Wednesday, May 23, 2007

Allergy patients 'failed by NHS'

GPs and pharmacists do not know enough about allergies, putting patients lives at risk, campaigners say. Allergy UK said training on the subject was extremely limited and many people were going undiagnosed. And the pressure group said even when diagnoses were made, medics often had nowhere to send patients as there were limited specialist allergy clinics.

GPs agree it is an issue that needs to be addressed, but pharmacists argue they already receive enough training. Allergic reactions are caused by substances in the environment known as allergens, of which the most common are pollen from trees and grasses, house dust mites, wasps, bees and food such as milk and eggs.

The number of people suffering allergic reactions has been rising over the last 15 years with over 6,000 people a year in England admitted to hospital. A quarter of these involve anaphylaxis - a sudden, severe and potentially life-threatening reaction, which can cause dangerous swelling of the lips or face and lead to breathing problems.

After listening to the hundreds of people contacting them, Allergy UK believes doctors and pharmacists are too slow to pick up allergies, leaving people vulnerable to severe reactions. A spokeswoman said: "Doctors and other health professionals get little training about dealing with allergies. "It means patients are being put at risk."

The charity also criticised the lack of specialist allergy clinics. Many hospitals have some kind of service, but there are just six clinics in the country which deal with all types of allergy. The charity is planning to launch a website for health professionals giving information about allergies and the common symptoms. They are also offering training on allergies.

Professor Mayur Lakhani, chairman of the Royal College of GPs, said: "Allergies must be taken seriously and we would like to see a stronger emphasis on training in allergies in both undergraduate and postgraduate medical training. "At the moment we don't have the facilities to adequately investigate, manage and treat patients with allergies and we would like to see a programme of national action implemented in primary care."

But the Royal Pharmaceutical Society of Great Britain rejected the idea that pharmacists were not trained enough.
A spokeswoman said: "Pharmacists receive five years education and training, a large focus of which is on allergy."


White pupils in British urban schools are failing academically: why?

Are white working class families the new victims?

In a season similar to this 30 years ago, British educationalists were preoccupied with something referred to as "the great schools debate", in which the urban comprehensive was placed under scrutiny. When the media got wind of this, one particular television crew was dispatched to the school I attended in south east London, having decided it was the epitome of an underachieving, inherently multi-racial school within a poor and neglected postcode. The documentary that emerged - Our School and Hard Times - revealed the literacy of teenage pupils was dramatically below par, truancy was high, and hope was at an all time low.

The sixties outakes on the teaching staff were steeped in theories of social engineering and hinted to the camera that surroundings and social class rather than the pupils themselves, or teaching methods, were responsible. It was an argument that appears to have been around since Aristotle was a lad, and served its purpose until the issue of academic underachievement shifted from social class to race. This occurred when it emerged that the poor performance of black pupils - notably boys - was disproportionate to the size of this particular minority.

Thirty years on, and with the new century in its infancy, the poor academic achievement of white pupils in urban schools is becoming an issue. And even additives and E-numbers can't take the flak for this one. More significantly, it's the ethnicity of this group rather than - solely - social class that is relative.

Today, London's Business and Design Centre plays host to a conference devoted to tackling the issue of white underachievement. It brings together figures said to be experts in this field, and is organized by Cambridge Education Associates. In Islington, the CEA has had some success in addressing the poor academic levels of black pupils. By shifting the focus to this trend among white pupils, and largely in urban schools in which these are the minority, the organisers are showing a nerve that is absent elsewhere.

This issue of "white underachievement" has risen to the fore sporadically over the last couple of years, but with little response or action taken. The TES previously released a report on the issue ("white working class pupils have less mobility and employment opportunities than the children of immigrants who moved to the UK in the 1960s"); the Social Policy Group, the think tank established by former Tory leader Iain Duncan Smith, published its own research last year. The latter revealed that for the first time white working class boys were falling behind their black and Asian contemporaries.

