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AI-generated fashion models: innovation, illusion or a step too far?

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AI-generated fashion models: innovation, illusion or a step too far?
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Fashion has always sold aspiration. Long before artificial intelligence (AI), it relied on carefully constructed images of beauty through styling, lighting, makeup and, more recently, digital retouching.

While consumers may have understood that these images do not reflect everyday reality, they continued to engage with them. They followed fashion trends and they bought the products being advertised.

The industry is now moving beyond enhancing images of real people, however. It is beginning to generate the people themselves.

AI-generated fashion models and digital twins (virtual replicas of real models) are becoming increasingly common. Brands like Balmain, Levi’s and H&M have experimented with the technology, arguing that it offers new opportunities to increase diversity, improve efficiency and reduce costs.

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But despite consumers’ familiarity with edited and idealised imagery, these developments have sparked a much stronger backlash. So, why does creating a model with AI feel fundamentally different from editing a photograph of a real person?

As a researcher in digital consumer psychology, I have become increasingly interested in this question. And a pattern is beginning to emerge. Consumers appear less concerned about whether an image is perfect than whether there is a real person behind it.

From retouching to creation

AI-generated models represent an important change because they move beyond alteration and into creation. Rather than modifying an existing person, brands can now generate entirely synthetic individuals. And they can create digital versions of real models that can appear in campaigns without ever stepping in front of a camera.

Supporters argue that this technology offers some advantages. AI models can be produced quickly, adapted for different markets and used across multiple campaigns.

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They can also be designed to represent a wider range of ages, body types and appearances than those traditionally featured in fashion advertising. So, in theory at least, this could help address some of the long-standing criticisms directed at the industry.

But consumer reactions to AI-generated models have been mixed. Some research suggests that synthetic models may reduce harmful social comparisons. Because consumers know they are not real people, they may be less likely to compare their own bodies with them. Other studies have found that AI-generated imagery can increase feelings of envy and reinforce unrealistic appearance standards.

These contradictory findings highlight a broader issue. Consumers have become accustomed to artificiality in advertising, but they often react differently when that artificiality becomes explicit.

Part of the explanation may lie in how people understand authenticity. Fashion images have never been entirely “real”, but they have traditionally been connected to real people. Consumers may recognise that a photograph has been heavily edited while still believing that a human being exists behind the image.
AI-generated models disrupt that relationship.

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Authenticity

Research suggests consumers’ responses to AI are shaped not simply by appearance, but by perceptions of humanness and authenticity. Brands increasingly rely on authentic storytelling, making that distinction especially important in fashion marketing.

Although synthetic models can be designed to look diverse, they do not possess the life and experience of a human being. They can’t speak about navigating life in a larger body, overcoming barriers as a disabled person or experiencing discrimination as a member of a marginalised community. They can simulate appearance, but they cannot replicate personal history.

As a result, authenticity may depend less on what a model looks like and more on whether consumers perceive them as genuinely human. This helps explain why some consumers remain sceptical of AI-generated models even when they support greater representation in advertising.

This debate extends beyond consumers too. Models, photographers, stylists and other creative professionals have raised concerns about the effects of AI on employment across the industry. Those concerns are understandable. AI-generated content can often be produced more quickly and cheaply than traditional campaigns.

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Fashion has played a powerful role in shaping ideas about beauty, identity and aspiration. AI-generated models may offer opportunities to challenge some of the industry’s limitations, but they also risk creating new forms of distance between brands and consumers.

In my view, the most responsible path forward is one in which AI enhances opportunities rather than replacing people. Used thoughtfully, it could help expand representation and support more inclusive forms of marketing. Used carelessly, it could simply create a new generation of unattainable ideals.

The Conversation

Hannah Marriott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Greek wildfires contained but weather conditions worsening

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Greek wildfires contained but weather conditions worsening

ATHENS, Greece (AP) — Firefighters west of Athens raced to exploit a break in high winds on Tuesday, working to strengthen containment lines as forecasters warned that stronger gusts and rising temperatures would return in the coming days.

