Patients face wait of six months for NHS physio because budgets have been slashed
Physio can sometimes get people going again quite rapidly, so this is deplorable
Patients needing physiotherapy on the NHS are facing waits of more than six months, a report warns.
This is because budgets for physio services have been slashed, the Chartered Society of Physiotherapy said.
The delays mean patients’ conditions are deteriorating, leading to more re-admissions to hospital and higher long-term costs for the NHS and social care.
The CSP’s audit of 115 primary care trusts in England found ‘significant variations in how physiotherapy services are commissioned and funded’.
West Sussex PCT said waiting times varied from four to 27 weeks, with an average of 11.8 weeks.
But in South Tyneside and Gateshead, patients were assessed by a physiotherapist within two working days of referral and had their first appointment within a maximum of 15 working days.
The report also surveyed more than 200 physiotherapy managers and found more than half – 57 per cent – reported cuts to services.
Nearly 60 per cent said these cuts had, or would, reduce the number of treatment sessions a patient could have, while one in four said patient safety was being compromised by the cuts.
Some 70 per cent of managers who reported safety concerns had also seen cuts in specialist physio posts and ‘down-banding’ of jobs, where less experienced staff filled jobs once reserved for somebody more senior.
Phil Gray, chief executive of the CSP, said: ‘This report paints a disturbing picture. Patients are waiting longer to get the treatment they need, which increases the risk that their condition will worsen.
‘When faced with this enormous challenge, it is hard to believe that the Government still wants to impose the destabilisation, massive upheaval and huge extra cost of its proposed NHS reforms.
‘Short-term, financially-driven cuts to physiotherapy services make no sense when physios can reduce long-term NHS and welfare costs by helping people get well and keeping them in work.’
Evidence shows that early access to physiotherapy services is cost effective and offers clinical benefits to patients such as stroke survivors and those with musculoskeletal disorders of the back, neck and joints.
The CSP said it had ‘serious questions’ over the ability of commissioners in GP consortia to effectively plan for future referrals in physiotherapy.
Mr Gray said: ‘Under the Government’s proposals, GPs will be given a huge pot of money but these findings suggest they will be asked to spend it on services that they will have little information about. ‘It is hard to see how they can commission the treatment their patients need if they do not know what services are available and how effective they are.
‘It is right that clinicians should have more of a say in the commissioning process, but the rushed nature of these reforms could leave patients without access to essential services.’
Nine-to-five GPs have lost trust of patients because of lack of out-of-hours care
Patients have lost faith in GPs because they are only prepared to work from nine-to-five and from Monday to Friday, a report commissioned by doctors’ leaders warns today.
It says illness can strike at any time and the sick should not have to assume they can only go to a surgery in office hours.
The report into standards of care, set up by the Royal College of GPs, also warns most patients now see a different, unfamiliar doctor every time they have an appointment.
This means there is a higher chance illnesses are missed as the GP does not know the patient and may not be able to spot whether their health has deteriorated.
The report, written by experts from organisations including the British Medical Association, the Department of Health and several leading universities, also warns many vulnerable patients do not ‘receive the service they deserve’.
The authors point out fewer than half of GPs have been properly trained to look after children and, as a result, many parents are taking youngsters straight to A&E as they think they will get better care.
They also warn other groups, such as the elderly in care homes, ‘are getting an especially poor deal’ as family doctors do not know how to manage conditions such as dementia.
The Royal College of GPs linked up with the Health Foundation think-tank for the probe into improving care. In particular, its authors express ‘big concerns’ over standards of out-of-hours care, warning it has ‘proved seriously lacking’.
Since GPs were allowed to opt out of working at evenings and weekends under a controversial contract brought in by Labour in 2004, patients have ‘lost confidence’ in their service, they say.
‘Illness does not strike during office hours only and people’s access to the services of their general practice should not be limited by a nine-to-five, Monday to Friday approach’, the report adds.
Since the ‘bungled’ contract was introduced seven years ago, GPs have seen their salaries soar from £70,000 to an average of £105,000, even though they now work fewer hours.
In many parts of the country, out-of-hours care is run by agencies who employ locum doctors, some with poor standards of English. The report warned this cover ‘had been seriously lacking’. The failings of out-of-hours care was exposed in 2008 when 70-year-old David Gray died after being given ten times the recommended dose of morphine by a German GP. Dr Daniel Ubani had just flown in to cover his first locum shift at a surgery in Cambridgeshire.
