Risk to patients left with no GPs out of hours
Patients are being put at risk because up to a quarter of out-of-hours GP shifts are unfilled in some parts of the country, according to latest figures.
A shortage of doctors deterred by long hours and poor pay means health providers are struggling to find cover — even turning to nurses to fill the gaps in some cases, according to an investigation by Pulse magazine. Doctors are paid between £50 and £120 for an out-of-hours shift.
GPs reported that out-of-hours providers were leaving gaps in rotas. There was a particular shortage in the east of England where, in the wake of the scandal involving Daniel Ubani, it was stipulated that only local GPs could work out of hours. On his first shift in 2008, the German doctor gave a patient in Cambridgeshire a fatal overdose.
In Suffolk, the proportion of unfilled shifts at the out-of-hours service run by the agency Harmoni was 25 per cent last June and has not fallen below 13 per cent since the introduction of the new NHS East of England policy in October 2010.
NHS Great Yarmouth and Waveney reported that 29 per cent of shifts were partly or totally unfilled last September, although this has improved. Among 250 GPs responding to a Pulse survey, almost half reported their out-of-hours provider was struggling to fill shifts.
Andrew Gardner, the chief executive of Harmoni, said: “The key to providing first class out-of-hours services is assessing whether the demand of patients is being met through good overall performance against national standards, not through the number of unfilled vacancies.”
Dr Simon Poole, a GP in Histon, Cambs, and deputy chairman of the GP Committee’s commissioning and service development subcommittee, said: “If doctors are absent, you have to be concerned about safety.”
Richard Hoey, the editor of Pulse, said: “At the end of the day the problem comes down to money. The government grossly underestimated the cost to PCTs of out-of-hours care. GPs work very hard and if you want them to also give up their time in the evenings and at weekends it has to be made worth their while.
“At the moment we are seeing nurses stepping in to cover the shortfall and they are being asked to make provisional diagnoses when their training has not prepared them for that. That is a worry and is not fair to them or their patients.”
Primary care trusts and providers contacted by Pulse denied patient care had been affected but some acknowledged recruitment was a problem.
Doctors may strike over cuts to their pension pots
Doctors have threatened their first industrial action for more than 30 years after refusing to accept cuts to their pension pots, which are each worth an average of £1.7million.
The British Medical Association, which represents 130,000 doctors and medical students, said two thirds of its members support industrial action which could cripple hospitals and GP surgeries throughout the country.
The association rejected cuts to doctor’s pensions despite warning that some hospitals are so financially stretched that patient safety can no longer be guaranteed and that “accidents will happen”.
Senior government figures said the reductions in their pensions were “modest” and in line with other public sector staff.
A government source said: “It seems a bit rich for doctors to be complaining about cuts and patient care when they leave the NHS as millionaires.”
Over the past decade, the average consultant has seen their pay rise by 54 per cent, with less qualified doctors enjoying a rise of 30 per cent. Their pay has recently been frozen, with the average GP now earning about £110,000.
Under controversial reforms introduced by Labour, they won the right to opt out of working at weekends and at night. They also enjoy generous final salary pensions, with figures released by the Department of Health showing that a typical NHS doctor retiring at 60 will receive a pension of more than £48,000 a year for life.
In addition, they receive a tax-free lump sum of around £143,000 on retirement, a pension scheme that would cost more than £1.7million in the private sector.
A spokesman for the Department of Health said the current situation was “unsustainable”. “Doctors and consultants who are among the highest earners in the NHS have benefited hugely from the current final salary scheme arrangements compared to other staff groups,” the spokesman said.
“The reforms to public service pensions will ensure that NHS pensions remain amongst the very best. The Government has made clear that this is our final position on the main elements of scheme design — it is a fair and affordable deal for both staff and the taxpayer.”
Dan Poulter, a Conservative MP and hospital doctor, said: “As a member of the BMA, I am disappointed by this hypocrisy. On the one hand we are hearing of the difficulty of finding the efficiencies the NHS needs. Yet, on the other, we have unreasonable opposition to reforms to pay and pensions that are both necessary and fair.”
Under the proposals, doctors will have to work beyond 60 to earn the same pension, although anyone within 10 years of retirement will not see any change in their situation.
The BMA said the reforms meant doctors would also have to sacrifice some of their pension in exchange for a lump sum payment on their retirement. It added that its members felt “betrayed” by the pension reforms, raising the spectre of its first unrest since 1975.
Results of a UK-wide survey of its members found that eight in 10 doctors rejected the pension proposals, with two thirds backing industrial action.
Only 20 per cent said they would be willing to strike, with the majority backing a campaign of action short of striking, such as a work-to-rule protest. More than of a third of doctors aged 50 or over said they intended to retire early if the changes went ahead.
A spokesman for the BMA added: “The strength and scale of feeling among doctors are abundantly clear. They feel let down and betrayed, and for many this is the final straw.”