Bad parenting was flagged up as the key culprit, with the high level of success of pupils from more family-based, insular, Chinese and Asian communities cited as the standard of attainment to aim for. If the response of those present at this day-long conference mimics that of the teaching staff at my own secondary school back in the punk spring of 1977, you can bet that the short-sightedness and fear around modern racial etiquette is responsible. With poor performance of black pupils the burden of blame is apportioned to those post-Macpherson fallbacks institutional racism or "unwitting prejudice". In the case of white pupils, racism can't by cited as a reason or excuse any more than the industrial revolution or the age of the child chimney sweep. However, were this any other ethnic group, cultural alienation, lack of high-profile role models and its derogatory portrayal within the media would be brought into the proceedings.

Therefore there might be an argument to suggest the fact that urban white working class communities have endured more change, dislocation and upheaval than any other over the last 40 years, added to the racial and classcist slurs targeted regularly at this group by the press, might have some small part to play. But the greater responsibility for what is very much a 21st century trend might rest with the cult of multiculturalism.

This is alluded to within the research to be revealed at Monday's conference and where the notion of nerve comes in: "in dialogues about diversity, white ethnicity and social class is often rendered invisible and as such is not included in studies of the diverse landscape of British culture". In short, the communities that have been most altered in order to create a multi-racial society and accommodate multiculturalism have been airbrushed from any discussion or literature on the subject.

By recognising this the CEA might not have the answers on why young white urbanites are getting bad exam results, but it does highlight the fault-lines in a modern "inclusive" culture that exiles them. This in itself says more about the myth of multiculturalism than secondary education: it's one thing to build a vision on a myth, it's another to build it on a lie


New evidence that British blacks really are madder

Three years ago an official inquiry into the treatment of black people within Britain's mental health services concluded that the system was riddled with institutional racism and blamed the Department of Health for ignoring what it called "this festering abscess... a blot upon the good name of the NHS".

But now senior psychiatrists, some themselves from ethnic minorities, are hitting back, arguing that labelling psychiatric services as racist is both wrong and counter-productive. Professor Swaran Singh, a consultant based in Birmingham says, "the high rates of psychosis and the high rates of detention are not a result of racism", he insists.

The experiences of black people in mental health services are undoubtedly shocking: black men up to 18 times more likely to be diagnosed with psychotic illness than whites and four times more likely to find themselves locked up under the Mental Health Act. Understandably, for many within the black community the figures are powerful evidence that services are profoundly racist.

Professor Singh's view has seen him accused of setting psychiatry back 20 years, but he is adamant. He says the term "institutional racism" damages the very people it purports to help and "is erroneous and too simplistic an explanation for ethnic differences. What it does is it creates a wall of mistrust between between service users and service providers."

But in the last few months, research by the Institute of Psychiatry in London has turned the argument on its head. The largest-ever study of psychosis tested the theory that psychiatrists wittingly or unwittingly allowed their clinical judgment to be influenced by the colour of their patients' skin. Researchers removed the ethnicity of a patient from their notes and asked a doctor to assess them. What they found was that psychosis was still diagnosed nine times more often in black people from the Caribbean - almost exactly the same rate as their presence within mental health services.

Professor Robin Murray from the Institute says the evidence is remarkable. "We have pretty well excluded the possibility that this is a result of misdiagnosis", he says. In fact, the results suggested the opposite. "Psychiatrists in the UK are less likely to diagnose psychosis in somebody who is black than white with the same symptoms", argues Professor Murray.

The real explanation for so many more black people in mental health services, it is claimed, is that they suffer from higher levels of mental illness. The reasons for that are thought to be social: fractured families, exclusion, poor education, unemployment and cannabis use - all problems which particularly affect the black community.

Research also came up with an explanation for the higher rates of detention under the Mental Health Act. Black people are twice as likely as white patients to be referred to a psychiatrist by the police or a court rather than their GP. In other words, black patients arrive in the system when their condition is much more serious, requiring their detention. According to some psychiatrists, the consequence of wrongly blaming racism for black people's high representation in mental services is that the real causes of mental ill health in the black community are ignored.

