Traditional hospital rotas ‘putting lives at risk’
Almost four in 10 hospitals are not providing any consultant cover at weekends due to “traditional” working practices, a report by the Royal College of Physicians (RCP) has found.
Patient safety is being put at risk because too many hospitals do not ensure that consultants are on duty on acute wards seven days a week, according to the comprehensive survey of English hospitals.
And consultants are also allowed too much freedom to pick and choose the days they work which means there is a lack of expert cover during anti-social hours.
Emergency patients admitted at weekends had a 14 per cent higher chance of dying within a month, than those admitted on weekdays, it discovered.
Responses from 91 acute trusts, running 101 hospitals, found that in over a third, there was inadequate weekend consultant cover.
Specifically, in 38 per cent of hospitals, there is at least one day a week when consultants are present on acute wards for four hours or less. This tends to happen on a Saturday, a Sunday, or both.
It might be the case that there is no consultant available at any time on either day in some hospitals, although the report did not go into such a level of detail.
Having an admitting consultant is important because they can often assess the new patient better than a less senior doctor. In addition, they have the authority to ensure the best treatment is given.
The study also found that in nine out of 10 hospitals, consultants did not have to work ‘blocks’ of two or more days, but could chose to work a day here and a day there if they chose.
This was particularly the case at weekends, when one-on, one-off was a “recognised pattern of work”.
The arrangement compromised patient care, concluded the report’s authors, leading to “excess weekend mortality”.
Dr Kevin Stewart, director of the RCP’s clinical effectiveness unit, said “traditional rotas” with few consultants working weekends were putting lives at risk.
He said: “The profile of acute medical patients has changed dramatically over the past 20 years, yet in some hospitals changes in consultant working patterns have been much slower.
“Traditional rotas are neither safe for patients, nor good for clinicians.”
He thought “substantially less” than four in 10 hospitals were acheiving the RCP’s “gold standard” of having a consultant on the acute wards for at least 12 hours a day, every day, despite the growing clinical need for such a service.
“Now, patients are older, sicker and have more complex conditions, and they require dedicated consultants to be available on site 7 days per week for at least 12 hours a day,” he said.
Death rates in large hospitals are lower than in smaller ones, according to the report, perhaps because those with fewer acute beds struggle to get good weekend cover.
The report also found that in half of hospitals, consultants only made one formal ward round per day.
The RCP calculated that one extra life could be saved per 443 acute patients, if consultants were made to work blocks of at least two days at a time, and carried out at least two wards rounds a day.
Elderly people make up the bulk of emergency hospital admissions.
Dr Simon Conroy, of the British Geriatrics Society, said: “We welcome the findings of the report, which emphasises the importance of getting frail older people seen at the earliest possible opportunity in their admission to maximise outcomes.”
Dr Chris Roseveare, president of the Society for Acute Medicine, said: “This study represents a really important step forward in the management of patients admitted as medical emergencies.
“For the first time, specific patterns of consultant working on the Acute Medical Unit have been shown to be associated with improved patient outcomes; hospitals now have a fantastic opportunity to identify the number of acute medicine consultants required to deliver best practice and to provide sustainable rotas for 7 day working in acute medicine.”
The study comes after Dr Mark Porter, chairman of the BMA’s consultants’ committee, called for members in acute departments to embrace weekend working.
*A network of 22 new major trauma centres that will save up to 600 lives a year are to be opened, the Health Secretary has announced.
Andrew Lansley said the network would mean more critically ill patients were taken to the right place first time, and would not have to be moved from one hospital to another.
He said: “For far too long, people have needlessly died from major trauma injuries because some local hospitals were not equipped with the right facilities or specialist teams to treat patients with life-threatening injuries quickly.
“I have always said that patients should be at the heart of the NHS and that services should be arranged around their needs, not how hospitals are organised. Seriously injured patients need to be assessed and treated quickly.
“With 22 new trauma centres now opening across England staffed with a full specialist trauma team, we hope to save up to 600 lives a year.”
The centres, in existing hospitals, will be equipped with “state of the art diagnostic and treatment facilities”, added a Department of Health spokesman.
Professor Keith Willett, National Clinical Director for Trauma Care, said: “This new system is a great example of the difference that can be made to patients’ lives by having all the expertise, experience and equipment in one place.”
