McConnell’s test: Can he do more than obstruct?

(CNN)Senate Majority Leader Mitch McConnell is facing a major test this week. Since revealing the details of the Republican health care plan, McConnell has watched as a number of important senators in his own party announced their concerns or opposition. Some, such as Wisconsin Sen. Ron Johnson, have urged him to postpone the vote based on the assumption that, at this moment, it would not pass the upper chamber where the majority only has a slim 52 seats.

Meanwhile, on Monday, the Congressional Budget Office announced that under the Senate bill there would be 22 million more uninsured Americans by 2026, making McConnell’s efforts to pass the bill that much more difficult.
But McConnell’s supporters believe he can make this happen. They see McConnell as a modern-day Lyndon Johnson, who has served as both Senate minority and majority leader, an old-school legislator who can twist arms and cut deals to bring his party together. They are confident that despite all the potential problems with this bill, McConnell must have enough tricks up his sleeve to defy conventional wisdom.
    But the truth is it’s nearly impossible to predict if McConnell will succeed. To many, he has defined his career as an obstructionist rather than as someone who creates new policies. The challenge he faces this week is fundamentally different than much of what he has confronted in his time as a party leader.
    Most of McConnell’s skills have come as a member of the congressional minority or as a majority leader facing a president from the other party. Under those conditions, McConnell could be brilliant and devastating. Shortly after President Obama’s inauguration, Utah Republican Bob Bennett recalled McConnell telling a retreat of Republicans: “We have a new president with an approval rating in the 70% area. We do not take him on frontally. We find issues where we can win, and we begin to take him down, one issue at a time.”
    His track record as an agent of obstruction is legendary. Throughout the Obama presidency, McConnell proved to be extremely effective at blocking many key legislative initiatives, from immigration reform to climate change regulations to criminal justice reform, that sometimes even commanded bipartisan support. The senator proved he knew how to whip up a no vote and to stand firm against intense political pressure to act.
    He demonstrated the same savvy with judicial and executive branch appointments. McConnell was more than willing to let seats remain empty. Never was his ability to hold the party together as clear as when Justice Antonin Scalia died during President Obama’s term. The Senate majority leader refused to even hold hearings on the nomination of Merrick Garland, based on the spurious argument that the next president should have the right to decide on the appointment. The seat remained vacant until a Republican controlled the White House.
    As an obstructionist, McConnell demonstrated he was able to ignore the scrutiny of the media no matter how hot it became. When pundits and policymakers took to the airwaves to lambast the Republicans for failing to govern or for creating a constitutional crisis, McConnell didn’t flinch. The breaking news cycle didn’t faze him. He plays, as he titled his memoir, the “Long Game” with an eye on the needs of his party. Between 2009 and 2017, he kept up the pressure on his colleagues in the Senate to stick to their guns, and it worked.
    Now the situation is different. For the first time in his career as a party leader (other than the brief moment he was selected as Senate majority leader in 2006), the public will see just how well he can perform in making things happen rather than blocking progress.
    But the skills are different on the other side of the line of scrimmage.
    Part of the job of the majority leader in times of united government is to bring disparate parts of the party together around proposals to change the status quo. “Trumpcare” would do just that. This is legislation that will strip away the health care benefits for millions of Americans and create a period of great uncertainty for health care markets.
    Some conservatives want Congress to do much more in dismantling government. To them, the government would still be spending too much money subsidizing markets and leaving too many regulations in place. Others in the GOP are not willing to make such grandiose changes, realizing the effects it will have on their electorate. In particular, they fear the effects of the rollback of Medicaid on their populations as well as the higher deductibles that people with more illnesses will face.
    Can McConnell bring these sides together, and work with the intransigent Freedom Caucus in the House, around legislation that will change the status quo and where Republicans will likely be blamed for any negative outcome?
    In the modern era, part of the job of the majority leader has also been to sell ideas to the public. This is where the job of the obstructionist is very different than the job of the policy creator. Unlike some recent Senate majority leaders, McConnell doesn’t really like to be on television and he tends to avoid reporters whenever possible. In this case, that comes at a cost since the natural face of the party is not out there convincing Americans why this is a good idea. That task is left to others, and right now his fellow salesmen, as reflected in public opinion polls about the health care bills, are doing a poor job.
    Until now, President Trump has not tested McConnell, since he has focused almost exclusively on executive actions and avoided the legislative front on large-scale issues.
    It is worth noting that McConnell does not really have many legislative issues that he is known for, other than his fierce opposition in the 1990s to campaign finance reform. This week he is dealing with a major issue that would have his signature in the history books.

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    Can McConnell deliver on this controversial legislation? Can he play the part of leaders like Senate Majority Leader Mike Mansfield, who delivered when Democrats controlled the White House and Congress in the mid-1960s? Or, is this problematic bill something that is just too hot for this legislative leader to deliver?
    This is a question that will be answered as the week unfolds.

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    Transgender firefighter marches as NYC Pride Parade grand marshal

    (CNN)When Brooke Guinan joined the New York City Fire Department in 2008 she publicly presented herself as a man. She had no idea that on Sunday she’d be one of the NYC Pride Parade’s grand marshals while identifying as a transgender woman.

