NHS ‘wasting billions with no benefits for patients’ on cash incentives for GPs
Paying GPs cash incentives to improve healthcare often fails to produce the desired results, a damning report says today. It accuses the NHS of wasting billions on ‘pay-for-performance targets’, which allow family doctors to supplement their incomes.
The study’s conclusions are based on a multi-billion pound plan to lower patients’ blood pressure, which had ‘no impact’ on cutting heart attacks and strokes.
Pay-for-performance targets were introduced by Labour in 2004 at a cost of £1.8billion a year as part of a new contract for GPs. Around one-third of their average income – currently £105,000 a year – is linked to achieving these targets. But the study found they did not help patients with high blood pressure and provides the strongest evidence yet that pay-for-performance offers little benefit.
The Government has pledged to reform the way GPs are paid for this type of work in the face of increasing criticism. They are to receive sweeping new spending powers under Health Secretary Andrew Lansley’s controversial reforms and will form consortia to replace the soon to be abolished Primary Care Trusts.
Dr Brian Serumaga, a Harvard Medical School fellow working at Nottingham University, and a team of experts investigated 470,000 patients with hypertension (high blood pressure) at 358 UK general practices.
They looked at various blood pressure measures between January 2000 and August 2007, before and after the Quality and Outcomes Framework (QOF) incentive scheme was introduced. The study found no change in the amount of blood pressure monitoring or in success in getting readings down. There was a rise in the number of patients receiving medication, but this was not because of the scheme.
The targets had no ‘identifiable impact’ on strokes, heart attacks, kidney failure, heart failure or deaths among patients starting treatment before 2001 and another sub-group of patients whose treatment started after the QOF. The study findings are published in the online journal bmj.com.
Around half of people aged over 50 have hypertension, which is one of the most treatable, but under-treated risk factors for heart disease and strokes.
Meeting blood pressure targets contributes around 8 per cent of QOF income. Other QOF areas include management of conditions such as heart disease, kidney disease, and epilepsy, as well as monitoring smokers and obese patients.
Dr Serumaga said: ‘No matter how we looked at the numbers the evidence was unmistakable. To date, there is little evidence of the effectiveness of pay-for-performance targets.’
Rachel Elliott, of Nottingham University, said: ‘These results show clearly the QOF programme hasn’t helped people with hypertension, despite increased prescribing of medicines. In a time of constrained budgets, policymakers need to consult evidence so they don’t introduce new initiatives that cost huge amounts of public money and don’t work.’
But Dr Laurence Buckman, chairman of the GPs committee of the British Medical Association, said the QOF wasn’t ‘simply an incentive scheme’. It was also designed to pay work by GPs that previously wasn’t funded, to help reduce inequalities in health care between areas and to improve public health over the long-term.
‘The QOF is still relatively new,’ he said. ‘Other studies have shown that it has improved care and treatment for people with diabetes and reduced the number of heart attacks and deaths, particularly in deprived areas. We expect the true gains will be seen in the long-term.’
The Department of Health said: ‘The QOF and other incentives for GPs are insufficiently focused on outcomes, including patient experience. ‘We therefore intend to reform the payment system so that GPs are rewarded appropriately for improving patient outcomes.’
British schools are lovely and the system isn’t broken, say Left-wing teachers. Have they been brainwashed?
By Katharine Birbalsingh
There is something very strange going on. For over a decade all I ever heard from teachers was about how hard the job was, how the children’s behaviour was shocking, the management poor, the system restrictive. Indeed, many left the profession because of it. Others stayed, disillusioned and fed up but soldiered on as best they could. Now, suddenly, at conferences and the like some teachers insist on declaring how happy they are, how lovely our schools are, and how the picture I paint of a “broken system” is one they simply do not recognise.
Have these teachers been probed by aliens?
Charlie Carroll, author of the recently published On the Edge, has written a remarkable account of his journey as a teacher through some of Britain’s toughest schools: thirty-eight to be precise. To quote the back of the book: “I cannot count how many times I have been told to f— off by a pupil.” Charming. Yet the teachers Charlie meets these days (in the papers or on the radio) paint a portrait of calm and dedicated learning in our schools.
