Tuesday, January 06, 2009

Teenager died of brain haemorrhage... after NHS doctors denied her a vital scan

When Jenna Lester's parents told doctors she had been suffering severe headaches, bouts of fainting and vomiting, they might have expected their fears of a serious illness to be shared. But medical staff thought the 16-year-old simply had a stomach infection and did not offer a brain scan. A week later she died of a brain haemorrhage.

Now, after a legal battle lasting almost three years, the NHS has admitted that the teenager might still be alive if doctors had acted sooner. Jenna, who had been expected to achieve straight As in her GCSEs, had been taken to the Medway Maritime Hospital in Kent, after collapsing unconscious in the bathroom. Her parents Mark, 42, and Sonia, 40, say they told doctors their daughter had been suffering from splitting headaches for two months. But as Jenna was not considered a 'patient of high priority', she was not sent for a brain scan.

It was only when her condition deteriorated considerably that she was finally given one - five days after she first collapsed. The scan showed that she had a blood clot on her brain, and at that stage one of the doctors turned to her parents and said: 'We should have done the scan days ago.' Jenna, who had been made sports-woman of the year at Fort Pitt Grammar School, Chatham, was transferred to King's College Hospital, London, for an operation to remove the clot. Doctors initially thought the surgery had been successful. But Jenna's brain swelled dramatically and she died on February 17, 2006.

Her parents spent almost three years pursuing the Trust through Health Service complaints procedures. And last week the Medway NHS Foundation Trust admitted it had 'failed to properly assess and investigate' the teenager's condition. Her parents were sent 10,000 in compensation. But Mr Lester, a plumber, who lives with his wife, and teenage son and daughter in Rochester, said the sum could never replace Jenna. 'When we first took Jenna into hospital, we kept telling everybody that she had hit her head when she fell in our bathroom. 'We made sure that the casualty office knew about her two-month history of headaches. 'But no one examined her head, gave her an X-ray or a scan until it was too late. Doctors were convinced that she was suffering from a gastric virus.'

At the inquest, in August 2007, the coroner ruled that Jenna had died from swelling of the brain because of bleeding from a rare condition called arteriovenous malformation. In a narrative verdict, the coroner said her chances of survival would have been 'enhanced' if doctors had got to the blood clot sooner. The condition would have been detected earlier if a scan had been performed.

The NHS Trust expressed its ' sincere apologies to the Lesters for the shortcomings in Jenna's care. 'Whilst nothing can compensate for this tragic experience, lessons have been learnt and robust arrangements are in place to ensure this does not happen again.' [Bulldust, bulldust!]


If You Think Health Care is Expensive...

Health care, says the man most concerned with that 17 percent of America's economy, can be "a nation-ruining issue." As Michael Leavitt ends four years as secretary of health and human services, he offers this attention-arresting arithmetic: Absent fundamental reforms, over the next two decades the average American household's health care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23 percent to 41 percent of average household income.

It is, Leavitt says, "predictable" that today's traumatizing economic turbulence, by heightening Americans' insecurity, will complicate reforming entitlements. This, too, is predictable: By curtailing revenues, today's recession will bring closer the projected exhaustion of the Medicare Part A trust fund, from early 2019 to perhaps 2016. That should get the president-elect's attention.

When Medicare was created in 1965, America's median age was 28.4; now it is 36.6. The elderly are more numerous and medicine is more broadly competent than was then anticipated. Leavitt says that Medicare's "big three" hospital procedure expenses today are hip and knee replacements and cardiovascular operations with stents, which were not on medicine's menu in 1965.

After being elected to three terms as Utah's governor, but before coming to HHS, Leavitt headed the Environmental Protection Agency. He came to consider it a public health agency because the surge in Americans' longevity in the last third of the 20th century correlated with cleaner air and fewer water-borne diseases. Longevity is, however, expensive, and demography is compounding the problem.