Dr Hamish Meldrum, chairman of the BMA council, says in an interview with today’s New Statesman that efficiency savings are undermining patient care. He warns that they will lead to a repeat of the Mid Staffordshire hospital scandal, where up to 1,200 patients died because cutting costs and hitting targets was prioritised above patient care. “You get trusts that try to stretch rotas or stretch the staffing of wards too thinly — well, then accidents will happen,” Dr Meldrum warns.
Ministers are close to a confrontation with several of the most high-profile organisations representing medical staff.
The Royal College of Nursing and the Royal College of Midwives last night announced they have joined the BMA and the Royal College of General Practitioners in outright opposition to the Government’s reforms to the NHS.
British plans for green energy drive ‘will cost families £400 a year by 2020’
Plans for a massive expansion of renewable energy will cost families an average of £400 a year each, a report warned last night.
It accuses Energy Secretary Chris Huhne of ‘misleading’ the public by suggesting energy costs could be lower as a result of the Government’s drive for green power.
It said official estimates had grossly underestimated the impact on families by leaving out much of the huge taxpayer subsidy for wind farms and other costly forms of renewable energy.
Mr Huhne told MPs in November that the Government’s green energy policies would reduce average household bills by 7 per cent – equal to about £94 a year.
Businesses will see average bills rise by 19 per cent. Government officials last night said ministers stood by the estimate.
But the study by the respected think-tank Policy Exchange says the Government’s figures are based on huge assumptions that households will cut their energy use. It suggests the overall impact of subsidies for green energy will cost the average family £400 a year by 2020 – the equivalent of adding 2.5p to the VAT rate.
The huge cost will raise fresh questions about the Government’s strategy of focusing resources on an expensive network of offshore wind farms in an effort to meet tough EU carbon emission targets.
Simon Less, of Policy Exchange, called on ministers to be ‘more transparent’.
The think-tank, which has close links to the Conservative Party, believes the Government’s green targets should be ‘renegotiated’ with Brussels, and that the private sector should be given incentives to come up with cheaper ways of cutting carbon emissions.
A spokesman for the Department of Energy and Climate Change said £400 was ‘not a credible figure, and appears to be based on flawed analysis’.
The anachronism of public service broadcasting
In last week’s Spectator, Charles Moore bemoaned the dumbing down of BBC Radio 3. In this week’s issue, several letters to the editor make the same point. Now, you may dismiss this as the snobbery of classical music afficionados. Or you might agree that Radio 3 presenters are indeed ruining the listening experience by telling you how you should feel about particular pieces of music (e.g. “blown away”) and entreating you to to email, text or tweet about what you are hearing. Frankly, I’m too much of a musical moron to have an opinion on the subject.
What this story really highlights is the futility of compulsorily funded “public service broadcasting”. The point of public service broadcasting is, one would assume, to address some failure in the broadcast market – to produce and air content which benefits the public, and which would not otherwise be produced or aired by commercial players. But if you buy this market failure argument, you have to concede that ‘public service broadcasting’ is likely to be a fairly elitist project. The intention may be to bring high culture to the masses, but in reality you will probably end up subsidising the tastes of the relatively wealthy and well educated with a tax paid largely by those who have no interest in such things. This is clearly a rather perverse outcome.
On the other hand, if you “dumb-down”, if you chase market share with populist programming, then the rationale for compulsorily funded public service broadcasting disappears. By way of illustration, let’s look at tonight’s broadcast schedule for the BBC 3 TV channel.
At 7pm, we get Pop’s Greatest Dance Crazes, “a top 50 countdown of the hippest, sexiest, quirkiest and campest dance crazes of the last 40 years.” At 8pm, it’s Don’t Tell the Bride, a reality TV show in which a man gets £12,000 to arrange his wedding, but isn’t allowed any contact with his wife-to-be while he does it: “Four weeks apart will push their relationship to the limit.” At 9pm, it’s How Sex Works, which is a documentary about twenty-somethings who get around a bit. At 10pm, it is time for Eastenders (a miserable soap opera), followed by documentary Bizarre Crimes (self-explanatory), and a series of cartoons imported from the US. If you are lucky enough to still be awake at 4.25am, you get to watch Cherry Healey look for “essential truths amongst the tales of sex and debauchery to see if losing your virginity is about more than just having sex for the first time.”
Can anyone really argue that programming like that justifies forcing television-owners, on pain of imprisonment, to pay £145.50 a year to a government agency? It’s a rhetorical question.
