Monday, September 29, 2025

Combination inhaler reduces asthma attacks in children by almost half

Imperial College London

Findings from a trial comparing the real-world effectiveness of asthma inhalers could reshape how children with asthma are treated.

In the first randomised controlled trial to investigate the use of a 2-in-1 inhaler as the sole reliever therapy for children aged 5 to 15, an international team found the combined treatment to be more effective than salbutamol, the current standard for asthma symptom relief in children, with no additional safety concerns.

The results show that using a single 2-in-1 anti-inflammatory reliever inhaler – which combines the inhaled corticosteroid (ICS) budesonide and the fast-acting bronchodilator formoterol – reduced children’s asthma attacks by an average of 45%, compared to the widely-used salbutamol inhaler.

Asthma attacks in children may be life-threatening and reducing their frequency and severity is a public health priority.

The 2-in-1 budesonide-formoterol inhaler is widely recommended as the preferred reliever treatment for adults, but children are still usually prescribed salbutamol.

Researchers say the findings, published today in The Lancet, provide the evidence needed to bring children’s global asthma guidelines into line with adults’, which could benefit millions of children around the world with mild-to-moderate asthma.

The CARE study (Children’s Anti-inflammatory REliever) was designed and led by the Medical Research Institute of New Zealand (MRINZ), in collaboration with Imperial College London, University of Otago Wellington, Starship Children’s Hospital, and the University of Auckland. It recruited 360 children across New Zealand who were then randomly assigned to receive either budesonide-formoterol or salbutamol for on-demand symptom relief.

The trial lasted a year and the budesonide-formoterol reliever resulted in a lower rate of asthma attacks than salbutamol reliever, with rates of 0.23 versus 0.41 per participant per year. This means that for every 100 children with mild asthma who are switched from salbutamol to a 2-in-1 budesonide-formoterol inhaler, there would be 18 fewer asthma attacks per year. Importantly, the study also confirmed the safety of the combined-inhaler approach, with no significant differences in children’s growth, lung function, or asthma control between the two groups.

Dr Lee Hatter, lead author of the study and Senior Clinical Research Fellow at the MRINZ, said: “This is a key step in addressing the evidence gap that exists between asthma management in adults and children. For the first time, we have demonstrated that the budesonide-formoterol 2-in-1 inhaler, used as needed for symptom relief, can significantly reduce asthma attacks in children with mild asthma. This evidence-based treatment could lead to improved asthma outcomes for children worldwide.”

Professor Richard Beasley, Director of MRINZ and senior author of the study, said: “Implementing these findings could be transformative for asthma management on a global scale. The evidence that budesonide-formoterol is more effective than salbutamol in preventing asthma attacks in children with mild asthma has the potential to redefine the global standard of asthma management.”

The burden of asthma in the estimated 113 million children and adolescents with asthma worldwide is substantial. The latest study builds on previous studies in adults led by MRINZ researchers (see detail in Notes, below) which shaped international asthma treatment guidelines. These findings contributed to the recommended use of the 2-in-1 ICS–formoterol reliever inhaler as the preferred reliever treatment for adults with asthma around the world.

The incorporation of findings from the CARE study into global asthma treatment strategies could help reduce disparities in care and ensure that more children access effective, evidence-based treatments.

The researchers say that global health organisations have long advocated for child-targeted asthma interventions, and their findings provide crucial evidence to support those efforts.

However, the authors acknowledge some limitations of the clinical trial. It was undertaken during the COVID-19 pandemic, during which stringent public health measures and fewer circulating respiratory viruses contributed to the lower than predicted rate of severe asthma attacks. The authors also acknowledge the challenges with the identification of asthma attacks in children, and the potential bias with the lack of blinding of the randomised treatments. They say though that the study’s findings are generalisable to clinical practice due to its pragmatic, real-world design.

Professor Andrew Bush, from Imperial College London, senior respiratory paediatrician and co-author of the CARE study, said: “Having an asthma attack can be very scary for children and their parents. I’m so pleased that we’ve been able to prove that an inhaler that significantly reduces attacks – already a game-changer for adults - is safe for children with mild asthma too. We believe this will transform asthma care worldwide and are excited to be building on this work with the CARE UK study.”

Professor Helen Reddel, Chair of the Science Committee of the Global Initiative for Asthma (GINA), commented on the global significance of the study, saying that it fills a critically important gap for asthma management globally. Professor Reddel said: “Asthma attacks have a profound impact on children's physical, social and emotional development and their prevention is a high priority for asthma care. It is in childhood, too, that lifelong habits are established, particularly reliance on traditional medications like salbutamol that only relieve symptoms and don't prevent asthma attacks.”

Professor Bob Hancox, Medical Director of the New Zealand Asthma and Respiratory Foundation, said: “This is a very important study for children with mild asthma. We have known for some time that 2-in-1 budesonide/formoterol inhalers are better than the traditional reliever treatment in adults, but this had not been tested in children. This research shows that this 2-in-1 inhaler is effective and safe for children as young as 5. This information will help to reduce the burden of asthma for many children, and both they and their families will breathe easier because of it.”

