NHS fails diabetics

The majority of NHS trusts are not giving people with diabetes enough help in managing the condition at home, a watchdog has warned. The Healthcare Commission said most primary care trusts were offering basic diabetes care such as yearly check-ups. But it warned that almost 130 out of more than 150 failed on home support.

Offering services to help patients manage their weight or plan an exercise regime are seen as crucial in reducing complications like heart problems. As such, they could also save the NHS millions of pounds each year. In 2002, about œ1.3bn - or 5% of NHS expenditure - was used to care for people with diabetes. Estimates from 2006 suggest this could even have crept up to 10% of total spending, the commission said.

Managing diabetes at home by controlling weight, or giving up smoking, have been touted as a key means of tackling complications of the condition. As well as heart problems, these include blindness, kidney failure and limb amputation.

Beefing up community services and the potential for self-management of long-term conditions such as diabetes is also one of the key planks of government policy. Diabetes is seen as a growing problem in the UK. According to the watchdog, the number of diagnosed and undiagnosed cases is likely to have risen by 15% between 2001 and 2010. Some 9% of this was due to increasing numbers of obese people, and a further 6% was the result of an ageing population, it suggested.

The Healthcare Commission said PCTs had to do better in supporting people to manage their condition.

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Ethically-challenged NHS doctor

A doctor accused of wrongly causing a health scare over the MMR vaccine paid children 5 pounds each to give blood samples at his son's birthday party, a disciplinary hearing has been told. Andrew Wakefield abused his position as a doctor and showed "a callous disregard" for the distress and pain that the children - thought to be as young as 4 - might suffer, the General Medical Council was told.

The allegations emerged yesterday along with charges connected to research by Dr Wakefield and his former colleagues, John Walker-Smith and Simon Murch, that claimed the combined vaccine against measles, mumps and rubella carried serious health risks. The doctors appeared before the GMC's fitness-to-practise panel charged with serious professional misconduct, which they deny. All three are accused of performing procedures, such as colonoscopies, barium meals and lumbar punctures, on children that were "contrary" to the children's clinical interests and conducted without the proper ethical approval and consent forms.

The GMC accused Dr Wakefield of bringing the profession into disrepute by taking blood from children at his son's party at some point before March 20, 1999, when he joked about the incident while giving a presentation at the Mind Institute, California. Footage was shown on ITN last night of the episode. Dr Wakefield is seen on video saying: "And you line them up - with informed parental consent, of course. They all get paid 5 pounds , which doesn't translate into many dollars I'm afraid. But . . . and . . . they put their arms out and they have the blood taken. All entirely voluntary." [Laughter] He says that two of the children fainted, while one was sick over his mother, which drew laughter from the audience.

Dr Wakefield is then heard joking: "People said to me, `Andrew, look, you know, you can't do this, people, children won't come back to you. [Laughter] I said, `You're wrong'. I said, `Listen, we live in a market economy. Next year they'll want 10 pounds'"

The MMR controversy began after the doctors published their research in The Lancet in 1998, claiming that the jab overloaded the immune system, causing bowel problems and also autism and other illnesses. Further research has quashed these conclusions. At the time, all three doctors were employed at the Royal Free Hospital's medical school in Hampstead, North London. They conducted the study on 11 British children without approval from the hospital's ethics committee, the GMC was told.

The list of allegations against Dr Wakefield took more than an hour to read out. One of the key accusations is that he failed to declare that he was being paid for advising solicitors on legal action by parents who believed their children had been harmed by MMR. Another charge is that he ordered subsequent studies "without the requisite paediatric qualifications". He is also alleged to have allowed one child - Child 10 - to be given an experimental cocktail of drugs, known as "transfer factor", with the view to it being developed into a new measles vaccine. Dr Wakefield admitted being involved in proposals to set up a company to manufacture the drug. The father of Child 10 was to be the company's managing director.

It was alleged that he did not reveal that he had accepted 50,000 pounds from the Legal Aid Board for research to support legal action by parents who believed their children were harmed by MMR. He was also accused of being "dishonest" and "irresponsible" when submitting his views about MMR for publication.

