Friday, March 20, 2009

Why does the NHS hate the elderly so much?

One day, when I was touring a North London hospital, I stopped in horror in front of an old lady in a blue bed jacket. Her face was a mass of bruises. I assumed she'd been brutally mugged, but the matron I was shadowing looked embarrassed. The old lady was, indeed, a victim - but of the NHS and its dreadful treatment of the elderly. First, a wrong prescription from her GP had left her so dizzy that she had tripped over and broken her hip. Then she had fallen out of her hospital bed and bashed her face.

I asked why the NHS bed lacked the cot sides available in private hospitals. 'We believe physical restraint is inappropriate to our patients' dignity,' reproved the matron. It is a case that sums up why the NHS is failing our elderly through misdiagnoses, ignorance and a culture that neglects and even despises them, putting Government targets over compassion and common sense.

I remembered that poor bruised woman when I read the horrific results this week of the Healthcare Commission's investigation into conditions at Staffordshire General Hospital. Hundreds of patients there, most of them elderly individuals who in any civilised society would expect to be treated with dignity, respect and compassion, may have died because of 'appalling' care, the commission suggested. The litany of complaints from families of the hospital's victims should shame us all: patients so thirsty they were forced to drink out of flower vases; wards described as war zones; people given wrong medication or none at all while others had to lie in soiled sheets and sick people left in A&E for hours, covered in blood and without pain relief. True, the problems did not apply exclusively to the elderly, but they were by far the most numerous among patients to be treated with such callous disdain.

And perhaps the most disturbing fact is that, far from being an isolated incident, if you are old and a health service patient anywhere in the country, you suffer more than any other patient.

Why does the NHS seem to hate the old so much? A recent survey of 201 doctors by the British Geriatrics Society found that seven out of ten specialists believe the elderly are less likely to receive a proper diagnosis and essential treatment than younger patients. Almost half believe the health service is 'institutionally ageist' and more than half admitted they were worried themselves about how the NHS would treat them in old age.

Most staff strive to treat patients with care and skill and there is a huge number of them whose dedication and professionalism we can only admire. But I spent a year researching a report on the NHS and I witnessed how the service betrays the elderly at every level. It sees neither they nor their most common illnesses as a priority. This is extraordinary because the elderly are the core business of the NHS. They occupy nearly two-thirds of general and acute hospital beds and account for half of the recent growth in emergency admissions.

And Britain is getting older. By 2025, the number of people over 80 will have increased by about 50 per cent. But simple demographics aside, it seems almost beyond comprehension that those who enter the NHS, those who choose a career caring for others, are actually denying civilised treatment to an entire swathe of the population. Surely we should, as a society, care properly for those who in earlier years have nurtured us and who now need our help. What kind of people have we become that we simply discard our elderly as an inconvenience because they get in the way of Government cost-cutting and performance targets?

As in other areas of political life, Government policy in the NHS has placed the emphasis on vote-winning targets such as waiting times and extended surgery hours for GPs. This has been at the expense of the patients who most use the NHS and are the least able to protest - the elderly. The problem is well known. A staggering 1,600 health service managers in a major national survey, reported in the Journal of the Royal Society of Medicine, believe that the elderly have benefited least from Government reforms.

But common conditions in old people - osteoporosis and incontinence, for example - still don't attract the Government's attention and spending. Meanwhile, free breast screening stops at 73, despite powerful evidence that it should continue for much longer, and anyone suffering from mental health problems is refused specialised treatment after 65.

It is not all the Government's fault. Discrimination against the elderly is prevalent throughout the medical profession. 'Old people deserve proper diagnoses and treatment,' says Dr David Oliver, a senior lecturer in elderly care medicine. 'But they are just not getting it.' Many doctors will blame symptoms such as confusion and falling on old age. But, in fact, points out Dr Oliver, acute confusion can be brought on by a change in the patient's circumstance, a bladder infection or a new medicine - and not always age at all.

Medical staff are often not helped by their training. Despite the increase in elderly patients, half of medical schools lack a geriatric medicine department. Doctors and nurses get only four or five weeks' training in caring for the elderly. As Dr Oliver says, old people are 'core users of NHS services, but they are still not high up on the agenda'. Nor are they popular with many members of medical staff. In surveys for the Royal Society for Medicine, medical students declare openly that they do not wish to work with old people. But the sheer number of old people using the NHS means that most of them will have to. How many of us want to be cared for by a doctor who has little or no interest in our ailments?