Several fires that burned through mountain communities and coastal areas west of the Greek capital were brought under control overnight. Planes and helicopters dumped water inside the contained perimeters through the morning, dousing hotspots while the winds stayed calm.

The army deployed tracked earth movers to carve fire breaks across the scorched hillsides, while specialist units pushed into forest areas on foot to extinguish smoldering embers before they could reignite.

Crews were working against the clock: Winds typically pick up in the afternoon, a coastal phenomenon common across the Mediterranean in summer as land heats faster than the sea and draws in stronger breezes.

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The blaze jumped containment lines a day earlier.

More than 1,000 people have been evacuated from around the seaside resort of Porto Germeno and other areas west of the capital, including more than 250 rescued by boats from beaches in the area.

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Crissy Rock speaks out on ITV show Benidorm returning to TV

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Crissy Rock speaks out on ITV show Benidorm returning to TV

There has been plenty of speculation about the prospect of an eleventh series, but no plans have materialised as of yet.

Crissy explained she would jump at the chance of returning to the show and hailed the brilliant script writing behind her character Janey Yorke.

Crissy Rock attending the ITV Summer Party 2019 (Image: Alamy Stock Photo)

Speaking on behalf of BestBettingSites.co.uk, home of the best casino sites, she said: “I’d love Benidorm to come back. And if it did come back, I’d love to be a part of that, but you never know. Never say never.

“I think what happened was everybody saw someone they knew or they associated with in that programme — or someone you’ve encountered on holiday at places like that.

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“And the writer was so clever; he observed every character like he knew them.

“And I think the bunch of people he picked helped to make it as well, like the Garveys and everyone else. So it was lovely and I was pleased that I was a part of it.”

Rock spoke specifically about the inspiration behind her portrayal of Janey, and whether the possibility of a new series could come to fruition.

“I took my kids on a holiday once where there was a rep, and this woman just didn’t want to be there, didn’t want to be a rep — hated children, hated people. I took that inspiration from her.

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“We rumble all the time [about a new series], but until it’s actually there with a script in your hands, you can’t say yes or no.

“If it did happen, I would love to be a part of it — I’d be a liar if I said I didn’t. But you don’t know. It’s ten years have gone by now.”

Should a new series of Benidorm not materialise, Crissy would love to appear on one of the UK’s longest-running TV soaps after a similar experience starring in Celebs on the Farm.

“I think I’d like to do Emmerdale,” she added.

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“I’ve done a thing called Celebs on the Farm, and absolutely loved it. And I thought, if that’s Emmerdale Farm, I want to go! I’ve still got my rosettes and everything.

“I like Emmerdale. I’d also love to do The Traitors — I’m addicted to that. I’d probably give myself away. But I also love the show — I watch that all the time. When they’re picking the Traitor, you go, ‘No, he’s not the traitor.’.”

More recently, Crissy’s career has taken her on the road, having recently finished a tour with her aptly titled show From Bedlam to Benidorm, which brought her written life story to life.

When revealing her inspiration behind the show, she explained: “What happened was a lot of people were asking me where they can get the book. And I’m going to get in touch and see if I can get it reprinted.

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“I talked about my life and being abused — me and my brother being abused. But it gets people laughing and crying at the same time. Like when I got married the first time, it was a £1.10 silver wedding ring, half a pound of boiled ham, and a Victoria sponge.

“The best man was his probation officer.

“And then when I was married to my second husband, I didn’t realise he was a functioning alcoholic.

“I’d never seen him drunk because I’d never seen him sober.

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“But it’s all about not letting things that have happened pull you back. You cannot change the past ever. You can only change the future.

“So I could spend my life going, ‘Poor me, poor me, poor me’, but you have to just say that was the cards that were dealt, and I have to try and make a hand out of it.”

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Illegal rave shut down in Welsh woodland after angry villagers call police

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Wales Online

The council received a number of noise complaints about the unlicensed music event in Monmouthshire

An illegal rave held in the woods saw nearby villagers enduring loud music throughout the night. Police officers were sent to the unlicensed music event which was held in Chepstow Park Wood during the early hours of Sunday, July 26.

