NHS surgery ‘lottery’: Bowel patients five times more likely to need second op depending on hospital
Some patients having bowel surgery are up to five times more likely to need another operation – depending on which hospital treats them.
The first analysis of reoperation rates at NHS hospitals in England reveals a huge postcode lottery and some ‘inexplicable’ variations. It shows unplanned reoperation rates were five times higher in some hospitals, prompting concerns about the performance of individual surgeons and NHS trusts.
Experts at Imperial College London used statistics for 246,469 patients treated in 175 English hospital trusts who underwent bowel resection surgery for the first time between 2000 and 2008.
A reoperation may be necessary for several reasons, including complications and a planned ‘second look’.
Of the group, 15,986 (6.5 per cent) patients needed further surgery within 28 days, including of the bowel, to control bleeding or for complications arising from their wound, according to the research published in the British Medical Journal. Eight out of ten patients underwent emergency surgery while still in hospital while the remainder ended up being readmitted.
Analysis showed that patients who had gone in for emergency surgery in the first place had slightly higher reoperation rates than those whose surgery was planned (seven per cent versus 6.2 per cent).
Men and people with inflammatory bowel disease such as colitis and Crohn’s, or other pre-existing conditions, were also more likely to need emergency surgery.
For those whose original surgery was planned, there was a five-fold difference between highest and lowest reoperation rates.
This was around 15 per cent compared with just under 3 per cent – among trusts performing more than 500 procedures during the study.
The researchers said reoperation rates could be a ‘powerful means of checking quality of surgical care’.They also said efforts should be made to reduce ‘inexplicable’ variation in reoperation rates.
Professor Norman Williams, president of the Royal College of Surgeons and consultant colorectal surgeon, said: ‘There is now clear evidence from other studies that publication of clinical audits helps drive up consistency and quality standards in surgery.
“This study will help improve the scope of future work across the profession. It is vital that as well as observing these differences in outcome we also measure aspects of care that help us understand why some units perform better than others and enable individual surgeons to improve.’
A Department of Health spokesman said ‘NHS trusts need to get it right first time and prevent avoidable readmissions’.
So what DOES it take to deport a criminal from Britain? Judge cuts drug-dealing migrant’s sentence so he won’t get kicked out
A judge cut the sentence of an illegal immigrant and drug dealer yesterday to help him escape deportation. Vincent Miller was kicked out of the UK twice but managed to return and stay for more than a decade by stealing the identities of British citizens.
Yet when the 33-year-old was sentenced, the judge said sending him home to Jamaica would be ‘devastating’ for his three children. Judge Farook Ahmed made his decision on Miller’s case during proceedings at Inner London Crown Court yesterday, claiming if he was to be deported it would be ‘devastating’ for his children
Judge Farook Ahmed made his decision on Miller’s case during proceedings at Inner London Crown Court yesterday, claiming if he was to be deported it would be ‘devastating’ for his children
Incredibly, he deliberately shortened the sentence Miller would have received from a year to 11 months. Criminals given 12 months face automatic deportation proceedings.
Recorder Farook Ahmed told Miller: ‘The sentence I have had in mind was 12 months, but it seems to me that it isn’t necessary for me to pass a sentence of 12 months because a sentence of 11 months will have the same effect, and it would take away the automatic triggering of deportation. I have taken into account that if you were to be deported it is bound to have a devastating effect on your three children, who I’m told are lawfully here in the UK.’
The judge’s decision provoked a fierce backlash. Sir Andrew Green, chairman of the pressure group Migrationwatch, said: ‘This raises serious questions about the attitude of the judiciary towards the whole question of removing from Britain those who no longer have a right to be here. ‘To shorten the sentence of a criminal so as to allow him to stay simply beggars belief.’
Tory MP Dominic Raab said: ‘The sentence should be tailored to fit the crime, not avoid Parliament’s rules on deportation which are there to protect the public.’
The case follows a string of outrages where the Human Rights Act has blocked deportation on family grounds.
Criminals have been permitted to stay even where they do not have children or a wife, but only a girlfriend.
Miller arrived in Britain at Christmas in 2000 when he was given permission to stay for only four days.
