Bed blocking epidemic in Scottish intensive care units
Thousands of beds in Scottish hospital wards earmarked for the most seriously ill patients are being ‘blocked’ by people well enough to be treated elsewhere, an official survey has found.
One in five beds in high dependency units (HDUs) and intensive care units (ICUs) are occupied by people who have a staged a recovery and are preventing other patients from taking their spot.
Auditors found that the scourge has reached record levels, with the proportion of blocked beds in the units almost doubling in five years to about 6,000 per year in 2009.
The report, by NHS Scotland, attributes much of the problems to a shortage of beds in other wards, meaning the patients cannot be transferred out of HDUs or ICUs when they are well enough.
However, it suggested Nicola Sturgeon, the Scottish health minister, was partially to blame for failing to set treatment targets in the units, akin to those already in operation in accident and emergency departments.
Health campaigners and politicians warned that lives would be risked unless the bottleneck is cleared as patients requiring high-intensity care may be prevented from getting a bed.
More than 30,000 seriously ill and injured people were admitted to critical care units in Scotland last year, including 9,760 to intensive care and 22,648 to high dependency units.
Margaret Watt, chair of the Scotland Patients’ Association, said: “This is quite unacceptable. These are very specialist units and they are needed for patients suffering from strokes, heart attacks and triple bypasses. “If there are no beds for patients in high-dependency units, then of course lives could be lost.”
The report, titled Audit of Critical Care in Scotland and published by the Information Services Division of NHS Scotland, analyses figures collected from last year. “There is a clear increasing trend to nearly 20 per cent of all critical care discharges in Scotland being delayed,” the authors found.
“The main factor causing delay is lack of available beds in (other) hospital wards. But we again highlight that critical care discharges do not have a time-related government target in contrast to Emergency Department patients.”
Miss Sturgeon has said 98 per cent of patients should be treated within four hours of arriving at accident and emergency.
The report’s statistics show 18 per cent of people admitted to ICUs last year ended up blocking beds. This represented an increase from 14 per cent in 2008 and nine per cent in 2005. For HDUs, the proportion of ‘delayed discharges’ increased from 11 per cent five years ago to 15 per cent in 2008 to 19 per cent last year.
The report says the increase can be partly explained by a change in the way the data was collected as previous years’ figures were probably an underestimate.
But it makes clear the main reason is “the lack of step-down beds” in other wards and this is a “major problem” that results in patients being transferred in the middle of the night when a bed becomes available.
About a third of bed-blocking cases in ICUs arise because of a shortage of beds in HDUs, where they are supposed to be transferred when they make a partial recovery.
A Scottish Executive spokesman said: “We expect health boards to look at their figures and take any action they think is necessary to maintain continuous improvement.”
Work experience at Britain’s Foreign Office? Not if you’re a middle class white male
William Hague was last night plunged into a row over new Foreign Office rules which ban white males from gaining work experience at his department. The Foreign Secretary was challenged to explain why his official work placement schemes specifically ban white, middle-class males from applying for the £367-a-week positions.
Under the tightly-drawn rules, only women, people from ethnic minorities and the disabled are entitled to apply for a chance to work at one of the great offices of state.
The placements give students a head start in the battle to win coveted jobs in the diplomatic service and possibly rise through the ranks to become an ambassador.Only one category of non-minority male applicants stand a chance – those whose families are poor enough to entitle them to qualify for a full student maintenance grant.
The bizarre ‘middle-class male’ ban came to light after Tory MP Dominic Raab was contacted by an irate constituent who tried to obtain work experience at the department.
Esher MP Mr Raab, an international lawyer who worked at the Foreign and Commonwealth Office (FCO) for six years, said last night: ‘I am raising this issue on behalf of a disappointed constituent barred from even applying for Foreign Office work experience because he did not fit the social quota criteria.
‘We surely need to scale back the unfair political correctness of the last Government. But we will not end discrimination in our society by introducing it through the back door, which is what positive discrimination like this does.’ Mr Raab has now written to Mr Hague asking him to intervene and review the work placement rules.
