GPs are blamed for cancer care referral lottery
Cancer patients face a lottery over how quickly their GP will send them to a specialist or whether they will be referred at all, a report warned yesterday. It shows a 35-fold variation in referral rates nationwide, with some patients sent to hospital unnecessarily while others never get to see a consultant at all.
The study by The King’s Fund think-tank says most GPs refer patients within the two-week deadline for suspected cancer. But it also found many late referrals, particularly for certain cancers. One in three patients with stomach or oesophageal cancer requiring urgent investigation were given a non-urgent referral instead, delaying their treatment.
The report said: ‘An important component of cancer referral relates to the assessment of urgency, and there is growing evidence questioning GPs’ ability to do this accurately.’
Britain has one of the lowest cancer survival rates in Europe, partly due to late diagnosis.
Evidence from cancer charities shows a quarter of cancer sufferers are being sent away by family doctors who dismiss their early warning signs as minor ailments. The King’s Fund report is based on the findings of an inquiry into general practice started by the think-tank in 2009.
An analysis of GP referral rates for suspected cancers from 51 practices in South London found wide variations. Referral rates for seeing a specialist within two weeks ranged from 0.7 to 25 per 1,000 patients, representing a 35-fold difference.
The percentage of diagnoses of cancer from these referrals also ranged from zero to 24 per cent.
The think-tank said that if the findings were replicated across England, practices that sent too many patients to see specialists – leading to a low rate of diagnosis because not many of them actually had the illness – risked creating anxiety and overburdening services.
On the other hand, GPs who did not refer enough suspected cases, which led to a high rate of diagnosis, could be leaving out patients with the disease who needed prompt specialist treatment.
Dr Laurence Buckman, of the British Medical Association’s GPs committee, said: ‘Given the increased intensity and complexity of general practice work, GPs need time off the treadmill so they can look critically at what they do and make improvements.
‘Reducing bureaucracy would help them, as would stopping the constant reorganisations within the NHS. Where GPs fall short, they need to be helped to see where they can make their service better and given the time, resources and staff support to do this.’
Chris Ham, chief executive of The King’s Fund, said: ‘Although general practice in this country remains the envy of the world, there is no room for complacency. Too many GPs remain unaware of significant variations in performance and do not give priority to improving quality.’
Health minister Lord Howe said: ‘We have a very strong system of general practice, but there is too much variation in quality.’
UK government tightens student immigration system
In a major revamp of its student immigration system, the UK government has announced tougher English language criteria, limits on work entitlement and an end to the post-study route, through which students were allowed to remain in the UK for two years after they completed their courses.
While the new English language rules will become effective from next month, all UK education institutions that want to recruit foreign students will have to become highly-trusted sponsors by April 2012, and accredited by statutory education inspection bodies by the end of 2012.
“It has become very apparent that the old student visa regime failed to control immigration and failed to protect legitimate students from poor quality colleges. The changes I am announcing today re-focus the student route as a temporary one, available to only the brightest and best. The new system is designed to ensure students come for a limited period, to study not work, and make a positive contribution while they are here,” UK home secretary, Theresa May , said while announcing the changes.
In a move that will impact Indian students planning to study in the UK, the two-year post-study leave to remain in the UK is being discontinued. International graduates will, however, be allowed to remain in the UK if they have skilled job offers under the Tier II work permit category.
“The students will be given three to four months after they finish their studies to look for a job. But graduates will not be allowed to take up unskilled jobs and will need a Tier II sponsor,” UK Border Agency regional director in Delhi, Chris Dix said.
Further, while students at universities and publicly-funded colleges will retain current work rights, others will no longer have the right to work while they study in the UK. In 2009, there were 57,000 student visas issued in India for the UK. The number went down to 41,350 in 2010.
Immigration detainees in Britain win only £1 damages
Two immigration detainees have been awarded nominal damages of £1 each for being illegally imprisoned for two years under a secret policy operated by the Home Office.
The majority judgment by the supreme court criticised the previous government’s reliance between 2006 and 2008 on unpublished regulations governing the detention of foreign national prisoners pending deportation.
The token compensation reflects the court’s belief that the men, one Congolese and one Jamaican, would have been held in prison anyway under other laws.
Walumba Lumba entered the UK illegally in 1994, the court said. He was later convicted of wounding with intent and sentenced to four years in jail. He had been due for release in 2006 but was held in prison under the Home Office’s secret rules. He left the country “voluntarily” last month.
Kadian Mighty, a Jamaican citizen, was originally granted leave to remain in the UK in 2003, but that permission was revoked after he was convicted of drug dealing and jailed. He was also detained after the end of his sentence, pending removal from Britain, but released in July 2008.
“Following adverse publicity in April 2006, the [home] secretary adopted a new policy which was not published,” the supreme court said in a summary of the decision. “Between April 2006 and September 2008, the secretary of state applied this unpublished policy, which imposed a near blanket ban on release of foreign national prisoners.
