Thursday, June 07, 2007

Cuts to NHS services blow out already-long waiting times

Drastic cost-cutting ordered by the Government across the NHS has derailed its flagship policy to ensure that no patient waits longer than 18 weeks for hospital treatment. A leaked e-mail seen by The Times reveals that the Department of Health is so worried that new data showing that some patients will have to wait “in excess of one year” will be highlighted by the media that it has issued special guidance on how to spin the news.

The Government is expected to announce today that the NHS has made a surplus of more than 500 million pounds in the past financial year after an aggressive drive to reduce spending by health trusts. The e-mail says that more than half of patients are still waiting longer than 18 weeks for treatment. It calls into question the Government’s ability to honour its key health pledge that all patients would be treated within this time by the end of 2008.

The memo, containing advice from the Department of Health sent to local NHS communications managers, reveals that 52 per cent of hospital inpatients are waiting longer than 18 weeks across the country. Full data on the situation will be published for the first time by the Government tomorrow. Ministers have pledged that by the end of next year no patients should wait longer than that time after being referred by their doctors.

The e-mail contains advice from the Department of Health for local NHS communications managers on how to handle media inquiries on publication of the figures and outlines “overarching messages” for press officers to quote in an apparent attempt to spin the story. It says: “The [referral to treatment] data due to be published on 7 June is a brand new data collection . . . While this new measurement – from referral to treatment – better reflects the patient experience, there are some issues for communicators to be aware of. “The data will show variations in referral to treatment waiting times across your area by provider and commissioner. It will also show differences by specialty. “There will be some long waits – of up to, and in excess of one year, in some areas. “There is a risk that the media’s attention will focus around long waits, and make claims that these new, more transparent measures of waiting times, undermine the effort to date to tackle waiting in the NHS.”

The e-mail, circulated by a press officer from the South Central Strategic Health Authority (SHA), appears to have been sent in error to a number of local MPs, including David Cameron. Peter Campion, the SHA’s head of communications and author of the e-mail, writes that the waiting time figures “have potential to generate negative inquiries locally”, but warns colleagues that they are “hamstrung” to prepare responses before the local data is revealed. The memo also suggests that differences seen across regions might be used as further evidence for a “postcode lottery” of treatment in the NHS.

Patricia Hewitt, the Health Secretary, is expected to announce today that the health service underspent by up to 500 million last year. She put pressure on local health chiefs to make savings after promising to resign if the NHS went into the red in 2006-07. But the drive to balance the books is thought to have come at the expense of other services, and attempts to cut waiting times. The 18-week target, set in 2004, is widely considered to be among the most ambitious of the Government’s aims for the NHS. A baseline estimate published in December suggested that 35 per cent of patients across the country were treated within this time.

At that time up to a quarter of patients needing operations such as hip or knee replacements were estimated to wait between one and two years for surgery, with a small number waiting longer than this. The figures showed that most specialities treat between 30 and 50 per cent of inpatients within 18 weeks. In trauma and orthopaedics the figure is only 20 per cent. The Government has set an interim target of 85 per cent of admitted patients and 90 per cent of nonadmitted to be treated within 18 weeks by March next year.

A spokesperson for the Department of Health said that the data concerning waiting times would be set out tomorrow. “This data is bound by the publication protocols of national statistics and we will not be commenting ahead of publication,” she said


The blind to see again?

A routine operation to restore the sight of people with the most common cause of blindness will be available within a decade, scientists believe. A team of British doctors said that a groundbreaking stem-cell treatment for age-related macular degeneration (AMD), which affects a quarter of people over 60 to some degree, should become widely available. The condition is responsible for the blindness of 14 million Europeans. The doctors are recruiting patients for the first clinical trials, scheduled to take place within five years. The team said that, after earlier studies, they were confident of success.

AMD is caused by the failure of retinal pigment epithelial (RPE) cells - the support cells under the retina that process light. The macula - the central area of the retina - then degenerates and gradually knocks out central vision. The doctors from University College London, Moorfields Eye Hospital in London and the University of Sheffield have already repaired the vision of a handful of patients with AMD using cells from the patients' own eyes. The London Project to Cure AMD, which was launched yesterday with 4 million pounds funding from an anonymous American donor, intends to carry out the same operation using retinal cells grown in the laboratory from embryonic stem cells. Stem cells are immature, dormant cells with the ability to turn into different cell types. Embryonic stem cells are obtained from early-stage embryos the size of a pinhead.