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Residents across Monmouthshire reported that “really loud music” could be heard coming from the woodland, in areas including Mathern, St Arvans, Devauden, and as far away as the Severn Bridge and the coastal path at Black Rock.

The council has since confirmed it is investigating after six noise complaints were received in relation to the illegal rave. A spokesperson for Monmouthshire council added that it had “no prior knowledge of the event taking place”.

Gwent Police said its officers attended Chepstow Park Wood after receiving reports of an unlicensed music event being held in the early hours.

“Officers attended, advised those in attendance to stop the music before safely dispersing the area”, a statement from the force said.

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A spokesperson for Monmouthshire County Council said: “We can confirm that Monmouthshire County Council had no prior knowledge of the event taking place.

“The event organisers did not engage with the Event Safety Advisory Group (ESAG) process. ESAG is a multi-agency forum chaired by Monmouthshire County Council and it provides an opportunity for event organisers to receive specialist advice and input to their event to ensure a safe and legal event can take place.

“Advice covers a range of issues, including the mitigation of any potential noise nuisance. ESAG is a voluntary process and whilst there is no legal requirement to engage, we do receive requests from numerous event organisers.

“It is disappointing that this event did not engage with this forum. We will continue to work with our partners, including Gwent Police, to seek to identify the organisers of this event and encourage them to engage with ESAG and prevent any future issues of a similar nature arising.

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“We encourage all event organisers to engage with ESAG and further information is available here: Event Planning – Event Safety Advisory Group – Monmouthshire.”

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Suspected human remains found near M67 in Tameside, police say

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Suspected human remains found near M67 in Tameside, police say

Greater Manchester Police said the discovery was made by road workers shortly after 11pm yesterday (August 3), near a bridge between junctions 3 (Hyde) and 4 (Hattersley) of the M67 in Tameside.

The force believes the remains have been identified and is working with specialist teams to establish what happened.

An officer said: “We are working with specialist teams to understand the circumstances behind this incident.

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“The road will be closed between junctions 3 and 4 while detectives carry out their investigation.”

The force said the road will remain closed while detectives carry out their investigation.

The force has asked the public to continue to avoid the area, and said it will provide updates when it has them.

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More than 150 migrants rescued after boat catches fire in Channel

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Mid shot of Andy Burnham wearing a black suit and black tie with black-framed glasses. In the distance is the white cliffs of Dover.

More than 150 migrants have been rescued after the boat they were using to cross the Channel caught fire on Tuesday morning, French authorities have said.

The boat was attempting to cross to the UK when its engine caught fire, according to the French maritime prefecture of the Channel and North Sea.

It said 157 people have been rescued and are being taken to port in Boulogne-sur-Mer. There are no reports of anyone having been injured or killed.

It comes just a day after Prime Minister Andy Burnham pledged his government will be “relentless” in curbing the number of people arriving in the UK on small boats.

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French authorities said the boat left France on Monday night.

Overnight “five people on board the vessel required rescue… the remaining people on board refused the assistance offered by the French patrol boats”, the French maritime prefecture said.

“Determined to reach the United Kingdom, migrants crossing the Channel in small boats refused assistance offered by French emergency service, accepting it only in situations of extreme emergency,” it said in a statement.

Because of the “structural fragility” of boats used to cross the Channel, it said they decided not to intervene further at that stage.

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But this morning the engine caught fire and the “vessel’s integrity deteriorated very rapidly”.

Rescue boats went to the scene from France and the UK, including the RNLI Eastbourne lifeboat and the UK Border Force vessels BSC Contender and BSC Courageous.

Two French boats rescued 103 migrants and the British boats rescued 54.

All of them are being taken to Boulogne-sur-Mer for treatment, where they are expected to arrive there at 12:30 local time (11:30 BST) on Tuesday.

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Earlier, the UK Coastguard said: “A vessel caught fire earlier this morning whilst in the French search and rescue region. UK vessels and a lifeboat are assisting.”