Babies treated in the womb for obesity: Overweight mothers-to-be get diabetes pill to cut the risk of having a fat child
Is this another DES disaster coming up? Where are the long-term double-blind studies to support this policy? Many molecules that are safe for adults can be teratogenic. Metformin works by suppressing glucose production by the liver. Could it cause long term liver damage or malfunction in some of the unborn? That it has been safely used by diabetics is no guarantee that is will be equally safe in unborn babies. We are looking at quite different metabolisms in the two cases
Babies are being medicated in the womb in an attempt to prevent them from being born obese. In a world first, dangerously overweight mothers-to-be in four British cities have started taking a diabetes drug during their pregnancy.
The doctors behind the controversial NHS trial say that obesity among pregnant women is reaching epidemic proportions and they need to act now to protect the health of tomorrow’s children.
However, there is likely to be unease about resorting to medication in pregnancy for a problem that can be treated through changes in diet and exercise.
If the strategy is a success, the treatment could be in widespread use in as little as five years, with tens of thousands of overweight but otherwise healthy mothers-to-be drugged each year.
The Daily Mail recently revealed the rise of the ‘sumo baby’, with the number of newborns weighing more than 11lb soaring by 50 per cent over the last four years.
More than 15 per cent of pregnant women are obese. This raises their odds of dying in pregnancy, of their baby being stillborn and of a host of pregnancy complications, some of which can be fatal.
Big babies are around twice as likely to grow into overweight adults, suggesting obesity and the lifetime of ill-health it can bring is ‘programmed’ in the womb. The trial involves 400 pregnant women in Liverpool, Coventry, Sheffield and Edinburgh.
They have started taking metformin, which has been safely used by diabetics for decades and is cleared for the treatment of diabetes in pregnancy. It costs just pence per tablet.
Some of the participants have already had their babies but many more births will be needed before it is clear if the treatment works. Mothers-to-be elsewhere are due to take part.
The study aims to exploit the ability of metformin to lower levels of the hormone insulin in the bloodstream.
Obese women make more insulin than other mothers-to-be and this leads to a greater nutrition supply reaching the baby.
It is hoped that lowering levels of insulin will reduce the supply and so cut the odds of babies being born obese.
Treatment with metformin may redistribute the baby’s fat stores, reducing the deposits around the liver and other organs.
Study leader Professor Jane Norman of Edinburgh University said: ‘One of the challenges is that many women feel perfectly healthy but there is very good evidence that women who are obese have an increased risk of pregnancy problems and their babies are at risk, and we’d like to reduce that risk.’
Addressing concerns about unborn babies being medicated for a problem that many would say could be treated by diet and exercise, she said: ‘I absolutely support the improvement of diet and encouraging exercise.
‘But we are increasingly faced with women who start their pregnancy obese. Saying at that stage to eat less and exercise more is not particularly helpful.’
Obesity experts have welcomed the study, which is funded by the Medical Research Council, the NHS’s health research arm and the baby charity Tommy’s, saying that while the situation is not ideal, it needs to be tackled.
Patrick O’Brien of the Royal College of Obstetricians and Gynaecologists described the study as ‘very important’. He said: ‘When you are overweight in pregnancy you are at increased risk of just about every complication you can think of.’
Britain’s obesity madness again
Stories like this pop up often — showing how mindless the definition of obesity has become. It’s child abuse
She dreams of becoming a ballerina and when she’s not dancing, four-year-old Sophie Kettle spends her free time swimming, roller-skating and riding her bike. So her parents were astounded to receive a letter from the NHS saying their daughter, who weighs just 2st 13lb, is ‘overweight’.
The medical note warned that Sophie is in the fattest 3 per cent of her age group and is at increased risk of heart disease, cancer and diabetes. The 3ft 3in youngster was taken to the family GP, who informed her she was ‘obese’ and in the ‘danger zone’.
Her mother Joanna said that Sophie, who had been happy and healthy, now often refuses her food. Herself a former anorexic, Mrs Kettle fears her daughter could eventually develop an eating disorder.
