Saturday, October 14, 2006


Fat maps, Labour's latest wheeze, reveal that the Department of Health will go to extraordinary lengths to preach their healthy-eating message. We must all be kept in line and patronised as inadequates who don't know how to feed ourselves. Caroline Flint, the self-righteous Public Health Minister, has even suggested that supermarkets show us how to eat and cook fruit and vegetables.

One way that the DoH has taken to crusading is through third-party "agents of persuasion". After all, it is not a given that the nanny state should have an automatic right to micromanage its citizens' most intimate activities, from how many pieces of fruit they eat a day to what they put in their children's lunchboxes. It is no surprise, then, that the department has a head of broadcasting strategy, and that a new phenomenon - "policy placement" - is ever more apparent on our television screens.

Take a cursory look at the TV schedules and you will find they are littered with programmes that uncritically regurgitate government messages on public health. Scaremongering about the supposed obesity epidemic, while challenged by many researchers as over-hyped, is accepted as a given in programmes such as Supersize Kids on Channel 4, Fat Families on ITV or Chubby Children on Living TV.

But the doyen of all of them is St Jamie Oliver. The DoH must adore him. I rather agreed with Boris Johnson's swipe at the TV chef. I also cheered when a couple of mums from Rotherham rebelled and told Salad Boy to stop telling the nation's children (and their parents) what not to eat. The great and the good of politics, however, flocked to Jamie's defence. Perhaps one reason why a TV pundit seems to have become such an untouchable Messiah is because he - and a new breed of lifestyle "experts" - have become the saleable face of "health correctness" and the unwitting popularisers of the nanny state.

You can see why politicians enjoy the prospect of outsourcing their policy messages to TV presenters. Arguments that, when presented by politicians, might be unappetising become pukka when pushed by a trendy campaigning chef. Ms Flint could not get away with deriding ordinary parents as "f***ing tossers", even though this is the implicit message behind so many of new Labour's health promotion initiatives.

But while all governments use whatever means necessary to get their policy priorities into the nation's living rooms, broadcasters seem blind to the way their programmes mesh with Government propaganda. The BBC's recent Fat Nation, a "fully integrated pan-platform campaign" across television, radio and online services, admitted that, although "the nation is bombarded by messages . . . from the Government", too many individuals have concluded that the obesity warnings do not affect them personally. Therefore Fat Nation offered to help, presenting itself as a "motivational service" aiming "to provide guidance and raise the nation's awareness of the issues; to change attitudes of people . . . and to motivate them to change their behaviour through diet and exercise over an extended period".

In the commercial sector, the Government regulator, Ofcom, now run by Tony Blair's former media adviser, Ed Richards, is threatening draconian bans on advertisements for "junk food" aimed at children. This is despite Ofcom's own research indicating that such advertisements have only a "modest direct effect on children's food choice". Ironically, while there is no shortage of programmes about unhealthy kids, according to the TV industry's campaign Save Kids TV, the ban means that fewer programmes will be made for children because of the loss of income from advertising. Apparently children's creative undernourishment is unimportant as long as they get the right messages about fatty foods.

While there is a fashionable queasiness about the big bad corporations influencing children to adopt unhealthy lifestyles, there is little queasiness about TV delivering the Government's messages. Celebrity endorsements of crisps, cola and sugary food by the likes of Gary Lineker are denounced as a shocking manipulation of children's minds. But somehow it is not shockingly manipulative when the Food Standards Agency advocates that broadcasters use - guess what - celebrities and cartoon characters to sell children 5 A DAY (five portions of fruit or vegetables a day) messages.

BBC Worldwide uses CBBC characters such as the Teletubbies and the Frimbles to brand food products deemed nutritionally sound. It appears that Ofcom's problem is not about using cartoon characters or celebrities to influence children's diet or lifestyle per se. Rather, if they are to be used, they have to endorse the right diet and lifestyle. And what is "right" is increasingly dictated by the State.