The Foreign Office, which employs 20,000 staff in the UK and around the world, operates three work placement schemes:
* A summer development programme open to ‘talented individuals’ from black or ethnic minority backgrounds;
* A summer placement scheme for ‘talented students’ with a registered disability; and
* A university placement scheme open to female students, students from an ethnic minority background and students who come from a household with an income of £25,000 or lower.
Westminster sources last night said the programmes came about after Robin Cook, the former Labour Foreign Secretary, arrived at the Foreign and Commonwealth Office’s headquarters in Whitehall and was horrified to see so many former public schoolboys working there.
Last night, the FCO insisted the schemes were legal and were designed to appeal to students who might not normally consider a career in the FCO. A spokeswoman said: ‘This includes students from an ethnic minority background and those with a disability, as well as students who are in receipt of a full maintenance grant.’
The spokeswoman added: ‘People from these backgrounds are currently under-represented in the FCO. ‘We believe that by having a more diverse and multicultural workforce the FCO is better able to represent British interests around the world.’
There was ‘absolutely no discrimination’ in the department’s normal job recruitment process, she insisted. But in a later statement, the FCO said the work experience schemes would now ‘be placed under review’.
How the value (but not the cost) of publicly-provided British services plummeted under Labour rule
The value for money given by public services collapsed in Labour’s final years in power. The more taxpayers’ money was thrown at the Health Service, schools, local government and social services, the less efficient they became, according to official figures yesterday.
The first estimates for how the public sector performed in 2008 showed that productivity in the the most costly public services went down as Gordon Brown pumped more money in.
During 2008, they showed, spending on public services went up by 2.8 per cent but output rose by only 1.9 per cent. The figures mean there was a 0.9 per cent fall in value for money from public services. The decline in efficiency was three times faster in 2008 than the average productivity drop during Labour’s years in power.
Calculations made by the Office for National Statistics showed that overall, the value for money given by the public sector dropped by 3.3 per cent between 1997 and 2008. The decline in efficiency came as public spending almost doubled from £318 billion a year to £621 billion last year.
The dismal performance of the public sector compares with a clear record of growing efficiency in private business and industry.
Although ONS officials warned yesterday that strict comparisons are hard to make, their own analysis suggests that productivity in market-sector enterprises rose at more than 1 per cent year from 2001 to 2007. Some independent estimates show that private-sector productivity went up by more than 25 per cent during Labour’s years in power.
The comparisons cast an alarming light on the scale of public sector spending, and in particular salaries. Pay for public sector workers has for several years been rising much faster than for their counterparts in private industry.
In particular public sector managers have been paying themselves spiralling salaries, claiming this is justified by their record of achievement.
Hundreds of officials in the NHS, local councils and the education system now earn more than £200,000 a year and local government managers’ pay has, according to Whitehall estimates, been rising at double the rate of managers’ pay in the private sector.
Yesterday’s productivity assessment brought fresh condemnation from experts. Ruth Lea, economist for the Arbuthnot Banking Group, said: ‘We know that money was thrown at the public services after 2000 without the necessary reforms that should have taken place.
‘These figures are confirmation of what we have known for some time. There has been a lot of money very badly spent in the public sector. ‘It has been wasted and this must be laid at the feet of the Labour government. The challenge for the Coalition is to reverse the decline.’
ONS analyst Katherine Mills said: ‘The public sector is responsible for a fifth of UK output. Everyone is a potential user of public services and has a legitimate concern over how they are provided.’
“Special needs” is a fad that harms British children
Pupils are being subjected to all manner of crank treatments in the name of helping them, says Francis Gilbert
Twenty years ago, when I started teaching in a tough, inner-city comprehensive, only three of my pupils were labelled as having “special educational needs”. All three were extreme cases: one girl liked to throw chairs at her teachers, another had severe hearing problems, and another didn’t have a working stomach.