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"Spastic" a Very Bad Word

We read:

"Nintendo has been forced to withdraw a computer game from sale in the UK because it contains the word 'spastic' in its script. Mario Party 8, a multi-player game for the Wii console, went on sale in the UK on Friday but was taken off the shelves after the mistake was discovered.

In the game, designed to be played by groups at parties, a blue wizard called Kamek appears on screen and intones: "Magikoopa Magic! Turn the train, spastic! Make this ticket tragic!"

It is the second time in as many weeks that a Nintendo game has been withdrawn for including the word 'spastic'. Earlier this month, MindQuiz, a 'brain-training' game made for the Nintendo DS by the French company Ubisoft, was pulled because it branded players who achieved low scores 'spastics' and 'super-spastics'.

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But you can call Christians "Taliban" and George Bush "Hitler" and that is just free speech, of course.

"Spastic" seems to be more decried in Britain than in the USA but even Tiger Woods got into strife a while back for using the word "Spaz". It seems that Americans are less aware that the term originates from an old term for cerebral palsy.

I must say that when I went to school many years ago, "spastic" was a common term of abuse. I was myself called that (and worse) often enough but it was like water off a duck's back to me, of course.





British recycling blues

The Government's strategy for reducing waste in landfill sites has been called "half-hearted and likely to fail" by a committee of MPs. Fortnightly rubbish collections are unsuitable for many areas and there is no proof they increase recycling, a report by the all-party communities and local government select committee claims. Its report says plans to charge householders who fail to recycle 30 pounds a year are too timid and too complicated and a reward of up to 30 pounds for "good" households is too low to encourage mass recycling

The committee, chaired by the Labour MP Dr Phyllis Starkey, says: "It is hard to see why any council will want to set up a complicated charging scheme that earns it no money and risks public disapproval." The report criticises some local authorities for "blundering" into fortnightly collections without proper consideration or consultation. Alternate weekly collections of food waste are "not appropriate" in many areas, particularly in highly populated areas with limited storage room for bins, the report says. Although recycling has increased in areas with fortnightly collections, MPs say that no direct link between the two has been proven.

Given the strength of public concern and anecdotal evidence about flies and other vermin, the report has called for more research into the health implications of fortnightly collections. The committee wants the Government to encourage councils to collect food waste separately once a week. The committee also points out that domestic refuse amounts to only nine per cent of national waste and that "far more can ultimately be achieved by recycling and reusing commercial, industrial and construction waste".

A spokesman from the Department for Environment, Food and Rural Affairs said: "We are disappointed that on financial incentives the committee has not recognised the need to try out innovative ways of encouraging sustainable waste behaviour. "We are consulting on our financial incentives proposal and will not finalise our policy until this is completed."

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Narrow-minded pundit thinks Europe is the world

Excerpt from Magnus Linklater

You might imagine, therefore, that the Swiss, for whom the mountains are the very soul of the country, would be impassioned in their defence of the environment. That combination of stern efficiency and national diligence which ensures that their trains run silently and on time, their streets are swept clean and even their mountain paths are carefully mowed, must surely place Switzerland in the forefront of the campaign to cut carbon emissions.

You would be wrong. High on the slopes above Zermatt, we came upon evidence that, even here, the defence of a profitable tourist industry takes precedence over the need to protect the natural environment. In the midst of a complex network of brilliantly engineered hydroelectric systems, designed to keep the towns and villages of the southern Alps supplied with power, stood row upon row of brand new snowmaking machines, ready for the next skiing season. Sometime in late autumn they will be transported to the fashionable ski resorts of Verbier, Zermatt and the rest, where early snow is desperately short, and used to manufacture a few more hectares of the white stuff so that this year’s tourists can be gulled for one more year at least into imagining that global warming is just an illusion and that the slopes will forever remain glistening and pure.

As an example of chronic and pig-headed frivolity, the snow machine has a lot to answer for. It is wasteful, energy-inefficient and environmentally indefensible. A single ski resort needs as much electricity as a small village just to keep its snowmaking systems going... It would be hard to conjure up a more potent symbol of environmental perversity than the use of carbon-spewing fossil fuels to help to dispose of millions of gallons of carefully extracted water in order that a few thousand tourists can slide down a slope for an extra week....

