Sunday, June 15, 2008

Heart attack admissions fall by up to 40% since smoking ban

I thought the headline above was too good to be true. It is. See, for instance, the bit I have highlighted. Reading the small print is important in health matters too. The honest headline would be: "Smoking ban makes no difference"

The number of heart attack patients being admitted to emergency wards has fallen sharply in more than half of England's hospital trusts since smoking was banned in public places. The figures, obtained under the Freedom of Information Act, are an early indication of the impact of the smoking ban on heart disease rates in England. Some hospitals have seen the number of cases fall by 41 per cent since last July. The British Heart Foundation said that it showed the ban was the "most significant public health initiative this century".

Studies in Scotland and Ireland, which introduced a public-smoking ban in 2006, showed hospital admissions for heart attacks falling by 17 and 14 per cent respectively. Comparable evidence has come from France and Italy. These drops in the rate of heart attacks have been attributed to a large number of people stopping smoking, and far fewer people being exposed to airborne toxins through passive smoking.

The Government has not yet published figures documenting the effects of the ban in England. But NHS records show that there were 1,384 fewer heart attacks in the nine months after the legislation was introduced than in the same period a year earlier. The figures, obtained by the Daily Mail, show admissions for heart attacks from 114 trusts: 66 saw a drop in admissions compared with the same period the year before. The most striking figures came from Shrewsbury and Telford Hospital NHS Trust, where there was a 41 per cent fall, or 418 fewer cases. In the remaining 48 trusts, the number of admissions remained the same or increased slightly.

The Department of Health welcomed the figures as "good news" but added that it was too early to attribute falls in heart attack rates to the new legislation. Rates of heart disease were falling before smoking in public was banned in European countries, and various factors, including mild weather, can contribute to a fall. Nevertheless, the health benefits of stopping smoking are well established. A year after a person quits smoking, the risk of a heart attack falls to half that of a smoker.

Nicholas Boon, of the British Cardiovascular Society, said: "When you place these figures with the research in Scotland, Ireland, France and Rome, it is consistent with the observation that the ban has been followed by improvements in heart attack rates."


Britain's socialists have INCREASED inequality

Attacking a major route to advancement -- the selective ("Grammar") schools did not help

Who would have thought that 11 years of a Labour government would make Britain more unequal? Yesterday's official statistics show that since 1997, the poor have - in relative terms - got poorer and the rich richer. Inequality in Britain is now at its highest level since it was first measured in 1961. And that is bound to put a dampener on Gordon Brown's attempts to make our society more mobile.

For the more unequal a nation is, the less social mobility it offers. David Cameron likes to claim that Britain is now a genuine meritocracy in which where we are going is more important than where we have come from. But that's simply not true if you look at the underlying figures. Our society is no more fluid now than it was a generation ago - and it is less fluid than it was a generation before that.

They buck you up, your mum and dad, or they muck you up. Either way, in modern Britain, what most determines where you will end up in life is your parents. If they are high-earning, ambitious professionals, the chances are you will be too. If they are poor and unemployed, you have only a small chance of improving your prospects, whatever the talents you were born with.

Britain - along with America - is one of the most socially rigid nations in the developed world. And that is not because it is uniquely difficult for a poor child to do well here. It is because there is so little downward mobility from the top. If your parents are in the top three social classes (out of the seven defined by sociologists), there is a 74 per cent chance that you will be too. It is only the fact that the middle classes have expanded, thanks to the economy generating more white-collar jobs, that some children born into the working class have been able to move up and join them.

Well-off children have an enormous head start in Britain, and the influences work on them long before they even begin school. The brightest poor children drop from the 88th percentile at the age of 3 (meaning that only 12 per cent of their contemporaries score more highly in tests) to the 65th by the age of 5. The least able rich children, meanwhile, move up from the 15th percentile at 3 to the 45th at 5. At that rate, the dim rich kids overtake the bright poor ones in test scores by the time they are just 7.

So it is not just innate ability that determines your fate. While it may - perhaps - be true that, on average, children of parents in intellectually demanding jobs have a higher IQ than those whose parents are poor and unemployed (as Bruce Charlton argued controversially in Times Higher Education), that could not on its own explain the fact that rich youngsters are more than four times more likely than poor ones to go to university.

Nurture seems to matter at least as much as nature. Children of poor parents here don't tend to be given the same intellectual stimulation or the same impetus to achieve. In a survey of 54 developed countries, England and Scotland showed the highest correlation between children's test scores and the number of books at home. Poor children are less likely to be read to, less likely to be taken to museums or the theatre and less likely to display the good behaviour and social skills that are also associated with success in later life.

They are also more likely to have parents who don't particularly value education. Attitudes to education are incredibly important - which is why disadvantaged Indian and Chinese pupils do much better at school than their white or Afro-Caribbean contemporaries from similar backgrounds.

