Wednesday, October 18, 2006

NHS centres 'rationing consultant visits'

New centres that "screen" patient referrals from GPs to hospital consultants are being used by the NHS to ration health care by stealth, say medical professionals. More than a third of primary care trusts (PCTs) have established "referral management centres" that, critics say, are preventing patients from seeing the doctor of their choice and in some cases are prolonging waiting times in order to save cash. In one case, GPs found thousands of referral letters stashed in a cupboard for weeks.

Patients' groups and doctors' leaders say the referral schemes, which are sanctioned by the Department of Health, are creating another tier of NHS bureaucracy and could actually harm people's health. GPs say some centres are refusing to let patients see consultants sooner than the Government's outpatient target of 13 weeks. This limits the number of appointments in any one year - saving the PCT money. In some trusts, people are being sent back to their GPs by doctors employed by referral centres, who decide they are not sick enough to warrant a hospital consultation. In a survey carried out by the medical magazine Pulse, 10 per cent of all PCTs admitted they had a specific target to cut GP referrals.

When patients in Milton Keynes started complaining of long delays, their GPs investigated. Milton Keynes PCT had set up a referral management centre, which was meant to scrutinise all referrals in order to speed access and ensure patients got the right treatment. But Dr Peter Berkin and colleagues discovered a backlog of more than 2,000 letters locked in a cupboard by the centre's secretaries until just short of the 13-week waiting-time target. "It got really scary," said Dr Berkin. "There were cases that could have been very serious and needed to see a consultant quickly. We were horrified. The decisions were taken by secretarial staff, not doctors." A spokesman for Milton Keynes PCT admitted there was a backlog, but said it had mostly been dealt with.

Katherine Murphy, of the Patients' Association, said: "These centres are springing up all over the place, but who's monitoring what they're up to? It seems to be another way of rationing patient care by stealth." Dr Hamish Meldrum, chairman of the British Medical Association's GPs' committee, said: "There is considerable concern among doctors. Where clinicians have been involved, things may be working well, but in other places there has been no effective consultation and it seems the main intention is to cut costs. This is potentially harmful to patients' health."

A Department of Health official said referral centres were a "local initiative" by PCTs, but national guidance had been issued on running them. "They must only be set up where they will have clinical benefits and should add value to patient services. They should not conflict with giving patients more choice [and] must not lengthen the patient journey or create 'hidden' waiting times."



Almost a million children in England are being let down by poor teaching and inadequate leadership in hundreds of under-performing schools, according to an influential committee of MPs. In spite of the Government spending almost 900 million pounds on schemes to raise achievement levels, the Public Accounts Committee (PAC) estimates that last year as many as 1,557 schools, including one in six secondaries, were failing to provide a decent education.

The report comes as Ofsted figures reveal today that the number of schools judged to be failing or requiring "significant improvement" had risen by more than 11 per cent in the past year, from 587 schools in August 2005 to 654 schools this year. At the same time, double the number of inadequate schools were closed in August compared with last. Head teachers and teaching unions reacted angrily to the "misleading and damaging" report, which they said did not give a true reflection of education in today's schools.

With almost one in seven schoolchildren being denied a quality education, Edward Leigh, chairman of the PAC, said that the long-term consequences for Britain's future were severe. "Nearly one million children in England attend schools that, according to government definitions, are providing a poor standard of education," he said. "To waste so much potential in this way is a tragedy." The Tory MP insisted that the "signs of decline" needed to be picked up early and dealt with swiftly. He voiced concern, too, over the lack of data by which to judge primary schools, amid fears that poor performers were slipping through the net.

Having examined trends in poorly performing schools over 2004-05, the 59th PAC report identified strong leadership, honest self-evaluation and collaboration with successful schools as key to raising standards. While accepting that fewer schools are weak or failing than were six years ago, the committee noted that more schools are missing the Government's baseline GCSE targets.

In 2004, the Government denoted "low-attaining" secondary schools as those where less than a fifth of children achieved five A*-C GCSEs. In 2005 40 schools failed this GCSE benchmark. While the MPs agree that poor-performing schools should receive more attention than high-performers, they give warning that weak heads often fail to give an honest assessment of their performance. "Of the schools inspected during the autumn 2005 term, only three judged their leadership and management to be `inadequate'. However, 85 schools were placed in special measures, indicating that Ofsted judged leadership and management to be weak in a much higher number," the report said. While leadership is clearly key to raising morale and the ethos of a school, the MPs also note that in spite of offering salaries of up to 100,000 pounds, schools are finding it increasingly difficult to replace them.