There are two types of AMD: "wet" and "dry". While much progress has been made in tackling wet AMD, which is characterised by leaking blood vessels and accounts for 10 per cent of cases, no treatment is available for dry AMD. It is believed that the new development will offer hope even to patients with the dry form.

Lyndon da Cruz, a consultant ophthalmic surgeon at Moorfields Eye Hospital, has carried out an operation in a few patients with wet AMD to take cells from the healthy periphery of the eye and transplant them into the affected area. The procedures have been successful but are associated with complications, take more than two hours and require two operations. To make it quicker, easier and more widely available researchers at the University of Sheffield have grown RPE cells from embryonic stem-cell lines. The hope is that this can be processed into a layer that can be injected into the patient's eye during a simple 45-minute operation. Tests of the laboratory-grown RPE cells in rats with AMD showed that they restored vision.

Professor Pete Coffey, the project director from the Institute of Ophthalmology at University College London, said that although they had grown RPE cells successfully they now needed to make sure that the cells were safe enough to be used in humans. "Using stem cells - which are far more adaptable - can only improve success of what has already been achieved and in addition establish this as a global therapy. "The goal is within five years to have a cohort of patients to put the cells into," said Professor Coffey, whose team is preparing the laboratory-derived cells for transplant. Given that AMD could affect up to one third of the population by 2070, with the majority suffering from dry AMD, the benefits could be substantial. "The potential to create a treatment strategy for this condition is critical and may have a major impact on vision loss," Mr da Cruz said.

He added that if in ten years the proposed 4mm by 6mm transplant patch of stem cells was not in global use, something major would have failed in the research. "We have the RPE, we have the evidence that doing this can restore vision. [We are dealing with] practicality issues rather than a big unknown."

More operations are also planned with patients' own cells in those suffering from dry AMD to test the procedure's effectiveness. Barbara McLaughlan, from the Royal National Institute of Blind People, said that taking the research from the laboratory into human trials was exciting. "This is particularly good news for the 150,000 people in the UK with dry AMD which currently has no treatment," she said. "However, even if all goes well with this project, potential treatment being made available on the NHS is still five to seven years away."

Last year The Times revealed that thousands of patients whose sight could be saved by the new drug Macugen were being denied treatment on the NHS on the ground of cost. Later an insurance company offered to cover the cost of drugs for older patients for an annual premium equal to their age in years.


The Failure of British schools is a failure to concentrate on the basics

If there is any political party out there flailing around in search of a mission statement to back up its leader's personal charm and cycle clips, here is a free suggestion. Confront the people (grinning, if you insist) and just say this: "We promise to protect your safety and your rights, and provide efficient and fair public services. Until we have achieved these core duties, we will not mess around with any frills, go-faster stripes or luxury fandangles. If this renders us boring, we're sorry. But it is pointless to tackle a pile of shit by spraying gold paint on it, or getting consultants and spin-doctors to dance around it waving dodgy statistics. We will get a shovel and mop, and tackle the basics. Even if it means we don't keep up Mr Blair's record of seven new laws a day for ten years."

This return to my hairy old theme of The Boring Party was sparked off by news that the National Institute for Health and Clinical Excellence (NICE) is drawing up plans to measure whether primary schools are improving children's psychological "wellbeing". They want the poor brats to fill out questionnaires and tick boxes ("I've been feeling good about myself all the time/often/some of the time/rarely/never" etc).

Now, the duty of primary schools to keep an eye on children's happiness is obvious. Some schools' innovations - familiar counsellors, chill-out rooms, and so forth - are useful and kindly extensions of the traditional pastoral role; they are probably needed more than ever today because of the commercial and social stresses on families. More traditional ways of advancing emotional literacy also flourish whenever staff can find a crack in the dry concrete of the curriculum: poetry, stories, music, exercise, outings and school visits got most of us through our schoolday puzzlements and griefs.

But a questionnaire? A self-conscious demand that a child of 6 should look inward rather than outward, and score on a scale of one to five how much it "feels loved"? Nah. For one thing, it is unscientific: small children are volatile and you can't have four quizzes per day. And how insulting is the implication that primary schools must be judged on a wellbeing scale dreamt up by distant academics? The general secretary of the National Association of Head Teachers, Mick Brookes, points out that any decent teacher knows how a child is feeling without a tickbox checklist; and there is no hard evidence whatsoever that encumbering little children with formal self-awareness makes them happier. Teenagers, just possibly. Eight-year-olds, no.