Public service broadcasting is caught between a rock and a hard place. If it sticks to its ‘market failure’ remit it will appear elitist and lose public support. If it chases a larger market, it will undermine any reasonable case for public funding. Ultimately, public service broadcasting and the licence fee that sustains it are an anachronism – something which might (just) have been appropriate when we had two TV channels and limited broadcasting spectrum, but no longer make sense in a world of thousand-channel satellite television and high-speed internet streaming. With almost limitless choice available at the click of a button, we don’t need government to entertain us, inform us, or filter our cultural diets for us. Curiously enough, the way that technology has democratized the media means that democracy itself no longer has any valuable role in broadcasting. It’s time the BBC and the government realized that.
Church of England faces court battle by dressup queen who claims he was blocked from becoming a bishop
A gay senior clergyman who claims he was blocked from becoming a bishop has threatened to take the Church of England to court.
Church sources say the Very Rev Jeffrey John, Dean of St Albans, believes he could sue officials under the Equality Act 2010, which bans discrimination on the grounds of sexuality. He has instructed a leading employment lawyer after being rejected for the role of Bishop of Southwark in 2010.
The dean is one of the most contentious figures in the church. In 2003 he was forced to step down as Bishop of Reading by Archbishop of Canterbury Rowan Williams after it became known that he was in a gay, though celibate, relationship. The furore fuelled a bitter civil war within the Anglican Church that has dominated Dr Williams’s decade in office.
The dean was again a cause of infighting in 2010 when he was a candidate for Bishop of Southwark.
A respected theologian and former canon at Southwark Cathedral, he had strong backing from senior Church liberals and it was said even David Cameron was supportive.
But the Crown Nominations Commission, whose members are responsible for selecting bishops and include Dr Williams, appointed another candidate.
Dr John was said to be furious and his supporters’ anger was stoked by a memo by another member of the commission, the late Dean of Southwark Colin Slee, claiming Dr Williams was one of those who tried to ‘wreck’ Dr John’s chances.
Dr John has instructed Alison Downie, partner and head of employment at London lawyers Goodman Derrick, to write to the Commission to suggest it risks breaching gay equality laws if it is blocking the dean over his homosexuality.
Ms Downie previously acted for a gay youth worker who successfully sued the Church in 2008 after the Bishop of Hereford Anthony Priddis refused him a job.
It is understood there has been a lengthy correspondence between Ms Downie and Church lawyers in an attempt to resolve the dispute. No legal action has been launched but it is thought Dr John has not ruled out the possibility, although one source said Dr John suggested he would drop his legal threat if he felt he would not be ruled out for future posts.
Church lawyers published new guidelines last summer which said that under the Equality Act, candidates cannot be barred from senior Church posts because they are gay as long as they do not have sex.
The guidance added that candidates could be blocked if they were regarded as divisive because their views or behaviour had angered a significant number of their flock.
Ms Downie refused to comment last night. A Church spokesman also refused to comment.
Catholic midwives challenge British ruling on abortions
Two Roman Catholic midwives are taking a health board to court for allegedly failing to recognise their conscientious objection to supervising staff involved in abortions.
Mary Doogan, 57, and Concepta Wood, 51, told NHS Greater Glasgow and Clyde they were not prepared to delegate, supervise or support staff who were looking after patients through “the processes of medical termination of pregnancy”. Their position was rejected by officials and they hope to have the ruling set aside in a judicial review.
The women claim the refusal to recognise their entitlement to conscientious objection violates their rights under Article 9 of the European Convention on Human Rights.
They say they “hold a religious belief that all human life is sacred from the moment of conception and that termination of pregnancy is a grave offence against human life”. Their involvement in the process would be wrongful and “an offence against God”.
Miss Doogan and Mrs Wood, both midwifery sisters at the Southern General Hospital in Glasgow, are seeking a ruling at the Court of Session in Edinburgh on their entitlement to conscientious objection under the 1967 Abortion Act. David Johnston QC, for the women, said the matter became an issue for the midwives, who were long-standing employees, in 2007.
They had both previously given notice of conscientious objection to any involvement in abortions and said they were not expected to participate in such treatment. But in 2007 the health board introduced changes that meant patients undergoing medical terminations were cared for in the labour ward, where the women worked. They were not expected to administer abortion-inducing drugs but management said requiring conscientious objectors to provide care for patients through a termination was lawful.
According to the court papers, Mrs Wood, of Clarkston, Glasgow, had to provide direct care to a patient undergoing the termination process, which caused her “considerable distress and anxiety” and resulted in her obtaining a transfer. Miss Doogan, of Garrowhill, Glasgow, has been absent from work through ill health since 2010 as a result of the dispute.
The hearing continues.
Last year, two Catholic nurses who had been told they could not refuse to work at an abortion clinic had the ruling dropped after claiming that the sanctity of unborn life was a philosophical belief protected under the Equality Act 2010.
School leavers better workers than graduates as universities fail to equip people for work, say British employers
One in five employers believe school leavers make better workers than university graduates, according to research published today. Over half of companies said that university graduates had unrealistic expectations of working life.