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Man arrested over incident at Open Jar festival in Seaton Carew

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Man arrested over incident at Open Jar festival in Seaton Carew

The incident took place at the Open Jar Tribute Festival in Seaton Carew on Saturday (August 1) – with police being made aware of the footage the following day. 

Officers have not received a complaint but identified a 25-year-old man, who was receiving hospital treatment, and he was visited in person by officers on Monday. 

Cleveland Police has now confirmed that a 27-year-old man has now been arrested on suspicion of Section 18 GBH and he will be questioned while enquiries continue.

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The festival, which took place across Saturday, was described as a “huge day of live music, energy, and unforgettable festival vibes”. 

This year’s line-up featured tributes to Queen, Oasis, Coldplay, ABBA, Pitbull, Sabrina Carpenter, Gerry Cinnamon, and Amy Winehouse.

The police statement said: “On Sunday (August 2) police were made aware of video footage apparently showing a man being assaulted by security staff at the Open Jar festival at Seaton Carew the evening before (Saturday, August 1).

“At that stage we had not received any complaint from a victim, however our enquiries soon identified a 25-year-old man who was receiving hospital treatment. 

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“He was visited in person by officers yesterday (Monday, August 3).

“A 27-year-old man has now been arrested on suspicion of Section 18 GBH and he will be questioned while enquiries continue.

“Our officers are continuing to liaise with the local authority and the event organisers.

 “We would appeal for anyone who witnessed or captured footage of the incident to contact Cleveland Police on the 101 number quoting ref 152776.” 

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Huw Edwards criticised for entering Eisteddfod competition

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Wales Online

‘It is far too soon for him to try to redeem himself’

Huw Edwards has been criticised after he revealed he entered a competition at Wales’ largest cultural festival. Writing on his Substack, the disgraced BBC newsreader said he had entered a poem at the National Eisteddfod centred on his relationship with his father.

Actress and survivor of child sexual abuse Sera Cracroft said it would have been “catastrophic” if he had won. Mr Edwards’ attempt fell far short of winning the competition, with his poem placed in the third rank of entries, according to Newyddion S4C.

Mr Edwards claimed he knew there was “no way” he was going to win the competition, and described the poem as a “tribute” to his father, intended to correct the “poisonous narrative encouraged by the press” about their relationship.

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In 2024 Mr Edwards pleaded guilty to three counts of making indecent images of children. Some of the images Mr Edwards accessed were the most serious category A type, depicting children as young as seven to nine.

He was given a six-month prison sentence, suspended for two years, and placed on the sex offenders’ register for seven years.

On Sunday Mr Edwards published a post on his Substack blog stating he had “attempted to write a poem” for the first time in his life having “drawn inspiration” from the National Eisteddfod.

BBC-produced Newyddion S4C said had it received confirmation that Mr Edwards’ poem, written under the pseudonym Y Gelyn (The Enemy), had been officially entered.

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The National Eisteddfod said it has a process in place which ensures nobody, including the judges, knows beforehand who has competed.

Actress Ms Cracroft, best-known for her role in long-running Welsh soap opera Pobol y Cwm, was highly critical of the former newsreader’s latest publication.

“Had he won, the image of him being crowned in front of the nation is hurtful to survivors,” she said. “Huw has said he is receiving mental health support and to be completely honest, I don’t think it’s working for him.

“I’m very, very disappointed that he’s done that so soon after being convicted of creating paedophilia online. Some of the images were in the worst category possible.” She added it was “far too soon for him to try and redeem himself.”

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In June Mr Edwards said he had returned to journalism by launching his own Substack. In the opening paragraph of his introduction to the platform the 64-year-old said he would be “tentatively” offering some commentary and analysis on events.

The former newsreader said he knew there would be some people who wouldn’t want to read his work but said he was “attempting to rebuild some kind of worthwhile life”.

In one of his most recent posts, titled ‘On Hatred’, he spoke about the hate he receives. He said he felt “abhorrence” towards the offences he committed and admitted to, and stated he was “not a child rapist”. He said his “crime was to click on files sent to me by someone else”.

