Friday, March 13, 2009

One million patients at risk in NHS, official figures find

One million patients a year are put at risk by hospital blunders and near misses, official figures have revealed. However experts warned many more are being swept under the carpet as healthcare staff and managers fail to report incidents. Data on the number of incidents relating to patient safety, the type and the level of harm occurring in each NHS organisation in England and Wales has been published for the first time.

Martin Fletcher, chief executive of the National Patient Safety Agency, said a high number of incidents should be regarded as a good thing because it shows the organisation is taking safety seriously and is identifying and reporting cases. He admitted it is not known at what level the number of incidents ceases to be good reporting and becomes an unacceptable number of incidents. Mr Fletcher said: "Just because one (NHS trust) has a low level of incidents that does not mean it is a safe organisation."

Overall the number of incidents being reported is increasing each year and he said he hoped that would continue but the proportion of incidents resulting in serious harm or death would decline. The figures show 370 out of 422 NHS organisations in England and Wales had reported incidents but trusts are not forced to report and 52 have declined to take part or have reported fewer than 11 incidents over six months. In total there were 439,612 patients safety incidents reported to the NPSA between April and September 2008 in England and Wales. Of those 66 per cent resulted in no harm, 33 per cent were patient accidents, 10 per cent were related to treatments or surgery and nine per cent were medication problems.

Prof Sir Bruce Keogh, Medical Director at the Department of Health, said patient safety incidents probably cost the NHS o2bn a year. He said he was 'keen' to see mandatory reporting of very serious incidents but routine reporting was still in its early stages and accuracy and completeness of data will improve.

Anna Walker, Chief Executive of the Healthcare Commission, said: "We know that a significant gap exists between the number of incidents that are reported by the NHS and the number that happen in reality. We welcome the publication of information from individual NHS trusts and increases in reporting because they bring us closer to the true picture of safety and allow a critical and honest assessment of where improvements need to be made. This is a vital part of improving the safety of patients."

Steve Barnett chief executive of the NHS Confederation said: "Patients need to be reassured that more incidents do not necessarily mean a less safe organisation. We need to get all staff actively reporting so that over time we can get to grips with making hospitals safer."


Is this another war on `Jewish science'?

The elite protest against today's Israel Day of Science in London is built on double standards and a deep disdain for academic freedom.

At the London Science Museum today, school students will be able to attend workshops on everything from solar energy to water desalination. That these science sessions will be run by experts in their fields, such as a physicist who worked on the Large Hadron Collider or a leading nanotechnology researcher, will be of immense value to the students, many of whom will be taking science A-levels this summer.

There is a problem, however. This `Israel Day of Science' is organised by the Zionist Federation and several Israeli universities, a fact of sufficient power to prompt a 400-strong protest organised by the British Committee for the Universities of Palestine (BRICUP), the same group which has consistently called for a ban to be imposed on Israeli academics. In an open letter to the Guardian, the protest organisers write: `The event is promoted by the Zionist Federation and is designed to showcase the scientific achievements of seven Israeli universities. But all of these are complicit in the Israeli occupation and in the policies and weaponry so recently deployed to such disastrous effect in Gaza. The event is being billed as a celebration of science. In fact it is an attempted celebration of Israel.' (1)

A celebration of Israel? While there's little doubt that the Israel Day of Science pays tribute to the achievements of scientists working in Israel, the content of the day is, as far as I can tell (and the title's a clue here), science. Subjects include cancer research, stem cells, biochemistry and water desalination. There are no sessions on 1948, Gaza or the West Bank. While the organisers of the day do seem to be showing off the achievements of scientists employed in Israel, that is considerably different to boasting about Israel the nation, or celebrating the `occupation of Palestine'.

Sadly, making a distinction between science and the nationality, let alone the opinions, of its practitioners seems to be beyond those calling for the Science Museum to expel the Israeli scientists in their midst. In the words of the frontpage splash in the Independent on Tuesday, `400 academics, a Nobel laureate and the former chair of the Science Select Committee called on the museum to cancel workshops due to be held this week that promote Israeli scientific achievements to schoolchildren' (2). Perhaps it is just unfortunate wording, but what on earth are `Israeli scientific achievements'? Does cancer research have national characteristics? Is physics in Tel Aviv different to physics at Imperial (London)?

Analogies with Nazi-era Germany are too easily and too carelessly flung around these days, both to the detriment of understanding events in the present and the horrors of the past. The protest against the Israel Day of Science bears no relation to Nazism, as some of the shrill defenders of Israel have claimed. And yet, insofar as the protesters are conflating scientific achievement with the national background of the scientists involved, the parallels with the wartime German persecution of the `Jewish Physics' of Albert Einstein or the `Jewish Science' of Freud are revealing: both then and now, in vastly different ways, the life and findings of the mind are being shot down by political expedience.

