Sunday, May 27, 2007


Gordon Brown, the Prime Minister-in-waiting, said today that the NHS had to "be there for people when they need it" after a damning report on the death of a woman who was forced to consult eight out-of-hours GPs in four days over an Easter weekend. Penny Campbell, a 41-year-old journalist and mother, died in March 2005 from multiple organ failure. She had become infected with septicaemia during an operation for haemorrhoids but none of the doctors she spoke to or met diagnosed it. A report by a panel of independent investigators published today found that the actions of at least one of the GPs, together with problems in how the out-of-hours service was run, meant that she was not offered appropriate care.

Camidoc, a private company contracted to provide out-of-hours cover, had no procedures to ensure that notes on patients were easily available to all GPs, so that each time she rang for help they treated her as a new patient. This was a "major system failure" and was a direct factor leading to Miss Campbell’s death, the report said. Ms Campbell's partner, Angus McKinnon, said today that he was convinced that a similar tragedy could happen again. "I’ve had dozens of people contact me, cases where people had really narrow escapes," he said.

Mr Brown was asked about the case at a South London school and said that the Health Service had to "do better". "What I’ve been talking about is how we can extend the range of facilities for healthcare at the weekends and out of hours," he said. "So we need more access to doctors, we need walk-in centres, we need local healthcare centres to be more effective, we need NHS Direct to be working. "And we need pharmacies, interestingly enough, to have more ability to, for example, do blood tests and some of the basic things where you can just walk in off the street and get some of the basic tests done. And we need prescriptions to be translated to people, directly to the chemist, in a way that you don’t have to queue up at the doctor’s for a repeat prescription. "So in all these areas we need more access for patients. The health service has got to be there for people when they need it and we need to do better in the future."

But Mr Brown's intervention was scorned by the Tories. “It is odd that Gordon Brown should now realise that GP cover needs to be improved," said Andrew Lansley, the Shadow Health Secretary. “Just three years ago he allowed a new GP contract to go ahead, which doubled the costs of providing out-of-hours care and led to worsening services for patients.

Today’s report identified weaknesses in the arrangements for out-of-hours care. Responsibility for providing the care passed from individual GPs to Primary Care Trusts in 2004 when the new GPs' contract came in. The report criticises the speed at which the change was implemented, and urges the Department of Health to provide a clear definition of the role of out-of-hours care.

Ms Campbell, from Islington, North London, was diagnosed with various conditions by the GPs, including colic, flu and viral infections, an inquest heard last year. The coroner ruled that the doctors contributed to Miss Campbell’s death because they failed to recognise the seriousness of her condition. All eight doctors voluntarily stepped down from out-of-hours care while the investigation into her death was carried out - although they continue to work as GPs.

Today’s report said that six GPs provided Miss Campbell with a "reasonable standard" of care but one, named as Dr Chuah, did not adequately explore her symptoms to see if she had an acute illness. Dr Chuah failed to offer Miss Campbell a reasonable standard of care during an 11-minute call at 4.50am on Monday, March 28, the day before her death. A transcript of their conversation shows that, when she checked with him that it was "not anything serious", he replied that if it was more serious, she would be a lot more sick and "wouldn’t be talking to me like this".

It adds: "Reviewing this transcript, it is apparent that Penny Campbell was articulate and coherent. In the course of the conversation she describes her symptoms quite clearly. "It is also evident that Dr Chuah did not pick up the cues offered by her or further explore any of these symptoms to clearly and definitely exclude any serious pathology that could have accounted for these symptoms."

The investigation found that the care offered by an eighth GP, Dr Bengi Beyzade, could not be adequately assessed in retrospect. Camidoc has said the six cleared of wrongdoing will be able to work again for them following a review. Dr Beyzade and Dr Chuah would have to go through a much more rigorous process involving a performance review with their PCT if they wished to return to work, it said.

Mr MacKinnon, 40, said the fact that the two doctors may be able to work again showed a "total lack of accountability" and was indicative of a wider problem regarding the work of doctors. "To get justice where doctors have performed unprofessionally, to get justice for the victims of their incompetence, you have to sue them. That’s a broader problem within our health system," he said. "Dr Chuah should be struck off." Mr MacKinnon plans to write to the General Medical Council (GMC) about the conduct of four of the doctors. He is also pursuing civil action over the case.