He did not return home and was arrested and deported in February 2001 only to return that Easter under a stolen identity. Within two years he was deported for supplying class A drugs.
From abroad he successfully applied for a new passport in the name of another man, Joseph Roche, who had no idea his identity had been stolen. That second identity crime allowed him to obtain a driving licence and start work as a barber.
As a result of his fraud, his wife and their three children, aged two, four and six, were able to claim UK citizenship.
His crimes were uncovered only when the real Mr Roche applied for a replacement driving licence, and DVLA officials realised two people were claiming to be the same man.
Miller, of Herne Hill in South East London, was arrested on July 5 and claimed he had given up Mr Roche’s identity some time earlier. He later pleaded guilty to possessing another person’s identity document, three counts of conspiring to obtain property by deception and three counts of dishonestly making a false representation.
Anyone sentenced to more than a year in prison is automatically considered for deportation by the UK Border Agency.
But the judge at Inner London Crown Court said he would reduce the intended sentence to allow Miller to stay in the country and look after his children.
Judge Ahmed told him: ‘You subverted immigration rules and you were able to construct a life in the UK based on your deception. ‘I have taken into account that if you were to be deported it is bound to have a devastating effect on your three children, who I’m told are lawfully here in the UK.
‘At least one other person benefited from your conduct, and that is I’m told your former wife,’ said the judge. ‘She was able to become a UK national as a result of your assumption of Mr Roche’s identity.’
The judge said it was a significant aggravating factor that he had made a ‘wholesale assumption’ of Mr Roche’s identity, who was himself then suspected of being a criminal. ‘He is a real person and is entirely innocent,’ he said.
The Home Office insisted it would still seek to deport Miller at the end of his sentence. However, the Jamaican will be entitled to use Article 8 of the Human Rights Act – the right to a private and family life – to attempt to stay in the country.
Figures obtained by the Daily Mail show nearly 400 foreign criminals escaped deportation last year by using Article 8.
A UK Border Agency spokesman said: ‘We will seek to remove this individual at the end of his sentence. If someone has no right to be in this country, and does not leave voluntarily, we will take action to enforce their removal.’
British family’s 18 months of hell after two children are taken away when blundering social workers wrongly accuse them of breaking baby’s limbs
A couple were accused of child abuse after doctors failed to realise their baby son’s ‘injuries’ were caused by a genetic bone disease. Both parents were arrested and prevented from seeing their children unsupervised for 18 months before their innocence was finally acknowledged.
Yesterday Amy Garland said she and her partner had been treated like criminals after they took their six-week-old son Harrison to hospital when he was ill.
Initial tests proved inconclusive, but X-rays later showed that he had suffered eight separate fractures in his arms and legs. Social services accused his parents of child abuse and took the baby and his elder sister into care.
Miss Garland and her partner Paul Crummey were arrested and banned from seeing their children alone before anyone realised that Harrison actually had brittle bone disease, or osteogenesis imperfecta.
The rare condition is caused by a gene defect which impairs the production of the protein collagen, making bones fragile. Those with the disease can break their bones while being cuddled or even in their sleep. Around 40 to 60 babies are born with the disorder each year.
Miss Garland, 26, who lives near Bristol, said her family had been left in tatters after she and Mr Crummey split up over the stress caused by being separated from their children.
As soon as the fractures were discovered, social services were called in. The couple could not explain the apparent injuries and police arrested them.
Their daughter Bethany, then 20 months, was placed in the care of Miss Garland’s father. When the case went before Bristol County Court a judge ordered them to live in a family placement centre where their every move was observed. Miss Garland said: ‘The judge didn’t want to separate me from Harrison because I was still breast feeding. We were watched 24 hours a day and there were cameras in every room. It was like a prison.’
After three months, staff could find nothing wrong with their parenting skills and recommended that the family be allowed to stay together.
But social workers applied for an interim care order and the children were placed into foster care with Miss Garland’s mother. They were allowed contact with their parents for six hours a day, under supervision. This continued for more than a year until Miss Garland found an expert who said Harrison probably had osteogenesis imperfecta. Six months later, doctors agreed that this was a possibility and South Gloucestershire Social Services dropped the case.