    Guinan began identifying as a transgender woman in 2011, three years into her firefighting career at FDNY. She first came out as a gay man at a young age, but began to question her gender identity in college.
    Before joining the department, Guinan was unsure what her professional life would look like.
      Despite being a third generation firefighter Guinan did not think there was a place for LGBTQ people in the male-dominated fire department.
      But Guinan’s love of public service ultimately drove her to continue her family legacy in the fire department. There was no LGBTQ training in the beginning.
      During her first few years in the department, she served in both firefighting and administrative capacities.
      For the past two years, Guinan has stepped out of the firehouse and has served the FDNY as its LGBTQ outreach coordinator.
      In this role she has directed and produced training tools and services to better equip the FDNY to understand and work with the LGBTQ community.
      “The firehouse can be fun, but I am so enamored with my community and I am very pleased and grateful to do a different kind of lifesaving work in the fire department,” Guinan said.
      The FDNY has promoted LGBTQ experiences through their social media pages and has also produced its own video in support of the “It Gets Better” campaign, highlighting the stories of LGBTQ public safety employees.
      James Fallarino, spokesperson for NYC Pride, said Guinan appears to be the first openly transgender member of the FDNY. She is the first transgender public safety employee to serve as an individual grand marshal. In 2002, two organizations — the Gay Officers Action League (GOAL) and FireFLAG — served as grand marshals after 9/11.
      Guinan participated in the Pride parade for years before being invited to be a grand marshal.
      “It is an amazing honor to be the Grand Marshal of this year’s Pride parade,” she said. “I have always found inspiration in other people’s voices and it is an honor to be given an opportunity for my voice to be heard.”
      She was one of four grand marshals. The others are Krishna Stone, the director of community relations at Gay Men’s Health Crisis; Geng Le, a leader of the LGBTQ equality movement in the People’s Republic of China; and the American Civil Liberties Union.
      “Our 2017 Grand Marshals are a snapshot of the numerous organizations, individuals, and philanthropists that will leads us through this unprecedented time in our nation,” noted NYC Pride March Director Julian Sanjivan in a press release.
      The NYC Pride March is the largest pride parade in the United States and is meant to celebrate the LGBTQ community and bring awareness to issues the community faces. The parade originated 48 years ago in the wake of the Stonewall riots, a series of protests by the LGBTQ community against a police raid of the Stonewall Inn in 1969.

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      What Beef Has Prince Harry Got With His Dad, Prince Charles?

      Prince Harry has got used to busting royal protocol.

      Whether for good (hugging foreign dignitaries, discussing mental health or dating a divorcee American actress) or for ill (who mentioned naked billiards in Las Vegas?) Harry has never been one to mildly toe the line.

      His latest protocol-busting habit is to give unprecedentedly revealing interviews to newspapers and websites, a habit which he started last year and has taken up again with vigor this year.

      Its all in the noble cause of promoting either his charitable event for wounded servicemen, the Invictus Games, or in the service of bringing forward a discussion on mental health by opening up about his own struggles in that department.

      He has thus far been widely praised for the honest and accessible remarks made in several of the interviews and one podcast. But his latest soul-baring comments, which included what amounts to a stinging attack on his father, Prince Charles, for obliging him to walk behind his mothers coffin as a 12-year-old boy, were greeted with sharp intakes of breath in royal circles yesterday.

      Harry made the remarks in Newsweekin the course of an interview in which, among other things, he suggested that neither he nor anyone else in the royal family desires to be the Monarch.

      We are not doing this for ourselves but for the greater good of the people, Harry said, Is there any one of the royal family who wants to be king or queen? I dont think so, but we will carry out our duties at the right time.

      Of course, any fair-minded person can see what Harry meansthat being the real life Monarch is pretty far from the fairy talebut the comment just begs to be taken out of context.

      The Daily Mail carried an extensive diatribe by Max Hastings, in which Hastings said the comments showed Harry to be unappreciative and over-entitled, and the papers in the UK are full of headlines stating that Charles didnt want to be King (this is not correct, he does, and he wants Camila to be Queen by his side).

      The way Harrys remarks on the hardships of royal life have been portrayed illustrates perfectly why, for decades, royal handlers followed a simple rule no print media interviews.

      Except for very rare exceptions, with tame journalists, interviews with the royals only took place on television, and on-camera answers were not allowed to be edited without permission. Indeed, the BBC has a full time employee whose sole job is liaising with the palace about interviews with members of the royal family.

      The Newsweek interview proves exactly what the previous generation of royal press handlers–who have all now left Kensington Palace to make way for a new guard led by thrusting young Canadian and lover of social media Jason Knauf–always argued: that there was nothing to be lost by being excessively cautious and deeply conservative when it came to media interviews.

      In other words, this new interview has done nothing for Harry or his causes, and has served only to shine a deeply uncomfortable light on tensions between Harry and his father.

      Harry, in his admirable effort to be relevant, stands accused of unwisely taking conversations more appropriate for the therapy room into the public domain.

      Although he did not mention his father by name in the interview, there is little doubt who Harry has in mind when he said: My mother had just died, and I had to walk a long way behind her coffin, surrounded by thousands of people watching me while millions more did on television. I dont think any child should be asked to do that, under any circumstances. I dont think it would happen today.

      The writer Penny Junor, the well-briefed author of a series of biographies about the royals who has recently completed a forthcoming biography of Camilla Parker Bowles, defended Charles to the Daily Beast.

      The fact is that Charles didnt make Harry walk behind his mothers coffin," Junor said. My understanding has always been–and this comes directly from someone who was with the family at the time, and who spoke to both princes about it–that it was the boys choice to do it. They were not pushed into it. In fact, provision was made right up to the last minute for a car to take them to the Abbey if they changed their minds.

      I suspect it may well be the case that Harry, aged 32, in therapy, is looking back and thinking 'Who would ever have allowed a child to do that?' Which is fair enough. I dont imagine for a second he could have understood the enormity of what he had agreed to do and maybe he should have been protected.

      But he wanted to do it. At the end of the day if your 12-year-old son says, 'I really want to do this, Daddy, I want to be with you and my brother,' what do you do? Some people dont let their children attend the funerals of deceased parents, and that can lead to great resentment also. So it was a horrible situation and there was probably no right answer.

      Lady Colin Campbell, a confidant of Princess Dianas and the first person to reveal she had an eating disorder, highlighted Harrys "therapy talk," telling the Daily Beast that the Prince had been very nave in giving such a revealing interview.

      He has made a typical mistake which people who are new to therapy often make; they are too willing to reveal too much too publicly. Most of us do it to our friends, but Harry has done it to the media. And this is the result. No more interviews.

      Junor is adamant also that Harry erred by laying all this emotional material out for the media to feast on.

      I cannot begin to imagine why he gave this interview. I cant really see an upside. It has blown up into an enormous story. He would be wise now to stop giving interviews, she says.

      Implicit in both Harrys podcast and this new interview is a suggestion that his father should have got him into therapy as a child.

      An informed source, speaking on condition of anonymity, said: It might seem odd today that he wasnt sent to see someone. But Charles is undoubtedly self pitying and self-centered and thought of his own troubles first. His consolations are not of the shrink type.

