They are too busy paying hordes of clerks and "administrators" to afford the best drugs for their patients
A pledge to give patients any approved medication on the basis of clinical need rather than cost risks creating an almost limitless drugs bill, the Government has been warned. Plans for a new NHS constitution, to be unveiled by the Prime Minister today, will enshrine a universal right to treatment if clinically appropriate in an attempt to end the “postcode lottery” of access to new drugs. Experts gave warning that the pledge, one of a series of new measures in the landmark draft document, carried huge costs that could not be covered by current NHS budgets.
Publication of the new constitution comes at the start of a week of celebrations to mark the 60th anniversary of the NHS. It will set out a “right to expect local decisions on funding of other drugs and treatment to be made rationally following a proper consideration of the evidence”.
While the drive to reduce inequalities of access to drugs will be welcomed, health economists question how the Government will be able to devise a policy that delivers on such a pledge without punitive costs. Roy Lilley, a former director of an NHS trust and independent health policy analyst, said: “We have to ask ourselves the question: will drugs get more complex? Yes. Will they get more expensive? Yes. “To say that we will buy them whatever, however much they cost, you might as well give the pharmaceutical industry a blank cheque. “It’s a huge worry. There are some fantastic drugs. I’m not saying we shouldn’t have them. But there has to be a rationale behind the use of resources. You can’t say because it’s here we’re going to buy it. That’s crazy.”
The National Institute for Health and Clinical Excellence (NICE), the watchdog that determines value for money on the NHS, can currently take up to 2½ years to decide whether to approve a drug. Ministers want this cut to a maximum of six months.
Alan Johnson, the Health Secretary, said yesterday that patients would have a universal right to approved treatments “if clinically appropriate” and might resort to legal action if they were still disappointed. The moves are expected to generate at least £100 million worth of extra prescriptions a year, funded centrally by the Department of Health.
While patients’ groups and health economists welcomed the Government’s aims to provide quicker treatment, they said that the increasing cost — and sometimes modest benefits — of new drugs could not be taken out of the equation. John Appleby, chief economist of the King’s Fund health think-tank, said: “There are cases where patients have died after being denied drugs for cancer. But these medicines often cost more than ten times NICE’s threshold for achieving one extra year of life. “In a system of finite resources you have to draw a line somewhere in terms of a drug’s effectiveness — it may add extra minutes, days, months of quality years to someone’s life but how much is enough? Perhaps the Government has decided that it can avoid bad headlines by promising greater access to drugs but it will have to look into this carefully or be braced for a surge in patient demand, with the associated costs.”
The Royal Pharmaceutical Society of Great Britain agreed that “better, more comprehensive access to new treatments will not be without cost”. Alan Maynard, Professor of Health Economics at the University of York, added: “Often new drugs that haven’t been approved by NICE simply aren’t cost-effective. We have to confront this issue head on, by speeding up the NICE appraisal process but also by putting pressure on pharmaceutical companies to lower their prices.”
One of the biggest “postcode lottery” disputes has been over drugs for “wet” age-related macular degeneration, which affects more than 250,000 Britons. Barbara McLaughlin, of the Royal National Institute for the Blind, said that NICE had been considering the drugs since February 2006 and that the slowness of the processes had threatened the sight of thousands of people.
Andrew Lansley, the Shadow Health Secretary, said that comparisons of access to emerging treatments between Britain and other countries was “frankly scandalous”. “We have some of the best cancer research in the world in this country but we have among the slowest uptake of new cancer drugs. So it is not just about a postcode lottery inside the UK.”
The Department of Health said the NHS constitution would be the first of its kind in the world and would state “what patients, public and staff are entitled to expect from the NHS”. It will be presented to Parliament this afternoon as part of the year-long review of NHS services completed by Lord Darzi of Denham, the surgeon brought in as a health minister by Gordon Brown.
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British markers award students for writing obscenities on examination papers
How low Britain has sunk: Write `f*** off' on a GCSE paper and you'll get 7.5%. Add an exclamation mark and it'll go up to 11%
Pupils are being rewarded for writing obscenities in their GCSE English examinations even when it has nothing to do with the question. One pupil who wrote "f*** off" was given marks for accurate spelling and conveying a meaning successfully. His paper was marked by Peter Buckroyd, a chief examiner who has instructed fellow examiners to mark in the same way. He told trainee examiners recently to adhere strictly to the mark scheme, to the extent that pupils who wrote only expletives on their papers should be awarded points.
