Some Brits need to win the lottery to get their knees fixed

Being in pain doesn't count, of course. The NHS was supposed to eliminate the gap between rich and poor but after nearly 60 years the gap is still a chasm. The poor are still reduced to the role of charity supplicants

For the lottery multi-millionaire, it must be a difficult choice. Which little luxury should we go for first - the mansion, the limo or the world cruise? But for Tony and Greta Dodd, the decision was a little more prosaic. After recovering from the shock of taking a 2,438,155 pound share in a rollover jackpot, they got straight on the phone to the nearest private hospital to book themselves in for four replacement knees.

The couple, aged 67 and 69 respectively, are both on the NHS waiting list for operations and suffer constant pain. "We're ecstatic," said Mr Dodd, a retired taxi driver. "As soon as it sank in that this money was for real we decided the first thing we want is a new pair of knees each. I've been on the NHS list for six months and up to now I've heard nothing - not even a proposed date for an operation. "Greta has only just gone on the waiting list so we were concerned that she would have even longer to wait. Now we are thrilled to be able to sign a cheque. "We have both been told that our knees are worn out. Mine went first and now Greta's have gone the same way. Walking any distance can be agony."

The couple have booked assessments with an orthopaedic surgeon for next week. A private knee operation costs between 8,000 and 10,000 pounds and even four won't make too much of a hole in their 2.5 million. "The doctors have told us we could have the operation within a few days if we wish but we will probably hold off a week or two because we have got some serious celebrating to do."

The win came after Mr Dodd changed his regular numbers for the first time since he began playing the lottery when it was launched in 1994. He said: "When I went to the newsagent I was a bit flummoxed because I'd lost the form with the numbers filled-in on it. "It meant I had to write a new one and for the life of me I couldn't remember all the numbers - only the first five - so I just picked 49 as the last one at random. "It was the greatest stroke of luck and I still can't think where it came from. I can only say that fate was on my side."

The couple, who live in Wallasey, Merseyside, have never won more than 10 pounds on the weekly draw. Mr Dodd said: "You could have knocked me over with a feather when I realised we had the winning line. When you see that you have crossed off those six numbers it's unreal. It's awe-inspiring."

After her operation Mrs Dodd, 69, who survived breast cancer seven years ago, plans to splash out on a holiday to Las Vegas with her best friend. The couple who have a daughter, Jane, 42, enjoyed breaking the news to her over the phone. Mr Dodd said: "I phoned my daughter and started singing, 'Who wants to be a millionaire...' She told me to stop messing around but when I told her it was for real she was jumping for joy."

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Diabetic ethnic minorities lose out in Britain

Patients from ethnic minorities are not only more likely to suffer from diabetes, but also receive lower quality care from the National Health Service (NHS), claims a paper published in the online open access journal, International Journal for Equity in Health.

Michael Soljak, together with colleagues from Imperial College, London, UK, investigated the treatment received in 2002 by 21,343 diabetic patients in three North West London Primary Care Trusts (PCTs): Ealing, Hammersmith & Fulham, and Hounslow. The researchers also compared the patients general health, shown by factors such as blood pressure and cholesterol levels, and diabetes control, to the patients treatment.

General practitioners (GPs) were encouraged to record new patients ethnicity by providing training and support to the practices. Of the diabetic patients in the three PCTs, 70 percent had a valid ethnicity code, obtained through patient questionnaires and entered by practice staff.

The authors found that although diabetes control was worse among the South Asian population, a smaller proportion of South Asians were prescribed insulin. They also found that although the White population studied was older, blood pressure differences between the groups were small, indicating poorer control in non-White ethnic groups.

The poorer quality of care for Asian diabetic patients could be explained by patient factors- such as poor understanding of the disease- or by the standard of care their GPs offered. Institutional racism is unlikely to be a major cause, as many South Asian patients are registered with GPs from their own ethnic group.

"This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences. But we don't just need to know more about both the practice and patient factors involved," says Soljak, "there should be more intensive management of diabetes and education about the disease in South Asian patients. The best option would be trials comparing different types of such interventions. Our study also shows that in future these trials can be carried out using routinely collected clinical information".

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Tony Blair's domestic legacy: corruption and the erosion of liberty

Some excerpts from THEODORE DALRYMPLE below

At the outset of his tenure, Mr. Blair said that his government would be tough on crime and on the causes of crime. He wanted to appeal--and succeeded in appealing--to two constituencies at once: those who wanted criminals locked up, and those who saw crime as the natural consequence of social injustice, a kind of inchoate protest against the conditions in which they lived.

Mr. Blair's resultant task was to obfuscate, so that the electorate and even experts could not find out, without great difficulty, what was going on. For example, Mr. Blair's government, aware of public unrest about the number of criminals leaving prison only to commit further serious crimes, introduced indeterminate sentencing--open-ended imprisonment--apparently a tough response to repeat offenders. But the reality was different: the sentencing judges still had the discretion to determine such criminals' parole dates, which, in England, are de facto release dates. The sentences that criminals would serve, in other words, would be no longer than before the new law.

Another way to confuse the public was to corrupt official statistics. Last year, to take one example, the government dropped three simple but key measures from the compendious statistics that it gathers about people serving community sentences--that is, various kinds of service and supervision outside prison: their criminal histories prior to sentencing, their reconviction rates, and the number given prison sentences while serving their community sentences. Instead, it introduced an utterly meaningless measure, at least from a public-safety perspective: the proportion of people with community sentences who abide by such conditions as weekly attendance for an hour at a probation office.