Yet if we take the warnings about climate change with any degree of seriousness, we have to change our terms of reference. Instead of hailing the inventiveness of the ski resort that makes its own snow, we should accept the harsh reality that nature has terminally curtailed the skiing season [In Europe maybe but quite the opposite in Australia. Our thicko pundit cannot distinguish local phenomena from global phenomena. No wonder he is so credulous. And the arrogance of thinking that what he sees on one trip to Switzerland is "terminal" is truly breathtaking. He is obviously quite unaware that Alpine glaciers undergo cycles of advance and retreat but he still thinks he knows it all. How wonderful to be a famous British pundit! He is the sort Australians would call a blowhard]

Much as we cherish our birds of prey, we should remember that their prospects of survival are threatened not so much by a freak collision as by the three-degree rise in global temperatures that will occur in the next 50 years if we do not manage to wean ourselves off a reliance on oil and gas. Stuff the skiers, sink the canoeists, gag the bird-lovers; this is a battle for survival, not an exercise in self-indulgence.

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Here is the news (as we want to report it)

By Antony Jay, brilliant co-writer of "Yes Minister" and former BBC denizen

This week the BBC was forced to apologise to the Queen for falsely claiming that she stormed out of a photo shoot. We shouldn't be surprised, says former producer Antony Jay. In this exclusive extract from a brilliant new CPS pamphlet, he argues that the anti-establishment views at the heart of the corporation have always dictated its mind set

I think I am beginning to see the answer to a question that has puzzled me for the past 40 years. The question is simple - much simpler than the answer: what is behind the opinions and attitudes of what are called the chattering classes? They are that minority characterised (or caricatured) by sandals and macrobiotic diets, but in a less extreme form found in the Guardian, Channel 4, the Church of England, academia, showbusiness and BBC News and Current Affairs, who constitute our metropolitan liberal media consensus - though the word "liberal" would have Adam Smith rotating at maximum velocity in his grave. Let's call it "media liberalism".

It is of particular interest to me because for nine years (1955-1964) I was part of this media liberal consensus. For six of those nine years I was working on Tonight, a nightly BBC current affairs television programme. My stint coincided almost exactly with Macmillan's premiership, and I do not think my ex-colleagues would quibble if I said we were not exactly diehard supporters. But we were not just anti-Macmillan; we were anti-industry, anti-capitalism, anti-advertising, anti-selling, anti-profit, anti-patriotism, anti-monarchy, anti-Empire, anti-police, anti-armed forces, anti-bomb, anti-authority. Almost anything that made the world a freer, safer and more prosperous place, you name it, we were anti it.

It was (and is) essentially, though not exclusively, a graduate phenomenon. From time to time it finds an issue that strikes a chord with the broad mass of the nation, but in most respects it is wildly unrepresentative of national opinion. When the Queen Mother died the media liberal press dismissed it as an event of no particular importance, and were mortified to see the vast crowds lining the route for her funeral, and the great flood of national emotion that it released.

Although I was a card-carrying media liberal for the best part of nine years, there was nothing in my past to predispose me towards membership. I spent my early years in a country where every citizen had to carry identification papers. All the newspapers were censored, as were all letters abroad; general elections had been abolished - it was a one-party state. Citizens were not allowed to go overseas without travel passes (which were rarely issued). People were imprisoned without trial, and the government could tell you what job to do and jail you if you didn't do it. Some of my contemporaries were forced to work in the mines.

Yes, that was Britain. Britain from 1939 to 1945. I was nine when the war started, and 15 when it ended, and accepted these restrictions unquestioningly. I was astounded when identity cards were abolished. And the social system was at least as authoritarian as the political system. It was shocking for an unmarried couple to sleep together and a disgrace to have a baby out of wedlock. A homosexual act incurred a jail sentence. Divorc‚es would not be considered for the honours list or the Royal Enclosure at Ascot. Procuring an abortion was a criminal offence. Violent young criminals were birched, older ones were flogged, and murderers were hanged. Two years' National Service was compulsory for 18-year-olds. Small children sat in rows in the classroom and were caned if they misbehaved. Drugs were confined to the surgery (and the aristocracy). The bobby on the beat made sure the streets were safe at night. And for an England cricket captain to miss a Test Match by flying home to be present at the birth of his child would have ruled him out of serious consideration not just as a cricketer but as a man.