      "He likes philosophers and men of faith, none of which was likely to help Harry. Shrinks they would see as very wacky and Woody Allen-ish. In fact, in Charles's mind, they were probably most associated with Diana, which would have put him off even more.

      The source described Harrys comments as a staggeringly public attack on Charles, adding, Camilla has always been the block. However much they [William and Harry] 'forgive,' she will always be the woman–in fact they will always be the couple–who broke their mother's heart and survived to tell the tale.

      The intriguing question at the heart of all this is whether Harry has taken against his father in the course of the past few years, and whether his therapy has anything to do with it.

      Junor says that the relationship between Charles and Harry, while not antagonistic, is not as close as it could be.

      It is a slightly tricky relationship, because Charles has always been quite a remote figure, he has always been consumed by work. Even after Diana died, he still worked his socks off. He made sure they were well looked after, but they are not as close as they might have been.

      "Thats not a product of a lack of love. Its a product of the fact he is so focused on his work, and the need to make a difference in the world that, like many people who are seeking to make a difference in the world, he has sometimes overlooked friends and loved ones beside him.

      However, she agrees that the remarks about "nobody" wanting to be the Monarch are likely to have riled Charles: I suspect he might have found it quite unhelpful, says Junor.

      Which could just be the royal understatement of the year.

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      Seattle Police Department suspends its Twitch channel following Charleena Lyles controversy

      Facing backlash on its handling of the officer-involved shooting death of Charleena Lyles, the Seattle Police Department will shut down its official Twitch channel.

      As GeekWire reports, the department started experimenting with community outreach over the game streaming platform earlier this year, starting a Twitch channel called Fuzzfeed206. While the effort likely intended to make the citys officers more available to the Seattle residents, it backfired when its public affairs director Sgt. Sean Whitcomb used Twitch to address questions surrounding the death of Lyles, a pregnant woman shot and killed by officers in her home after reporting a burglary. The officers reported that Lyles, who may have been mentally ill, was holding a knife, though many questions remain.

      During the June 21 Twitch broadcast about Lyles, Whitcomb addressed shortcomings in the mental health system, expressing remorse that Seattle officers ended the 30-year-olds life. Our hearts go out to Charleena Lyles family and certainly, most of all, her children, Whitcomb said in the stream. This outcome is totally, totally unacceptable.

      As he spoke, Whitcombs avatar was moving around the digital world of Destiny but not shooting anything at the time. Still, Destiny is a sci-fi first person shooter that displays a characters gun in its fixed point-of-view perspective, another choice that makes the Twitch channel and the choice of game all the much more questionable. Like in many other mainstream shooters, shooting things is the primary way of interacting in Destinys virtual world.

      This was never done maliciously or to cause hurt, Whitcomb told GeekWire. This was meant to answer questions and share information and be accountable.

      The department also maintains a presence on Twitter, Nextdoor, its own blog and Reddit, where officers answer questions in regular Ask Me Anything events. TechCrunch has reached out to both Seattle PD and Twitch for comment and will update the story accordingly.

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      DeepMind Health inks another 5-year NHS app deal in face of ongoing controversy

      DeepMind Health, the division of the Google-owned AI company thats applying machine learning to medical data in the hopes of profiting from diagnostic gain, has inked another services agreement with the U.K.s National Health Service expanding the deployment of an alerts, messaging and task management app, Streams, to a hospital in Taunton & Somerset.

      This expansion comes despite ongoing controversy over the companys first NHS data-sharing agreement. The sharing of 1.6 million patients medical records with DeepMind by the Royal Free NHS Trust during the development of Streams remains under investigation by the U.K.s data protection watchdog, the ICO.

      Patients were not informed nor their consent sought. Yet the Streams app has since been actively deployed in the Royal Frees hospitals. And DeepMind is now forging ahead further, by inking a commercial agreement with a third NHS Trust to deploy the task management app, following an agreement with Imperial College Healthcare NHS Trust last December.

      Announcing the latest Streams app agreement on its blog, DeepMind makes no mention of the ongoing data-sharing consent controversy attached to the apps development.

      At Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust, [Streams] features will alert doctors and nurses to a potential deterioration in their patients vital signs that could indicate a serious problem, it writes. We believe that by making it as quick and easy as possible for clinicians to intervene if something is wrong, well be able to improve patient safety across the hospital.

      DeepMind would not comment when asked about the ethics of expanding a commercial rollout when doubt has been cast over the legal basis under which patients data was obtained and used during the development phase of the app.

      DeepMind and the Royal Free previously maintained there was no need for them to obtain patient consent for the sharing of medical records as the Streams app would be used for so-called direct patient care. However, thisMay a review of the arrangement by the U.K.s patient data safety advisory body, the National Data Guardian (NDG), resulted in Dame Fiona Caldicott taking a very different view.

      My considered opinion therefore remains that it would not have been within the reasonable expectation of patients that their records would have been shared for this purpose, wrote Caldicott in a letter sent to DeepMind and the Trust in question on February 20.

      The NDG has been liaising with the ICO as part of its investigation into the data sharing.

      Asked whether it has had any specific concerns relating to the controversy surrounding Streams, the Trusts deputy chief executive Peter Lewis told us: Clearly we are taking the information governance issues around this very seriously. And weve looked at exactly what we are doing with that app, and will be doing with DeepMind. Clearly weve taken the appropriate advice on that. So were quite clear in terms of what weve done and that its legal, what were doing.

      There is not yet a firm date for launch of Streams within Musgrove Park Hospital, whose website states it treats more than 450,000 patients annually. Were starting on the planning phase just now, Andrew Forrest, CIO, told us. Well be quite open about when were going to start using it as a pilot once we know.

      The Trust also said it does not yet know how many patients medical records will be shared under the arrangement because work has not yet commenced and no data has started flowing.

      In astatement about the forthcoming deployment of the Streams app at Musgrove Park Hospital, the Trust saysthe app will be available at the bedside to alert doctors and nurses to any patients needing immediate assessment, and help them rapidly determine whether the patient has other serious conditions such as acute kidney injury.