The study was made possible by the generous support of the Health Research Council of New Zealand, Cure Kids (New Zealand), and the Barbara Basham Medical Charitable Trust managed by Perpetual Guardian. Symbicort Rapihalers for the trial were provided by AstraZeneca.

Budesonide-formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial is published in The Lancet; https://doi.org/10.1016/S0140-6736(25)00861-X

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00861-X/fulltext

This press release uses a labelling system developed by the Academy of Medical Sciences to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf

NOTES TO EDITORS

Study key points:

The CARE study is the first randomised controlled trial comparing ICS–formoterol anti-inflammatory reliever inhaler treatment with salbutamol reliever inhaler treatment, in children aged five to 15 years with asthma.
Budesonide-formoterol demonstrated a significant reduction in asthma attacks, with a 45% decrease in the rate of attacks compared to salbutamol (0.23 vs 0.41 attacks per participant per year; relative rate 0.55, 95% CI 0.35–0.86, p=0.01).
These findings are consistent with established benefits seen in adults, where ICS–formoterol has become the preferred reliever treatment for asthma management.
The study found no safety concerns regarding the use of a combined inhaled steroid treatment in children, with no adverse effects on growth or lung function.
This study provides compelling evidence that switching from a salbutamol reliever inhaler to a budesonide-formoterol reliever inhaler can help prevent asthma attacks in children with mild asthma as young as five, which could lead to a potential shift in asthma treatment globally.

Previous evidence from MRINZ Adult Clinical Trials of anti-inflammatory reliever therapy:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31948-8/abstract

Journal

The Lancet

DOI

10.1016/S0140-6736(25)00861-X

Method of Research

Randomized controlled/clinical trial

Subject of Research

People

Article Title

Budesonide-formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial

Article Publication Date

28-Sep-2025

HubMP2012

Can we recover hope in dark times?

SEPTEMBER 23, 2025

Michael Calderbank previews “Can Labour still deliver the change we need – and stop the rise of Reform?”, an upcoming Labour Conference fringe event In Liverpool (details below).

Twelve months on from last year’s Labour Party Conference, the mood could scarcely be different. Last year was full of self-congratulatory back-slapping following the landslide victory of the General Election, along with a readiness to schmooze with the corporate lobbyists descending on Liverpool like vultures.

Not that the horizon was without entirely without clouds, even at that stage. The decision to axe the winter fuel payment for all bar the poorest pensioners seemed needlessly cruel and punitive, as did withdrawing the whip from MPs who voted for an amendment to the King’s Speech to scrap the two-child benefit limit on Universal Credit. The relentlessly downbeat economic narrative jarred with the promise of ‘change’ on which the Party was elected, and appeared more concerned with appeasing the bond markets than tackling the cost of living crisis.

One year later, and the storm clouds are all around us. The populist far right are consistently ahead in the polls in the shape of Nigel Farage’s Reform, whilst earlier this month Tommy Robinson mobilised the largest far right demonstration in British history.

Black and minority ethnic voters are increasingly left alarmed and afraid, with open expressions of racist hatred resurfacing in a way not seen for generations. In the departures of Angela Rayner and Peter Mandelson, the Party is linked with tax-dodging and the defenders of paedophiles. Labour’s response to the demonisation of migrants has often been to echo Farage’s rhetoric and talk about speeding up deportations. Are we sleepwalking towards a far right takeover of Britain?

It should be recognised that whilst the organisers and many of the hardcore activists on the “Unite the Kingdom” march were ideologically committed racists, the demo attracted some broader elements, and still more who broadly identified with it on social media. Aspects of the populist narrative understandably resonate – the politicians aren’t taking decisions in our interests; public services are buckling; young people will likely never get a foot on the housing ladder; the money isn’t going where it’s most needed; our lives are getting harder, and things were better for earlier generations, etcetera. In the absence of any more compelling popular outlet for the expression of political discontent, is it any wonder that people are drawn towards ‘state of the nation’ protests that present themselves?

How does the labour and trade union movement respond? The form of political blackmail being posed by commentators like Paul Mason (vote for anyone other than Keir Starmer’s Labour and you’ll get Farage) simply won’t wash. Labour will be punished if it fails to deliver on the promise of change it made to the electorate.

Nor will the far right be defeated simply by mobilising counter-protests denouncing them. Instead, what’s needed is the building of a mass movement which offers perceptible improvements in peoples’ lives, and gives grounds for hope by beginning to tackle the root causes of the present crisis. In the short-term there is little realistic expectation that the Starmer leadership has either the appetite or the capacity to offer such hope. Therefore politics can’t just be left to what happens in Westminster – far right ideas have to be contested in workplaces and communities, and here the role of trade unions could be central.

Affiliates to the Trade Union Coordinating Group are campaigning for a political alternative based on the delivery of a thorough-going restructuring of the economy based on (i) a reversal of austerity and significant investment in public services and extension of public ownership, to be funded by (ii) wealth taxes on the richest in society; (iii) delivering on the promise of the “biggest wave of insourcing for a generation”; (iv) developing a radical new industrial strategy at the centre of which is the restoration of sectoral collective bargaining across the economy, which would require a part two of the Employment Rights Bill; (v) to deliver a new phase of workers’ rights adequate to the meet the challenge of AI; (vi) a just transition to tackle the climate crisis to deliver high quality, secure, well-paid jobs; and (vii) the extension of a genuine system of social security for those unable to work – and the Right to Food so no household goes hungry.

