Saturday, August 08, 2009

British hospitals creaking under the strain as NHS vacancies are left unfilled

Hospitals across England are experiencing staff shortages, but London is particularly affected. Not many people want to work in such a chaotic environment

Medical leaders have warned that shortages of doctors, nurses and other clinical staff are putting the NHS under unsustainable pressure as a generation of health workers enters retirement amid cutbacks in junior doctors’ working hours.

The number of vacancies for hospital doctors, dentists, nurses and midwives has risen for the first time in five years as trusts struggle to recruit and retain staff. New data from the NHS Information Centre revealed that more than one in twenty medical and dental posts were vacant at the end of March, in some cases for months at a time, while thousands of nursing and midwifery posts were also unfilled.

Of the total number of vacant posts, one in five — 5,500 jobs — had been left unfilled for three months or more, suggesting long-term problems with recruitment. Senior staff leaving the service and the reluctance of younger people to replace them were blamed for the shortfalls as total vacancy rates increased across most staff groups. Doctors’ leaders have also warned that the European Working Time Directive, which from this month limits junior doctors to a maximum 48-hour week, could create shortages, leaving trusts to rely on temporary or locum staff.

The Times reported last week that trusts were spending tens of thousands of pounds to fill vacant posts, with recruitment agencies charging from £90 to £116 an hour to provide nurses and doctors on demand. The latest statistics only cover vacancies where trusts are actively recruiting for a post, however, so may underestimate the true scale of shortages, which are particularly acute in London.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available. A study published last year by the London School of Economics suggested that trusts that relied heavily on agency nurses to cover vacancies had higher mortality rates among patients who had a heart attack than those with more permanent staff.

Peter Carter, the chief executive of the Royal College of Nursing (RCN), said that the scale of the problem was worrying. “While we are concerned about long-term vacancies, even unfilled short-term ones leave nurses under unsustainable pressure and, with higher workloads, too busy to provide the standard of care they would like,” he said. “Rising vacancy rates are due to a combination of factors — more nurses are retiring and fewer are coming out of training; add to this an increase in demand for nurses, coupled with recent changes in migration policies, restricting recruitment from outside of the EU.”

The number of empty jobs was measured on March 31 this year. Among hospital doctors and dentists, excluding trainees, the vacancy rate was 5.2 per cent, compared with 3.6 per cent in the same month last year. The long-term vacancy rates for this group jumped two thirds from 0.9 per cent to 1.5 per cent. Vacancy rates for GPs increased only slightly from 1.6 per cent to 1.9 per cent.

Medical leaders have said that qualified nurses and midwives are retiring at a greater rate than newly trained staff can enter the professions. For nurses, vacancies rose from 2.5 per cent to 3.1 per cent in a year. London had the highest long-term vacancy rate among qualified nursing staff, increasing from 1.2 per cent in 2008 to 1.6 per cent this year. A poll of more than 8,600 children aged between 7 and 17, conducted for the RCN this year, found that only 1 in 20 considered nursing to be an attractive career.

The Royal College of Midwives (RCM) has also called for 5,000 extra staff to be recruited to fulfil official pledges to improve care and choice of services for mothers and babies. The Government has promised funding for the equivalent of 3,400 posts. Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long-term vacancies accounting for about one in four of all empty posts.

Cathy Warwick, general secretary of the RCM, said: “The overall increase in vacancy rates may suggest there are more midwifery jobs available but employers are struggling to fill them. Perhaps increasing numbers of student midwives are not yet resulting in enough newly qualified midwives coming through the system. It could also mean that more midwives are leaving a service suffering from very heavy workloads.”

Anthony Halperin, trustee of the Patients Association, said: “Nursing staff see that there are higher rewards in the private sector while doctors and dentists no longer see medicine as a career for life, or are having their hours cut back by European legislation. All of this has negative outcomes for patients.”

Stephen O’Brien, the Shadow Health Minister, said: “With swine flu continuing to spread and the European Working Time Directive limiting doctors’ working hours, this is the worst time for staff vacancies across the NHS to rise.”

The Government said that more medical staff were working in the NHS or in training than ever before. Ann Keen, the Health Minister, said: “Across most staff groups vacancy rates continue to be low at around 2 per cent. The number of longer-term vacancies show a slight rise on last year but remain lower than 2006.”


Tax the poor!

Bar them from selling their junky old houses until they upgrade them to top Greenie standards

Owners of poorly insulated homes should not be allowed to sell or rent them until they have invested in energy efficiency measures, the Government’s advisory body on domestic energy use says.