      What were doing with DeepMind is not inconsistent around the roadmap we had with digital anyway, addedLewis, in an interview with TechCrunch. In terms of thinking about how do we need to run a hospital if we can really take advantage of what we can do digitally what will make a big difference?

      Data streams under review

      DeepMind co-developed Streams between fall 2015 and 2016 with the Royal Free NHS Trust. The app uses an existing NHS algorithm to push alerts to care staff when a patient might be at risk of a condition called Acute Kidney Injury.

      However, after it emerged how much patient-identifiable data was being shared under the original arrangement, and how regulators had not been pro-actively informed of the project, the ICO initiated a probe.

      DeepMind and the Royal Free subsequently went on to reboot the project viaa new contractin fall last year. Yet underlying data governance questions remain.

      The new services agreement, withTaunton & Somerset NHS Trust, appears, at first glance, to be more a robustly defined entity than the original information sharing agreement (ISA) inked with the Royal Free NHS Trust.

      A redacted version of the services agreement between DeepMind and Somerset has been uploaded to DeepMindswebsite. Several portions have been entirely redacted such as a section listing subcontractors on the project, and a diagram showing a data flow map.

      Notably, though, theres a narrowing of the types of data that are being shared to specify the Somerset Trust shall not provide DeepMind with access to the personal data of patients who are not active patients.

      This contrasts favorably with the first Royal Free ISA, which included sharing historical medical records from patients dating back five years, for example, many of whom may no longer be actively undergoing treatment at the hospital or ever likely to return.

      There also is a limit on DeepMinds processing of Trust patients personal data so it cannot be used to develop software outside the remit of the agreement.

      And there are what look like terms to purpose-limit how DeepMind can exploit any IP that emerges as a result of the collaboration i.e. insights that can be deduced from the data, and/or derived as a result of the company being in a position to see how NHS detection moves through to treatment, for example.

      Again, IPR limits were missing from the first Royal Free ISA.

      Heres the relevant paragraph from the Somerset agreement:

      The Trusts Lewis told us: Two things are really important that we have been very clear about: one is that were not using any patient data for testing. We will use dummy data for testing the app here. And we will then, as we roll it out, we will be using live data and it will only be our clinical staff who are accessing that live data to treat the patients when we do it.

      The second important consideration was the amount of data that is transferred so that were only transferring data that relates to active patients who are under our care So its very clear therefore what patients are active and only transferring data relating to them.

      He added that active patients means patient who are on an open treatment pathway with us, and patients admitted in emergencies in some circumstances given there may also be a risk of A&E admissions developing AKI.

      What weve also done is written to the National Data Guardian outlining this approach not just to seek advice if we are taking the wrong approach but to confirm that we are doing work which is safe and which is legal, added Forrest. We havent started this work yet this is our planned approach.

      Giving an early take on the latest Streams agreement, professor Eerke Boiten, who conducts research in data privacy and ethics, suggested that lots of lessons have been learned by DeepMind after its Royal Free collaboration ran into trouble noting, for example, that the Somerset agreement includes an explicit statement that data will not be linked.

      Concerns have previously been raised about what else the Google-owned company might do with Royal Free patients data as a result of a lack of clearly defined limits in the contract.

      Digitizing health data and delivering apps

      Streams has never utilized anyof DeepMinds AI expertise or its own machine learning algorithms. Although a memorandum of understanding between the company and the Royal Free set out DeepMinds hope to gain data for machine learning research as part of the wider, multi-year collaboration between the pair.

      There is no similar MoU with the Taunton & Somerset NHS, according to Lewis. Nor is there any mention of applying AI or DeepMind machine learning algorithms to its patients data the focus is on text messaging and clinical task management.

      This is specifically about the Streams application. We dont have any other agreement an MoU or a formal contract with DeepMind. Just this one, he confirmed, adding that the Trust has no interest in applying AI to patient data at this time.

      The five-year services agreement with the Taunton & Somerset NHS Trust, which was signed on May 10 this year, covers both the delivery of the Streams app and an underlying patient data API infrastructure whats known as an FHIR API which DeepMind fleshed out in more detail last year.

      While the company began its health tech push by working on a single app (Streams), it has since bolted that to this underlying app delivery infrastructure thereby potentially positioning itself to be a broker for other app developers wanting to push their own apps to NHS Trusts in the future.

      On this possibility the Trust sounded upbeat.

      The whole point of the FHIR development is its open and standardized so that there are options which become available. I think the FHIR standard will become the defacto standard across the NHS completely, saidForrest.

      While the services agreement is tied to Streams, the Trust also is evidently hoping to be able to apply a similar task management app approach to additional conditions in the future with the agreement talking about additional modules that might be developed for the app, i.e. to expand out from just acting as an earlier detection warning system for AKI.

      Lewis explained the aim is to digitize other existing paper-based process though its not yet clear exactly which additional condition alerts might be bolted on to its deployment of Streams in the future.

      This is really based on the patient, so that what weve got in there is data about the patient and about whats happening to the patient while theyre here with us as an in-patient that can help us identify when there are potential problems, said Lewis.

      So whether its about AKI or whether its about sepsis, for instance, we will know when things are happening with that patient that we need to react to. And all of that happens at the moment the problem is a lot of it is recorded manually on paper, and staff have to do specific calculations to calculate whats called things like early warning scores, which means we need to react. So whilst that works well on paper youll appreciate its much better to digitize that and have it done much more in real time, and then the alerts and so on are automated.

      Thats how we really will drive safer patient care through doing this, he added.

      Commercial question marks

      Lewis confirmed to TechCrunch that the Trust did not put out a tender for the development of what it bills as a patient-focused mobile app.

      Rather, the agreement with DeepMind came out of a series of conversations with the company. He noted that the Trust was last year one of a handful named as a global digital exemplar, which led it to various conversations with suppliers aimed at delivering on a digital roadmap.

      We were having a conversation with various suppliers, including DeepMind, and this agreement has come out of that, he told us.I cant remember exactly when the initial contact happened but there was quite an informal contact between us and DeepMind and this just grew out of a conversation that was happening It wasnt something that we deliberately went and said this is what we need to do.

      What we havent done, and havent needed to do, because weve got legal advice for this, is gone out to a full competitive tender process.