In response to S4C and the BBC’s request for comment, the National Eisteddfod said: “We have a process in place which ensures nobody, including the judges, knows beforehand who has competed. After each Eisteddfod we have a period of appraisal to ensure our processes are appropriate – this year will be no exception.”

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Mr Edwards said: “The poem was a tribute to my father. Nothing more or less than that. There was no way on earth I was going to win the competition and I knew that. The poisonous narrative encouraged by the press two years ago needed correcting.”

Addressing Cracroft’s criticisms, he added: “This wasn’t a poem for the sickeningly self-righteous Welsh speakers – Sera amongst them – who take advantage of every opportunity to speak unthinkingly on every subject under the sun.

“She and her type are far too willing to ignore the damaging effects of mental ill health. In that, they are loyal to the heritage of London’s tabloid papers.”

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Cabinet minister defends ‘Bunk Off Burnham’ as PM heads abroad for a holiday just TWO WEEKS into his premiership… leaving Louise Haigh as minister in charge

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Andy Burnham, pictured with his wife Marie-France van Heel and daughter Rosie in June, is taking a holiday with his family after just two weeks as Prime Minister

A top Cabinet minister today defended Andy Burnham for taking a holiday after just two weeks as Prime Minister.

Mr Burnham, who only entered office on 20 July, is taking a break from his day-to-day duties to travel abroad with his family for a long-planned trip.

He is not expected to appear publicly this week, but Downing Street insisted he will still be working and is prepared to travel back to the UK if required.

Reform UK has accused Mr Burnham of ‘bunking off’ while even Labour insiders questioned the PM’s decision to go away.

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But Alex Norris, the Justice Secretary, this morning backed Mr Burnham over his choice to take a holiday and insisted the PM would be ‘in constant contact’ with his office.

‘The Prime Minister is having a few days away with his family,’ he told Sky News. ‘You know, he will be in constant contact with his office.’

‘I mean, I might gently say that I’ve spoken to him virtually every day since I joined the Cabinet, and I suspect that won’t change.

‘These last couple of weeks I’m really proud of the work we’ve been doing on the cost of living, on social care, on homelessness, on defence. And that work is happening at pace and will continue to do so.’

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Andy Burnham, pictured with his wife Marie-France van Heel and daughter Rosie in June, is taking a holiday with his family after just two weeks as Prime Minister

Alex Norris, the Justice Secretary, backed Mr Burnham over his decision to take a holiday and insisted the PM would be 'in constant contact' with his office

Alex Norris, the Justice Secretary, backed Mr Burnham over his decision to take a holiday and insisted the PM would be ‘in constant contact’ with his office

In Mr Burnham’s absence, Mr Norris was left to field questions about the Government’s decision to still allow the killers of PC Andrew Harper to be eligible for early release from jail.

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The Justice Secretary acknowledged that the decision had ‘created harm’ but said the alternative was seeing prisons cease to function.

Some 5,000 people are expected to be released early under sentencing changes, down from 6,000 after the PM exempted rapists and child sex offenders as part of the scheme to tackle overcrowding in jails.

But two of PC Harper’s killers, Jessie Cole and Albert Bowers, remain eligible for early release after their 2020 convictions for manslaughter despite an outcry from the officer’s family that prompted a review of the early release plans.

PC Harper sustained fatal injuries while responding to a quad bike theft in Sulhamstead, Berkshire, in August 2019.

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Until recently, both close friends and staff of Mr Burnham claimed the PM had cancelled plans to join his family on holiday, with this replaced by a tour of Britain to meet voters towards the end of August.

As recently as July 25, Downing Street told the Mail that Mr Burnham would not be heading off for a break after becoming Prime Minister.

But on Monday No10 confirmed he would be travelling abroad to spend time with his family, after making a blizzard of spending pledges on bus fares and energy bills that could cost up to £96billion during his first two weeks in charge.