Charlie tells me that he too has had the same experience: that before, all over the country, not just in these dreadful schools, but everywhere, he would hear from teachers crying out to be heard. And now that they have their chance… silence! Not a word. What on earth is going on?
Charlie’s book is well worth a read if you can stomach the constant misery of his existence as a supply teacher. Like some kind of educational suicide bomber, Charlie loads up his van and scours the British Isles in search of adventure, or death… one is never quite certain. Nottingham, Manchester, Birmingham, The Peak District (yes, I did say The Peak District), Sheffield, West Yorkshire, London, The West Country, (giving a break to the madness and sees Charlie in a good school), Liverpool, and Middlesbrough all manage to get a look-in on this journey only fit for fantasy television.
Because that’s how shocking it is. Even with my “inner city” experience I didn’t quite realise just how terrible some of our schools are. It made me feel positively wretched, especially in light of my recent escapades, arguing with half of Britain, trying to persuade them that the system is indeed broken. “Just read Charlie Carroll’s book!” is what I want to say, but I know they’ll just laugh and tell me that his experiences aren’t representative of the whole. Too right they aren’t. I have never worked in schools like the ones in his book. It is as if Charlie’s schools jumped straight out of a horror film, only that the true horror is that they are just down the street from where you live.
The book is packed full of all sorts of statistics that you’ll find fascinating if you’re interested in education. And you’ll enjoy the running commentary given by Charlie, telling it as it is, from a real teacher, on the frontline. Here I was thinking I was on the frontline. But, no, I wasn’t. So many of our nation’s children have been left to rot in schools that we have abandoned. But apparently I’m mistaken to claim that our education system is broken.
Charlie Carroll not only taught in them – he found the energy and dedication to write about his experiences. Why? Because he wanted us to know the truth. No doubt, like me, he naively thought that if he could just tell them, and that if he could just let people know what’s happening, someone might do something about it. Little did we realise that great numbers of people would turn a blind eye and deliberately ignore the truth because it is easier to believe the lie.
Charlie Carroll still works as a teacher. His real name remains a secret. Lucky him. He’s still entitled to his life as it was. He wasn’t as foolish as me to get up at the Conservative Party conference and shout the truth out loud. Instead, he has written it in his book, On the Edge. If you want to know just how bad our schools can get, On the Edge is a must-read.
The BBC became a propaganda machine for climate change zealots, says Peter Sissons… and I was treated as a lunatic for daring to dissent
Institutionally biased to the Left, politically correct and with a rudderless leadership. This is Peter Sissons’ highly critical view of the BBC in his new memoirs, in which he describes his fascinating career over four decades as a television journalist. Here, in the latest part of our serialisation, he reveals how it was heresy at the BBC to question claims about climate change
My interest in climate change grew out of my concern for the failings of BBC journalism in reporting it. In my early and formative days at ITN, I learned that we have an obligation to report both sides of a story. It is not journalism if you don’t. It is close to propaganda.
The BBC’s editorial policy on climate change, however, was spelled out in a report by the BBC Trust — whose job is to oversee the workings of the BBC in the interests of the public — in 2007. This disclosed that the BBC had held ‘a high-level seminar with some of the best scientific experts and has come to the view that the weight of evidence no longer justifies equal space being given to the opponents of the consensus’.
The error here, of course, was that the BBC never at any stage gave equal space to the opponents of the consensus.
But the Trust continued its pretence that climate change dissenters had been, and still would be, heard on its airwaves. ‘Impartiality,’ it said, ‘always requires a breadth of view, for as long as minority opinions are coherently and honestly expressed, the BBC must give them appropriate space.’ In reality, the ‘appropriate space’ given to minority views on climate change was practically zero.
Moreover, we were allowed to know practically nothing about that top-level seminar mentioned by the BBC Trust at which such momentous conclusions were reached. Despite a Freedom of Information request, they wouldn’t even make the guest list public.
There is one brief account of the proceedings, written by a conservative commentator who was there. He wrote subsequently that he was far from impressed with the 30 key BBC staff who attended. None of them, he said, showed ‘even a modicum of professional journalistic curiosity on the subject’. None appeared to read anything on the subject other than the Guardian.
