Transforming Technology: The Self- Driving Cars Debate

Politics, Science and Technology Studies, science policy

CaptureLast week I took part in a Guardian Pubic Leader’s debate on transforming technology. The newspaper had assembled a group of ‘experts’ to discuss driverless vehicles, data and government regulation. The group was made up of a number of those involved with developing driverless and vehicles – and me, billed as ‘the ethicist’.

The discussion was interesting. You can read the edited version of the thread here. The topics ranged from how data from self-driving cars should be stored, to what the government’s priorities should be.  But overall, the gist of the discussion was that driverless cars are coming, they are going to be good and we need the government to help their progress by removing barriers.  One of the participants in particular voiced her view that her dream was for all cars to be driverless by a certain point in the future.

I, of course, had to spoil the party. Because the promise of self-driving cars is far from straightforward. As my colleague Jack Stilgoe has written extensively, there are serious questions about the desirability, practicalities and safety of autonomy.

For me however, the questions are much more around who decides and who benefits. It is easy to see why rich entrepreneurs in Silicon Valley are pushing to develop these cars, but underneath their claims of safety and ease of use are more sinister matters of ownership, power and money. While it makes no sense to spend tens of thousands of pounds on a lump of metal that sits outside your house most of the time, do you really want to hand over your freedom to move around the country to a group of large, unaccountable corporations? If you’ve tried booking a room on Airbnb during a busy conference or holiday period, you’ll have experienced their surge-pricing algorithm – do you want to rely on that to budget your daily commute? And how keen are you on letting Uber or Google know your every move? There is much more at stake than simply who sits behind the wheel.

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Communicating Science in Post-Truth Europe

Science Communication

berlin-embassy

Last week (28th February 2017) I had the honour of giving a keynote speech to a group of science communicators at the British Embassy in Berlin, Germany.

The theme of my talk was ‘Science Communication in a Post-Truth Europe’ and my aim was to reflect on the current political situation in Europe – particularly the rise of populist views, which to many seem to be non-evidenced positions – and to put forward some concrete proposals for things science communicators can do.

I thought I would share my key points:

Firstly, people aren’t necessarily rejecting the science and enlightenment values, but instead are experiencing the world very differently to the way that experts are describing it. I have written more about that previously here and spoken about it at the Wissenschaftcommunikationforum 2016 and in my UCL STS departmental seminar in December 2016.

Secondly, we know that people base their opinions on more than facts. This is particularly true in science – and researchers in science and technology studies have spent decades evidencing and explaining this. I gave a bit of history, telling the story of how, in the 1980s and 1990s, we believed that improving the public’s understanding of science would make them more knowledgeable and so supportive of science. Research in the 1990s however revealed that the relationship between knowledge and attitudes is more complicated than simply “to know it is to love it”. In particular, Durant, Evans and Thomas (1995) carried out a survey of knowledge and attitudes of 2000 members of the British Public and concluded that understanding of science is weakly related to more positive attitudes in general, but it is also associated with more coherent and more discriminating attitudes. They argued that knowledgeable members of the public are more favourably disposed towards science in general, but are less supportive of morally contentious areas of research than are those who are less knowledgeable. This makes sense if you think about (for example) anti-nuclear protestors, who tend to be very well informed about the science and technology, despite being firmly against it. Indeed the more information they get about the technology, the more firm those anti-views become. Something else is driving their attitudes.

Instead, I explained that lots of research in science and technology studies has shown that factor like existing technologies and cultural frames of reference – that is, interests, values, previous experience and ways of responding to and interpreting the world – also shape people’s evaluations of technologies. For example, in my own research, I have found that people’s views of carbon capture and storage technologies (CCS) are strongly shaped by comparisons to nuclear and wind energy, and by trade-offs between particular energy futures (Lock, Smallman, Lee, & Rydin, 2014); and that a sense of ‘naturalness’ strongly affects views on the limits that should be put upon research (Smallman, 2016).

Added to that, trust in sources is important too – and gaining trust isn’t simply a communication exercise, but it involves changing your organisational behaviour to become trustworthy. This, I explained was the approach we took when I was leading science communication for the UK Government Department DEFRA in the mid 2000s – admitting our mistakes, rectifying them and then communicating what we had done to fix them. It was a long slog, but it paid off in the end, because for an organisation like Defra, reputation means more than popularity – as the department in charge of emergency responses to sudden disease outbreaks, for example, it was essential that they were trusted in order to gain support and compliance with actions and policies.