Jim Knight, the Schools Minister said the report had exaggerated the number of failing schools. "A significant proportion of these schools are not failing. In some, 60 to 70 per cent of pupils get five good GCSEs and many others are improving very quickly," he said. John Dunford, general-secretary of the Association of School and College Leaders denounced the report as "misleading and damaging". He said: "Let us be clear about the current situation. Even though Ofsted has raised the bar for inspections, only 54 secondary schools out of 3,500 are in special measures. "Of the other schools cited as `low attaining', many have good value-added scores for very weak intakes. They are certainly not failing."


Asbestos: The BBC loves a Greenie scam

Imagine that a very experienced, knowledgeable and brave whistleblower sets out to expose a commercial racket that is ripping off businesses and members of the public to the tune of hundreds of millions of pounds a year, and which a government agency, despite being supplied with factual evidence, does nothing to stop. If a leading BBC "consumer affairs" programme learned about this story, might one not expect it to throw all its resources into exposing the racket?

It might seem odd that, using evidence supplied by the very people who are behind the scam, the BBC would instead pull out all the stops to discredit the whistleblower. Yet such is the bizarre situation that will arise this Wednesday, when Radio Four's You and Yours programme attempts to sabotage the four-year campaign waged by Prof John Bridle, Britain's leading practical asbestos expert, to expose the malpractices of many firms in the asbestos industry. This column has supported Bridle's crusade since 2002, when the Health and Safety Executive (HSE) proposed new asbestos regulations that, on its own original figures, would cost 8 billion pounds. Introduced to me by the Federation of Small Businesses, Bridle explained how these regulations were so seriously flawed that they would open the door to shameless exploitation by many of the firms to which the HSE gave the exclusive right to handle asbestos.

When I checked this out with some of the leading asbestos scientists in this country, they not only endorsed what he was saying but said they were enthusiastically behind his campaign. Such support did it win from members of the public, not least readers of this column, that Bridle set up Asbestos Watchdog, a company dedicated to giving honest advice to the ever larger number of people who were victims of the racket.

So powerful was Bridle's case that Asbestos Watchdog was given the HSE's official support, and on November 26 2004 was appointed by Bill Macdonald, the HSE's head of asbestos policy, as an official "stakeholder" to advise on policy. One leading asbestos company was so alarmed by the practices rife in the industry that it even gave Asbestos Watchdog significant financial backing.

But so vast were the sums now at stake that there have recently been clear signs of a concerted move by the powerful "anti-asbestos lobby" to silence Bridle. One of their greatest successes to date has been winning the support of the You and Yours team. Fortunately, the programme has informed him of 18 of the charges they plan to throw at him, all of which have been levelled before by different branches of the anti-asbestos lobby. It is hard to believe that the BBC will be so reckless as to repeat them (when he offered documentary evidence to refute their charges, one journalist said they were so confident they were right that this was not necessary).

Some charges are laughable, such as that Bridle falsely claims to have been made in 2005 an honorary professor of the prestigious Russian Academy of Medical Sciences. Confirmed by the academy's official certificate, this was widely reported in Russia at the time as the first occasion on which anyone had been so honoured.

The BBC charges him with falsely claiming to have advised the Conservative Party leadership. Yet in 2002 when, after a briefing from Bridle, Iain Duncan Smith, then the party's leader, wrote to the Government asking for the regulations to be delayed until they could be debated by Parliament, Bridle (and I) gave extensive written and verbal briefings to John Bercow, the front-bench Tory spokesman who led the debate, as You and Yours could have confirmed by consulting Hansard.

The BBC denies that Asbestos Watchdog, much to the rage of the asbestos industry, has saved businesses and homeowners tens of millions of pounds by advising how asbestos work could legally and safely be carried out for a fraction of the sums they had been quoted by contractors, as I have reported here (not least because many of the beneficiaries were readers of The Sunday Telegraph). The BBC did not even want to look at the evidence.

The central point on which the whole asbestos scam rests, as You and Yours seems unable to grasp, is the confusion, now made worse by some very bad law, between two completely different minerals, both passing under the general but unscientific term "asbestos". One includes the genuinely dangerous blue and brown forms (amphiboles with sharp metallic fibres that, remaining in the lungs, can cause cancer). The other, very much commoner, "white asbestos" (chrysotile, the soft silky fibres of which dissolve in the lungs within 15 days) is usually encapsulated in cement or textured coatings, from which it is virtually impossible to extract a single fibre. Yet it is on the sleight of hand allowing the dangers of one mineral to be attributed to the other that huge sums of money are now being made by those who play on public fear and ignorance, a commercial racket the HSE does nothing to stop.

