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    Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine

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    Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      The Question of Transgender Care

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      Hilary Cass is the kind of hero the world needs today. She has entered one of the most toxic debates in our culture: how the medical community should respond to the growing numbers of young people who seek gender transition through medical treatments, including puberty blockers and hormone therapies. This month, after more than three years of research, Cass, a pediatrician, produced a report, commissioned by the National Health Service in England, that is remarkable for its empathy for people on all sides of this issue, for its humility in the face of complex social trends we don’t understand and for its intellectual integrity as we try to figure out which treatments actually work to serve those patients who are in distress. With incredible courage, she shows that careful scholarship can cut through debates that have been marked by vituperation and intimidation and possibly reset them on more rational grounds.Cass, a past president of Britain’s Royal College of Pediatrics and Child Health, is clear about the mission of her report: “This review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves or rolling back on people’s rights to health care. It is about what the health care approach should be, and how best to help the growing number of children and young people who are looking for support from the N.H.S. in relation to their gender identity.”This issue begins with a mystery. For reasons that are not clear, the number of adolescents who have sought to medically change their sex has been skyrocketing in recent years, though the overall number remains very small. For reasons that are also not clear, adolescents who were assigned female at birth are driving this trend, whereas before the late 2000s, it was mostly adolescents who were assigned male at birth who sought these treatments.Doctors and researchers have proposed various theories to try to explain these trends. One is that greater social acceptance of trans people has enabled people to seek these therapies. Another is that teenagers are being influenced by the popularity of searching and experimenting around identity. A third is that the rise of teen mental health issues may be contributing to gender dysphoria. In her report, Cass is skeptical of broad generalizations in the absence of clear evidence; these are individual children and adolescents who take their own routes to who they are.Some activists and medical practitioners on the left have come to see the surge in requests for medical transitioning as a piece of the new civil rights issue of our time — offering recognition to people of all gender identities. Transition through medical interventions was embraced by providers in the United States and Europe after a pair of small Dutch studies showed that such treatment improved patients’ well-being. But a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.Unfortunately, some researchers who questioned the Dutch approach were viciously attacked. This year, Sallie Baxendale, a professor of clinical neuropsychology at the University College London, published a review of studies looking at the impact of puberty blockers on brain development and concluded that “critical questions” about the therapy remain unanswered. She was immediately attacked. She recently told The Guardian, “I’ve been accused of being an anti-trans activist, and that now comes up on Google and is never going to go away.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      U.K. to Cut Taxes Again as Election Nears

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      The Conservative government, trailing badly in the polls, proposed the second tax cut in four months.Amid lackluster prospects for economic growth, the British government announced it would cut taxes for workers ahead of a general election this year.Jeremy Hunt, Britain’s top financial official, told lawmakers on Wednesday that he would cut National Insurance, a payroll tax paid by workers and employers that funds state pensions and some benefits, by two percentage points. It would take the rate for about 27 million employees down to 8 percent, and follows a two percentage point cut announced less than four months ago. Together, the cuts would save the average employee about 900 pounds ($1,145) a year, Mr. Hunt said. The rate was also cut for self-employed workers.