Finally, as well as acknowledging your audience’s values and framings, I highlighted how important it was that the scientific community also acknowledge the values and framings they bring to science. In particular, I explained how my own research looking at public and expert discussions of science and technology has shown that while scientists see science as a problem solver, with social and ethical issues seen as further obstacles to be overcome with more science, the public see these same issues as inherent parts of the science and technology, that need to be traded off with the benefits. To be good communicators, to address this seeming distrust of expertise, we need to recognise the perspectives we bring, and allow them to be opened up and challenged.

Are Robots Rubbish?

Science and Technology Studies

An elderly man was in the queue in the newspaper shop in a busy London station. Seeing that there was a long wait, a shop assistant suggested that the man use the self-service check-out where there was no queue. “Goodness Gracious no!” the elderly man replied “I will not talk to robots”.

This story, shared widely on Facebook, might be comical and apocryphal, but it raised an important point for me. It made me realise that robots are indeed amongst us. But rather than being little humanoid characters that steer our space-ships or even do our housework, their most familiar cry is “unexpected item in the bagging area”. So what happened to science’s dreams of robots bringing us a better, labour-saving future? And does it matter that such high aspirations have produced something so mundane – and perhaps annoying? Should we be less concerned about ‘rights for robots’ (as Nature magazine has argued as recently as March 2015 than just how disappointing they are?

Authors in my field of Science and Technology Studies (STS) have written about how imaginaries of science and technologies play a role in shaping the development of these technologies – and in shaping our worlds too (Jasanoff & Kim, 2009, 2015). These sociotechnical imaginaries also help to make the case for ongoing investment in science and technology, and, at the same time advances in science and technology help demonstrate how the state (in investing in technology) is acting for the public good (Jasanoff and Kim 2009).

Given how these imaginaries help scientists and engineers build support, attract resources and interest, Mike Michael (in Brown, Rappert, & Webster, 2000) argues that promises of technologies become inflated in order to get attention, especially in the early stages of technological development. When the mundane nature of the reality of the technologies comes to light however, the early hype eventually gives way to disillusionment (Nik Brown & Michael, 2003). Arguably this is what has happened with our robots. Rather than producing life-changing applications, technologies which were once imagined to be great – and into which considerable amounts of public money have been invested – now manifest themselves in our lives as ways for large corporations to increase profit by pushing the customer into unpaid labour. While other, more life-enhancing, applications might come along in the future, the risk is that our understanding of what robots are will be forever changed, based on our experience with these more modest versions.

So are we destined to be disappointed with robots and could this lead to a wider disillusionment with science and technology’s power to improve our lives? In his book ‘Our Robots, Ourselves – robotics and the myth of autonomy’ (Mindell, 2015) MIT STS Professor David Mindell argues not. Having spent years working on undersea robotics and looking at military applications, he concludes that the aspiration of fully autonomous robots is both unrealistic and undesirable. He describes how soldiers in the field, looking at autonomous helicopters, reported that they want to work with equipment that is predictable and with a fixed pattern of behaviour, rather than a machine with ‘a mind of its own’. As a result, ‘behaviours’ of robots had to be reduced dramatically, such that they were at best semi-autonomous. And you could imagine this idea working more widely – in self driving cars, for instance. While it would be amazing to hand over control of the car to a machine as you’re cruising down a sun-drenched highway, do you really want a teenage programmer in Seattle to have decided how your car reacts when a cat runs out when you’re driving on a foggy, icy lane? Mindell believes that we don’t. Rather than thinking of anything but fully-autonomous robots as disappointing, he argues that we should be aiming for what he calls ‘a perfect five’ – the sweet-spot somewhere midway between full autonomy and fully-operated robots. In other words, the kind of world human beings really want is not the same as our science fiction fantasies. And that this human world is more likely to be fulfilled by creating less autonomous and more mundane robots.

This might be a very practical and real world adjustment of technological aspirations. But it still leaves a big question for science – what do people expect from robotics and what happens when they realise the mundane nature of these machines? Back in 2007, I was involved in a series of public dialogue events in the UK called ScienceHorizons, which specifically discussed robotics. The robotics researchers who presented their science at these events had to spend considerable time explaining to the public participants that robots were not, nor likely to be, humanoid characters. Nevertheless, participants were enthusiastic about the idea of such characters helping with household chores and continued to express concerns that robots might have quasi-human emotions and intellect. On one hand, these concerns seem to be expressing a desire for Mindell’s ‘perfect five’ of semi-autonomous robots. On the other hand, they are perhaps belying a far more ambitions dream of the potential of robots – as machines that can learn, interact and help us live more fulfilling lives.