Why are Britain and America (supposedly the land of opportunity) less mobile than other countries? Economists put it down to our high levels of inequality. The more unequal a society, the harder it is to move out of your social class. The distances are greater, for a start. It is no accident that the most socially mobile nations are Scandinavian.

How depressing, though, for Labour ministers that so much has been done to try to increase social mobility here to so little effect. There has been a huge redistribution of money from the middle classes to the poor. There has been extra investment in inner-city schools. And there has been the introduction of SureStart, a scheme aimed at improving the life chances of children from an early age. Yet all Labour has managed to do is stabilise the decline in mobility.

The trouble is that the countervailing forces have been so strong. The more that we move to a knowledge economy, the more employers value educational succ-ess. Jobs that used to be open to non-graduates now expect a degree, and junior employees without one can no longer hope to be promoted into them. Britain and the US have higher returns to education than most other countries, meaning that graduates can expect to earn far more than those who have not been to university.

This is something that middle-class parents understand, and all their efforts are devoted to ensuring that their children go to university - preferably one of the best ones - and end up in a good, graduate-only job. To this end, they work single-mindedly to find a place for their offspring in the best nursery school, the best primary and the best secondary. If they can't afford to go private, they may employ a tutor to top up at home what their children are taught at school. High educational achievement, for girls as well as boys, has become even more of a spur in middle-class families than it was a generation or two ago.

It is hard for poor parents to compete with these dedicated rivals. The working classes on the whole have a smaller (though often closer) network of friends. The middle classes tend to have a wider (if shallower) circle of acquaintances from whom they can get the best advice on schools, universities and jobs, and with whom they can place their children on work experience. They can afford to buy houses in better catchment areas. They have broadband internet access at home, shelves of books and quiet places for their children to study. They can even "help" with coursework.

Then there is what economists call "assortative mating". We tend to marry others from the same social class. When girls were not so well educated and mothers stayed at home, this made less difference. Now that high-achieving, high-earning men marry high-achieving, high-earning women who often carry on at work after they have children, the advantages for their offspring are greater still - and so is the polarisation of society.

And finally, of course, there is the question of private schools. Yes, state schools have improved in the past ten years. It would be a scandal if they hadn't, given the amount of money that has been poured into them. But private schools have improved at least as fast. They have upped their fees, allowing them to recruit better teachers and build more facilities. The best ones have become far more academically selective - witness the wails of Old Etonians who can no longer get their sons into the school.

We all know the odd privately educated person who ends up as a poverty-stricken failure. But that sort of downward mobility is almost perversely difficult to achieve in Britain. Private schools give children the social skills, the networks and the academic results that pretty much guarantee them the same status that their parents have enjoyed. In many private schools these days, every sixth-former goes on to higher education. After that start in life, it is pretty unlikely that they will be stacking supermarket shelves. As the Sutton Trust has shown, privately educated people still take a disproportionate share of Britain's top jobs.

There is nothing wrong with middle-class parents wanting the best for their children and going all out to achieve it. The left-wing response, led by Ed Balls, Secretary of State for Children, Schools and Families, has been to penalise these parents by introducing school lotteries and banning selection by interview. Rather than dragging them down, though, would it not be better to try to equalise the chances of less privileged children?

IntoUniversity, a charity with three centres in inner-city London, is trying to do just that. It offers disadvantaged youngsters the sort of opportunities and expectations that middle-class children take for granted. From the age of 7, it not only hosts after-school study sessions with tutors, books and computers, it also introduces the idea of university and professional careers to children who might never have contemplated them. They get taken to museums and theatres, take part in debates, do workshops with bankers and lawyers and journalists, and spend a week hosted by a university discovering how learning can be enjoyable.

Many are then paired with a mentor who is already an undergraduate, often from a similar background, who not only helps them study, but also makes university seem as normal an aspiration as it would be for a middle-class child. And the charity also gives help and guidance that their parents can't always offer: on GCSE and A-Level choices, filling in a UCAS form, choosing a course and a college.

It is startlingly successful and has so far sent more than 80 students to university. Ayisha Adedeji, now 19, started with IntoUniversity at primary school. She won straight As in her A Levels and is now studying law and sociology at Warwick. She remembers being taken on a trip to Belgium, ostensibly to learn about the Second World War, but also to help her and her fellow pupils raise their ambitions. "We stuck stickers on ourselves saying `I want to be a doctor' or `I want to be a lawyer'. IntoUniversity gave me that extra push."

Andrew Chaplin, a teacher at Walnut Tree Walk Primary School in inner-city Lambeth, recently took his whole Year 6 class to a week run by IntoUniversity. "Every child in the class now talks about going to university and what course they would like to do," he says. "It is something many of them would never have even considered before."