General neglect on the ward is another major problem. People in their 70s and 80s come from a generation that respects authority and hates to complain. And in a busy hospital, the quiet old lady in the corner can be safely overlooked. In a corridor of an A&E department in a London teaching hospital, I came across one old lady lying on a trolley. She had arrived at 10.30pm the previous evening and it was now lunchtime the following day. 'It's very hard on the bones,' she said, trying to smile. 'I wouldn't recommend it.' She had not been given anything to eat. 'And I haven't had a wash either. Of course, they try their best,' she said. A few hours later I returned. She was still there, but a nurse had brought her a blanket. Every time she turned over, however, it fell on the floor.

The old-fashioned matron used to be the patient's advocate. She had the power to oversee all elements of a patient's care, and take responsibility for their well-being. But the modern matron, an invention of the current Government, lacks clear authority at ward level. Some, through sheer force of personality, do an excellent job. But too many fail to ensure that even basic care is provided - and it is the elderly patients who suffer. Busy ward staff don't consider helping an elderly person to eat a priority - and so six out of ten older people are at risk of becoming malnourished while in hospital.

Patients complained to me all the time about the food. In one ward, I saw an old man wearing an oxygen mask and sitting in bed staring disconsolately at a wash bowl sitting on a bedside table covered in detritus. Next to the wash bowl lay his uneaten breakfast. A nurse, who should have helped him to wash and eat, had simply abandoned him. Indeed, many of the nurses I saw seemed indifferent or helpless. And the fact that so many of our elderly are going hungry on our wards, unnoticed, is an appalling indictment of the NHS and its attitude to the old.

No one is asking that old people should get privileged treatment. But they should get their fair share of resources and care. As the case of Staffordshire General Hospital shows all too graphically, this simply is not happening.


A bowl of porridge in the morning 'will make you feel fuller for longer'

I had porridge for breakfast for the first 16 years of my life and I certainly felt sustained by it. I was very slim then too!

Eating a bowl of porridge in the morning really will keep you feeling fuller for longer, scientists have discovered, in what could be the key to how the GI diet works. A new study suggests that foods with a low glycaemic index (GI), like oats, trigger the release of greater amounts of a hormone in the gut which delays hunger pangs by creating a "full" sensation. Scientists previously knew that a low GI diet took longer to digest, releasing sugar more slowly into the bloodstream.

Now a team of researchers have discovered that foods with a low GI score, which include brown bread and most fruit and vegetables, stimulate the release of around 20 per cent more of the GLP-1 hormone per meal than foods with a high GI ratio.

Dr Reza Norouzy, who led the study, said that the chemical was "one of the most potent hormones for suppressing appetite". She added:"Our results suggest that low GI meals lead to a feeling of fullness because of increased levels of GLP-1 in the bloodstream. "This is an exciting result which provides further clues about how our appetite is regulated, and offers an insight into how a low GI diet produces satiety."

The team, from King's College London, looked at the effects of different diets on 12 healthy volunteers. The results of their findings were presented at the annual Society for Endocrinology BES meeting in Harrogate. The GI score ranks carbohydrates according to the effect that they on the body's blood sugar levels.

Foods classed as having a low GI include granary bread, milk, most fruit and vegetables, while high GI foods include white bread, croissants and cornflakes.


Victims Of Socialism

Deadly Rationing: The gatekeeper for Great Britain's national health care system is denying cancer patients drugs that would extend their lives. Why? Because the medication is considered too expensive.

What's a life worth? Apparently not much in Great Britain. The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.

Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis. Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?

Promises of an effective, cost-effective health care system operated by the federal government are cruel fabrications. The British system shows that the state makes a mess of health care. So does the Canadian plan, which is plagued with unhealthy and often deadly waiting times for treatment.

The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so "would set a bad precedent and lead to unequal access to medicine." Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.

A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she - or his or her immediate group - is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we've been waiting for.

Medicine needs experimentation to progress. But experiments need to stay in the laboratories, not spread to the domain of public policy. Americans are not lab rats. They deserve to be treated with dignity and not shoved aside as expendables to be sacrificed in deference to a sacred totem of the political left.


The western world needs more like this guy

There's a huge Union Flag flying proudly outside Deva Kumarasiri's house and it's been there so long the edges are tattered and torn. Nearby, another one flutters from the back of his favourite Land Rover as he drives to work as the local cornershop postmaster.

In case it's not immediately clear, the Sri Lankan born father of two - who fulfilled a dream to come this country 17 years ago and took citizenship to make his life here - is proud to be British. So proud, in fact, that he's insisting all his fellow immigrants embrace our culture and pride with the same enthusiasm as he does.