The Energy Saving Trust said that the 5.5 million homes in the lowest two bands for energy performance — more than a fifth of all homes — should also be subject to higher council tax bills and additional stamp duty. It believes that tough measures will be needed to achieve the Government’s target of reducing carbon dioxide emissions from home heating by 29 per cent by 2020 and to “almost zero” by 2050.

The trust estimates that 85 per cent of the homes in bands F and G could be made fit to sell for less than £5,000. However, owners of the remaining 15 per cent face paying as much as £10,000 to upgrade their homes to a new minimum standard.

Since last October, all homes offered for sale or rent have had to have an energy performance certificate, which ranks them in one of seven bands, from A to G. The trust is advising the Government to make it illegal, from 2015, to offer for sale homes rated lower than Band E. There would be exceptions for listed buildings if the owners could prove that energy efficiency measures would damage their historic character.

The Government said in its low carbon White Paper last month that existing measures, which focus on giving advice and offering grants towards the cost of insulation, might not be sufficient to achieve reductions in energy use.

There are very few A-rated homes, which feature triple glazing, heavily insulated walls and ceilings and solar panels for heating water. F-rated homes include Victorian terraced properties with single-glazed sash windows and boilers at least ten years old. G-rated homes tend to be detached and have no loft insulation.

In an interview with The Times, Marian Spain, the trust’s director of strategy, said: “We need a powerful incentive to act as a backstop in case other measures do not work. To sell your home you would need to have done the basics to take it out of the F and G ratings. The final deadline should be 2015.”

Ms Spain said that homeowners were likely to recoup their investment, because buyers would be willing to pay more for a home with lower energy bills. The prospect of higher council tax would also help to push people into paying for insulation.

The trust is also recommending that planning permission for extensions should be made conditional on the whole home improving its energy performance.

Jonathan Stearn, of Consumer Focus, the government-funded watchdog for energy prices and fuel poverty, welcomed the trust’s proposals but said they needed to be balanced by improved grants to help poorer households to pay for insulation. “We need a mixture of carrot and stick,” he said. “We have particular concerns about those who can’t afford energy efficiency measures.”


UK: Curbs on freed violent offenders

This will just be a cover for letting offenders out early. Politics in Britain are seldom what they seem

Asbo-style Violent Offender Orders (VOOs) that can restrict criminals' movements after they are released from prison are coming into force. Civil VOOs are intended to help cut re-offending by banning criminals from certain places or from contacting particular people for up to five years. But the Howard League for Penal Reform said it feared they could be overused and counterproductive.

Ministers have also announced £3.2m of funding for victims of sexual assault.

The measures are part of an updated strategy by the government to tackle violent crime and were contained in the 2008 Criminal Justice and Immigration Act. Under the terms of VOOs, serious offenders who have reached the end of their prison sentences or licence can be banned from places, events, and from contacting specified people for between two and five years. They must also tell police if they move home, change their name, or go abroad. Breaking the terms of a VOO could be punishable by five years in prison.

Police can apply to a magistrates' court to grant a VOO for any offender who has served at least 12 months in prison for offences including manslaughter, attempted murder or grievous bodily harm. Policing Minister David Hanson said: "Violent crime can have a devastating effect on victims and on communities. "Violent Offender Orders are a valuable tool to help protect the public and disrupt offending behaviour."

West Mercia Chief Constable Paul West said they would help deal with offenders who were "no longer subject to any statutory supervision, but nevertheless are still deemed to pose a risk of serious violent harm".

But Andrew Neilson from the Howard League said he had concerns about the idea. "Our experience of these civil orders, as with Asbos, is that we are told they will be used in a minimal way, but then over the years they seem to be overused in every way possible by agencies who are covering their backs," he told the BBC News website. "One of the reasons our prison population is growing so rapidly is because many of the people in there have broken the terms of these sorts of orders. Initiatives like this need proper training, implementation and evaluation if they are to be worthwhile

"Our other worry is that they can be counterproductive. They can actually impose restrictions that make it more likely that someone will reoffend, not less likely. "For example, restrictions that prevent someone gaining employment, when we know that getting a job is one of the best ways to prevent reoffending."

Deborah McIlveen, from domestic violence charity Women's Aid, said that while the initiative was welcome, it would remain to be seen how consistently and effectively it would be implemented across the country. "There are already procedures in place to protect victims, but they are not always followed by police and other justice agencies," she said. "For example, ex-partners of offenders should always be told when they are released from prison, but they're not. "Initiatives like this need proper training, implementation and evaluation if they are to be worthwhile."