Policy placement threatens journalistic integrity and political accountability. When policy issues are the focus of current affairs programmes, the journalists must adhere to strict guidelines of veracity. The Paxmans and Snows keep a rein on the wilder claims of politicians. Such stringent broadcasting criteria do not apply when policy messages are delivered through entertainment formats. Kris Murrin, presenter of the misanthropic Honey We're Killing the Kids, can get away with terrifying hapless parents into believing they are poisoning their offspring by letting them munch on a bag of crisps, without any cross-examination of her "facts". Where is the evidence to back up Sainsbury's poster boy's litany of ill-founded contemporary prejudices against modern food? Shouldn't St Jamie be challenged to explain how our digestive systems distinguish between the nutritional content of ciabatta with a drizzle of olive oil versus bread and dripping?

Policy placement is not just about diet. Just when Tony Blair focuses the domestic agenda on "the politics of behaviour", we have a flurry of reality TV shows about changing people's behaviour. The message is that private lives need mentoring and monitoring by third party "experts". The TV equivalent of the Government's Sure Start and Every Child Matters policies include Nanny 911 or Supernanny. As for the preoccupation with yobbish behaviour, Channel 4 has commissioned both Mind Your Manners and The Nightmares Next Door.

As Boris Johnson has found to his cost, challenging orthodoxies can get you into trouble. But it's time to drag the politicians out from behind the celebrity TV stars and hold both to account for the policies they peddle


Multicultural failure in Britain

An east London teenager who became a drug dealer and a knife-wielding member of a street gang lays the blame on the transformation of his neighbourhood into an ethnic minority "ghetto" where turf warfare flourishes. "I fell in with the wrong crowd," said Syed Miah, 19, who regrets his life of crime. "Before, it was mixed and you would get to know other people, but now no one meets anyone. You grow up with this mentality that `we're Bangladeshis, whites are whites and blacks are blacks'." Miah became a full-time gangster when he was expelled from school for holding a knife to his teacher's throat. He says he eventually earned up to 960 pounds a week dealing heroin before being sentenced to 18 months in jail.

Miah's account of the failure of multiculturalism encapsulates the growing debate over how ethnic minorities should be integrated into society. At last week's Conservative conference, David Cameron, the party leader, warned that in some cities "we have allowed ghettos to develop - whole neighbourhoods cut off from the rest of society". He spoke of "parallel lives", citing "communities where people from different backgrounds never meet, never talk, never go into each other's homes". There are ethnic gang fights in Manchester and Birmingham and last week they spread to Windsor, where rioting erupted around an Asian-owned dairy and nearby prayer centre.

Last weekend, Stevens Nyembo-Ya-Muteba, 40, a maths and finance student, was stabbed to death in his block of flats in Hackney, east London. It later emerged he and his wife Veronique, who came to Britain 10 years ago as refugees from the Congo, had asked the authorities to improve security on their building because they were worried about loitering youths.

Nowhere is the ethnic basis of gangs more evident than in London, where the cultural patchwork is the most complicated in Britain. According to new figures, in the borough of Brent there is an 85% chance that any two people chosen at random would belong to different ethnic groups. Bangladeshis, Somalis, Pakistanis, Afro-Caribbeans and Turks have all formed their own gangs who are as likely to fight each other as they are to attack or be attacked by white thugs.

Last year Lee Jasper, a policing adviser to Ken Livingstone, the London mayor, warned that one south London gang, the Muslim Boys, was the "most serious criminal threat" the black community had ever faced. It was accused of shooting a man, execution-style, after he refused to convert to Islam, and has been implicated in dozens of other muggings and attempted murders.

Tower Hamlets, Miah's home borough, is one of the most ethnically diverse in Britain, with whites comprising just 51% of the population. It has been portrayed in books such as Brick Lane by Monica Ali as an area where there is tension, but communities manage to coexist. However, there is now strong evidence of the extent of segregation in the area. A recent report by Bristol University found 40% of Bangladeshi children went to schools where at least 90% of the pupils were Bangladeshi, while 60% of whites attended overwhelmingly white schools. The report described education in Tower Hamlets as "highly segregated".

Abdi Hassan, a representative of the local Somali community, recently complained to the council that segregation was fuelling violence. "There are many groups here, Moroccans, Irish and Algerians, but nobody mixes with anybody," said Hassan. "Why do we have community ghettos? Why shouldn't people want to interact with each other?"