“We can now help families not just with temporary cost-of-living support but with permanent cuts in taxation,” Mr. Hunt, the chancellor of the Exchequer, said in Parliament. “We do this to give much needed help in challenging times. But also because Conservatives know lower tax means higher growth.”Mr. Hunt also announced a sweep of smaller measures, including freezing taxes on alcohol and fuel, proposals to increase productivity in the public sector, and abolishing the tax advantages for foreign earnings of British residents living abroad.The chancellor has been under political pressure from the governing Conservative Party to lower taxes ahead of the general election, which is expected to take place this year, though a date has not been set yet. The party is substantially lagging the opposition Labour Party in the polls.But Mr. Hunt’s ability to offer sweeteners to voters has been constrained by the fact that the British economy is growing slowly — if at all. Stretched public services need money and there are calls to invest more in infrastructure. The chancellor also has to meet his self-imposed budget rules, which gave him even less fiscal room to maneuver.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Rishi Sunak’s Dilemma: When to Hold an Election He Looks Poised to Lose

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      Prime Minister Rishi Sunak is 20 percentage points behind in opinion polls. But history suggests the timing of a vote might make a difference.No question in British politics will be more regularly asked, and reliably brushed aside, over the next few months than when Prime Minister Rishi Sunak plans to call the country’s next general election.He must do so by January 2025. The conventional wisdom is that with his Conservative Party trailing the opposition Labour Party by 20 percentage points in the polls, Mr. Sunak will wait as long as he can. Given the fact that Britons do not like electioneering around Christmas or in the dead of winter, that would suggest a vote next fall.But some of Mr. Sunak’s colleagues last week pushed for an earlier timetable. Having lost a critical legal ruling on his flagship immigration policy, the prime minister came under pressure from the right of his party to go to the polls in the spring if the House of Lords blocks the government’s efforts to revamp legislation to deport asylum seekers to Rwanda.Turning the election into a referendum on immigration might deflect attention from the economic woes plaguing Britain. But that assumes voters could be persuaded to swing to the Conservatives out of a fear of asylum seekers crossing the English Channel in small boats, rather than blaming the party for a stagnant economy, a cost-of-living crisis and hollowed out public services.Britain’s Supreme Court last week struck down the policy of deporting asylum seekers to Rwanda as unlawful. But Mr. Sunak has vowed to keep the matter alive by negotiating a new treaty with the East African country that would include a legally binding commitment not to remove migrants sent there by Britain — one of the court’s objections.Mr. Sunak also pledged emergency legislation that would declare Rwanda a safe country for asylum seekers. It remains unclear whether that would survive legal challenges and in the House of Lords, the unelected upper chamber of Parliament that has the right to review the legislation and could block it (though its appetite for a full-scale clash with the government was not clear.)“I know the British people will want this new law to pass so we can get flights off to Rwanda,” Mr. Sunak told reporters last week. “Whether it’s the House of Lords or the Labour Party standing in our way, I will take them on because I want to get this thing done and I want to stop the boats.”Asylum seekers disembark from a lifeboat in Dungeness, England, after being picked up at sea while crossing the English Channel.Henry Nicholls/Agence France-Presse — Getty ImagesPolitical analysts say immigration remains a resonant issue in England’s north and Midlands, where support for the Conservatives in 2019 gave the party a landslide general election victory. Those voters, many of whom traditionally supported the Labour Party, were drawn to the Tory slogan, “Get Brexit done.”“Immigration is now the top priority for 2019 Conservative Party voters, above even the cost-of-living crisis and the dire state of the country’s National Health Service,” said Matthew Goodwin, a professor of politics at the University of Kent, who has written about populism and identity politics.“This means, in short, that Rishi Sunak has no way of winning the next election unless he connects with these voters by reducing immigration and regaining control of the country’s borders,” he said. “Yet both of those things currently look unlikely.”Far from accelerating the date of an election, Professor Goodwin argued that the salience of immigration would pressure Mr. Sunak to delay a vote. It will take months to surmount the legal problems with the existing policy, the professor said, let alone begin one-way flights to Rwanda.Other experts are more skeptical that an immigration-dominated election would play to the advantage of the Tories. Most voters view the party negatively on immigration, said Sophie Stowers, a researcher at the U.K. in a Changing Europe, a think tank in London. The number of people crossing the channel has remained stubbornly high since Mr. Sunak became prime minister, while legal migration has soared.