Sunday, August 19, 2007

Elderly people suffering abuse and neglect in British residential care homes

Elderly people are suffering from abuse, neglect and malnutrition in hospitals and care homes, according to a report by peers and MPs. The report, published today by the Joint Committee on Human Rights, calls for changes in the law to safeguard the care of older people, and for a "complete change of culture" in health and care services.

More than a fifth of care homes have been found to be failing basic standards for privacy and dignity, with the most vulnerable residents struggling to eat without proper help, being subjected to verbal and physical abuse or being left to lie in their urine or excrement.

Two thirds of NHS hospital beds are occupied by the over65s, while the number of older people in the population is growing such that, by 2050, there will be twice as many Britons aged over 80 as there are today. Although the committee was told that some patients received excellent care, it said "there are serious concerns about poor treatment, neglect, abuse, discrimination and ill-considered discharge".

It also found evidence of "historic and embedded ageism" within healthcare services, causing a failure to "respect and protect the human rights of older people". The report includes the example of an 80-year-old woman who was sexually assaulted by a fellow resident in a care home in 2004: "It was recorded in a log book but no action taken . . . It was only reported to the resident's daughter in July 2005. She reported the matter to the police."

Another woman, who had difficulty feeding herself, "appeared to be slowly starving to death" because visitors who could have helped her were discouraged from staying during meal times. In other cases, bed sores were not treated because staff said "it was not their job". The charity Age Concern estimates that 500,000 older people are subject to abuse at any one time, mostly in healthcare settings.

The committee's report adds: "In our view, elder abuse is a serious and severe human rights abuse which is perpetrated on vulnerable older people who often depend on their abusers to provide them with care. Not only is it a betrayal of trust, it would also, in certain circumstances, amount to a criminal offence."

It also cites problems with malnutrition, dehydration and the abuse of medication as a means of controlling older patients. The Alzheimer's Society said that up to 40 per cent of patients with dementia were being prescribed powerful sedative drugs, despite the risks to their health. Other examples of neglect included a lack of hygiene in some hospitals that encouraged potentially deadly infections such as Clostridium difficile.

Some 21 per cent of care homes failed to reach minimum standards for privacy and dignity last year, the Commission for Social Care Inspection told the committee. Problems included the use of mixed-sex wards and, a lack of confidentiality in discussing medical problems. Despite this, the committee was "alarmed" that the Government's planned new healthcare inspectorate would not be given powers to investigate individual complaints from patients or their families.

It criticised the Department of Health and Ministry of Justice for failing to "provide proper leadership" and guidance on the Act to providers of health and residential care. Local authorities are increasingly referring elderly patients to homes run by the private and voluntary sector, which are exempt from the Human Rights Act. The committee calls for care standards regulations to be amended so that all care homes are brought under the terms of the Act.

Ivan Lewis, the Minister for Care Services, said: "We recognise this anomaly and will continue to work closely with the Ministry of Justice and all other interested parties to ensure that people cared for by the NHS and councils have the protection of the Act." Kate Jopling, head of public affairs at Help the Aged, said: "The shocking examples highlighted by this report provide all the evidence this Government needs to justify urgent action."


The British education charade continues

Getting top marks in A-level examinations could become harder after the introduction of a new A* and an A** grade, exam chiefs suggested yesterday, after record results showed that more than a quarter of all A-level entries were awarded an A. The pass rate rose for the 25th year in succession, with nearly three in ten candidates achieving three A grades, traditionally enough to secure them a place at a top university. The results meant that a record 316,549 pupils were able to confirm their university places on results day, up from 294,567 last year, the Universities and Colleges Admissions Service (Ucas) said.

Ministers and teaching unions congratulated students on their results, attributing the rises to improved teaching and learning and a greater awareness of the importance of mastering exam techniques. Examination boards insisted that the A level remained the gold standard examination and denied that the number of A grades achieved, which accounted for 25.3 per cent of all marks, was a result of grade inflation. [And all those wishy-washy subjects they do these days have nothing to do with it, of course] There was no escaping the fact, however, that rising grades have made it more difficult for many bright pupils to get into their university of choice. Whereas once a B grade was regarded as a respectable score, it spelled failure for the academic plans of some pupils yesterday.