In the 43 years since America decided that health care for the elderly would be paid for by people still working, the ratio of workers to seniors has steadily declined. And the number of seniors living long enough to have five or more chronic conditions -- 23 percent of Medicare beneficiaries -- has increased. Many of those conditions could be prevented or managed by better decisions about eating, exercising and smoking. The 20 percent of Americans who still smoke are a much larger percentage of the 23 percent who consume 67 percent of Medicare spending. Furthermore, nearly 30 percent of Medicare spending pays for care in the final year of patients' lives.

Suppose, says Leavitt, buying a car were like getting a knee operation. The dealer would say he does not know the final cumulative price, so just select a car and begin using it. Then a blizzard of bills would begin to arrive -- from the chassis manufacturer, the steering-wheel manufacturer, the seat and paint manufacturers. The dealership would charge for time spent there, and a separate charge would cover the salesperson's time.

Leavitt says that until health care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system: "In the auto industry, if the steering-wheel maker charges an exorbitant price, the car company finds a more competitive supplier. In health care, if the medical equipment supplier charges an exorbitant price, none of the other medical participants care."

Medicare is a price-fixing system for upward of 12,000 procedures and drug codes -- and for hundreds of categories of equipment, the providers of which tenaciously oppose competition. Leavitt began implementing a tiny program of competitive bidding covering just 10 products in 10 cities. Based on the 15 days it lasted before Congress repealed it, savings were projected to be substantial. That is why equipment providers got it repealed.

Rather than ruining the new year by dwelling on Medicare's unfunded liabilities of about $34 trillion (over a 75-year span), ruin it with this fact: In the next 50 years, Medicaid, the program for the poor -- broadly, sometimes very broadly defined -- could become a bigger threat than Medicare to the nation's prosperity.

This is partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard -- sometimes as high as income under 200 percent of the federal poverty level. And many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use "income disregards" to make poverty an elastic concept. For example, they say: A person who gets a raise that eliminates his eligibility can disregard the portion of his income that pays for housing, or transportation.

Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free.


Costly innumeracy in Britain

Children who fail to master basic maths cost society up to 44,000 pounds by their late thirties, a report concludes. Research by KPMG suggests that innumeracy costs Britain 2.4 billion every year as people fall behind at school and in the workplace. Children who fail to master basic maths are more likely to truant and be excluded from school, and run a higher risk of being unemployed and being drawn into crime, it says.

The report was commissioned by Every Child a Chance Trust, an educational charity, which says that 30,000 children leave primary school each year unable to do simple calculations. The report says: "Competent numeracy would appear not only important in relation to employability and the economy, but also as a protective factor in maintaining social cohesion." An earlier survey that tested maths skills concluded that 15 million adults have numeracy skills at or below those of an 11-year-old.

The KPMG research said that there was a significant link between poor numeracy and antisocial behaviour, even when other factors were considered. The raw wage premium from having adequate numeracy is greater now than in the early 1990s, according to researchers from the London School of Economics, the report said.

Teenagers who leave school without basic maths cost the taxpayer 1.9 billion a year because of unemployment, the report's authors calculated. The report said that those costs were incurred by people with numeracy difficulties, but who were competent at reading and writing. It added: "For all those with numeracy difficulties, the total costs to the public purse arising from the failure to master basic numeracy skills in primary school are estimated at between 4,000 and 44,000 pounds per individual to the age of 37, and between 4,000 and 67,000 over a lifetime."

The charity is starting a campaign to encourage businesses to help local children with maths problems. Children will receive maths toolkits that include dice, counters, bead strings, traditional games such as dominoes and snakes and ladders, maths computer games, and CDs of number songs. John Griffith-Jones, chairman of KPMG and of the trust, said: "Every pound put forward now will save the nation at least 12 later on in reduced crime and unemployment and other savings."


Britain's misguided social "services"

The satirical Jeremy Clarkson mocks their badly misdirected efforts

When I was a keen young reporter on a local newspaper, I was dispatched to the council house of a young woman who'd called and said her home had been overrun by cockroaches. Home turned out to be the wrong word. It was a structure of sorts containing nothing but upturned boxes and several children who looked like they'd walked straight off the set of Kes. As we tried to sort out a family picture, it transpired that the woman had absolutely no idea which kids were hers and which ones belonged to what I'd taken until that point to be a puddle of lard but was in fact her sister. Nor did she have the first clue what cockroaches were. "You know what they do?" she said. "They burrow into kiddies' heads, lay their eggs and the kiddies end up with a head full of spiders."