Ultimately this is an agenda which would genuinely transform the lives of working people, and provides a basis for a positive alternative to hatred and division, based on unity and solidarity. Tuesday’s meeting is not just for Labour conference delegates, or even just Labour Party members – it’s for anyone who wants to discuss how we can improve the lives of all our communities across the UK and restore hope to our politics.

“Can Labour still deliver the change we need – and stop the rise of Reform?”

Tuesday 30th September, 6.30 – 8.00pm (followed by a solidarity social with drinks and hot buffet), Love Lane Brewery, 62-64 Bridgewater St, L1 0AY

No conference security pass required.

Hosted by the Trade Union Coordinating Group, with Institute of Employment Rights and Campaign for Trade Union Freedom.

Speakers: Taj Ali, Kim Johnson MP, Ian Byrne MP, John McDonnell MP, Dr Jo Grady (UCU), Fran Heathcote (PCS), Steve Wright (FBU). Chair: Paul Fleming (Equity).

Michael Calderbank is Trade Union Liaison Officer of Tottenham CLP.

UK Women hit hardest as State Pension Age rises

By the National Pensioners Convention

SEPTEMBER 23, 2025

Women in their late 50s who were out of work have been the hardest hit by the rise in the state pension age from 60 to 66, according to new research from the Institute for Fiscal Studies (IFS).

The report found that unemployed women in their 50s experienced far greater income losses than those still in paid work when the reforms were phased in between 2010 and 2020. On average, weekly incomes for unemployed women fell by £81, compared with a £42 drop for women who were working in their late 50s.

The study, funded by the IFS Retirement Saving Consortium, noted that these women were also more likely to have lower incomes, health problems, or disabilities.

Despite the sharp fall in income, researchers found no evidence of reduced spending on essentials such as food or energy. However, participation in social activities – including sports clubs, museum visits and theatre trips – fell by eight percentage points, dropping from 53% before the reforms. Well-being also declined.

The government’s ongoing third review of the pension age must consider how best to support those struggling. Read the report here.

Meanwhile, behind the headline-grabbing 4.7% State Pension rise, a majority of pensioners still struggle on a smaller old pension.

Thanks to the Triple Lock the State Pension looks set to increase by 4.7% next spring – but the National Pensioners Convention warns that the media headlines do not tell the whole story.

Only a third of the UK’s 12.95 million retirees receive the ‘new’ state pension. However a staggering 8.7 million – including our oldest and most vulnerable – are on the old, pre-2016 state pension, so will see a much smaller rise.

Brian Sturtevant, Chair of the NPC Pensions and Income Working Party said: “A reported 4.7% rise in the State Pension under the Triple Lock mechanism may sound generous on paper, yet millions of older people still face serious hardship. Many are on the much lower basic State Pension, and do not receive the full amount, so the actual cash increase they see is far smaller than the figures being widely quoted.

“At the same time, inflation remains stubbornly high, energy bills are set to rise by 2% in October, and food prices continue to climb. Pensioners on a fixed income, many of whom rely solely on the state pension, are still being forced to make impossible choices between heating and eating. We need a serious conversation about how to protect the most vulnerable from falling further behind.”

The government’s “triple lock” guarantees the state pension rises each year by the highest of three measures: 2.5%, inflation, or average earnings growth. Data released by the Office for National Statistics (ONS) shows that total pay, including bonuses, rose by 4.7% in the three months to July. With inflation forecast at 4% for September, it is likely that the 4.7% wage growth figure will be used to set next year’s state pension rise for the third consecutive year.

There is also a catch for those receiving the new state pension increase next April – many will start paying income tax for the first time. Currently, the personal tax allowance stands at £12,570, frozen until 2028. As the value of the state pension edges closer to this threshold, more pensioners will find themselves paying tax on their main source of income, very often because they also have a small occupational pension or receive interest on savings that take them over the limit.

Image: https://www.rawpixel.com/image/5919287 Licence: CC0 1.0 Universal CC0 1.0 Deed

Starmer and Reeves’ approach is wrong – we can tackle inequality and poverty now!

HubMP

SEPTEMBER 24, 2025

Vincent Conquest

For all the recent talk of ‘patriotism’, has anyone talked about the fact that one of the biggest staples of living in Britain is just how much poverty there is all around us? The Child Poverty Action Group (CPAG) estimates that 4.5 million children are currently growing up in poverty – equating to an average of nine children in a classroom of thirty. Most worryingly, poverty rates in the UK have been relatively stable for years now, with successive Conservative governments seemingly uninterested in mediating this problem. The right-wing will have you believe that patriotism is when you wave a flag, while enacting, backing or advocating policies that push vulnerable people – often disabled people, pensioners, and children – further into poverty. But a better society is possible – one where poverty and inequality are tackled for good.