Miss Garland told last night how Harrison had been in obvious discomfort in the weeks after his birth, but hospital tests found nothing. But when she got home she noticed his legs were swollen, and X-rays later showed he had several fractures in his arm, feet and legs. Miss Garland said: ‘We had no idea that this condition was in our family so when they asked us how they happened we didn’t know.
‘They said they needed to investigate it and we were happy for them to do that. The police and social services asked us a lot of questions. They asked me if there was any family history of violence. The police spoke to our neighbours asking what we were like. They went through our house. I was in absolute shock. I felt like a criminal.’
Even in hospital, she was not allowed to be alone with her son. ‘I wasn’t eating and I couldn’t sleep because I was worried they would take him from me,’ she said.
The strain caused the couple to split up two months after the children went into foster care. Miss Garland said: ‘It was horrible. When I went home at night and the kids weren’t there, I broke down. We took things out on each other.’
A month after the case was finally dropped two years ago, Harrison was officially diagnosed with osteogenesis imperfecta. Bethany, now five, was found to have a lesser type of the condition.
Harrison still has vitamin D injections to strengthen his bones and sees a physiotherapist to build up his muscles. Brittle bone disease is often confused with osteoporosis – thinning bones in women after the menopause – but the two are not the same.
Mr Crummey, 41, who recently lost his job as a civil servant at the Ministry of Defence, said: ‘All we wanted to do was help our sick child but we were treated like criminals. We’ve never received an apology from social services. It makes me feel very angry.’
A spokesman for South Gloucestershire Council said: ‘We have a legal duty to protect children and young people and we always put the welfare of the child at the heart of how we deliver our services.’
The Barbarians Inside Britain’s Gates
All the young rioters will have had long experience with the justice system’s efforts to confer impunity upon law breakers
by Theodore Dalrymple
The youth of Britain have long placed a de facto curfew on the old, who in most places would no more think of venturing forth after dark than would peasants in Bram Stoker’s Transylvania. Indeed, well before the riots last week, respectable persons would not venture into the centers of most British cities or towns on Friday and Saturday nights, for fear—and in the certainty—of encountering drunken and aggressive youngsters. In Britain nowadays, the difference between ordinary social life and riot is only a matter of degree, not of type.
A short time ago, I gave a talk in a school in an exquisite market town, deep in the countryside. Came Friday night, however, and the inhabitants locked themselves into their houses against the invasion of the barbarians. In my own little market town of Bridgnorth, in Shropshire, where not long ago a man was nearly beaten to death 20 yards from my house, drunken young people often rampage down one of its lovely little streets, causing much damage and preventing sleep. No one, of course, dares ask them to stop. The Shropshire council has dealt with the problem by granting a license for a pub in the town to open until 4 a.m., as if what the town needed was the opportunity for yet more and later drunkenness.
If the authorities show neither the will nor the capacity to deal with such an easily solved problem—and willfully do all they can to worsen it—is it any wonder that they exhibit, in the face of more difficult problems, all the courage and determination of frightened rabbits?
The rioters in the news last week had a thwarted sense of entitlement that has been assiduously cultivated by an alliance of intellectuals, governments and bureaucrats. “We’re fed up with being broke,” one rioter was reported as having said, as if having enough money to satisfy one’s desires were a human right rather than something to be earned.
“There are people here with nothing,” this rioter continued: nothing, that is, except an education that has cost $80,000, a roof over their head, clothes on their back and shoes on their feet, food in their stomachs, a cellphone, a flat-screen TV, a refrigerator, an electric stove, heating and lighting, hot and cold running water, a guaranteed income, free medical care, and all of the same for any of the children that they might care to propagate.
But while the rioters have been maintained in a condition of near-permanent unemployment by government subvention augmented by criminal activity, Britain was importing labor to man its service industries. You can travel up and down the country and you can be sure that all the decent hotels and restaurants will be manned overwhelmingly by young foreigners; not a young Briton in sight (thank God).
The reason for this is clear: The young unemployed Britons not only have the wrong attitude to work, for example regarding fixed hours as a form of oppression, but they are also dramatically badly educated. Within six months of arrival in the country, the average young Pole speaks better, more cultivated English than they do.