Mr Kumarasiri, who taught his two young daughters every word of the National Anthem and is encouraging them to join the RAF when they grow up, introduced a controversial new regime at his post office counter. If his customers can't be bothered to learn English, he tells them, they must go away and learn it before he serves them.

His bold stand against non-integration has sent a shudder of political correctness down whatever spine the post office has these days, and infuriated some local do-gooders who accused him of inciting division among the community. But even a few minutes spent with the 40-year-old Liberal Democrat councillor is about all it takes to establish that his motives are pure - and that he's driven only by a passion for the country he loves so much.

'Nobody stands up for anything in Britain any more,' he said. 'It's the best country in the world as far as I'm concerned, but the great country I once called Great Britain has changed a lot since I came here. All I'm doing is telling people that if they want to live in Britain, be British.

'Don't boo our soldiers when they come home from Iraq. Don't live your life without embracing our culture. Don't stay here without making any effort to learn the language. And if you don't want to be British, go home.'

Mr Kumarasiri runs the sub-post office inside a corner shop in Sneinton, an inner city area of Nottingham that boasts a diverse ethnic mix. He became so weary at of customers expecting to be served without uttering a word of English that he took to telling them to go away and learn the language. It's not exactly a ban, he says, because they keep coming back anyway. But he tells those who make no effort to speak English they will need an interpreter if he is to give them a proper standard of service. 'Our laws are written in English; our culture is chronicled in English. How can anybody understand that if they can't understand English? 'I tell them if they don't speak the language and they can't be bothered to learn, then don't bother coming here. It's up to them whether they take any notice - but if they want to live here in Britain, they should take notice.'

Mr Kumarasiri, whose wife is a nurse, likes to call his regular customers 'duck' and 'dear', following local tradition. 'The fabric of the nation begins to unravel if we don't all speak the same language. You can't be wholly part of British culture if you don't speak the language.

'When I left Sri Lanka I left behind that country's culture, customs and language. I have done my utmost ever since to be part of this country's culture. There are far too many people who come here and expect Britain to change to suit them.

'White people can't say what I'm saying because they'd end up in jail,' he explains.


My imam father came after me with an axe

Hannah Shah had been raped by her father and faced a forced marriage. She fled, became a Christian and now fears for her life

We are all too familiar with the persecution of Christians in countries such as Pakistan and Afghanistan. Yet sitting in front of me is a British woman whose life has been threatened in this country solely because she is a Christian. Indeed, so real is the threat that the book she has written about her experiences has had to appear under an assumed name.

The book is called The Imam's Daughter because "Hannah Shah" is just that: the daughter of an imam in one of the tight-knit Deobandi Muslim Pakistani communities in the north of England. Her father emigrated to this country from rural Pakistan some time in the 1960s and is, apparently, a highly respected local figure.

He is also an incestuous child abuser, repeatedly raping his daughter from the age of five until she was 15, ostensibly as part of her punishment for being "disobedient". At the age of 16 she fled her family to avoid the forced marriage they had planned for her in Pakistan. A much, much greater affront to "honour" in her family's eyes, however, was the fact that she then became a Christian - an apostate. The Koran is explicit that apostasy is punishable by death; thus it was that her father the imam led a 40-strong gang - in the middle of a British city - to find and kill her.

Hannah Shah says her story is not unique - that there are many other girls in British Muslim families who are oppressed and married off against their will, or who have secretly become Christians but are too afraid to speak out. She wants their voices to be heard and for Britain, the land of her birth, to realise the hidden misery of these women.

Hannah's own voice is quiet and emerges from a tiny frame. She is clearly nervous about talking to a journalist and the stress she has been under is betrayed by a bald patch on the left side of her head. Yet she has a lovely natural smile, especially when she reveals that she got married a year ago; her husband works in the Church of England, "though not as a vicar".

I tell Hannah that the passages in her memoir about her sexual abuse are almost impossible to read - but I also found it hard to understand why, now that she is in her early thirties, independent and married, she has not reported her father's horrific assaults on her to the police. "What has stopped me is that if my dad went to prison, the shame that would be brought upon the rest of the family would be horrific. My mum would not be able to . . . I mean, it's bad enough having a daughter who's left, is not agreeing to her marriage and is now a Christian. Then to have my dad in prison would be the end for her."