This attitude was underlined a year later in another statement: ‘BBC News currently takes the view that their reporting needs to be calibrated to take into account the scientific consensus that global warming is man-made.’ Those scientists outside the ‘consensus’ waited in vain for the phone to ring.
It’s the lack of simple curiosity about one of the great issues of our time that I find so puzzling about the BBC. When the topic first came to prominence, the first thing I did was trawl the internet to find out as much as possible about it.
Anyone who does this with a mind not closed by religious fervour will find a mass of material by respectable scientists who question the orthodoxy. Admittedly, they are in the minority, but scepticism should be the natural instinct of scientists — and the default setting of journalists.
Yet the cream of the BBC’s inquisitors during my time there never laid a glove on those who repeated the mantra that ‘the science is settled’. On one occasion, an MP used BBC airtime to link climate change doubters with perverts and holocaust deniers, and his famous interviewer didn’t bat an eyelid.
Meanwhile, Al Gore, the former U.S. Vice-President and climate change campaigner, entertained the BBC’s editorial elite in his suite at the Dorchester and was given a free run to make his case to an admiring internal audience at Television Centre.
His views were never subjected to journalistic scrutiny, even when a British High Court judge ruled that his film, An Inconvenient Truth, contained at least nine scientific errors, and that ministers must send new guidance to teachers before it was screened in schools. From the BBC’s standpoint, the judgment was the real inconvenience, and its environment correspondents downplayed its significance.
At the end of November 2007 I was on duty on News 24 when the UN panel on climate change produced a report which later turned out to contain significant inaccuracies, many stemming from its reliance on non-peer reviewed sources and best-guesses by environmental activists.
But the way the BBC’s reporter treated the story was as if it was beyond a vestige of doubt, the last word on the catastrophe awaiting mankind. The most challenging questions addressed to a succession of UN employees and climate activists were ‘How urgent is it?’ and ‘How much danger are we in?’
Back in the studio I suggested that we line up one or two sceptics to react to the report, but received a totally negative response, as if I was some kind of lunatic. I went home and wrote a note to myself: ‘What happened to the journalism? The BBC has completely lost it.’
A damaging episode illustrating the BBC’s supine attitude came in 2008, when the BBC’s ‘environment analyst’, Roger Harrabin, wrote a piece on the BBC website reporting some work by the World Meteorological Organization that questioned whether global warming was going to continue at the rate projected by the UN panel.
A green activist, Jo Abbess, emailed him to complain. Harrabin at first resisted. Then she berated him: ‘It would be better if you did not quote the sceptics’ — something Harrabin had not actually done — ‘Please reserve the main BBC online channel for emerging truth. Otherwise I would have to conclude that you are insufficiently educated to be able to know when you have been psychologically manipulated.’
Did Harrabin tell her to get lost? He tweaked the story — albeit not as radically as she demanded — and emailed back: ‘Have a look and tell me you are happier.’
This exchange went round the world in no time, spread by a jubilant Abbess. Later, Harrabin defended himself, saying they were only minor changes — but the sense of the changes, as specifically sought by Ms Abbess, was plainly to harden the piece against the sceptics. Many people wouldn’t call that minor, but Harrabin’s BBC bosses accepted his explanation.
The sense of entitlement with which green groups regard the BBC was brought home to me when what was billed as a major climate change rally was held in London on a miserable, wintry, wet day.
I was on duty on News 24 and it had been arranged for me to interview the leader of the Green Party, Caroline Lucas. She clearly expected, as do most environmental activists, what I call a ‘free hit’ — to be allowed to say her piece without challenge.
I began, good naturedly, by observing that the climate didn’t seem to be playing ball at the moment, and that we were having a particularly cold winter while carbon emissions were powering ahead.
Miss Lucas reacted as if I’d physically molested her. She was outraged. It was no job of the BBC — the BBC! — to ask questions like that. Didn’t I realise that there could be no argument over the science?
I persisted with a few simple observations of fact, such as there appeared to have been no warming for ten years, in contradiction of all the alarmist computer models.
