Caesareans and pain relief for mothers giving birth ‘should be cut to save the NHS money’
Family doctors are being told to try to talk women out of having Caesareans and very strong painkillers during birth to save the NHS money.
New guidelines drawn up for GPs urge them to encourage women to have natural labours with as little medical help as possible.
They also remind doctors to tell women to consider having their babies outside hospital in midwife-run units or in their own homes.
Caesareans cost the NHS around £1,200 a time while epidurals – anaesthetic injections into the spine – are around £200.
The guidelines state that, as well as being expensive, they both slow down a mother’s recovery after labour and impede breastfeeding.
The advice does not suggest women should not be given any painkillers, such as gas and air which are commonly used.
However, it specifically tells doctors to try to reduce the numbers given epidurals and other anaesthetic injections into the spine.
The advice – drawn up by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the National Childbirth Trust – has enraged campaigners and some senior doctors.
Felicity Plaat, consultant anaesthetist at Queen Charlotte’s Hospital, London, said: ‘In the 21st century, where the resources are available, it’s unacceptable and unethical to withhold effective pain relief from women who require it.
‘Furthermore, only the woman in pain can decide whether and what analgesia, or pain relief, she needs.’
Deborah Morgan, of Perinatal Illness UK, a charity which supports women with post-natal depression, said: ‘The physical and mental health of women and the lives of babies are now being compartmentalised to fit a system.
‘It is not really in their interests, and instead is all about saving money – bottom line.
‘Under the guise of “choice”, women are being covertly pushed into accepting a supposedly cheap option.’
Professor Philip Steer, editor-in-chief of the British Journal of Obstetrics and Gynaecology, said: ‘To try to achieve increased rates of uncomplicated births – by reducing the availability of induction, epidural anaesthesia and Caesarean section for informed women who request them – reduces choice without any guarantee of an improved outcome.’
The advice has been sent out to the new groups of GPs – clinical commissioning groups – which are replacing primary care trusts under NHS reforms.
It tells GPs to think of midwife-led centres as the ‘default’ option, rather than hospitals.
Although the majority of women have their babies in hospital, most are perfectly capable of giving birth at home or in such centres, it points out.
These clinics aim to help women to give birth naturally without epidurals, anaesthetics or the help of doctors.
GPs are also told to discourage women from having Caesareans, particularly if they had one for their first birth and are convinced they are unable to have their second baby naturally.
But the advice conflicts with guidelines from the National Institute of Health and Clinical Excellence, which states that women should be offered Caesareans if they were very worried about giving birth.
Earlier this year NICE relaxed its rules and stated that those who had a particular phobia of birth should be allowed the operations.
The RCOG has removed the guidelines from its website although they have already been read by a number of doctors and health professionals.
It will hold a meeting next week to discuss if they should be rewritten.
Cold sweats? Soaring blood pressure? You must be tangling with the GP’s receptionist
There are many organisations I dread phoning. My bank, for one (a call-centre in India where workers try to engage me in chummy scripted conversation about EastEnders). My mobile phone provider, with its touchtone-menu hell, for another.
But there’s one, above all, that makes me want to bang my head repeatedly against a wall: my local GP’s practice.
I have no complaints about its fantastic doctors and nurses. But seeing one of them in person is a process so complex it makes the discovery of the Higgs Boson look like deciphering Book One of Janet And John.
My childhood GP was a latter-day Dr Finlay. To get to see this kindly medic, you simply called the surgery when the need arose and arranged an appointment for a convenient time. Sometimes he made house visits (I know, can you imagine it?), because he understood that the sick often find it hard to leave their beds.
Today, booking a doctor’s appointment involves such huge reserves of energy and finesse that it’s only a matter of time before it’s categorised as an Olympic sport.
The rules are as inflexible as granite. For a next-day appointment, you must call, heart racing, at 8am. Sharp.
Don’t delay until 8.02 am because, who knows, you might be distracted by the demands of family breakfast, or even — and here’s a shocker — by the cries of an ill child, and you then stand as much chance of seeing a doctor within 24 hours as you do of hearing Prince Harry announce he fancies a quiet night in re-reading Trollope.