Tackling the structural reasons for poverty in and of itself is not necessarily easy in light of the Government’s commitment to neoliberalism, but there are very simple ways that poverty could be dramatically reduced in the short term. CPAG predicts that if the two-child benefit cap, introduced in 2016 by the Tories, were removed, then 350,000 children would be lifted out of poverty, and a further 300,000 children would be living in less deep poverty. Critics will say that this costs a lot of money, and people should think about the cap before having children in the first place. Even if that argument is taken as legitimate – which it isn’t, not least because more money would be circulating in the economy and boosting growth – why should children go hungry and be punished? If there is enough money to increase military spending on Donald Trump’s orders, there is surely enough money to support children in the most critical years of their lives.

If this Labour Government were serious about tackling poverty, removing the two-child benefit cap is an absolute bare minimum – so it was very telling as to this Government’s priorities when seven MPs were removed from the parliamentary Party for voting against it. Since then, the pressure on the Government to act has ramped up, and calls for the two-child benefit cap to be removed have grown louder. Indeed, both candidates in Labour’s Deputy Leadership race, Lucy Powell and Bridget Phillipson, have made noises indicating that the lifting of the cap would be an absolute priority – though they both voted to keep the cap last year, so whether this will actually come about is a different question.

CPAG also predicts that 900,000 children in England alone miss out on free school meals. Labour has made welcome moves on free school meals: from the beginning of next year, every pupil whose household is on Universal Credit will have an entitlement to free school meals, benefiting over 500,000 children and saving affected parents £500 a year. Clearly, this is good policy and the type of thing you would expect from a Labour Government, but universal free school meals have to be looked at if Labour are serious about not only alleviating poverty but eradicating it.

As mentioned previously, poverty affects everyone, but particularly already those groups such as disabled people effected by the ‘free-market’s’ structural inequalities. The Government’s planned cuts to disability support may have been watered down as a result of months of campaigning from disabled people and their allies, but cuts to the Universal Credit health element remain. Though we do not have a full idea of what the cuts will look like once passed, we know it will hurt disabled people, pushing lots of them into poverty, and pushing those already in poverty further into poverty.

More generally, racial and regional inequality affects poverty rates, too. 65% of children of Bangladeshi origin and 59% of children of Pakistani origin live below the poverty line, with the highest rates of poverty in inner London, the West Midlands, and the North West. In order to tackle the most basic staples of inequality, poverty in these communities must be reduced, and taking the measures outlined above would be a good first step.

Overall, a wide range of economic redistributive measures are needed to tackle inequality and remove poverty from society. Poverty is not an inevitability, and many people in politics got involved in politics to try to eradicate it. It seems that many politicians have forgotten this fact, and Labour would do well to remember that reducing poverty is a key priority for their voter base – even if that should not be the main reason for doing so.

It should be the super-rich and the corporate profiteers who pay to improve our broken society, not the poor. Remove the two-child benefit cap, expand free school meals so they are universal, and introduce a wealth tax rather than any further cuts to welfare. Bring back universalism and start to build a better society for all.

LIVERPOOL EVENT: We CAN tackle poverty and inequality. Sunday September 28th, 12.30pm. Join Neil Duncan-Jordan MP, Ian Byrne MP and other guest speakers. Register here.

Vincent Conquest is an Arise – a Festival of Left Ideas Volunteer and Young Labour member.

Image: https://www.flickr.com/photos/53941041@N00/4103261671/ Licence: Attribution-ShareAlike 2.0 Generic CC BY-SA 2.0 Deed

Why the best wealth tax is a land value tax

Natural resource rents go to the wrong people, argues Heather Wetzel.

SEPTEMBER 25, 2025

When we look at where the richest few get their incomes from, we see so much comes directly or indirectly from land and other natural resources including oil, minerals, aggregates, the spectrum, solar and wind power, water, forestry, etc.

The most efficient, transparent, unavoidable/unevadable and fairest form of Wealth Tax lies in diverting land and other natural resource rents from those claiming ownership of them to local and national governments to pay for our public services.

A fact that is mostly ignored by politicians and economists is natural resource wealth only arises from society’s demand to use them and, as our economy grows, so does their value and price. Because they are no longer held in common, the incomes that arise from our combined demand to use them goes to the few who claim ‘ownership’ of them.

To place a levy on land and other natural resource rents cannot be avoided and returns the value society creates to maintain and develop our public services.

Society currently pays economic rents for each of the natural resources we use but that rent goes to the wrong people. It should be returned to the public purse to pay for maintaining and developing our public services.

Initially, the simplest action to make a real and immediate economic difference would be to replace all property taxes with an annual Land Value Tax. Land speculation and land hoarding would stop and idle development sites and underused buildings would be brought into their full, permitted use, providing homes and business premises at affordable and not inflated prices to rent or buy. The next stage could be to get back water and energy sources under public ownership – without compensation – and charge the economic rent for each one. The third stage could be to bring remaining natural resources into common ownership and again, charging the economic rent for each one.

By replacing current property taxes with an annual Land Value Tax, society would benefit economically, socially and environmentally:

Economically because the value we all create would be returned to pay for public services.
Socially because homes would become much more affordable and businesses could afford to start up or expand creating jobs.
Environmentally because we would use land in our towns and cities much more efficiently and reduce the need to build in rural areas that do not have the infrastructure to support them.

A Land Value Tax (LVT) is a charge levied on the economic rent of each site valued at its permitted use value. The taxes LVT replace will depend on the Government but the easiest to replace following valuation of each site, are current property taxes. Providing no loopholes or exemptions are included, LVT cannot be avoided or evaded.

