NHS Patients dying in pain needlessly
Patients are needlessly suffering pain and distress at the end of their lives because of unfounded fears over the use of morphine and other strong painkillers, the NHS drugs body has warned.
Doctors should talk to patients and their families about the uses of opioid painkillers and allay fears that may prevent them from receiving adequatae pain relief.
In draft guidance on the use of opioids in palliative care, the National Institute for Health and Clinical Excellence, said patients were being ‘undertreated’.
In Nice guidance also stressed the importance of communication with patients and relatives to ensure pain is managed effectively.
The document said: “Despite the increased availability of strong opioids, published evidence suggests that pain which results from advanced disease, especially cancer, remains under-treated.
“The explanation for this is complex and includes failure to assess pain and monitor symptoms, patients’ and professionals’ fears of opioids and their adverse effects, and difficulties accessing prescriptions and analgesia.
“Furthermore, the increased range of treatments may confuse some prescribers and so there is a clear need to identify the evidence base in support of strong opioids and produce guidance on their use.”
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at Nice, said: “Nice published guidance highlighting the importance of effective pain control for adults with cancer in 2004.
“However, when reviewing the current evidence, the group developing this new guideline found that pain in advanced disease remains under-treated. The aim of this forthcoming guidance is to help tackle common assumptions about opioid use and ensure patients receive pain relief appropriate to them.
“We know that many people worry about becoming addicted to this strong medication and we also know that others are concerned about focusing on pain relief rather than on treating the underlying disease. We hope to provide reassurance to patients whilst highlighting that effectively managing pain can have a significant effect on a patient’s quality of life.
“Prescribing these drugs can also be complicated. Doctors need to identify the right opioid for each individual patient and because drug doses cannot be estimated or calculated in advance, the dose must be individually determined. The guideline will support prescribers in making these decisions, helping to improve pain management and patient safety.”
Professor Mayur Lakhani, Chairman of the National Council for Palliative Care, a professional body for those working in this area, said: “Opiods can be effective and play an indispensable role in pain relief for people who are dying, which is why there needs to be wider confidence in their use so that people don’t die needlessly in pain.
“As a practising GP I know that patients can become anxious when the use of morphine is suggested and that healthcare professionals too may not feel always comfortable.
“I therefore welcome this draft guidance, which when finalised will enable doctors to give confident reassurance to patients about the safe use of morphine. It is essential that opiods are used correctly, which is why I welcome the emphasis on training of healthcare professionals and the importance of excellent communication with patients.”
Pay for what is yours
In Britain and Australia, welfare rules now encourage and cajole single mums on benefits to find part-time work once their children start school. Absentee fathers are required to pay child support to help with the costs of raising their children.
But one section of the population is still allowed to evade the financial responsibilities of parenting –men on benefits who father children but have no means of paying for them.
The Daily Telegraph recently named Jamie Cumming, a 34-year-old unemployed man from Dundee, Scotland, as Britain’s ‘most feckless father.’ Cumming has fathered 15 children with 12 different women in 16 years. Two more of his babies are on the way. One of the mothers is Australian.
Nothing can be done to force him to take responsibility for the children he has sired. Nor can he be prevented from fathering even more in the future, if he can find women stupid enough to sleep with him. Most of his female partners have been young, and like him, few of them appear to work. Presumably he meets them in the dole queue when he goes to sign on.
How does Cumming support all these women and his children? He doesn’t, nor is he expected to. Being unemployed, the most he is required to give the mothers of his children under Britain’s benefits rules is £7 per week. That’s £7 in total, not £7 per child.
So who picks up the bill for all these ‘families’ he keeps creating? Not Cumming, nor the women he impregnates.
No, total strangers are paying to raise Cumming’s brood – people who (unlike Cumming and his partners) go to work, earn wages, pay their own way, support their own families, and are then required by law to support his multiple ‘families’ too. Such is the morality of the modern welfare state.
Obviously Cumming is an extreme case. But I estimate there are between one-quarter and one-third of a million absent fathers in Britain living on welfare and contributing almost nothing to the costs of raising their children.
Such men should be required to work full-time, no matter what kind of job it is, so they can start paying for their children’s upkeep. If that doesn’t cover the bills, their relatives – parents, grandparents, siblings, uncles, aunties and step-parents – should contribute (why should strangers be expected to pay for a child’s upbringing before its relatives?). And if that fails, these deadbeat dads of the welfare system should be locked up for the criminal offence of child neglect – for if failing to organise financial provision for the upkeep of your children doesn’t constitute neglect, I don’t know what does.
