Out-of-hours care ‘falling short of standards’
More than one in 10 urgent out-of-hours cases are not being clinically assessed by doctors within the required 20 minutes, a new report shows. In some areas the figure is as high as four in 10, according to the study, which was commissioned by the Department of Health.
It found some out-of-hours services do not have “safe and effective” systems for prioritising urgent calls, while a number of urgent cases are being missed altogether.
The research, which covers almost 100 of the 150 primary care trusts (PCTs) in England, was carried out by the independent Primary Care Foundation. Although it covered Christmas week last year when demand for services was high, this was no higher than expected and “followed a predictable pattern”.
Most providers failed to meet at least one key standard on out-of-hours care laid down by the Department of Health, it found. Under its guidelines, calls to out-of-hours services should be prioritised into one of three groups. Life-threatening emergencies should be passed to the ambulance service within three minutes.
With urgent cases, a clinical assessment should start within 20 minutes of the out-of-hours provider phoning back after the initial call. With non-urgent cases, that assessment should start within 60 minutes. However, the report found that almost a quarter (24 per cent) of non-urgent cases were not clinically assessed within an hour.
More than half of providers were failing to meet a requirement that, where “clinically appropriate”, urgent cases receive a face-to-face consultation within two hours.
The report also highlighted the “wide variation” of patients defined as needing urgent care, ranging from almost zero to more than 50 per cent. “Some services have so few cases identified as urgent on receipt compared with others that we doubt they can demonstrate they have a clinically safe and effective system for prioritising calls,” it noted. “Some services need to review prioritisation to ensure that they are not at risk of missing urgent cases when they are received.”
Too many cases ended up being “escalated” to urgent status because patients’ illnesses had initially been underestimated, the authors warned, while too many patients were being “double assessed”, which wasted time. Additionally, there was “wide variation” around the country in the numbers who received home visits, were offered telephone advice or told to report to an out-of-hours unit.
The Department of Health stipulates that out-of-hours providers “have to demonstrate 100 per cent compliance” with its standards. Where the average performance is more than 10 per cent below the requirement, services are regarded as “non-compliant”.
Henry Clay, one of the report’s authors, said out-of-hours standards were “way higher” than in other areas like accident and emergency.
A Department of Health spokesman said: “We are determined to urgently reform out of hours care, and that is why the coalition Government has set out proposals to transfer commissioning of local health services, including out of hours care, to GPs.”
Unstoppable social worker evil in Britain
In 43 years of medical practice, said the family’s GP, he had “never encountered a case of such appalling injustice”. To their neighbours, it was so shocking that up to 100 of them were ready to stage a public protest, until being banned from doing so by social workers and the police.
This was the case of Tony and Debbie Sims, which I first reported in July 2009 under the headline “’Evil destruction’ of a happy family”, and whom I can now name because their daughter, torn from them for no good reason, has finally, after three years of misery in foster care and 74 court hearings, been adopted.
The story of Mr and Mrs Sims was my first introduction to that Kafka-esque world of state child-snatching which I have so often reported on since. It illustrates so many of the reasons why, hidden behind its self-protective wall of secrecy, this ruthless and corrupt system has become a major national scandal.
Until April 2007, Mr Sims, a professional dog breeder, and his wife, then a branch vice-chairman of the local Conservative Party, were a respectable middle-class couple living happily with their five-year-old daughter, who was the apple of their eye. Shortly after Mr Sims was interviewed by the RSPCA over his unwitting infringement of a new law banning the tail-docking of puppies, their home was invaded by two RSPCA officials and 18 policemen, who had been given a wholly erroneous tip-off that there were guns on the premises.
When the dogs were released from their kennels and rampaged through the house, ripping apart his daughter’s pet boxer, Mr Sims strongly protested – verbally but not physically. He and his wife were arrested and taken away, leaving their little girl, aged five, screaming amid the chaos. Social workers were called and the child was removed into foster care. While Mrs Sims was being held for several hours in a police cell, she had a miscarriage. She returned home that night to find her daughter gone.
When the couple next saw their child – months later, at a “contact” – she said she had been told they were dead and had gone to heaven. For three years they tried to get her back through those 74 court hearings. The social workers claimed the child had been maltreated, because her home was an unholy mess. But this was only because of the police raid and the dogs – a WPC who had visited the house a month earlier on other business reported that it had been “neat and tidy”.
The child could not understand why she was not allowed to go back home with her parents. The courts were unable to consider a report by an experienced independent social worker which the couple were told described them as responsible and loving parents. The only evidence the court heard was that from the social workers and their own “experts”.
When the couple were eventually told that their child would be adopted, they appealed. In a judgment last year, which the media were permitted to report, Mr Justice Boden ruled that because the parents had not shown sufficient co‑operation with the authorities (after four psychiatric assessments of the couple, the father refused to submit to a fifth), the adoption had to go ahead.