So what happened? How did we get from there to here? Unless we understand that, we shall never get inside the media liberal mind. And the starting point is the realisation that there have always been two principal ways of misunderstanding a society: by looking down on it from above, and by looking up at it from below. In other words, by identifying with institutions or by identifying with individuals.

To look down on society from above, from the point of view of the ruling groups, the institutions, is to see the dangers of the organism splitting apart, the individual components shooting off in different directions, until everything dissolves into anarchy. Those who see society in this way are preoccupied with the need for order, discipline, control, authority and organisation.

To look up at society from below, from the point of view of the lowest group, the governed, is to see the dangers of the organism growing ever more rigid and oppressive until it fossilises into a monolithic tyranny. Those who see society in this way are preoccupied with the need for liberty, equality, self-expression, representation, freedom of speech and action and worship, and the rights of the individual. The reason for the popularity of these misunderstandings is that both views are correct, as far as they go, and both sets of dangers are real but there is no "right" point of view. The most you can ever say is that sometimes society is in danger from too much authority and uniformity and sometimes from too much freedom and variety.

In retrospect it seems pretty clear that the 1940s and 1950s were years of excessive authority and uniformity. It was certainly clear to me and my media liberal colleagues in the BBC. It was not that we openly and publicly criticised the government on air; the BBC's commitment to impartiality was more strictly enforced in those days. But the topics we chose and the questions we asked were slanted against institutions and towards oppressed individuals, just as we achieved political balance by pitting the most plausible critics of government against its most bigoted supporters. And when in 1963 John Profumo was revealed as having slept with a call girl and lied to Parliament about it, the emotion that gripped us all was sheer uncontrollable glee. It was a wonderful vindication of all we believed. It proved the essential rottenness of the institution.

Ever since 1963, the institutions have been the villains of the media liberals. The police, the armed services, the courts, political parties, multinational corporations - when things go wrong, they are the usual suspects. In my media liberal days our attitude to institutions varied from suspicion to hostility. From our point of view, the view from below, they were all potential threats to human freedom. Even though I worked in a great institution, I did not identify with it. To describe a colleague as anti-BBC was a term of praise.

Obviously all institutions have to be watched pretty closely. Although their justification lies in the service they provide, their fundamental objective has always been self-preservation. Without their critics, 10-year-old children would still be going up chimneys, women would not be able to vote, and sheep-stealers would still be being hanged. Nevertheless they are all that stands between the civilised world and the chaos of anarchy or the violence of tyranny.

It would have been more than reasonable for us to have opposed specific abuses by institutions; homosexual acts were decriminalised during my BBC years, which we all applauded. But the focus of our hostility was the institutions themselves. It was not - and is not - shared by the majority of our fellow citizens: most of our opinions were at odds with the majority of the audience and the electorate.

Indeed, the BBC's own 2007 report on impartiality found that 57 per cent of poll respondents said that "Broadcasters often fail to reflect the views of people like me". It often surprised me how regularly the retired brigadier from Bournemouth and the taxi driver from Ilford were united against our media liberal consensus. Those same media liberals who today demonise Margaret Thatcher simply cannot understand why she won big majorities in three successive general elections and is judged by historians around the world as having been Britain's most successful peacetime prime minister of the 20th century.

So how did it happen that this minority media liberal subculture managed to install itself as the principal interpreter of Britain's institutions to the British public? And even more interestingly, where do its opinions and attitudes come from?

Some of the ingredients have a proud and ancient lineage: resistance to oppressive political and social authority, championship of the poor, the Factory Acts and the abolition of the slave trade, are golden threads that run though the fabric of British history. But there are four new factors which in my lifetime have brought about the changes which have shaped media liberalism, encouraged its spread, and significantly increased its influence and importance.