Most exam boards do accept that the introduction of a new A* grade for the 2010 exams would help universities and employers to identify the very brightest students from among those qualifying for an A. The A* will be awarded to students who achieve 90 per cent in their exams.

Mike Cresswell, director general of AQA, England's biggest exam board, went further. He accepted that a new A** could eventually be required as more pupils get the new top A* grade. "The A* is an eminently sensible response to what is essentially a problem of success," he said. "More and more students are doing better and getting grade A. You can see why a small number of universities at the moment have a problem differentiating between the very, very, very best and the very best. "Were one to find oneself in a situation at some point in the future where things had improved to such an extent that there was now a similar difficulty with an A*, the sensible thing to do would be to repeat the medicine.

Alan Smithers, Professor of Education at the University of Buckingham, described the idea of a possible A** as "just plain daft", saying it would amount to an admission of failure. "For the A* to work it must be based on tougher questions which will sort out those with real understanding of the subject," he said.

Jim Knight, the Schools Minister, said he thought it would be an extraordinary achievement for any student to get three A*s and said the need for an extra top grade at A level was "a long way away". He pointed out that, from this year, universities will be given the percentage mark of all pupils in every A level module to help them to distinguish between those who have scraped through with an A and those who had passed with flying colours.

Michael Gove, the Shadow Children, Schools and Families Secretary, said that he agreed that it was important to allow the new A* to bed down before thinking of reforming A levels again. The results for the 310,000 students sitting 806,000 A levels were released yesterday by the Joint Council for Qualifications, representing the exam boards. The pass rate was 96.6 per cent. Girls continued to score better grades than boys in every major subject apart from further maths and foreign languages, although boys did manage to narrow the gap overall by 0.3 per cent.


Australia relaxes its immigration rules to persuade skilled young Britons to emigrate

Australia is making sweeping changes to its immigration policy in an attempt to attract skilled British workers to move Down Under. The changes - which will target workers in the medical profession, the IT sector and tradesmen and women - will result in the country's points-based immigration system being adapted to make it easier for fluent English-speaking professionals between the ages of 30 and 35 to gain work visas.

Under Australia's Skilled Migration Programme, points are awarded to potential immigrants according to their age, ability to speak languages, occupation, skills and experience. Immigrants who gain a total of 120 points are automatically fast-tracked through the migration process. Previously, however, British professionals aged 30-35 often struggled to gain work visas, losing out on precious points because to their age. Under the new scheme, five extra points will be automatically awarded to anyone who passes an "optional standardised English-language test", making it simpler for English speakers to achieve a perfect score. The new recruitment drive is reminiscent of the country's "Ten Pound Poms" scheme, when British migrants paid a mere œ10 fare to move to Australia to plug gaps in the economy in the 1950s and 1960s. The programme prompted about one million Britons to up sticks and head for a place of work in the sun.

Then, as now, the problem was an acute shortage of skilled labour. Australia has huge gaps in an economy which continues to grow and the government is looking for more immigrants than ever before. It has already increased targets for this year - 102,500 new residents, from its original target of 97,000.

Chris Cook, spokesman for the Australian Visa Bureau, said: "The implications of these changes are vast. The Australian government realises it is lacking workers in many professions which it desperately needs to fill, so the country is throwing its doors open to huge numbers of skilled and experienced British people and making it easier for them to meet the minimum eligibility requirements."

Professionals who are being sought by the Australian government include doctors, teachers, accountants, plumbers, nurses, carpenters, dentists and IT managers. The country's weekly list of migration occupations in demand currently includes 38 managerial and professional jobs, one associate professional position, 10 posts in computing and 46 positions in trades. Australia's capital, Canberra, is experiencing a record-breaking boom in its construction industry, but local unemployment is the lowest in the country meaning that there is a mass shortage of skilled builders.

Between July 2001 and 2002, the total number of Britons who settled in Australia was 8,749. By last year, of the 150,000 foreigners who were granted permanent visas to live in Australia, 24,800 were British, followed by 15,865 Indian nationals and 14,688 Chinese. Two-thirds of the total were skilled migrants. The majority of migrants last year listed their occupations as accountants, computing professionals and registered nurses. Their average age was 31.



