Saturday, May 26, 2007

Arrogant and life-threatening British bureaucracy gets a well-deserved black eye

These walking anal orifices cared more for their precious little bureaucratic procedures than they did for the life of a distressed person. You wonder if they are really human beings

A Citizens Advice Bureau adviser who was dismissed after she broke confidentiality rules to help to save the life of a suicidal caller has won her claim for unfair dismissal. Terri King, 58, of Southampton, had acted after a distraught client called the service to say she had taken an overdose of pills because she could not deal with her debt problems. Rather than following the time-consuming procedure of contacting her manager, who would then have had to consult a committee for advice, Mrs King immediately alerted the caller's GP, who was able to get to the woman and treat her.

Despite her lifesaving actions, the divorced mother of three was dismissed from her 13,000 pound-a-year job, on the ground of breaching confidentiality. Peter Wales, her boss at the Lymington branch of the CAB in Hampshire, said that she had made an "irrational and emotional error", the hearing was told.

Delivering a judgment yesterday, the tribunal chairman, Ian Soulsby, condemned the management's attitude towards the incident, which tested the extent to which patient confidentiality should be respected in the event of an emergency. Mr Soulsby said it was ridiculous to say that Mrs King's actions had been an irrational error. "Viewed objectively, there is no criticism of the claimant to act in this way. A life may have been in imminent danger. From any point of view this was a sensible course of action to take."

Mrs King was granted damages of a little more than 18,000 pounds by the Southampton Employment Tribunal, which said she had done the right thing in phoning the caller's doctor. The hearing was told that Mrs King had worked for five years at the bureau.


Appalling and unhealthy results of recycling mania in the Unhinged Kingdom

Sharon Lock, 36, has three bags of rubbish in her cluttered garage. They have accumulated there in the three days since her husband spent his Sunday morning driving to the tip seven miles away. Since February, when East Cambridgeshire District Council introduced fortnightly black-bag collections in Bottisham, he has been making the journey twice a week. "It's a real pain in the butt, to be honest with you", the mother of one said. "My son, Drew, is 2 and we can't have dirty nappies and food sitting in the garage for a fortnight. The smell is horrendous."

Lucy Baynes, who gave birth to her first child Zac only five weeks ago, tells a similar story. Two days before the fortnightly collection in leafy Bottisham, there is already a pile of black bags stacked against a post outside her garden, one of the communal collection points for the village. "Initially I thought the scheme was a good idea, but the stacks of rubbish are disgusting. That pile will be humming in the summer, and there will be more foxes and cats."

The council halved black bag collections in Bottisham only weeks ago, having already done so last summer in the village of Witchford. The pilot schemes are a response to the Government's controversial drive to push councils into cutting down on landfill and boost recycling, which Ben Bradshaw, the Environment Minister, said has resulted in 144 councils already experimenting with fortnightly collections.

Voters in many of these local authorities, including East Cambridgeshire, will be taking part in local elections next week. If sitting councillors are going to suffer as a result of their decisions to cut back on the dustmen, you would expect it to be at the hands of people such as Mrs Lock and Ms Baynes. Yet neither of these women will be voicing their frustration over refuse at the polls next week, because neither of them will be voting at all. Both cite their young children as a reason why they have not engaged with the election campaign, and both seem decidedly uninterested in whether the 17 Liberal Democrat councillors, 16 Conservatives and 6 independents will hold their seats on May 3.

Among those in the village who will vote, post office closures and council tax were both mentioned as reasons to back one party over the other, but not one person told The Times that the backlog of binbags would influence their decision. Which is perhaps why Colin McLean, the village's Conservative councillor, is relatively relaxed about the issue: "People have not been shaking hands over it on the doorstep," he said, "but nor have they been shaking fists."

Back in Bottisham, where the residents have had less time to adjust to the changes, John Humphreys expresses the mood of many people: "It is a diminution of the service which they tell us is an improvement, which gets up people's noses, and its an imposition, but compared with the big issues like the NHS it is not important. The retired teacher is less than thrilled about having to store nonrecyclable rubbish for two weeks before it is taken off his hands. But he will not be swayed by the battle of the binbag when he goes to vote. "We are the compliant people of England, and life's too short," he said. "It's not worth going to the barricades over."



British government is all talk

BP has abandoned plans to build a "green" power plant in a snub to Alistair Darling on the day that the Trade and Industry Secretary unveiled a new energy strategy aimed at reducing carbon emissions. Just hours after Mr Darling announced his Energy White Paper yesterday, the oil giant halted work on a 1bn-plus carbon capture and storage facility in Scotland, blaming delays in state subsidies.

BP's decision is an embarrassment for the minister, whose White Paper is designed to underline the Government's commitment to take a global lead in cutting greenhouse gases. The oil company, in a joint venture with Scottish & Southern Energy, has spent 30m during the past 18 months preparing to build a gas-fired power plant that would generate electricity and store 90pc of the emissions created in a depleted North Sea oil field. Similar projects are planned by other power companies.

