While the Government delays, cities are taking radical steps to cut carbon

Cities are where the biggest experiments can take place; look to them to see the future of the UK.

Our cities are the R&D facility for the country. From 4G rollout to community energy, they let us experiment with what’s possible. This is useful, because we’ve just agreed to change everything. The recent Energy Bill accepts how inevitable a low carbon future is for the UK. It also guarantees the money to deliver it on time – all we have to do now is actually do it.

Of course, some don’t seem to realise this. Some ministers hang desperately onto a gas over renewables strategy, like a hipster to a mini disc player, convinced its time will come again. No evidence will dissuade them back into reality. This wouldn’t be a problem, but the indecision and delay they introduce makes it harder to ensure that the UK will get the maximum benefit from a low carbon future – to own the patents, build the factories and get exporting to the others following behind. Luckily, we don’t need to wait for national government to get its story straight, because our cities are set to leap ahead.

A city has traditionally been something that demands a lot from a country and gives back money and jobs. London has around the same working population as Scotland, Wales and Northern Ireland put together, and so it soaks up more electricity than any of those nations. Without freight coming in from the rest of the world, it would run out of food in four days. Sure, cities pay for this stuff, but it’s the rest of the country that has put up with its infrastructure: the power stations, water reservoirs, and industrial waste facilities all put into the countryside to serve the cities. However, this is changing.

The density of the population and the buildings make for a unique testing ground for the new kind of infrastructure we’re developing - the low carbon, resource efficient approaches to heating and power generation, transport and waste management. They all work best if done where the demand is greatest, and that means at the city scale.

This is what Green Alliance’s new report argues – cities are morphing themselves and what they do ahead of the rest of the country and they are well placed to get the economic reward for doing so. The recent city deals process, initiated by the Cabinet Office transfers new powers, control over funding and approaches to financing to the cities. The first eight cities have thought about what this means to reverse employment trends and attract inward investment which is why most have used their deals to grow their low carbon economy.

Newcastle is going for £0.5bn of investment in offshore energy, bringing eight thousand jobs. Liverpool plans to accelerate £100m in wind and offshore energy, bringing three thousand jobs to the area. Manchester is using its ambitious emissions reduction targets to attract an additional £1.4bn into the UK’s economy and Birmingham has secured a £3m injection to its housing retrofit programme.

Many of these projects, which are central to how our country will work in the future, are already real in the cities. London will have 1,300 different electric vehicle charging points by next year and, in the capital, a Prius seems a more common sight that an Escort. Islington is rolling out council-owned Combined Heat and Power to 700 homes, a power station set up not miles away, but amongst the people that will benefit, protecting them from soaring bills. Meanwhile, Birmingham council is doing the same, trying to reduce the energy it imports every year at a cost of £1.5bn and replace it with energy they make themselves. In the centre of the city, on Broad Street, Birmingham’s CHP serves the ICC, the town hall, the new library and local hotels and theatres. Nottingham too, aims to double its district heating network in five years.

This is where the future is happening. It proves that green infrastructure is the model that keeps costs down for the public and profits up for businesses. All we need now is for Westminster government to realise this. As it plans a big push on renewing our national infrastructure, it should learn from and work with our cities, who are demonstrating that a modern, sustainable approach, employing ideas that reduce energy, reuse waste and simplify our public transport, will bring the biggest rewards.

Photograph: Getty Images

Alastair Harper is Head of Politics for Green Alliance UK

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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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