Health white paper: the details
A radical new vision for the health service has been laid out by ministers affecting all areas of the NHS and healthcare.
£80bn of NHS funding will be handed to GPs to buy care for patients in their area, with primary care trusts and strategic health authorities to be abolished by 2013. It will mean management costs will be cut by almost half and GPs could subcontract out the work to private companies.
Foundation Trust hospitals will be allowed greater freedoms to treat more private patients to boost income and more patients with long-term conditions will be given their own health budgets to buy their care.
A new patient champion organisation called HealthWatch will be established as part of the regulator, the Care Care Quality Commission.
The patient is to be put at the centre of the health service, under a Government motto of “no decision about me, without me”.
Patients will have greater control over their medical records and will decide who gets to see them. An aim is to make it easier for patients to download their records to share with healthcare organisations of their choice. Doctors and patients will also be able to communicate via email for greater efficiency and convenience.
Hospitals will be ordered to tell patients about mistakes and make greater use of patient surveys.
More comprehensive information about treatments, healthy lifestyles and diseases will be released by a wider range of organisations, with consideration given to a ‘kite-mark’ quality standard.
The Department of Health will focus more on improving public health and less on the day-to-day running of the NHS.
A National Public Health Service will be set up with jointly with local authorities with a ring-fenced budget and responsibilities covering areas such as obesity, smoking and alcohol problems, as well as running vaccination and screening programmes. Regions with unhealthy inhabitants will be given extra cash to reduce inequalities.
A review of long-term care funding is also under way, with both an insurance scheme and a shared-cost partnership under scrutiny.
The diet and nutrition advice role of the Food Standards Agency is likely to be taken on by the new service but Mr Lansley would not be drawn on whether the entire organisation would be one of the quangos to be abolished.
Hospitals and doctors’ teams performance will be scrutinised in greater detail with data published on infections, deaths, readmission rates and accidents.
Patients will be asked if they thought their treatment was effective and lived up to their expectations and this will be published so others can use the information to choose where to be treated.
In a move away from waiting time targets, hospitals and doctors will be judged on the clinical effectiveness of their work.
The health service will be judged on measures such as the number of deaths from treatable conditions, improvements to one-year and five-year cancer survival rates and the National Institute will draw up a range of quality standards that the NHS must adhere to.
The End of Britain as We Know It
The article below has considerable logic to it but reality can be peskily complex. Australia has had the voting system proposed for Britain for around a century now and is one of the most stable, conservative and prosperous countries in the world. It was also one of the few countries that was virtually unaffected by the global financial crisis. How about that?
Additionally it is far from a done deal that the new voting system for Britain will be approved at the proposed referendum. Britain has few referenda but Australia has had rather a lot — and they have mostly been lost (i.e. got a majority “no” vote)
And the agreement to hold elections at strict 5 year intervals is only an agreement of the moment. It is nothing like America’s 4 year constitutional requirement for Presidential elections. It can be overturned at any time by the British parliament and there are already rumbles of dissatisfaction over it. Few observers think it will outlast the present coalition government and it may not even last that long — JR
By Dick Morris and Eileen McGann
The United Kingdom, the mother of all democracies, is about to change its political system in fundamental ways — changes that will spell disaster for the nation and for its politics. For those who love Britain, the news of these impending alterations can only cause angst and distress.
As a result of the inability of either the Conservatives or Labor to win a majority in Parliament in the recent elections, both parties had to bid for support from the Liberal/Social Democratic Party. The price the Conservatives ultimately paid was to agree to some of these changes and to refer others to the electorate for a referendum.
The changes that the parties have agreed to will transform the British government from a decisive decision-making machine into a morass of compromise, half-measures and deadlock. Gridlock will be exported across the ocean to the United Kingdom.
Right now, the prime minister can dissolve Parliament anytime he wants, forcing new elections. He is also obliged to order new elections if he loses a vote of confidence. This power holds the members of his parliamentary majority in check and restrains them from turning on their leaders since, should they succeed in a vote of no confidence, it would plunge them into the uncertainty of a new election, which would imperil their own seats.
The new rules would bar the prime minister from dissolving Parliament during its five-year term and vest that right in a two-thirds majority of parliament. In other words, Parliament would have to vote itself out of office — something likely never to happen.