But because the advanced technology makes such plants uneconomic, the Government promised to kick-start two or three facilities with subsidies. BP said yesterday that it had hoped to get a decision on state aid by the end of 2006, but this was pushed back to the end of 2007. But the White Paper indicated that a decision might not come until well into 2008 or beyond. "That's an extension too far," said a BP spokesman. "It would have been difficult to keep the project alive when there is uncertainty about funding. We have already spent a lot of money on the project."


Alcohol and pregnancy: Bureaucracy trumps science

Lying to people as a way of getting them to behave in an approved manner is a hoary old Leftist strategy -- e.g. their patently absurd but endlessly-repeated claim that there is no such thing as race

Women who are pregnant or trying for a baby should stop drinking alcohol altogether, the Government's leading doctors give warning today. The new advice radically revises existing guidelines, which say that women can drink up to two units once or twice a week. Fiona Adshead, the deputy chief medical officer, said that the change was meant to send "a strong signal" to the thousands of women who drank more than the recommended limit that they were putting their babies at risk. But she admitted that it was not in response to any new medical evidence

Women are often confused about what drinking in moderation really means, the new guidelines say, and surveys suggest that many accidently or deliberately exceed the limit. "Our advice is simple: avoid alcohol if pregnant or trying to conceive," Dr Adshead said. "We have strengthened our advice to women to help ensure that no one underestimates the risk to the foetus." She suggested that bottles of beer, wines and spirits should carry the new warning that pregnant women give up drinking. However, it emerged yesterday that the Royal College of Obstetricians and Gynaecologists intended to stick with its advice that moderate drinking was perfectly safe, which could leave many pregnant women confused. The college said that it would examine the new advice and decide whether to adopt it "in due course".

The change brings Britain into line with a growing list of countries which recommend abstinence. For years, the US, Canada, Australia and New Zealand have recommended that pregnant women abstain from alcohol. France joined them last autumn, saying that research had linked moderate levels of drinking and permanent brain damage.

Research from the Office for National Statistics has shown a sharp rise in fatal drinking habits among women. The study, of "preventable mortality", found that the annual rate of alcohol-related deaths had risen by two thirds between 1993 and 2005, to 1,873. However, the statistics only refer to death certificates where alcohol-related conditions such as cirrhosis are specifically mentioned. Charities put the annual death toll for both sexes at about 22,000.

Ministers were moved to act over drinking in pregnancy after recent research found that 9 per cent of expectant mothers drink more than the recommended limit. Other data found that a quarter drink right up to the limit. The existing advice to drink in moderation has been in place for about ten years. Previously, midwives regularly told pregnant women to drink up to eight units a week, and even recommended Guinness to prevent anaemia.

Heavy drinking can cause foetal alcohol syndrome, an incurable condition resulting in retardation, poor memory and, in the worst cases, facial abnormalities. About 1 in 1,000 babies are born with the syndrome each year worldwide. But a milder condition, foetal alcohol spectrum disorder, is more common, affecting more than 6,000 children in Britain each year, and is a leading cause of learning difficulties.

Because many women do not realise that they are pregnant for the first few months, the advice was extended to those trying to conceive as well. It also states that should a pregnant woman choose to carry on drinking, she should not get drunk and keep to the previous recommendation of one to two units once or twice a week in order to minimise risks to the baby.


Dumbing down Britain's doctors

The collapse of Britain's online Medical Training Application Service (MTAS) has been widely welcomed. The web-based system was designed to match junior doctors to specialist training posts, but following junior doctors' complaints about a lack of available posts, poorly designed recruitment forms and technical failures in the new online system, it has now been scrapped. However, the real threat to standards of medical practice - and ultimately patient care - comes from the Modernising Medical Careers programme, of which MTAS is merely one aspect.

`If one of my own children had been in that position', UK health secretary Patricia Hewitt told Channel 4 News on the day she finally suspended MTAS, she would have fully shared the distress of the parents of those affected by the series of scandals afflicting the new computerised application system for specialist medical training (1). This curious presentation of the issue from a parental perspective is echoed on the website of RemedyUK, the grassroots organisation of junior doctors that has led the revolt against MTAS, staging unprecedented mass demonstrations in March (2). The site prominently displays a colourful poster proclaiming `Mums4Medics' (with subsidiary slogans, `Dads4Medics', `Partners4Medics', `Everyone4Medics').

By the time they have completed five or six years of medical school and two years of the new post-qualification `foundation programme', the youngest of the doctors applying to MTAS is 25 and many are over 30. Yet it seems that these `junior' doctors are regarded by the health minister as children and that they even regard themselves in similar terms. The infantilisation of doctors implicit in these representations reflects the real threat to the medical profession and to the quality of medical practice posed by the current wave of `modernising' reforms.

