Incompetent NHS doctors ‘protected by silence’ of colleagues who fear retribution
One in four doctors who believes a colleague to be behaving incompetently fails to sound the alarm, a survey has found. They keep quiet because of fears of retribution, or because they think nothing will happen, or that someone else will take care of the problem.
The survey comes as complaints against doctors have hit record levels and MPs are holding an inquiry into the medical complaints system.
Almost 3,000 doctors were surveyed from the U.S. and UK, including 1,078 Britons.
Some 19 per cent of the British doctors said they had had experience of an incompetent colleague in the last three years, compared with 16.5 per cent of U.S. doctors. Nearly three out of four British doctors said they had alerted individuals or bodies responsible for investigating such behaviour. Of those who did not, a third said they feared retribution, while a quarter thought someone else was taking care of the problem. One in seven UK doctors said they thought nothing would happen if they did, according to the survey published online in BMJ Quality and Safety,
Katherine Murphy, of the Patients Association, said: ‘It’s appalling that some doctors seem still to be operating a cosy club from a misguided sense of loyalty to colleagues rather than protecting their patients.’
Peter Walsh, of the patient safety charity Action against Medical Accidents, said there was not enough protection for ‘whistle-blowers’ who could see their careers vanish because they had done ‘the right thing’.
The survey also found only six out of ten felt they should disclose any financial ties they had with pharmaceutical companies to their patients.
And not all doctors agreed it was ‘never appropriate’ to have a sexual relationship with a patient, according to the survey responded to by four out of ten UK doctors.
Doctors’ leaders last night moved to reassure patients. Dr Mark Porter, chairman of the British Medical Association’s consultants committee, said: ‘Our primary responsibility as doctors is to our patients.’
Niall Dickson, of the General Medical Council, the regulatory body for the profession, said: ‘Doctors have a clear duty to put patients’ interests first and act to protect them. This includes raising concerns about colleagues when necessary.’
I’ll set business free vows British PM in blast at civil service
David Cameron launched an extraordinary attack on his own civil servants last night for loading costs on to business, as he set out the ‘moral’ case for enterprise.
The Prime Minister expressed intense frustration with the failure of officials to understand that firms buckling under the weight of Labour’s red tape ‘frankly cannot take it any more’. ‘If I have to pull these people into my office in No 10 to argue this out myself and get them off the backs of business, then, believe me, I’ll do it,’ he said.
His remarks, in a speech to the Conservatives’ spring conference in Cardiff, appeared to be a deliberate echo of Tony Blair’s famous complaint about the ‘scars on my back’ in July 1999. The then prime minister attacked the ‘forces of conservatism’ for holding back Labour’s public sector reform agenda.
Mr Cameron said his was an ‘enterprise government’ and promised the most ‘pro-growth Budget for a generation’ this month, highlighting a pledge to cut corporation tax from 28 to 24 per cent.
He echoed Margaret Thatcher’s pitch as the champion of the hard-working small-business owner, telling the Tory faithful: ‘At its beating heart this is still a party of start-ups, go-getters, risk-takers’.
The Conservatives had always been a ‘party of builders and businesswomen, electricians and engineers, roofers and retailers’, he said. But he conceded there was ‘so much more still to do’ to boost small and medium-sized firms, attacking what he called the ‘enemies of enterprise’ who were standing in the way.
Mr Cameron condemned ‘bureaucrats in government departments who concoct those ridiculous rules and regulations that make life impossible for small firms’. He also attacked the ‘town hall officials who take forever to make those planning decisions that can be make or break for a business, and the investment and jobs that go with it’, and the ‘public sector procurement managers who think that the answer to everything is a big contract with a big business and who shut out millions of Britain’s small and medium-sized companies’.
Mr Cameron insisted that setting up and creating successful businesses was ‘about more than money’. The Tories, he said, understand that ‘enterprise is not just an economic good, it’s a social good’. ‘It’s about morals, too,’ he declared. He hailed practical men and women who build a business and see it grow ‘not just for the money, not for the glory but for the simple reward and deep satisfaction of seeing your efforts pay off’.
‘What drives us is getting things done, and what drives us mad is the bureaucracy, the forms, the nonsense getting in the way,’ he added.
With no money left by Labour in the Treasury coffers, Mr Cameron said the ‘only strategy’ for growth was to back entrepreneurs.