Curtailing the freedom of those with whom one disagrees is damaging enough to the exchange of ideas and the development of human knowledge. But to try to prevent people from speaking or from educating sixth-form students - not because one is outraged by what they have to say about desalinating water or making solar panels, but rather by their nationality - is a common disgrace.

There is great hypocrisy in the condemnation of the Israel Day of Science. Labour MP Ian Gibson objects to the Day on the basis that `science is not neutral': `It is part of the political process, and very much so in that part of the world.' (3) He is right: science is not `neutral'. It has meaning as part of a universal human desire to understand the world. It is pursued, not for its own sake, but for us; not neutrally, but contextually, humanly.

But Gibson, of course, is saying something more. He is saying that in Israel, science is corrupted by politics, tainted by the demands (and funding) of the Israeli nation state. One wonders where he thinks certain British university departments get their funding from, if not from his own ruling Labour government, the destroyer of Afghanistan and Iraq. And does the granting of honorary degrees to Bill Clinton or Tony Blair infect certain university departments with the Clinton/Blair virus of fact-defying, war-mongering zeal? By the criterion of BRICUP's accusation of `complicity', it would be a struggle to find any university in the world not guilty by state association. There are extraordinary double standards at play here.

What has been utterly buried by the impassioned rhetoric and craven moralising directed at the Israel Day of Science is the principle of freedom that ought to be enshrined in the academy - that is, the freedom to pursue knowledge without impediment, to question orthodoxies, to engage in the free exchange of ideas. Such open pursuit of knowledge is a bastion of freedom of speech itself. But the righteousness of the anti-Israel cause is so overpowering that it seems this freedom is to be withheld from those deemed `unacceptable' or `tainted'. If such freedom is limited in this way, if the freedom to pursue one's research or to engage with students is curtailed, then academic freedom as a whole is compromised. The liberty to explore and articulate ideas is not negotiable, a license to be dispensed or withheld depending on the academic's background; it must be universal. This week's protest against the Israel Day of Science is built on prejudice, illiberalism and anti-intellectualism.


Women, keep drinking

Why was a flimsy study apparently showing a link between booze and breast cancer so uncritically accepted? The woman who headed the study is a fraud and a liar whose results were the opposite of what she claimed

For over a decade, a constant stream of studies has warned women who drink that they run an increased risk of getting certain cancers, particularly breast cancer. But this steady stream of anti-drinks advice last week gave way to a global torrent when two new studies about the link between drinking and cancer in women received huge, and typically uncritical, international media attention.

The study that attracted the most attention is sponsored by Cancer Research UK and was published in the Journal of the National Cancer Institute. The lead researcher, Naomi Allen from Oxford University, told the Guardian: ‘Given that this is the largest study in the world to look at this, it’s clear that even at low levels of alcohol consumption, there does seem to be a very significant increase in cancer risk, and most women are probably not aware of that.’

Allen came across with even scarier news for Americans, telling the Washington Post that the ‘take-home message’ was this: ‘If you are regularly drinking even one drink per day, that’s increasing your risk for cancer [since] there doesn’t seem to be a threshold at which alcohol consumption is safe.’

One can’t help but wonder just what Allen herself has been drinking in the Senior Common Room at Oxford. After all, her public pronouncements, her recommendations to government, and the reports about her study in the media are certainly not supported by her results.

First, Allen’s study is an observational one, based on data from the UK’s Million Women Study, which is a study about the association between Hormone Replacement Therapy and cancer and heart disease. Allen’s study comes from self-reports about the drinking habits of women in that study.

This means that the study, as an observational study – the weakest kind of epidemiological endeavour and certainly nothing close to the gold standard of a randomised controlled trial – is inherently unable to draw any causal conclusions about a link between drinking and cancer.

Second, the study fails to meet even the most basic requirement of science – that is, being able to validate its measurements – since it is entirely based on the women’s self-reports of their recollection of their drinking. None of these reports was checked and the authors can make no claim about how reliable they are. No one knows how much or how little these women really drank since no one bothered to measure it. This makes any conclusions based on such ‘evidence’ just a tad dicey. At its foundation, therefore, the study can’t warrant that any of its data about the key fact – the drinking habits of its subjects – is accurate. However, the worst is yet to come.

Third, the study is full of significant puzzles that suggest that its results are unreliable. For example, it reports that the incidence of all types of cancer studied in its non-drinking subjects was 5.7 per cent compared with 5.3 per cent for those subjects who had at least a drink a day, and up to 14 drinks a week. In other words, not only was there no dose-response in terms of cancer risk, but teetotallers had a higher population incidence of cancer than those consuming up to 14 drinks a week! Even those women in the study who drank the most (15 or more drinks a week) had a cancer incidence of 5.8 per cent, which is virtually identical to those who drank nothing. But this particular take-home message somehow escaped Allen’s notice, and that of the media as well.

