Hospitals missing vital chance to ensure elderly are eating properly as two in three patients not checked for malnutrition
Two out of three hospital patients are not being checked for signs of malnutrition, alarming figures have revealed. The largest survey carried out into malnutrition in hospitals and the community also found most carers are not keeping track of nutrition problems among the old – or even weighing them.
Health Service guidelines say all patients going into hospital and all outpatients should be questioned about their weight and diet, as well as all those going into care homes.
The scandal of elderly hospital patients dying of neglect was laid bare earlier this year when official figures revealed dehydration contributed to the deaths of 800 a year, with malnutrition accounting for a further 284.
But a major survey of 5,000 adults in England, Scotland and Wales commissioned by the Patients Association shows little has changed, even though it is supposed to be a key priority for the NHS.
Altogether 69 per cent of hospital inpatients did not recall being screened for malnutrition on admission. This could mean fewer than one in three are being checked. A slightly higher proportion (38 per cent) were asked about their weight and diet if they were staying in hospital for more than two nights, but only a quarter who were in for shorter stays were screened.
Even though the plight of older patients has been repeatedly highlighted by the Daily Mail’s Dignity for the Elderly campaign, those aged over 50 were no more likely to have been checked than those under 50. No action was taken in the cases of two-thirds of inpatients aged over 50, according to the survey, conducted by YouGov.
Worryingly, the survey found even less action being taken by carers – who are ideally placed to check on the weight of those they are caring for. More than half of 1,800 carers taking part in the survey had concerns about the weight of someone they looked after but only 8 per cent had used formal assessment methods to check for malnutrition. Just one in six had ever weighed a person they were looking after.
Among 1,500 people with close friends or relatives in a residential care home, two thirds were unaware how often their diet and weight was monitored.
The Patients Association report – Patients’ Understanding of Nutrition – says it is ‘alarming’ that so few are being checked when staff should be following the screening guideline issued by the National Institute for Health and Clinical Excellence.
Katherine Murphy, the association’s chief executive, said: ‘It is unbelievable that in the UK today there are more than three million people either malnourished or at risk of malnutrition in hospitals and the community.
Local authorities must ensure that health and social care is properly integrated and that vulnerable patients are not discharged and left to fend for themselves. ‘We also need to be questioning why only 31 per cent of inpatients are being screened for malnutrition when the NICE guideline clearly states this is a clinical priority.’
She said that treating an individual patient with malnutrition over six months costs the NHS £1,000. ‘It is now almost a year since the Coalition announced its plans to reform the NHS, but we are no clearer as to how these reforms will tackle the issue of malnutrition,’ she said. ‘Malnutrition not only affects patients, their families and carers but it costs the NHS more than £13billion a year.’
Dr Mike Stroud, chairman of the British Association for Parenteral and Enteral Nutrition, said: ‘We have long campaigned for all patients to be weighed and screened for malnutrition on admission. ‘If screening does not take place, malnutrition remains unidentified and untreated which results in increased complications, longer hospital stays and even death. ‘Hospitals have all the evidence, guidance and training materials they need.’
A Department of Health spokesman said: ‘In line with NICE guidance, the NHS should screen all inpatients, when admitted to hospital and at weekly intervals. ‘Care homes should screen for malnutrition upon admission and whenever there is cause for concern.’
UK riots: It’s not about criminality and cuts, it’s about culture… and this is only the beginning
Condemned as a racist for his comments on ‘Newsnight’ following the riots, the historian David Starkey speaks out below against those who tried to silence him for confronting the gangster culture that has ruptured British society
What a week! It’s not every day that you’re the subject of direct personal attack from the Leader of Her Majesty’s Opposition. On Tuesday, after he had spoken at his old school, Haverstock Comprehensive, about the riots, Ed Miliband was invited by a member of the audience to “stamp out” the now-infamous opinions I had expressed on the same subject on last Friday’s Newsnight.
Mr Miliband might have replied that he disagreed with what I said, but in a liberal democracy defended my right to say it since it broke no laws. Not a bit of it, I fear. Instead, Miliband – the son of a refugee who fled from Nazi Europe to preserve his life and freedom of thought – agreed enthusiastically with the questioner. Mine were “racist comments”, he said, “[and] there should be condemnation from every politician, from every political party of those sorts of comments.”
Strong words. But what do they mean? Well, the following statements are verbatim quotations of some of the principal points I made on Newsnight: “A particular sort of violent, destructive, nihilistic, gangster culture has become the fashion.” “This sort of black male [gang] culture militates against education.” “It’s not skin colour, it’s cultural.”