A further one in three believed that the education system was failing to equip young people with the skills required by British businesses, the survey by recruitment giants Adecco found.
Newcomers to the world of work were found to be most lacking in interpersonal and computer skills, while one in four employers reported a lack of basic literacy and numeracy skills among graduate recruits.
Adecco called on the education system, employers and the Government to tackle ‘substantial shortcomings’ in workplace skills.
Chris Moore, from Adecco Group, who surveyed 1,000 firms in the study, said: ‘Undeniably, Britain has one of the best and most advanced education systems in the world but it must deliver a talented, reliable graduate workforce that brings demonstrable value to UK plc.
‘On a significant scale, employers believe it is failing to do that. ‘Although extremely valuable, a strong academic record is no longer a sufficient prerequisite for entry into today’s working environment. ‘Employers now hold attitude and personality in greater esteem than academic or even vocational qualifications when assessing new recruits.
‘Collectively, we – the Government, businesses and educators – must work together and take full responsibility for developing skills in line with commercial needs.
‘Financial acumen, communications techniques and a full appreciation of the attitude required to excel in the commercial world must now form a core part of curricula.
‘We have to listen to employers who are telling us that our education system has to ensure soft skills are valued alongside an emphasis on academic excellence.’
Asthmatic children’s lives put at risk by ‘red tape’ as British schools banned from keeping spare inhaler
But the bureaucracy is adamant
Children with asthma are being prevented from getting access to inhalers in schools due to ‘needless red tape’, a leading charity has warned. Asthma UK said schools are prevented from keeping a spare blue reliever inhaler on their premises because they are prescription-only medicines. But this puts children’s lives at risk when they have forgotten to bring their own inhaler to school or have run out, it said.
The charity is calling for a change in the rules to allow schools to keep inhalers in their first aid kits.
Some 1.1 million children in the UK have asthma and just over 30,000 are admitted to hospital with the condition every year. There are around 1,100 asthma deaths every year among both adults and children.
A small survey of more than 200 youngsters for Asthma UK found almost two-thirds have had an asthma attack at school. One in five children said they find it ‘quite difficult’ or ‘very difficult’ to access their inhaler at school and 55% do not always know where it is or how to get it.
Emily Humphreys, head of policy and public affairs at Asthma UK, said: ‘These medicines are very safe but going without them can be very dangerous, so it is crucial that the Medicines and Healthcare products Regulatory Agency (MHRA) changes the rules and allows schools to keep a spare inhaler as a last resort.
‘The majority of children know to find a teacher if they don’t have their own inhaler when having an asthma attack at school but the reality is that there is very little that staff can legally do to help in this situation. The charity says the MHRA could provide an exemption to the regulations to allow schools across the UK to supply the inhalers.
Similar exemptions already exist for organisations such as the Royal National Lifeboat Institution (RNLI) and the armed forces.
Stephen McPartland, Conservative MP for Stevenage, said: ‘The tragic case of Stockport schoolboy Samuel Linton, who died in 2007 following an asthma attack at school, shows that there is a real lack of understanding and awareness as to what to do if a child has an asthma attack whilst they are at school.
‘This is why this campaign is so crucial, not only in terms of giving teachers access to an emergency inhaler but also empowering them with understanding, awareness and support in how to deal with asthma at school.’
Dr Kevin Gruffydd Jones, from the Primary Care Respiratory Society (PCRS-UK), said: ‘Asthma attacks are serious and children need access to inhalers as soon as possible. ‘Introducing a spare inhaler for emergencies could prevent a serious asthma attack by getting prompt help for a child when it’s needed.’
A spokesman for the MHRA said: ‘In the interests of patient safety, asthma inhalers should only be supplied on prescription to the individual named, for his or her own use. ‘The MHRA has no plans to change the current legal position.
‘Exemptions exist because of the nature of the conditions in which these organisations operate. For example, the conditions in which military operations are undertaken will tend to mean that access to medical care or advice may not be readily available.’
Sam Linton’s parents, Paul and Karen Linton, said: ‘Sam was a wonderful son and his loss has been devastating. The past few years have been horrendous, especially in the knowledge that things could, and should, have been different. ‘The thought that his death may have been prevented with better training and clearer policies is too much to bear. ‘Our family has suffered enormously since Sam’s death and we know our lives will never be the same again.
‘We only hope that serious lessons have been learned by all schools so that no one else has to suffer what we have been through so that our son’s death is not in vain.’
Jonathan Betts, from law firm Irwin Mitchell, which represents the Linton family, said: ‘If left untreated, asthma attacks can have devastating consequences. ‘A simple national policy would help, which instructs teachers to call an ambulance if a child suffers an asthma attack and is not showing signs of improvement within five to 10 minutes.
‘If easing the restrictions on schools stocking spare inhalers helps prevent further tragedy in future then we wholeheartedly support it.’