I tell Hannah, perhaps a little cruelly, that in her use of the word "shame" she is echoing the sort of arguments that her own family had used against her. "I understand that, but what I'm saying is that if I do that, then there will never be a door open to me to have contact with my family ever again. I'm still hoping that there will be some opportunity for that." Of course, by writing this book, albeit under an assumed name and with all the places and characters disguised, there is a chance that her family and community will identify themselves in it. What does she think they would do, then?

"To be honest, I don't even want to think about that. Either they will decide between them that they are not going to say anything because it will bring shame on all the community, or they will decide that they want to take action. Then my life will become even more difficult, because they'll all be looking for me."

Hannah's description in the book of the moment when her "community" discovered the "safe" home where she had fled after becoming an apostate is terrifying. A mob with her father at its head pounded and hammered at the door as she cowered upstairs hoping she could not be seen or heard. She heard her father shout through the letter box: "Filthy traitor! Betrayer of your faith! Cursed traitor! We're going to rip your throat out! We'll burn you alive!" Does she still believe they would have killed her? "Yes, without a doubt. They had hammers and knives and axes."

Why didn't you call the police afterwards? "First, I didn't think the police would believe me. That sort of thing just doesn't happen in this country - or that's what they'd think. Second, I didn't believe I would get help or protection from the authorities."

Hannah had good reason for this doubt. When, at school, she had finally summoned the courage to tell a teacher that her father had been beating her (she couldn't bring herself to reveal the sexual abuse), the social services sent out a social worker from her own community. He chose not to believe Hannah and, in effect, shopped her to her father, who gave her the most brutal beating of her life. When she later confronted the social worker, he said: "It's not right to betray your community."

Hannah blames what is sometimes called political correctness for this debacle: "My teachers had thought they were doing the right thing, they thought it showed `cultural sensitivity' by bringing in someone from my own community to `help', but it was the worst thing they could have done to me. This happens a lot. "When I've been working with girls who were trying to get out of an arranged marriage, or want to convert to Christianity, and they have contacted social services as they need to get out of their homes, the reaction has been `we'll send someone from your community to talk to your parents'. I know why they are doing this, they are trying to be understanding, but it's the last thing that the authorities should do in such situations."

This is the sort of cultural sensitivity displayed by Rowan Williams, the Archbishop of Canterbury, last year when he suggested that problems within the British Muslim community such as financial or marital disputes could be dealt with under sharia, Islamic law, rather than British civil law. What did Hannah, now an Anglican, think on hearing these remarks? "I was horrified." If you could speak to him now, what would you say to the archbishop? "I would say: have you actually spoken to any ordinary Muslim women about the situation that they live in, in their communities? By putting in place these Muslim arbitration tribunals, where a woman's witness is half that of a man, you are silencing women even more."

She believes the British government is making exactly the same mistake as Rowan Williams: "It says it talks to the Muslim community, but it's not speaking to the women. I mean, you are always hearing Muslim men speaking out, the representatives of the big federations, but the government is not listening to Muslim women. With the sharia law situation and the Muslim arbitration tribunals, have they thought about what effect these tribunals have on Muslim women? I don't think so."

It's fair to say that Hannah Shah is an evangelical Christian, who clearly feels a duty to spread her new faith to Muslims- something with which the Church of England's eternally emollient establishment is very uncomfortable and the government even more so. She points out that even within this notionally Christian country, people are "persecuted" for evangelism of even the mildest sort. She cites the recent cases of the nurse who was suspended for offering to pray for a patient and the foster parents who were struck off after a Muslim girl in their care converted to Christianity.

"Such people - I'm not talking about apostates like me - have been persecuted or ostracised in this country simply because they want to share their faith with others. People call this political correctness but I actually think it is based on a fear of Muslims, what they might do if provoked."

Shah's conversion seems to have its origins in the fact that the family who put her up after she ran away from the prospect of an arranged marriage in rural Pakistan were themselves regular church attenders. She began to go with them and, to put it at its most banal, she liked what she heard. "It was the emphasis on love. The Islam that I grew up knowing and reading about doesn't offer me love. That's the biggest thing that Christianity can and does offer. I sense that I belong and am accepted as I am - even when I do wrong there is forgiveness, a forgiveness which Islam does not offer."

So does Hannah offer Christian forgiveness to the father who raped and abused her and who, by her own account, was even prepared to murder her? "It's taken a long time and it's only in the past few years that I've got to that. It's very hard to get there and it's taken a lot of shouting and screaming behind closed doors, and praying, to get me to the point of being able to say: I forgive. I have to, partly because otherwise I would be a very bitter and angry person and I don't want to livea life that's full of anger."