Baroness Finlay, who led the study, said: ‘There are big concerns with out-of-hours care. Patients become ill day and night. There isn’t a simple solution but it needs a complete rethink.’
The report also calls for GPs to have an additional two years’ training to ensure they have the skills to look after certain groups of patients, such as children.
It points out only between 40 and 50 per cent of family doctors have undergone paediatric training even though children comprise a quarter of all their patients.
The report also recommends GPs form small groups to take charge of a list of patients. This would mean patients get used to seeing the same familiar doctors, who would also get to know their patients better.
Idiot British Judge DID rule migrant’s pet was a reason he shouldn’t be deported
A judge allowed an illegal immigrant to dodge deportation because he feared separating him from his cat risked ‘serious emotional consequences’, it emerged yesterday.
The human rights ruling, obtained by the Daily Mail, vindicates Home Secretary Theresa May over the ‘cat-gate’ row with Justice Secretary Ken Clarke at the Tory Conference.
She claimed that the cat, Maya, was a key reason behind the decision to let the man, a Bolivian national, stay in Britain, citing it as an example of how the Human Rights Act has been badly applied by judges. But Mr Clarke accused her of ‘misrepresenting’ the judgment.
Yesterday it was revealed that the Bolivian not only argued that he would suffer from being separated from his cat, but also that his pet’s quality of life would be affected.
It emerged that officials discovered he had arrived in Britain as a student in 2002 and overstayed his two-year visa only when he was arrested for shoplifting in 2007. He was never charged over the shoplifting allegations.
The fallout from the row continued yesterday as David Cameron, in his own Conference speech, publicly sided with Mrs May. He also slapped down Mr Clarke and appeared to mock the Justice Secretary for being on the side of criminals.
Immigration Judge James Devitte allowed the Bolivian to stay in this country under Article 8 of the Human Rights Act – the right to a private and family life. The case had been thought to have involved a man and his girlfriend, but in fact the judgment reveals that the couple are two gay men.
The judge heard evidence from the man’s boyfriend’s siblings, who confirmed the pair had lived together for three years and said the Bolivian was regarded as their ‘brother’s partner’.
In his six-page ruling, the judge said: ‘In 2005 the appellant and his partner acquired a cat, whom they called Maya and who has lived with them since that date.’
He revealed that the Home Office had rejected arguments from the man that removing him would have ‘consequences’ for Maya. The Home Office’s initial ruling stated: ‘Although you have a cat called Maya she is considered to be able to adapt to life abroad with her owners. ‘While your cat’s material quality of life in Bolivia may not be at the same standard as in the United Kingdom, this does not give rise to a right to remain in the United Kingdom.’
But Judge Devitte stated unequivocally: ‘The evidence concerning the joint acquisition of Maya by the appellant and his partner reinforces my conclusion on the strength and quality of the family life that [the] appellant and his partner enjoy.’
Bizarrely, he added: ‘In Canada and to a much lesser extent in the United States there is an increasing recognition of the significance that pets occupy in family life and of the potentially serious emotional consequences pet owners may suffer when some unhappy event terminates the bond they have with a pet.
In her speech, Mrs May listed the case along with a string of other examples of how Article 8 was being misapplied by judges. She said he ‘cannot be deported because – and I am not making this up – he had a pet cat’.
At a fringe event later the same day Mr Clarke said: ‘They are British cases and British judges she is complaining about. I cannot believe anybody had ever had deportation refused on the basis of owning a cat.’
A licence to kill freedom of expression
Licensing journalists was a bad idea in John Milton’s day – so why are politicians and editors keen to revive it now?
‘For who knows not that Truth is strong next to the Almighty; she needs no policies, nor stratagems, nor licencings to make her victorious, those are the shifts and the defences that error uses against her power.’
Who knows not? John Milton, in his 1644 polemic against the Licensing Order of 1643, Areopagitica: A speech of Mr. John Milton for the liberty of unlicensed printing to the Parliament of England, evidently thought he was asking a rhetorical question: surely it’s plain that the truth will out without the help of licences or government policies, which would instead cause ‘the incredible losse, and detriment that this plot of licencing puts us to, more then if som enemy at sea should stop up all our hav’ns and ports, and creeks, it hinders and retards the importation of our richest Marchandize’.