Mr Buckroyd, chief examiner of English for the Assessment and Qualifications Alliance (AQA), an examination board, said that he had given the pupil two marks, out of a possible 27, for the expletive.
To gain minimum marks in English, students must demonstrate "some simple sequencing of ideas" and "some words in appropriate order". The phrase had achieved this, according to Mr Buckroyd.
The chief examiner, who is responsible for standards in exams taken by 780,000 candidates and for training for 3,000 examiners, told The Times: "It would be wicked to give it zero, because it does show some very basic skills we are looking for - like conveying some meaning and some spelling. "It's better than someone that doesn't write anything at all. It shows more skills than somebody who leaves the page blank."
Mr Buckroyd says that he uses the example to teach examiners the finer points of marking. "It elucidates some useful points - it shows some nominal skills but no relevance to the task." He also acknowledged that the language was inappropriate - but added that using the construction "different to" would also be inappropriate language.
The choice phrase, given in answer to the question "Describe the room you're sitting in", on a 2006 GCSE paper, was not punctuated. "If it had had an exclamation mark it would have got a little bit more because it would have been showing a little bit of skill," Mr Buckroyd said, "We are trying to give higher marks to the students who show more skills."
The AQA, which as the largest of the three examination boards awards half the full-course GCSEs and 43 per cent of A levels, distanced itself from Mr Buckroyd's comments, saying: "If a candidate's script contains, for example, obscenities, examiners are instructed to contact AQA's offices, which will advise them in accordance with Joint Council for Qualification guidelines. Expletives in a script would either be disregarded, or sanctioned."
Ofqual, the Government's examinations regulator, refused to condemn Mr Buckroyd's approach. "We think it's important that candidates are able to use appropriate language in a variety of situations but it's for awarding bodies to develop their mark scheme and for their markers to award marks in line with that scheme," it said.
Other examining bodies said that their marking schemes would not reward such language. Edexel said: "If the question was `Use a piece of Anglo-Saxon English', they may get a mark, but if they had just written `f*** off', they may get sanctioned. If it was graphic or violent they may get no mark for that paper."
The Joint Council for Qualifications, which represents exam boards, said that examiners were required to report instances of "inappropriate, offensive or obscene material" in exam scripts, and the awarding body must investigate. "If malpractice is identified, the awarding body will decide on the appropriate sanction, which could include loss of marks or even disqualification," a spokesman said.
Nick Gibb, the Shadow Schools Secretary, said of Mr Buckroyd's strategy: "It's taking the desire for uniformity and consistency to absurd lengths."
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Unbelievable: British health meddlers trying to cut the number of holes in fish-shop salt shakers
This might just be lucrative for the lawyers. When some keen eater of fish and chips dies prematurely, their relatives may find that people on salt-restricted diets actually die sooner. The council could then be up for compensation!
Pot-holed roads, crumbling schools, litter-strewn streets - there's no shortage of problem areas crying out for their attention. But councils believe they have found a better use for their money: reducing the number of holes in chip shop salt shakers. Research has suggested that slashing the holes from the traditional 17 to five could cut the amount people sprinkle on their food by more than half. And so at least six councils have ordered five-hole shakers - at taxpayers' expense - and begun giving them away to chip shops and takeaways in their areas.
Leading the way has been Gateshead Council, which spent 15 days researching the subject of salty takeaways before declaring the new five-hole cellars the solution. Officers collected information from businesses, obtained samples of fish and chips, measured salt content and `carried out experiments to determine how the problem of excessive salt being dispensed could be overcome by design'. They decided that the five-hole pots would reduce the amount of salt being used by more than 60 per cent yet give a `visually acceptable sprinkling' that would satisfy the customer.
The council commissioned Drywite Ltd - a catering equipment company based in the West Midlands - to make five-hole shakers and bought 1,000 of them at a cost of 2,000 pounds, giving them away to fast-food outlets in their areas. Drywite confirms that it has since received orders for the shakers from at least five other councils, including Rochdale Borough in Greater Manchester. Another giving the shakers away is Labour-controlled Middlesbrough Council, where the idea has run into fierce criticism.