Downing Street published an official portrait of Mr Burnham on Tuesday as he took a holiday from No10

Downing Street published an official portrait of Mr Burnham on Tuesday as he took a holiday from No10

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Mr Burnham, who only entered No10 on 20 July, is taking a break from his day-to-day duties to travel abroad for a long-planned trip

Mr Burnham, who only entered No10 on 20 July, is taking a break from his day-to-day duties to travel abroad for a long-planned trip

While Mr Burnham is on holiday, his de-facto deputy Louise Haigh, the First Secretary of State and Chancellor of the Duchy of Lancaster, will be the most senior minister in Westminster

While Mr Burnham is on holiday, his de-facto deputy Louise Haigh, the First Secretary of State and Chancellor of the Duchy of Lancaster, will be the most senior minister in Westminster

Reform UK chairman Lee Anderson said: ‘Two weeks into the job and Andy Burnham has already had enough.’

‘After dropping a number of unfunded commitments and overseeing over 2,000 illegal migrants breaking into our country he’s bunked off for a jolly abroad.

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‘This isn’t a PM that’s serious about leading.’

And a Labour source told the Mail: ‘Talk about easy mode. A week’s holiday? Because he’s had a difficult summer? Because he had to fight a by-election?’

The source said that Keir Starmer ‘barely went on holiday’, adding that when he did ‘he would just sit there with a bottle of rosé and talk through work over the phone. It was inspiring.’

The former PM cancelled a planned holiday in August 2024 – about six weeks after entering No10 – due to the riots that erupted after three young girls were murdered in Southport. He eventually went on a family holiday in Madeira at the end of December 2024.

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When Sir Keir was away, Downing Street insisted that he remained in charge, rather than handing over power to the then deputy prime minister, Angela Rayner.

While Mr Burnham is on holiday, his de-facto deputy Louise Haigh, the First Secretary of State and Chancellor of the Duchy of Lancaster, will be the most senior minister in Westminster.

It is understood that convicted fraudster Ms Haigh will be working this week as normal, however, No 10 insisted that she will not be taking day-to-day decisions in Mr Burnham’s absence.

The PM’s spokesman said: ‘The Government continues to operate as normal with [the] PM remaining in contact with officials, holding meetings and receiving regular updates on government business.’

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There were no further details on where Mr Burnham will go on holiday as prime ministerial holiday destinations are not usually confirmed by Downing Street.

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Transfer news LIVE: Guimaraes to Arsenal FC done deal, Vinicius offer; new Man Utd target; Liverpool, Chelsea latest

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Transfer news LIVE: Guimaraes to Arsenal FC done deal, Vinicius offer; new Man Utd target; Liverpool, Chelsea latest

The summer window continues to hot up as Arsenal work on a huge double deal for Bruno Guimaraes and Vinicius Junior, while the likes of Manchester United, Chelsea, Liverpool and Tottenham continue talks to bolster their squads. The Gunners have seen a first official bid for the Newcastle captain rejected, and are said to have agreed personal terms on a club-record contract for the Real Madrid star.

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Hundreds of people in England died before doctors diagnosed their tuberculosis

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Hundreds of people in England have died before doctors diagnosed their tuberculosis

Dave, a retired dockworker, has smoked since his teens. When he develops a persistent cough, he dismisses it as “just a smoker’s cough”.

Then he loses weight, develops fevers and wakes at night drenched in sweat. After several courses of antibiotics, he continues to deteriorate and is admitted to hospital.

Doctors find emphysema, a smoking-related condition in which damaged air sacs make breathing difficult. A chest X-ray also shows a white patch in his lung, raising concerns about cancer. A sample of sputum, the mucus coughed up from the lungs, is sent for further testing.

Dave dies before the laboratory identifies tuberculosis (TB).

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Dave is fictional, but his story shows how easily TB can be missed when its symptoms resemble those of other illnesses. In a 2026 study, colleagues and I found that 574 people in England were diagnosed with TB only after death between 2010 and 2022. That is almost one person every week.

The people who died represented 0.8% of all TB diagnoses, but nearly one in five deaths recorded among people with TB. The data could not establish whether TB caused or contributed to each death.