Chancellor George Osborne’s March 23 Budget will include plans for at least ten new enterprise zones, with tax breaks and relaxed planning laws. Steps are also expected to try to increase trade with economies such as India and China, cut red tape and open up public sector contracts to small firms.
The Prime Minister said he was going to ‘watch banks like a hawk’ to make sure they delivered on a pledge to boost lending to small businesses by £10billion.
And, as the Tories gear up for local and regional elections in May, Mr Cameron omitted the praise for his Liberal Democrat coalition partners that has become standard in his high-profile speeches.
Where they teach you how to be thick
The writer below says that state education in Britain has consistently encouraged working-class children to accept their lot in life. He has some interesting history but ignores several problems: Such as the virtual abolition of discipline and IQ differences
As loudly as the middle classes moan about the state school system, it is the working class that has been let down. Middle-class children do very well out of state education. It is the middle-class children who pass the exams, and get the college places. They go on to get good, well-paid jobs, too. Working-class children, however, do worse than they ever have.
Studies for the Sutton Trust found that social mobility in Britain started to go backwards from 1970 onwards – those born after 1970 will earn no more than their mums and dads. Since 1973 wages have fallen as a share of Britain’s wealth, from 65 per cent to 55 per cent.
Since the 1960s there have been big reforms in schools and colleges:
* Comprehensive schools were brought in, in 1969.
* The school leaving age was raised from 14 to 16.
* The share of those going on to colleges and universities was boosted from 8.4 per cent in 1970 to more than a third today
These reforms were supposed to help working-class people. Instead the working class has lost out. Wages have not kept up with growth. Working-class people are doing no better than their mums and dads before them.
You might argue that the schools did not make the class divide – and you would be right. But schools have not done anything to fix the class divide, either. All those years of education reform have done nothing for working-class people.
The state education system has let down the working class. It has not helped people to better themselves. Instead it churns out school-leavers who are more divided along class lines than ever before. For working-class children, state education is not part of the solution. It is part of the problem.
The origins of state education
When Robert Owen opened the Hall of Science in Manchester, a committee of churchmen and mill owners was set up to put down ‘that hideous form of infidelity which assumes the name of socialism’. The good burghers of Manchester founded their own school to rival Owen’s. Soon after, the Hall of Science was set on fire.
The attack on the Hall of Science was just the beginning of the ruling-class attack on working-class schools. Sir James Kay-Shuttleworth, a baronet, was made Britain’s first secretary of education in 1839 – it was his job to set up a state education system in Britain.
Kay-Shuttleworth’s principal motivation in 1839 was a fear of the growing, and independent, working-class movement: ‘We confess that we cannot contemplate with unconcern the vast physical force which is now moved by men so ignorant and so unprincipled as the Chartist leaders.’
The mill owners and landlords did not like parting with their money, but Kay-Shuttleworth told them schools would ‘promote the security of property and the maintenance of the public order’. Spending a little money on schools now would save them their whole fortune, said the first minister of education, ‘Only by experience and education can the workmen be induced to leave undisturbed the controls of commercial enterprises in the hands of the capitalists.’ Ever since then, the whole point of state schools has been to curb the threat of the working class.
Forster go to school
The first law to say that you could be forced to go to school – compulsory education – was passed in 1870. It was the idea of William E Forster: ‘We had this fearful state of things – a large portion of the nation growing up in our large towns without education, and ready to become members of the dangerous classes.’
Forster’s backer, MP Charles Buxton, made it clear at whom the act was aimed: ‘No feeling of tenderness for the parents would deter him for one minute from adopting compulsion. Society was suffering grievously from their shameful apathy with regard to the education of their children.’ (House of Commons, 12 March 1869)
Forster forced mums and dads to hand over their children to the vicars and priests who ran the church schools – who duly beat the word of God into their backsides – from the age of eight to 13. Later on Forster would force Irishmen to obey British rule under the so-called ‘Coercion Act’.
The 1944 Act and a Brave New World of tripartite education
Tasked with setting up schools for children aged 11 to 15, Labour education minister Ellen Wilkinson told local authorities to ‘think in terms of three types’ of state school (Circular No 73, 12 December 1945). The three sorts of schools were: grammar schools for clever boys and girls; technical schools for practical children (only a few were built); and, last of all, new ‘modern’ schools for working-class children ‘whose future employment will not demand any measure of technical skill or knowledge’ (Ministry of Education, 1945). ‘Not everyone wants an academic education’, Wilkinson said: ‘After all, coal has to be mined and fields ploughed.’