The icing on the cake, as it were, is that social charges on labor and the minimum wage are so high that no employer can possibly extract from the young unemployed Briton anything like the value of what it costs to employ him. And thus we have the paradox of high youth unemployment at the very same time that we suck in young workers from abroad.
The culture in which the young unemployed have immersed themselves is not one that is likely to promote virtues such as self-discipline, honesty and diligence. Four lines from the most famous lyric of the late and unlamentable Amy Winehouse should establish the point:
I didn’t get a lot in class
But I know it don’t come in a shot glass
They tried to make me go to rehab
But I said ‘no, no, no’
This message is not quite the same as, for example, “Go to the ant, thou sluggard, consider her ways and be wise.”
Furthermore, all the young rioters will have had long experience of the prodigious efforts of the British criminal justice system to confer impunity upon law breakers. First the police are far too busy with their paperwork to catch the criminals; but if by some chance—hardly more than one in 20—they do catch them, the courts oblige by inflicting ludicrously lenient sentences.
A single example will suffice, but one among many. A woman got into an argument with someone in a supermarket. She called her boyfriend, a violent habitual criminal, “to come and sort him out.” The boyfriend was already on bail on another charge and wore an electronic tag because of another conviction. (Incidentally, research shows that a third of all crimes in Scotland are committed by people on bail, and there is no reason England should be any different.)
The boyfriend arrived in the supermarket and struck a man a heavy blow to the head. He fell to the ground and died of his head injury. When told that he had got the “wrong” man, the assailant said he would have attacked the “right” one had he not been restrained. He was sentenced to serve not more than 30 months in prison. Since punishments must be in proportion to the seriousness of the crime, a sentence like this exerts tremendous downward pressure on sentences for lesser, but still serious, crimes.
So several things need to be done, among them the reform and even dismantlement of the educational and social-security systems, the liberalization of the labor laws, and the much firmer repression of crime.
David Cameron is not the man for the job.
British bosses condemn ‘useless’ degrees which leave graduates unemployable because they lack basic skills
Millions of school leavers and graduates with ‘fairly useless’ degrees are unemployable because they lack basic skills, a major business lobby group will warn today. The devastating report, from the British Chambers of Commerce, reveals small businesses are frustrated at the quality of applicants, who they say can barely concentrate or add up.
Nearly half of the 2,000 firms surveyed said they would be ‘fairly or very nervous’ about hiring someone who has just finished their A-levels.
The report warns: ‘Too many people [are] coming out with fairly useless degrees in non-serious subjects.’ Its findings raise serious questions about the type and standard of education and skills training in Britain.
The group questioned the owners of ‘micro-businesses’, those with fewer than ten employees. Many have vacancies which they are desperate to fill but were scathing about the quality of candidates.
The report states: ‘In general, younger people lack numerical skills, research skills, ability to focus and read, plus written English.’
One unnamed entrepreneur told researchers: ‘Plenty of unemployed, mostly without experience in my sector. The interpersonal skills of some interviewed in the past have been very poor.’
Dr Adam Marshall, director of policy at the British Chambers of Commerce, said the fault lies with the education system, not with the young people themselves. He said new courses spring up because there is demand from would-be students – but not necessarily from businesses.
Dr Marshall said: ‘There may be a course in underwater basket weaving, but that does not mean anybody will actually want to employ you at the end of it.’ He cited the American television crime drama CSI as a prime example. It sparked a huge growth in the popularity of forensic science courses, but Dr Marshall said demand for these graduates is low.
He said: ‘Despite high levels of unemployment, many micro-firms are frustrated by the quality of applicants for vacant roles. ‘There is a real mismatch between business needs and local skills supply. Many businesses are unable to find school leavers or even graduates with the right mix of skills.’
Dr Marshall said he is desperate for the country to listen to business and create the right courses to fit the jobs that are available.
More than half micro-firms want to employ new workers over the next four years, but fear they will not be able to find suitable candidates. When asked how they do hire workers, many said they rely on their own family, personal contacts and people who have been recommended.
The report comes amid the growing ranks of business leaders attack Labour’s record on education and skills.
The former boss of Tesco, Sir Terry Leahy, described school standards as ‘woeful’ in 2009. His comments were echoed in the same year by former Marks & Spencer chairman Sir Stuart Rose, who said many school leavers were not ‘fit for work.’