Try requesting a specific time-slot, or your favourite doctor, and you’ll be treated like Oliver Twist in the orphanage when he asks for more. As for bagging a slot in a fortnight for a non-urgent but vital appointment, you’d have a better chance of unearthing Lord Lucan.
No wonder that complaints to family doctors’ surgeries have risen by nearly 10 per cent in the past year. More than 53,590 written complaints were lodged by patients against local surgeries — that’s well over 1,000 a week.
This is up from 49,765 last year and a rise of a quarter since 2007, when the NHS data was first collected.
The biggest increase involved those complaints relating to the surly attitude of receptionists, phone-lines being engaged or lack of appointments.
If you’re surprised by these findings, I’d like to break it to you that the Pope is devoutly Christian.
Two years ago, the Government conveniently scrapped its target that all patients should be seen by their GP within 48 hours, after figures revealed one in five patients was unable to get an appointment in that time.
So we’re stuck with a system that couldn’t have been better designed to send every patient’s blood pressure into orbit.
Assuming you do dial on the dot of 8am (I now set an alarm for 7.58am in order to have my finger on the trigger), you’re then subjected to around 15 minutes of Muzak, interspersed with a sub-Joanna-Lumley-type voice telling you: ‘The surgery is currently experiencing high call volumes. But your call is important to us.’
‘No, it bleeding isn’t!’ you scream. ‘You’re hoping I’ll cave in and just give the little brute Calpol!’ In your agitation, you jab the keyboard and are cut off.
Naturally, when you finally get through again, at 8.32am, all appointments are gone.
If you do succeed in getting through early, the real fun begins. For now, as if in some ghastly video game, you must wrangle with the receptionists — the modern world’s answer to Cerberus, the three-headed hound of Greek mythology who guarded the gates of the Underworld.
‘My child’s in agony with earache,’ you blurt out, and she replies, ‘Sorry, caller can you hold?’
When she returns 20 minutes later (while you develop a hernia as it dawns that you could have bought the surgery for the cost of this premium-rate call), you take a deep breath, then say wheedlingly: ‘I know you’re meant to make appointments 24 hours in advance, but is there any chance that we could see someone today?’
‘Come in and wait,’ the receptionist will snarl. ‘Right now.’
‘Well, first my other child needs to be taken to school,’ I apologise, saying I can get to the surgery by 9.15am.
‘You won’t be seen until after lunch, then,’ she snaps. ‘Maybe not before four. We’re very busy, you know.’
‘I’d have to leave before 2.30pm to pick up my eldest from school,’ I say, sweating so much I feel I must have been struck by the Ebola virus.
‘I can’t help you there,’ she replies.
To be fair to the receptionists at my inner-city GP’s, they may be jobsworths and they’re often gorgons, but they are also saints — as has been brought home to me on the occasions when I’ve wasted eight hours in the waiting room for an eight-minute appointment, the result of which has been instructions to give my child Calpol.
During the wait, you must hush tetchy children who are sick, but sadly not so sick that they obey the ‘No-running’ rule and who think the most amusing way to pass the time in this germ-infested hellhole is to take each one of the dozens of leaflets (usually, ironically, ordering us to see our GPs at the first hint of illness), and scatter them like confetti on other patients’ heads.
On our last visit, diversion came in the form of a man rushing wildly into the gents.
We then listened to the poor man vomiting loudly for the following hour, while everyone pretended to be fascinated by their yellowing copy of Country Life. Except, of course, my five-year-old, who kept up a running commentary throughout.
Normally, the only way to pass the time is to observe the receptionists. They heroically wrangle with a never-ending stream of people who are (obviously) unwell, stressed, confused, often elderly, and frequently speak no English.
One second, they’re dealing with an elated woman who’s just had a pregnancy confirmed, the next with a distraught grandfather recently diagnosed with terminal cancer.
The phones never stop ringing as they calm agitated and potentially dangerous drug addicts, and soothe distraught young mothers.
As a result, I’m tolerant of their occasional tetchiness and their habit of asking me in loud tones to outline my symptoms to the packed waiting room.
Theirs is a tough job, yes, but it doesn’t make it easier for us patients.
We know the system is cash-strapped and beleaguered by time-wasters. But if we’re sick, we want to be resting, not giving ourselves stress-related ulcers through repeatedly jabbing redial.