“To me, it seems counterintuitive to bring attention to an issue where you have a poor image with the public,” Ms. Stowers said.The question is whether the Conservatives would do even worse if the election were decided on the economy, which matters more than migration to voters at large, according to opinion polls. Mr. Sunak did achieve one of his key economic goals last week, halving the rate of inflation. But he has yet to achieve the other two: reviving growth and reducing public debt.Clothing for sale in London last month. Mr. Sunak did achieve one of his key economic goals last week, halving the rate of inflation.Hannah Mckay/ReutersIt’s not yet clear that the economic news will improve between the spring and fall, analysts said. While inflation has cooled, the lingering effect of higher interest rates — propelled upward by Liz Truss’s market-shaking tax policies last year — is still cascading through the economy in the form of higher home mortgage rates.Historically, many successful prime ministers, including Margaret Thatcher and Tony Blair, called elections earlier than they needed, rather than risk becoming the victim of unforeseen events. They usually opted for the summer months, when the weather — and the public mood — is typically better, although Boris Johnson successfully broke that pattern with his victory in December 2019.Mr. Sunak’s room for maneuver is limited. One option would be holding the vote in May 2024 to coincide with local elections, or in June. Another possibility would be October or November, which would coincide with elections in the United States. But the possibility of a victory by Donald J. Trump could have an unpredictable effect, potentially pushing some British voters to a more centrist option. As a last resort, Mr. Sunak could hold off until Jan. 28, 2025.Some of Mr. Sunak’s predecessors paid a high price for miscalculating the timing of elections. Despite speculation that he would call an election in 1978, the Labour Party prime minister James Callaghan delayed voting until the following year. Labor unrest escalated into what became known as the “winter of discontent,” sweeping Mrs. Thatcher to victory in 1979.Margaret Thatcher, campaigning in 1979, won election as prime minister after the Labour Party incumbent, James Callaghan, decided not to call an election the previous year.Press Association, via Associated PressGordon Brown, another Labour prime minister, had been expected to capitalize on his early popularity by calling an election soon after taking over from Tony Blair in 2007. Instead, he delayed, ultimately losing power in 2010.Theresa May made the opposite decision, calling an early election in 2017 in which she lost her majority, though probably more because of her unpopular agenda and poor campaign skills than bad timing.“Once the election is underway, everything is on the table,” said Peter Kellner, a polling expert. “You lose control of the agenda.”Trying to build an election campaign around the issue of small boats bringing migrants is likely to fail, Mr. Kellner added, suggesting Mr. Sunak will only call an early vote if he calculates he has a realistic prospect of keeping his job.“If, at the point when you have to make a decision, you have no chance of winning, then you might as well wait,” he said, “because maybe there is a five percent chance of winning in six months, and a five percent chance is better than no chance.” More

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      As Sunak Makes His Case to Britons, the Economy Could Undermine It

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      Britain’s Conservative government faces a morass of problems, some new, others longstanding, that are stymying Prime Minister Rishi Sunak.Prime Minister Rishi Sunak hopes to hold onto power by selling himself as the repairman for a broken Britain. On Wednesday, he got a faint sign that the repair work was gaining traction: the government announced that Britain’s inflation rate in June was 7.9 percent, a decline from the previous month.But the rate is still higher than that of Britain’s European neighbors and more than twice that of the United States. And it is just one of a morass of economic problems — from spiraling debt to labor shortages to sputtering growth — that are stymying Mr. Sunak as he makes the case that his Conservative Party, in government for the past 13 years, deserves to stay there after an election that he must call by January 2025.The Conservatives will face an early test of their political fortunes on Thursday, with three by-elections, special elections to fill seats in Parliament vacated by Tory lawmakers. The party is girding itself for a long day.