NHS shafts carers

Thousands of dementia sufferers are being denied access to crucial drugs because of "critical errors" by the Government's drug watchdog, the High Court is to be told today. The National Institute for Health and Clinical Excellence (NICE) is accused of using "flawed and out-of-date figures" to play down the impact of the drugs on the lives of carers of dementia sufferers. When it decided to restrict access to three key drugs, NICE concluded that even on the most optimistic assessment, the benefit to carers of more widespread use of medication was negligible.

Central to the case being presented by the Alzheimer's Society today is its calculation that the drugs, which slow the progress of dementia, can save carers an hour and a half each day in caring duties. The society, which represents dementia sufferers and their families, will also tell the court that NICE underestimated the cost of full-time residential care at 355 pounds a week. In fact, the weekly cost can be 1,500. The charity says that wider use of the drugs would help dementia sufferers to stay in their homes longer, saving local authorities millions of pounds.

The case, the first legal challenge to a NICE decision, has been brought by Eisai, the licensed holder of one of the three drugs in question. The pharmaceutical company Pfizer is backing Eisai's case. The Alzheimer's Society is acting as an "interested party" in the judicial review. Its evidence on how carers could benefit from wider use of the drug is new to the case. It will run until Thursday. The judge will then take several weeks to reach a decision. The court can order NICE to reconsider.

In 2005 NICE said that the three drugs, Aricept, Reminyl and Exelon, should not be available on the NHS. After a protest by those affected, NICE reconsidered and decided that the drugs could be prescribed, but only to people with middle-stage dementia. Five appeals were rejected, and a judge ruled in April that there were grounds for a judicial review. NICE has never said how much its decision to restrict access to the drugs would save the NHS, but experts put it at about 9.4 million a year.

Neil Hunt, chief executive of the Alzheimer's Society, said: "These treatments have benefited so many families. Where is the justice in NICE's decision to snatch them away? Another 100,000 people will develop dementia this year."

Andrew Dillon, chief executive of NICE, said: "Non-drug interventions have an important part to play and the evidence indicates that drugs are not effective for some patients."

Elsie Johnson is certain that her husband, Alan, 68, has benefited greatly from the Aricept he was prescribed as soon as his Alzheimer's was diagnosed in 2000. Under NICE's guidelines, he would have had to wait until his condition had deteriorated. Seven years on, the couple can still go on holiday, shop and take outings near their Gateshead home. "A month or two after he was put on Aricept, he really perked up and started to take more interest in life. We lead a pretty good life together," Mrs Johnson told The Times. "It is a terrible situation when psychiatrists are telling their patients that they know they have Alzheimer's and they know what will help, but they can't do anything until they get worse, so come back in a year." She added: I don't understand why scientists are spending time and money developing new drugs if NICE is going to stop people from getting them."

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School tests: a little bit of stress is good for you

The only thing worse than the UK government's conveyor-belt testing of schoolkids is the anti-testing argument that says exams are evil and children 'can't cope'

There is no need to have one day each year when the `nation's 11-year-olds' are reduced to `a state of panic', argued Keith Bartley, chief executive of the UK General Teaching Council (GTC), last week. SATs tests, he said, must go. SATs, or Standard Assessment Tasks, are carried out when children are seven, 11 and 14 years old, in order to test students' grip of the national curriculum at Key Stages 1, 2 and 3. The results of the tests are used as the basis for school league tables, which show parents and others how a school is performing overall. SATs - along with GCSEs and AS levels - have been under scrutiny for some time. Teachers have been accused of `teaching to test' (focusing on the achievement of `targets' during the examination period to the detriment of encouraging real understanding); `drilling to test' (exerting too much pressure on kids to pass); and even `fiddling tests' (in order to make their school's performance look better on paper). Now, however, the focus has shifted on to the stress and panic that SATs apparently provoke in young people.

`England's pupils are among the most frequently tested in the world', the GTC's Bartley said in an interview with the Observer last Sunday. Apparently, a typical British school pupil will sit 70 tests during his or her time at school, starting in Year 2 and continuing (at the discretion of individual schools) every year thereafter, until they reach Year 10 and begin preparing for their GCSE exams.