A listener from one of the sceptical climate-change websites noted that ‘Lucas was virtually apoplectic and demanding to know how the BBC could be making such comments. Sissons came back that his role as a journalist was always to review all sides. Lucas finished with a veiled warning, to which Sissons replied with an “Ooh!”’
A week after this interview, I went into work and picked up my mail from my pigeon hole. Among the envelopes was a small Jiffy Bag, which I opened. It contained a substantial amount of faeces wrapped in several sheets of toilet paper.
At the time no other interviewers on the BBC — or indeed on ITV News or Channel Four News — had asked questions about climate change which didn’t start from the assumption that the science was settled.
I’m glad to say that more recently a number of colleagues have started to tiptoe on to the territory that was for so long off-limits. After the abortive Copenhagen climate summit and the Climategate scandal at the University of East Anglia, a questioning note was injected into some BBC reports. But even then, leading ‘sceptics’ were still generally regarded with disdain and kept at arm’s length.
White children in Birmingham ‘a minority’ this year because of immigration
Children from white families are in the minority in both Birmingham and Leicester, according to researchers. More than half of those under 16 in the cities are now from black, Asian and other ethnic communities, they believe. White children make up 47 per cent of the population in both cities, the researchers estimate.
The figures, which are expected to be confirmed by this year’s census, mean that for the first time white children are a minority group, although they are the biggest single ethnic group.
A report on Birmingham suggests that the figures could be explained by a younger population, more white families moving out of the city and immigration. The report estimates that in 2006 53 per cent of children under 16 in Birmingham, Britain’s second biggest city, were from white families. It also forecast that the proportion of children aged under 16 who are from ethnic minorities will rise to about 64 per cent by 2026, while the proportion of children from white families will be 36 per cent.
In Leicester it is predicted that children from white families will make up 31.8 per cent of under 16s by 2026.
The predictions are contained in reports by the Cathie Marsh Institute at the University of Manchester. The Birmingham report was commissioned by Birmingham City Council while the Leicester estimates are from a student’s dissertation.
At the time of the last census in 2001, 70.4 per cent of Birmingham’s population of all age ranges was white and 29.6 per cent from a variety of ethnic backgrounds, dominated by those with Asian, Caribbean and African origins.
It is predicted that by 2024 no ethnic group will form a majority. At present the total population of the city is just over one million.
In Leicester, white British people made up 60.54 per cent of the population at the time of the 2001 census.
More than half of children in Birmingham will be from black and Asian communities, making white families a minority group, a report says
More than half of children in Birmingham will be from black and Asian communities, making white families a minority group, a report says
According to the University of Manchester predictions, Leicester will become Britain’s first city where no ethnic group forms a majority in about 2019. Leicester’s population at present is more than 300,000.
Professor Ludi Simpson, who led the research team, said: ‘In Leicester and Birmingham, the white group will remain the largest by far – though it will not account for a majority of the population as a whole.
‘These and most other cities are already diverse with many different ethnic minorities. ‘Indeed it is indisputable that whether the whole of Britain or its city districts are considered, there will be more cultures represented in more equal numbers than in the past.’
The findings for Birmingham chime with Department for Education figures released last January. They showed that 43 per cent of children at Birmingham’s primary and secondary schools were white. Out of 148,900 pupils attending council-run schools, 63,800 were white.
The 2011 census is being conducted in March, when 25million households across England and Wales will be required by law to answer a range of questions including who is registered as living at a property, their age, their education and their ethnicity. The results, the first official figures since 2001, will be announced later this year.
Vicious murder by black gang in Britain
A 15-year-old schoolboy was killed in a ‘merciless’ knife attack planned on Facebook, during rush hour at Victoria station, a court has heard. GCSE student Sofyen Belamouadden was ‘hunted down’ by a heavily armed group of 20 teenagers before being stabbed, punched and kicked, jurors were told.
On the day of the attack in March last year two of the defendants were said to have left school at lunchtime to buy a block of knives from Argos, prosecutors said.
Sofyen was killed after tensions between pupils from two west London schools, some of whom saw the station as ‘home territory’, the Old Bailey heard.