Like most parents, I’ve ludicrously been forced to drive ten miles to the already overstretched hospital A&E department because a GP’s appointment was unobtainable. I’ve felt horribly guilty, but what choice did I have if I was to obtain a prescription for my screaming child before Christmas?
Personally, unless one arm dropped off and I stopped breathing, I’d never bother to call the surgery. And as for the children — well, best just give them another dose of Calpol.
Thousands of British students being ‘hoodwinked’ into taking courses for jobs they will never get
Armies of students are graduating from courses with qualifications for jobs that aren’t there.
Many are being trained in fields such as video games design, media, hair and beauty, forensic science and PR.
However, their numbers far outstrip the positions in the employment market. For example, colleges trained 94,000 students in hair and beauty in 2011, to fill only 18,000 new jobs.
Critics claimed young people were being ‘hoodwinked’ into spending thousands on college courses and university degrees that promise a dream career but in reality offer few prospects.
In contrast, there are dire shortages of trained staff in fields such as engineering and physics.
Research for a book on consumer society shows that 52 universities offer degrees in film studies, 37 run courses in cultural studies and 66 offer television studies.
In addition, 130 video games degrees are available but only eight are accredited by the industry body.
While 5,664 students were taking forensic science degrees in 2009, only 5,000 in total worked in the UK forensic science industry.
Figures also show that nearly 83,000 college students finished media courses last year at ‘level three’ – roughly equivalent to A-level standard – but only 65,000 vacancies were available.
In hospitality, leisure, travel and tourism, nearly 98,000 completed courses with only 43,000 jobs advertised.
In contrast, fewer than 40,000 students completed courses in building-related engineering – even though 72,000 jobs were available.
Steve McKevitt, a marketing expert who draws on the figures for his new book Everything Now, said young people were being failed by an education system which ignored the needs of employers.
‘The decision to supply the labour market with more graduates was taken without really considering what the needs of the labour market actually were,’ he said.
‘I do think it is a scandal that so many young people are being hoodwinked into studying for expensive degrees under the auspices that these qualifications are the key that will open the door to a dream career.’
Mr McKevitt argued that Britons increasingly measure success by their careers and how ‘interesting’ their lives are. Jobs in the creative industries are therefore attractive. ‘The irony is that while it is very difficult to get a job in the creative sector, it is usually very easy to gain a place on one of the supposedly related courses,’ he said.
‘The key point is not that studying for these degrees is a waste of time. There is nothing necessarily wrong with undertaking a degree in PR, media studies, video games or any of the others…Nor does it mean that if you study one of these then you won’t be able to get a job in your chosen field.
‘The fundamental issue here is that these degrees do not necessarily lead to a job in the sector so if that is your only reason for studying them, then you are probably better off studying something else.’
The warning follows research by the Local Government Association earlier this year, which found that Britain is ‘teaching too many young people the wrong skills’.
The Department of Business said: ‘Graduates continue to do better than non graduates and we must ensure they enter the labour market equipped to succeed.’
Border Agency decision threatens thousands of international students in Britain
The UK Border Agency (UKBA) has revoked London Metropolitan University’s power to teach or recruit international students, leaving nearly 3,000 students facing deportation unless they can find another place to study within 60 days.
The university’s vice-chancellor, Malcolm Gillies, has warned that the decision to revoke its licence to take non-EU students would create a £30m loss – equal to nearly a fifth of the university’s budget – and threatens the institution’s future. Of the 30,000 students expected at the university in the new academic year, about 2,700 from outside the EU.
A statement posted on the university’s website on Wednesday night said: “The implications of the revocation are hugely significant and far-reaching, and the university has already started to deal with these. It will be working very closely with the UKBA, Higher Education Funding Council for England [HEFCE], the NUS and its own students’ union. Our absolute priority is to our students, both current and prospective, and the university will meet all its obligations to them.”
The NUS has contacted David Cameron and the home secretary, Theresa May, to “express anger at the way that decisions have been made in recent weeks and to reiterate the potentially catastrophic effects on higher education as a £12.5bn a year export industry for the UK”.
The university’s “highly trusted status” for sponsoring international students was suspended last month over fears that “a small minority” of students did not have accurate documentation.