TB is the world’s leading cause of death

TB is a bacterial infection that usually affects the lungs and spreads through the air. It remains the world’s leading cause of death from a single infectious organism. In 2024, an estimated 10.7 million people developed TB and 1.23 million died. Global progress has recovered from setbacks during the COVID pandemic, but remains too slow.

England cannot eliminate TB without international progress. In 2024, more than four in five people diagnosed in England were born outside the UK. This is sometimes presented simply as a migration issue. It instead reflects global inequalities in prevention, diagnosis and treatment.

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TB also affects UK-born people and remains closely associated with poverty. Rates in England’s most deprived areas are more than five times those in its least deprived.

Homelessness, imprisonment, smoking and harmful alcohol or drug use can increase exposure, weaken the body’s defences or make healthcare harder to access. These factors all contribute to active TB disease.

England is close to losing its status as a low-incidence country, defined by the World Health Organization as fewer than ten cases per 100,000 people. Its rate reached 9.4 per 100,000 in 2024, following the largest annual increase since 1971.

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Early diagnosis is vital. Globally, about one in five people who develop TB are not diagnosed, officially reported or treated. Many of these “missed millions” die. In England, the median interval between symptoms beginning and diagnosis of lung TB was 72 days in 2024.

During that delay, an infectious person may transmit TB while their illness worsens. Delays can also disrupt family and working life and create avoidable, sometimes catastrophic costs for people with TB, their households and health services.

The most extreme delay

A national study examined the most extreme delay: TB confirmed only after death. This meant a sample had been collected while the person was alive, but the result arrived later.

TB bacteria grow slowly, so traditional laboratory cultures can take several weeks. Rapid molecular tests, which detect the bacteria’s genetic material, can sometimes provide results much sooner, but doctors must first suspect TB.

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The likelihood of diagnosis after death rose sharply with age. It was also higher among men, UK-born people, people with recorded harmful drug or alcohol use, those with TB outside the lungs and those diagnosed outside London.

Older UK-born people may have encountered TB during childhood, when infection was more common. The immune system can contain the bacteria for decades without symptoms. This is called latent TB infection. It can later become active, particularly when immunity weakens because of age, illness or medicines.

Smoking damages the lungs’ defences and increases TB risk. An older man with a cough and weight loss may therefore be investigated for cancer or chronic lung disease before TB is considered. Previous BCG vaccination – the childhood vaccine that was once routinely offered in the UK to protect against tuberculosis – does not rule it out. The vaccine protects young children against severe disease, but does not reliably prevent TB in adults.

TB outside the lungs can affect the lymph nodes, bones, bowel, kidneys, brain or other organs. Diagnosis may require scans or tissue samples. It is generally much less infectious than lung or throat TB, although people can have both forms.

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People outside London were more likely to receive a diagnosis after death. Doctors in London may encounter TB more often and have better access to specialist services. Differences in reporting may also contribute. Our findings probably underestimate the problem because some people may die without being tested.

A diagnosis made only after death should be treated as an important patient-safety warning. TB deaths are not currently defined as a formal NHS “never event”, a term reserved for a small number of wholly preventable incidents. Based on our study findings, we recommend that each post-mortem TB diagnosis should prompt a review of symptoms, tests and referral decisions.

Public awareness also matters. A persistent cough, fever, drenching night sweats or unexplained weight loss deserves medical attention, regardless of age or birthplace. Healthcare professionals must consider TB even when cancer, pneumonia or chronic lung disease initially appears more likely.

Prevention must extend beyond detecting active TB disease. England offers some recent migrants testing for latent TB, but only 17% of those eligible were tested in 2024. Strategies should also consider historical exposure among older UK-born people.

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England can learn from countries with much greater TB burdens. Lessons include reaching people at higher risk of being missed, such as the homeless, the poor and the socially excluded; reducing stigma; and making services easier to access.

Dave’s fictional laboratory result arrived too late. The next person with an overlooked cough should receive theirs while treatment can still help.

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