So, under the new rules, if a government loses a vote over a major legislative item — or fails to survive a no-confidence motion — it must resign, but there need not be new elections. Instead, Parliament can refuse to order new elections and just re-form a new government out of the old Parliament.
The effect of this rule change is likely to be that governments will rise and fall all the time since they may do so without forcing members to face new elections. Like in Italy, the new governments will just be formed by reshuffling the current parliamentary deck into new combinations and coalitions.
Whereas now, if a government falls, there is an election to decide the issue, under the new procedure, the deadlock could just go on and on without resolution.
More dangerous is the proposed new voting system that must be approved by a popular referendum. Rather than vote for one candidate for Parliament in each district, voters will be obliged to rank the candidates in their order of preference. If nobody gets a majority of first-place rankings, the candidate with the least votes drops off and his second place votes are distributed among the other remaining candidates. The Liberal/Social Democrats are pushing this change in the hopes that there may never again be a parliamentary majority for the Conservatives or Labor and that they will always hold the balance of power in a hung parliament.
And they are likely to achieve their objective if the new voting system passes. Most districts in the United Kingdom, as in the U.S., tend either to the left or to the right.
In a leftist district, for example, the Labor Party usually finishes first, the Liberal/Social Democrats second and the Conservatives third. If the Labor candidate did not win a majority of first place votes on Election Day — and they frequently don’t — the Conservative candidate will drop off and his second-place votes will determine the winner. But what Conservative voter is going to name Labor as his second choice in the polarized politics of the U.K.? Most will name the Liberal/Social Dems as their second choice, and that candidate will win the seat. In right-wing districts, the same process will happen in reverse, again to the benefit of the Liberal/Social Dems.
That means more hung parliaments, less decisive election results and more mush compromise. Together, these changes will tend to paralyze the British government, substituting muddled, mushy compromise for decisive and bold action. We will miss the old United Kingdom.
British Prime Minister doubts that he can find a good State school for his children in London
David Cameron has admitted that he is “terrified” by the prospect of trying to find a good state secondary school for his children in London. Mr Cameron said that, living in central London, he sympathised with parents in areas across Britain where there was no choice of decent schools.
“I’ve got a six-year-old and a four-year-old and I’m terrified living in central London,” he said in an interview with a Sunday newspaper. “Am I going to find a good secondary school for my children? I feel it as a parent, let alone as a politician.”
Mr Cameron, who was educated at Eton, said he remained determined to send his children to state schools despite rejecting 15 primary schools for his six-year-old daughter Nancy, before sending her to St Mary Abbots, Church of England primary in Kensington.
Good schools in central London are hugely over subscribed, with six parents chasing every place in one near Downing Street, and Mr Cameron said the dilemma has strengthened his resolve to drive up standards so there are “really good state schools available for all”.
People are forced to “break the bank” to send their children to private school because “in some parts of the country, there isn’t a choice of good state schools”.
Mr Cameron and his wife, Samantha, also have a four-year-old son, Elwen, and are expecting another child in September.
He said the coalition Government was trying to ensure there were more good schools with their plans for “free” schools set up by parents and others.
In their general election manifesto, the Conservative pledged to restore discipline and raise standards in the classroom, vowing to bridge the gap between rich and poor by giving “every child the kind of education that is currently available only to the well-off”.
One method they are studying is addressing the financial shortfall in the education budget by allowing private firms to fund and run state schools in London.
One school, Turin Grove, in Edmonton, already has private company involvement. Edison Learning won a £300,000-a-year contract from Enfield council to provide a headteacher and two deputies. A Swedish schools group, Kunskapsskolan, is to open two non-profit making, state-funded academies in Richmond in September.
According to London Councils, a lobbying group for the capital’s 33 local authorities, around 50,000 extra school places need to be created between now and 2016 to cope with demand, costing approximately £880 million.
Westminster City Council, Mr Cameron’s local education authority, insisted its schools were providing “first-rate education”.
It invited him to send his children to one of its primaries. St Mary Abbots is in the neighbouring borough of Kensington and Chelsea, where he lived before becoming PM.
Nickie Aiken, Westminster’s cabinet member for children and young people, said: “We welcome the Prime Minister’s interest in improving central London education. We can assure him that our schools are delivering first-rate education every day.
