness and compulsory (marital) heterosexuality. The paper examined crisis that occurs when a body becomes by age or injury and how this impacts on gender. The other paper in this panel was my bisexual approach to examining liminality of gender and psyche in Spenser and Shakespeare, an argument that these texts offer ways to present positive, festive outcomes for madness. This reading was welcomed as being particularly important to a presentist approach to early modern texts, taking into account impact of exclusionary readings for present-day queer and spectators and readers.The next panel was devoted to and was chaired by keynote speaker Allison Hobgood. Dr Liam Haydon, from Manchester University, spoke on Milton and Universal Blindness, arguing that Paradise Lost is not an account of an individual's blindness but rather taps into an early modern metaphorical understanding of blindness as denoting a loss of virtue. Haydon compared quotations from Paradise Lost with King James and Geneva Bible verses from Psalms, describing being compassed about by enemies and calling for help. Haydon argued that doubly reconfigures his own and challenges his audience to see right. Then Adleen Crapo from Toronto presented her paper Staging Disabled Authorship in Early Modern Literature: The Cases of Paul Scarron and John Milton, focusing on two writers with acquired disabilities. Crapo outlined how their enemies and detractors used Milton's blindness and Scarron's physical deformities (probably caused by rheumatic fever) to call their morality into question, and how both men used rhetoric and self-publicity to counter these accusations. …

Is the Maritime Domain a Security Vulnerability To Be Exploited During London 2012 and Beyond?

The United Kingdom will welcome the world when London hosts the Olympic and Paralympic Games for 44 days in the summer of 2012. Fourteen thousand athletes from 205 countries will participate in eve...

Corrigenda for Adams and Turner (2010) J. Exp Bot 61: 4373-4386: The line of authors and related addresses to be changed as follows

Corrigenda for Adams and Turner (2010) J. Exp Bot 61: 4373-4386: The line of authors and related addresses to be changed as follows

Odds on for Lansley's gamble?

I am glad I bet on Andrew Lansley as the frontbencher best able to help David Cameron to de-nastify the Conservatives on health. His pro- NHS approach, like that of most Tory voters, contrasts with the pro- BUPA line of his radical rightwing predecessor, Dr Liam Fox.

Dr Liam Fox as the next Tory leader

Eight years ago I learned why doctors, except in emergencies, do not disclose their calling when away from their surgeries or hospitals, to avoid being pumped endlessly by everybody.

To choose the Right of ‘The Right To Choose'?

As a leader, Iain Duncan Smith didn't leave the Conservative Party much of a legacy. OK, they knew where they stood on Europe – firmly outside, thank you very much. There was a brief concern, launched on the Easterhouse council estate in Scotland, for the poor and the dispossessed. In health terms, Duncan Smith and his health spokesman Dr Liam Fox gave us the Patient's Passport: a subsidy to those who use private health surgery of 50% of the NHS cost of their operation.

Should Doctor Fox be snarling at immigrants?

In case readers think my preoccupation with Dr Liam Fox, the Tory health spokesman on health, is like my Guardian colleague Simon Hoggart's obsession with Michael Fabricant, it is not. Simon is fascinated by Michael's artificial orange-yellow thatch.

Laughing and crying about foreigners’ “health tourism”

I don't know whether to laugh or cry about Dr Liam Fox's re-resurrection of the Tories’ periodic crusade against health tourism by foreigners exploiting the NHS; this time with the additional gimmick of an uncosted entitlement card. Cunning Dr Fox does not want to disclose its cost, for fear of precipitating cardiac arrest on the part of any future Tory Chancellor.

Foundation hospitals may fall into Labour's natural fault line

Health Secretary Alan Milburn's much-touted ‘foundation hospitals’, approved of both by T o ny Blair and the Tories’ Thatcherite health spokesman Dr Liam Fox, may require severe redesigning if they are to survive. This is not only because their underlying concept of allowing excellent hospitals to outstrip others is under severe challenge.

Please don't shoot my Fox, Mr Duncan Smith

As soon as the rumours reached me in late July of a new looming shake-up of the Conservative front bench, I got down on my knees and sent up my agnostic prayer to the bald deity with a perpetual frog in his throat: “Dear IDS, please don'tshoot my Fox: my Dr Liam Fox. It takes so long to tell the real opponents of the NHS from its constructive critics!”

The phoney fight over federalism

It is fairly rare that you can say that both sides are correct in a bitter partisan battle in which the participants seem to be at daggers-drawn. Tory Leader Iain Duncan-Smith backs his ultra-right-wing Health Spokesman Dr Liam Fox in proclaiming Labour as ‘centralising’ the National Health Service. in seeming contradiction, Health Secretary Alan Milburn takes great pride in the extent to which he is ‘devolving’ power to the best hospital trusts.

Managing NHS change more slowly but surely

As the signals strengthen that a General Election may be imminent, our series of interviews with the representatives on health policy for the major parties at Westminister continues. This month, we speak to Dr Liam Fox MP, Shadow Health Secretary for the Conservative Party.

Shadow Health Secretary announces slim and shadowy policy

One of the best guarantees of good government is good opposition. The announcement by Shadow Health Secretary Dr Liam Fox of the Conservative Party's new health policy falls far short of offering any serious alternative to government policy.

Fox hunting foreigners’ fraud of the NHS: summertime, and the living ain't easy ...

I was vastly amused by The Times' week-long front page campaign (The Times, 2000) against the foreigners allegedly defrauding the NHS at the expense of British taxpayers. August is a slow month for news. Additional glee came from seeing Dr Liam Fox, William Hague's health spokesman, joining in like a young cub who had suffered a lobotomy.

Post-revolutionary era for the NHS?

My consultant cousin in Leeds will be happy. He complained about the NHS changes when we dined recently:‘It's been like a Trotskyist permanent revolution...’ All that seems to be receding. After the T o ry ‘revolution’ and Labour's ‘counter-revolution’, the continuing Parliamentary pillow fight will become somewhat of a side-show. The Tories’ terrier-like spokesman, Dr Liam Fox will continue to nip at the heels of the new Health Secretary, Alan Milburn. And Milburn will try to rub his face in all the past Tory inadequacies, real and exaggerated. But Dr Fox's bites and sound-bites are not taken seriously by those who see a Tory comeback still seven years away.