Land cannot be hidden in the Cayman Islands, an offshore account or in the attic or a lock-up – other assets can!

Some key points on why LVT is a fair and just tax benefiting the whole of society:

LVT recognises that every individual helps create land values through their work, their community activities and their spending.
LVT means that the growing number of non-property owning adults who are tenants or economically forced to live with family or friends also share in existing and future increases in land wealth, rather than just freeholders and the big land owners.
LVT recognises that every new investment – public and private – helps create land values, whether it is in public transport, businesses, leisure facilities, schools, hospitals, airports, making neighbourhoods smarter and more pleasant, or in homes or jobs.
LVT also recognises that existing services and businesses – public and private – add to land values.
By including land that is currently kept idle, LVT encourages better use of land, particularly in towns and cities and reduces the demand to build on green spaces or in rural areas.
By stopping land speculation, investors will seek worthwhile investments including in those areas that currently have high levels of unemployment and deprivation, thus redistributing wealth on a regional and individual basis fairly.
With LVT, homes would be bought for people to live in and not be kept empty for speculative purposes.
LVT encourages investment in more jobs and businesses and more affordable homes.

LVT will rid communities of derelict sites and buildings that encourage anti-social behaviour.
Unlike other taxes, it is impossible for people and businesses to evade or avoid paying their share of LVT.
LVT increases the funds available for public services, including public transport, health, education, leisure facilities, crime prevention and social welfare.
Land value and taxes are inversely related so as LVT is introduced, land wealth, reflected in rent and capitalised value, transfers to the public purse and away from land owners.

By collecting the economic rent of land, land wealth would be recycled and used to benefit the whole of society economically, socially and environmentally and it would force us to use land sparingly and efficiently.

Note:

The law of economic rent – there are three factors of production – labour, capital and land (that is, all natural resources). The return to labour is wages; the return to capital is profit or interest; and the return to natural resources is ‘economic rent’ – the excess income left after the costs of labour and capital (including ‘reasonable’ profit) have been made.

Taxes and economic rent are inversely related – this means that as taxes increase, land values go down and when taxes reduce, land values go up. Similarly, subsidies increase land values and end up in the pockets of those claiming ownership of land thus frustrating the purpose intended.

Land value only arises because of society’s combined demand to use it for homes, public services, businesses and leisure – not from owning land. Values will vary according to access to good public services, private investments and from natural attributes.

A list of frequently asked questions with answers can be provided if required and is on the Labour Land Campaign website here.

Heather Wetzel is Vice Chair of the Labour Land Campaign.

Image: Banner on the Make Them Pay demonstration in London on September 20th, c/o Labour Hub

HubMP2

Tackling poverty means the right to food for all

SEPTEMBER 26, 2025

By Sarah Woolley

The scale of food insecurity in Britain today is shocking. Over 7 million adults are going hungry or skipping meals, and children, disabled people and single-parent families are hit hardest. This isn’t just about poverty: it is about health inequality, life expectancy and whether people can live with dignity.

The context to this is that over one year into the Labour Government, it is clear that austerity didn’t end with the Tories being voted out. Working people are still paying the price. Food prices are still sky high. Wages are still far too low. Homes are still cold and damp. Public services are still being cut back to the bone – there was an announcement only a couple of weeks ago about further cuts to firefighter jobs. And it is disabled people, low-paid workers and young people who are feeling it the hardest.

When it comes to food insecurity specifically, the much-vaunted NHS Ten-Year Plan talks about prevention and population health. But prevention has to mean tackling the root causes of poor nutrition: poverty pay, insecure work and lack of access to affordable, healthy food. If we don’t get that right, then all the talk about prevention will ring hollow.

That is why the BFAWU (the Bakers, Food and Allied Workers’ Union) has campaigned so strongly for a Right to Food to be enshrined in law. We know from our members that the crisis in access to decent food is not about supply, it is about inequality. We also helped establish the Food and Work Network, bringing together academics, campaigners, unions and community groups to connect the dots between work, wages and nutrition. The evidence is clear: good jobs, fair pay and strong food access schemes are inseparable from good health.

Schemes like Healthy Start are lifelines. But they are underfunded, poorly promoted and far too limited. We need government investment to expand these programmes, and we need local, community-led food initiatives to be supported, not left to rely on voluntary goodwill. And we need a properly resourced workforce – including dietitians – to bring expertise into communities where health inequalities are at their starkest.

This is not just a public health issue – it is a question of justice. No one in one of the richest countries in the world should be forced to choose between heating and eating. No parent should have to skip meals so their children can eat. And no worker should be producing food they themselves cannot afford to put on their own table, as so many of our BFAWU members do.

Alongside this, in the food sector, we’re also demanding action on food security and sustainability. Workers shouldn’t be asked to churn out cheap, unhealthy products for poverty wages while supermarkets rake in profits. A just transition in food means decent pay and conditions for food workers, public ownership of key supply chains, and investment in local, sustainable production that puts communities before corporate greed.

Not only would such policies dramatically and immediately improve the lives of millions, but they would point towards a different kind of economy, a restructured economy based on investment and an end to austerity for good.