Islington Primary Care Trust (PCT), which commissions Camidoc’s services, issued a statement today extending its sympathy to Ms Campbell's family and admitting failings in her care.

Today’s report says the system of "safety netting" - where Miss Campbell was told to call back if she did not recover - was "seriously flawed". Each of her calls to doctors were treated as an individual "episode", with Miss Campbell having to recount her symptoms again and again. Although Camidoc had put in place methods to transfer to a computerised records system, it failed to address existing risks and take steps to overcome the problems. The report says that Camidoc was unprepared for its shift to a major out-of-hours provider of care. It also criticises Camidoc’s lack of process for driving up standards, saying that the systems for ensuring clinical governance was in place were not fit for purpose.

The system of out-of-hours care in England has been much criticised, with a recent study from the Public Accounts Committee saying that the Government thoroughly mishandled its introduction. Prior to 2004, out-of-hours care was managed by GPs but this was handed over to PCTs as a result of the new GP contract.

Mr MacKinnon backed those criticisms today. "If Tesco can open till midnight every night, why can’t our GPs open till midnight every night?" he said. "The National Audit Office said last year that the reform of out-of-hours has been incredibly expensive - it’s massively over-budget - so if they had spent a little less money on doubling doctors’ wages they would be able to afford better night-time and weekend care." Ms Campbell had a son, Joseph, who was 6 at the time of her death.


Dumbed-down British vocational qualification

Tens of thousands of teenagers are taking a new qualification worth up to four good GCSEs but which government experts say an average 11-year-old could pass. Half of all secondaries are estimated to be opting for the OCR national level 2 in ICT, where tasks include sending an email and searching the internet. It is being adopted as a replacement for the GNVQ in ICT, which controversially helped many low performing schools leap up the league tables. As with its predecessor, schools can use the OCR exam to gain the equivalent of four A*-C GCSEs, even though it only requires the teaching time of one.

But a document leaked to The TES shows consultants from the Government's National Strategies have found a pass in the qualification's compulsory unit "generally" equals level 4 of the key stage 3 national curriculum - the standards expected of an 11-year-old. Some points matched level 5, those of a 14-year-old. The revelation is a new blow to the Government's attempt to ensure vocational qualifications gain parity of esteem with academic ones.

A local authority ICT adviser has rated some of the qualification's most popular optional units and told The TES he found exactly the same standards uncovered by the National Strategies consultants. "The demands of this specification are very low indeed," he said. "Schools are using it to get soft certificates. Many are now putting all their students in for this in the expectation that they will all pass."

Some schools argue the consultants' verdict is too harsh. Mike Reid, an ICT teacher at Broughton Hall high in Liverpool, said: "The level of the tasks they have to perform are industry standard." To gain a distinction in the OCR national, equivalent to A* GCSEs, pupils must master extra tasks that include using quotes and words such as `and' and `or' when searching the internet. The local authority adviser described it as a "tick-box" course, enabling E grade pupils to gain the equivalent of Cs.

A spokesman for the OCR exam board said the National Strategies consultants could not have carried out a genuine comparison because the first results of the new qualification or details about the candidates taking it were still unknown. He said: "The ICT national level 2 is doing incredibly well because it was created in partnership with teachers and is interesting enough to be very learnable for students."

Clare Johnson, a National Strategies ICT programme adviser, said the conclusions by consultants from the West Midlands were part of a draft document that would not be distributed to schools. She did not know of anything that contradicted their conclusions, but said comparing vocational qualifications with an academic programme of study was inappropriate. The Qualifications and Curriculum Authority said it will monitor the new qualification.


Absurd British "human rights" laws to be suspended?

John Reid faced growing anger as he signalled the Government was ready to declare that Britain faced an "emergency" over terrorism and opt out of human rights legislation. As the recriminations flew over the disappearance of three radical Islamists who had been on control orders, he made clear his determination to bring in tougher curbs on terror suspects. The Home Secretary said that could mean "derogating" from the European Convention on Human Rights (ECHR) so he could impose tougher control orders on suspects. The convention, which entered British law via the Human Rights Act, allows countries to suspend parts of the ECHR in "time of emergency".