“We are proud that several of our secondary schools are considered outstanding by Ofsted and that our nearest primary schools to Downing Street are also both rated outstanding. “We acknowledge that there is still room for improvement and will continue to strive to build on our success to date.
“We would be delighted if the current Prime Minister followed in the footsteps of his two immediate predecessors and sent his children to Westminster state primaries. We would welcome the opportunity to show the Prime Minister our schools in action.”
New hope for arthritis sufferers as pioneering stem cell treatment is to be tested on patients for the first time
Millions of patients suffering the agony of arthritis could soon benefit from pioneering stem cell treatment, scientists claim. They say the therapy could be used to help repair worn-out joints, which cause crippling pain and stiffness.
Scientists have come up with a technique of using stem cells to treat osteoarthritis – a disease which gradually wears down the cartilage in between bones.
More than eight million Britons suffer from this type of arthritis which results in the joints becoming inflamed, painful and stiff. In severe cases, the cartilage becomes so thin that the ends of the bone rub against each other causing them to be deformed.
But researchers say that stem cells taken from the patient’s bone marrow could be transferred to the infected joint to encourage growth of the cartilage. The cells would initially be removed by keyhole surgery and then put into a laboratory for three months allowing them to grow. They would then be implanted into the joint and scientists believe that over the course of a few months the cells would form new cartilage – drastically reducing the inflammation and pain experienced by the patient.
The scientists, from the University of Keele, plan to carry out the first human trial of the treatment later this year at the Robert Jones and Agnes Hunt hospital in Oswestry, Shropshire.
Around 70 people with osteoarthritis in their knees will take part. Doctors will monitor them over the course of the year looking at their cartilage and their ability to carry out day-to-day tasks.
The researchers hope that the treatment will be available for patients within the next five to ten years but they stress there is still a long way to go. Professor Sally Roberts, one of the leaders of the trial, said it was important not to see stem cells as a ‘miracle cure’. She added: ‘They certainly have huge potential. We just need to learn how to harness it properly.
‘Stem cells are portrayed as ” wonder cells” that can do anything but they can’t give you the joints of a 15-year-old. At the moment they are not the ”magic bullet” and they don’t solve the underlying problem of osteoarthritis which still needs to be addressed.’
Professor James Richardson, a co-leader of the study, said: ‘The benefit to the patient may be not to prevent the need for a joint replacement, but to prevent the need for a revision joint replacement.’
Stem cells are immature cells which can be removed from the body and turned into different types of tissue in the laboratory. They can then be used to replace dead or worn-out cells.
Osteoarthritis tends to affect people over the age of 40 and is far more common among women. There is currently no cure and patients generally take painkillers or anti-inflammatory drugs to control their symptoms. Each year around 60,000 hip replacements and another 60,000 knee replacements are carried out on the NHS, the majority due to osteoarthritis. The cost of surgery alone is £400million but far more is spent on treatments, GP consultations and physiotherapy.
Checking The Hockey Team
The third British investigation into the Climategate scandal — led by former civil servant Sir Muir Russell — amounts, at best, to a greywash. No reason, it claims, to doubt the honesty of the scientists related to the Climatic Research Unit of the University of East Anglia (which commissioned the review). However, buried within the review’s 160 pages considerable doubt is raised about the operations of both the CRU and the organization that it serves, the United Nations’ Intergovernmental Panel on Climate Change.
For anybody who wants to understand the scientific and psychological background to Climategate, there is no better read than Andrew Montford’s new book, The Hockey Stick Illusion: Climategate and the Corruption of Science.
Climategate was based largely on emails related to the so-called “Hockey Stick,” an iconic graph that purported to show that 20th-century temperatures were unprecedented in at least a thousand years. As Mr. Montford points out, “[T]he chief importance of the Hockey Stick lies not in that it is central to the case for man-made global warming, but in the fact that the IPCC promoted it as if it were.”
In other words, the real scandal lies in whoever was pulling the political strings of the IPCC.
The U.K.-based Global Warming Policy Foundation, an influential skeptical institution, has now appointed Mr. Montford to run an inquiry into the three British inquiries. There will be no whitewash here, although it will be fascinating to see how far Mr. Montford can penetrate into the Yes Minister nature of the investigations, whose guiding principle seems to have been that of the Three Wise Monkeys.