“Disgusting and outrageous”, are they? In which case, those who agree with Miliband must believe the opposite of all these. They are therefore convinced that gang culture is personally wholesome and socially beneficial.
But how, then, to explain the black educationalists Tony Sewell and Katharine Birbalsingh defending the substance of my comments on “gangsta” culture, as well as Tony Parsons, who wrote in the Labour-supporting Daily Mirror that, “without the gang culture of black London, none of the riots would have happened – including the riots in other cities like Manchester and Birmingham where most of rioters were white”.
Even stranger is Miliband’s apparent notion that, far from militating against educational achievement as I suggested, “the gang culture of black London” must therefore be a seedbed for scholarship and sound learning. Odd, isn’t it, that Waterstone’s bookshop was the only business unlooted in the Ealing riots? And odder still that Lindsay Johns, the Oxford-educated mixed-race writer who mentors young people in Peckham, argues passionately against “this insulting and demeaning acceptance” of a fake Jamaican – or “Jafaican” – patois. “Language is power”, Johns writes, and to use “ghetto grammar” renders the young powerless.
“So why,” some of my friends have asked, “didn’t you stop there?” “Why did you have to talk about David Lammy MP sounding ‘white’? Or white chavs becoming ‘black’?” The answer is that I thought my appearance on Newsnight was supposed to be part of a wide-ranging discussion about the state of the nation. Central to any such discussion, it seems to me, are the successes and failures of integration in Britain in the past 50 years. And it was these that I was trying to address.
On the other hand, there is no doubt that my remarks on this subject produced especial outrage. I was accused of condemning all black culture; of using white and black culture interchangeably to denote “good and bad”, and of saying that blacks could only get on by rejecting black culture. Actually, I said none of those things and nothing that I did say could have been construed as such by any fair-minded person.
Instead, I was trying to point out the very different patterns of integration at the top and bottom of the social scale. At the top, successful blacks, like David Lammy and Diane Abbot, have merged effortlessly into what continues to be a largely white elite: they have studied at Oxbridge and gone on to Oxbridge-style careers, such as that of an MP.
But they have done so at the cost of losing much of their credibility with blacks on the street and in the ghettos. And here, at the bottom of the heap, the story of integration is the opposite: it is the white lumpen proletariat, cruelly known as the “chavs”, who have integrated into the pervasive black “gangsta” culture: they wear the same clothes; they talk and text in the same Jafaican patois; and, as their participation in recent events shows, they have become as disaffected and riotous.
Trying to explain why, led me to what all my friends agree was my greatest error: to mention Enoch Powell. Tactically, of course, they are right, as the “Rivers of Blood” speech remains, even 40-odd years after its delivery, an unhealed wound.
Unfortunately, the speech and still more the reaction to it, are also central to any proper understanding of our present discontents. For Powell’s views were popular at the time and the London dockers marched in his support. The reaction of the liberal elites in both the Labour and Tory parties, who had just driven Powell into the wilderness, was unanimous: the white working class could never be trusted on race again. The result was a systematic attack over several decades: on their perceived xenophobic patriotism, on symbols like the flag of St George, even – and increasingly – on the very idea of England itself.
The attack was astonishingly successful. But it left a void where a sense of common identity should be. And, for too many, the void has been filled with the values of “gangsta” culture.
Consider the converse. One of the most striking things about the England riots is where they did not happen: Yorkshire, the North East, Wales and Scotland. These areas contain some of the worst pockets of unemployment in the country. But they are also characterised by a powerful sense of regional or national identity and difference that cuts across all classes and binds them together. And it is this, I am sure, which has inoculated them against the disease of “gangsta” culture and its attendant, indiscriminate violence.
Scotland, Alex Salmond says smugly, is a “different culture”. It is indeed, since the Scots are allowed – and even encouraged – to be as racist as they please and hate the English with glad abandon.
I do not want a similar licensed xenophobia here. But an English nationalism we must have. And it must be one that includes all our people: white and black and mixed race alike.
Fortunately, there is a powerful narrative of freedom that runs like a golden thread through our history. “The air of England is too pure for a slave to breathe in,” counsel declared repeatedly in Somersett’s Case, about the legality of slavery in England, in 1772.
We must focus on the righting of the wrong rather than the original wrong itself. The former heals; the latter divides. And we have had enough of division. There is a final point. If all the people of this country, black and white alike, are to enter fully into our national story, as I desperately hope they will, they must do so on terms of reciprocity. In other words, I must be as free to comment on problems in the black community as blacks are to point the finger at whites, which they do frequently, often with justice, and with impunity.