Mark Heywood QC, prosecuting, said the attack on the schoolboy took place in ‘broad daylight’ in front of hundreds of commuters in the heart of London. Samuel Roberts, of Camberwell, Obi Nwokeh, of Bermondsey, Enoch Amoah, of Camberwell, and Victoria Osoteku, of Deptford, all aged 18, each deny murder. They have also pleaded not guilty to conspiracy to cause grievous bodily harm and violent disorder. Four 17-year-old youths, two from Streatham, one from Stockwell and one from Brixton, also deny each of the charges.
Details of the trial were able to be published for the first time today after reporting restrictions were lifted.
Sofyen was stabbed nine times, including to the lung and chest. ‘He was given no chance of life,’ said Mr Heywood. ‘So brazen and confident were his killers that they openly carried the various weapons that they used with them as they ran towards him and together hunted him down.
‘Such was their arrogance that they carried out that kind of attack in the heart of the capital city, in a public place, a terminus station at the height of the rush hour, and in sight of scores if not hundreds of people passing by, people going to their own homes.’
Mr Heywood added: ‘They were so heavily armed that no other individual or smaller group or even police officer or member of station staff could withstand them or stop them.’
The attack on the schoolboy, in March last year, was said to have been in revenge for an ‘inconsequential’ skirmish at Victoria the previous day when a boy from a rival school had been left with a bloody nose.
During Facebook chats that evening, some of Sofyen’s alleged killers discussed what was to happen the following day, and getting weapons, jurors were told. Later, at the station, witnesses saw youths with weapons including a samurai sword with a blade 20-30cm long (9-12in), a flick knife and a Swiss Army knife, and possibly machetes and screwdrivers.
Police based at Victoria station, aware of the possibility of trouble, had conducted higher visibility patrols the next day, he added.
At lunchtime on the day of the attack, Osoteku went out of school with one of the 17-year-olds to buy a block of five knives for £3.99 from Argos, jurors were told. Later when Sofyen’s group was confronted at Victoria and a sword was produced, the victim and his friends turned and fled, the court heard.
Mr Heywood said: ‘They were hopelessly outnumbered. They had already lost the arms race and it was obvious that they had seriously underestimated what they were likely to meet at Victoria that afternoon. ‘They did not expect the kind of weapons and they almost certainly did not expect the level of ferocity.’
One witness described looking up the stairs from the Underground station to see a group of 10 to 15 teenagers pushing someone from the top, said Mr Heywood. ‘The level of aggression was indescribable,’ he added.
Jurors were told that seven of the eight defendants were among those who went down into the District and Circle line ticket hall where the attack took place. Some left the scene on a bus where they were later arrested.
A number of knives, including one found wrapped in a newspaper on the bus, were found to have the victim’s blood on it.
Other members of the initial group of 20, including one with the sword, were said to have peeled off before the attack on Sofyen and chased another youth. All have been charged with the same offences but for practical reasons cannot be tried at the same time.
Town hall spies curb as British councils stopped from abusing terror powers to snoop on families over ‘bin crimes’
Town halls will be banned from spying on the public over ‘bin crimes’ and school catchment area rules. In a victory for the Daily Mail, Home Secretary Theresa May will say that only offences which carry a jail term should be subject to the intrusive surveillance powers. Even then, councils must first seek the formal approval of a magistrate before they are allowed to make use of the controversial Regulation of Investigatory Powers Act.
It will end the scandal of councils using Big Brother ‘direct surveillance’ tactics against people suspected of the most minor misdemeanours. Spying for dog fouling, leaving out the rubbish on the wrong day and other offences which carry only a fine will no longer be allowed.
The only exception to the rule – which states an offence must carry a sentence of up to six months or more before RIPA can be applied – will be undercover operations for underage sales of alcohol and tobacco.
In reality, it will restrict councils to going after more serious criminals, such as benefit cheats, con-artists and industrial fly tippers. Civil liberties campaigners will view it as an end to the ‘tyranny of the town hall Stasi’.