Today, things have swung to the other extreme: classrooms are swamped by pupils classified as “SEN”, or having learning difficulties. All told, one in three of those aged between six and 16, or more than two million children, are identified as having some sort of learning difficulty. And it’s getting worse: in the past two years, the number of under-fives with learning difficulties has risen by almost 20 per cent, and the number of teenagers being diagnosed has also increased exponentially.
Why is this? Is it that our children have got a lot thicker? Are teachers getting better at identifying problems? Or is some kind of chronic “SEN” inflation going on?
Partly, the explanation is medical. A recent survey by Glasgow University showed that babies born even a week early have a greater propensity to develop special needs. Overall, eight out of 10 severely premature babies go on to have learning difficulties, with two out of 10 having a severe disability. Even a decade ago, many such children would have died; with today’s improved survival rates, they will grow up to enter the education system.
At the same time, teachers are undoubtedly getting better at spotting SEN. There are, of course, huge variations from school to school, with some, particularly in more deprived areas, identifying as many as 70 per cent of their pupils as such. To my mind, they are justified in doing so, because there is a clear link between social deprivation and what we call SEN: poverty breeds students who really struggle to read and write. In that inner-city classroom I mentioned, alongside the three children labelled as having special needs there were many others who struggled to read even simple picture books. Nowadays, most would be diagnosed as having SEN. And with good reason – they needed a lot of extra help.
It’s a moot point, however, as to whether they have genuine difficulties, or are just the victims of parents who don’t value education. These parents usually hate their child being labelled in this way, and cause more problems by making their children feel ashamed of their diagnosis. At the other end of the social scale, I’ve found that many middle-class parents are chomping at the bit to have their child dubbed SEN. In fact, increasing numbers of pupils don’t seem to have any learning difficulties whatsoever. What they do have are pushy parents who know that a SEN diagnosis means that their kids will get preferential treatment: extra time in exams, more attention from teachers, and even special equipment like laptops and MP3 players.
That said, many teachers, myself included, like to “work the system”, too. We realise that having a child diagnosed as SEN is greatly to our benefit because it means that we get extra resources – and it also lets us off the hook if they fail their exams.
In other words, pupils categorised as having special needs have been wrongly labelled: a government survey of teenagers classed as having SEN in 2009 showed that almost half had no such diagnosis six years earlier. A particularly worrying trend is the increasing numbers of children who are being identified as having attention-deficit hyperactivity disorder (ADHD), a phrase which in the teaching profession is a politically correct euphemism for “being completely out of control”.
According to data released under Freedom of Information legislation, there has been a 65 per cent increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer more than £31 million a year. In the US, the use of prescription drugs to “cure” learning difficulties has become a billion-dollar industry.
This “medicalisation” of SEN is deeply worrying; it promotes the lie that a child’s learning difficulties can be solved by drugs rather than good teaching. It’s meant that all sorts of self-help quacks are grabbing money from schools and gullible parents by promising to “cure” children with herbal remedies, head massages, visualisation techniques, brainwave measurement, or the chanting of mantras.
All of which makes me think that perhaps it’s time to junk the term “Special Educational Needs” altogether, along with much of the jargon that goes with it. Sadly, these terms have become excuses to hide behind rather than steps towards solutions. Instead bandying around vague pseudo-scientific terms like “dyslexia” and “ADHD”, we need to demand that learning difficulties are identified simply and specifically. If a pupil has a problem with reading books aimed at their age range, let’s call it precisely that, rather than saying he’s “dyslexic” – a notorious word that seems to mean something different every time it’s used.
It’s time we all realised no amount of jargon, drugs or massages can solve our children’s problems. The only real solution, as it always has been, is hard graft.
The “Times” of London going green?
Their new “pay to view” regime could be making them desperate to get new classes of readers. But it might lose them readers too. I just read the Daily Telegraph and the Daily Mail these days and feel no loss at all
To the colourful Daily Telegraph blogger James Delingpole, it was winner of the coveted award for the “Biggest front page non-story in history of journalism”. What he was referring to was a tale published a week ago under the by-line of The Times’s enviromment correspondent Ben Webster which led the paper, covering virtually the entire front-page and with a whole further page inside, beneath the huge headline “Oil giant gives £1 million to fund climate sceptics.”