And that last point is perhaps the most important. Because it brings into sharp focus a real-world enactment of the STS concept of coproduction – that natural and social orders are produced together (Jasanoff, 2004). In creating robots we are creating a particular kind of world. The elderly man’s view of a robot as a shoddy human replacement, my disappointment in the mundaneness of the self-scan machines and the resilience of the aspirations of the participants in the dialogue in the face of scientists attempts to modify their expectations, represent three public views of robots. And underlying these views, there appears to be a disappointment in the kind of world produced by the boring robots as much as a disappointment in the machines themselves. And this should be of concern to scientists and engineers, because the collective visions of good and attainable futures that science and technology helps us create are not just serving to shape science, but they also serve to legitimate it too. So if people are disappointed with the kind of world that rubbish robots help make, we shouldn’t be surprised if one day, they are disappointed with science too.

 

Bibliography

Brown, N., & Michael, M. (2003). A Sociology of Expectations: Retrospecting Prospects and Prospecting Retrospects. Goldsmiths Research Online, 15(1), 3– 18. Retrieved from http://research.gold.ac.uk/2379/2/SOC_Michael_2003a.pdf

Brown, N., Rappert, B., & Webster, A. (2000). Contested futures: A sociology of prospective techno-science. Ashgate Aldershot, UK:

Jasanoff, S. (2004). States of Knowledge: The Co-production of Science and the Social Order. Retrieved from http://www.amazon.co.uk/States-Knowledge-Co-production-International-Sociology/dp/0415403294

Jasanoff, S., & Kim, S.-H. (2009). Containing the Atom: Sociotechnical Imaginaries and Nuclear Power in the United States and South Korea. Minerva, 47(2), 119–146. doi:10.1007/s11024-009-9124-4

Jasanoff, S., & Kim, S.-H. (2015). Dreamscapes of Modernity: SOCIOTECHNICAL IMAGINARIES AND THE FABRICATION OF POWER. (S. Jasanoff & S.-H. Kim, Eds.). The University of Chicago Press.

Mindell, D. A. (2015). Our Robots, Ourselves: Robotics and the Myths of Autonomy. Viking. Retrieved from http://www.amazon.com/Our-Robots-Ourselves-Robotics-Autonomy/dp/0525426973/ref=sr_1_3?ie=UTF8&qid=1429574481&sr=8-3&keywords=david+mindell

 

A Science Communication Strategy for Europe

Science Communication

Last week, 25 science communicators from across Europe, gathered in a remote village in the North of Germany to discuss the future of Science Communication. I was lucky enough to be one of the 25, who ranged from university press officers, to freelance podcasters, who made up the ‘Siggen Circle’.

Over our time at the beautiful Gut Siggen, we shared our experiences of communicating science, presented current and future trends and set out to develop a common plan for taking science communication forward over the next 10 years. It was an intensive environment and whether we were hiking to the beach or in workshop sessions, the future of science communication was not off our minds.

During the final day, I worked in a small group looking at the future of science communication from the perspective of the public, or society. Our task was to think about what people want from science communicators.

Up until that point, as is the case in the field in general at the moment, the focus of the meeting had been on public participation and citizen science. But while we all knew that the relationship between knowledge and attitudes to science and technology is much more complicated than the deficit model suggests (or ‘to know it is to love it’), we acknowledged there are still some people with an appetite for more information about science. More importantly, there are instances where it is vital that we can communicate scientific information to large groups of people – during emergency situations such as floods, or in order to protect populations by vaccines, for instance. Discovering more effective ways to give information in these circumstances is a useful activity that has become desperately unfashionable over the past 20 years.

Alongside that there appears to be an unmet appetite amongst some not just to know science, but to get involved too. And the growing potential to process big-data is whetting scientists’ appetite to involve citizens in their research too. We heard from colleagues involved in citizen science projects about how much potential there is to help people understand the process of science as well as the excitement of science.

Beyond that however, my group agreed that it was also important to enable people to have a say in the course and direction of scientific research – not least to make sure that science really does address the kinds of issues that wider society is concerned about. We did however acknowledge that for participation to be truly effective, decision makers have to be committed to taking the views expressed into account.