“They’re running out of runway,” said Tim Bale, a professor of politics at Queen Mary University of London. “These by-elections are likely to be a referendum on the government, and they could lose all three.”Shoppers in London last month. Britain’s annual inflation rate is higher than that of its European neighbors and twice that of United States.Tolga Akmen/EPA, via ShutterstockMr. Sunak, a former chancellor of the Exchequer who once worked at Goldman Sachs, has cultivated a reputation as a technocrat and problem solver. He has thrown off the supply-side ideological experimentation of his predecessor, Liz Truss, and the have-your-cake-and-eat-it style of her predecessor, Boris Johnson.But Mr. Sunak’s return to fiscal prudence has yet to reinvigorate Britain’s growth. On the contrary, inflation is forcing the Bank of England to hike interest rates aggressively to avert a wage-price spiral. The tight-money policy threatens to tip the economy, already stagnant, into recession. And it is inflicting pain on millions of Britons who face soaring rents and higher rates on their mortgages.Inflation, economists agree, is likely to continue to drop in the next six months, perhaps even enough to meet Mr. Sunak’s goal of halving the rate to 5.2 percent by year-end. But Britain’s other problems — anemic growth, low productivity, a labor shortage, and a crumbling National Health Service — are not likely to be fixed in time for him to claim a full turnaround before he faces the voters.“Low productivity and low growth make economic policy challenging,” said Mahmood Pradhan, head of global macro economics at Amundi, an asset manager. “It reduces fiscal space. It’s a very tight straitjacket to be in.”With deteriorating public finances, Mr. Sunak can neither spend heavily to raise wages for striking doctors or railway workers, nor can he offer tax cuts to voters. As things stand, he is already at risk of missing another of his five pledges: to reduce national debt. Government debt has risen to more 100 percent of gross domestic product for the first time since 1961, according to the latest data.Striking junior doctors outside Queens Hospital in Rumford in March.Andrew Testa for The New York TimesFor two years, the government has frozen the income brackets for personal income taxes rather than raising them with inflation, driving up the effective rates. As a result, Mr. Sunak finds himself in an awkward paradox: a free-market Conservative heading into an election with a government that is imposing the greatest tax burden on the electorate since World War II.Critics argue he has no one to blame but himself. Mr. Sunak supported the fiscal austerity of the Conservative-led government of David Cameron and his chancellor, George Osborne, which hurt Britain’s productivity and hollowed out its public services. And he championed Brexit, which cut into its trade with the European Union, scared off investment and worsened its labor shortage.“He’s quite rare in being directly associated with both Cameron-Osborne austerity and Johnsonian hard Brexit,” said Jonathan Portes, a professor of economics and public policy at Kings College London. “Many other senior Tories could plausibly claim that they didn’t really buy into one or the other. Not Sunak.”This week’s by-elections attest to Mr. Sunak’s predicament. One seat belonged to Mr. Johnson, who resigned from Parliament after a committee recommended suspending him for misleading lawmakers about his attendance at parties during the coronavirus pandemic lockdowns. Another was held by an ally of Mr. Johnson, who also quit, and the third by a lawmaker who resigned after allegations of drug use and sexual misconduct.While Mr. Johnson’s soiled legacy and Conservative Party scandals will play a role in these races, analysts say the cost-of-living crisis will be the dominant theme. Few governments, Professor Bale noted, win elections when real wages are eroding, as they are in Britain. In the latest polls, the opposition Labour Party leads the Conservatives by close to 20 percentage points.The specter of a sweeping defeat has put Mr. Sunak under pressure from Tory backbenchers to offer voters relief in the form of tax cuts or help in paying their mortgages. The most analysts expect, however, is for him to promise a reduction in income taxes next spring, to be deferred until after the election.As Mr. Sunak likes to remind people, not all of Britain’s problems are unique or self-inflicted. Like many other countries, it suffered from supply bottlenecks after pandemic lockdowns ended, from rising food prices and from the lingering impact of soaring energy prices after Russia invaded Ukraine.Yet Britain’s core inflation rate — which excludes volatile energy and food prices and is a gauge for domestic price pressures — has remained high at 6.9 percent, compared to 4.8 percent in the United States and 5.4 percent in the eurozone.