The Hockey Stick Illusion leaves no doubt about Mr. Montford’s reporting abilities. He tells a gripping detective story in which the star gumshoe is semi-retired Canadian mining consultant Steve McIntyre. Mr. McIntyre, unfortunately for his opponents, happens to combine mathematical genius with a Terminator-like relentlessness. He also found a brilliant partner in Ross McKitrick, an economics professor at the University of Guelph. Their story is one of intellectual determination in the face of Kafkaesque “peer review” and Orwellian “freedom of information.”
The Hockey Stick derived from the arcane science of paleoclimatology, which reconstructs pre-thermometer temperatures from proxies such as tree rings. The most oft-quoted of the Climategate emails referred to a “trick” to “hide the decline” in proxy data after 1960. Those post-1960 proxy figures not merely failed to correspond with actual temperature increases, they raised inevitable issues about past reconstructions. This was particularly important because the Hockey Stick had — conveniently — eliminated the Medieval Warm Period, when the Vikings were farming in Greenland.
If temperatures were as warm or warmer a thousand years ago, then the claim that 20th-century heat was unprecedented and due to rising levels of man-made CO2 was weakened. (And even if the 20th century was unprecedented, that still wouldn’t have “proved” man-made global warming. Correlation is not causation.)
The Hockey Stick reconstruction was led by an ambitious and aggressive young climatologist named Michael Mann of the University of Massachusetts. It was eagerly seized upon by the IPCC. Its prominence made Prof. Mann an academic star and the recipient of hefty research grants. In 2002, Scientific American named him one of “50 leading visionaries in science.”
However, Mr. McIntyre’s determined digging suggested that Prof. Mann’s conclusions rested on dodgy statistical manipulation of a tiny amount of data from a few unreliable proxy trees in very specific locations. It also led to two U.S. congressional inquiries, one of which Mr. Montford notes was flagrantly rigged.
Mr. Montford’s book might be accused of being one-sided, but Mr. McIntyre’s opponents emerge as an unresponsive clique who were hardly likely to co-operate with a narrative that had them lying, destroying data, and mounting vicious ad hominem attacks (such as that Mr. McIntyre had close links to the perpetually demonized “fossil fuel industry.” He didn’t.).
“The Hockey Team,” as Mr. McIntyre wryly called them, were also no credit to the scientific method. CRU head Phil Jones — whose emails were at the heart of Climategate — sent an amazing response to an Australian researcher asking why he should provide data “when your aim is to try and find something wrong with it.” But that is exactly why data and methods should be made freely available.
Messrs. McIntyre and McKitrick were in fact brought into the IPCC review process for the 2007 Fourth Assessment Report, but presumably mainly to keep an eye on — or muzzle — them. However, being involved in the process confirmed how rigged and conflicted it was.
Mr. Montford concludes that the Hockey Stick affair suggests that “the case for global warming, far from being settled is actually weak and unconvincing. The implications for policymakers are stark. They have granted an effective monopoly on scientific advice to an organization that has proven itself to be corrupt, biased and beset by conflicts of interest. Their advisors on the global-warming issue are essentially a law unto themselves ….”
Meanwhile, the hockey stick may be only one of many other examples of botched or manipulated science. “Who knows what other instances there are of arguments contrary to the IPCC consensus disappearing into the ether, of doubts suppressed and questions ignored?” asks Mr. Montford. “It is clear that it would be foolish in the extreme to give the IPCC the benefit of the doubt. Their record is too poor, the stakes too high.”
Mr. Montford’s book is required reading, but it only scratches the surface of the much bigger scandal. The Hockey Stick graph was used as a promotional tool for a political agenda. No inquiry has even begun to address the origins and nature of that agenda, which amounts to building a rationale for unprecedented global economic control. Prof. Mann writes in one of the Climategate emails about letting “our supporters in higher places” deal with Messrs. McIntyre and McKitrick. But who were these “supporters?” Another Hockey Team member, Keith Briffa, wrote: “I know there is pressure to present a nice tidy story as regards ‘apparent unprecedented warming in a thousand years or more in the proxy data,’ but in reality the situation is not quite so simple.”
Where was that “pressure” coming from?