“… The secretary of state is liable to both appellants in the tort of false imprisonment as the statutory power to detain them was exercised in breach of public law duties. The appellants are, however, only entitled to nominal damages assessed at £1. They are not entitled to exemplary damages.”
The supreme court found it was illegal to operate a clandestine policy which is “inconsistent with her published policy and which applies a near blanket ban on the release of foreign national prisoners”. Jacqui Smith was Labour’s home secretary between June 2007 and June 2009.
Three of the nine judges, Lords Phillips, Brown and Rodger, dissented from the judicial majority on the question of whether the treatment of the men amounted to false imprisonment.
Lumba’s case had been backed by the Public Law Project, a legal charity that aims to improve access to justice. It said: “The secret policy required detainees to be held indefinitely and regardless of whether they posed any risk to the public.
“Lord Dyson … held that there is ‘clear evidence that [UK Border Agency] caseworkers were directed to conceal the true reason for detention during this period and, in a reference to the then home secretary, Jacqui Smith, that there was a “deliberate decision taken at the highest level to conceal the policy.”
Responding to the judgment, Jo Hickman, Lumba’s solicitor, said: “This decision is a vindication of the rule of law and of the fundamental principle that no one should be deprived of their liberty by the abuse of executive power.
“The supreme court has made clear that all detention decisions must be properly, openly and lawfully made, or the resultant detention will be unlawful. This is a principled judgment in the context of individual liberty, and will help guard against any further abuse of the Home Office’s detention powers.”
The Home Office has amended its published policy several times since then. In September 2008 it declared there should be a presumption that all foreign national prisoners would be detained – bringing it into line with its unpublished policy. In January 2009, however, as a result of this case, references to any presumption of detention were dropped.
British homeowner who put up security gates after series of burglaries ordered to tear them down because they are 6in too tall
A control-freak council
When businessman Robin Arnold installed security gates to protect his home, he never expected to end up hauled before a court. But the father-of-eight is facing prosecution because his local council has ruled the top of the gates should be a different colour and the height must be reduced by six inches.
Mr Arnold, 63, installed the gates in 2008 after a series of break-ins at his home in Stockport, Greater Manchester. But he didn’t apply for planning permission for the gates and a retrospective application, and subsequent appeal, were refused.
The 5ft 6in gates are black with golden arrowheads, but Stockport council says they should be slightly smaller and the arrowheads black.
Mr Arnold, managing director of a restoration company, has refused to make the alterations, saying his gates are no different to others in the area. And when he ignored an enforcement notice sent in December the council began a prosecution against him.
Mr Arnold said: ‘I will be among thieves and burglars. It’s absolutely ridiculous it has come to that, but there are times you have to stand up and be counted and show up foolish attitudes for what they are. ‘The council is gambling on a successful prosecution with taxpayers’ money when people are losing their jobs. All I’m trying to do is protect my home and family.
‘There are numerous designs and colours of gate in the area and some are bigger than mine. If I lower the height it will be easier for thieves to jump over them.’
Mr Arnold, who lives with his wife Julie, will appear before Stockport magistrates on a date yet to be fixed. He lives in the Davenport conservation area where planning laws are tighter to protect the neighbourhood’s character.
A council spokesman said it had agreed to let the gates remain if the alterations were made. He said a similar arrangement had been made with other residents, who agreed to changes and were allowed to keep their gates. He added: ‘We aim to resolve breaches of planning control through negotiation. This matter has been on-going since August 2008.
‘The council has been extremely flexible, but in the interests of fairness to other residents who have followed the correct procedures, we have no option but to take action against a continued breach of planning control.’
Human rights laws result in a tripling of sham marriages in Britain
Human rights rulings by judges have led to a tripling in the number of suspected sham weddings. The courts have repeatedly weakened rules designed to prevent non-EU immigrants from marrying solely to remain in the UK. In four years, cases have risen from 282 annually to 934 – or 18 every week.
And the Human Rights Act has left the Home Office with no option but to scrap all remaining legal safeguards against fake ceremonies within weeks.
Mandy Brammer, a registrar in Brent, north London, tells tonight’s BBC Panorama programme that up to 2004 ‘we’d have waiting rooms full of people, all of whom were trying to arrange a sham marriage. There’s every likelihood of going back to that situation’.
A legal crackdown was introduced by Labour in February 2005 after the number of suspected sham ceremonies – often arranged by criminal gangs who could earn £10,000 a time – reached 3,700 a year. The clampdown, which reduced this figure by 90 per cent, was targeted at those who marry Britons, or EU citizens with full residency rights, to gain permission to remain indefinitely.
Migrants were forced to seek a special certificate to marry if they lived outside the EU, or had only limited rights to live in the UK. Those with only three months leave to stay were routinely refused on the grounds that the ceremony was intended only to avoid removal from the country.