As part of our campaigning for that better society, we will strongly make the demand for prevention that goes beyond rhetoric – prevention that starts with the Right to Food, delivered through fair pay, decent work, and universal access to nutritious food, as part of building a different kind of economy, for the many not the few.

As Labour meets for its Conference this week, as the Party in government, the time for excuses is over. Working-class people have waited long enough. Now it’s time to deliver.

Sarah Woolley is BFAWU General Secretary.

Image: Neater Heat Partners with Aldershot GrubHub. https://www.neaterheat.co.uk/neater-heat-supports-aldershot-grubhub-warming-hearts-homes-and-heaters/ Licence: Attribution-NonCommercial 4.0 International CC BY-NC 4.0 Deed

HubMP2012

Standing up to fascism and racism is the duty of the working class and the labour movement!

SEPTEMBER 26, 2025

By Dashty Jamal

On Saturday September 13th, a counter-demonstration was organized in London by Stand Up To Racism against the far-right Tommy Robinson demonstration, in which we participated to reject the hatred and bigotry spread by Tommy Robinson and the far-right. The far-right demonstration, which drew nearly 110,000 participants, was one of the largest far-right gatherings against refugees in Britain in recent years. Their fascist agenda is built on racism, Islamophobia and intimidating citizens, but we will not be divided. Our protest was not only against Tommy Robinson and the entire far-right movement and their fascist and racist agenda, but also to defend the values that the fascist ideology seeks to destroy.

The Stand Up To Racism demonstration was attended by close to 20,000 people and brought together trade unions, women’s organizations, refugee organizations, and left-wing and socialist organizations who came to the streets to defend the human and civil values of British society like coexistence and tolerance. They attended the demonstration to confront this reactionary and inhumane trend that seeks to destabilize our society through the dissemination of hatred, bigotry, and violence, and keep it in a state of constant fear and war.

Some of Robinson’s supporters clashed with the police. They attempted to break through barriers to attack anti-racism demonstrators, alongside the chanting of racist slogans, reflecting their core content and message. They carried nationalist symbols, including the St. George’s Cross and the Union Jack flags. Some of the anthems and chants were explicitly anti-refugee, for example: “Stop the boats,” “Send them back.”

Robinson claimed the march was about defending freedom of speech and British culture. Elon Musk delivered a speech at the rally, criticizing the British government and its refugee policy. Political leaders condemned the violence. With concerns and fears growing, particularly within Muslim communities, about the racist and anti-Muslim rhetoric being spread, the police issued a statement to reassure people that they are safe and to remain in their homes.

Analysis of the event, its implications, and the number of participants shows that the message that brought Robinson and his extremist groups together, particularly around the issues of refugees, is based on identity and nationalism.

Tommy Robinson used the framework of free speech to cover up policies of xenophobia, racism, and hateful speech. These incitements to hatred can escalate, spiral out of control, and plunge society into violence. British society, which is a multi-ethnic, multi-lingual society with a long history of immigrant labour, is now targeted by such propaganda. This kind of event threatens community cohesion and can lead to backlash, crime, and violence, as seen in attacks on refugee hotels. As the National Institute Against Racism and Fascism highlights, racist hate crimes have increased significantly following the resurgence of anti-refugee protests and the calls for mass deportations this summer.

On September 9th, a Sikh woman in Oldbury, Birmingham, was allegedly assaulted, and her attackers reportedly told her, ‘You don’t belong to this country, get out.’ According to newspapers, a man has been arrested but released on bail pending further investigation. This incident is being treated as a ‘violent racial assault’.

Fascism has a criminal history. It is not merely a political ideology but a violent reaction against social progress. Fascism is an extreme right-wing, nationalist ideology that seeks to concentrate power in a single leader or party and is used to divide people, dismantle democratic institutions, trade unions and left-wing and socialist movements.

Fascism is built on fear, hatred, and lies. It also has an economic motive, serving the interests of the capitalist class when they fear losing power. In the 1920s and 30s, the elites of Italy and Germany funded Mussolini and Hitler to crush the communists and trade unions. Fascism promises to protect private property, profit, and the class structure by any means necessary. As Leon Trotsky argued, the bourgeoisie turns to fascism when its power is threatened by the working class. When parliamentary democracy and traditional control instruments are insufficient, the ruling class utilizes fascist movements to protect its power.

Fascism is a movement of hunger, pain, misery, despair, ruthlessness, and hopelessness. We must strive to deal with the sections of the society now entangled in fascism, either by integrating them into our struggles or at least by neutralizing and sidelining them in our struggle and battles. We must use the utmost clarity and strength to prevent them from empowering the bourgeois counter-revolution. Fascism does not only attack political enemies; it destroys the soul of society. Freedom of speech, the right to vote, independent media and Jewish people, Muslims, refugees, LGBTQ+ groups and others who are victims of war and insecurity are blamed and scapegoated for societal crises and problems.

Coexistence and justice for a better future are our options and must be fought for by organizing, educating and together. We can build a world based on genuine equality, peace and prosperity, where fascism has no place and never will.

Fascism in Hitler’s Germany led to the Holocaust, World War II, and the killing of over 60 million people. Mussolini’s Italy crushed democracy and joined Nazi Germany in war crimes. Franco’s Spain silenced generations with executions and censorship.

