‘Quality and safety’ at risk in NHS shake-up, officials warn
Patient safety is at risk at an “extremely turbulent” time during which the NHS will be under “huge financial pressures”, an official document warns.
The guide to the “unprecedented” restructuring of the health service in England points out that previous reforms had a “negative effect” on services, staff morale and productivity.
It claims that “quality of care provided to patients” and “continuity of services” is in danger as tiers of management are removed and experience staff leave.
And the paper, signed by senior civil servants including the Chief Executive of the NHS, reminds staff that the Government’s reforms are taking place at the same time as £20billion in efficiency savings must be made.
It comes amid growing speculation that ministers will row back on the most contentious parts of the Health and Social Care Bill currently going through Parliament, in the face of widespread opposition.
Several Liberal Democrat and Conservative backbenchers have signed amendments calling for a re-think of the plans – which will see power for buying treatment handed from middle managers to GPs and private healthcare firms a much greater chance to look after patients as state-run hospitals – while health experts and leading charities say they will lead to the disintegration of the NHS.
The new report, published without any publicity by the Department of Health on Thursday, sets out the planned changes and provides help for NHS bodies in coping with them without damaging patient care.
A foreword signed by Sir David Nicholson, the Chief Executive of the NHS and others, states: “Over the next four years, the NHS will need to rise to some of the greatest challenges in its history.
“Despite the relatively strong financial settlement afforded by the spending review, rising demand, demographic changes and the cost of new drugs and technologies mean the NHS will need to deliver efficiency savings of up to £20 billion over this period if it is to improve the quality of the comprehensive service on offer to patients.”
Meanwhile, “modernisation plans will leave few parts of the current system untouched and past experience and lessons from elsewhere shows that any period of structural change can put quality and safety at risk”.
Addressing the Government’s plan to scrap England’s 10 Strategic Health Authorities and 152 Primary Care Trusts, in favour of new local GP-led commissioning consortia and a national NHS Commissioning Board, the report says: “We must remember that the knowledge and corporate memory of an organisation’s employees is a rich resource that needs to be preserved in order to maintain the continuity of services and, more importantly, improve the quality of care provided to patients.”
The report itself, written by a body called the National Quality Board, states: “Managing a smooth transition to the new system whilst ensuring the quality of services provided to patients is maintained and improved represents a highly complex challenge.
“It is also a challenge that must be delivered at a time when the NHS will be under huge financial pressures.”
It says the current reorganisation of the NHS is “unprecedented” but previous, smaller ones have shown that “mergers have a negative effect on delivery of services because of a loss of managerial focus on services”, “mergers have a negative effect on staff” with “high levels of stress, anxiety, staff turnovers, lower job satisfaction” and that major structural change is a “key risk factor for serious service failure”.
Drawing a parallel with the situation on hospital wards, the report warns: “The most risky time is the handover between one set of clinical staff and another.”
As a result, the study says that harnessing the “knowledge of expertise of staff and patients” will be critical in “an extremely turbulent time, with the additional risks brought by organizational change”.
It highlights the importance of listening to patient feedback and staff whistleblowers who raise concerns “before they become serious failures”, and says the National Quality Board will publish a leaflet reminding staff of their responsibility to speak up when things go wrong.
The study also says managers should keep an eye on sickness absence rates, staff turnover and the proportion of temps in the workplace as clues to “how healthy an organisation is”.
It says that the NHS, which employs more than 1million people, relies on their knowledge so the “major system redesign” requires ways in which their experience can be preserved, such as staff in axed organisations writing “legacy documents” and meeting their successors face to face before handover.
A small Latin revival in England
The Dragon is a private co-educational boarding and day school in Oxford with a long and prestigious history. As with many British private schools, Latin is taught there. Some of the pupils from the Dragon now help pupils from a taxpayer-funded church school to learn Latin too
Visit the after-school Latin club at SS Philip and James’s C of E primary school in Oxford, Phil and Jim for short, and the first thing that strikes you is how quiet it is. Not that there’s any shortage of teachers; in fact, there are four. It’s just that Mary, Alex, Nicholas and Will aren’t adults but Year 6 children from the Dragon School, an independent preparatory a short minibus ride away.
And, rare as it is even to find Latin on offer in a state primary (primus, first) school, it’s the fact that this club is run by children for children that makes it so unusual, especially given their ages. At just 10 and 11, the teachers are scarcely older than their pupils.
Latin, as any fool knows, isn’t a subject for the faint-hearted, what with its declensions and all that. But the free schools debate has put the language squarely back on the educational agenda (agenda, things which must be done).
The Oxford experiment, by putting the children in charge, has overturned every classics cliché in the book; but it’s worked. About 200 children from the two schools have been club students or teachers so far, and several Phil and Jim graduates (gradus, step) have gone on to excel in the subject at secondary school.
It isn’t a completely adult-free zone. Dragon teacher Peter Norton tops and tails the 50-minute sessions with games of Latin charades and bingo, both hugely popular, together with short films about life in Roman times.
But the in-depth coaching is all down to the Dragons and they take their duties very seriously. One girl even came up with her own teaching aid, a working balsa wood model of a Roman taxi meter, operated with marbles.