Hewitt was quick to emphasise that, though doctors are angry about MTAS, the `underlying principles of Modernising Medical Careers' are widely accepted by both junior doctors and the professional bodies that have been closely involved in the development and implementation of this programme. Before looking more closely at Modernising Medical Careers (MMC), let's briefly look at the MTAS fiasco.

In many respects MTAS is just another National Health Service IT failure: an online system that is vastly expensive, badly designed, difficult to use and which crashes frequently. When the system made publicly available doctors' personal details, including religion, sexual orientation and criminal records, this was more than a breach of confidentiality. It raised questions over why a medical appointment scheme should require that candidates submit such information. Though it is these failures that have led to the collapse of MTAS, its defects go much deeper.

In its modernising zeal, MTAS gives priority to doctors' subjective `learning experiences' and downplays objective indicators of performance. It allocates 75 per cent of its points to 150-word vignettes of clinical cases, in which doctors display fashionable concerns about `reflexive learning', `team-working' and ethical dilemmas. According to critics this amounts to meaningless self-promotion as well as being open to plagiarism (which the system lacks the software to detect). Only 25 per cent of points are allocated to academic or research achievements. Extracurricular activities are marginalised, references sidelined and interviews rigidly standardised.

The elite Academy of Medical Sciences has condemned MTAS for its discrimination against talent and excellence, as `a threat to UK biomedical research and healthcare' (3). For the Academy, MTAS reflects `a mindset in which academic, educational and research achievement are seen as almost irrelevant to the future quality of healthcare'.

It is true that the old system of selection for specialist training posts was susceptible to nepotism, favouritism and discrimination against those from ethnic or other minorities. It is New Labour's signal achievement, in this as in many areas, to have replaced a corrupt and inefficient system with one that is potentially more corrupt and certainly more inefficient - and even more damaging to the morale and standards of the medical profession.

The spirit of political correctness that imbues MTAS has already established deep roots in the modern medical profession. These can be traced back to the adoption by the General Medical Council in 1993 of the document Tomorrow's Doctors, which outlined the `goals and objectives' of a new medical curriculum under the rubric `knowledge, skills and attitudes' (4). While `knowledge' was reduced to a `factual quantum', extensive and detailed attitudinal objectives `reflected the values of the culture of therapy and the demands of political correctness' (5). Launched in 2004, Modernising Medical Careers sought to extend the approach of Tomorrow's Doctors from the medical school into the world of post-graduate medical practice, in hospital and in primary care (6).

The first major MMC initiative was the replacement in 2005 of the traditional year doctors spent as `house officers' in hospitals immediately after qualification with a two-year `foundation programme' (part of which could be completed in General Practice). There can be no doubt that the old system had many flaws: many young doctors were exploited by absentee consultants, obliged to work excessive hours and received minimal supervision or training (to the detriment of both themselves and their patients). The foundation programme sought to replace the old `apprenticeship' model - celebrated in the surgical saying `see one, do one, teach one' - with a closely supervised programme of instruction in the attitudes and values deemed appropriate for the modernised doctor.

The new programme is `trainee-centred, competency-assessed, service-based, quality-assured, flexible, coached, structured and streamlined'; it is managed and structured, progressive, robust and seamless; it is `outcome-based' and evaluates `observed behaviour, skills and attributes'. No doubt some of this jargon conceals valuable educational and clinical activity, but it is difficult to believe that all the ticking of boxes reflects any improvement in the rigour of medical training. What remains unquantified in this system is the quality of doctors' clinical knowledge and their experience of taking responsibility in treating and caring for patients.

The 1858 Medical Act, which is established the General Medical Council, sought to establish a system of medical education that produced a doctor who, on qualification, was a `safe general practitioner'. This concept of an independent and competent general practitioner symbolised the confidence of the modern medical profession at the moment of its emergence in the nineteenth century. By contrast, the `never quite competent' doctor, one who requires continuous formal instruction and regulation, monitoring and mentoring, support and counselling, symbolises the abject state of the profession in the new millennium. While the junior hospital doctor of the past may have been used and abused, today's doctors appear to have lost all initiative or autonomy in relation to their own professional development and in relation to their patients. If tomorrow's doctors are reduced to the status of children, to be patronised by politicians and parents, as well as by their trainers and tutors, the future of the medical profession is in jeopardy.

For the Academy of Medical Sciences, MTAS is `an object lesson in what happens when we take medical education out of the hands of those who value objective academic achievement and put it in the hands of those who wish to create a uniform and biddable workforce unencumbered by the spirit of inquiry needed to challenge dogma and central directives'. The consequences of this lesson are not confined to MTAS, but go back through MMC to Tomorrow's Doctors, and the wider framework of medical education and training established over the past decade.


The BBC still hates America: "White lynch mobs are back in the Deep South. At least according to the BBC, which is broadcasting a special program on it, headlined "Stealth Racism Stalks the Deep South." Apparently six young black men have been charged in an attack on a white student. The Bolshie Beeb knows this story line. It hasn't changed in a hundred years --- if you believe the Beeb".

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