That was 30 years ago, and you might imagine things on the sink estates of grim northern towns were much better these days. But no. Over the Christmas holidays we read about the Mansfield couple who went on a seven-hour drinking binge with their sick-encrusted baby. The father was an extraordinary-looking creature who appeared to be part mouse, part pipe cleaner, and the mother had six previous drunk-and-disorderly convictions. Plainly, then, they are entirely unsuitable parents, and unless the social services continue to keep a close eye, their poor child will wake up one day in a box under a bed and it'll be Shannon Matthews all over again.

I was therefore delighted to read last week that the government is going to take action to make life that little bit better for the children of this great nation. However, it is not talking about increasing its vigilance on children who are made to eat only what they can find in the heroin-laced stairwells of the tower blocks in which they live, or those who are sent out to exchange stolen car radios for six-packs of Rohypnol. Instead, it will be employing a vast army of men and women with clipboards who will come round to your house when your child is two to make sure it can speak properly. This is bound to be a worry if you are Glaswegian or the love child of Ant and Dec.

The initiative is being developed in response to a report that found some two-year-olds were unaware they had a name, let alone what it was. And that one in 10 of all children in deprived areas didn't know a single nursery rhyme.

Hmmm. I've given this some thought, and I can't see the problem. Nursery rhymes are cruel and terrible things full of stories about dismembered sheep and the bubonic plague. You have Simple Simon, who was obviously a retard, Hickory Dickory Dock, which is just rubbish, and Wee Willie Winkie, who ran through the town in his nightclothes, peering through the windows of children to see if they were in bed. Clearly, the man was a paedophile, and the less two-year-olds know about such things, the better.

In fact, I applaud any parent who hides these sordid and frightening stories and encourages their children to play Grand Theft Auto instead. But I very much doubt the parka army with its clipboards will share my views. Nor do I expect it will concentrate its efforts in areas where children are in real need of help.

In the same way that airport security people blunderbuss their antiterrorism efforts across the board, which means they are just as likely to jab a digit in the back of Harry Potter as they are a sweating Afghan with wires poking out of his shoes, social workers are just as likely to target the local vicarage as they are the sink estate. Indeed, they've already said as much. Someone called Jean Gross, who is spearheading the government's drive to make children learn nursery rhymes by the time the umbilical cord is cut, says that such problems also affect middle-class families, especially if their undertwos spend long periods in mediocre childcare while both parents work hard to pay off a big mortgage.

I find this a bit terrifying because I remember, when my children were young, having them examined by someone who didn't know them, didn't know us and could summon, with the stroke of a ballpoint, a government machine that could at worst take them away and at best give them a problem with a Latin name that they'd spend the rest of their lives trying to overcome. And all because they didn't know Humpty Dumpty was not an egg, or a fatty, but a civil war cannon.

I actually know one couple who, quite wrongly, had their child taken away. And could have it back only if they lived in secure accommodation with 24-hour surveillance. It remains the most barbaric example of a useless and dangerous system that now is set to get even worse.

When it comes to the rearing of a child, there is no definitive right and wrong. Social workers - whom I admire for the most part - will continue to be too cautious in some cases and too heavy-handed in others. Mistakes will continue to be made, which is fine if you are a shelf-stacker or you pick vegetables for a living. But when your mistake devastates a family, it is absolutely not fine at all.

If we go back to the children I encountered 30 years ago in that cockroach-infested house, it's entirely possible they are all now in jail for selling ketamine to toddlers. But it's also possible (just) that they are university professors. And let's finish with the example of a young girl whose father was an abusive alcoholic and whose mother became so fed up that she shot him dead in front of the child. Every rulebook in the world would say she should be taken into care. She wasn't. And she grew up to be Charlize Theron.