In 2006 the courts ruled the entire system was unfair under human rights law. Two years later, the House of Lords found the rules to be a breach of Section 12 of the European Convention on Human Rights, the right to marry. It meant people could no longer be denied a certificate to marry based on the length of time remaining on their visa.
Since then the number of suspected sham ceremonies a year has rocketed, from around 300 to 900. Now, following further human rights rulings, the Home Office will shortly scrap the certificate system altogether. Under the current system, it receives 20,000 applications for certificates of approval each year, with officials refusing only one in 20.
Immigration Minister Damian Green confirmed that the human rights judgments had left the Home Office unable to keep or replace the certificate of approval. He said it would be replaced by a system of ‘enforcement’ and ‘education’. ‘We will not tolerate immigration abuse, including sham marriages.
‘The UK Border Agency investigates all reports of suspected sham marriages – and recent enforcement action has resulted in 155 arrests. ‘The most effective action is to increase our enforcement efforts and work closely with registrars and churches to identify marriages that may not be genuine.’
Registrars will be trained to look for suspicious activity, and anybody involved in fake ceremonies will be arrested.
Recent cases include the prosecution of Rev Alex Brown, who was jailed for four years after being found guilty of carrying out the biggest fake-wedding scam Britain has ever seen. He abused his position at his Victorian parish church in the seaside town of St Leonards, East Sussex, to marry 360 illegal immigrants to complete strangers. Between 2005 and 2009, Brown married up to eight couples a day and was found guilty of breaching immigration laws.
Why Britain’s maths teachers are among the worst in the world
Maths teachers in England are among the most poorly trained in the developed world, a report revealed yesterday. And it found that the average maths specialists in our secondary schools are inferior mathematicians to those teaching primary pupils in Japan.
The research saw England languishing second from the bottom of an international league table which included China, Russia and Hungary. Only the Czech Republic was ranked lower.
Not only are our teachers ill-qualified but many drop out of teaching within five years, which is the point at which they reach their potential in the classroom.
Maths teachers in English primary schools need only a C grade at GCSE in the subject, while many teaching at the same level in Japan have a maths degree. In England’s secondary schools, a maths teacher must be educated to degree level in a maths-based subject.
The study tracked 200 trainee teachers in nine countries. As qualifications are not directly comparable, they were tested on their ability at maths with questions such as ‘What is the value of 25 (or two to the power of five)’. The answer is 32.
Researchers said English youngsters ‘lack mathematical progress compared to our economic competitors’ and put this down, in part, to ill-qualified teachers.
They have called for staff to be barred from teaching maths in primary schools if they have less than a B grade in the subject at GCSE. And they want all secondary teachers to have a maths degree and to continue to study, while teaching, for a masters.
The report, by Plymouth University’s Centre for Better Teaching, said: ‘The lack of progress is not helped by having, in the primary sector, many teachers who are not as well qualified in mathematics as those in other countries, whilst in the secondary sector, we suffer from a very transient workforce.’
The Plymouth research follows a study by the Organisation for Economic Cooperation and Development which found England had tumbled from eighth place in 2000, to 28th place last year in international league tables for maths.
Tony McAleavy, of the Plymouth centre, said: ‘Teaching needs to become a respected profession in this country, on a par with the law and medicine, and then we will attract more able people.’
Professor Celia Hoyles, of the Institute of Education, said there was a need to ‘find ways to improve primary maths teachers’ competence and confidence in maths’.
An Education Department spokesman said the Government wanted to attract better quality maths graduates by offering a fast-track route and raising the bar for entry into training to a 2:2 degree to receive funding.
That incorrect doll again
“They saw it as a harmless stunt to highlight the more hysterical elements of the politically correct bandwagon. But perhaps it proved their point a little too well. Two prospective Tory councillors have resigned from the Conservative Party after being suspended for posting pictures of themselves holding golliwog dolls on Facebook.
Married couple Bill and Star Etheridge, who campaign against political correctness, say they were trying to promote ‘healthy debate’ about whether the doll was a racist symbol. But the pair were summoned before a disciplinary committee after a colleague made a complaint.
Mr Etheridge, 41, who was due to stand alongside his wife for the Tories in the Dudley Council elections in May, has now joined UKIP as he claims his right to express his views is being stifled by the Conservative Party.
He said: ‘We just wanted to stimulate debate and gollies are a perfect example of an innocent child’s toy that’s been transformed into something sinister by the politically correct brigade. ‘We need to get back to a point where people can say what they think and not live in fear. That’s real democracy.’
Mrs Etheridge, 39, a mother-of-three, said she and her husband had wanted to promote debate, not cause offence. She added: ‘It’s just a child’s toy and the politically correct brigade are the ones who have turned it into a racist symbol. I grew up in Bury in Lancashire, so I have a lot of black and Asian friends and as children we had golly dolls and we never once thought of them as racist.
‘Some people say it is offensive, but they’re generally do-gooders who are offended on behalf of other people.’
Golliwog dolls have been around for more than a century and first appeared as friendly characters in children’s books in the 1890s.