Just as concerning is the claim that some dangerously ill black patients are discharged into the community because white mental health tribunals are worried they may be accused of racism. Dr Shubulade Smith, a consultant psychiatrist at the world-famous Maudsley Hospital in South London says an all-white panel wouldn't listen to her arguments about one of her black patients. "He was really at risk getting hurt because of the illness that he had, and the tribunal discharged him", she says. "I don't know what was going on in their minds other than they were too scared of thinking that they might be being racist towards him."

Dr Smith, herself a black woman, believes psychiatry needs to focus less on internal racism and more on helping deal with the real causes of mental illness out in the community. "Let's do something about those factors that increase the likelihood of people becoming unwell in this way," she says. "Let's do something about that."


Immigration anger getting recognition in Britain

Established British families should be given social housing even if they need it less than new immigrants, a government minister said yesterday. Margaret Hodge said that indigenous families' "legitimate sense of entitlement" should be taken into account in deciding who was housed. Ms Hodge, an Industry Minister, has called before for the Government to do more to counter the resentments created by immigration.

Yesterday she suggested that national insurance contributions could be used as part of a points system of housing allocation. She said the Government currently "prioritised the needs of an individual migrant family over the entitlement that others feel they have to resources in the community". She added: "So a recently arrived family with four or five children living in a damp and overcrowded privately-rented flat with the children suffering from asthma will usually get priority over a family with less housing need who have lived in the area for three generations and are stuck at home with the grandparents."

Hazel Blears, Labour's chair-woman and a candidate for deputy leader, agreed that ministers had to do more to convince people that the system was equitable. "I think that people in this country have a real sense of fairness. They are prepared to do their bit but they want to know the system actually works for them. So I do think we need to tackle these tough issues."

However, Nancy Kelly, of the Refugee Council, a campaigning group, said that Ms Hodge was aping the BNP. "The way to counter some of the views that are put forward by the far-right parties is not by trying to follow their lead." Ms Kelly said that asylum-seekers were not entitled to council housing and arrivals from new EU states had restricted access to benefits. "People who are recognised as refugees are entitled to council housing but on exactly the same basis a UK national, on the basis of need," she said.

Ms Hodge, an immigrant herself - she was born in Egypt to Jewish refugee parents - said that she had seen many voters in her Barking constituency turn to the BNP because of concerns over housing allocations. She said a transparent points system, giving more weight to length of residence, citizenship and national insurance contributions, could be a better way of allocating housing.

Writing in The Observer, she said that there was widespread concern about the changing face of Britain, and people needed to be reassured. "We should look at policies where the legitimate sense of entitlement felt by the indigenous family overrides the legitimate need demonstrated by the new migrants. We must address these difficult questions."

Damian Green, the Conservative immigration spokesman, said that Ms Hodge's comments acknowledged the Government's "long-term failure" to control immigration. Andrew Stunell, the Liberal Democrat local government spokesman, said that the Government was continuing to sell council houses although there were 1« million families on the council housing waiting list.



Across Britain, cities are plunged into darkness. In London, the Underground grinds to a halt, leaving panicked commuters stranded in oppressively hot carriages. In office blocks, lifts stop operating and the air-conditioning shuts down. Employees swelter in stifling conditions. This is not the postapocalyptic vision of some film-maker, but a realistic scenario as Britain grapples with a looming energy crisis.

The statistics are frightening. In only eight years, demand for energy could outstrip supply by 23% at peak times, according to a study by the consultant Logica CMG. The loss to the economy could be 108 billion each year."The idea of the lights going out is not a fantasy. People seem to accept that security of energy supply is a right. It is not. The industry will have to work hard to maintain supply and for that we need a clear framework," said Simon Skillings, director of strategy and energy policy at Eon UK, Britain's largest integrated energy company.

This Wednesday, the government's delayed energy white paper will attempt to provide some answers. It is a crucial document that will determine whether Britain can deliver on its pledge to slash carbon emissions by 20% from 1990 levels by 2020. The white paper will seek to tackle a host of tough issues -- from nuclear power to energy efficiency, renewable power sources and clean-fuel projects. A planning white paper, due tomorrow, is also seen as crucial after a number of energy projects have been delayed for years or slapped down by local authorities.