And - to return to the manifesto of the Boring But Efficient Party (BBEP) - let me point out that many of these children will not, under present conditions, even have an NHS dentist. Many will be in oversized classes. Some will have parents who speak little English, and whose entitlement to free lessons has just ended. Some of the children filling in the forms will, thanks to poor social services communication, be struggling carers for their parents, as exposed recently by the Princess Royal Trust. Many have no safe outdoor space to play in because the streets and parks are dangerous and there is no community policeman. And if they do suffer from serious mental illness later, their parents will have to struggle for proper psychiatric support.

And if, heaven forfend, they get into trouble, they may well end up like poor little Adam Rickwood, aged 14, who was shunted off to a child prison 150 miles from home, and taken off suicide-watch despite a three-year record of mental disturbance. Adam wrote a last despairingly affectionate letter to his mother and hanged himself with his shoelaces. The youth justice system remains a callous, inefficient mess. Many other systems - which should be at the core of governmental duty - are equally moribund.

Yes, it is hard to get everything right. My complaint is not that governments are imperfect, but that in every area of public endeavour there is an unstoppable centrifugal force, pushing effort out to the margins. We need relaxed, well-run schools with trusted teachers - we are given ditzy questionnaires. We need the best cancer treatments and proper care for the elderly, and instead we get a promise of IVF for all - which, to be brutal, frequently fails - and an assurance that smokers will get a cessation drug gratis on the taxpayer (never mind all the money they'll save on not buying fags; or the simple psychological fact that if it's free they won't value it or let it work).

In other realms the same thing happens, sparks flying outward from an ever-less-efficient engine. We need control of house prices, and instead we get misconceived Hips. We need good social services, unhampered by political correctness, and instead we get patronising leaflets telling fathers how to cuddle the baby. We need all children to have their intelligence recognised and fed in orderly schools, and instead we put pressure on universities to take children from bad schools, merely because it isn't fair that they're so bad and because government needs to disguise the fact in its statistics.

Suppose you hired an assistant and he failed to open the post, tidy the office, lock up at night or answer the phone. You'd remonstrate. Even if he brought in orchids, did a daily tap-dance on the desk, juggled bananas and arrived dressed in a different historical costume every morning. But government and - under its influence - public bodies behave like this the whole time. And we go on hiring them.


Surprise! British professors protect Muslim radicals

A union of British academics voted unanimously to reject a government plan to tackle Islamic extremism in universities, likening the initiative to "witch hunts" that would single out Muslim students. The University and College Union, which represents more than 120,000 British academics, agreed to the motion Wednesday at its inaugural conference in Bournemouth in southern England. The motion calls for members to "resist attempts by government to engage colleges and universities in activities which amount to increased surveillance of Muslim or other minority students and to the use of members of staff for such witch hunts."

The Department for Education set guidelines last year urging university staff to contact police to identify and isolate Muslim students suspected of being radicalized. The report included real-life cases, including students watching online bomb-making videos in college libraries and using prayer rooms for radical meetings.

Critics said the plan unfairly singled out Muslims for surveillance and threatened free speech and academic freedom. "Lecturers want to teach students," said Sally Hunt, general secretary of the union. "If they wanted to police them, they would have joined the force."

Bill Rammell, higher education minister, said there is serious but not widespread Islamist extremist activities within universities. "The guidance is not about targeting one particular community," he said. "It is about promoting safety... It is also about protecting vulnerable students from bullying and harassment and other recruiting tactics of violent extremist groups."

But universities trying to implement the guidelines would have trouble forcing professors and staff to comply after the vote, said Dan Ashley, a spokesman for the union. If the university tries to enforce it on the staff, they won't do it, they won't spy on their students," he said. "You want them to be radical. That's the whole point: universities are where you encourage people to think outside the box."


British Firemen Fight Their Union's PC Policy

Leaders of the fire service union are facing a challenge over a system which gives special treatment to black, gay and women members. Delegate at next week's conference of the Fire Brigades Union will hear a call from two branches that minority groups should no longer have extra votes in deciding its affairs. But the leadership of the Leftwing union, including general secretary Matt Wrack, is anxious to crush the idea.

The FBU's 19-strong executive includes representatives from 'equality sections' for blacks, gays and women. Objectors say this 'political correctness' means members of those groups have more votes than other firemen. A gay black fireman, for example, has a say through his black and gay representatives as well as his regional member while a white heterosexual gets just the regional vote.