      — Peter Lewis

      Is that standard practice for the Trusts procurement of services? It depends on exactly what we are doing and how we are testing those options. So we didnt just say DeepMinds the only option and thats what were going to do weve been looking at alternatives. What we havent done, and havent needed to do, because weve got legal advice for this, is gone out to a full competitive tender process.

      He also confirmed there are no wider agreements with the company such as the Royal Frees MoU.But he declined to disclose anything about the commercial arrangement with DeepMind.

      Were not at liberty to discuss the commercial detail of the contract, said Lewis.

      Commercial terms have been redacted from the ISA uploaded to DeepMinds website:

      On this, a DeepMind spokeswoman told us: The contract is minimally redacted I believe it would be up to the Trust if they wish to disclose any further commercial information.

      Regarding the business model, under our agreement the Trust will pay DeepMind a limited service fee if DeepMind incurs support costs when providing the services. As with our other agreements, we dont believe in charging the NHS for yet-to-be-proven solutions, she added.

      Only when we can prove that we have improved outcomes will we be paid accordingly within IT supplier market rates. Were not driven by a desire to maximize profit, but rather to create a mutually sustainable business model so that we can continue to grow our team, work with more hospitals and, ultimately, help more patients.

      The ongoing lack of any commercial information for the pricing of the Streams service is significant given that this is a service being sold to the public sector. And if NHS Trusts are inking deals with a tech giant without putting out open tenders, there could be legal issues to consider such as compliance with procurement rules, and even concerns relating to possible anticompetitive behavior.

      Although, evidently, Lewis is confident that the Trusts own legal advice on the procurement point is sound i.e. that it didnt need to run an open, competitive procurement in this case.

      Another consideration: The BBCreported earlier that NHS patients are not being offered an opt-out for their medical records to be shared with the Google-owned company.

      Asked about this, Lewis said their aim is to engage with patients so they are aware of the app and its implications.

      We need to work this through. Clearly theres a balance here were trying to be very open about what were doing and therefore we have a process in place from here on about how were engaging with patients to work through exactly how we do that. But this is built on the premise that we are using the information about these patients in this way to improve their care and make them more safe so that particularly were escalating deteriorating patients much earlier and we can therefore react to that, he said.

      Thats the whole premise on which were doing this but we are going to go through that engagement process with patients one so they can understand exactly what were doing, and two so that we can understand those concerns and look at how we can mitigate them.

      The Trust will be holding workshops, displays and open day events with staff and the public in the coming days and weeks, so that people can see how the app works, what it will mean for patients and how it might be developed in future, as it puts it.

      The first of these events will take place on July 17, with information slated to be displayed in the public concourse of the hospital.

      The Trust also has indicated it intends to publish its Privacy Impact Assessment of the agreement with DeepMind though at the time of writing, this document has not yet surfaced.

      In a statement about its ongoing investigation into the original data-sharing deal between DeepMind and the Royal Free, an ICO spokesperson told us: The ICO continues to investigate the sharing of 1.6 million patient details by the Royal Free NHS Foundation Trust with Google DeepMind in support of the testing and development of an alert, diagnosis and detection system for acute kidney injury. We hope to conclude that work shortly.

      We will also speak with Taunton and Somerset NHS Foundation Trust to offer our advice on the law, the spokesperson added.

      Correction: This post originally stated that DeepMinds Somerset services agreement is the second agreement it has inked with an NHS Trust to roll out the Streams app; in fact it is the third. The earlier agreements are with the Royal Free NHS Trust and Imperial College Healthcare NHS Trust.

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      Fruit and veg farmers facing migrant labour shortages – BBC News

      Media playback is unsupported on your device

      Media captionFruit farmers are finding it hard to recruit pickers

      UK summer fruit and salad growers are having difficulty recruiting pickers, with more than half saying they don’t know if they will have enough migrant workers to harvest their crops.

      Many growers blame the weak pound which has reduced their workers’ earning power, as well as uncertainty over Brexit, according to a BBC survey.

      About 80,000 seasonal workers a year pick and process British fruit and veg.

      Most of them are from the European Union, mainly Romania and Bulgaria.

      One in five growers says they already have fewer pickers than they need.

      British Summer Fruits, the body which represents soft fruit growers, says labour shortages are now the worst seen since 2004.

      Recruitment was getting harder even before the vote to leave the EU. But the industry believes Brexit is exacerbating the problem and if access to non-UK workers dries up, it could cripple home-grown berry production.

      Big response

      Their concern is backed up by an in-depth survey of growers by the BBC.

      The questionnaire was sent to members of the British Leafy Salad Association and British Summer Fruits, which represent 90% of growers in their sector.

      There was a big response. Three-quarters of growers completed the survey, which was carried out between 16 May and 5 June, as harvesting started to peak.

      We asked if they had enough seasonal workers for the start of the main picking season:

      • 32% said they weren’t sure
      • 18% said they had slightly fewer than they needed
      • Just over 3% reported having many fewer than required
      • 42% said they had just enough
      • 1% said they had more than enough

      Meanwhile, 78% of respondents said recruitment had been more difficult than last year, with 20% saying it had been the hardest for years.

      ‘Not comfortable’

      At Wilkin and Sons in Essex, the picking season for strawberries is in full swing. But this year, they have 20% fewer workers than they would like.

      “We’re managing, but we’re not comfortable,” said joint managing director Chris Newenham.

      “Our seasonal workers are a critical resource for us to be able to save our crop each year. And the logical extension of not being able to harvest that crop is that we will have to bring our production in from overseas and that’s a position none of us want to see. ”

      He’s not the only one. Of those surveyed, 71% said they would consider reducing UK production if there were future restrictions on seasonal workers.

      British Summer Fruits has commissioned its own separate report, just published, on the potential implications for its growers, and consumers, of Brexit.

      It warns that soft fruit prices could rise by up to 50% if the UK relied solely on imports.

      “It is inconceivable that people who voted to leave the European Union wanted to destroy an iconic and incredibly competitive British horticulture industry,” said Laurence Olins, chairman of British Summer Fruits.

      “Failure to secure the future of soft fruit production in the UK will have a negative impact on the economy, family budgets, the nation’s health, UK food security and the environment,” he added.