‘She comes home from school saying, “Mummy, I’m fat”, and I have to explain to her that she’s just perfect as she is,’ said Mrs Kettle, 29, from High Wycombe, Buckinghamshire. ‘It’s terrible that a child so young should be worrying what she eats.’
Sophie and her classmates at Hamilton primary school in High Wycombe had their height and weight measured by NHS staff to calculate their body mass index (BMI) as part of the National Child Measurement Programme, which aims to pinpoint youngsters with weight problems.
For adults, BMI is measured by dividing weight in kilograms by height in metres squared.
Although the calculation for children begins the same way, the result is then compared with those of others of the same age and sex to calculate the child’s ‘centile’ – or position relative to others on a scale of one to 100.
The letter to Mrs Kettle and her husband James, a traffic warden, said their daughter has a BMI ‘centile’ of 97 – meaning she is in the top 3 per cent. Between 91 and 97 is classed as overweight while 98 and above is clinically obese.
‘If she was a teenager and overweight, I would be the first to be concerned,’ said Mrs Kettle. ‘But she’s not even five and she’s a tiny little thing without an ounce of fat on her.
‘The GP told me to give Sophie smaller portions, but she’s being given healthy food, not biscuits and crisps.’
In her school packed lunch, Sophie takes two or three pieces of fruit, and her mother says there are always vegetables with dinner.
‘She’s such an active child,’ she added. ‘Her dream is to become a ballet dancer and she’s on a waiting list for lessons.’
Mrs Kettle, who also has a two-year-old son, Ryan, is concerned her daughter might struggle with the same food issues she herself faced as a teenager. She said: ‘I ended up damaging my body, and I would hate for Sophie to do the same.’
Susan Ringwood, chief executive of the eating disorder charity BEAT, said: ‘It is important that any health-related information is given very sensitively. ‘BMI alone is a very unreliable measure of overall health especially where children are concerned as they are still growing taller. ‘Raising a child’s insecurities about weight and shape can lead to problems in the future.’
But tweets will never hurt me
The imprisonment of a UK student for posting ‘aggravating’ tweets about an ill footballer is no LOL matter
‘See the young man who was abusive about Muamba got a custodial sentence. Let it be a warning to all you immature souls. #thinkbeforeyoutweet.’ So tweeted ex-footballer Gary Lineker, popularising the #thinkbeforeyoutweet hashtag used in reaction to the news that 21-year-old student Liam Stacey was to be imprisoned for 56 days. Stacey had posted abusive comments about Bolton footballer Fabrice Muamba who fell ill during an FA Cup match.
Lineker was far from alone in seeing the imprisonment of Stacey as an important warning for internet ‘trolls’ everywhere. The Apprentice star Lord Alan Sugar responded to the news with the tweet ‘BLOODY GOOD JOB. Be warned idiots!’, and veteran broadcaster James Whale claimed ‘people who abuse Twitter take note’. Others went still further, tweeting that they hope people will ‘rape the fuck out of him’ in prison, with the #DONTDROPTHESOAP hashtag being frequently used. One Twitterer even claimed, ‘I wouldn’t really care if Liam Stacey died. He’s a sick man, from the scum of the earth.’
Sure, even if Stacey had drunk the eight pints he claimed to have done before tweeting ‘LOL. Fuck Muamba he’s dead!!! #Haha’, you would still have to be pretty sick in the head to do so. And his racist responses to some people who criticised him afterwards were obnoxious. Stacey rightly deserved to be challenged and put in his place.
But the censorious Twittersphere wouldn’t stop at that. One person proudly boasted about being ‘one of 100s who reported his racist tweets to the police’, which eventually led to him being incarcerated. Upon being sentenced at Swansea Magistrates Court, district judge John Charles announced, ‘At that moment, not just the footballer’s family, not just the footballing world, but the whole world were literally praying for his life. Your comments aggravated this situation.’ The judge told Stacey he had done ‘untold harm’ to his future.
So you can now be locked up for 56 days simply for saying something that aggravates people? That Liam Stacey had less than 300 followers on Twitter out of a potential 140million means that a very small number of people would have been aggravated by him, and these could simply have chosen to block his comments. Had the comments been ignored, rather than highlighted by offence-seeking campaigners, they would have remained a miniscule drop into the ocean of 340million tweets made each day. Certainly a number of Stacey’s comments were racist, but to claim – as Judge Charles did – that this instigated other nasty tweets against Muamba is highly questionable. People are not automatons, and don’t just read comments and decide to mimic them. If others tweeted nasty comments about Muamba, they are responsible for them, not Stacey. A couple of racist tweets does not a racist pogrom make.