This system is under attack in motions from Nottinghamshire and Northern Ireland. Union leaders, however, point out that there are no objections to other special interest groups for officers, emergency room workers and part-time firemen. An FBU spokesman said: 'The executive has decided unanimously to oppose these motions.'


Heroic Scottish fireman escapes being fired

But only because of publicity

A hero fireman who faced the sack for jumping into a river to save a drowning woman has been cleared. Tayside firefighter Tam Brown, 42, faced disciplinary proceedings for rescuing the 20-year-old from the River Tay in Perth in March because his actions contravened brigade regulations. Tayside Fire&Rescue rules state firefighters should not enter the water but throw lines and talk instead.

After the Sunday Mail exclusively revealed Tam's plight and the subsequent nationwide furore over the threat to him and his commander David Wallace, fire chiefs have now told the men that no disciplinary action will be taken.

Yesterday, Tam, a fireman for 15 years, said: "We're very relieved common sense has won the day but the regulations haven't changed. I'd still face disciplinary action because I'd still have to do the same thing tomorrow if I saw a drowning person."

Tayside fire chiefs are now establishing a working group to report on what extra measures need to be brought in.


The beady eyes of Britain's official Puritans are now focusing on wine-drinking

Middle-class wine drinkers will be the focus of government plans to make drunkenness as socially unacceptable as smoking, The Times has learnt. Under the plans published today, a fresh audit is to be conducted by the Government into the overall costs of alcohol abuse to society and the National Health Service. “We want to target older drinkers, those that are maybe drinking one or two bottles of wine at home each evening,” a Whitehall source said. “They do not realise the damage they are doing to their health and that they risk developing liver disease. We are not talking here about the traditional wino.”

The assault on Middle England’s drinking habits is part of a three-strand approach, which will also target underage drinking and heavy alcohol consumption among those aged 18-24. “There are growing numbers of people turning up in hospital with drink-related diseases and drink-related injuries. They are getting younger and more of them are turning up needing treatment,” the source added.

The move comes as The Times has been told that the British Medical Association is to investigate measures used in other countries to curb excessive alcohol consumption. Doctors’ leaders are also calling for pubs and restaurants to display warnings stating how many units of alcohol are contained in drinks served by the glass.

Today’s strategy, by the Home Office and the Department of Health, broadens the Government’s offensive against excessive drinking, with the focus moving beyond teenagers and the binge-drinkers to include those regularly sipping wine at home. As part of the strategy, ministers wish to highlight the increasing burden that drink-related disease is placing on the NHS, which four years ago was estimated to be costing between £1.3 billion and £1.7 billion. Ministers want drunkenness in public to be as socially unacceptable in ten years’ time as smoking or drink-driving is today.

Last night Ian Gilmore, President of the Royal College of Physicians, gave his full support to the focus on the health costs of heavy drinking. “We really need the spotlight more on health. While crime and antisocial behaviour is important it’s too easy to concentrate on that because it’s somebody else causing the trouble. “When you look at health it’s more uncomfortable because there’s a very significant percentage of the population already drinking at potentially hazardous levels." With alcohol costing 54 per cent less in real terms than in 1980, Professor Gilmore, a liver specialist, also called on the Chancellor to raise drink taxes. “We know from international evidence that it’s measures that tackle price and availability where one can really make a difference. There is a very clear link between price and consumption. It’s never been cheaper in real terms than it is now.”

All alcoholic drinks sold in bottles and cans will be expected to carry labels disclosing the number of units and recommended safe drinking limits by the end of next year. The strategy is also expected to require pubs, supermarkets and off-licences to display health warnings on alcohol at the bar or tills, as well as labels. But the British Medical Association said yesterday that such measures did not go far enough, adding that customers in licensed premises needed better information to raise awareness of the dangers of excessive drinking and drink-driving. Vivienne Nathanson, the head of science and ethics at the BMA, said: “It is not the nanny state. It is about informed choices. It is hard for the average person to work out how many units are in a drink these days. Glasses of wine are much larger than they used to be and many beers and wines are much stronger”.

Although ministers are seeking voluntary agreements with the £30-billion-a-year industry on safe drinking messages, there is private concern that drinks firms have been slow to act over the issue. A spokesman for the British Beer and Pub Association said: “We are in discussion with government about how to make people more aware about how much they are drinking.”


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