“That does suggest these inflation dynamics have become more embedded than they have in other countries,” said Kristin Forbes, a professor of management and global economics at the Massachusetts Institute of Technology, and a former member of the Bank of England’s rate-setting committee.Britain, she said, had the misfortune of being hit by both the energy spike, like its neighbors in Europe, and strong domestic inflationary pressures because of a tight labor market, like the United States.Commuters cross London Bridge last week. Unlike most countries, Britain still has more people out of the labor force than before the pandemic.Andy Rain/EPA, via Shutterstock“The U.K. was facing a more difficult challenge than the other countries, in the sense it was really hit by a confluence of shocks that were greater than the individual shocks hitting other countries,” Professor Forbes said.But there are other problems that are distinctively British. Unlike most countries, Britain still has more people out of the labor force than before the pandemic. A majority say they can’t work because of long-term illnesses, a problem exacerbated by the crisis in the N.H.S. With so many job vacancies, wages are rising rapidly, which further fuels inflation.Mr. Sunak has offered to increase public sector wages by 5 percent to 7 percent to end strikes that have closed Britain’s schools and crippled the health service. But that has yet to quell the labor unrest.Britain has so far avoided a recession, surprising some economists. But its resilience could crack, as people curtail spending to pay their rising mortgage bills. Already, about 4.5 million households have had to swallow rate increases since the Bank of England started raising interest rates in December 2021. The rest, another 4 million, will be affected by higher rates by the end of 2026.As with other Western leaders, Mr. Sunak’s fortunes may be largely out of his hands. Last month, the Bank of England, stung by the virulence of inflation, unexpectedly raised interest rates by half a percent, to 5 percent. Traders are betting that rates will climb further still, to about 5.8 percent by the end of the year — implying several more rate increases that would mean higher financing costs for businesses and households and hurt economic growth even more.“The more tightening we see, the risk of recession rises,” said Mr. Pradhan, who served as a deputy director of the International Monetary Fund. “It wouldn’t take very much to tip the U.K. economy into recession.” More

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      Sunak Makes Sweeping Pledges to Britons, Promising Path to Prosperity

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      His promises represented an effort to regain momentum at a time of steep challenges for Britain, but some pressing problems, like the National Health System, defy easy solutions.LONDON — With Britain’s health system and economy both in acute distress, Prime Minister Rishi Sunak on Wednesday laid out a series of promises to restore the country to prosperity and well-being, putting his own political future on the line by challenging Britons to hold him to account.Mr. Sunak’s pledges, delivered in a sweeping speech that echoed a State of the Union address by an American president, represented his effort to grab back momentum after a period in which he replaced a discredited predecessor, Liz Truss, and mopped up after her calamitous foray into trickle-down economics.“No tricks, no ambiguity,” Mr. Sunak said to a polite audience in East London. “We’re either delivering for you or we’re not.”Among the promises, the prime minister said he would cut inflation in half, reignite the economy and reduce waiting times in emergency rooms — ambitious goals for a government that has so far been largely a hostage to a series of disruptive events.But some of Britain’s most pressing problems, like its overwhelmed and investment-starved National Health System, defy easy solutions. Even with more funding, Mr. Sunak said, “people are waiting too long for the care they need,” citing the ambulances lining up in front of hospitals that are short of beds for patients.Budget strains and a cost-of-living crisis have triggered widespread labor unrest, with nurses walking off hospital wards and railway workers shutting down trains. The government is expected to announce new anti-strike legislation, but Mr. Sunak conceded the difficulty of making deals with multiple unions, even though polls show Britons generally support the workers.