Early mortality among British school dropouts

Dropouts often seem to indulge in risky behaviour -- particularly to do with drugs -- so this is sad but not unexpected

Fifteen per cent of school-leavers not in employment or education are dead within ten years, research suggests. Jon Coles, director general of schools at the Department for Children, Schools and Families, said that the figure proved that education was a “matter of life and death”.

Nearly one in six people aged 16 to 24 in England is classified as Neet, or not in education, employment or training. Mr Coles told a seminar in London that there was a clear social cost of being outside the system, The Times Educational Supplement reports today.

He said that one city in the north of England had conducted long-term research into Neets and the results were profoundly shocking.

“Those who had been outside the system for a long period of time ... 15 per cent of those people were dead by the time that research was done [ten years later]. “For those of us who console ourselves with the thought that education is not a matter of life and death, actually for those young people for the most vulnerable children and young people in our society it really is.”

A spokeswoman for the department said: “The official made clear that this was one bit of local research which could not be taken as representative of the whole country. However, it is clear that young people who are Neet are at greater risk of poor health and negative outcomes in later life, which is one of the key reasons we see reducing the Neet numbers as such a high priority.”


Is Britain's Jewish Free School Racist?

A decision has been handed down in the British Court of Appeal that sets a monumental precedent for those wishing to place their children in a faith-based school. Reading this sorry saga Americans will be grateful for separation of Church and State and for the independence afforded parochial schools.

The British school crisis started this way: one of two couples whose children were rejected by the Jewish Free School in 2007 went straight to the High Court because in one case the rejection was based on a view that the mother had “stopped living an Orthodox lifestyle.” Mr. Justice Munby ruled that the school’s right to determine admission criteria was as valid as that of Christian or Islamic schools and their being censured could sabotage "the admission arrangements in a very large number of faith schools of many different faiths and denominations". The decision was appealed.

Putting aside the intricacies of Jewish religious law this story is an intriguing one because this summer Lord Justices Sedley and Rimer and Lady Justice Smith of the Appeals Court have handed down a decision saying that the criteria for admitting a child to the Jewish school are in breach of the Race Relations Act. The Chief Rabbi, Sir Jonathan Sacks, has interpreted this as a condemnation of Jewish ecclesiastical regulations as “racist.” He said, “Jews have been in Britain for 353 years and the JFS in existence since 1732. In all those years the same principle has applied… we extend Jewish education to applies to all Jewish schools, Orthodox and non-Orthodox alike… Now an English court has declared this rule racist and since this is an essential element of Jewish law, it is in effect declaring Judaism racist..”

The Appeal Court is saying that religious criteria violate the same laws as those laid down against racial discrimination. In other words, if you want your kid to go to Catholic School or some other faith establishment, effectively the very concept of a single-faith environment smacks of racism.

The uproar this story has caused in Britain has been something to behold and has even made its way into the columns of the mainstream newspapers. Anguished commentators have been writing columns about the crisis. JFS is an outstanding state-funded school that has enjoyed a national rating in the first 1% in the scholastic excellence tables, but the judge in question is saying that taxpayers should not be footing the bill for a “racist” entry system. This reverberates not just with Jewish establishments but with Muslim and Christian schools. So -- is it reasonable for a Jewish or Muslim family to expect their children, if they so wish, to be able to observe halal and kashrut in early childhood? Once they get to Oxford or Harvard they will be exposed to bacon sandwiches and alcohol but in their formative years many feel they have a right to reassurance that their religious beliefs will be respected in a supervised school environment.

Equally so, Christian children are entitled to an education structured in Catholic, Protestant or other denominational tenets and need not be constrained by having to worry about others’ religious beliefs. In other words, if Catholic or Protestant children want to bring ham sandwiches to school or sing about Jesus they have a right to their observances with their own flock, rather than being forced by a judge to “tackle racism” and mingle with non-Christians who, in turn, could be miserable too.

The ruling will mean that it is open season on admissions. The Orthodox Chief Rabbi Sacks should never have allowed JFS to subject the couples in question to such an ordeal, and Jewish communal conflict should never have reached the mainstream press. Journalist Andrew Sanger points out that the far-right British National Party supports the JFS on this issue because the decision means no group or institution will be safe from liberal interference in defining a unique ethnic or national group. A comment from “Lord Reith” on Sanger’s blog says, “ The state should not be paying for faith schools. Why should people pay for schools they can't send their children to? If people want to indoctrinate their kids in faith schools and dogma, let them pay for it themselves.”