The scale of the challenge is immense. By 2015, Britain's generating capacity could be cut by a third as ageing coal and nuclear power stations are closed. Britain is also moving from being self-sufficient in oil and gas as North Sea production declines. In 2005, the UK became a net importer of gas. By 2010, imports could account for 40% of British gas needs; by 2020, 80% to 90%.

The most contentious area is likely to be nuclear power. Nuclear reactors account for about 20% of Britain's electricity, but this will shrink to 6% in 20 years as ageing plants are closed down. By 2023, only Sizewell B could be in operation. Already controversial, the government's commitment to building new nuclear power stations became even more sensitive when the High Court agreed with the environmental lobby group Greenpeace that the consultation process was"seriously flawed".

The white paper is expected to give guidance on how the government would like to see new reactors built, but will have to stress that any decision will depend on a new, more detailed, consultation round. What the energy industry wants is clarity. Even so, energy companies, including RWE, Eon, Suez, EDF, General Electric and Westinghouse, have already held talks with British Energy about using the sites of its eight nuclear power stations to build new reactors.

Combining the need to secure Britain's energy supply and reduce carbon emissions will require 55 billion in investment in the next few decades, according to Logica CMG. Exactly where the money will be spent hangs in the balance. One of the big issues is how the government plans to encourage operators to build cleaner but more expensive power stations.

To make the economics work, much will depend on the price of carbon and the credits power operators need to buy if they overshoot emissions targets. This falls under the EU emissions-trading scheme. If the EU cracks down and imposes higher penalties on"dirty" power producers, the price of carbon would in theory be pushed up. Centrica believes that carbon prices would need to double from the current, 19 euros per tonne to make a1 billion clean-coal project it is considering in Teesside economically viable."If the UK is to hit tough targets on reducing CO2 emissions, it is vital that the structure of the EU emissions-trading scheme is optimised to encourage the building of really low-emitting power generation stations," said Jake Ulrich, managing director of Centrica Energy.

Another key area is carbon capture; this involves trapping carbon-dioxide emissions from coal or gas-fired stations and storing them underground, probably in old North Sea oil reservoirs. Schemes include Centrica's Teesside proposal while BP is considering building a 500m power station in Peterhead, Aberdeenshire, in partnership with Scottish & Southern Electricity. However, power-industry executives claim that each project would need several hundreds of millions of pounds in government support -- far higher than the Treasury's financing plans.

Meanwhile, the government is under pressure to encourage desperately needed new gas-storage facilities. The UK has storage capacity to cover only two weeks of gas needs against two to three months for France and Germany. New objectives for renewable energy are also expected. The renewables obligation, where suppliers are bound to source a rising percentage of electricity supply from renewable sources, will be refocused to give more support to costlier offshore wind farms and biomass projects used to co-fire coal-powered stations.

Britain is already struggling to meet its ambitious target of supplying 10% of electricity needs from renewables by 2010 and 15% by 2015. Today's figure is about 2%."The goals are very ambitious and we are currently behind the curve. Investment would have to be accelerated very substantially to have any chance of meeting those targets," said Jayesh Parmar of Ernst & Young.

Those targets are likely to get even tougher. In a little-noticed detail, the EU agreed in March to make it compulsory for 20% of all energy used to come from renewable sources by 2020. As for the British consumer, the white paper will underline the need for smart meters, which measure exact energy use and cost, to be installed in people's homes. There is also support for microgeneration projects -- small-scale wind turbines, solar panels and gas devices to create electricity. However, the sums are tiny -- "12m pounds in grants is up for grabs this month from the Department of Trade and Industry, in addition to6.8m already paid out.

The big question is whether the UK can act fast enough to tackle the looming crisis. Even if the government's nuclear plans remain intact, it could be at least 10 years before the first new nuclear station is ready. A typical coal or gas-fired project could take between three and five years to construct.


For history buffs, Dan Mandel has an excellent summary of how pro-Jewish Winston Churchill was -- despite much opposition from the "practical men" of his own cabinet and staff. My own comment about Churchill's politics is here.

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