      So why doesn’t horticulture, now a 3bn industry, simply try to employ British workers?

      The answer is straightforward for Beverley Dixon, from G’s Fresh, which employs some 2,500 seasonal workers growing salad crops across large areas of Cambridgeshire and Norfolk, as well as other farms dotted across the UK.

      “We operate in areas of such low unemployment, so here in Cambridgeshire, it’s less than 1.5%,” she said.

      “So there simply aren’t the people available to do the work, added to which UK people tend to want permanent year-round work and this is seasonal work.’

      Reliance on migrant workers isn’t a specific challenge for the UK, according to David Swales, analyst at the Agriculture and Horticulture Development Board.

      “If we look at other developed countries around the world, places like Australia and New Zealand, they source labour from the Pacific Islands.

      “In the US, they source labour from Mexico and the Caribbean countries. So there are a number of places where countries have to go outside their borders to source the seasonal workers that they need,” he added.

      Obvious solution?

      The nationalities of these workers have changed over the decades in the UK. There used to be a seasonal agricultural workers scheme which allowed growers and farmers to attract workers from across the world.

      The industry says it worked and believes it’s the obvious solution now Britain has decided to leave the EU.

      During a recent select committee inquiry into seasonal labour shortfalls, the government said net migration figures showed that sufficient labour was available in the UK and that there was currently no need for a seasonal agricultural workers scheme for migrants.

      The BBC survey is hard evidence that recruitment has proved tougher this year, with some shortages reported.

      A government spokesperson said: “The government places great value on the UK’s food and farming industries, both as a crucial component of the UK economy and of the fabric of rural Britain.

      “We are determined to get the best deal for the UK in our negotiations to leave the EU, not least for our world-leading food and farming industry, which is a key part of our nation’s economic success.”

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      Alcohol-linked deaths ‘54% higher in Scotland’ – BBC News

      Image copyright Thinkstock

      An average of 22 people a week died from alcohol-related causes in Scotland in 2015, figures show.

      The figure is 54% higher than in England and Wales.

      NHS Health Scotland looks annually at the nation’s relationship with alcohol – bringing together information on sales, price, consumption, deaths and hospital admissions.

      Alcohol-related death rates were six times higher in the 10% most-deprived areas than in the 10% least deprived.

      The report highlighted inequalities, with alcohol-related stays in hospital nearly nine times higher in the 10% most-deprived areas than in the 10% least deprived areas in 2015/16.

      ‘Harmful consequences’

      In 2016, the equivalent of 10.5 litres of pure alcohol were sold per adult in Scotland, representing 20.2 units per adult per week.

      Official guidelines advise against men and women drinking more than 14 units a week on a regular basis.

      NHS Health Scotland said this meant enough alcohol was sold last year in Scotland for every adult to exceed the weekly guideline by 44% every week of the year.

      Sales of alcohol per adult per week were 17% greater in Scotland than in England and Wales – although the rate, which had increased between 2013 and 2015, returned to a similar level as in 2013.

      Image copyright Getty Images

      The alcohol-related death rate was more than twice as high in men as in women, with 30 deaths per 100,000 of the population in men compared with 13.8 deaths for women.

      Public health intelligence adviser Lucie Giles, lead author of the report, said: “It is worrying that as a nation we buy enough alcohol for every person in Scotland to exceed the weekly drinking guideline substantially.

      “This has harmful consequences for individuals, their family and friends as well as wider society and the economy.

      “The harm that alcohol causes to our health is not distributed equally; the harmful effects are felt most by those living in the most disadvantaged areas in Scotland.

      “Alcohol has become more affordable in recent years as disposable income has increased.”

      The report’s authors also highlighted some “encouraging” findings, with self-reported consumption data showing the proportion of people drinking at harmful levels had fallen while the proportion of non-drinkers had risen.

      ‘Cheap and high-strength’

      Meanwhile, the proportion of children reporting drinking in the last week had fallen over time, according to the study.

      For 13-year-olds, it dropped from 23% in 2002 to 4% in 2015, and for 15-year-olds from 46% in 2002 to 17% in 2015.

      Rates of driving under the influence have fallen consistently over time, from 21.8 per 10,000 population in 2004/05 to 10.2 per 10,000 population in 2015/16.

      Public Health Minister Aileen Campbell, said: “This report shows that, whilst some progress has been made in tackling alcohol misuse, we need to do more.

      “Over the last few years, more than half of alcohol sold in supermarkets and off-licences was sold at less than 50p per unit and enough alcohol was sold in the off-trade alone to exceed the weekly drinking guideline by a considerable amount.

      “That is why we need minimum unit pricing, which will largely impact on the off-trade and will increase the price of the cheap, high-strength alcohol.”

      Alcohol Focus Scotland chief executive Alison Douglas, said: “Alcohol is so cheap and widely available that it’s easy to forget how it can damage our health.

      “We need to introduce this long-delayed policy as soon as possible to improve Scotland’s health, cut crime and save lives.”

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      Is it safe to live on a former landfill site? – BBC News

      With the need for more housing, developers are moving in to build on top of former landfill sites. But how safe are these places, and should people be concerned about living on top of them?

      The UK dumps nearly 50 million tonnes of industrial, commercial and domestic waste into landfill sites every year – enough rubbish to fill Wembley Stadium to the brim more than 50 times over.

      The process is tightly regulated. Meticulous records are kept of what we dump and where we dump it.

      But landfill hasn’t always been this well managed – and Britain’s appetite in years gone by for filling huge holes in the ground with waste is beginning to haunt us.

      There are 20,000 former landfill sites across the UK – 1,200 of them are on England’s coastline. File on 4 has had exclusive access to an unpublished report commissioned by the Environment Agency, looking at these sites and the impact of flooding and coastal erosion.

      Prof Kate Spencer from Queen Mary University of London led the investigation and has now raised serious concerns about the impact not only on the environment – but on public health.

      Image caption Historic landfill sites buried underground are being exposed by coastal erosion

      One example can be found on Clinker Beach in East Tilbury, along the foreshore of the River Thames in Essex, where a layer of old clothes and plastics hangs out of a muddy bank. The spot has become a popular spot for treasure hunters.