Cllr Chris Hobson, leader of the Conservatives, said: `This is just silly, a total waste of money in an area where council tax is very high. I'm all for good health but do they really think they are going to stop people using as much salt simply by putting fewer holes in thecellar? They'll just shake it for longer.'
Beryl Scott, who owns the Chipchase Chippy in Linthorpe in the city, said a council worker had visited the previous week to explain the merits of less salty fish and chips. `He said he had a salt cellar with five holes to give me free. I thought it was a joke. It doesn't matter how many holes it has, people are going to put on as much salt as they want.' Another local chip shop owner, Carol Ackerman, who runs Carol's Plaice in the suburb of Acklam, said: `People will just put on more salt if they want more. `In fact, we have had some people unscrewing the lids to do so.'
Gateshead Council defended its decision. A spokesman said: `Research carried out by us discovered customers were often receiving huge quantities of salt with their fish and chips - up to half their daily allowance. The council was so disturbed it decided to commission a manufacturer to produce a salt shaker with fewer holes, which it distributed free to every fish and chip shop and hot food takeaway in Gateshead. `We believe the cost to be a small price to pay for potentially saving lives.'
The scheme is being promoted by the Local Authorities Coordinators of Regulatory Services, which is responsible for ensuring councils follow food hygiene rules. A spokesman said: `Heart disease costs taxpayers 7billion a year so to say that projects such as this are a waste of money is mind-boggling.'
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Rigid British bureaucrats force the destruction of perfectly good fruit
A wholesaler has been banned from selling a consignment of kiwi fruits because EU laws deemed them too small.
Tim Down, a market trader for 25 years, said he was not permitted even to give away the 5,000 Chilean fruits, each of which is about the size of a small hen's egg and weighs about 60g. Mr Down said his family run firm would lose several hundred pounds in sales because of the ban. "It is bureaucratic nonsense, they are perfectly fit to eat," Mr Down said at his stall at the Wholesale Fruit Centre in Bristol.
Inspectors from the Rural Payments Agency, an executive agency of the Department for Environment, Food and Rural Affairs (Defra), made a random check on his stall, and found a number of his kiwis weighed 58g, four grams below the required minimum of 62g.
Mr Down said that 4g in weight was the equivalent of about one millimeter in diameter. He said: "They (the inspectors) went through a lot of my stock using their own little scales. "These regulations are enforced in the United Kingdom with a higher level of rigour than is applied in mainland Europe. There is not a level playing field. "This fruit will now go to waste at a time when we are all feeling the pinch from rising prices." He said there would also be the environmental cost of taking the fruits to a landfill site. Mr Down said he was not permitted by law to give away the kiwis to a school or hostel and faced a fine of several thousand pounds if he did.
Barry Stedman, head of the Rural Payments Agency's inspectorate, said the consignment had failed to meet the minimum standards for saleable produce, in contravention of EU grading rules. "The inspector's decision is consistent with RPA's commitment to protect consumers, who must feel confident that the produce they are buying is of the right quality," he said. "RPA's role is to work with traders to provide advice and assistance to ensure that this happens and to help traders carry out their business within the law."
The agency said Mr Down has been given a number of options, including sending the fruit back to the importer. The European Commission said recently that it wanted to relax the regulations which prevented misshapen or underweight fruit and vegetables being sold. The rules have previously banished curved cucumbers, straight bananas and skinny carrots.
"The inspectors visit us on a random basis, probably two to three times monthly and select items at random that they wish to inspect," said Mr Down. "The latest inspection took place subsequent to the announcement by the EC that the regulations are being modified. "We have had many items rejected over the years, but this, for a variety of reasons, is one of the most nonsensical."
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This equality for women is an injustice for men
Comment from Britain
Equality is a principle that is constantly being tested to destruction. Harriet Harman's proposed Equality Bill is a startling case in point. She is right to insist on equal pay for equal work; that is a principle that nearly every woman in the country must believe in passionately, and by now most men as well. It is clearly wrong to pay one person less than another for the same work, simply because of her sex (or indeed his colour or age). It is and ought to be illegal.