So these are the keys: early intervention to stop bright children tailing off before they reach school; high expectations from teachers to keep them on track when they get there; and initiatives such as IntoUniversity to replicate the home environment that middle-class children enjoy.

These things can work wonders. The introduction of really good universal childcare in Denmark in the 1970s doubled the odds of children with ill-educated parents completing the equivalent of A Levels. And a US programme, aimed at disadvantaged mothers while they are still pregnant and sends a nurse to visit them for the first two years of their child's life, has been shown to give the child a larger vocabulary and a higher IQ. A similar scheme is being piloted here.

Gordon Brown and David Cameron can argue over whether the State or the voluntary sector should be helping poor children to aim high. But they both want to extend opportunity more widely. And they must agree that - while they can't buy an Eton education for everyone - the great start in life that they enjoyed as children is a boon that is still spread far too unevenly in Britain.


Upscale Brits moving out

Even Bulgaria seems preferable to some Brits

As the economic mood darkens, Britain's wealth generators are moving abroad. So where exactly is everybody heading? The exodus is accelerating faster than house prices are falling. Refusing to risk their livelihoods on our spluttering financial situation, or have their spirits crushed by fear of rising crime, a new swath of high-flyers, executives and entrepreneurs are departing Britain for fresher, brighter economies. Think Brazil, China, Morocco, even Bulgaria and Albania.

Up to one million more Britons are predicted to join the five million expatriates currently abroad over the next five years. But evidence suggests that, driven by the economic gloom, availability of property and the ease of working abroad via the internet, the departure rate will increase still further. Almost two million have moved away in the past decade, according to figures released last month, with 200,000 quitting our shores in 2006, the last year for which official statistics are available.

The figures make for happy reading for some. ''Our turnover has increased by more than 70 per cent," says former immigration officer Liam Clifford, who now runs Global Visas, which helps people negotiate the tortuous process of getting clearance to work abroad. "We are swamped. People are disillusioned with Britain, and the tax system is punishing working people. About half of those going are entrepreneurial, types - what you might call aspirational non-doms. The people with get-up-and-go are getting up and going."

Among them is Michael Loughlin, 39, whose company, Eurologix, based in Staffordshire, makes X-ray scanners for airports and prisons. He is moving his family and his company's manufacturing operations to Toronto, from where he will export back to Britain. ''The Canadian government is biting my arm off to get me there, offering financial incentives and introducing me to potential customers, but no one here cares. We don't support entrepreneurship any more."

Although the predicted exodus of hundreds of affluent non-doms from Britain has, to some extent, been averted by Government concessions, many other wealthy individuals are leaving, says Andrew Langton, chairman of international estate agents Aylesford International, which has offices in Spain and France. Forty per cent of his company's business is now in overseas property. ''Brits are saying enough is enough and are quitting the nanny state. Those who are successful are asking, why stick around here and lose everything to inheritance tax?"

Experts say the wealthy are moving themselves and their money to Singapore, Dubai and Hong Kong - which, despite Chinese control, remains a temple to capitalism and offers the privacy in banking and tax affairs that are under fire in traditional havens such as Monaco. Closer to home, even the previously unsympathetic tax regimes of Spain and France have become more welcoming in comparison with Britain.

Figures from overseas property advice site support the trend towards an exodus of the more affluent: the number of inquiries from those planning to emigrate has risen seven per cent over the past year. A shift upwards to properties costing between œ100,000 and œ300,000 suggests that home owners are capitalising on their UK properties before prices slump even more. Paul Collins, the website's property editor, adds that inquiries about properties in excess of œ1 million have increased fourfold in the past year.

At the same time, people are becoming more adventurous about their destinations. ''We have recently introduced new online guides to buying property and living in Albania, India and Malaysia because of growing demand. And Morocco is attracting a lot of interest because it's a big country, with a good government, and there is a lot of development. It's only another 30 minutes' flying time from the Costa del Sol."

China, too, is attracting Brits because it is seen as a land of opportunity in the way that Russia was in the mid-1990s, but without the corruption and mafia. The Communist government is desperate to open up markets further to Western interests - the Olympics offers an ideal opportunity that they are exploiting to the max. Many rich people are also attracted to Hong Kong.

According to Paul Collins, it's the prospect of economic hardship on the horizon here that ''crystallises thinking among people, prompting them to make decisions about their future that they have been considering for some time". This was precisely the case with Barry and Barbara Mardell, who lived outside Bognor Regis in East Sussex, and who moved to Cyprus in April. Aged 56 and 52 respectively, they are some way off retiring, but sought a better lifestyle when forced to rely upon one salary after Mrs Mardell, a former executive with Qinetiq, the defence contractor, had to give up work on health grounds. '

'The quality of life in Britain is not what it was," says Mrs Mardell. ''Our village was no longer a real village because of over-development; we suffered every time the Government changed taxes to penalise middle- class, middle-income people and our children couldn't find work because the immigrants took all the jobs." Now settled in Cyprus, her husband is starting his own facilities management company and they are shortly about to move into a three-bedroom detached house with swimming pool.