      “You see people rummaging through it, picking up bits of material and taking them home. Certainly I wouldn’t touch any of this without gloves,” says Kate.

      “Here on the floor you can see these little black cylinders – they’re the cells from inside old batteries and we know that batteries used to contain lead and mercury. We’ve analysed the waste and it contains pretty much all the nasty chemicals that you can think of at concentrations that would be predicted to cause significant ecological harm.”

      She says it would cost billions of pounds to clean up all the sites so it is important to identify which pose the biggest threat.

      “We need to come up with some suitable management scenarios. The ultimate responsibility either lies with the local authority or with the Environment Agency but I don’t think they have the resources to deal with it.”

      Image caption Barry Falgate, site manager at Dunbar landfill

      In 1990, the Environmental Protection Act set out a regime for regulating and licensing the disposal of controlled waste.

      One site in Dunbar, on the east coast of Scotland, handles 5,000 tonnes of waste every week from Edinburgh, which is around 30 miles away.

      “Before we put any waste in, we put in a metre of engineered clay,” explains site manager Barry Falgate. “Then it’s lined with a heavy duty plastic, then gravel on top, which catches the water which comes from the waste as it degrades.

      “Then, when we’ve finished, we put plastic over the top and then we put soils on it. We have the aftercare of this site for at least 60 years, so we want to make sure that that waste is safe and we can control the waters and gases out of it. I was brought up around here so I care what we do.”

      The Department of Environment, Food and Rural Affairs used to offer grants to local authorities to clean up contaminated land, via the Contaminated Land Capital Projects (CLCP) programme. This funding stream came to an end in March this year.

      Image caption Prof Kate Spencer says managing former landfill sites is essential

      In Amber Valley in Derbyshire battle lines are being drawn, where a developer wants to build 200 homes on a former landfill site.

      “My mum stopped growing vegetables because of what was under the ground here,” says campaigner Kellie Judson.

      “We used to get foul smells on my mum’s garden when I was a little girl – a TCP smell and an eggy smell.”

      Amber Valley Rugby Club now occupies the former landfill site – but they’ve been offered brand new facilities by the developer if they move.

      Underground testing has shown that remedial work could make the area safe, but Kellie and other residents are worried about an adjacent former landfill which contains known hazardous waste.

      “We’re concerned that contamination from the other site could potentially leach on to this one – that disturbing the ground in this area could pose a threat to people living locally,” she says.

      Image caption Kellie Judson is leading the campaign against 200 new homes near a hazardous landfill site

      The development has twice been turned down by the planning board of Amber Valley Borough Council and it goes before the planning inspectorate next month.

      Whether it goes ahead or not, little will be done to further risk assess the surrounding area unless something new emerges, because government guidelines don’t demand it.

      The deputy leader of the council, Trevor Ainsworth, supports the development plans.

      “There are things in the ground that, on the face of it, would be dangerous to human health. However I know it can be remediated and made safe. It is one of our policies that we regenerate land that has been used as tips – lots of houses now have been built safely on old tips,” he says.

      Image caption President of Amber Valley Rugby Club, Steve Evans, is backing the development, which includes plans for new pitches and changing rooms for the club

      A spokesman for Defra told the BBC: “Our revised Statutory Guidance means more resource can be directed to those sites most in need and allows local authorities to take a more stringent, risk-based approach when identifying and cleaning up contaminated land.”

      The Local Government Association said: “Councils take this issue very seriously and work closely with the Environment Agency, continuing to monitor sites long after they have closed.”

      File on 4: What Lies Beneath – The Legacy of Landfill is on BBC Radio 4, 20 June at 20:00 BST – catch up on BBC iPlayer Radio.

      Have you got something you want investigating? We want to hear from you. Tweet us or email

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      What fathers do

      Some fathers do these things.

      Some fathers go to the Columbus Public Library used book sale in about 1980 and buy five big boxes of books on every topic. They place those books in a playroom and they result in a consistently relevant personal library for his kids. Every year they learn something new out of that room.

      Some fathers take their sons and daughters to Computer Express, a small computer shop, after taking you to Radio Shack and Sun TV and deciding the prices there are too high. Some fathers help you decide on an Atari 800XL with tape drive and they buy you River Raid to go with it.

      Some fathers buy you a modem and let you call BBSes all night.

      They take you to Boy Scouts and help you win the local Pinewood Derby. They drive you to Bell Labs where you learn UNIX and shell scripting.

      Some fathers sit with you and type in programs out of the back of ANTIC Magazine.

      They convince the family it wants a dog and picks a special breed, a Kerry Blue Terrier, because it doesnt shed.

      They get drunk at the Sheraton hotel bar happy hour and fall out of the car and turn you off alcohol until late in college. Thats when you really find you have a taste for it.

      Some fathers help you with your science fair projects and explore wind power with you by making balsa wood models of various generators.

      Some fathers give you phone wire, broken stereos, and a soldering iron and tell you to experiment. You do. Some fathers have a garage full of tools and show you how to cut wood and fix brakes and listen to NPR on a broken radio.

      Some fathers buy you a Packard Bell 286 and help you learn programming.

      Some fathers leave a basket of vinyl in the basement and in it you find Dylan, the Stones, and Janis Joplin, thereby making you the least pop-culturally-aware high schooler in Columbus.

      Some fathers work for 40 years at the same boring job to pay for a house and food.

      Some fathers take you to Europe and show you the magic of travel. They buy you Mad Magazine in German.

      They take you to Mad Magazines offices in Manhattan where you meet Dick DiBartolo, Nick Meglin, and Bill Gaines. That could inspire you to be a writer.

      They marvel at your new novel, The Tale of the White Worm, you write when youre twelve. They edit your school essays and, one night, they write an entire research paper about The Crucible for you because youre sick.

      Some fathers drive you from college to college looking for the right one. Then some fathers come drive you back from the right college every summer because you dont have a car.

      Some fathers help you sell your car when you move to Poland for work.

      Some fathers come to your wedding in Warsaw.

      They Skype you almost every day, leaving cryptic messages and posting links from Craigslist. Some fathers listen to Rush Limbaugh all day because hes a pleasant distraction.

      Some fathers drive twelve hours to visit you in Brooklyn.