One of the first people to contact the parents when this was made public was that independent social worker, who expressed astonishment, saying he had assumed that, because the social workers’ case seemed so flimsy, the family would have long since been reunited. Last week, however, Mr and Mrs Sims had a two-sentence note to say their daughter has now been adopted.
Since I first wrote about this case in 2009, I have come to recognise many of its features in dozens of others I have followed: the mob-handed involvement of the police; the seizing of children for no good reason; the inability of social workers to admit they have made a mistake; the way lawyers supposedly acting for the parents seem to be on the other side; the refusal of judges to look objectively at all the evidence, and their willingness to accept nonsense if told to them by social workers and their “experts”. Too often, these proceedings get away with standing every honourable principle of British justice on its head.
Such is the Frankenstein’s monster created by Parliament in the 1989 Children Act. Yet apart from the tireless John Hemming, and a handful of other MPs shocked into awareness by individual cases in their constituencies, the majority seem wholly unconcerned. So what do we pay them for?
Salary bar to be £40,000 for highly skilled migrant workers
Highly skilled workers from outside the European Union will have to be coming to a job in Britain paying them at least £40,000 a year under new government plans.
The proposals are to be unveiled this week as ministers reveal the first annual “cap” on immigration into Britain which will apply from next April.
Last week Professor David Metcalf, chairman of the independent Migration Advisory Committee, recommended a total limit of between 37,400 and 43,700 workers a year from outside the EU. Mr Metcalf also recommended a 13 to 25 per cent cut in the number of “Tier 1” highly-skilled workers and “Tier 2” skilled migrants coming to the UK, despite worries from employers that they will be unable to fill key posts.
The Sunday Telegraph understands that under current plans Tier 1 migrants will in future have to come into a job paying at least £40,000 a year – putting the large majority of them into the 40 per cent tax bracket – with a contract for at least 12 months. New categories of Tier 1 immigrant will be unveiled including “investor”, “major businessman” and “special talent.”
In June, the Home Office introduced a temporary limit of 24,100 workers to enter the country before April 2011, when this cap will be replaced by permanent measures.
Any increase in overall numbers allowed in will be seen as a victory for Vince Cable, the Business Secretary, who has protested on behalf of employers that they must be allowed to attract the best talent from overseas.
Mr Cable said two months ago he was being warned by business leaders that companies were relocating overseas because of what they saw as harsh restrictions in Britain from employing people from outside the EU.
The issue is one of the biggest fault lines between Conservative ministers and their Liberal Democrat coalition partners.
In the last year of the Labour government, net migration – the number of people coming to live in Britain compared with those emigrating – stood at almost 200,000. The coalition has pledged to at least halve this by 2015 – largely by cutting down the number of skilled workers.
Some promising new policies for British schools announced
Two truly radical initiatives were announced by the Government last week that made less of an impact on public discourse than they deserved. Almost lost to view amid the jubilation over The Wedding, and the spectacular vindication of the Eurosceptic cause, these proposals could have as tumultuous an effect on Britain’s future as any political reforms in the past half-century.
The first had such a brief spell in the limelight – before being swept away in a tide of engagement-ring photos – that it may yet have escaped the notice of most of the population. This was Michael Gove’s statement that all schools will be able to apply for academy [charter] status if they affiliate themselves with a school that has been judged to be “outstanding” by Ofsted.
The implications of this seemingly small step are at least as significant as the new emphasis on grammar and spelling to be promised in the White Paper. While initially only outstanding schools could become academies and thus be liberated from local education authority control, now any school will be able to do so provided that it is prepared to join with another that has proved itself to be successful and – most important – competently led.
At a stroke, this permits good schools, and good head teachers, to extend their influence over poorer ones. It makes a reality of what every government has hoped to achieve in education: spreading “best practice” throughout the system, pulling the standards of under-performing schools up to the level of better ones by allowing the best to become active mentors to the others.
In logistical (and political) terms, it will avoid what might have been a damaging effect of the free schools policy. Instead of poor schools having to be seen to fail, in a long, painful process of losing student numbers through parental choice and thus losing funding – with their gradual decline becoming a source of national shame and local outcry – those schools that might have died a lingering death may now save themselves by being adopted by a successful one.
No one can pretend that this solution will be unproblematic. Will the outstanding school actually take over the less good one? Will this oblige it to absorb disruptive pupils or incompetent staff? Or alternatively, might the association be so nominal that it will have little effect on the standards of the poorer school?