Pulling these three discussions together, we agreed that a European science communication strategy that meets the needs of the public needs at least three strands:

  1. Letting people know about science
  2. Letting people have a go at science
  3. Letting people have a say-so about science.

These three strands together, seem to offer a coherent approach to science communication not just for Europe, but for National Institutions wanting to clarify their role too.  Rather than forcing a choice between information giving and public participation, with this approach, we can tailor our approach to the needs of the audience by acknowledging that some people want information, while others want more of a say in the direction of science, and others still want to get involved. We can be truly effective science communicators.

At the end of the workshop, we had produced a draft ‘text’ that lays out our aspirations and proposals for the future of science communication in Europe, which we will be refining over the next few weeks, before sharing it more publicly (hopefully) in the run-up to the ESOF Conference in July. So watch this space.

Out of the Loop – why public dialogue finds it hard to influence policy.

Science Communication, science policy

This article first appeared in Research Fortnight, February 2015.

Fifteen years ago, in the aftermath of Mad Cow Disease, the House of Lords Select Committee on Science and Technology looked into the relationship between science and the public. Their report, ‘Science and Society’, published in 2000, identified a ‘crisis in trust’ between the public and science that, if ignored, could lead to technology being ignored or abused. In response, the report called for a ‘new mood for dialogue’, which would ‘help the decision-maker to listen to public values and concerns; and give the public some assurance that their views are taken into account, increasing the chance that decisions will find acceptance.’

Since then the old ‘deficit model’ style of public understanding of science, which focused upon explaining science to the public in order to build support, has largely been replaced in most funding structures by a public engagement/public dialogue approach. In this approach, the public are invited to debate and discuss science with various experts and organisations, through activities ranging from formal debates and Q&A sessions, to consensus conferences and citizens juries. Through programmes like ScienceWise, numerous public dialogue activities have taken place on new and emerging areas of science and technology – from nanotechnology and synthetic biology, to human-animal hybrid embryos and stem cells.

So what have we learned from talking to the public about science and technology and has it made a difference? For the past few years this is one of the questions I have been trying to answer. I have been looking at how the public talk about science and technologies in reports of public dialogue events and comparing this to how ‘experts’ have been discussing the same issues in the various reports from the learned societies, and how policymakers settle the matters in their final policy reports. While there are some echoes of the public’s voice in the policy reports, particularly around the need to anticipate and act upon unforeseen consequences, it is clear that the policy reports are more closely aligned with they way in which scientific ‘experts’ see science and innovation. Interviews with government officials, advisers and politicians have reinforced this conclusion – the views of expert bodies, rather than the outputs of public dialogue, appear to be the key sources of advice for policymaker.

Why is this the case and should we be concerned? One possible explanation lies in the visions of science that emerge from the public dialogues. For the public, science is seen as a source of progress – particularly in biosciences’ ability to produce medical cures. But this sense of progress is tempered with a clear understanding that the benefits that science and innovation can offer come hand in hand with risks, downsides, social and ethical issues and unforeseen consequences. While science represents progress, it has also caused problems and these problems are inherent in the science itself. The experts, in contrast, talk about science as a much greater force for progress bringing about changes beyond medical cures, and offering the power to address the really big problems ahead – particularly around the economy and the environment. Social and ethical issues are seen as being either the result of poor public perceptions or insufficient scientific knowledge. Downsides can be dealt with by more information or more research. For a science policymaker operating under the constant eye of the Treasury, and where science is seen as an important driver of economic growth and competitiveness, it is possible to see how this ‘expert’ vision of science is much more helpful as it offers a way to develop innovation while managing away any associated problems.

Interviews with policymakers tell a more complex story though. All of those I spoke to understood the nuanced nature of the role and challenges of science within our society – and how inter-related they were. They were also clear that the views of wider society needed to feed into the decision-making in a meaningful way. They did however have very different understandings of how this would happen. Firstly, they were keen to take advice from ‘experts’ – whether that was legal advice on ethical matters, hearing the implications of a particular policy from service users or particular faith groups. The outputs of public dialogue, with its focus on deliberately lay views, appear to fall outside this category of ‘expert advice’. Secondly, policymakers rely heavily on their networks for advice and support – and public dialogue activities also appear to be outside these networks. As a result, when public input is needed, other sources of advice are turned to – networks of stakeholders and, for politicians, feedback at advice surgeries and in their post-bags.