For the other pernicious legacy of the reaction to Powell has been an enforced silence on the matter of race. The subject has become unmentionable, by whites at any rate. And any breach has been punished by ostracism and worse. As the hysterical reaction to my remarks shows, the witch-finders already have their sights on me, led by that pillar of probity and public rectitude, Piers Morgan, who called on Twitter for the ending of my television career within moments of the Newsnight broadcast.
But the times have changed. Powell had to prophesy his “Tiber foaming with blood”. We, on the other hand, have already experienced the fires of Tottenham and Croydon. Moreover, the public mood is different from the acquiescent and deferential electorate of the Sixties. We are undeceived. We are tired of being cheated and lied to by bankers and MPs and some sections of the press.
We will not continue, I think, to tolerate being lied to and cheated in the matter of race. Instead of “not in front of the children”, we want honesty.
But this is only the beginning. The riots are the symptom of a profound rupture in our body politic and sense of national identity. If the rupture is not healed and a sense of common purpose recovered, they will recur – bigger, nastier and more frequently. Can we stop bickering and address this task of recovery and reconstruction – all together?
BBC praises Communist spy
Which tells you a lot about their attitudes: They’re Britain’s Kremlin
The Courtauld Institute was once the best place in Britain to study the history of art. But its director, Anthony Blunt, had, earlier in his life, spied for the Soviet Union. He was the “Fourth Man” in the ring with Burgess, Maclean and Philby. He confessed to the British intelligence services in 1964 (having repeatedly denied all the accusations over many years). The information was kept quiet, partly because he was Surveyor of the Queen’s Pictures. In 1979, he was publicly exposed, stripped of his knighthood and disgraced.
The Reunion brought together five distinguished people who had studied under Blunt. They included the director of the British Museum Neil MacGregor, the novelist Anita Brookner and the critic Brian Sewell. All five agreed what a wonderful chap Blunt was – brilliant, kind, civilised, terrific work on Poussin. And all said how appalling it was that Blunt had been attacked by the press after his exposure. Sue MacGregor (no relation of Neil, I think), who presented the programme, said that Blunt had been the victim of “public vilification”; she referred to the scandal as “what had happened to him”.
We were told only in the thinnest outline what Blunt himself had done to others. In the mid-Thirties, he began working for the NKVD (the forerunner of the KGB), and helped recruit other British agents for them. It is often alleged that people in the West at that time had no means of knowing what Stalin was up to. This was not the case. Malcolm Muggeridge, attacked on this programme for attacking Blunt, went to the Ukraine in 1933 and reported – in this paper’s sister, The Morning Post – that millions were starving there as a deliberate act of Stalin’s policy. There were many like him (though not nearly enough).
Much was made, particularly by Brian Sewell, of the claim that the threat of fascism was so great in the Thirties that Communism seemed the only way. This does great injustice to all those – the majority of the population – who detested both. If Sewell is right, why did Blunt, Philby, Burgess etc continue to work for Stalin after he made his pact with Hitler, which lasted from 1939 to 1941, the time of greatest danger for Britain? And why did Blunt continue to shelter Burgess, Maclean and Philby from discovery after the war, when Nazism had been defeated and the Soviet Union was the deadly enemy of the West?
As for Blunt’s acts of spying, these were brushed aside by the programme on the grounds that there had been “very exaggerated estimates” of the number of people who had died as a result of his actions. His treachery, said another former pupil, Michael Jacobs, had been “a minor and ultimately irrelevant aspect of his life”.
It is a good thing that people feel gratitude to their teachers. It is also true that Blunt’s work on Blake, Poussin, Borromini and so on does not become bad because he turned out to have been a Communist spy. So it was difficult to blame the five for their loyalty to Blunt, even when they were talking rubbish.
What was disgraceful, though, was the structure of the programme. For many, The Reunion’s version may be the first they have heard of the subject. It is the duty of the BBC to apply to history the impartiality on which its Charter insists. Yet, as with the same programme’s treatment of the 30th anniversary of the Brixton riots (which this column criticised on March 28), the entire panel was on the same side. Blunt was a virtually innocent victim, we were told, and the only villain was the press.
Sue MacGregor explained that Blunt “made no secret of his Marxist beliefs”. This was perfectly irrelevant. The issue in his story was not his beliefs, but his treachery, which, by definition, was secret. He pretended that he was a normal British citizen and, during the war, a loyal officer of MI5, but in fact he was working for a murderous tyranny. Almost the only censure in the entire programme came from Neil MacGregor. Blunt, he said, had been guilty of “a very serious breach of trust”. This understatement was rendered powerful by its solitary splendour.