This afternoon, 11-year old Nicholas is helping Harry, 10, to find the Latin origin of some English words. Harry has already cracked “dominant” (dominus) and “nautical” (nauta) but is finding “exclamation” more of a puzzle. “Is it clamo?” he asks. “Maybe,” replies Nicholas cautiously, clearly primed not to give away too much.
The other three Dragons, small groups of children clustered around them, are poring over a crossword – English clues with Latin answers – before moving on to the subtleties of translating “Poeta dicit quis epistolam mittit?” and other similarly challenging sentences.
Alex, 11, leans right across the table in his eagerness to help nine-year-old Grace puzzle out the Latin for “they run”. “You know curro,” he says. “Take the ‘o’ off, then put on the ending.”
Nearby, two more 10-year olds, Issy and Pema, are working with Mary, who is just a few months older. Issy solves her final clue. Beaming with pride, Mary draws a “well done” smiley face on the work. “I keep forgetting the double letters,” says Pema, sounding a tad doleful. “It’s a tricky one,” Mary consoles her, turning to help.
Originally the brainwave of a Phil and Jim teacher with a child at the Dragon, where Latin lessons begin in Year 5, the club has been going for over four years.
Both schools gain from working together. “The children from the Dragon are so enthusiastic,” says Irene Conway, Phil and Jim’s head teacher. “Our children welcome them into their school and let them take charge. There’s no jealousy or bad feeling.”
Perhaps that’s partly why the club is so popular with Dragon pupils. It is by invitation only and despite the huge range of after-school activities on offer, it’s widely seen as something rather special. “It’s fun because it’s different,” Will says.
Before they’re let loose on their students, the would-be teachers work on their classroom technique. Being good at Latin is a given. Perhaps more elusively, they also need a winning way with words.
Some are born to it. Others, say Peter Norton, take a little longer to find out what works. “They learn to communicate (munus, gift, so ‘to share’) ideas – and to rephrase them if they don’t get through the first time.”
The hardest part, agree the Dragons, is knowing the answer but not blurting it out, instead mastering the teacher’s art of holding back and helping their pupils work it out for themselves.
But the effort is worth it. When children teach other children they can reach out to them in a way that no adult, however kindly and inspiring, can match. It can be far easier to believe that you can master a tricky point of grammar when somebody your own age is helping you. “You explain something as you would to a friend and if they don’t understand, they say,” Will says.
Not surprisingly, the young Dragon teachers are in growing demand. A second branch of the club has just started up at another local primary school. It’s enough to gladden the heart of anyone concerned about declining levels of classics teaching.
And when it comes to conclusive (cludere, to close) proof that being the same age, or size, as your students is no barrier to being a good Latin teacher, the clincher is the children’s relish for the subject. All want to carry on with it after they leave Phil and Jim. And if you ask what they’ve most enjoyed about the club, few are in any doubt. “Everything,” they answer.
Avandia under fire again
This is just part of a war on drug companies. Anything successful or popular is hated. I covered this issue in detail a year ago, where I noted what the research available then showed:
“In other words, a survey of the strongest data available showed that taking Avandia increased your risk of having a heart attack from 1.05% to 1.46%, an increase in risk of less than one half of one percent — which is vanishingly trivial compared to the risks we take in most things we do. Given the large sample size, however, the result is statistically significant, if not significant in any other sense. If we were to reject such small risks as that we would have NO drugs on the market because all drugs have some adverse side-effects.
But here’s the real kicker. Read the last clause in the abstract above. What it means in plain English is this: Although Avandia takers had a minutely greater risk of having heart attacks, the “extra” heart attacks DID NOT KILL THEM. Avandia takers were no more likely to die from a heart attack than anybody else!”
The effects noted in the report below would appear to be equally inconsequential
A study of 810,000 people, published today online in the British Medical Journal, found that those taking Avandia were 23 per cent more likely to suffer congestive heart failure and 14 per cent more likely to die while on it, compared to a similar medication. In addition, they were 16 per cent more likely to have a heart attack.
Last September the European Medicines Agency (EMA) suspended the licence for the drug, after 10 years on the market, saying the evidence of its harmful effects had tipped the balance against it being prescribed.
Today’s study is further evidence supporting that decision. It analysed the results of 16 separate studies in 810,000 patients, of which 429,000 were on Avandia (also known by its generic name rosiglitazone) and 381,000 were on Actos (also known as pioglitazone). Most were over 60. The drugs both belong to a class that help control blood sugar levels in patients with Type 2 diabetes.
It found that Avandia could have led to an extra 431 deaths per 100,000 people on Avandia, an extra 170 heart attacks and an extra 649 cases of heart failure.
Dr Yoon Kong Loke, a lecturer in pharmacology at the University of East Anglia, who led the study, warned that although the drug had been withdrawn in the UK patients could still be affected by it. He said: “We don’t know yet if stopping taking the drug at once gets rid of the increased risk of heart disease or if the effect lasts over a long period of time. “It is possible that symptoms may develop years afterwards. These are studies that need to be carried out in the future because Avandia has not been around all that long.”