So where does that leave those championing public participation in science? Firstly, I would argue that the dialogues to date have helped us develop a more detailed understanding of how the public conceptualise and come to know new technologies. This understanding could and should help to make public policy – and science and technologies – more in-line with wider societal concerns. Secondly, while politicians appear to access alternative sources of public input, officials, arms-length bodies and research scientists don’t have that same regular and direct access to outside voices. Indeed officials made up the group that mentioned reports from ScienceWise projects most often, and they had clearly been affected by them. Public dialogue activities in the UK could perhaps have the most value in supporting decision-making at this level and in building themselves into the policy networks that exist. Finally, and perhaps most importantly, airing inconvenient truths is in itself valuable, regardless of whether they are acted upon by those with power. As science and technology continues to change almost every aspect of our lives, continuing to question and challenge the way in which we come to terms with these changes has to be a vital role in a healthy democracy.

Why the world needs more female scientists

science policy

I am currently helping set up the UK hub on Responsible Research and Innovation (RRI) at UCL. One of the keystones of the concept of RRI is gender. Responsible research is research which reflects the views of society – men and women. To me, this must mean more than the traditional ‘women in science’ approach that aims to get more women doing science (which is an activity I fully support), but more explicitly seeks to take account of women’s perspectives.

Just as I was starting to give this some thought, I was asked to write a piece responding to an article that claimed that there is no point in getting more women into science because we aren’t good at it. My reply, published on the Progress website is below:

Last week, the Times Education Supplement ran a story with the headline ‘Gender equality in science would “deny human nature”’. Reporting on a recent education conference, the article cited Gijsbert Stoet, a (male) psychologist at the University of Glasgow who has declared that trying to get more women into science was a was a waste of effort because innate differences meant that boys and girls would always be drawn to different subjects and careers.

This is, of course, nonsense. As many girls as boys study science at GCSE and while fewer study maths and physics at A level, girls do better than boys. And though the history of science is built around stories of great male discoveries, whether it is the codebreakers at Bletchley Park, Watson and Crick’s discovery of the structure of DNA or Richard Doll’s research into the link between smoking and cancer, in so many cases the crucial work was carried out by (overlooked) female scientists.

But as well as irritating women like me who love science, articles like this (which appear on a regular basis) perpetuate a mythical view of science which ultimately will only serve to damage science – and its place in our society. Because, although science is undoubtedly one of the greatest achievements of human ingenuity, based as it is around the notion of truth and objectivity, it is also very much a product of society – or a product of our male-biased society to be more precise. Science and its history has been developed by men, based on their knowledge, perspectives and values, to address their visions and aims. Most of the time that coincides with the wishes of the other half of us, but we should not be surprised when they say it is something that women are inherently incapable of doing. Nor should we be surprised when science displays the characteristics of other male-dominated industries like financial services – the focus on individual goals and achievements rather than teamwork, competition rather than collaboration, or power-seeking rather than consensus, for instance.

But we should be concerned. Because the world, science and its place in our society has changed. From mobile technologies that are extending our friendship circles or surveillance technologies that challenge our sense of privacy, to personalised medicines that are changing the way we treat illness (and fund the NHS), or emerging areas like synthetic biology that have the potential to make us rethink what life itself is, science and technology is changing how we think, act and feel in profound ways. We can no longer separate the social or ethical effects of science and technology from the science itself. As we saw with the debate around GM, the ‘people’ side of science has become as important as the ‘rational’ side.

As well as our relationship with science and technology becoming more entangled, so too are the challenges ahead. Male-dominated science has been very good at understanding and solving things that can be reduced to the sum of its parts – such as infectious diseases of the west and computing. But the big problems ahead – like feeding, growing world population, tackling health issues like obesity, dealing with climate change and creating a more equal society – are all far more complex and entangled. If science is to keep its place at the problem-solving centre of our society, it has to have something to say to address these problems. And, while it is almost impossible to imagine any other way of understanding the world offering more effective solutions, the current, male-dominated form of science still does not seem to have the interdisciplinary, collaborative and holistic approaches that will be needed to produce effective and socially acceptable answers to these problems.

To keep its place in the 21st century, science needs all of the perspectives it can get. In the face of urgent challenges like this, saying that women, by nature, are not fit to do science runs the risk that society will conclude that science, by nature, is not fit to solve our problems.