The breach of trust was made even worse by the “establishment” career which Blunt chose to pursue. At least Burgess, Maclean and Philby ended up, drink-sodden, in miserable Moscow flats supplied by the dictatorship they so admired. Blunt, however, stayed, advised the Queen about her pictures, was knighted and honoured in academe. For a quarter of a century, throughout which time he concealed what he had done, he lived in the Courtauld’s grace-and-favour Georgian elegance in Portman Square. His entire (non-spying) career was constructed on principles in direct conflict with his Marxism.
And when he was finally unmasked, even his handling of the news reflected his love of the privilege which had always surrounded him. He had lunch at The Times (then the establishment paper) before the press conference, and restricted access to selected reporters.
The Reunion propagated the theory that spying for the Soviets in the Thirties and Forties was nothing worse than an excess of zeal. This is a shocking untruth. Hitler and Stalin were moral equivalents. Indeed, at the time when Blunt signed up for the Soviet Union, Stalin had actually killed far more people than Hitler because the Führer was only just getting into his stride. The BBC would (rightly) never dream of making a programme which sought to excuse traitors who worked for the Nazis.
In our generation, Blunt’s equivalents are the intellectual apologists for Islamist extremism. No doubt it will turn out that some of them worked secretly for countries like Iran, and no doubt, in due time, the BBC will laud them too.
How the British Labour Party let a generation down with easy High School courses
The number of pupils studying core GCSEs more than halved under Labour, creating an under-skilled generation, figures have revealed. Experts said the decision to introduce a raft of easy GCSE-equivalent qualifications had led to dumbed-down teenagers deprived of key skills for survival in the workplace.
Only 22 per cent of youngsters – 152,000 – took GCSEs in English, maths, two sciences, a humanity and a language last year. This is a reduction from 50 per cent – 293,000 – in 1997 when the last Labour Government took power.
Instead of rigorous subjects such as physics, tens of thousands sat soft subjects such as a Certificate in Personal Effectiveness, which includes a module on how to claim the dole. Ministers have now called for pupils to sit the EBacc, a new qualification based on the old O-levels which focuses on traditional subjects.
Tory MP Damian Hinds said: ‘These figures show categorically how, over 13 years, the last Labour government undermined the life chances of a generation by steering them away from the subjects that employers value most.’ He said students need a ‘core of recognised key academic subjects’ to ‘compete in an increasingly global marketplace with their counterparts from countries like China and India’.
The figures, revealed today, emerge as around 750,000 children in England, Wales and Northern Ireland prepare to receive a bumper crop of GCSE results on Thursday. It is predicted that nearly one in four could be awarded at least an A grade and one in 12 exams could score a coveted A*. Last summer, the pass rate rose for the 23rd year in a row, with 69.1 per cent of entries achieving at least a C grade.
The figures showing the sharp decline in core subjects – revealed in response to a parliamentary question – followed a massive increase in non-academic qualification awarded since 2004. Some 115,000 non-academic subjects were taken in school in 2004 – and this soared to 575,000 in 2010. Most of these were taken at the age of 16 and included BTECs in subjects such as ICT, which is equivalent to four separate GCSEs.
An independent review by Professor Alison Wolf, of King’s College London, found that 350,000 young people each year are pushed into courses with ‘little to no labour market value’. She said schools have ‘deliberately steered’ pupils away from the more difficult core subjects to improve their league table rankings.
Official figures show that while only 22 per cent of pupils took five EBacc subjects, fewer than one in six achieved them last year. The EBacc measure was included for the first time in the league tables in January this year. It is thought that next year its effect will be seen in results, bringing a halt to the year-on-year rise of pass rates.
Union leaders are against the EBacc. Mary Bousted, general secretary of the Association of Teachers and Lecturers, said it would do more harm than good. She added: ‘The pressure on schools and teachers of the league tables has already led to too much teaching focusing on getting pupils through exams.
‘The Government’s intention to devalue and limit vocational qualifications in league tables will tie schools’ hands and push many people into qualifications that don’t allow them to develop their talents and excel.’
Is now the time for a castle law in Britain?: “At a time where home and small business owners face a real threat of violence towards themselves and their property, and when police resources are increasingly stretched beyond their limits, better defined rights of defending personal property would offer peace of mind as well as a definitive deterrent to would-be criminals. Rather than questioning what constitutes ‘reasonable force’ we would be safe in the knowledge that if we were to ever be put in the terrifying situation of facing an intruder the law would offer us the absolute upper hand.”
There is a new lot of postings by Chris Brand just up — on his usual vastly “incorrect” themes of race, genes, IQ etc.