There is no doubt that high blood pressure is a warning sign so the slight reduction in blood pressure shown below is encouraging. Somewhat amusing that the wicked cholesterol appears to have been unaffected, though. Popular summary below followed by journal abstract

Thirty minutes of walking three times a week may be enough to help lower blood pressure and start you on the path to better health. A new study shows that even a little bit of weekly exercise is enough to lower blood pressure and improve overall fitness. The results showed that 30 minutes of walking three times a week - even if it was broken into 10-minute walks throughout the day - was enough to have a healthy effect on blood pressure as well as measurements around the waist and hip.

National guidelines recommend that people exercise at least 30 minutes a day on most days of the week to maintain optimum health. But few people achieve that goal, citing lack of time as the biggest obstacle. Researchers say these results may help motivate people to fit in even a little exercise here and there to benefit their health.

In the study, published in the Journal of Epidemiology and Community Health, researchers invited 106 healthy but sedentary civil servants to take part in an exercise program for 12 weeks. About a third were told to briskly walk for 30 minutes, five days a week. Another third were told to briskly walk for 30 minutes a day, three days a week; the remaining third were told not to change their sedentary lifestyle at all.

The participants wore pedometers to monitor their walking, and researchers measured their blood pressure, blood cholesterol, weight, hip and waist size, and overall fitness before and after the study. The results showed systolic (the top number) blood pressure dropped - and waist and hip measurements shrunk significantly - in both the three-day-a-week and five-day-a-week exercise groups.

Systolic blood pressure dropped by 5 points among those who exercised three days a week and by 6 points among those who exercised five days a week. Waist and hip measurements fell by 2.6 centimeters and 2.4 centimeters respectively among the three-day-a-week exercisers and by 2.5 centimeters and 2.2 centimeters among the five-day-a-week exercise group. No changes were found in the sedentary group.


Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults

By Mark A Tully et al.


Objectives: To determine, using unsupervised walking programmes, the effects of exercise at a level lower than currently recommended to improve cardiovascular risk factors and functional capacity.

Design: 12 week randomised controlled trial.

Setting: Northern Ireland Civil Service; home-based walking.

Participants: 106 healthy, sedentary 40 to 61 year old adults of both sexes.

Interventions: Participants were randomly allocated to a walking programme (30 minutes brisk walking three days a week (n = 44) or five days a week (n = 42)) or a control group (n = 20). Participants could choose to walk in bouts of at least 10 minutes. They used pedometers to record numbers of steps taken. Intention to treat analysis of changes within groups was done using paired t tests; extent of change (baseline to 12 week measurements) was compared between groups using analysis of variance and Gabriel's post hoc test.

Main outcome measures: Blood pressure, serum lipids, body mass index, waist:hip ratio, and functional capacity (using a 10 m shuttle walk test).

Main results: 89% (93/106) completed the study. Systolic blood pressure and waist and hip circumferences fell significantly both in the three day group (5 mm Hg, 2.6 cm, and 2.4 cm, respectively) and in the five day group (6 mm Hg, 2.5 cm, and 2.2 cm) (p<0.05). Functional capacity increased in both groups (15%; 11%). Diastolic blood pressure fell in the five day group (3.4 mm Hg, p<0.05). No changes occurred in the control group.

Conclusions: This study provides evidence of benefit from exercising at a level below that currently recommended in healthy sedentary adults. Further studies are needed of potential longer term health benefits for a wider community from low levels of exercise.


Soviet-style patience required for life in bureaucratized Britain: "A customer who was trying to report a problem to BT [British Telecom] was kept hanging on the company's helpline for 20 hours without getting an answer. Hannah King, 51, rang an 0800 number after a telephone line she had paid for was not installed at her new home. From 1pm until 9pm she listened to piped music and a recorded message every few minutes. She gave up until the next morning, when she dialled the same number and waited another eight hours without a reply. The next day Mrs King tried between 8am and noon - but again no one from BT picked up. "I was so frustrated and angry I broke down in tears," she said. "It is a helpline for goodness' sake, surely a company as big as BT can answer their phones." Mrs King, who has a new flat at Milford Haven, called the helpline after an engineer failed to turn up. She said: "The problem is that if something goes wrong you have no other point of contact with BT. You have to ring their helpline number and you end up listening to music and voice prompts without ever speaking to a real person."

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