Talking to the BBC, John Bangs, head of education at the National Union of Teachers, said: `There are all sorts of malign effects from the current testing regime. There is enormous pressure on youngsters and there's a lot of training to take the tests.' Sarah Teather, Liberal Democrat spokesperson for education, agrees. She says her party has `called for tests to be scrapped for years'. Psychologists, meanwhile, report that they are now `going into schools at unprecedented rates to tackle exam stress, with children as young as six suffering anxiety' (1). `All are affected by the anxiety transmitted by their teachers', said Martin Johnson of the Association of Teachers and Lecturers.

There are plenty of reasons to attack the culture of testing in schools - but stress isn't one of them. Government testing schemes are part of an educational climate in which teachers are no longer trusted to get on with their jobs. And that is the basis on which the GTC should attack SATs. Teachers should have autonomy in their own classrooms, to teach their pupils unfettered by the educational vogue of the month; to enthuse pupils with their own idiosyncratic love of a subject; and, yes, to set tests in order to monitor children's progress, but when they feel that it is necessary and in an independent way that allows the teacher to tap into the class's abilities.

By contrast, the targets set by the government are often arbitrary. The authorities' externally-imposed tests on all children from seven to 14 come across like abstract hoops that both teachers and children must jump through. These tests bear little relation to actual understanding or enjoyment of a subject. Instead, they are a means of ticking a box to show that each child has achieved the same bland level of rudimentary skills, and thus they can stifle passion, flair and originality in the classroom.

To its credit, the GTC has made some of these points about the `testing culture' - but by choosing to focus mainly on the alleged stress and panic caused by exams it has actually undermined the idea of testing per se. In this sense, its criticisms of SATs, alongside the criticisms made by others, are not a great improvement on the government's testing culture, since they communicate the idea that examination itself is problematic: too elitist; too judgemental; too stressful.

Since New Labour swept to power in 1997, there has been a permanent revolution in education. Every minute facet of education has been held up to the light and found wanting - but no coherent idea of what education should consist of has been put forward. Instead of challenging the degradation of education at the hands of the Blairites - of which the constant government roll-call of ever-changing targets is a symptom - the GTC has seized on a trendy issue: stress. The union doesn't point out how teachers are now regarded, at best, as an impediment to a child's osmosis-like learning and must therefore be monitored closely; instead it claims that the very nature of testing is iniquitous, which it isn't.

Indeed, far from questioning the government's insatiable thirst for statistics, the GTC puts forward its own version of targets, targets, targets. It proposes that a system of `cohort sampling' should replace the current SATs system. Under this scheme, less than one per cent of primary school children and less than three per cent of secondary students would take national tests. The samples would be selected randomly and tested to see how the school overall is performing. `You do not have to test every child every four years to know whether children are making more or less progress than they used to', Bartley said, somewhat ridiculously inferring that the nation's children will progress as one through the education system, and that a one to three per cent sample is perfectly representative of all their collective achievements. And what will `cohort sampling' mean for the little `stressed-out' martyrs selected to take on all the exam stress of the exam-free 97 to 99 per cent of the kids? Six-year-old hara-kiri? Bartley doesn't hypothesise.

Tests for young children and teenagers can be a good thing - when set by teachers and schools rather than imposed from on high. They can sharpen the brain. There's nothing like a bit of independent cramming to ram a principle home - and once principles are rammed home they can be applied throughout a subject, aiding understanding. What would be the point of learning French, for example, if you didn't have to go through all that dull stuff about grammar and vocabulary? (Which simply has to be learned in a laborious, repetitive way; that is, it has to be `drilled' home. And nothing will make a pupil learn better than the threat of a test to pass or fail.) Yet the GTC seems to have absorbed the idea that testing is essentially elitist and bad, and that the worst thing a child can do is fail. In truth, the worst thing for education is the demonisation and fetishisation of its disparate elements: exams are this week's bogeyman; next week it will be something else.

The idea of a classical, liberal education must be reclaimed: an education where teaching is thorough and where free ideas circulate, unbridled by government diktat. A first step to this will be allowing teachers to claw back their independence: and that means allowing them to set their own tests, as a way of aiding a class's learning, as and when they please.

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There is a new lot of postings by Chris Brand just up. Chris notes that the British "Conservatives" are now to the Left of Labour in many ways