Wilkinson was on the far left of the Labour Party. But just what ‘left wing’ meant was changing. In Churchill’s war cabinet Labour ministers got into the habit of pushing people from pillar to post. The ‘tripartite’ education system seems a bit stiff-necked today; it treated boys and girls like cogs in a machine. But that was pretty much in keeping with the way that ministers bossed workers around in the war.
The ‘Blackboard Jungle’ scare
The upwardly-climbing liked grammar schools. Ellen Wilkinson’s Ardwick Grammar School helped her out of the working class and into Manchester University. Another Labour minister, Roy Jenkins, went to Oxford after Abersychan County Grammar – not bad for a miner’s son. Shopkeeper’s daughter and later Tory education minister Margaret Thatcher went to Kesteven and Grantham Girls School before going to Oxford.
But three-quarters of children did not go to grammar schools. An exam at age eleven – the ‘Eleven Plus’ – sorted children out into the grammar school winners and the secondary modern school losers. It was called ‘selection’. That meant a lot of unhappy children, and unhappy parents.
Before long, the better-off began to get scared of what was going on in secondary modern schools. Newspapers ran scare stories about crime and violence in ‘The Blackboard Jungle’ (taken from the title of a New York school novel and film).
‘A 15-year-old boy draws a knife on a master who is chastising him then waits for the teacher with a studded belt outside – forcing him to ask for police protection.’ This lurid tale was part of a big ‘Blackboard Jungle’ spread in the Sunday Graphic, 12 July 1959. The News Chronicle editor backed up such scare stories, saying, ‘until the black spots in secondary schools are cleaned up they will continue to taint the whole’ (in a letter to The Schoolmaster, 23 September 1955).
Secondary modern teachers wrote racy novels, like ER Braithwaite’s tale of hopeless youngsters stirred by a young Guiana-born teacher, To Sir, With Love. It was published in 1959 and made into a film with Sidney Poitier eight years later. Another was Edward Blishen’s The Roaring Boys – a Schoolmaster’s Agony. The blurb read: ‘They came from the backstreets and slums of London’s east end. They were the roaring boys. Teenage delinquents living for kicks. Young tearaways full of searing hate and fury.’
It was fear of the young tearaways that put an end to school selection and the tripartite system. It was fear of the class war getting out of hand. In a speech in 1966, Labour minister Tony Crosland owned up to a ‘deeply felt’ and ‘controversial’ view that ‘separate schools exacerbate social division’ and ‘the eleven plus divides overwhelmingly according to social class’.
Crosland did not want to start a class war. He wanted to stop one. He promised he would not ‘argue the point in terms of equality’; he would argue it ‘in terms of a sense of cohesion’. ‘We only have to consider our industrial relations’, he warned, ‘to see the depth of social division’. ‘But so long as we choose to educate our children in separate camps’, he warned, ‘for so long will our schools exacerbate rather than diminish social divisions’.
The rise of the meritocracy?
Crosland’s fears of class war were outlined by the social scientist Michael Young, the collator of the 1945 Labour Party manifesto in which Labour promised to build new secondary schools. In 1958 he wrote The Rise of the Meritocracy, a darkly comic fable set in the year 2033, which tries to guess at what will happen to a country that selects its children according to their ‘eleven plus’ scores – what he called ‘a meritocracy’.
In The Rise of the Meritocracy the upper-class owes its standing to intelligence, not money or land. But they have made an awful mistake. The lower orders, domestic servants and the ‘Technicians Party’ rise up in revolt against the cruel meritocracy. Half a million copies of The Rise of the Meritocracy were sold worldwide. The case for the comprehensive school, and against selection, was won. It was won because while the ruling class were too scared of what would happen to the working class if they were shut up in no-hope schools, the middle class were too embarrassed to say out loud what they secretly thought: that their sons and daughters deserved better than the rest. (Michael Young is Toby Young’s dad.)
Even though comprehensive schools became the norm, the professional classes were never really happy about it. Right-wing university lecturer GH Bantock was outraged at the idea that ‘the future doctor, dustman, admiral and cabin-boy must be taught together in the same mixed-ability class’. Instead of calling for a return to the eleven plus and selection, critics called for different kinds of schools and for school choice.