“I don’t think anybody thinks a 19 percent pay rise is affordable,” he said of the nurses’ wage demands.A crowded King’s Cross station in London last week. Industrial actions by railway workers disrupted travel over the holidays.Hollie Adams/Getty ImagesBeyond that, the British economy is also likely to deteriorate further before it bottoms out and begins to recover. Mr. Sunak acknowledged that sobering reality, noting that many Britons were looking ahead to 2023 with “apprehension.”For Mr. Sunak, who has come under criticism for his below-the-radar style, the speech was an effort to offer much-needed reassurance and to present an image of a sturdy leader at the helm. With two years to go before he must call an election, he billed his five promises — which also included cutting public debt and stopping the perilous flow of migrant boats across the English Channel — as yardsticks with which to judge his government.Understand the Political Situation in BritainA Political Test: Rishi Sunak, who took over as prime minister with the hope of restoring stability to a government in turmoil, is facing formidable political and economic challenges.Worker Strikes: Crippling strikes across multiple industries have Britain’s Conservative government facing a “winter of discontent,” just as a Labour government did 44 years ago.Migrant Crossings: Under growing pressure to curb the arrival of migrants in small boats on the English coast, Mr. Sunak announced plans to tackle Britain’s backlog in asylum claims and to fast-track the return of most Albanians seeking refugee status.Selling Austerity: With an elite pedigree and a privileged lifestyle, Mr. Sunak must now persuade ordinary Britons that they should support his government through a painful ordeal of tax increases and spending cuts.Eschewing the ideological extremism of Ms. Truss or the have-your-cake-and-eat-it-too optimism of her predecessor, Boris Johnson, Mr. Sunak struck a nuts-and-bolts tone. Characteristically, his most widely promoted initiative was a plan for all school children to study mathematics until the age of 18.“One of the biggest changes in mind-set we need in education today is to reimagine our approach to numeracy,” said Mr. Sunak, a line that would have been unlikely to turn up in a speech by Mr. Johnson.Still, some experts said there was less to some of Mr. Sunak’s promises than met the eye. The Bank of England has already projected that the inflation rate, currently 10.1 percent, will decline to roughly half that by the end of 2023. That downward trend, in any event, has less to do with fiscal than monetary policy.Mr. Sunak’s pledge to “grow the economy” by the end of the year was noteworthy, given that it is now likely shrinking. But he offered few prescriptions for how the government planned to do that. Britain has struggled with lackluster productivity and stagnant growth for more than a decade.Shopping for groceries in London last November, when inflation hit a record 12.4 percent.Andy Rain/EPA, via Shutterstock“Growth will return, almost certainly in the next year or so, but that’s a very low bar,” said Jonathan Portes, a professor of economics and public policy at Kings College London. “I would point out that Truss set an explicit growth target of 2.5 percent, so Sunak is being much less ambitious.”Mr. Sunak, a 42-year-old onetime investment banker who served as chancellor of the Exchequer under Mr. Johnson, faces a huge task improving public services. The N.H.S., one of Britain’s most revered institutions, suffered during years of austerity under Conservative-led governments, and was then battered by the pandemic.Jill Rutter, a senior fellow at the Institute for Government, a London-based research institute, said that by the time of the next general election, Mr. Sunak will need to be able to show the British public that things were improving and that it would therefore be a risk to eject him from power.“Most public services were looking pretty fragile at the time of the pandemic, and the pandemic then piled problems on top of them, including big treatment backlogs in health and exhaustion among the work force” Ms. Rutter said. Those problems, she said, were “compounded by inflation and a big squeeze on public sector pay.’’Most of these underlying weaknesses will remain, even if the government resolves the pay dispute with nurses and ambulance drivers. “Even if Rishi Sunak and Jeremy Hunt write a big check to the National Health Service, that doesn’t solve the capacity problem quickly,” she said, referring to the current chancellor.Similarly, Mr. Sunak has a limited number of options for reviving the economy even if inflation tapers off and interest rates stop rising. Last fall, Mr. Hunt reversed the tax cuts announced by Ms. Truss, replacing them with a raft of tax increases and spending cuts. The reversal restored Britain’s tarnished reputation in financial markets, but at a cost to economic activity at home.Nurses striking outside St. Thomas’ hospital in London last month. Kin Cheung/Associated PressMr. Sunak also needs to manage divisions within his fractious Conservative Party, while knowing that Mr. Johnson harbors ambitions to return to Downing Street, if given the opportunity.