But coupled with Mr Gove’s other neglected pronouncement – that education funding is to be handed direct to schools, thus avoiding the overweening political influence of local education authorities – this measure just might help to achieve a stunning improvement in the quality of state education. Of course, such school affiliations will require the sincere desire to improve on the one hand, and a genuine commitment to offer guidance on the other, but these will be the responsibility of heads and teachers: the Gove mechanisms are offering as great an opportunity for national educational improvement as any politician could humanly manage.
Remarkably consistent with this move toward self-reliance and mutual assistance among schools was the second of last week’s policy launches: what has become known, inevitably, as the “John Lewis” model for restructuring public services. Offering an invitation – and even a small pot of start-up money – to public sector staff willing to take over and run the hospital, job centre or whatever in which they are employed, is a move of stunning political bravery.
Not that the concept is all that original in itself. (It has an ancestor, after all, in the co-operative movement.) Labour actually put a tentative, under-publicised toe in the water of mutualism as a formula for more productive and efficient public services, but it lacked the conviction to present the idea with anything like the gusto and evangelical commitment with which Francis Maude is now selling the Tory version.
The basic theory is simple and incontrovertible: staff who are what John Lewis calls “partners” in the enterprise – who share ownership of it and benefit directly when it is doing well – have a stake in its efficiency, productiveness and popularity with clients of a kind that no time-serving employee is likely to possess. This would also have the effect of “localising” the service and making it more responsive: staff who knew and understood the needs of their own community would be free to adapt their approach to suit those specific requirements, rather than simply carrying out impersonal diktats passed down from central government. (This is a consistent government objective: the Communities Secretary, Eric Pickles, wants to devolve planning power from politicians down to real people in real neighbourhoods.)
Again, there are some obvious risks which the Government, in spite of its eagerness to be un-prescriptive – to go for bottom-up suggestions rather than top-down formulae – will have to guard against. When an earlier Conservative government ordered councils to disband their direct labour forces and take competitive bids for contracted work instead, too many of them simply permitted their labour gangs to form “companies” whose tenders for council contracts were, mysteriously, always successful. So the same old people ended up doing the same old jobs with as little enthusiasm as ever.
If employees are to bid to become owners and managers of a service-providing business, then they must, like the staff of John Lewis, be exposed to real competition in something like a real marketplace. Otherwise, this whole venture will end up as nothing but a species of producer capture. But mention the words “market” and “competition” and you bring a sneer to the lips of Labour/trade union axe-grinders. How can anything as crass as the principles of retailing be applied to areas such as health and social services? Getting access to chemotherapy isn’t like buying cereal, they breathe piously.
Except that, in the terms which we are discussing, it might be better if it was: why shouldn’t medical treatment and social care involve more informed choice and more respect for individual preferences? This is not about “privatisation”. It is about creating an analogous kind of power to the one people are accustomed to exercising as consumers.
There is a theme here. From its welfare and education reforms to a revolution in the running of public services, the Government has a Big Idea which involves personal freedom within the bounds of community responsibility. This is worthy of all the attention we can give it.
British teachers given a few new powers to discipline pupils
Teachers will be given new powers to discipline pupils as part of a government plan to restore order in classrooms. An education white paper being published next week will give school staff the right to confiscate mobile phones, iPods, MP3 players and other electronic gadgets. For the first time, teachers will be able to search pupils for any item they believe troublemakers can use to cause disruption during lessons.
The move follows a series of incidents in which pupils have taken photos and videos of teachers then uploaded compromising images on to the internet. Last year, Peter Harvey, a science teacher, attacked a 14-year-old boy after being goaded by students who covertly filmed the episode on a camera phone.
Michael Gove, the Education Secretary, warned that the balance of power in schools had shifted in recent years, with teachers “living in fear of breaking the rules while troublemaking students felt the law was on their side”. The reforms, which are designed to tackle bad behaviour, will give staff the power to search pupils for any item, including legal highs, pornography, cigarettes and fireworks.
Previously, teachers could only frisk pupils’ clothes and search bags without consent for weapons, drugs, alcohol and stolen goods. The white paper will also set out plans to:
* Simplify rules on the use of physical force, giving teachers more powers to remove disruptive children from the classroom without fear of legal action;
* Protect teachers from false and malicious allegations made by pupils and parents, giving them anonymity until a case reaches court;
* Give head teachers the power to expel pupils from school without the decision being overturned by an independent appeals panel;
* Allow teachers to impose “same day” detentions, scrapping rules that require schools to give parents a 24-hour warning;
* Introduce rules giving head teachers the ability to punish pupils for bad behaviour outside school.
Mr Gove said teachers “had to be respected again”. “Under the last Government’s approach to discipline, heads and teachers lived in fear of breaking the rules while troublemaking students felt the law was on their side,” he said. “We have to stop treating adults like children and children like adults. “We will ensure that the balance of power in the classroom changes and teachers are back in charge.”