Control orders, which restrict movements and contact with other people for terror suspects who cannot be brought to court, were introduced two years ago. They replaced the detention without trial of the "Belmarsh detainees," which was ruled illegal. The latest disappearances bring to six the number of people on control orders who have vanished in the past year and have left the control-order system in disarray.

A major police search was under way last night for Lamine Adam, 26, his brother Ibrahim, 20, and Cerie Bullivant, 24, after they went missing this week. Police believe they may try to travel to Iraq or Afghanistan. A third Adams brother, Anthony Garcia, 25, was jailed for life last month for his part in the "fertiliser bomb" plot to attack targets including a shopping mall and a London nightclub. Bullivant is due to stand trial over claims he breached his control order on 13 occasions over the past 10 months. All three had been assessed at the lower end of risk, but the fact that they co-ordinated their disappearances has alarmed the police.

Sir Ian Blair, the Metropolitan Police commissioner, said: "Nobody can be perfectly satisfied they are not a risk to the public here, but the intelligence is pointing in another direction." However, Mr Reid had said the men were "not considered at this time to represent a direct threat to the public in the UK".

News of the absconders triggered fiery clashes over the control-order system in the Commons. The Home Secretary admitted that he would prefer to detain terror suspects or deport those who are foreign nationals, but said he was constrained by legal and political opposition to that approach. He said he wanted to impose tougher control-order regimes, but was hampered from doing so by court judgments under the ECHR. Mr Reid said he wanted the convention modernised by European leaders to reflect the realities of the terrorist threat. But he added: "We will consider other options, which include derogation, if we have exhausted ways of overturning previous judgments on this issue."

Nick Clegg, the Liberal Democrat home affairs spokesman, said: "By threatening to derogate from the European Convention on Human Rights, John Reid reveals a worrying mix of sloppy thinking and buck-passing." He said it was "wildly inaccurate to claim that the three escapees were somehow helped by our respect for human rights".

David Davis, the shadow Home Secretary, said the escapes were caused by the Government failing to use existing powers, such as tagging suspects. He also said the delay in releasing the identities of the fugitives had allowed them to flee abroad. "He is now blaming his own Human Rights Act when he has not even tried to derogate under its provisions. He can blame the courts and the opposition, but the problems are of his own making," Mr Davis said. Shami Chakrabarti, the director of the campaign group Liberty, said: "This is last year's rhetoric from yesterday's Home Secretary."


Claims are mounting against child-rearing "experts"

CLAIMS are mounting that child-rearing experts such as Supernanny and Gina Ford are damaging family life by undermining parents' authority in the home. There was growing confusion among parents over how to bring up children because of the parenting advice "industry", a leading sociologist has warned. He said that relying on techniques from the so-called experts could be destroying some parents' confidence in their own child-rearing abilities, weakening their control over their offspring.

Professor Frank Furedi also cautioned that the spread of the nanny state was adding to bewilderment among parents.
The Kent University sociologist was among academics to challenge increasing interference in family life at a two-day conference at the British university. He claimed figures including TV Supernanny Jo Frost, whose discipline techniques include the "naughty step", portrayed mothers and fathers as incompetent. "They basically assume the high ground 'I am the supernanny, unlike you, the incompetent, bumbling idiot'," Professor Furedi said.

But he warned that the wealth of advice available, from Frost and others including the no-nonsense author Gina Ford, risked demoralising parents. "Parents who don't believe in themselves are not going to be very confident," he said. "The main thing is that it leads to estrangement. Mothers and fathers become estranged from each other and their children. Rather than a family developing a strong sense of itself, it is looking too much to the outside."

Professor Furedi, author of Paranoid Parenting and the Culture of Fear, went on to accuse governments, particularly the British Labour Government, of politicising parenting. "Over the past 10 years, virtually every aspect of childrearing is turned into a problem that requires their support or intervention," he said. "This undermines parents' confidence. "Targeting parents has become a national sport. New Labour politicians appear to take the view that almost every social problem is caused by bad parenting. This allows failed politicians to avoid confronting their policy failures - in health, in education and in community building."

He also criticised as patronising advice booklets published by the British Government. For example, a "Dad Pack" published last year advised men not to have affairs during their partner's pregnancy. Professor Furedi added: "Parenting has become an industry. It's no longer about the relationship with your children, it's something for politicians and professionals to have an opinion about."