“One of the problems for Sunak is that his party is so all over the place that, on a whole range of issues, if he goes one way, he’ll alienate a bunch of them and if he goes another, he’ll alienate another bunch,” Ms. Rutter said.Any attempt to solve labor shortages by relaxing immigration rules, for example, would prompt opposition from a right-wing faction within the Conservative Party, as could any compromise with the European Union over post-Brexit trade rules for Northern Ireland.One of Mr. Sunak’s most immediate challenges is cutting down the flotilla of small boats carrying asylum seekers across the channel. On Wednesday, he pledged new laws that would stop the crossings, but provided neither a timetable nor evidence of how deporting illegal migrants would stop the influx.By sketching out his priorities for the next year, however, Mr. Sunak will hope to quiet critics who claimed that he has stayed out of the spotlight as alarm spread over the state of the health service, and as the latest wave of strikes paralyzed parts of the country.The leader of the opposition Labour Party, Keir Starmer, was scheduled to make a speech on his agenda on Thursday. Mr. Sunak’s hastily scheduled appearance prevented his rival from exploiting a political vacuum to build on Labour’s polling lead over the Conservatives, now more than 20 percentage points.Like Mr. Sunak, Mr. Starmer is regarded as an uninspiring public speaker. His critics accuse him of excessive caution and of failing to articulate how he would change the country as prime minister.For Mr. Sunak, the challenge is more immediate but no less daunting: convince skeptics that he measures up to the job of prime minister at a time of converging crises. More

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      Your Friday Briefing: The U.S. Will Train More Ukraine Troops

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      Plus: Chinese companies are hit by U.S. trade restrictions.The U.S. said it would more than double the training provided to Ukraine’s military next year.Brendan Hoffman for The New York TimesThe U.S. will train more Ukrainian troopsThe Pentagon plans to train 600 to 800 Ukrainian troops — one battalion — each month in advanced battlefield tactics at a base in Germany, starting next year. That’s a major increase: Right now, the U.S. trains about 300 people each month.President Biden approved the broader training effort this week, according to two U.S. officials. The Pentagon has already trained 610 Ukrainians to operate an advanced rocket launcher. The troops have used the system to devastating effect, hitting targets far behind Russian lines.Next year, the U.S. will train bigger groups of Ukrainians on various strategies, such as coordinating ground infantry troops with artillery support. The decision to step up training comes as the administration is poised to send a Patriot antimissile battery, America’s most advanced ground-based air defense system, in response to urgent demands from Kyiv.Other updates:The U.S. announced new sanctions on prominent Russians.A Ukrainian Army surveillance team is using infrared technology to try to locate and strike Russian positions.Moscow’s propagandists are broadcasting clips from American cable news and Chinese media to spin a narrative that Russia is winning.Limiting the flow of technology to global rivals has become a key part of U.S. foreign policy.Oliver Contreras for The New York TimesChinese companies hit by U.S. trade restrictionsThe U.S. restricted 36 companies and organizations from accessing American technology that could be used for military purposes, in its latest effort to impede China’s development of advanced semiconductors.In October, the U.S. announced sweeping limits on semiconductor exports to China, both from American companies and those in other countries that use U.S. technology.U.S. officials say that China has increasingly blurred the lines between its military and civilian industries. In response, Chinese diplomats said that the U.S. “has been stretching the concept of national security” and “abusing export control measures.”Details: Yangtze Memory Technology Corporation, which was said to be in talks with Apple to potentially supply components for the iPhone 14, is on the list.Related: Years of Covid restrictions have left behind a collective trauma, Li Yuan writes. Some now want the government to apologize for its hard-line approach, a quixotic hope.Britain’s free health care has long been a national point of pride.Henry Nicholls/ReutersU.K. nurses strike for the first timeBritish nurses went on strike yesterday for the first time in the 74-year history of the National Health Service.The walkout is one of a series of labor actions taking place across Britain this month as sky-high inflation, rising interest rates and a recession put pressure on workers. Rail employees, airport baggage handlers and