The new neo-fascist movements continue to threaten rights, minorities and democracy. Wherever fascism emerges, human suffering follows. Fascism is not a relic of the past but remains a threat today. Economic crises, inequality, and fear can give it new life. Therefore, it must be confronted, not only with words but with action. We must confront racism, sexism, xenophobia, and homophobia wherever they appear. We must stand with workers, trade unions, and social movements that demand freedom, coexistence, humanity, and justice. Racism, also, focuses on differences in culture, language, and tradition, claiming that they threat the unity of European societies while all human beings, regardless of culture, language, or colour, are people with universal rights.

The current trend of fascism and racism in Britain and Europe is based on racial discrimination and the identification of the European race as superior. It strives to take away social gains achieved by the working class and to fragment the labour movement and incite war between sections of society. A section of the bourgeoisie uses racial identity against refugees and migrant workers who came to European countries for work, turning it into an electoral programme.

In the current era of economic crisis, with European governments facing major political and economic challenges, racism has not remained confined to opposing foreigners and discriminating between people; it has now become a political programme adopted by many far-right parties which are allowed to participate openly in elections, opening the door to their accession to power.

Some of these far-right parties are already in power. The programme and agenda of these racist and far-right parties are not limited to vilifying refugees and migrants but aim to organize society in a way that secures low wages and long working hours, dismantle social benefit and social services, raise the retirement age to 70 and deprive women, children, the elderly and the disabled of services. Simultaneously, it seeks to keep the modern societies of Europe and Britain in a constant state of internal racial strife.

So, what can be done to confront racism and fascism? Martin Niemöller, a German pastor, is famous for his powerful statement about the cowardice of German intellectuals, especially the churches, after the Nazis rose to power. Although he initially supported Hitler, Niemöller became an outspoken critic of the Nazis, especially after they began interfering in the church, saying:

“First they came for the socialists, and I did not speak out—because I was not a socialist. Then they came for the trade unionists, and I did not speak out—because I was not a trade unionist. Then they came for the Jews, and I did not speak out—because I was not a Jew. Then they came for me—and there was no one left to speak for me.”

A better future is possible. The working class cannot leave this fight to others, to deal with it indifferently! We must organize ourselves, unite our forces, and connect our struggles. We must spread the awareness about the history of fascism, its crimes, and its attempts to set society back.

The rise of this far-right trend is also a warning to refugees and minorities that they must not remain on the sidelines of this battle. They are part of the working class of this country and must strengthen this humane front alongside the trade unions, and left-wing, socialist, and freedom-loving organizations.

We must intensify pressure on the government not to pander to the far-right and fascist groups. Their financial and political support must be cut off. Their sources of funding must be made clear. Calling for political gatherings and delivering speeches that incite violence, and discrimination must be considered a serious crime. The government must prioritize improving people’s lives and livelihoods, improving National Health Service, municipal services, and housing, and adopting refugee policy based on a humane policy far from the threat of deportation. Any institution or person promoting bigotry and racism must be punished.

This is our task, the task of the working class and the labour movement: to protect society from the threat of far-right extremists.

Dashty Jamal is a member of the Solidarity with the Iranian Workers’ Movement Committee (Chair: John McDonnell MP).

Image: Banner on the Make Them Pay demonstration in London on September 20th, c/o Labour Hub

UK

NHS 10-Year Plan: The Corporate Capture Continues

Esther Giles of the Socialist Health Association responds to the Plan.

SEPTEMBER 26, 2025

There are many aspects of the NHS 10-Year Plan (The NHS10YP) to consider. Here, we will focus on the capital investment needed in primary and community care- and the NHS10YP proposal to adopt a “Public Private Partnership” (PPP) approach to provide infrastructure for primary care. We draw on work we have done in the SHA regarding NHS structure and privatisation, and primary care services.

The real economy

According to the post-WWII political philosophy of the welfare state, it is the Government’s job to ensure that people have the essential public services they need, including housing, health and social care, education, water, energy and a transport infrastructure.

Whereas the private businesses formerly in charge of these areas were limited in their social role by their need to make profit, the Government’s actual limits are set only by its own goals, by the real resources available in the economy – the labour, skills, energy and materials it can bring to use – and by managing any inflationary pressures that might arise should spending exceed those real capacities.

The Treasury rules that constrain us

Rooted in the anti-welfare state philosophy that shaped governments from the mid-1970s, associated with Margaret Thatcher, the 2024 fiscal rules include the investment rule – “to reduce public debt” – defined as public sector net financial liabilities (PSNFL) as a share of the economy. This is why public sector capital investment is constrained as it is – despite the clear need for infrastructure investment. Spending on public sector capital formation less depreciation (net fixed capital formation) is presently only 1% – whereas overall capital investment in the economy is 15-20% of GDP.

The Government debt target (PSNFL) is a political choice and self-imposed. It can and should be challenged.

If we have the real resources to build infrastructure, we don’t need private capital to do it. In fact, we can do what private capital cannot.

