Friday, December 21, 2007

Babies dying due to NHS confusion

Scores of premature babies may be dying unnecessarily across England because the NHS mismanaged a reform of neonatal units in 2003, parliament's spending watchdog reveals today. Health ministers provided 73 million pounds over three years to link up hospital neonatal units in 23 regional networks that could provide specialist services to save premature and low birth weight babies. But the National Audit Office finds that the Department of Health did not issue instructions for the units to be adequately staffed. As a result the service was overstretched. Its specialist nursing workforce was nearly 10% below strength. There were not enough cots to respond to every emergency and there was a lack of specialist 24-hour transport to move babies and mothers to other hospitals.

Jacqui Smith, when health minister in 2003, said she agreed with recommendations from the British Association for Perinatal Medicine for minimum staffing ratios. But the government did not order NHS trusts to implement them. The NAO says there was "confusion" over whether staffing ratios were mandatory, making it difficult for unit managers to convince NHS trusts they needed more staff. Half the 180 units providing neonatal services did not meet the approved ratio for high dependency care of one nurse to two babies. And only 24% met the intensive care ratio of one nurse to one baby.

The NAO acknowledges that the 2003 reform improved standards, leading to fewer babies travelling long distances for suitable treatment. But the improvement was not as great as ministers anticipated. Every year about 60,000 newborn babies need specialist care - about 10% of all births. In 1975 half the premature babies with a low birth weight died and many were stillborn. By 1995 the proportion had fallen to one sixth. In 2003 ministers said the reorganisation could save an extra 200-300 lives a year, but by 2005 the mortality rate had fallen by only about 120.

Units had to close to new admissions on average about once a week in 2006-07, mainly due to a lack of cots or staff shortages, the NAO says. A third of the units had a cot occupancy rate of more than 70% - the maximum recommended to avoid harming babies through increased risk of infection or inadequate levels of care. Only half the units provided round-the-clock specialist transport services. Staff often had to leave the unit to accompany a baby on a transfer, leaving colleagues even more overstretched.

Hospital managers had little idea of the service's real costs. Intensive care cot charges varied from 173 pounds a day to 2,384.

The NAO says it found wide variations in the death rates of the networks, not all of which could be explained by the social characteristics of their catchment areas. In 2005, the south-west Midlands network had the highest death rate at 4.8 babies per 1,000 live births. Surrey and Sussex had the lowest at 1.8 per 1,000.

Karen Taylor, NAO director of value for money in health, said babies needing the most intensive care were the least likely to receive adequate service. "The organisation and provision of care is not satisfactory," she added. However parents were likely to express high levels of satisfaction and even those whose babies died were usually grateful for the efforts made by staff.

A spokeswoman for the premature baby charity Bliss said: "More babies are being born each year in England, and more are being admitted to neonatal units. The report has found there is no strategic plan in place to manage this increasing demand." Dr Sheila Shribman, the Department of Health's maternity tsar, said: "While the UK is one of the safest places to give birth, we recognise there is still more to do. We will be working closely with the NHS to look at these services in the light of the issues highlighted in the report."


Britain: Private schools should not be a 'guilty secret'

Parents should not be embarrassed at sending their children to private school but should feel the same pride they do in buying expensive jewellery, the new leader of Britain's independent girls schools has said. Vicky Tuck, the incoming president of the Girls Schools Association and principal of Cheltenham Ladies College, said people should not feel apologetic or "sheepishly" hide the fact that they are buying a good education

"We are not embarrassed by paying a decent sum for a nice house or a nice jacket or a nice engagement ring," she said. "Yet if you decide to spend your earnings on the most valuable thing you can do - to give your children an education - you are damned for doing so."

Mrs Tuck, who takes over the association in the New Year, said that the public school sector in the UK was renowned around the world, and that the "sheepishness" some parents felt about admitting to using it was not apparent in other countries. The head launched a strong defence of the right of families to choose. "It goes back to this question of opportunities and life chances," she said in an interview with The Sunday Telegraph. "If you are able to afford it, you are giving your child a better life chance - I can see the moral dimension to that. "But we should not be embarrassed by the fact that we are providing something that is excellent just because, sadly, it is not available to everyone. We would be perfectly happy not to have to exist. If the state provision was so excellent, it would be inconceivable that you would pay twice for education.

Official figures published last month showed a rise in the proportion of children aged 11 to 15 in England attending the independent sector, from 7.1 per cent in 2004 to 7.3 per cent this year. The figures show the Government's failure to persuade the middle classes that state schools have improved so much that parents no longer need to opt for the private sector.