EU denounces British socialite's carbon offset project

A PIONEERING climate change project in Africa run by Robin Birley, the socialite, has been accused by the European commission, its main donor, of making unsubstantiated claims about its environmental impact. The project has received more than 1m pounds in public grants and money from celebrities in the music and film business. They include Ronnie Wood of the Rolling Stones and Brad Pitt, the actor. The project attempts to offset an individual's carbon footprint by paying poor farmers in Mozambique to plant trees, which absorb CO2, and to protect existing forests.

The commission's criticism comes amid increased concern about the worth of these fashionable but largely unregulated carbon offset schemes. Critics say it is almost impossible to guarantee that the trees will survive the length of time needed to offset any significant carbon emissions.

Birley, the stepbrother of Zac Goldsmith, the environmentalist, set up the N'hambita Community Carbon project five years ago in partnership with Edinburgh University. His company, Envirotrade, manages it and sells "carbon credits" to the public, while the university monitors the emission levels and the deforestation rates. The project, based on the edge of the Gorongosa national park, had promised to bring "enormous and positive social, economic and environmental change to the developing world".

However, The Sunday Times has obtained a highly critical report from the European commission that says "the quality of the technical work . [is] far below what could reasonably be expected of a pilot project managed by a university". Written last May, just before the five-year funding period came to an end, the report noted that the project "continued to make positive claims about its impact that could not be substantiated". The commission also warned that the money flowing into the Gorongosa area had attracted hundreds of poor farmers who were now cutting down trees, contrary to the project's intention.

An official source said: "We also asked for disclosure about carbon trades in the interest of transparency. None of this information was forthcoming. [Envirotrade] are selling products that are not delivering what was promised and the public needs to know."

The commission, which has so far donated Euros 1.13m to the project, does not suggest there has been any dishonesty. However, it felt that the scientific concerns raised with the project since May 2006 remained unaddressed. Consequently, in October 2007 it suspended payment of the last instalment of the grant, worth Euros 453,000. Both the company and Edinburgh University say they will respond to all the criticism in a report they are writing for the commission. In a statement, Birley said that all the money raised so far from selling carbon credits - 750,000 pounds - has gone back into the project and he has also invested his own money. He added that the project's "well intentioned shortcomings" were to be expected with such a challenging idea and Envirotrade had been transparent with all its clients.

However, one of the commission's main concerns was about the way carbon credits are being sold when it is difficult to verify the amount of emissions actually saved. Despite this, Envirotrade has sold a further 100,000 worth of carbon credits since it received the report....

More here

British eco-town proposals receive fresh blow

The Government's flagship eco-town strategy has suffered another damaging blow after an independent report said one of the proposed towns was "unworkable". The Pennbury plan for a 12,000 home development near Leicester is one of 12 shortlisted by ministers as part of their plans to build a string of environmentally sustainable new towns across the country. But a leading consultancy on urban design and planning has damned the Pennbury scheme, submitted by the Co-operative supermarket and property group, as economically "unsustainable", "ambiguous" and "fundamentally weak".

The Halcrow Group, which was commissioned by four local authorities covering Leicester and the surrounding towns and villages to assess the Co-op's plans, said the new town was likely to produce fewer jobs than envisaged, would suffer from poor transport links and would be out of keeping in what is currently a rural setting. The report's findings are another major setback for the Government's eco-town proposals, which have already been widely condemned by opponents as threatening the green field character of many sites for little if any environmental or economic benefit.

The strategy has been beset by problems since it was placed at the heart of Labour's policy agenda by Gordon Brown at his first party conference as leader in September 2007. A shortlist of 15 was cut to 12 after developers dropped out and schemes were reconsidered. The final list of 10 is expected to be announced shortly. The schemes will then go through the normal planning process. But there are growing doubts over the viability of several of the schemes in the wake of the worsening housing crash.

Eco-towns, which will contain between 5,000 and 20,000 homes, are intended to be carbon neutral and act as an "exemplar" for environmentally-friendly development. Each must contain at least 30 per cent "affordable" housing, while properties must be on average only a 10-minute walk away from public transport and local services, such as doctors' surgeries and primary schools. At least one person in each household should be able to get to work without a car.