The announcement, which will be made in a statement to MPs, is part of a string of changes to anti-terrorism laws – which also include the scrapping of abused stop and search powers, and the replacement of the control order regime. It follows revelations by this newspaper about over-zealous officials training hidden cameras and even undercover agents on the law-abiding public. These include spying on people suspected of dropping litter and attempting to cheat school catchment area rules.
Council staff – who have been accused of having James Bond delusions – have been secretly taking photographs and videos. In some cases, cameras have been hidden in tin cans, or inside the homes of the neighbours of their ‘target’. It has provoked public outrage and undermined faith in the RIPA regime, which was passed by Labour in 2000, ostensibly to fight terrorism.
The legislation will remain available to the police and the security services.
The Coalition – expecting a backlash over the decision to retain curfews for terror suspects – will point to the hacking back of RIPA as proof that it is serious about restoring civil liberties.
Labour repeatedly promised to tackle the legislation. In the meantime, town halls and other public bodies have continued to use the law on a massive scale. Notoriously, Poole Borough Council admitted spying on Jenny Paton and her family to find out if they were living in a school catchment area. They were put under surveillance for more than two weeks.
The Coalition’s review of RIPA laws considered a string of options for clamping down on such abuse. Ministers decided it would be best to set up a system of double checks.
Initially, council officials will require a magistrate’s approval to use any of the techniques available under the legislation – which also allows the checking of phone records – to establish a person’s location at a specific time. This requirement is then backed by the rule that surveillance tactics should be confined to cases where the offence under investigation carries a custodial sentence.
Today, it will also be announced that section 44 of the Terrorism Act 2000, which allows police to search people without reasonable suspicion, will be scrapped. Those who have suffered include photographers taking pictures of tourist attractions.
Old-style same-sex schools best?
When I was 11, I waved goodbye to co-education and, armed only with a lacrosse stick, sank blissfully into the oestrogen-plumped world of Walthamstow Hall, an all-girls’ school in Sevenoaks. These were the days of A-line skirts, knee socks and vast, regulation knickers that entombed your nether regions. In this safe, bluestocking atmosphere, we struggled through the worst indignities of puberty, free from the jibes of equally pimply boys.
Yes, schoolgirls can be bitchy, but the downsides of the vixen tongue have never diminished, for me, the enormous pluses of female friendship. I retain seven bosom friends from those days. We’ve been bridesmaids at each others’ weddings and act as godparents to assorted offspring. I simply cannot believe I would have carried such a tight raft of female friendship with me – for over 30 years now – if I had been at a co-ed school.
So I was sorry to read that all-female education is on the decline. According to The Good Schools Guide, girls’ schools account for only 13 per cent of the leading establishments in their ratings – the lowest proportion since the list started in 1986. I have always been able to see how boys benefit from the civilising effect of having girls in their secondary school classes, but I have never been so sure if girls reap an equal benefit. I remember a friend who joined a public school that had recently taken girls in its sixth form: on her first day an anonymous note was posted under her door. It just read “flat”; it took her time to work out it referred to her chest.
I didn’t realise it at the time, but I was lucky my school’s science labs and debating forums were ruled by women and that we girls got to play all the best roles in Shakespeare. I wonder if even our horseplay would have been stifled if we had been in mixed classes: the bras left on desks, the wasps freed from jam jars, or the time the whole form crushed into the school’s Wendy house. I heard comedian Miranda Hart tell a similar story, about hiding in a cupboard for the entire class before bursting out, and thought how “girls’ school” that anecdote was.
In co-ed classes, girls are too worried about male approval to behave with such carefree idiocy. Girls-only schooling raises aspirations and boosts confidence – and it helps women forge unbeatably strong professional and personal relationships with other females. Even now, I can generally tell if a woman’s had a single-sex education: alumni often have an air of bright-eyed intrigue about them, as if you and they were still perched on a radiator in the common room, discussing the pros and cons of French kissing. You can take the girl out of St Trinian’s, but…
Three cheers for the House of Lords: “People argue that the Lords is undemocratic, has no mandate, and therefore shouldn’t delay the will of the government. But without the unelected Lords making trouble for the coalition, this would be close to an elected dictatorship.”