The first of these is detribalisation. That our species has evolved a genetic predisposition to form tribal groups is generally accepted as an evolutionary fact. This grouping - of not more than about five or six hundred - supplies us with our identity, status system, territorial instinct, behavioural discipline and moral code. It survived the transition from hunting to agriculture: the hunting tribe became the farming village. It even survived the early days of the industrial revolution, in pit and mill villages: the back-to-back city slums were the tribal encampments of industrial Britain.

But the evolution of cities, of commuter and dormitory suburbs, has deprived millions of people of tribal living. There is a saying that it takes a village to raise a child, but fewer and fewer of us are now brought up in villages, even urban villages. The enormous popularity of television soap operas is because they provide detribalised viewers with vicarious membership of a fictional, surrogate tribe. Many people find strong substitute tribes at their places of work - they are not the birth-to-death, 24 hours a day tribes we evolved from, but they provide many of the same social needs.

But we in the BBC were acutely detribalised; we were in a tribal institution, but we were not of it. Nor did we have any geographical tribe; we lived in commuter suburbs, we knew very few of our neighbours, and took not the slightest interest in local government. In fact we looked down on it. Councillors were self-important nobodies and mayors were a pompous joke.

We belonged instead to a dispersed ''metropolitan-media-arts-graduate'' tribe. We met over coffee, lunch, drinks and dinner to reinforce our views on the evils of apartheid, nuclear deterrence, capital punishment, the British Empire, big business, advertising, public relations, the Royal Family, the defence budget. it's a wonder we ever got home. We so rarely encountered any coherent opposing arguments that we took our group-think as the views of all right-thinking people.

The second factor which shaped our media liberal attitudes was a sense of exclusion. We saw ourselves as part of the intellectual ‚lite, full of ideas about how the country should be run, and yet with no involvement in the process or power to do anything about it. Being na‹ve in the way institutions actually work, yet having good arts degrees from reputable universities, we were convinced that Britain's problems were the result of the stupidity of the people in charge. We ignored the tedious practicalities of getting institutions to adopt and implement ideas.

This ignorance of the realities of government and management enabled us to occupy the moral high ground. We saw ourselves as clever people in a stupid world, upright people in a corrupt world, compassionate people in a brutal world, libertarian people in an authoritarian world. We were not Marxists but accepted a lot of Marxist social analysis. Some people called us arrogant; looking back, I am afraid I cannot dispute the epithet.

We also had an almost complete ignorance of market economics. That ignorance is still there. Say ''Tesco'' to a media liberal and the patellar reflex says, "Exploiting African farmers and driving out small shopkeepers". The achievement of providing the range of goods, the competitive prices, the food quality, the speed of service and the ease of parking that attract millions of shoppers every day does not show up on the media liberal radar.

The third factor arises from the nature of mass media. The Tonight programme had a nightly audience of about eight million. It was much easier to keep their attention by telling them they were being deceived or exploited by big institutions than by saying what a good job the government and the banks and the oil companies were doing.

The fourth factor is what has been called ''isolation technology''. Fifty years ago, people did things together much more. The older politicians we interviewed in the early Tonight days were happier (and much more effective) in public meetings than in television studios. In those days people went to evening meetings. They formed collective opinions. In many places party allegiance was collective and hereditary rather than a matter of individual choice based on a logical comparison of policies.

It is astonishing how many of the technological inventions of the past century have had the effect of separating us off from the group. The car takes us out of public transport, central heating lets each member of a family do their own thing in their own room, watching their own television, listening to their own music, surfing the net on their own PC or talking to a friend on their own mobile. The fridge, the microwave and the takeaway mean that everyone can have their own meal in their own time. Our knowledge of public events and political arguments come direct from the media rather than from a face-to-face group. We still have some local, territorial group memberships, but their importance is now much diminished and their influence weakened.

These four factors have significantly accelerated, and indeed intensified, the spread of media liberalism since I ceased to be a BBC employee 40 years ago. It still champions the individual against the institution. The BBC's 2007 impartiality report reflects widespread support for the idea that there is "some sort of BBC liberal consensus". Its commissioning editor for documentaries, Richard Klein, has said: "By and large, people who work in the BBC think the same, and it's not the way the audience thinks." The former BBC political editor Andrew Marr says: "There is an innate liberal bias within the BBC".