However, the Government admitted in November that only one of the 12 sites being considered is officially ranked as "generally suitable" for an eco-town. Rackheath, in Norfolk, was judged to be Grade A because it was near Norwich and a working railway line. The vast majority of the schemes, including Pennbury, were judged to be Grade B - which meant they "might be a suitable location subject to meeting specific planning and design objectives".

But the new report on Pennbury casts doubt on this. It states: "The Co-op have at this stage in the planning process provided insufficient information to support the Pennbury proposal at this moment. We have serious reservations at this stage that neither the required transport infrastructure, nor the level of jobs required can actually be delivered. "Both the economic strategy and transport proposals should therefore be substantially revised, as these are fundamental to the overall sustainability of the concept."

Dr Kevin Feltham, a Leicestershire county councillor and a campaigner against the scheme, said: "This report has left the Co-op's plans for Pennbury in tatters. The time is now ripe for them to withdraw their bid in the face of overwhelming evidence that the plans are unworkable."

The report's findings are a particular blow to the Pennbury scheme because Halcrow's consultants said it could have brought potential benefits to the region "in terms of new jobs, homes, community facilities and infrastructure, as well as pioneering new approaches to zero carbon living". But it said the plans "are not matched by sufficiently detailed commitments and proposals to ensure that these objectives can actually be delivered." It found:

* The Co-op had produced no convincing evidence to support the assumption that 60 per cent of residents would be able to work in the town.

* The planned location has poor transport links, making it unattractive for potential employers and businesses.

* It is unclear from population projections whether there is in fact a need for so many new homes in the area.

* There has been no survey of local environmental features such as ecology, landscape and cultural heritage.

However, the Co-operative Group defended its proposals, claiming the Halcrow report recognised the potential benefits of the Pennbury eco-town. Ruairidh Jackson, its head of planning and property strategy, said: "We are in close discussions with Leicester Regeneration Company about the benefits our proposals offer and to improve the regeneration potential of the city as a whole. This story goes far wider than simply employment. It's about education and skills, about helping regeneration sites to come forward, about housing in the city, about unlocking public transport investment and, not least, about helping Leicester to market and promote itself to additional sources of investment. "Our proposals are fully complementary to these objectives and we believe that we can help Leicester to be an even stronger and more successful city."

The four councils who commissioned the report - Harborough District, Oadby & Wigston Borough, Leicestershire County and Leicester City - are themselves split on the question of the eco-town. Leicestershire County opposes the scheme and has accused Leicester City, which backs it, of being "too easily bought" by the promise of 5 million pounds from the Co-op to carry out a feasibility study into running a tram from Pennbury into Leicester city centre. Harborough and Oadby have yet to decide whether they support the plans.


British PM's `bluff' on migrant permits

The Labour MP Frank Field has accused ministers of staging a "gigantic bluff" over new laws to curb the growing numbers of migrants entering Britain. Field said Gordon Brown's much-trumpeted controls on work permits for overseas workers would entirely fail to defuse the UK's "population time bomb".

The former Labour welfare minister dismissed claims by the home secretary, Jacqui Smith, that a points system would keep the population below 70m. "We cannot afford to let our population grow at the extraordinary pace now officially forecast. The pressures on our public services and communities would be too great to bear," Field said. "This time bomb must be defused, and that requires radical action now. Government claims that they are taking effective action are no more than a gigantic bluff."

Projections of the UK population show a rise to 70m by 2028, with 70% of this due to immigration, which is running at 237,000 a year, up fivefold on the 1997 figure. Smith and Phil Woolas, her immigration minister, have said the work permits will keep the population below 70m. However, this weekend Field released research showing that even if all 96,000 overseas work permits granted annually were refused, the UK population would still rise from the present 61m to more than 70m later this century.

The new research, commissioned by the cross-party parliamentary group on immigration, which Field co-chairs, claims that existing work permit controls would only cut the number of migrants given work visas by 12%, or just 11,500. The research shows that in order for the population not to reach 70m, immigration would have to fall by 190,000 a year.

However, ministers recognise that imposing any kind of immigration quota is taboo in Labour circles.


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