Fourth, the study looked at 21 types of cancer incidence. Of these, it found statistically significant associations between drinking and only four types of cancer. Moreover, these associations were barely significant. The association with breast cancer, with by far the largest number of cases in the study (almost 22,000), was non-significant. Therefore, of the cancer-drinking correlations examined, virtually none was statistically significant.

What is the real take-home message of this study? Perhaps it should be to avoid drinking policy advice produced by Oxford epidemiologists.


Prince Charles accused of 'outright quackery' over detox food supplement

Prince Charles has been accused of ‘ exploiting a gullible public’ by putting his name to a detox treatment. Professor Edzard Ernst, Britain’s top expert on complementary medicine, said the 10 pound Duchy Herbals Detox Tincture relied on ‘ superstition and quackery’ rather than science. Nicknaming the range ‘Dodgy Originals’ after the Prince’s Duchy Originals brand, Prof Ernst said that using herbal potions to detoxify the body was ‘implausible, unproven and dangerous’.

The 10 pound tincture was launched last month as part of the Prince’s range of luxury organic products. Customers are advised to add a few drops of the dandelion and artichoke solution to a glass of water twice a day. Combined with a balanced diet, it is claimed, the product will help the body cleanse itself of ‘toxins’ and aid digestion.

But Prof Ernst, a complementary medicine researcher at Exeter University and a former homeopathic doctor, said there is no evidence that the tincture works. He said: ‘I know everything about artichoke that there is to know. There is a hint it might lower cholesterol to a very minor degree, but that’s all. ‘And there is nothing to know about dandelion. They say they have produced it to the highest standards, and that may be so. But high quality nonsense is still nonsense.’

The professor warned that detox products could be dangerous if they were viewed as a ‘quick fix’ to unhealthy habits. He said yesterday: ‘Prince Charles contributes to the ill-health of the nation by pretending we can all over-indulge and then take his tincture and be fine again. 'Under the banner of holistic and integrative healthcare he promotes a “quick fix” and outright quackery. ‘Prince Charles and his advisors seem to deliberately ignore science and prefer to rely on makebelieve and superstition. ‘Prince Charles thus financially exploits a gullible public in a time of financial hardship.This comes from somebody who should know better and from somebody who arguably should not be deluding the nation and contributing to its ill-health.’ Prof Ernst added that those who do over-indulge should simply drink lots of water, take exercise and get some rest.

The Duchy Originals website states: ‘HRH The Prince of Wales… believes poor health does not exist in isolation, but is in fact a direct consequence of our lifestyles, cultures, communities and how we interact with our environments. ‘He is passionate about adopting an integrated approach to health, as well as exploring how safe, proven complementary therapies can work in conjunction with mainstream medicine.’

A Duchy Originals spokesman said the tincture satisfied ‘all of the relevant sections of both UK and European food laws’. Andrew Baker, the firm’s chief executive officer said: ‘It is a natural aid to digestion and supports the body’s natural elimination processes. ‘It is not – and has never been described as – a medicine, remedy or cure for any disease.’ He added: ‘Duchy Herbals Detox Tincture contains globe artichoke and dandelion which both have a long history of traditional use for aiding digestion. ‘We find it unfortunate that Professor Ernst should chase sensationalist headlines in this way rather than concentrating on accuracy and objectivity.’

Nelsons Organic Pharmacy, which makes the tincture for Duchy Originals, said that artichoke and dandelion had been used for hundreds of years to aid digestion. Its chairman, Robert Wilson, said: We do not believe this product encourages ill-health through over-indulgence.’


NHS frees another dangerous nut

A lazy "care coordinator" leads to a man being killed

A paranoid schizophrenic who killed a man and hurt five others after hearing voices ordering him to murder English people was repeatedly failed by the NHS, an investigation has found. An independent inquiry into the treatment of Ismail Dogan found that he "slipped through the safety net" of mental health care services in North London. The authors claim Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust failed to share information about treatment, engage with his "isolated" family and assess his care in the community.

Two days before Christmas in 2004, Dogan left his family home with a knife and after driving around Tottenham and Edmonton attacked six strangers within 90 minutes. He stabbed one man to death and hurt four men and a woman. The minicab driver, originally from Turkey, later told police that he had heard a bird telling him he was the son of Allah and so should kill English people. Dogan, now 34, was convicted of killing Ernest Meads, 58, and is currently being held at Broadmoor top security hospital. He had been diagnosed as a paranoid schizophrenic three years before the killing and placed in the care of the community mental health care team after being released from a psychiatric ward.