For a time it puzzled me that after 50 years of tumultuous change the media liberal attitudes could remain almost identical to those I shared in the 1950s. Then it gradually dawned on me: my BBC media liberalism was not a political philosophy, even less a political programme. It was an ideology based not on observation and deduction but on faith and doctrine. We were rather weak on facts and figures, on causes and consequences, and shied away from arguments about practicalities. If defeated on one point we just retreated to another; we did not change our beliefs. We were, of course, believers in democracy. The trouble was that our understanding of it was structurally simplistic and politically na‹ve. It did not go much further than one-adult-one-vote.

We ignored the whole truth, namely that modern Western civilisation stands on four pillars, and elected governments is only one of them. Equally important is the rule of law. The other two are economic: the right to own private property and the right to buy and sell your property, goods, services and labour. (Freedom of speech, worship, and association derive from them; with an elected government and the rule of law a nation can choose how much it wants of each). We never got this far with our analysis. The two economic freedoms led straight to the heresy of free enterprise capitalism - and yet without them any meaningful freedom is impossible.

But analysis was irrelevant to us. Ultimately, it was not a question of whether a policy worked but whether it was right or wrong when judged by our media liberal moral standards. There was no argument about whether, say, capital punishment worked. If retentionists came up with statistics showing that abolition increased the number of murders we simply rejected them.

The same moral imperatives determined our attitude to the dissolution of the British Empire. It was right, so there was no further argument. We would not even discuss whether the prosperity and happiness of the Ugandans or the Rhodesians or the Nigerians would be better served by a partial or more gradual transfer of power; it had to be total and it had to be immediate. We were horrified by the arrogant way our grandparents' generation had used their political and economic power to impose Christianity on religiously backward peoples. Were we, as missionaries for democracy, not guilty of imposing media liberal democracy in exactly the same way?

If I had to mount a defence of our media liberalism, I would say that in the first place the BBC was still in the shadow of John Reith. Political impartiality was much more strictly enforced than today. In the second place we had seen all too clearly the dangers of oppressive and unchallenged authority in Nazi Germany and Soviet Russia. In the third place, there were areas of British life - the legal status of women, homosexuality, divorce, penal policy - in which most people agreed that liberal reform was necessary. In the fourth place, large areas of British life - the law, industry, banking, the Civil Service, the Armed Forces, the Cabinet - were dominated by an upper class ‚lite who were holding the country back. For all these reasons I would defend, not our ideas and attitudes, but at least their consequences. I believe - well, at least hope - that we did not do too much damage.

I do not think the same is true today. The four mitigating factors above have faded into insignificance, but the media liberal ideology is stronger than ever. Today, we see our old heresy becoming the new orthodoxy: media liberalism has now been adopted by the leaders of all three political parties, by the police, the courts and the Churches. It is enshrined in law - in the human rights act, in much health and safety legislation, in equal opportunities, in employment protections, in race relations and in a whole stream of edicts from Brussels.

It is not so much that their ideas and arguments are harebrained and impracticable: some of their causes are in fact admirable. The trouble - you might even say the tragedy - is that their implementation by governments eager for media approval has progressively damaged our institutions. Media liberal pressure has prompted a stream of laws, regulations and directives to champion the criminal against the police, the child against the school, the patient against the hospital, the employee against the company, the soldier against the army, the borrower against the bank, the convict against the prison - there is a new case in the papers almost every day, and each victory is a small erosion of the efficiency and effectiveness of the institution.

I can now see that my old BBC media liberalism was not a basis for government. It was an ideology of opposition, valuable for restraining the excesses of institutions and campaigning against the abuses of authority but it was not a way of actually running anything. It serves a vital function when government is dictatorial and oppressive, but when government is ineffective and over-permissive it is hopelessly inappropriate.

I can't deny that my perceptions have come through the experience of leaving the BBC. Suppose I had stayed. Would I have remained a devotee of the metropolitan media liberal ideology that I once absorbed so readily? I have an awful fear that the answer is yes.

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