However, despite the increasing popularity of independent schools, some parents feel reluctant to admit their "guilty secret". Earlier this year Ruth Kelly, at the time communities minister, faced criticism from backbenchers when it was revealed she had decided to send her son to private school. While Tony Blair - who attended Fettes College, in Edinburgh - supported colleagues who went private, Gordon Brown has pushed his state school credentials and stated that his children will attend the local school.

Mrs Tuck, who has been credited with modernising the regime at the o26,000-a-year Cheltenham Ladies College, said the Government had created a climate where the independent sector felt "under siege". "At one level the Government is clearly aware of all the quality that we are providing in our schools," she said. "Yet at another level we still feel under siege. There seems to be an idea that we are having an easy time but people couldn't work harder than our staff here."

Professor Alan Smithers, the director of the centre for education and employment research at Buckingham University, said the emphasis on widening access to university and social mobility was "tending to engender a certain unease" about private schooling. "By drawing attention to the gap you make people feel guilty," he said


English a minority language in 1,300 British schools

Children with English as their first language are now in the minority in more than 1,300 schools, according to official figures. The Daily Telegraph has obtained data from the Department for Children, Schools and Families illustrating the impact of high levels of immigration on the education system. The figures show that in a total of 1,338 primary and secondary schools - more than one in 20 of all schools in England - children with English as their first language are in the minority. In 600 of these schools, fewer than a third of pupils speak English as their first language.

The disclosure led to warnings that the rising number of foreign pupils without a decent grasp of English was putting intense pressure on teachers and undermining education standards. The figures have fuelled demands from teachers' leaders for more money to help meet the costs of teaching foreign-born children. Teachers' unions said educating a single non-English-speaking pupil could cost as much as œ30,000 a year. Coping with large numbers of foreign children risked undermining the quality of teaching given to all pupils, they said.

Philip Parkin, the general secretary of the Professional Association of Teachers, said rising levels of immigration and a lack of multi-lingual teaching staff were "providing serious challenges" for schools trying to maintain standards. Dealing with non-English- speaking children "makes it much harder to deliver the curriculum", Mr Parkin said. "Schools that are in that position need considerable support in order to give those children help with English and help with our curriculum. "The Government needs to be looking at funding the employment of teachers or teaching assistants, in addition to the staff they have, who are bilingual or multilingual."

Last month, the National Association of Head Teachers said some schools were struggling to cope with the influx of foreign pupils. Mick Brookes, the union's general secretary, told a Lords committee that the situation was "out of control". A rush of migrants into an area can "strain or even break the resources of the school", he said. Last night, Mr Brookes said the latest figures proved the case for putting additional resources into the areas dealing with large numbers of non-English speakers. "There are children who cannot speak the language," he said. "Others are refugees who may have witnessed some horrible things. "These children may not just need support to speak English, but often they require counselling to talk them through the trauma they have witnessed."

Data from the Department for Children, Schools and Families show that in 574 of the 17,361 primary schools in England, children without English as a first language make up between 51 and 70 per cent of all pupils. Another 569 primaries have more than 70 per cent who count English as a second language. In 112 of the 3,343 secondary schools, children without English as a first language make up 51 to 70 per cent of all pupils. In another 83 secondary schools, the proportion is above 70 per cent. The total number of schools where pupils with a first language other than English make up at least 51 per cent of the population is 1,338.

Following patterns of immigration, children who do not speak English as a first language are heavily concentrated in certain areas of the country, especially London. The 20 councils with the highest concentration of non-English speaking children are in London. In the borough of Newham, nine out of 10 schools have a non-English first language majority. The same is true of a third of schools in Leicester and in Blackburn, and a quarter of schools in Birmingham.

Gordon Brown last week repeated calls for immigrants to learn English, but critics say he is not doing enough to fund proper language teaching for immigrant children. David Davis, the Conservative shadow home secretary, accused the Government of failing to meet the costs of its immigration policy. "We have been warning the Government for years now of the consequences for schools of the very high rate of immigration," he said. "This shows how many schools will face real difficulties."

The Government said last night that it was properly funding schools facing extra costs from children struggling with English. A DCSF spokesman said: "We have listened to the unions' concerns and are increasing funding in the Ethnic Minority Achievement Grant to œ206 million by 2010. "We have also introduced new guidance for teachers to work with new arrivals. There's actually surplus money in the school system to deal with any 'exceptional circumstances'."

But even Labour MPs have expressed concern that the Government is failing to keep up with immigration. Phyllis Starkey, the Labour chairman of the communities and local government committee of MPs, last week warned Mr Brown that funding delays risked inflaming "community conflict". Many of the pupils without English as their first language are the children of the 600,000 eastern Europeans who have come to Britain since the European Union's eastward expansion in 2004. Official statistics last week showed that one in five births in Britain last year was to a woman from overseas.


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