What they meant was that some schools could be made more ‘academic’ and that they could ‘choose’ to send their kids there.
The Labour Party leaders do not send their children to comprehensive schools. Tony Blair sent his children to the London Oratory – a grant-maintained school. So did New Labour stalwart Harriet Harman. Alastair Campbell, Blair’s press secretary, is one of few who does send his sons to a comprehensive school: William Ellis in Camden. It was Campbell who coined the phrase ‘bog standard comp’.
A small spasm of realism from the BBC
Says carbon tax ‘may not reduce CO2’
When the government changed the terms of a new tax on the carbon emissions of large companies in last year’s Spending Review, it was accused of hitting firms with a “green stealth tax”.
Money raised through the Carbon Reduction Commitment (CRC) will now go to the government, rather than to those firms who cut their bills the most, as had been originally planned. The business group, the CBI, is calling on the government to turn the tax back into an incentive-based scheme or scrap it altogether.
And a report by Carbon Retirement has said that the tax, which is due to come into force next month, may fail to reduce overall pollution levels. The report draws on data from the government and its independent committee on climate change which suggests overlap between this and other emission reduction schemes may limit its effectiveness. The report forms part of responses to the government’s consultations on the measures.
The CRC applies to large companies which are not currently covered by the European emissions trading scheme. It forces firms to measure and report their emissions – mostly the result of gas and electricity use – and then pay œ12 per tonne of carbon dioxide they emit.
The problem is the number of schemes. Companies buy their electricity from power providers who themselves hold permits under the European carbon trading scheme for every tonne of carbon they release. These permits are limited – if someone needs more permits in the UK, someone else, somewhere else, must pollute less. As demand for them varies, so does the price.
If companies reduce their electricity demand it could simply free utilities to give their permits to someone else, perhaps another power provider or a cement works, allowing them to increase their carbon emissions.
The report estimates that “between 2011 and 2020, the 90m tonnes of carbon dioxide savings the CRC participants are expected to achieve will be emitted instead by heavy industry”.
The problem may be fixed in future as the European scheme is itself reformed, but accountants Ernst and Young suggest it is not the only issue with the new tax. “The CRC assumes a fixed carbon intensity for electricity and doesn’t reward sourcing electricity renewable energy under green tariffs,” says Ben Warren, partner at Ernst and Young. “This is starting to have an impact on green tariffs as companies resent getting no benefit for this under the CRC.”
The Department of Energy and Climate Change accepts there is a problem, and told the BBC: “We are looking at a range of measures to try and simplify the scheme and recognising the overlap with some other schemes is one of the areas of complexity for it.”
Horrors! British public sector workers could be forced to stay on until 65 or have their pensions cut
Millions of public sector workers will be forced to work until they are 65 and pay thousands more into their pensions under Coalition plans. In a report for the Government to be unveiled on Thursday, former Labour work and pensions secretary Lord Hutton is expected to conclude that a pension age of 60 for state employees is unsustainable. He will recommend bringing ‘gold-plated’ public sector pension schemes into line with the private sector, where most people retire at 65.
It is part of a broader shake-up of state employees’ retirement funds, which have created a £1trillion black hole in public finances. Whitehall sources also expect Lord Hutton to propose a large increase in pension contributions – around 3 per cent more of annual salary. That will be an effective pay cut of thousands of pounds for many public sector staff.
Teachers, NHS staff, local government workers and other state employees are expected to be switched away from final salary schemes into less generous ones based on career-average earnings.
Measures are expected to shield lower-paid staff from the pain of the reforms, given the Coalition’s pledge not to balance the books on the backs of the worst-off. But the reforms will still plunge the Government into a major battle with militant public sector unions.
The reforms will not result in workers losing benefits they have accrued. But it is expected that from a future date, probably 2014, all future pension entitlements could not be claimed until they reach 65. As a result, a public sector worker aged 40 with 20 years’ service would get only half the pension they expected. Someone with 30 years’ experience would get three-quarters; someone with ten years would get a quarter. They would have to wait until 65 before claiming their full pension.
The newly created Office of Budget Responsibility estimates that without reform the cost of paying public sector retirees would more than double, to £9.4billion a year, by 2015.