However, it seems that to shadow culture minister Ivan Lewis the hindering and retardation of journalism is a reasonable price to pay for tackling ‘irresponsible’ journalists. After the scandal of phone hacking at the News of the World, Lewis clearly believes that Truth is in need of his help in order to emerge victorious. At the Labour Party Conference last week, Lewis suggested that journalists who are guilty of ‘gross malpractice’ should be ‘struck off’ and prevented from working in the industry, the implication being that a register of those who are fit to practice or not would be drawn up by any future Labour government.
Despite stressing the ‘independence’ of such an initiative from government, Lewis failed to explain who exactly would decide what was ‘malpractice’ and what wasn’t. Without state support, how could such a register be enforced? Cue thousands of horrified tweets from journalists from all colours of the political spectrum, including staunch Labour supporters. Within hours, Labour leader Ed Miliband was forced to step in and declare that a journalists’ register was not the party’s official policy.
Rather than being a potential Mugabe-in-the-waiting, what’s telling about Lewis’ idea was that, despite its announcement at the Labour Party’s biggest event of the year, it seemed to have been barely thought through. Not only does this policy hokey-cokey reveal much about the chaotic state of Labour right now, but it also shows how ignorant senior politicians are of the importance of freedom of speech.
Strikingly, however, even after Lewis had gone to ground red-faced, at least one prominent individual within the newspaper trade came out of the woodwork and advocated such a system of licenses. Speaking on BBC Radio 4’s The Media Show last week, the new editor of the Independent, Chris Blackhurst, rallied to Lewis’ defence and said he’d made ‘some good points’: ‘I know there’s an issue with the fact that there is a register of journalists, but frankly maybe we should’, he said, ‘there ought to be an ability to have that person removed. Let’s not just look at doctors, all sorts of professions… The Jockey Club. They actually bar jockeys from riding horses. Why can’t we bar journalists from writing articles?’
While emphasising that he didn’t want the state to play a role in issuing such licenses, when pushed on who would issue the license, Blackhurst said he ‘hadn’t thought it through that far’. He didn’t seem to know how to deal with papers that simply chose to opt out, although he suggested that the Press Complaints Commission or another body should have the power to ‘go onto news floors, seize documents, seize computers’. How such an approach could be carried out without the backing of the state went unexplained.
Remarkably, Blackhurst claimed he was taking this shudderingly anti-democratic approach in the name of the public: ‘If you put yourself in the position of the public, what they see is journalists behaving badly and nothing happening to them.’ However, he seemed oblivious to the actual contempt he was showing to the public by floating the idea that they should be prevented from reading articles that a journalist has written, sharing their insights, just because this journalist happens to have been blacklisted.
Blackhurst is not alone in favouring such a licensing system for the UK press. Another commentator for the Guardian claimed that, while Ivan Lewis was wrong to single out journalists, he should instead have focused his draconian gaze on where the ‘real’ power lies: ‘owners, editors and newsroom offices’.
And, earlier in the year, Independent columnist Yasmin Alibhai-Brown stunned BBC Dateline presenter Gavin Esler by praising Italian journalist Annalisa Piras as having ‘quite a good idea’ when she proposed: ‘You don’t want in a democracy people who behave unprofessionally to give information. So why don’t we establish a kind of register and if you actually commit a crime like bribing the police, you are struck off?’ Such is a bizarre sense of ‘democracy’, where people are deprived of one of the most fundamental aspects of it, freedom of expression, in its name.
While there are currently few people openly advocating licenses for journalists, even some of those journalists who oppose formal licensing are actually enforcing an informal kind of licensing, with their suggestion that it’s fine for tabloids to be closed down and that only respectable broadsheet journalism should be protected from the police.
Although he may not be explicitly in favour of licences for journalists, Guardian writer Jonathan Friedland, for example, has declared that the ‘public interest’ was served by the closure of the News of the World: ‘The textbooks of the future will struggle to find a better example of a story in the public interest than that one’, he says referring to the Guardian’s investigation into phone hacking. ‘It had an enormous public impact, from the closure of the NotW and abandoning of the BSkyB bid to the departure of the Met’s commissioner and one of his most senior officers.’