The police also received encouragement to keep crime numbers down by not recording crimes. The crime rate has fallen in part because shoplifting has ceased to be a crime, for instance. Police now deal with it the way they do with parking violations: shoplifters get on-the-spot fines worth half, on average, of the value of the goods that they have stolen.

The problem of unemployment in Britain illustrates perfectly the methods that Mr. Blair's government used to obscure the truth. The world generally believes that, thanks to Labour's prudent policies, Britain now enjoys low unemployment; indeed, Mr. Blair has often lectured other leaders on the subject. The low rate is not strictly a lie: those counted officially as unemployed are today relatively few.

Unfortunately, those counted as sick are many; and if you add the numbers of unemployed and sick together, the figure remains remarkably constant in recent years, oscillating around 3.5 million, though the proportion of sick to unemployed has risen rapidly. Approximately 2.7 million people are receiving disability benefits in Britain, 8% or 9% of the workforce, highly concentrated in the areas of former unemployment; more people are claiming that psychiatric disorders prevent them from working than are claiming that work is unavailable. In the former coal-min- ing town of Merthyr Tydfil, about a quarter of the adult population is on disability. Britain is thus the ill man of Europe, though all objective indicators suggest that people are living longer and healthier lives than ever.

Three groups profit from this statistical legerdemain: first, the unemployed themselves, because disability benefits are about 60% higher than unemployment benefits, and, once one is receiving them, one does not have to pretend to be looking for work; second, the doctors who make the bogus diagnoses, because by doing so they remove a possible cause of conflict with their patients and, given the assault rate on British doctors, this is important to them; and finally, the government, which can claim to have reduced unemployment.

But such obfuscation is destructive of human personality. The unemployed have to pretend something untrue--namely, that they are sick; the medical profession winds up humiliated and dispirited by taking part in fraud; and the government avoids, for a time, real economic problems. Thus the whole of society finds itself corrupted and infantilized by its inability to talk straight; and that Mr. Blair could speak with conviction of the low unemployment rate, and believe that he was telling the truth, is to me worse than if he had been a dastardly cynic.

Tony Blair's most alarming characteristic, however, has been his enmity to freedom in his own country, whatever his feelings about it in other countries. No British prime minister in 200 years has done more to curtail civil liberties than has Mr. Blair. Starting with an assumption of his infinite beneficence, he assumed infinite responsibility, with the result that Britain has become a country with a degree of official surveillance that would make a Latin American military dictator envious. Sometimes this surveillance is merely ludicrous--parking-enforcement officers' wearing miniature closed-circuit security cameras in their caps to capture abusive responses from those ticketed, say, or local councils' attaching sensing devices to the garbage cans of three million homes to record what people throw away, in order to charge them for the quantity and quality of their trash.

But often the government's reach is less innocuous. For example, in the name of national security, the government under Mr. Blair's leadership sought to make passport applicants provide 200 pieces of information about themselves, including bank-account details, and undergo interrogation for half an hour. If an applicant refused to allow the information to circulate through other government departments, he would not get a passport, with no appeal. The government also cooked up a plan to require passport holders to inform the police if they changed their address.

A justification presented for these Orwellian arrangements was the revelation that a would-be terrorist, Dhiren Barot, had managed to obtain nine British passports before his arrest because he did not want an accumulation of stamps from suspect countries in any of them. At the same time, it came to light that the Passport Office issues 10,000 passports a year to fraudulent applicants--hardly surprising, since its staff consists largely of immigrants, legal and illegal.

As was often the case with Mr. Blair and his government, the solution proposed was not only completely disproportionate to the problem; it was not even a solution. The government has admitted that criminal gangs have already forged the U.K.'s new high-tech passports. The only people, then, whom the process will trouble are the people who need no surveillance. No sensible person denies the danger of Islamic extremism in Britain; but just as the fact that the typical Briton finds himself recorded by security cameras 300 times a day does not secure him in the slightest from crime or antisocial behavior, which remain prevalent in Britain, so no one feels any safer from the terrorist threat despite the ever-increasing government surveillance.

Mr. Blair similarly showed no respect for precedent and gradual reform by Parliament itself, which--in the absence of an American-style written constitution--have been the nation's guiding principles. By decree, he made the civil service answerable to unelected political allies, for the first time in history; he devoted far less attention to Parliament than did any previous prime minister; the vast majority of legislation under his premiership (amounting to a blizzard so great that lawyers cannot keep up with it) passed without effective parliamentary oversight, in effect by decree; one new criminal offense was created every day except Sundays for 10 years, 60% of them by such decree, ranging from the selling of gray squirrels and Japanese bindweed to failure to nominate someone to turn off your house alarm if it triggers while you are out; he abolished the independence of the House of Lords, the only, and very limited, restraint on the elected government's power; he eliminated the immemorial jurisprudential rule against double jeopardy; he wanted to introduce preventive detention for people whom doctors deemed dangerous, even though they had as yet committed no crime; he passed a Civil Contingencies Act that permits the British government, if it believes that an emergency anywhere in the world threatens serious damage to human welfare or to the environment in Britain, to confiscate or destroy property without compensation.

That Mr. Blair should have turned out to be so authoritarian ought to come as no surprise to those who listened to the timbre of some of his early pronouncements. His early emphasis on youth; his pursuit of what he called, grandiosely, the Third Way (as if no one had thought of it before); his desire to create a "New Britain"; his assertion that the Labour Party was the political arm of the British people (as if people who did not support it were in some way not British)--some have thought all this contained a Mussolinian, or possibly Peronist, ring. It is ridiculous to say that Tony Blair was a fascist; but it would be equally absurd to see him as a defender of liberty, at least in his own country.....

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