Pensions expert John Wright, of Hymans Robertson, said: ‘The Government would like to raise the retirement age of public sector pension schemes from 60 to 65 straight away, but attacking the accrued rights of workers is legally very difficult. ‘Ensuring benefits paid after, say, 2014 are not paid until later will save the taxpayer billions in the long term, but there will probably be some tapering to soften the blow to older workers.’
Mark Serwotka, of the Public and Commercial Services union, said: ‘This Government seems determined to levy a tax on our members by making them work longer and pay more for their pensions. ‘We will oppose any attempts to make our members pay for a crisis that even [Bank of England governor] Mervyn King agrees was caused by greedy bankers.’
My fingers and toes ached in the cold – until I took Viagra!
The pain first started whenever Anne Mawdsley was out in cold weather. ‘My fingers would turn red and felt like they were burning,’ she says. ‘It sounds like just a minor inconvenience, but I was in excruciating pain. I had to give up working as a PE teacher because being outdoors in cold weather was so difficult. I became a swimming teacher instead.’
However, the problem continued to worsen, and Anne ‘really struggled’ to look after her two sons, then both under two-and-a-half. ‘The pain seemed to reach a peak at night — my fingers would throb, and I’d be shattered because I couldn’t sleep.’
She then developed ulcers on her fingers; one finger even became gangrenous as a result. Anne’s doctor suggested the finger be amputated. ‘Although I was desperate, this sounded like medieval medicine. I was just horrified,’ says Anne, 68, of Alsager, Cheshire.
She managed to avoid this drastic solution, but for the past 30 years Anne has battled to find an effective treatment for her condition, which had also spread to her toes. And two years ago she discovered an unlikely solution — the impotence drug Viagra.
Like ten million Britons, Anne suffers from Raynaud’s syndrome, a disorder triggered by a sudden drop in temperature. The blood vessels in the fingers and toes contract, cutting off blood supply. It can also affect the tiny arteries in the nose, ears and tongue.
Typically, Raynaud’s causes the fingers or toes to turn white and numb. Then, as the blood flow returns, they turn blue and eventually red, accompanied by a burning sensation. Attacks can last from a few minutes to an hour.
Nine out of ten cases are in women, with most sufferers having their first attack before the age of 40. Although attacks peak in the cold winter months, symptoms can be triggered by everyday tasks such as taking food out of the freezer, air conditioning, or even stress — all of which cause blood vessels to contract.
There are two types of Raynaud’s. Primary Raynaud’s, which tends to run in families, is generally quite mild. Most patients can cope by wrapping up warm, although some develop painful weeping ulcers, which can become infected.
Secondary Raynaud’s is far more serious and painful, but about ten times less common. Indeed, it’s only in the past 20 years that doctors have discovered there is a difference between the two.
The secondary form of Raynaud’s, which Anne has, is usually caused by an auto-immune disease such as scleroderma, which causes a hardening of the skin, muscle and internal organs.Here, Raynaud’s is a symptom of the underlying disease. The secondary form is worse, as circulation is less likely to return to normal completely between attacks, so patients can be left in permanent pain.
When Anne appeared on a TV programme to highlight Raynaud’s and received more than 400 letters from people desperate for information, she set up the Raynaud’s & Scleroderma Association, which raises money for research and offers advice to patients.
Meanwhile her own condition worsened. She developed difficulties swallowing and had to have her oesophagus dilated to be able to do so properly.
Two years ago Anne was invited to take part in a trial at the Royal Free Hospital, led by Professor Denton, using the erectile dysfunction drug sildenafil — more commonly known as Viagra.
Viagra helps by increasing blood supply to the body’s extremities. ‘I had to smile when I was offered Viagra, but by that stage I was so desperate I would have tried anything,’ says Anne.
She took the tablets three times a day and immediately noticed improvements in her symptoms. ‘Although the numbness and pain in my fingers didn’t disappear completely, it was a lot less severe, and I can now use my hands more for things like typing,’ she says.
‘Luckily, I haven’t suffered any side-effects you can sometimes get with Viagra, such as dizziness or headaches — and I haven’t noticed any effect on my sex life either!’
The trial compared Viagra with a placebo and results show a benefit, explains Professor Denton. He presented the results at a scientific meeting, and a full paper will soon be published. ‘This is an off-label use of Viagra — meaning the drug is not licensed for this purpose,’ he adds. ‘Viagra would be reserved for treating patients with the most severe types of Raynaud’s and/or scleroderma who had already tried more conventional treatments — we’re not advocating it for everyone.’