Judge Charles concluded that, ‘I have no choice but to impose an immediate custodial sentence to reflect the public outrage at what you have done’. But he did have a choice. He could have ignored the ‘public outrage’, much of it emanating from snitches on Twitter, and upheld Stacey’s freedom of speech, the foundational freedom upon which all of our democratic freedoms rest upon. He could have recognised that if you lock someone up for saying what are deemed to be the ‘wrong’ things, no matter how vile, then free speech no longer exists in the UK. The state, in the form of court judges, is now seemingly permitted to become the arbiter of the boundaries of what can or cannot be said.
Even mounting a defence of the bedrock liberty of modern society is likely to see you attacked by the Twitterati, however. Broadcaster Piers Morgan, for example, tweeted to over 2million followers: ‘Trying to work out who’s more idiotic – that dumb, racist cry-baby #LiamStacey or those trying to defend him on grounds of “free speech”.’ Morgan continued: ‘Still getting Twitter trolls demanding their “free speech” right to racially abuse black footballers as they lie in comas. Just p*** off… Actually, I’ve got a better idea – keep spewing your racist filth, vile trolls, and let’s get you all arrested and jailed like #LiamStacey.’ (Hilariously, he then responded to his detractors claiming, ‘Come on you vile little trolls – let me have your worst. I can handle it. #SticksAndStones.’)
In a bitter irony, only last week, Tony Wang, the UK general manager of Twitter, declared that Twitter is ‘the free speech wing of the free speech party’. While Twitter itself may be neutral regarding the content of what is said on its site, it’s evident that many of its users are using it to erode free speech in the UK in the most chilling fashion. Twitter is as likely to be used to snitch on people to the police for making comments they disapprove of, or to campaign for offending people to be fired from their jobs or get kicked out of universities (there is currently a campaign to get Stacey kicked off his course at Swansea University), than it is to be used for members of the ‘free speech party’ to champion their cause. Indeed, it seems that for some, defending free speech on Twitter is tantamount to spewing ‘racist filth’.
Following Stacey’s arrest, censorious Twitter users are bending over backwards to try to out-censor one another. One such user wrote ‘LOL at Liam Stacey getting jailed by the Twitter police for racial comments. Hope all the coloured men rape the fuck out of him.’ He was then promptly reported to the police by another user, Ivor Sawbottom, who told him, ‘@ScoobyDrew93 your tweet is an incitement to violence. I am reporting you to @metpoliceuk.’ Twitter is fast becoming a highly intolerant sphere, with what can and cannot be said without censure shrinking all the time.
It is little surprise that Stacey was imprisoned for making comments about a footballer. At the present moment, there is an unprecedented crackdown on the behaviour and comments of football fans – people seen by the media and politicians to be little more than bigoted lowlifes. But make no mistake, Stacey’s imprisonment for expressing views on Twitter, no matter how vile, could have wide-ranging implications for the ability of all of us to speak freely.
Certainly, we should all think before we tweet (and speak) – to ensure we convey what is on our mind as accurately as possible. But we should not have to factor into this consideration whether or not we will be incarcerated by the state as a result. Stacey’s imprisonment demonstrates that such considerations do now have to be made. This marks a dark day for the most fundamental of our democratic freedoms.
‘Please Sir, we’d like some more': Teachers claim pupils are served ‘very small’ dinners by cost cutting British schools
Children are going hungry at school as cost-cutting canteens serve up tiny portions despite the price of meals rising, teachers have warned.
In echoes of the era of Dickens’ Oliver Twist, portions in some schools are ‘very small’ and staple dishes run out quickly, a survey of staff revealed.
Yet the cost of school meals is rising, with parents likely to be paying an extra £95 this year compared with 2010/11.
Teachers surveyed by the Association of Teachers and Lecturers complained that youngsters are too often given limited choice and unhealthy, carb-heavy meals of chips, pasta or rice.