The celebration of the closure of a newspaper as being of ‘enormous public impact’ is licensing in all but name, where we get a subtle – but very powerful – idea that there is a ‘good journalism’ and a ‘bad journalism’, with the reprehensible gutter press broadly unworthy of a licence to print.
And who should deem what is worthy or unworthy of being published? What makes them infallible? As Milton pointed out, ‘The State shall be my governours, but not my criticks; they may be mistak’n in the choice of a licencer, as easily as this licencer may be mistak’n in an author.’ Much the same could be said about a pseudo-state body, such as the Press Complaints Commission, which deems to decide what is in the public interest rather than leaving that judgement to the public itself.
The ‘arrogance’ on behalf of a potential licenser to make such decisions on our behalf was more than evident to Milton, as it should be to us. Which is why any time the idea of licensing journalists is raised, we would do well to adopt his approach of ‘endur[ing] not an instructer that comes to me under the wardship of an overseeing fist’.
British bureacracy good at being offensive but hopeless at helping
Ellen Hiscox has lived in the same house for 60 years. Since her husband died, she’s been cared for by her daughter Catherine.
Back in August, 88-year-old Mrs Hiscox had an operation on her leg, which left her incapacitated. When she was released from hospital, they contacted social services to request some temporary home help.
Although Catherine looks after her mum full-time, she needs some assistance with basic tasks such as getting her up and down the stairs. The nurse at her local GP’s clinic also recommended she should ask for the loan of an orthopaedic back rest and footstool.
It took six letters and as many phone calls to Dacorum Borough Council, Hertfordshire, before she received a reply. Eventually, the council agreed to a home visit to decide whether Mrs Hiscox qualified for help and sent two officials to her house in Hemel Hempstead to process the application.
Catherine wondered why it needed two people. Turns out one was a social worker and the other would be conducting an elf’n’safety risk assessment. While the social worker considered Mrs Hiscox’s clinical needs, her oppo wandered round the house making notes. After a while they left, saying they’d be in touch.
Shortly afterwards, a letter arrived from the council detailing the results of their investigation.
It was decided that Mrs Hiscox was not entitled to any home help, despite her lack of mobility. The request for a back rest and footstool was also refused, even though her own doctor thought she needed them to make her more comfortable while she recovered from the operation.
But that wasn’t all. The letter said they should put up a ‘Mind Your Head’ notice on the stairs, for the benefit of anyone who may be required to use them in an official capacity, ‘e.g.: a loft insulation installer’.
This was apparently because an occupational therapist had ‘scrapped’ (sic) her head while going upstairs on a previous visit. The assessor concluded that anyone over 5ft 6in was at risk of injury. She also recommended that the house should be ‘de-cluttered’ just in case someone tripped over and hurt themselves.
Catherine was livid. ‘How dare they tell us to put up a Mind Your Head sign in our own home? Mum’s lived here for 60 years and I’ve lived here for nearly 50. No one has ever hit their head up to now.’
Admittedly, Catherine and her mum are both shorter than 5ft 6in. But her dad was 5ft 8in and he managed to negotiate the stairs for more than half a century without knocking himself senseless. They’ve got friends over 6ft who have found their way to the bathroom safely.
Now you might be thinking that maybe the Hiscox home is one of those restricted-headroom Anne Hathaway’s Cottage jobs, where you have to bend double to get through the front door.
You’d be wrong. Hiscox Towers is a perfectly normal, three-bed detached house put up during the building boom of the 1920s. There are tens of thousands of similar properties all over Britain.
And the last time anyone looked, the hallways of suburbia weren’t littered with the corpses of people who bashed their heads and suffered irreparable brain damage while climbing the stairs.
Catherine was equally furious at the suggestion her home needed ‘de-cluttering’. She admits it was a bit untidy when the council officials turned up, because she’d just been shopping and was halfway through emptying the bags. She’s also been rushed off her feet looking after her mum round the clock.
Catherine said: ‘I write children’s stories and there’s always lots of books around. But I’m almost OCD about cleanliness. The house is spotless.’
There are a few pieces of extra furniture which used to belong to Catherine’s aunt, who died recently aged 90. But it’s hardly Steptoe’s scrapyard.