Some local gangs were set up to resist racist attacks but turned to crime. In one incident in 1994, a Pakistani was left with severe brain damage after an attack by eight white thugs on Whitechapel Road. Emdad Rahman, 39, one of his friends, said: "The whole community was enraged. I remember a lot of my peers thinking, `Right, if they're going out Paki-bashing, we basically need to go out honky-bashing now'."

Often the gangs fight over territory merely for the sake of it. One seven-year feud in the area began with a row over who would get the last doughnut at school and ended with men in their twenties beating, blinding and stabbing each other. Miah's story of growing up amid segregated gang violence suggests such divisions are now entrenched. He used to live on the Solander Gardens estate where he was a member of the 70-strong Shadwell Massive gang. He now has an antisocial behaviour order that bars him from the area after 9pm.



State schools should introduce ethnic quotas into admissions criteria to break down the extreme segregation of pupils along cultural and religious lines, the head of the Local Government Association said yesterday. In remarks that sparked an immediate debate about the state of social cohesion in Britain, Lord Bruce-Lockhart said that Britain would never achieve integration and full social cohesion while neighbouring schools were divided along ethnic lines. It was unacceptable that non-white pupils should form 90 per cent of the population of one school, when white pupils formed 90 per cent of a neighbouring school down the road.

One solution, he suggested, would be for schools in areas with high concentrations of minority ethnic groups to incorporate some kind of ethnicity quota into admissions policies. Although reluctant to specify a quota, Lord Bruce-Lockhart, the former Conservative leader of Kent County Council, said other experts had suggested that schools should offer at least 25 per cent of their places to those from other ethnic groups.

Lord Bruce-Lockhart's comments drew a mixed reaction. Trevor Phillips, chairman of the Commission for Racial Equality, agreed that urgent action was needed but was sceptical about the use of quotas. "I'm open to discussion, but I would not have said this is the first place we need to go," he told the Commons Education Select Committee. He warned MPs that school segregation had now become a "settled pattern" in many towns, often with disastrous effects. "The information we get from the front line . . . is that (segregation) contributes to conflict among young people. Gangs form at school and the ethnicisation of gang culture is part of that," he said.

Twinning agreements between schools and summer camps where children from different backgrounds mix would be more workable, he said. Tahir Alam, education spokesman for the Muslim Council of Britain, said that ethnic quotas had been shown to be unworkable in the US, where the problem of pupil segregation was far more extreme. "You cannot tell a parent that they cannot send their child to the school of their choice because it has met its racial quota. The right of parents to send their children to the school they want is a fundamental right in this country," he said.

Sir Dexter Hutt, executive director of the Ninestiles federation in Birmingham, who has dealt with the problem of segregated schools at first hand, said that if quotas were to be used, the level would have to be set closer to 40 than 25 per cent. Although he was sceptical about how practical quotas would be, he accepted that urgent action was needed. "Children learn by rubbing shoulders with each other and by having arguments with each other in a restrained situation like a school. A multiracial school population would be far more likely to lead to social cohesion," he said.

Lord Bruce-Lockhart accepted that such policies would be difficult to put into practice, but said the most important thing was that a debate on school segregation should take place. "Proactive admissions policies could be used to establish a better ethnic balance in schools. In towns where the totality of the minority ethnic population is 15 per cent of the whole, we should consider the use of numbers in admissions policies. "We have to get to a situation where people regard the total ethnicity of a town as being represented in schools, otherwise we are never going to be properly integrated," he told The Times. "Children start off being colour-blind and this is a wonderful thing. But if you have schools where the children are being educated in different ethnic groups you are going to lose that and you are simply not going to have integration. "If we are to have stable communities and to prevent the rise of the far Right, our job now is to put all these issues on the table and open a public debate," he said.

He added that pairing, or twinning schemes, where predominantly white schools link up with predominantly non-white schools for sports and drama activities, were another way forward. So too were federations of white and non-white schools that brought the management of the two institutions together under a single leadership.

Lord Bruce-Lockhart's comments follow new research published by Simon Burgess, Professor of Economics at the University of Bristol. Entitled Sleepwalking towards Segregation, it reports that ethnic segregation in schools is now fully entrenched in areas where the minority ethnic population is above the 8 per cent national average. In Bradford, 62 per cent of secondary schools are predominantly white, while 21 per cent are predominantly non-white. In the London borough of Tower Hamlets 47 per cent of secondary schools are described as "exclusively non-white", while 33 per cent have a white majority.