This brings me to the story of one of the Founding Fathers. Alexander Hamilton’s mother, living amongst the seventeenth-century Sephardi community of the Caribbean island of Nevis, had left her Jewish husband and given birth after a liaison with a new, non-Jewish partner. Because he was regarded as “born out of wedlock” Alexander could not gain admission to the Christian schools on the island. The one Jewish school in existence decided to let him enroll. He enjoyed a fine education at the little synagogue on Jew’s Walk and learned Hebrew. Later in life he rejoiced in being able to read a Hebrew bible and write in the language. He often said he was indebted for life to the Jewish community for taking the view that education overtook any other aspiration. Likewise did anything bad happen to the cheder (Hebrew school) he attended? Was its stature diminished because he was the offspring of a gentile mother? No. Hamilton’s biographer Dorothie BobbĂ© wrote: "..Denied schooling, [his mother] sent him to the Jewish school.. The Jews were respectable, and respected, in the islands...His teacher liked to stand him on a table and make him recite the Decalogue in Hebrew."

When a practicing lawyer he said during a case , “ the progress of the Jews...from their earliest history to the present time has been and is entirely out of the ordinary course of human affairs. Is it not then a fair conclusion that the cause also is an extraordinary one---in other words that it is the effect of some great providential plan?..”

What an irony that in 2009, two-hundred-and fifty years after one of the most revered of the Founding Fathers enjoyed a full Jewish education despite his un-Jewish roots, a British school could impose on families restrictions that could have been resolved within its own community and not become a national cause celebre. As I write this, headlines abound: “JFS ruling leaves schools in chaos;” “The Court judgment that has declared Judaism racist” and “This is a battle for justice and unity.” Rabbi Jonathan Wittenberg passionately decries the “profoundly unjust” behavior of JFS.

Having said earlier on that children of faith tend to be happier amongst their own, I would venture that JFS should have adapted to the modern world and modified its rules to accommodate the children of converts. Life would have gone on. Some historians posit that Alexander Hamilton’s mother was indeed Jewish and so was he. Whether he was or not, his school bent the rules and the Hamilton experience produced a man who treasured his core religious education, venerated Judaism for the rest of his life and became a great leader.

For those who wish to keep their offspring in a religious environment this case has resulted in a judgment that effectively declares the centuries-old tradition of faith schools a violation of race laws. Some on the Right are saying the British court judgment is the first step to abolishing faith schools in a passionately secular, Dawkins-esque nation. On the Left it is being mooted that this is a sinister plot to close down Islamic madrassahs across Britain and force a mass-exodus of Muslims from our shores, just as the campaign to ban ritual slaughter has been perceived as an attempt to make Britain Muslim and Jew-free.

Although separation of Church and State will preclude even a super-liberal US Supreme Court from following suit, and secularism in France, for example, will also make such crises unlikely there, those who favor faith schools should take note of the enormous influence the courts can wield and the seismic shocks they can inflict.


Incentives needed to keep brightest immigrants in Britain (?)

The UK is failing to retain “super-mobile” workers as immigrants move on because of the economic downturn, according to a report to be published today.

Super-mobiles are the brightest of the foreign workers who arrive in Britain and stay for less than four years, the study says. They move several times in their lifetimes to take advantage of globalisation. The study suggests that tax breaks be introduced to encourage talented workers to stay and that efforts be made to persuade Australians and New Zealanders who arrive in Britain as part of the “Big Overseas Experience” to remain permanently.

About half the six million immigrants who arrived here in the past 30 years have since left, according to the report by the Institute for Public Policy Research. Tim Finch, from the think-tank, said: “The migration debate is fixated with the idea that immigrants come to settle and not enough attention has been paid to the fact that more and more are spending only short periods in the UK.

“Migrants are coming to study and work for short periods and then moving on. As global competition for highly skilled migrants increases in future years, schemes to retain migrants may become as important as attracting them in the first place.”
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Migration in which people remain for less than four years doubled between 1996 and 2007; most were students or from countries that joined the EU in 2004. Only a quarter of migrants who arrived in 1998 were still here in ten years later, the report says.

The report warns of increasing competition from other EU countries also keen to attract bright migrants. It recommends that schemes to help students find work be extended and that highly skilled migrants who are committed to remaining here be given extra points. It also suggests that it be made easier for skilled migrants to renew their visas or work permits and for their families to join them in the UK.


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