Why we must save our sons from feminized education
I have myself seen evidence of the advantages for boys of having male teachers. I sent my son to a private High School where his mathematics teachers were all male and enthusiastic about mathematics. He now has a B.Sc. with a first in mathematics and is working on his Ph.D. in it at a university known for its excellence in mathematics — JR
By David Thomas
Fred and his father
So now it’s official — young women are outdoing men at work. The Office for National Statistics has confirmed that female twentysomethings earn more than their male peers — 3.6 per cent more, to be precise. As the father of two daughters in their 20s, I can’t say I’m surprised.
I’m incredibly proud of my girls. Holly, 23, is working day and night to make her way in journalism, a profession that is even more competitive and insecure than when I started out 30 years ago.
Lucy, 22, is training to be a doctor, a profession which, it emerged this week, will have more women than men in just six years’ time. I’ve seen how much effort and determination both have displayed, from their first GCSEs onwards.
They went to a comprehensive, so they weren’t spoon-fed their A-grades. They had to put in the hours, keep themselves motivated and sweat for their achievements. They’ve earned their success.
I also have a 13-year-old son, Fred. He attends the same school as his sisters did. He has just as much energy and, when he puts his mind to something, just as much determination. But he is growing up in a world that seems more and more biased against boys; one in which our sons are falling behind our daughters in almost every measurable way.
A world in which politicians still obsess about every conceivable form of discrimination against women, but ignore the young men who so desperately need help.
That’s why it’s time to send out an SOS message: Save Our Sons.
Huge numbers of young men are effectively being thrown on the scrapheap when they are barely old enough to shave. It’s not just that they are failing or choosing to fail within the education system: the system is failing them.
Let’s just start by looking at the facts. Barely half the pupils in this country get five or more GCSE passes at grades A-C. Of those who do, well over half are girls. The majority of boys in this country, therefore, are failing to reach the basic level of educational attainment. Every year hundreds of thousands of teenage boys leave school with virtually no chance of getting any kind of decent, well-paying job.
In fact, of all the class, race and gender groups in this country (with the sole exception of the tiny number of traveller children), working-class white boys perform the worst. A staggering 85 per cent of boys from poor white families fail to get those five good GCSEs.
The prevailing dogma in early education now demands that both lessons and sport are devoutly non-competitive. It requires children to sit still around tables in which they work together as groups, rather than alone at desks. It is, in other words, perfectly suited to sociable little girls and anathema to boisterous, competitive little boys.
Thus it is all too easy for boys to conclude early on that school is what girls are good at — and they, by extension, are not.
And yet it does not have to be this way. When my daughters went to a small village primary school, the teachers were all women. They were absolutely dedicated to their pupils, but they could not relate to the boys as naturally as to the girls. And then, for a single year, a young, male teacher took over the Year Five and Six class of ten and 11-year-olds.
Suddenly the boys in the class had someone they could talk to about football, computers and other Boy Things. There was someone who understood them, and they blossomed. Then that teacher left, and it was Girl Time again.
Seeing that convinced me I would pay for Fred’s prep school education if it meant he would be taught by male teachers and be given the chance to play competitive sport. Sure enough, he thrived in that environment.
By the time they get to secondary school, though, too many boys who don’t have that opportunity are actively hostile to education. That hostility is a defence mechanism, of course, a way of masking their own sense of alienation, but if that outlook continues until they are 16, they may well be headed for the scrap-heap.
Some will get one of the ever-decreasing number of manual jobs that remain in manufacturing and industry, others will join what’s left of the Armed Forces. But many more slip into the twilight, underclass world of unemployment, drugs, crime and the feckless spawning of children who are then effectively fathered by the State via the benefits system.
These young men have little to offer women, no lasting contribution to make to society, no hope for their own lives. They cost society a fortune, all the way from the dole queue to the prison cell. And if that’s not a major social and political issue, I don’t know what is…..
This may be a politically incorrect and sexist observation in the eyes of some delicate Guardian-reading souls, but most women still want a man who can provide for his family, and who is confident enough in his own status not to feel insecure about his partner’s.
And this leads us on to a deeper, more human issue that has nothing to do with statistics or incomes. We have, as a society, lost the ability, or the will, to acknowledge that our sons have anything at all to offer the world as men.
Our daughters, raised in the era of Girl Power, have rightly been encouraged to believe that anything a man can do, they can do, too. But they’ve also been told again and again that they have qualities men lack. They are more emotionally mature, more sensitive, better communicators, better team-workers, and so on.
In other words, they have been taught that men and women are equal — except for all the ways in which women are superior.
There is now a massive equal rights industry that is obsessed with every real or imaginary form of female inequality. But equality must work both ways, and if it is now boys who are lagging behind, then the political and educational establishment must make it a priority to help them.