However, this principle soon grows into much more ambitious and more nebulous ideas about equality at work, including the dubious concept of equal representation - equality not just by person but by group. These ideas, as Harman's bill clearly shows, lead not only towards an explosion of bureaucracy and cost, but also towards injustice and inequality - towards the destruction of the very principle.
Harman proposes to replace a "thicket of legislation" against various different kinds of discrimination with a single duty of equality covering everything from race and gender, through religion and belief to sexual preference and age. That seems reasonable, and it is true that despite the Equal Pay Act of 1970 there are still persistent, incontrovertible inequalities at work. There are some disgraceful cases both at the top and the bottom of the market. Women employees in local authorities are in some cases still being paid less than men for comparable semi-skilled jobs, and employment tribunals regularly expose huge gender differences in City high-flyers' pay.
What's more, the gender pay gap - these weighty subjects create horrible expressions - still appears to be marked in government itself. According to civil service number crunchers' figures for 2006, it was 26% in the Treasury, 21% in the transport department, 17% in Defra, 16% in the culture department and 7% in the work and pensions department. (However, in the government equalities office, women were paid 4% more than men; do not smile.) Harman explained with passion on the Today programme that a part-time woman worker is paid 40% less than her full-time male equivalent. "Do we think she is 40% less intelligent, less committed, less hardworking, less qualified? It's not the case. It's entrenched discrimination."
Her plan, or part of it, is to allow employers to discriminate in favour of women and ethnic minorities, against equally qualified white men. She has other inflammatory suggestions, such as forcing public sector employers (and "encouraging" private ones) to reveal what they pay people, and explain what they are doing to close the gender gap, and to provide opportunities for ethnic minorities and disabled people. One could argue about all that - I'm not sure I am entirely opposed to employers revealing what they pay their employees, though the unintended consequences would no doubt be awesome.
These issues, though important, are secondary. What really matters is that we have a minister who is prepared, with the full backing of a Labour government, to enshrine in law, in the name of equality, the principle of institutionalised inequality against men. Employers will be free (and, it seems, pressed, by other provisions of this bill) to take positive action to recruit more women and ethnic minorities, to achieve what they have learnt to assume would be a "better balance" within their companies.
White men are no longer to be equal to everyone else; they will lose their rights in employment tribunals (unless they are beyond retirement age, when they may possibly regain them); they are to pay for the sins of their fathers (or rather for the sins of their fathers' bosses) against working women and against ethnic minorities by being unjustly treated in their turn. And Harman is prepared to do this terrible thing on the basis, merely, of unexamined assumptions about the facts.
For it is an unexamined assumption that equality must be connected with representation. Why do people so often assume equality for women - in, say, nuclear physics or welding or the police force - must mean the representation of women in equal numbers in those fields? If a certain percentage of policewomen are not Muslims or Hasidic Jews, does that of itself mean they have been discriminated against? Clearly not. And why do people assume that women earning less over a lifetime, and being underrepresented in senior posts, must of itself mean they were discriminated against?
Both assumptions are irrational. Women and men are different, and make different choices. We still understand little about such things, but are beginning to recognise that women often choose to work less, or less regularly, or with less responsibility than one would have predicted on their abilities alone. Many have other priorities.
We are also recognising that across a population women's and men's abilities vary; you would expect women to be underrepresented in quantum mechanics or navigation; though individual women may excel in these fields, women in general are unlikely to do so, for innate reasons. And vice versa with the low visibility of men in some fields.
The same is true of pay. The figures Harman has been discussing look depressing, but one ought not to rush into any assumptions about them. There are many explanations for women's lower earnings besides unfair exploitation, and while any one case might be blatantly unjust - and employment tribunals exist to redress such inequalities - again it ain't necessarily so. In some circumstances women may earn less than men for reasons that are not inherently unjust.
Women move in and out of jobs more. In devoting time to their families, they lose time at work to develop skills, not to mention experience and contacts, and in many careers that makes them less valuable as employees, with the result that in an equal market they might well earn less.
The only occupations to which it doesn't much apply involve unskilled and semi-skilled work. For this reason it ought to be possible to ensure equal pay in this sector. It is a shameful thing that the long march towards equality for women has been forced into a dead end of institutionalised inequality for men.