Manufactured by GlaxoSmithKline, Avandia was once one of the best-selling drugs in the world, with annual sales peaking at £3 billion in 2006. It is still available on a restricted basis in the US.
A GSK spokesman said that the meta-analysis contained disimilar studies that should not have been combined, a view taken by the Food and Drugs Administration (FDA) in the US last July. She continued: “It is important to note that there are no head-to-head clinical studies with cardiovascular outcomes results between the two medicines.
“GSK believes that definitive conclusions about differences in cardiovascular data of the two medicines are hard to make in the absence of long-term trials directly comparing both medicines.
“GSK stands behind the safety and efficacy of Avandia when used appropriately. Since 2007, results from six randomized clinical trials with data related to the cardiovascular safety of Avandia have been reported. “Taken together, these trials showed that Avandia does not increase the overall risk of heart attack, stroke or death.”
What do we see when we rely on actual thermometers?
As noted yesterday, the temperature record presented by Warmists like James Hansen is largely fictional. With its reliance on invalid proxies like tree rings, its selective use of temperature measuring stations, and the final “adjustments’ made by Hansen and his ilk, only a true believer could accept the resulting record as proving anything. As we saw yesterday, the confected record can even show the opposite of what we know happened.
The wonder is that the Warmists haven’t presented an even more severe temperature rise than they do. As it is, they show a temperature rise over the last 150 years that is entirely trivial: Less than one degree Celsius. It looks like the data is very un-co-operative with Warmist fantasies. It’s entirely possible that there has not been any warming at all.
So let us look at some of the actual thermometer measures that we have. See the graphic immediately below. As you can see, it does show the tiniest long-term creep upwards over the centuries but there is absolutely nothing unique about either the 20th century or the late 20th century. And the record that goes back furthest — from central England (CET) corroborates that
But the graph of the CET record is not entirely up to date. Below is the CET extended through 2010 — including rapid two year cooling.
Extension by Joseph D’Aleo [Jsdaleo6331@aol.com]
Unprecedented global warming is a myth — JR
Now it’s Britain’s turn: Government to slash subsidies for solar power
The Government plans to slash subsidies for large-scale solar installations to divert money to smaller alternative energy projects, in a move that the industry has called a “horrendous strategic mistake”.
A review of the Feed-in Tariffs was announced in February, in response to concerns that large solar projects would soak up the available subsidy at the expense of other technologies. This followed a study that showed there could already be 169 megawatts of large-scale solar capacity in the planning system – equivalent to funding solar panels on the roofs of around 50,000 homes if tariffs were left unchanged.
Greg Barker, climate change minister, said: “I want to make sure that we capture the benefits of fast falling costs in solar technology to allow even more homes to benefit from Feed-in Tariffs, rather than see that money go in bumper profits to a small number of big investors.”
However, the Renewable Energy Association & Solar Trade Association said that the government was making a mistake. “There is disbelief within the industry that the Government has totally undermined the solar sector without having first properly understood its potential,” the trade body said.
The proposals, published on Friday, would reduce the tariff for roof-mounted schemes of more than 50 kilowatts by 39pc to 49pc and the tariff for stand-alone schemes may be reduced by more than 70pc.
New British immigration rules to affect Takeaways
I must say that the prospect of having a Brit cook one’s food is rather terrifying
The new British immigration rules leading to clamp down on migrant chefs can threaten Britain’s takeaway food industry, said a report in ‘The Guardian’. Immigration minister Damian Green has announced decision to tightens rules on recruiting skilled cooks which closes door to senior care workers, the paper said.
The future of those traditional staples of British cuisine, Indian and Chinese takeaways, have been thrown into doubt by new Home Office restrictions on the overseas recruitment of skilled migrants.
The immigration minister has decided to halt the recruitment from overseas of migrant chefs from outside Europe to work in any establishment that provides a takeaway service. When the Labour government made a similar proposal in 2008 to restrict the influx of skilled cooks and chefs, it provoked a demonstration in London’s Trafalgar Square by thousands of people from the Bangladeshi, Indian, Pakistani, Turkish and Chinese communities.
The change is proposed as part of a package of further immigration restrictions, which will see eight jobs removed from the official shortage occupation list under which skilled migrants from outside Europe can come to work in Britain. The package will reduce the number of jobs open to non-European skilled migrants from 500,000 to 230,000 – fewer than 1% of the UK labour force. About 5,500 skilled migrants who came to the UK in 2010 to work in shortage occupations will be excluded by the new rules.
More than one million jobs were open to skilled non-EU migrants when the government’s migration advisory committee produced its first shortage occupation list in 2008. The eight occupations being removed from the the official shortage list include high-integrity pipe welders, airframe fitters, electricity industry site supervisors, skilled meat boners and trimmers, skilled senior care workers and skilled sheep shearers.
The change means the list will now mainly include skilled engineers, jobs in medical, nursing and veterinary professions, maths and science teachers, visual effects and computer animators and certain ballet / contemporary dancers and musicians. Green said: “”This government is also determined to get people back to work and provide business with the skills they need from the British workforce – reducing the need for migrants at the same time as we reduce their number.”