Though they are rarely celebrated any more, there are solid male virtues that still exist in decent men: reliability, stamina, physical strength, the desire to provide for and protect their families, and sometimes, as unfashionable as it might be, the ability not to be too emotional. There are times when an arm round the shoulder and the offer of a drink can do more good than all the agonised empathy in the world.
All of us, men or women, are moved by pictures of soldiers coming home from war. The men reach down, their arms open to greet the children running towards them in an image that embodies the strength and courage of a warrior and the love of a father.
But who is telling our sons about that kind of positive, benevolent manliness? Who sets them a good example? Having more male teachers, especially in primary schools, would be a start.
And we should stop being afraid to say anything positive about men, or masculinity, for fear of offending women. In a culture in which so many young men do not have father figures at home or at school, too many boys take their lead from the ill-disciplined brats of Premiership football; the swaggering, misogynist materialism of rap music; or the psychotic violence of computer games.
Our boys — including my own son Fred — are full of potential, full of energy and full of ambitions. All they need is the encouragement and the attention to help them realise their dreams.
British schoolchildren to be banned from using calculators amid fears of generation growing up with poor maths skills
Pupils are set to be banned from using calculators in primary schools amid fears a ‘sat-nav’ generation of children are growing up with poor maths skills. Schools minister Nick Gibb said pupils should not ‘reach for a gadget every time they need to do a simple sum.’
It is understood that in future, teachers could be told to stop allowing children aged under nine to use calculators in state schools. Maths exams taken by 11-year-olds are also likely to be reformed – scrapping an existing section that allows pupils to use calculators.
The move comes after a recent survey revealed that Britain was falling behind its international rivals in league tables rating children’s mathematics skills.
British teenagers are now ranked 28th among peers in developed nations after slumping dramatically in the last decade, while Singapore, which has virtually no calculator use for 10-year-olds, was second.
Almost half of all adults have basic maths skills that are no better than those of children aged nine to 11, Government-commissioned research has shown. More than five million people were also found to be struggling with simple reading and writing.
The latest Skills for Life survey questioned more than 7,000 16- to 65-year-olds in England to examine literacy and numeracy levels. The findings reveal that many adults still have maths and English skills similar to those expected of primary school children.
Campaigners warned that there are ‘far too many’ people with poor basic skills, and more needs to be done for them. In total 16.8million adults – or 49.1 per cent – have numeracy skills at Entry Level 3 or below. This level is equivalent to the achievement expected of a child aged nine to 11.
In literacy, 5.1 million adults, or 14.9 per cent, were at Entry Level 3 or below. Adults with numeracy skills below this level would struggle to pay household bills, or understand price labels on pre-packaged food.
The survey showed that millions of adults are no better at maths and English than five to seven-year-olds.
In total, 2.3 million people in England were found to be at Entry Level 1 or below – the level of attainment for five to seven-year-olds in numeracy, while five per cent were at this stage for literacy. Adults below this level may not be able to write short messages to family, or select floor numbers in lifts.
According to a previously published report, adults are considered to have ‘functional’ literacy skills if they are above Entry Level 3, and ‘functional’ numeracy skills if they are above Entry Level 2. Today’s survey reveals that 8.1 million adults in England (23.7 per cent) are at Entry Level 2 or below.
Carol Taylor, director for research and development at the National Institute of Adult Continuing Education (Niace), said: ‘We have far too many people with very poor basic skills in this country and the system isn’t working for them.
‘The headline results of today’s survey show a welcome increase in those adults working at Literacy Level 2 (GCSE equivalent) from 44 per cent (in 2003) to 57 per cent, which proves the powerful impact the Skills For Life strategy has had. ‘However, it’s alarming that 15 per cent of the adult population are performing at Entry Level 3 or below in literacy and 24 per cent in numeracy at Entry Level 2 or below.
‘Put simply, around one in six of the adult population has difficulty with aspects of reading and writing which means they are seriously disadvantaged as employees, citizens and parents.
‘And around one in four of the adult population struggle with the basics of numeracy, a skill which can have a greater impact on life chances than literacy. ‘This is why we’re calling for a specific challenge fund to help those with the lowest skills.’
Quarter of British homes ‘face fuel poverty’: Green taxes add to burden for struggling families
One in four households will struggle to keep warm this winter because of costlier gas and electricity and the impact of green taxes, figures out today show. More than five million households in England alone are living in fuel poverty as incomes stagnate and energy bills soar.
Fuel poverty is where a family spends more than 10 per cent of its income on energy.
Ministers are under increasing pressure to abandon green energy targets amid warnings that fuel surcharges will put the lives of the most vulnerable at risk as they struggle to pay bills.