10-Year Infrastructure Strategy June 2025

In June 2025 the Government published its 10-year Infrastructure Strategy. This announced plans to sign more partnerships with the private sector for the delivery of UK public services – including health and education – despite the criticism and failure of the Blair Government PFI schemes. In the strategy it says it wants to”evolve our infrastructure finance models and will consider the use of Public Private Partnerships (PPP) in projects and sectors where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.” (our emphasis).

In line with this intention, the Department for Health and Social Care (DHSC) and the National Infrastructure and Service Transformation Authority (NISTA) have published a preliminary market engagement notice for what they call “Project Wings” and which concerns “certain types of primary and community health infrastructure projects.” The total value of the project is estimated at £1.2bn (including VAT), running for 30 years from June 2027. Investors have been invited to design, build and manage up to 200 neighbourhood health centres (NHCs), with contracts for between 25 and 30 years. It is expected that a final decision on the approach will be announced in the Autumn Budget on 26th November.

The Return of PPP/PFI

The 10-year Infrastructure strategy underpins the investment plans in the NHS10YP and the return to PPP.

The context to this is that (from the Infrastructure Strategy): “Capital investment in the NHS has lagged international peers for over a decade, with the UK sitting amongst the lowest in the Organisation for Economic Co-operation and Development (OECD) indicators for capital investment. This has led to a c.£37 billion infrastructure gap, highlighted by the Darzi Report, which has left the NHS with outdated, inefficient, and ill-suited infrastructure.”

Despite the very low number of hospital beds in the UK across the OECD (see chart below), shifting patient care out of hospitals and into the community remains one of three core themes of the 10-year health plan.

NHS England has already started work – based on the 10-year infrastructure strategy – on a new model to draw in private finance to pay for health infrastructure, using what its leadership calls an “off-balance sheet capital investment mechanism”.Which means that nothing real changes, but we change the way we measure it to comply with the treasury rules.

In the NHS now, (politically chosen) “capital constraints” together with elective capacity shortfalls and primary care investment backlogs, combine to usher in a new PPP/PFI model.

The NHS Confederation stated in a report released on 8th September 2025: “off-balance sheet models, which keep the debt off the government’s books, are a political necessity in the current fiscal climate.” This is despite the Conservatives having banned PFI for central government projects in 2018 after the National Audit Office declared them poor value. Hundreds of PFI projects from this period are still mired in legal disputes between Government and private investors. Now the Government is saying that any new PPP models would be “drawn up differently to avoid the problems of the PFI era”.

Neighbourhood Health Centres (NHCs)

The proposed NHCs would bring together healthcare and local authority services in a “one-stop shop”. The development of combined premises for primary and community care has happened in only a limited way in the past because of the fragmented nature of the private contractor model in primary care, with primary care premises primarily being provided by general practitioner (GP) private contractors to the NHS. The current contractor model brings with it high risk of market failure and the Royal College of General Practitioners (RCGP) has previously called on the Government to invest £2bn into GP premises, after a survey found that 40% of GP staff think their premises are “not fit for purpose”.

Furthermore, under the measures in the 2014 Five Year Forward View and its successor, the 2019 Long-Term Plan, many practices are now being “bought out” by large corporations such as HCRG (previously Virgin), Centene and Operose. These commercial companies have been gifted opportunities for profit where there is a need for a publicly provided model.

Initiatives for private sector investment in primary care have been attempted before, principally via a type of PPP called LIFTs (local improvement finance trusts) of which there are around 50 and which a Labour health minister at the time compared favourably with Kaiser Permanente in the USA). But the bureaucracy, the profit motive and margin requirement; problems over the question of ownership – all are problematic, as with PFI projects.

Our View

The government is constrained only by its own will and the real resources available in the economy. Present Treasury and austerity constraints are a political choice. Capital funding constraints are self-imposed by the Government and can and must be challenged. Local publicly funded and managed building schemes are likely to be much cheaper and more socially useful than the LIFT/PPP equivalent. We must reverse and avoid private finance use of the NHS. There is no place for profit in healthcare.

Investment in primary care does not in itself provide a ‘silver bullet’ that will address the UK’s very low number of hospital beds and the marketisation and privatisation of the NHS. The NHS must be restored to a comprehensive, universal service operating in the context of a functioning welfare state.

The NHS10YP plan fails to acknowledge the role of the market in perpetuating many of the infrastructure problems in primary care – and proposes market solutions supposedly to resolve them.

The co-location of community and primary care could serve communities well – particularly in the event they can access publicly provided GP care, NHS dental care, and other community services in a single hub connected to a secondary or tertiary healthcare provider. The only purpose of inviting corporations to ‘help’ fund or deliver neighbourhood health centres is to shape them around private sector expansion rather than public need. We are mindful of documented negative financial and health outcomes resulting from private sector involvement in public healthcare restructuring.

A national NHS salaried contract must be introduced for GPs and Dental Practitioners (DPs) (as supported by Doctors in Unite) as part of a consolidation of publicly provided primary care services and we need to bring an end to Alternative Medical Provider Service (APMS) contracts, which allow private companies to buy up GP contracts. There may continue to be partnerships of professionals who are involved in direct service provision: these could include DPs and other healthcare professionals.

Esther Giles is a National Officer of the SHA and former NHS Regional Finance Director for specialist services.

LA REVUE GAUCHE - Left Comment