Alzheimer's drugs appeal refused

Two pounds and fifty pence per day per patient is too expensive for the NHS!

Alzheimer's disease groups have condemned a decision by the NHS drugs watchdog to reject their appeal for greater access to certain drugs. The National Institute for Health and Clinical Excellence said donepezil, rivastigmine and galantamine could be used to treat moderate stage disease. Campaigners had argued patients in the early stages of Alzheimer's should also have access to the 2.50 pounds-per-day drugs. But NICE said studies showed the drugs "did not make enough of a difference". NICE guidelines cover England and Wales, but the health bodies in Scotland often follow suit.

The body has also ruled another drug, memantine, should be used only in clinical studies for people with moderately severe to severe Alzheimer's disease. Eisai and Pfizer, who produce donepezil, also known as Aricept, said they were considering whether to seek a judicial review of the decision.

About 750,000 people in the UK are estimated to have dementia, but only 78,000 patients take donepezil, rivastigmine and galantamine, with two thirds of those taking donepezil. Galantamine is also known as Reminyl, rivastigmine as Exelon and memantine as Ebixa.

NICE guidance in 2001 recommended the drugs - which can make it easier to carry out everyday tasks - should be used as standard. However, in July 2005 it said access to the drugs should be restricted because they were not good value for money. It has now issued its final guidance, which will apply only to newly-diagnosed patients. Those already taking the drugs will continue to do so.

Andrew Dillon, chief executive of NICE, said: "Alzheimer's is a cruel and devastating illness and we realise that today's announcement will be disappointing to people with Alzheimer's and those who treat and care for them. "But we have to be honest and say that, based on all the evidence, including data presented by the drug companies themselves, our experts have concluded that these drugs do not make enough of a difference for us to recommend their use for treating all stages of Alzheimer's disease. "We have recommended the use of these drugs where they have the potential to make a real difference, which is at the moderate stage of the illness." He told the BBC the appeal was "not designed to re-run the whole evaluation", but that "the appeal panel is to make sure the process has been followed properly".

Action on Alzheimer's, an alliance of more than 30 professional and patient organisations, reacted angrily to the ruling. "The decision will force patients to wait until their condition deteriorates into a state of fear and confusion before receiving drugs that work," it said. Speaking on the BBC's Today programme, Professor Clive Ballard, from the Alzheimer's Society, claimed there were "a number of clear errors during the [Nice] appeal process" that did not appear to have been "addressed". He said: "I think that is a very serious allegation but I believe that to be true."

Help the Aged said one in five people over 80 were affected by dementia and the number of people living with the disease was set to double in a decade. Jonathan Ellis, senior policy manager at the charity, said: "It cannot be right to allow the health of thousands of older people to deteriorate on the altar of cost." A Department of Health spokesman said it would be "entirely inappropriate" to overrule NICE's decision.



Quality standards and financial management in the NHS still need improvement, according to a hard-hitting report into the service. More than half of all NHS trusts in England provide services that are only weak or fair, and four fifths fall into the same category for their use of resources.

The ratings are the first produced by the Healthcare Commission under a system that has replaced star ratings. The criteria are broader and tougher, which is reflected in the results. Among hospitals, 11 qualify as excellent and 12 are described as weak in quality of service. Primary care trusts (PCTs) come out even worse: only six deliver excellent services and 24 are weak.

The new scales offer four rungs, roughly corresponding to the old three, two, one or zero stars. Services are assessed as excellent, good, fair or weak, and a similar scale is used to measure financial management, described as "use of resources". Not a single PCT wins the accolade of excellent for financial management and 124 are described as weak. Among ambulance trusts, not one is deemed excellent in either category.

The report will make unhappy reading for ministers, who have argued that the extra money going into the NHS is having real effects. The Healthcare Commission agrees: it sees a lot of positives in the findings and says that more demanding criteria, rather than declining performance, are behind the gloomy ratings.

The commission ranked 570 trusts in England, including PCTs, acute hospital trusts, mental health trusts and ambulance trusts. It concluded that 60 per cent were weak or needed to improve. Only two hospitals - Harrogate and District NHS Foundation Trust and the Royal Marsden Hospital in London - gained excellent ratings for services and use of resources. Eight scored weak in both categories. Overall, 24 trusts were ranked as weak for both quality of services and use of resources. For these - eight hospital trusts, 11 PCTs, four ambulance trusts and one mental health trust - the strategic health authorities would be demanding an action plan to put things right within 30 days.