The wholesale acceptance of the alarmist hypothesis by virtually the entire global political establishment and an overwhelming proportion of the world’s popular media also demands analysis.
Prof. Mann, who is now at Penn State, continues his campaign of bluster and demonization of those who would merely dare to ask questions. In an interview in the wake of the Russell report, he continued to deride the “malicious” and “dishonest” attacks on him by alleged “professional climate change deniers” and “contrarians” and “special interests.” (In the interview he exploded his scientific credibility by claiming that the current North American heat wave is proof of man-made global warming!)
Anybody who reads Mr. Montford’s book will understand that Prof. Mann’s charges of “well-funded” opposition are ludicrous. The only oversight of the Hockey Team was “provided by volunteers like McIntyre and his ragtag band of skeptic supporters.” But, as Mr. Montford points out, Prof. Mann’s strategy has always been to try to shout “louder and longer.”
Ultimately, Prof. Mann and his colleagues were merely foot soldiers in a bigger ideological thrust to use the environment as a rationale for assuming global economic control.
Mr. Montford writes of one of the early climate meetings that “One can almost detect the germ of an idea forming in the minds of the scientists and bureaucrats assembled in Geneva: here, potentially, was a source of funding and influence without end. Where might it lead?”
But it is unlikely that such thoughts were articulated as anything other than concern for the planet, and a burning desire to “speak up” for those who were most vulnerable to bad weather caused by materialism and greedy “fossil fuel interests.” The lust for power almost invariably cloaks itself in high moral purpose. What higher purpose could there be than saving the world?
Badly behaved children shouldn’t be excused
“Medical” conditions should not be blamed or used as an excuse for children’s bad behaviour
‘It’s not his fault, he’s got a disability,” said the mother as her son ran around the outpatient clinic causing mayhem. He had just upturned a table, sending magazines skidding across the floor. One of the receptionists began picking them up and looked at me, rolling her eyes.
“He’s got conduct disorder, you can’t blame him,” his mother continued as I ushered them into my room. While I was working in child psychiatry, I’d frequently see children such as this boy whom, to the casual observer, would be branded as “badly behaved”. But in medicine, extremes of such behaviour have in recent years attracted psychiatric diagnoses. They are now illnesses. Terms such as “school refusal disorder” and “oppositional defiant syndrome” (hostile and defiant behaviour to authority figures) are labels often given to children. But are these illnesses in the traditional sense? And, if so, what causes them?
A team based at Cambridge University, and funded by the Medical Research Council and Wellcome Trust, published research last week, which, it is claimed, suggests that abnormalities in the brain may be responsible for anti-social behaviour. This is of great importance because it helps to establish such behaviour firmly in the realm of psychiatric morbidity. The study, based on brain scans conducted on teenage boys who had childhood or adolescent onset “conduct disorder” (characterised by aggressive and anti-social behaviour) shared similar brain patterns – typically less activity in the parts of the brain associated with processing emotions.
I’m not sure that such a reductionist approach is helpful. While the implication is that abnormalities in the brain are the cause of the behaviour, this ignores the fact that our environment and experiences help shape these neurological connections. Are such defects present at birth or do they develop in response to external factors? The research cannot show if parenting skills impact on the presence of such abnormalities.
The sentiment that the mother voiced – that blame cannot be attributed to anti-social behaviour because it is a medical condition – is pervasive. Yet we must take responsibility for our actions, and surely children need to understand this. Of course, there are times when a diagnostic label can be beneficial. It helps professionals understand the problems, and enables access to services and interventions. But the downside to this is that the medicalisation of behaviour comes with a tendency to remove responsibility. Children suddenly become untouchable, beyond reproach or remonstration.
While children can only be held responsible for their behaviour to a degree because they are, after all, minors and are, by definition, still developing emotionally and morally, the medicalisation of behaviour absolves everyone from responsibility.
But the law sees things differently. Adults with anti-social behaviour have also been shown to have structural differences in their brains, but does this mean they can be excused when they break the law? Of course not. I think we’re doing children a disservice by giving them the impression that because they now have a medical label, they are unable to control their behaviour. After all, when they become adults, anti-social behaviour is dealt with legally, rather than medically. It also stops us asking about social and environmental factors. The brain may hold the key to our behaviour, but it’s not to blame for it.