I can't help asking how she would react if a future child of hers decided she wanted to abandon the Christian faith of the family home and become a Muslim. "It would be very hard for me, obviously." Would she try to discourage it? "No. I'd bring them up as Christians, take them to church, but I'd also want them to know about, well, my culture, about Islam. Because being Christian should be a choice, not what you're born to. But yes, it would be hard if they chose Islam." Somehow, though, I think Hannah Shah would cope.


British plan to halt migrants at Calais (That's news to us, say French immigration chiefs)

A joint Anglo-French detention centre is to be built outside Calais to deal with thousands of migrants trying to reach Britain, the immigration minister has claimed. In a surprise move, Phil Woolas revealed that he has held talks with his French counterparts over a secure camp. He says he is trying to persuade them that it would be the solution to dealing with would-be asylum seekers trying to get into the UK.

Describing his plans for the centre, Mr Woolas emphasised that it would not be like the infamous Sangatte. He said the new facility would house migrants before they are sent home. Britain is willing to help pay for and run the camp, Mr Woolas said, and to share the costs of flights with the French authorities to deport illegal immigrants back to their homes in Iraq, Afghanistan and elsewhere before they can reach the UK.

However, Mr Woolas's unscheduled announcement took his Whitehall officials by surprise. The Home Office was unable to provide details of how the proposed detention centre would work. But more embarrassingly for Mr Woolas, his claims even caused bemusement in Paris, where a spokesman for the French immigration ministry said he too had 'no information' about plans for the detention centre.

Meanwhile, a source at Calais town council said there were 'certainly no plans for the building of a new prison structure'. Mr Woolas, who has developed a reputation for putting his foot in his mouth, told reporters he was anxious to agree a deal with the French by the beginning of May, in time for a formal announcement at an Anglo-French summit later that month.

Proposals for a new secure detention camp appear to run contrary to French government's current approach to the problems at Calais, where immigration minister Eric Besson last week confirmed that new 'light building' facilities are to be built offering food, showers and legal advice to illegal immigrants trying to reach the UK. The centres have already been dubbed 'mini-Sangattes' after the notorious camp which was closed down in 2002.

Former Home Secretary David Blunkett persuaded the French to bulldoze the site, but only on condition that Britain accepted hundreds of migrants living there. Pressure on the French government has grown in recent months to deal with the growing numbers of rough-sleepers.

Referring to Sangatte, Mr Woolas said: 'Last time the pressure was on the French to let people through the Channel Tunnel. Now the pressure on them is humanitarian.' Charity workers believe as many as 2,000 are living in a series of squalid shanty towns in areas of woodland known as 'the jungle'.

Tory immigration spokesman Damian Green dismissed the plans as a 'waste of money' which would not tackle the real problem of weak borders and crowds of determined illegal immigrants. He added that they 'will only be deterred by proper protection of our borders, which is why Conservatives propose to set up a specialist Border Police Force'.


Less than $4,500 a year... a British university graduate's paltry pay premium

Thousands of graduates end up in jobs that don't pay enough to justify the cash spent on tuition fees and living expenses, a study revealed yesterday. With some university chiefs wanting fees to rise as high as 20,000 pounds a year, research showed the graduate earnings 'premium' is minimal for many students - especially arts and humanities graduates with middling or poor degree grades. Studies have already suggested the earning power of a degree is declining as student numbers soar.

Ministers claimed that graduates could earn 400,000 pounds more over a lifetime as they sought to justify raising fees to 3,000 a year three years ago. Subsequent studies put the figure at 160,000. Now a study from Warwick University has found that the earnings 'premium' for some graduates is negligible. Male arts and humanities graduates earn on average just 2,800 a year more than counterparts who went straight into jobs after A-levels. With debts accrued through tuition costs and board, those who attended more obscure universities and gained unremarkable grades may have been wealthier if they gave university a miss.

The research comes amid a growing row over a call yesterday by university chiefs for fees to be more than doubled to 6,500 a year. Meanwhile a BBC survey showed that some vice-chancellors wish to see fees rise to 20,000. Former Education Secretary David Blunkett said it would be 'unacceptable to lift the cap on fees and have a free-for-all across universities'.

The Warwick research, involving almost 3,000 Britons born in 1970, found that the earning power of a degree varies widely according to the discipline and class of degree attained. Social sciences, including law and economics, gave the highest return. The report found that on average there was still a 'substantial' earnings premium linked to gaining a degree, but for students at less prestigious universities who get mediocre degrees the decision to attend university will be 'marginal', and more so with a hike in fees.


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