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A quarter of British adults to face 'anti-paedophile' tests
A quarter of the adult population faces an "anti-paedophile" test in an escalation of child protection policies, according to a report. The launch of a new Government agency will see 11.3million people vetted for any criminal past before they are approved to have contact with children aged under 16.
But the increase in child protection measures is so great it is "poisoning" relationships between the generations, according to respected sociologist Professor Frank Furedi.
In a report for think tank Civitas, he said the use of criminal records bureau checks to ensure the safety of children and vulnerable adults has created an atmosphere of suspicion. As a result ordinary parents - many of whom are volunteers at sports and social clubs - now find themselves regarded "potential child abusers".
The checks were introduced to tighten procedures to protect children after school caretaker Ian Huntley murdered 10 year olds Jessica Chapman and Holly Wells in Soham in 2002. However, there are growing fears that the measures have now gone too far.
Professor Furedi said most adults now think twice before telling off children who were misbehaving, or helping children in distress for fear of the consequences. He said that the need for the checks had transformed parents "in the regulatory and public imagination into potential child abusers, barred from any contact with children until the database gives them the green light".
From next year the new Independent Safeguarding Authority will require any adult who come into contact with children or vulnerable adults either through their work or in voluntary groups to be vetted.
But Prof Furedi's report, Licensed to Hug, highlighted examples of when adult-child relationships were distorted by the need for CRB checks already being required by schools and other organisations. In one example, a woman could not kiss her daughter goodbye on a school trip because she had not been vetted. In another, a mother was surprised to be told by another parent that she and her husband were "CRB checked" when their children played together. In a third example, a father was given "filthy looks" by a group of mothers when he took his child swimming on his own in "a scene from a Western when the room goes silent and tumbleweed blows across the foreground".
Prof Furedi details how one woman was made to feel like a "second class mother" because she was barred from a school disco because she did not have a CRB check.
Prof Furedi, a sociology professor from Kent University, said that "adults are no longer trusted or expected to engage with children on their own initiative". He said: "When parents feel in need of official reassurance that other parents have passed the paedophile test before they even start on the pleasantries, something has gone badly wrong in our communities. "We should question whether there is anything healthy in a response where communities look at children's own fathers with suspicion, but would balk at helping a lost child find their way home."
Prof Furedi, the author of a book called "Paranoid Parenting", said there was a trend to treat parenthood as a "professional endeavour that demanded increasing regulation and monitoring". Prof Furedi said that CRB checks did not "provide anything like a cast-iron guarantee that children will be safe with a particular adult". "All it tells us is that the person has not been convicted of an offence in the past," he said. He called for a national review to demonstrate the need to "improve and clarify adult authority".
Prof Furedi said: "The adult qualities of spontaneous compassion and commitment are far more effective safeguarding methods than pieces of paper that promote the messages 'Keep Out' and 'Watch Your Back'." Figures show that volunteering is on the decline with 13 per cent of men saying they would not volunteer because they were worried people would think they were child abusers, according to a survey last year.
The report comes after Children's Commissioner, Sir Al Aynsley Green, said 50,000 girls were waiting to join the Guides because of a shortage of adult volunteers, partly caused by the red tape of the CRB process.
Martin Narey, chief executive of children's charity Barnardo's, said his behaviour had been affected by the suspicions around adult-child relationships. Writing in The New Statesman, he says: "I am likely to usher my wife forward if a child falls over in the street, lest my picking up the child could be misinterpreted. We need to address that. Adults - particularly men - should not routinely be seen as potential child abusers. " And we need urgently to expose the nonsense of 'stranger danger' and convince parents that, although the risk of a child of theirs being abused at all is small, that risk comes not from lurking strangers, but from people known by their children - often relatives - who are able to exploit a child's trust."
However, he stressed that not to run any checks on past behaviour that could point to potential abuse would be "scandalously reckless" and he supported plans for the new Independent Safeguarding Authority whose work he said "will restore parental confidence" in adults who volunteer to help groups like the Scouts.
The CRB said yesterday that it will process 3.6million checks this year - up from 3.4million last year - of which 20 per cent were for volunteers. Vince Gaskell, the bureau's chief executive, said he did not believe that CRB checks were poisoning the relationship between adults and children.
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