Anna Walker, the chief executive of the commission, said that there were examples of good work, but added: "The NHS does need to raise its game to ensure a universal guarantee that general standards on both quality of services and use of resources are being met. What this assessment is about is systematically looking at each of these trusts to see how they are performing. What we are saying about the weak ones is not that they are unsafe but that they do have issues that they need to address quickly."

All trusts that ran a deficit in 2005-06 were automatically rated as weak in use of resources. But many, especially among the PCTs, would have scored the same even if they had not run a deficit, because their financial management was poor, Gary Needle, head of the annual health check at the commission, said. Ms Walker said: "This is a worrying picture of an NHS where financial management is not good enough. There are too many weak trusts, which failed to manage finances properly and too many fair trusts, which means that there is room for improvement. "It is no secret that the NHS has struggled with finances over the past year, but this assessment shows it is not only deficits that are the problem. It shows that many organisations do not have adequate financial systems in place. "Patients' care will suffer in the end if this is not put right."

The commission examined quality of services in a variety of ways. They included 24 core standards, looking at areas such as safety, clinical effectiveness and patient focus. Also incorporated were the old targets, mostly concerned with waiting times, where trusts did relatively well, and new targets, such as promoting good health, reducing obesity and helping people to give up smoking, where they did less well.

Patricia Hewitt, the Health Secretary, urged the NHS to redouble its efforts to meet patients' expectations. "The best of the NHS is among the best in the world and we should all be proud of its achievements," she said. "But I want to see the best everywhere. "This is the toughest and most comprehensive assessment of the NHS and it takes forward the commitment we made to patients and the public to provide them with detailed and easily understandable information about the performance of their local health services."

Nigel Edwards, director of policy at the NHS Confederation, said that the spread of results was proof that the latest round of reorganisations had adversely affected services. "Foundation trusts, who have not been reorganised and have extra freedoms to manage their own affairs, have been able to get on with the job and improve services, as the health check shows," he said.

Niall Dickson, chief executive of the King's Fund health think-tank, said: "There is clearly a mountain to climb here, especially in financial management: in part a legacy of the health service not grappling with underlying deficits early enough."



At what point is a person dead? And how does a perm work? You may need to talk your way out of questions like these to get into Britain's elite universities, a survey of applicants has revealed. They were some of the more curious questions recently pitched by interviewers at Oxford and Cambridge looking to find the very best among the thousands of students trying to get on courses at the prestige institutions. The survey of around 1200 students by Oxbridge Applications, which advises applicants, showed the interview process was living up to its reputation for being notoriously tough. The questions reported by students included:

Here is a piece of bark, please talk about it. (Biological Sciences, Oxford)

Are you cool? (Philosophy, Politics and Economics, Oxford)

At what point is a person "dead"? (Medicine, Cambridge)

Put a monetary value on this teapot. (Philosophy, Politics and Economics, Cambridge)

Other questions, though it was not clear who asked them, included: What percentage of the world's water is contained in a cow; of all 19th-century politicians, who was most like Tony Blair?

Jessica Elsom, of Oxbridge Applications, said the interview process was "notoriously eccentric" as the universities try to recruit the sharpest-witted among youngsters with flawless British school-leaving exam results. "With the increase in the numbers of students excelling at A-level, the Oxbridge interviews are one way of finding out who really cuts the mustard," she said.


Rushdie: Veils for Muslim women "suck": "British author Salman Rushdie Tuesday joined the delicate debate about face veils for Muslim women saying they 'suck' and weakened a woman's position. The writer, who was the subject of a fatwa by Ayatollah Khomeni of Iran in the late 1980s over his novel, The Satanic Verses, said he regarded the veil as a way of taking power away from women. Speaking in a BBC interview, Rushdie supported the position of Jack Straw, the former British Foreign Secreatry, who last week sparked controversy with his comment that the veil was a 'visible statement of difference and separation. ... He (Straw) was expressing an important opinion which is that veils suck -- which they do,' the Indian-born author said."

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