Even Bulgaria is seen to offer more opportunities for a better life than Britain, says David Hollands, who set up after realising that its low cost of living and competitively priced properties - a tenth of what they might cost in Tuscany or the Dordogne - would be attractive to disenchanted Brits. ''We are getting up to half a dozen inquiries a week from people who are going, or want to go in the immediate future," he says. ''People are fed with all the CCTV cameras, having all this global warming stuff rammed down their throats and not having anywhere to park the car."

One of those who have taken the plunge is Martin MacMaster, 40, who runs an agricultural contractors in Bedfordshire and will soon be moving most of his business to Bulgaria. "I'm fed up with the rising cost of everything, including diesel fuel. I've given up banging my head against a brick wall. The quality of life in this country has dropped by 50 per cent over the past five years. It's not a political thing," he adds. ''I didn't vote for any of them."

He is one of a number of potential wealth generators of the future who are now lost to Britain. Simon Greenwood, 27, and his partner Charlotte Senior, 28, both left behind the prospect of good careers in London for a fresh start in undeveloped Puglia, southern Italy. ''We were fed up with commuting and the rat race. When we come back now, London seems so crowded, polluted and dirty." In the three years since they left, Ms Senior has written a novel and they have started a company that helps others relocate to the area.

Next year, Damon Kestle, 40, and his wife, Sarah, who is expecting their first child, plan to move to Brazil to start a restaurant in a new luxury housing complex in the north-east of the country. Mr Kestle, who runs a gastro-pub in north London, says: "Making money is not the only reason for going there, but I think we can expect a better standard of living. The economy is growing and I think in five years' time it will become the place to be. We come from Nottingham, which has a very high crime rate, and we are living in north London, which is full of knife crime, so I think Brazil is actually a better place to bring up a child." Whether it is Brazil, Italy or Bulgaria, he speaks for many when he says of his new chosen home: "It is where we see our future."


NHS reforms deliver no significant patient benefit

Rhetoric not matched by results

Almost 1 billion pounds spent increasing choice and competition in the health service has not delivered any significant benefits for patients, an official report published today says. Changes intended to introduce "market style" reforms in the NHS have delivered some improvements, the Audit Commission and Healthcare Commission concluded. But there was still "some way to go before patients see any significant benefits", said Ian Kennedy, the chairman of the Healthcare Commission, who co-authored the report. Around half of patients are still not being offered a choice about where they would like to be treated, the report found

The changes have also failed to increase the number of patients being treated outside hospital, one of the key aims of the reforms. Although there have been "significant improvements" in some areas, the report concluded that progress was "behind" what it might have been.

The reforms, brought in at different points since 2000, include allowing patients more choice about which hospital they visit, increased use of the private sector and paying hospitals a set rate for each procedure, encouraging them to treat more patients more efficiently. But they were introduced with no clear "vision", the report found, and no system was set up to monitor or evaluate if they were working.

In 2006 ministers announced that patients would be allowed to choose between a limited number of hospitals for their care, a policy extended to all hospitals earlier this year. However, the report found that only 50 per cent of patients were being offered any choice at all, well short of the government's target of 80 per cent. The health service also does not collect enough information to allow patients a true choice, the report found. Most patients want details on the quality of care provided by different hospitals but that data is not being collected by the Department of Health.

The report also shows that outpatient appointment numbers remained generally static across the country, despite a stated aim to treat more people in the community instead of in hospital. And only 16 per cent of GPs believe that a new system which gives them more control over money spent by their surgery had actually helped patients.

However, the report's authors said that the reforms could deliver benefit to patients in the future. "Conceptually the measures should work and we should look to the start of improvement. In the next couple of years we will know whether the idea was correct," Michael O'Higgins, chairman of the Audit Commission, who co-authored the document, said.

The Tories accused ministers of missing "a golden opportunity" to make a real difference to standards in the NHS. Andrew Lansley, the shadow health secretary, said: "They have spent a lot but achieved far too little. "The Government has said many of the right things about reforming the NHS but when it comes to actually delivering them, it has dithered and delayed. Giving GPs responsibility for budgets for their patients should have been one of the strongest drivers of change but Labour hasn't implemented it. "Too much money that could have been spent on improving care for patients has been wasted."

Norman Lamb, Liberal Democrat health spokesman, said: "This is a depressing verdict on 11 years of endless, contradictory reform in the NHS which have cost taxpayers a lot of money and delivered little benefit to patient care. "Choice in the NHS must be made to work for everyone. Without information and support for all patients, choice will succeed in only improving care for the well informed - leaving more disadvantaged groups behind."


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