“Nuclear Energy Sounded wonderful 40 years ago” – public attitudes towards CCS

Research, Science and Technology Studies, Science Communication

Around the world there is increasing interest from government and industry in the potential for Carbon Capture and Storage (CCS) technologies to play a part in decarbonisation – indeed the UK government has made their commitment to this technology clear. In their 2012 Carbon Capture Roadmap they say:

“Carbon Capture and Storage (CCS) has the potential to be one of the most cost effective technologies for decarbonisation of the UK’s power and industrial sectors, as well as those of economies worldwide. The Government is committed to helping make CCS a viable option for reducing emissions in the UK and in doing so to accelerate the potential for CCS to be deployed in other countries. Our vision is for widespread deployment of cost-competitive CCS “(DECC, 2012).

Yet despite so much high-level faith, this is a technology that is still at the experimental stage and surrounded by many unknowns.  And it has been the subject of little public debate.  So what do ordinary citizens think about Carbon Capture and Storage?

Over the past year or so, my UCL colleagues and I have been exploring this question, through a series of discussion meetings with environmental activists, planning councillors, and adult and youth community group members.  We found that views on CCS are shaped strongly by factors wider than the technology alone.  In particular, people made trade offs between different energy futures – thinking about how supporting CCS affects the government’s likelihood to support wind energy, or whether CCS will lock us into a fossil fuel future for longer, for example.  Most importantly, people very quickly drew parallels to nuclear power – the industrial scale of the technology and the potential for unforeseen negative consequences, for instance.  

While there might not be much public disquiet around CCS at the moment, this is far from a positive reaction waiting to be voiced – in private opinions were generally negative. This, and the use of nuclear power as a framing device, may present a challenge to policy-makers and industry committed to implementing CCS while promoting education as the main mechanism for public acceptance.

The full paper is now open access and so freely available here.

Save our Hospitals – my letter to the IRP

Uncategorized

The A&E units (and other services) in the four hospitals local to me in West London are threatened with closure.  An independent panel is currently reviewing the NHS’s decision and will report to the Secretary of State for Health by September 2013.  

I feel strongly that the proposed closures will put lives at risk.  Here is the letter that I have submitted to the review – please join me in objecting by emailing your comments to info@irpanel.org.uk

To: The Independent Reconfiguration Panel, 6th floor, 157-197 Buckingham Palace Road, London

Dear Sir,

I would like to register my objection to the current proposals to close the accident and emergency units at Hammersmith, Charing Cross, Ealing and Central Middlesex Hospitals and ask you to reject the proposed closure.

My initial concerns about the proposals related to the impact it would have on myself and family.  Closing these A&E units will mean that our nearest emergency unit will be in St Mary’s, Paddington, which is at least 30 minutes drive away – and longer during heavy traffic.  Should anyone in my house suffer from a suspected stroke or heart attack, where time is of an essence, then this delay in reaching hospital could have fatal consequences.

In the last few months however, I have been going door-to-door, taking to many local residents across Hammersmith and Fulham and Ealing and Acton about the proposals.  The stories I have heard have persuaded me even further that the planned closures will put unnecessary worry and pressure on local residents, put the remaining services under undue strain and put lives at risk.  In particular, it has been the poorest and most vulnerable residents – those with sick or disabled children and the elderly – who are most worried about the plans.  For instance, I met one elderly woman who faces three bus-rides to get to the nearest A&E unit.  As her nearest A&E and GP surgery are already working beyond capacity and therefore cannot offer regular appointments to her, she is currently relying on her local vet to change the dressings on a wound she recently sustained.  This is a shameful story of the NHS in the 21st Century but is sadly only likely to be replicated if the proposed closures go ahead – three whole London Boroughs will be left without a major hospital.

 Finally, I understand that a number of clinical arguments have been put forward in support of the proposed closures.  While I appreciate that access to specialists is an important factor in the quality of emergency treatment, I am confident that you will agree that access to specialists must be balanced out with access to resources overall – and in a timely fashion.  The current A&E services are stretched, with waiting times already on the increase.  It seems difficult to argue that this can be anything but worsened by closing further units, not to mention the additional pressure that will be put on the ambulance services.  Furthermore, if there are strong clinical arguments, I hope that you will question the clinicians as to why these proposals were not put forward prior to 2010, when there was significant investment in the NHS. The coincidence of these clinical arguments with the desire to dramatically reduce costs undermines their credibility. 

 Far from being in the clinical interests of the West London population, the current proposals represent a significant downgrade in health services to the area, put forward in light of a desperate desire to cut costs quickly.  They are proposals that have little support in the community and which will put lives at risk.  They should therefore be firmly rejected.

 Yours Faithfully

Melanie Smallman