The Government faces calls to tear up or delay plans to force through a £200billion shift to wind turbines, wave power and new nuclear power stations.
Previous official projections had forecast that 4.1million households would be in fuel poverty this year, but calculations following rises in energy prices over the summer have shown that a million more will be hit.
The figures provided to Consumer Focus are based on actual bills after the rises.
William Baker, of the statutory consumer body, said: ‘With over five million households currently in fuel poverty, it is difficult to see how the Government is going to eradicate fuel poverty by 2016, as required by the Warm Homes and Conservation Act 2000.
‘We therefore urge the Government to use the proceeds from new carbon taxes to provide vital funds to support a national energy efficiency programme.’
All six of the big energy suppliers pushed up their prices with the biggest, British Gas, putting up its gas and electricity prices by 18 per cent and 16 per cent.
The government-appointed Fuel Poverty Advisory Group last night urged ministers to act. Chairman Derek Lickorish said that the average family’s dual fuel bill has doubled since 2003 and is now more than £1,300.
‘The Government needs to reflect on what’s happening to ordinary people. It has not been taking this seriously enough,’ he said.
The figures show the severity of the problems in parts of the country with more than 40 per cent of households in Wales in fuel poverty. The North East and West Midlands have fuel poverty levels of more than 30 per cent. Around 2.5million people are now in debt to their energy supplier, with the average gas bill arrears now £320.
A Government-commissioned study earlier this year warned that more than 2,700 people are dying each year in England and Wales because they cannot afford to keep their homes warm.
The study by social policy expert Professor John Hills, of the London School of Economics, concluded that green taxes on household power bills have a disproportionate impact on poorer homes.
Energy companies meanwhile are under pressure to cut prices following significant falls in the wholesale cost of fuel.
Unusually warm weather and the lack of demand from industrial customers as the economy falters have created a glut of cheap power. The fall in wholesale prices kicked in at the end of August – exactly the time that price rises began.
Experts at independent industry analysts ICIS Heren said: ‘UK energy markets are in freefall as the eurozone teeters on the brink of recession.
‘UK wholesale energy prices plummeted to 12-month lows this week, finally cancelling out increases earlier in the year that caused energy companies to raise household prices.’
Could a simple pill costing 30p a day be the answer to getting pregnant?
A small study on an a-typical group
A 30p multi-vitamin pill could more than double a woman’s chance of having a baby, according to a study. It found that 60 per cent of those taking the supplements while undergoing IVF became pregnant compared to just a quarter who did not take them.
Researchers say the pills contain nutrients that may boost fertility such as vitamins A, C and E, zinc and selenium, that are often absent from our diets.
The study carried out at University College London involved 56 women aged 18 to 40, who had all tried unsuccessfully to fall pregnant using IVF for at least a year.
Half were given a multi-nutrient pill to take every day and the other half given folic acid pills to take daily. The micronutrient pill also contained folic acid which prevents birth defects and has also been shown to help boost fertility.
The team found that 60 per cent of women taking the multi-nutrients fell pregnant, and did not miscarry in the first three months when it is most common.
This compared to 25 per cent of women in the group taking folic acid who were still pregnant after three months.
The study published in the journal Reproductive Biomedicine also found that women taking the micronutrients needed far fewer attempts to become pregnant. Of those who fell pregnant, 75 per cent conceived in the first course of IVF.
By comparison just 18 per cent of those on folic acid who became pregnant did so after the first IVF course.
The particular pill, Vitabiotics Pregnacare-Conception,contains folic acid, vitamin B, vitamin E, vitamin A, vitamin C, zinc, selenium and some antioxidants. It costs just over £10 over the counter for a month’s supply.
Lead researcher Dr Rina Agrawal said: ‘The implications of this study are far reaching as they suggest that prenatal micronutrient supplementation in women undergoing ovulation induction improve pregnancy rates. ‘There is a large body of evidence establishing the relationship between placental development, foetal growth, pregnancy outcomes and adequate nutrition, particularly vitamin intake.’
But other scientists pointed out that the study was very small so the results should not be taken too seriously.
Dr Allan Pacey who specialises in fertility at the University of Sheffield said: ‘The influence of nutrition on our fertility is of general interest to the public and professionals, but there are relatively few studies which have examined this systematically and few which have shown direct benefits of taking supplements to enhance things.’
‘Therefore, on the face of it, this study is interesting but we should acknowledge that this is a relatively small number of patients and the study would need to be repeated in a larger trial before we could be certain of the results.’
A woman’s fertility is known to be affected by a number of factors including her age, weight, alcohol consumption, whether she smokes. High levels of stress and even drinking too much coffee have also been shown to reduce the chances of falling pregnant.