Itself a victim of this confusion, the BBC seems desperate to pin on Bridle the damning charge that he claims that "white asbestos is harmless". Yet he is always scrupulously careful to cite the most comprehensive review yet conducted of the scientific literature (Hoskins and Lange 2004) as showing that white cement products pose "no measurable risk to health". Instead of falling for such distortions and untruths, the BBC team should be asking why they plan to give credence to the most disgraceful commercial racket flourishing in Britain today.



And there is no group suffering official discrimination like white middle-class males do

The vast majority of people in Britain are officially oppressed, according to a report that claims we have become a "nation of victims". The study calculates that 73 per cent of Britons are members of officially recognised "victim groups", including the disabled, women, ethnic minorities and homosexuals. Each group is given government support, including protective legislation. The report, We're (Nearly) All Victims Now, by the socially conservative think- tank Civitas, gives warning that the rise of a "victimocracy" undermines democracy because people are no longer considered equal under law.

"We have become a nation of victims," it says. "Victimhood today is a political status that is sought after because of the advantages it brings, including preferential treatment in the workplace, the possibility of using police power to silence unwelcome critics, and financial compensation. To be classified as a victim is to be given a special political status, which has no necessary connection with real hardship or oppression."

In October next year the Government is setting up the Commission for Equality and Human Rights, which merges the disability, race and equal opportunities commissions.

Many people, such as black women, are victims of so-called multiple discrimination. The report uses official figures to strip out the overlapping groups to calculate that nearly three quarters of people belong to one category or other. The biggest oppressed group is women, who constitute 51 per cent of the population and are protected by a range of legislation covering discrimination, equal pay and domestic violence. Ethnic minority men amount to 4 per cent; white disabled men 11 per cent; white male pensioners 5 per cent; and white, gay, able-bodied men, 2 per cent.

The report attacks the increasing tendency to judge crimes as more serious if they are committed against official victims - so-called hate crimes. Police have been encouraged to give priority to such cases, which the Civitas report says is undermining equality under the law. It cites the trial this year of the killers of Jody Dobrowski, a barman murdered on Clapham Common, South London, in October last year. Jailing the two men for 28 years, the judge said that the sentence would have been halved if they had not voiced any opposition to the victim's sexuality. "Is animosity to gays a worse motive than, for example, a calculated killing to silence a witness?" it asks.

It also states that claiming official victim status enables groups to silence critics, often using taking offence as a political tactic. The benefits of taking offence are so great in any debate, that it has encouraged the growth of "increasing touchiness" in Britain. However, the report gives warning that seeking victim status can harm the victims, denying them personal responsibility by always blaming others and undermining their self-respect



Pregnant women have been warned against consuming too much oily fish, as scientists believe it may increase the risk of delivering the baby too early. Researchers told New Scientist magazine the harm is probably caused by high mercury levels in oily fish such as mackerel, salmon and sardines. However, experts warn that it is still important to eat at least two portions of fish a week. Indeed, studies indicate that eating enough fish can boost the birth weight and brainpower of babies and help prevent premature labour in pregnant women.

Species, such as shark, marlin and swordfish should be avoided though, because they are particularly high in mercury and other pollutants, according to a BBC report. Girls, women who are breastfeeding and those trying for a baby should eat two portions of oily fish per week, and other women, men and boys, can eat up to four portions.

The latest work in New Scientist, also published in the journal Environmental Health Perspectives, looked at 1,024 pregnant women living in Michigan, the US. Dr Fei Xue and colleagues measured the amount of mercury these women had in their hair and compared this with the date that the women delivered their babies. The women who gave birth more than two weeks early were three times as likely to have double the average mercury level in their hair samples. On the whole, these women also tended to eat more oily fish, and particularly canned fish. Only 44 of the women gave birth prematurely, however, and the researchers said more work was needed to corroborate their findings.

They also pointed out that the women were asked to recall how much fish they had eaten, which might be inaccurate. It is also possible that the women could have been exposed to mercury from other sources too, they said.


("If ifs and ans were pots and pans, there'd be no room for tinkers". I hope there are still some people who understand that old saying. No product of a "modern" education would, of course)

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