The investigation has again renewed calls for a review of the way mentally unstable people are being cared for in the community. Marjorie Wallace, chief executive of Sane, said the findings highlighted a series of "blunders" that showed how the NHS was failing patients and putting innocent people at risk. Last week Surrey and Borders Partnership NHS Foundation Trust was criticised for its poor treatment of Daniel Gonzales, a paranoid schizophrenic who murdered four people, despite his and his family's repeated appeals for help.

Referring to the latest report, Mrs Wallace said: "Yet again the warnings and pleas of family members went unheeded, with fatal consequences. "Following so soon after the Daniel Gonzales report, it begs the question: is care in the community working? Can all patients be safely treated by a jigsaw of mental health teams which fail to communicate with each other, respond to crises, or assess and act upon the risk that some individuals may pose to themselves or others?" The charity is calling for a "red alert" system where police and mental health are called on to respond immediately to family's warning that a relative poses a threat.

The inquiry found Dogan's care was severely compromised by the lack of consistent medical management: "For this the consultant medical team must take a great deal of responsibility." The authors said that it was obvious Dogan was a "significant risk", particularly after he had been repeatedly held in police custody for acts of violence. The report adds that Dogan's risk assessments were not always coherent or complete, meaning that when his mental health reached crisis point there was nothing in place to try to identify or rectify the problem. "It is the view of the investigation team that there was a significant system failure in that a disjointed tripartite system was operating whereby inpatient services, outpatient services and community mental health teams operated separately," the report says.

"At the time that Dogan was receiving his care different Consultants led the inpatient and outpatient services thereby ensuring that there was little continuity of care. This was compounded by poor communication systems and a care coordinator who appeared to have been performing to a standard well below that expected from someone of her experience and seniority."


British immigration crackdown cuts migrant workers by just 6,000, Home Office says

A much-heralded crackdown on illegal immigration will cut highly skilled migrant workers by as little as 6,000, the Government said. Critics said the impact of any changes on immigration levels would be "a drop in the ocean". The new curbs on highly-skilled migrants coming to Britain are aimed at making sure Britons are given a "fair crack of the whip" before jobs are offered abroad. Workers from outside the European Union will need better qualifications and guarantees of better paid jobs before they are given work permits.

A detailed analysis of the impact of the changes showed they were likely to reduce the number of successful applications by between 6,000 and 24,000. The cost of the changes - in part due to lost income to the UK Border Agency from visa fees - could be as high as 15 million pounds.

New rules to prevent abuse of the immigration system by people pretending to be students were also announced. Phil Woolas, the immigration minister, said the changes would limit the amount of time people could spend on "low level" courses and set stricter limits on courses which include work placements.

Sir Andrew Green, chairman of Migrationwatch, said that compared with "net immigration of nearly 240,000, [the figure] is a drop in the ocean. "If we want to avoid our population hitting 70 million we have to get immigration down to 50,000 a year." Damian Green, the shadow immigration minister, added: "The Government is floundering around to claim it has immigration under better control. "It is now reduced to discouraging the sort of highly-educated people that are most likely to contribute to Britain's future wealth."

A Home Office spokesman said: "The important thing is that numbers start to go down rather than up in a recession. "Those migrants who do come [must] either have a high level of skill and therefore bring the most economic contribution or have a specific job to come to which no resident worker can fill."

Meanwhile, Sir Gus O'Donnell, the Cabinet Secretary, called for the Office for National Statistics to stick to "predictable deadlines". Sir Gus was speaking after Mr Woolas accused the organisation of trying to "grab headlines" over the "sinister" timing of figures showing one in nine British residents was born abroad. Sir Gus insisted that figures should be released on "clear, predictable deadlines". Speaking at a civil service conference, Sir Gus said: "I want (the ONS) to be boring, to put out the plain facts, and nothing but the facts, and on clear, predictable deadlines." It would then be for politicians and Government press officers to interpret the figures, he said. [How nice!]


UK: Web founder's "snooping" warning: "The integrity of the internet is under threat if online 'snooping' goes unchecked, one of the web's most respected figures has told Parliament. Sir Tim Berners-Lee, inventor of the World Wide Web, said browsing habits could now be monitored as if someone had put a `TV camera in one's room.' Laws must be better enforced to ensure such 'sensitive' data was not misused for commercial gain, he added. . Parliamentarians are worried about technology allowing firms to track which websites people visit and to share the information with companies for the purpose of sending what is known as `behavioural advertising.' Google has become the latest firm to launch a system to send advertisements to web users based on their online activities."

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