      Some fathers get grumpy.

      Some fathers still make you laugh.

      Some fathers get lung cancer.

      Some fathers make you scared.

      Their failing health encourages you to run again and quit drinking because watching a man who looks so much like you get sick is frightening. But it also encourages you to reconnect with him.

      I know: Some fathers beat you. Some fathers leave you. Some fathers die early. Some fathers are cruel. Some fathers die inside.

      But some of us get lucky.

      Some fathers are great. Some fathers are kind. Some fathers educate, expand, and elucidate. Some fathers give all.

      Some of us get lucky.

      Happy Fathers Day.

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      Feminism, politics and death: my mum died the night Hillary Clinton lost

      They may seem like unrelated events but the end of Clintons campaign and my mothers life made me reflect differently on my own political career

      My mother died the night Hillary Clinton lost. These might seem like two very unrelated events and youd be right about that. But for me, and my somewhat particular circumstances, Ive found a plethora of meaning about life and death, feminism and politics.

      See, it was also the night I was due to be sworn in as a councillor for my local city council. It was my first political foray and Ive reflected on the start of my own political journey while on the other side of the world a smart and skilled female politician saw the end of hers, with our whole gender brutalised by a despicable Trump. And though Mum doesnt know it, all my political guts I got from her.

      Mum was diagnosed with breast cancer 10 days before the 2016 Australian federal election. Dad called me from Canberra to say he had taken Mum to hospital and she had acute pneumonia. I was going through the processes of my Labor nomination for council elections. With days to the federal election, every spare moment I wasnt working I was door-knocking and pre-polling.

      I dont remember that first conversation with Dad. I do remember the call the next day when Dad told me Mum had terminal cancer (as well as acute pneumonia) and the cancer had spread through her ribs, spine and pelvis. I was at my desk so I booked a flight home and, as I headed out the door, asked a colleague to cancel me out of every election activity I was signed up for.

      Breast cancer is a disease that inflicts itself predominantly on women. Its also one of the most misdiagnosed cancers around. Mum had her last mammogram only months earlier and it hadnt appeared. I grew bitter quickly.

      At the same time this was a federal election where it was one bloke versus another bloke versus another bloke, and women barely seemed to get a mention. I had volunteered the bulk of my time on campaigns to support female candidates in tough Victorian seats, none who won. I sat bedside my mother who taught me everything and watched women largely erased out of public life.

      On Sunday 3 July, a day after the federal election Mum was only in the second week of a disastrous five week stint in hospital my journal shows compassion draining out of me:

      I suspect I will grow rough and battle hardened and unforgiving from this. A part of me hopes I will. Perhaps I will grow ruthless and mean and brutal like life and that might make me powerful like men. I dont think Mum will like the new me. Ill have an excuse to be mean now, finally.

      I thought at length about quitting the council race. We didnt know the timeline Mums cancer was working to, although wed been told up to 24 months for stage four breast cancer. I was enjoying caring for her and all her needs. But quality of life for Mum was also about quality of life for her daughters and, honestly, I just always thought shed make it a little longer.

      So I ran my council campaign in between working full time and flying back home to care for Mum, alternating every second weekend with my sister. Offering a parallel world to my campaigning life, my life with Mum gave me such relief. I loved the quiet nights I shared with her. From the carers bed in her room, I would lie facing her and would listen for her breathing as her lungs drew in air from her oxygen tank.

      In late October, I won the third and final spot at the council ward elections; Mum went back into hospital and I flew home again.

      While nothing can prepare you for the death of a parent I did everything I could to prepare myself. I read memoir and non-fiction (by women) and I talked with women who had experience, both personal and professional.

      In the final days, as Mum slept sedated, I read A Very Easy Death by Simone de Beauvoir. It was the 50th anniversary of the translation of the French feminists account of her mothers death. The months of that death also mirrored my mothers own: a few long weeks over October and November.

      De Beauvoirs mothers death was frightening to me because it was everything her maman didnt want. She wasnt ready for death and her medical wishes were not respected: the doctors operated on her even though she had begged de Beauvoir that she wouldnt let them touch her body. Her final moments were full of pain and distress. De Beauvoir wasnt even there as she had slept through the panicked phone calls from her sister.

      I was not watching the US election results that afternoon and evening in November. Mum was at Canberras public hospice set amongst beautiful gardens and overlooking Lake Burley Griffin. For the last few days she had been heavily sedated. Mums breathing changed late in the afternoon and we knew, not long now.

      In academia, philosopher Michel Foucault called it a heterotopia, but most of us might think of it as a bit of a headfuck, a space or place in time that has more meaning or relationship to another space than it might first appear. As my mum lay dying, I was in a room full of strong women with her. My cousin brought in the bad news from the US and I slumped in my chair beside Mum, overwhelmed by yet more insurmountable grief. I thought if I was back in Melbourne, if my mum wasnt dying, Id be at my council ceremony right now and Hillary might even have been winning but here I was in this awful parallel universe that happened to be real.

      Mum died that night. A little after midnight, I woke from a light doze and Mum was turned slightly in her bed, facing me and she had stopped breathing. I leaned in close and checked for a pulse on her wrist. Her skin was so perfectly warm. The family all woke and we said our goodbyes.

      I stayed with Mums body till morning. I picked out clothes for her as the nurses cleaned and dressed her. Then finally watched on as they are you ready for this? put Mums body into the transport bag. I followed the nurses as they pushed her bed down the hallway to the cold room, where I thanked them and having already said my goodbyes, left for my car and for my first day without my mum in a bleak, bleak new world.

      In the months after, it was through the company of women, and particularly women who have lost their mothers, that I have found my feet again. I havent turned bitter and mean as I once thought or hoped I would. My feminism is softer with new compassion but also bolder with new militancy.

      Im still finding my political feet, but Ive been elected to a council with majority women membership plus we have a female mayor and CEO too. At every council meeting I reflect deeply on the values, learnt from my mother, that drive my decision-making even if at times they wont make me popular.

      I dont see much of Hillary in the news these days, which Im thankful for. It reminds me of Mum each time and when I do, bystanders watch me dab at my eyes and think she must really have liked Hillary. Little do they know that was the night my mum died.

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