Britain: Comparing apples and oranges

A multiculturalism debate didn't get off the ground last week - mainly because the panellists failed to define what they were talking about

On Friday night I attended a charity fundraiser where the big draw was a debate with Trevor Phillips and Kenan Malik arguing that "multiculturalism encourages separateness", and the MP Sadiq Khan and Arun Kundnani arguing that it doesn't. When questions were invited from the floor, I castigated the panel for their failure to define "multiculturalism", which had resulted in a dog's dinner of a debate with rambling monologues at cross-purposes. The subsequent attempts by each of the panellists to define the word were rather revealing.

Reminding them of last week's Rowntree report, produced by the New Policy Institute, I raised one particular finding. The income poverty rate of the British population as a whole stands at around 20%. The same rate for Bangladeshis is about 65%. The researchers had discovered that half of the difference was due to the fact that huge numbers of Bangladeshi women were not in paid work. I asked Khan if this was because values in that community were keeping women from going out to work?

Khan's response was to enumerate a litany of complaints about racism, discrimination in employment, unfair housing policy and all the rest of it. Khan must have been very tired when he read the report (or its summary) because he evidently failed to note that the report itself states that half of the difference is the figure it arrives at after taking into account those very factors that Khan mentioned. Clearly Khan, like the other panellists, was more comfortable discussing vague terms like multiculturalism, especially when they're left undefined.

When the chair pressed them to define the term, Arun Kundnani said that multiculturalism was "ethnic pluralism recognising difference between groups within the public sphere". Sadiq Khan said multiculturalism was "mutual respect based on common ethics". Trevor Philips said that multiculturalism was "valuing the things that divide us more than the things that unite us". Finally, Kenan Malik spoke of multiculturalism as consisting of "policies of cultural diversity which require us publicly to celebrate difference".

There we have it: a plurality of definitions and no two the same. This is Babel. It's not possible for two people to have a debate about the truth of a proposition, if they are both considering different propositions: you ask me if I think apples are tasty, and I tell you that oranges are delicious. The debate was ultimately farcical, a mix-up, a fruit-salad of a debate. Philips was talking about apples, Malik about oranges, Kundnani about pears and Khan about goodness knows what.

Take Khan's definition, "mutual respect based on common ethics". Who on earth would think that "mutual respect based on common ethics" could encourage separateness? Surely not even Trevor Philips, the bane of multiculturalists? And isn't Khan's definition as far from Philips's as you can get? Khan's "common ethics" might arguably be opposed to Philips's "valuing the things that divide us more than the things that unite us". Here are two almost diametrically opposed and certainly inconsistent definitions.

Which definition is right is irrelevant: the point is that without a common definition, there's no sensible debate, just a multiculturalism debate gone mad. When pressed, we see that the panellists reached for "thin" definitions, which invariably are not robust or controversial enough for divisions to show or which, alternatively, build in the arguments their advocates seek to advance.

There is, however, a way out of these sorts of thin and unsatisfying discussions. But it requires courage, something touched on by Malik, who brought a shaft of light in an otherwise dreary debate. Multiculturalists, he said, want public affirmation of cultural difference and this undermines much of what is good about diversity as a lived experience. By affirming those differences, we limit the scope of disputes, of a healthy kind, from taking place. After all, Malik observed, what is diversity good for? "It allows us to consider alternatives and thereby enhance debate. These clashes and conflicts are what multiculturalists most fear."

We need culture clashes and conflicts, not race riots but lively debate and discussion. While we discuss abstract distended nouns of unwieldy "ismic" proportions, like multiculturalism, we must make greater space to pose challenging questions and say difficult things about "thick values". Are women being held back by your culture's values? Your culture doesn't value marriage and that's wrong. Do you value friendships with non-Pakistanis as much as you value your friendships with Pakistanis? Your culture doesn't value family enough: you abandon your elderly.

Creating space for a diversity of views means ending the state- and establishment-endorsed fetish for celebrating diversity of ethnicity and faith. But a diversity in the views we ventilate is not an end in itself. Clashes and conflicts are vital for creating the circumstances in which citizens engage in a discussion about values so that society and culture can evolve in directions that draw everyone in.


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