Some canteens are skimping on portion sizes, prompting suspicions that firms providing school meals are putting profits before children’s nutritional needs.
More than a third of staff surveyed believed school meals offered poor value for money, while nearly a fifth said the meals were not healthy.
The revelation came as figures showed how the number of children eligible to receive school meals free-of-charge is rising due to the recession.
The number of children who qualify for free meals edged up from 1,012,000 in 2009/10 and 1,055,00 last year as growing numbers of parents are made redundant.
Discussing the survey findings, Dr Mary Bousted, ATL’s general secretary, said: ‘It’s absolutely the case that children are going in hungry in school and we all know what hunger does to your ability to learn.
‘Teachers do raise issues about the quantity of food that children get, and about choice. ‘Some teachers are saying that children don’t get enough food. ‘Some parents say their children may be eating food that is against their religion because the choice has gone, the other option has run out.
‘In an age of austerity, in rising child poverty… free school meals become increasingly important as a major source of nutrition for children and young people.
More than two-fifths of primary school children and a third of secondary school pupils are now opting for school meals, according to the latest official figures.
Take-up has been growing since the school meals revolution was kick-started six years ago.
‘If they are rising in importance in that way, we need to make sure they are nutritional, they are adequate in terms of quality and there is choice so children can exercise choice in what they want to eat.’
The survey of school dinners, covering 500 teachers and classroom assistants in primaries and secondaries, found that 62 per cent of respondents said the price of meals had gone up in their school this year.
Most said the price had risen by up to 50p per day, leading to an additional cost to parents of £95 a year. But 34 per cent said meals failed to represent good value for money and 19 per cent said meals were not healthy.
A primary school teacher said: ‘The food provided for our school varies in quality. Some meals are delicious, others are far from it.
‘The portions served to the children are very poor, and there seems to be no regular inspection of the food, kitchens or portion size by the local authority provider.’
Another primary teacher said: ‘There are times that meals are good but others when they are most unappetising. There are occasions when the portion size is very small and there have been times when portions have run out.’
A third added: ‘The young children often get very small portions and very limited choice. Children who come with packed lunches eat a lot more at lunchtime.’
Meanwhile, a reception class teacher said: ‘The younger children pay the same price but get much less than the older ones. Also they do not get the choice as this is saved for the older ones.’
Overall, staff felt meals were healthy but one secondary teacher said: ‘There seems to be a lot of carbohydrates on offer each day. ‘There are usually chips, pasta and rice available, while vegetables and salad don’t seem to be on offer.
‘As the meals are cooked in-house, the choice is limited to what our cook is able to make in large quantities.’
Commenting on the findings, Dr Bousted added: ‘One respondent said we could do with more inspection of the standard of the meals.
‘If it’s not inspected, then there is a danger that private market forces can just take over and you’re getting as much profit as you can out of feeding the nation’s children.
‘If, as is usual they have been provided by an outsourced company, by a private company, the size of the portion and the quality of the food will impact directly on the extent of the profits.’
The findings were published as ATL members debated a motion on free school meals at their annual conference in Manchester.
Delegates passed a resolution recognising that a rise in child poverty will further increase the importance of school dinners and cooking skills for the health of children and young people.
It calls on the Government to introduce a universal credit system to make sure that qualifying for free school meals becomes the accurate indicator of child poverty.
Clare Kellett, a teacher at West Somerset Community College, said some pupils came to school having had no breakfast, while some also failed to eat lunch.
‘They don’t really need to read Pope and Dickens, they don’t really need to read Dickens and write essays about it to find out about child poverty, neglect, hunger,’ she told delegates. ‘They don’t need to read it because they live it, in 2012.’
A School Food Trust spokesman said: ‘Every child’s appetite is different so portion sizes aren’t set nationally – but cooks do get to know their pupils, and should make sure they are getting a portion that’s appropriate for them.
‘If parents or teachers are ever concerned that children aren’t getting enough to eat, we always advise that they talk to their cooks in the first instance.’
She added: ‘School meals need to be affordable for families. Our research proves that school food is particularly sensitive to changes in price and in these tough financial times, access to decent food at school for children has never been so important.
‘Schools need support to build their market, run their catering efficiently and to deal with rising costs