What we have here is a classic example of just about everything which is wrong with local government in Britain. We pay our taxes and expect to get a few basic services in return — in this case, a little help for an 88-year-old lady after a routine operation until she’s back on her feet.
What we get is a bureaucratic system run for the benefit of those who work within it, not those who pay for it. First it takes a dozen letters and phone calls to get a reply from social services. After an unacceptable delay, the council rejects out of hand a perfectly reasonable request for assistance.
Instead of getting a footstool and back rest, Mrs Hiscox is forced to endure a dopey bird with a clipboard poking her way round her home, carrying out an unnecessary and intrusive risk assessment.
Then, to add insult to injury, she receives an illiterate letter — Catherine says it was littered with grammatical and spelling errors — telling her to ‘de-clutter’ her home and put up a ridiculous Mind Your Head notice on the stairs. The letter also addressed Mrs Hiscox as ‘Gwendoline’, even though her full name is Florence Eleanor and she has always been known as Ellen, for short. So much for dignity for the elderly.
I’m only surprised the council hasn’t insisted on Catherine and her mum wearing hi-viz jackets, hard hats and steel toe-capped boots in the house at all times, as well as keeping a stock of protective headgear and footwear by the front door for any visitors.
Incidentally, Catherine tells me that yesterday they received a visit from another council officer who rejected a further request for help tending their 100ft garden. Probably just as well, otherwise they’d have had to ‘de-clutter’ the herbaceous border, erect a couple of dozen hazard warning signs and cordon off the rose bushes with traffic cones.
Big upset now British pupils are not allowed to cheat
In a report published today, Ofqual warned that the introduction of “controlled assessments” in England had led to a drop in the amount of teaching time and reduction in the number of school trips.
The watchdog said the new system had also led to “widespread concerns” among teachers who reported problems finding classroom space, equipment and chasing down absent pupils.
The conclusions come two years after coursework was axed in most GCSE subjects. Some 600,000 children a year are now banned from writing up assignments at home to stop them asking parents for help and using the internet to cheat.
They are required to complete projects in class under “controlled” exam-style conditions, supervised by teachers and with limited access to websites and books.
But Ofqual said that more than four-in-10 secondary school teachers found the changes difficult to implement, particularly those teaching French, geography and history.
“The amount of time taken up in each subject by controlled assessment, meant a narrowing of teaching, and fewer opportunities for activities such as off-site trips that deepen students’ understanding and interest,” the study said. “In several subjects the loss of teaching and learning time was the single biggest drawback to controlled assessment.”
Controlled assessment was introduced in September 2009 in subjects including business studies, classical subjects, economics, English literature, geography, history, modern foreign languages, religious studies and social sciences. Maths coursework was axed two years earlier.
As part of the move, assignments are set by examination boards rather than teachers to ensure tasks are more rigorous.
In today’s report, Ofqual surveyed more than 800 teachers and staged in-depth interviews with senior education officials. Although the move has led to a dramatic reduction in cheating, some one-in-five teachers complained that the change had coincided with a loss of teaching time in the final year of school.
The report also said the system had a “negative impact on pupil well-being” as it meant children were forced to sit additional exam-based assessments. Some schools now spread work over two years instead of one to reduce the workload.
Many teachers also cited logistical difficulties, the study said, with foreign language assessments proving particularly problematic because students were forced to prepare for oral French exams in silence.
The lack of clear guidance in how to deal with pupils who are absent on the day of assessments “threatens to undermine the reliability of the new assessment”, said Ofqual.
The report added: “The most commonly mentioned problem was limited resources and finding classroom space. Many teachers prefer students to write up their tasks using computers, which creates pressure on school ICT resources, and requires careful timetabling.”
Controlled assessment was introduced by Labour.
A Department for Education spokesman said: “In the longer term, we will review the proportion of controlled assessment within GCSEs. “We recognise the value of such assessment in certain subjects but will make sure we have the right balance between controlled assessments and external exams in each subject.”
Chris Keates, general secretary of the NASUWT union, said: “Ofqual’s evaluation of controlled assessment practice reveals further worrying evidence of unsustainable assessment practices in schools which must now be taken seriously by the Coalition Government.
“The report by Ofqual is right to point to the concerns that Controlled Assessments has reduced teaching and learning time in our schools and increased the burdens on teachers in ways which could seriously jeopardise pupils’ learning and educational progress.