Everything about this story was bizarre. Its essence, based on information which as Webster told us was had been supplied by Bob Ward, policy director of the Grantham Institute on Climate Change, was that Exxon Mobil, the world’s largest oil company, last year gave “almost £1 million” to four US think-tanks.
These hired lackeys had then shamefully gone on to describe the various official inquiries into the Climategate emails scandal as “whitewashes”, apparently citing them as evidence that the dangers of global warming had been “grossly exaggerated”.
The story concluded by suggesting that Exxon Mobil had clearly corrupted these four venal think tanks into giving “the oil company at least another year of freedom to reap the profits of its high-carbon strategy”.
The most obvious puzzle was why this remarkably tenuous tale should have been put by The Times on its front page, presumably rating it as the most important news of the day. The evidence assembled by Mr Ward, who had apparently “been monitoring Exxon’s links to sceptic groups,” hardly seemed to stack up even in its own terms.
One think-tank had apparently received $50,000 last year, another had also received $50,000 – but how all this added up to “almost £1 million” in the past 12 months was far from clear. Furthermore, none of these think-tanks had really been anything but bit-players in the great ongoing row over Climategate.
Not one of the knowledgable sceptics who have torn those reports apart in detail, led by Steve McIntyre on Climate Audit, has ever received a cent of funding from “Big Oil”. And what makes all this particularly laughable is that the penny-packets given to think-tanks which were almost wholly irrelevant to the debate are utterly dwarfed by the colossal sums poured into all the groups and organisations on the other side of the argument.
Even the big oil companies have long since been putting their real money into projects dedicated to showing how they are in favour of a “low carbon economy”. In 2002 Exxon gave $100 million to Stanford University to fund research into energy sources needed to fight global warming. BP, which famously rebranded itself in 2004 as “Beyond Petroleum”, gave $500 million to fund similar research.
In fact two things made The Times’s grotesque overblowing of this story rather much more interesting than many Times readers might have guessed. The first was the fact that the origin of the story was Bob Ward, who has in recent years become familiar to followers of the climate debate as a tireless advocate in the media for warmist alarmism.
Looking raather like a night-club bouncer, though not so polite, Mr Ward seems to have set himself up as a professional attack dog for the cause, harrying anyone who dares publicly to promote scepticism by any means he can find.
He used to work in this capacity for the fanatically warmist Royal Society, in which role, in 2007, he organised a voluminous series of complaints to the regulatory body Ofcom, signed by “37 professors”, against Channel 4’s documentary The Global Warming Swindle. A year later, after wasting huge quantities of everyone’s time, Ofcom failed to uphold any of Ward’s complaints.
Since then Mr Ward has been employed in a similar capacity by the Grantham Institute on Climate Change at the LSE, where he acts as policy director alongside its chairman Lord Stern. Formerly Sir Nicholas Stern, this ex-Treasury official has, since his famous but much derided 700-page report in 2006, become one of the real high-priests of the warmist religion. And he has made a fortune from touring the world to advise mankind on how to reduce its “carbon footprint”.
Since he joined the Grantham Institute, Mr Ward has not only written countless letters to the press and appeared frequently on TV, he has also launched a number of similarly time-wasting complaints to the Press Complaints Commission against articles by climate sceptics such as myself.
Mr Ward’s employer, the Grantham Institute, is backed by significantly big money. It was set up in two parts, one under Lord Stern at the LSE, the other run by another committed warmist Sir Brian Hoskins at Imperial College, funded with £24 million from Jeremy Grantham, an investment fund billionaire. Its chief purpose is to advise governments, firms and investment funds on how to promote and invest in ways to “fight climate change” – which is now of course one of the fastest-growing and most lucrative industries in the world….
How The Times’s front-page headline might rather more relevantly have been re-worded was “Governments, foundations, multi-national corporations including the owners of this newspaper and Big Oil give hundreds of billions of pounds to promote worldwide climate bonanza.” But doubtless The Times’s editors would have ruled that this was too long for their front page.