ambulance workers are also scheduled to stage walkouts over the next several weeks. The nurses are planning a second 12-hour strike next Tuesday.The labor actions come at a time when the health service is in crisis: There have been record delays for ambulance responses and a major backlog for medical procedures, among many other problems.Demands: The nurses are calling for a 19 percent pay increase and better working conditions, which they say will make the profession more attractive and help address staffing shortages. The government has said the pay demands are “unaffordable.”Quotable: “We were out supposedly clapping for our nurses and all of our N.H.S. workers during the pandemic, and here we are treating them like trash,” one supporter said. THE LATEST NEWSAsia PacificFiji’s incumbent surged ahead after the app went down. The opposition leader had a lead beforehand.Saeed Khan/Agence France-Presse — Getty ImagesFour political leaders in Fiji said the country should stop vote counting after the results app experienced a glitch, The Associated Press reports.India has successfully tested a long-range ballistic missile that could carry nuclear weapons, Al Jazeera reports.Around the WorldTedros Adhanom Ghebreyesus, the leader of the W.H.O., said that Eritrean forces had killed his uncle and 50 others in Tigray, despite a cease-fire.The European Central Bank and the Bank of England both raised interest rates by half a percentage point, in an effort to fight stubborn inflation.A U.N. peacekeeper from Ireland was shot and killed in southern Lebanon.Boris Becker, the former German tennis champion, returned home after he was freed from a British prison. He hid his assets in a bankruptcy case.U.S. NewsThe House passed a bill that would allow Puerto Ricans to vote on whether the island should be an independent country or a U.S. state. Elon Musk said he had sold another $3.6 billion of Tesla’s stock, perhaps in an effort to prop up Twitter. He’s now sold $23 billion this year.New York City will ban sales of dogs, cats and rabbits starting in 2024 in an effort to crack down on commercial breeders.Claudine Gay will be the first Black person to lead Harvard.The Week in CultureHarry spoke about his strained relationship with Prince William, the heir to the throne.Ben Birchhall/Associated PressIn the latest episodes of “Harry & Meghan,” Harry blames a tabloid for Meghan’s miscarriage.Adriano Pedrosa, who turned around São Paulo’s leading art museum, will oversee the 2024 Venice Biennale.The famously private author Thomas Pynchon sold his archive. But there are no photographs of him in it.Inmates in France picked a winner in an offshoot of the Goncourt, the country’s top literary prize.“The Little Mermaid” will be added to the National Film Registry, along with two dozen other films.Our Styles desk picked their best photos of 2022.A Morning Read“It’s a better hobby than playing video games,” said Talil al-Humaidi’s father.Erin Schaff/The New York TimesFalconry — one of Qatar’s oldest traditions — now involves modern training methods. Drones drag pigeons high into the sky, to teach the falcons to hunt.SPORTSIn the only other World Cup final of his career, Lionel Messi lost to Germany in 2014. Richard Heathcote/Getty ImagesThe World Cup finalFrance will play Argentina at 6 p.m. local time on Sunday in Qatar. (That’s 8:30 p.m. in Delhi, midnight in Seoul and 2 a.m. on Monday in Sydney.)Argentina will rally behind Lionel Messi, who has never won a World Cup. Now, he has a final, glorious chance at soccer immortality. At 35, Messi is arguably the finest player of all time.France, though, has his heir apparent: Kylian Mbappé, 23, who is the tournament’s leading scorer. France won the last World Cup, in 2018, and is now the first country in over 20 years to qualify for consecutive finals.What else: Croatia and Morocco will play on Saturday for third place.PLAY, WATCH, EATWhat to CookAndrew Scrivani for The New York TimesMake pancakes for breakfast this weekend.What to Read“Eccentric Lives,” a collection of cheeky obituaries from Britain’s Daily Telegraph, includes one about a viscount who shot at a hot-air balloon.What to Watch“The Volcano: Rescue from Whakaari” recounts an eruption off the coast of New Zealand that left several groups of tourists struggling to survive.ExerciseDo you really need to stretch?TravelIn just a weekend in Seoul, you can hike fortress walls, bike along the Han River and taste mung bean pancakes at a covered market.Now Time to PlayPlay the Mini Crossword, and a clue: Space between (three letters).Here are the Wordle and the Spelling Bee.You can find all our puzzles here.That’s it for today’s briefing. Have a lovely weekend! I’ll be back on Monday. — AmeliaP.S. Sam Stejskal of The Athletic joined CNN to debate who’s the greatest soccer player ever.“The Daily” is about Russia’s draft. You can reach Amelia and the team at briefing@nytimes.com. More