Despite a doubling of spending on education since 2000, from £35.8billion to £71billion, Britain has plummeted down world rankings, according to the respected Organisation for Economic Co-operation and Development.
A spokesman for the Department for Education said: ‘We share the concerns of many businesses that too many of our young people leave school without the skills needed for work – in particular in the basics of English and maths. ‘It is good qualifications in these key subjects that employers demand before all others. That’s why we are prioritising them.’
Myth of ‘eco-friendly’ bags exposed as British supermarket chain dumps ‘green’ carriers that may actually harm the environment
Tesco has stopped using biodegradable carrier bags because they may be even worse for the environment than the conventional type. The decision is an embarrassment for the chain, which hailed its introduction of the bags as the centrepiece of its efforts to tackle litter and waste. Tesco stores hand out more throwaway plastic bags than any other retailer in the country – well over two billion a year.
Most supermarket carriers are used for only 20 minutes before being thrown away, but they can take up to 1,000 years to decompose. Many end up in landfill while others blight the countryside, beaches and the sea.
Tesco claimed that the biodegradable bags, which include an ingredient that makes them break down after 20-36 months, would defeat this problem. However, it is pulling them from stores after five years following independent scientific research funded by the Government which suggests they may damage wildlife and the environment.
Tesco said it began changing to new bags, which are not biodegradable but include 15 per cent recycled material, earlier this year. However, the company has made no official announcement on the change, and its website still boasts about the company’s commitment to using biodegradable bags.
It states: ‘We recognise that many of our bags may go to landfill, so we have made our carrier bags biodegradable. This means that they break down into water, carbon dioxide and biomass, which have minimal impact upon the environment.’
Tesco’s failure means other measures to tackle the blight caused by carrier bags are now necessary.
An independent study published last year raised serious questions about the value of the biodegradable bags. Experts from Loughborough University pulled together all the published research into such bags and concluded that they may do more harm than good. Their report warned that these bags can litter the countryside for up to five years before they degrade, far longer than the supermarket claims. This is because they are not exposed to enough of the heat and sunlight they need to break down.
The additive used in the bags to make them break down also means that they cannot be recycled.
The biodegradable bags do eventually crumble into a fine dust, according to the researchers.
But they said: ‘Although these bags are regarded as beneficial by the producers, concerns have been raised that these particles of plastic may be ingested by invertebrates, birds, animals or fish.’
No evidence was found that the fragments cause harm, ‘but neither was there evidence that they do not’, the authors added.
Explaining the decision to drop the bags, Tesco said it was based on scientific advice and also addressed customers’ concerns that they were weak and likely to break. A spokesman said: ‘We took the decision to remove the biodegradable additive because we believed it contributed towards bags becoming weaker and to help better promote their re-use and recycling at end of life. ‘This decision was underpinned by a detailed review of the science to help us understand the full life-cycle environmental impacts of our carrier bags.’
The Daily Mail’s Banish the Bags campaign, which began in 2008 and is calling for a drastic reduction in the billions of bags handed out each year, has gained support from all major political parties.
Yesterday Scottish ministers announced the start of a public consultation to find ways to limit the use of plastic bags. They are considering a compulsory charge for the throwaway bags.
How the Daily Mail has led the way in trying to banish plastic bags
Wales will introduce a charge of 5p on all single-use bags from October 1, including those from major supermarkets such as Tesco.
Northern Ireland is bringing in charges on April 1, 2013 and a public consultation is taking place about how much to charge.
England looks likely to be on its own in failing to take action, but David Cameron and Nick Clegg are under pressure to follow suit at Westminster.
Despite pledges by the Prime Minister and Deputy Prime Minister while they were in opposition, the Coalition currently has no policy on plastic bag reduction.
Last month it emerged that an extra 330million plastic bags have been handed out by supermarkets in the past year. It is the first time the total has gone up in five years.
In 2010/2011, around 6.4billion single-use plastic bags were given out, compared with 6.1billion in 2009/10, according to figures from WRAP, the Government’s waste reduction agency. That means everyone in the country is given 8.6 bags per month on average.
Marks & Spencer was the first major chain to bring in a 5p charge, in 2008.