The revocation of this status means that any students not involved in the failures around monitoring their status will be allowed to remain in the UK and given 60 days to find a new sponsor, “regularise their stay” or leave the UK. Any longer stay may lead to deportation and refusal for any application to enter the country for 10 years. The Home Office guidance to universities states: “If a student has already been given a visa when we revoke your licence, we will cancel it if they have not travelled to the UK. If they then travel to the UK, we will refuse them entry.”
A border agency spokesman said the decision had been made after the university “failed to address serious and systemic failings that were identified … six months ago.” He added: “We have been working with them since then, but the latest audit revealed problems with 61% of files randomly sampled. Allowing London Metropolitan University to continue to sponsor and teach international students was not an option.”
The universities minister, David Willetts, said a taskforce led by the HEFCE and Universities UK would help overseas students affected by the decision: “It is important that genuine students who are affected through no fault of their own are offered prompt advice and help, including, if necessary, with finding other institutions at which to finish their studies.
The taskforce, which will also include UKBA and the NUS, will work with London Metropolitan University “to support affected students and enable them to continue their studies in the UK”.
In an email before the licence was revoked, Gillies appealed for help to Keith Vaz, the chairman of the Commons home affairs select committee, saying university leaders “absolutely accept” some processes on international student recruitment “will need further adapting”.
In a letter to Home Office minister Damian Green, Vaz said: “While the committee is fully supportive of the government’s efforts to clamp down on the abuse of student visas, and the need to follow rigorous processes, I share the vice-chancellor’s concerns about the procedure in the case.”
Liam Burns, NUS president, said: “It is disgusting that international students continue to be used as a political football by politicians who seem either incapable of understanding, or are simply uncaring about the impact of their decisions on individuals, universities and the UK economy.
“This decision will create panic and potential heartbreak for students not just at London Met but also all around the country. The needs of students must be at the heart of any process to find new places of study and NUS will be working with UUK and HEFCE to support affected students and ensure as far as possible that they can continue studying in the UK.”
“Politicians need to realise that a continued attitude of suspicion towards international students could endanger the continuation of higher education as a successful export industry. This heavy-handed decision makes no sense for students, no sense for institutions and no sense for the country. This situation and the botched process by which the decision was arrived at could be avoided if international students were not included in statistics of permanent migrants.”
Must not try to brighten up common areas of British welfare housing
Residents of a block of flats have been ordered to take pictures down from communal walls because they are dangerous and breach health and safety rules.
Housing bosses have warned the tenants of nine properties in Stockport, Greater Manchester, that any ‘non-compliant’ photos and portraits will be removed and eventually destroyed after an inspection tomorrow.
Even doormats are being outlawed by the killjoys who say they are too dangerous.
Those living there say they have put up their own pictures to brighten up the corridors and some photos belonged to a former neighbour who has died.
But to their dismay they were warned of the inspection in a letter from social landlord Stockport Homes, which runs their building.
It said ‘obstructive’ or ‘combustible’ items – including doormats as well as picture frames – were banned from communal areas because they could potentially pose a fire hazard.
The letter, signed by neighbourhood housing officer Abbie Booth, said Stockport Homes was prepared to allow just two pictures in the entire ground floor corridor – one on each side of the hallway.
The letter warns anyone who fails to do so will be in breach of their tenancy agreement.
Resident Stewart Edge, 64, said he and his neighbours had been ‘gobsmacked’ by the warning. Mr Edge, who has lived in the block for 12 years, said: ‘It seems ridiculous. We were just trying to brighten up our home and we’re really hurt that we’re going to have to take them down.
‘It’s very heavy-handed and I just can’t believe they see this as a priority and something they should be devoting time to enforcing.
‘If a picture frame is a fire hazard then I don’t know where you draw the line. Surely sending out these pointless letters could be classed as a fire hazard as well?
‘It’s just so over the top and bizarre it’s hard to know whether to laugh or actually get quite angry about it.’
Stockport Homes was not available for comment.
Joan Marshall, 68, told The Sun: ‘It’s stupid — we all want to keep the pictures up. We all see the corridors as part of our homes.’
End of welfare culture as young Brits must work unpaid before claiming benefits
Young people will have to complete three months of work experience before they can claim unemployment benefits under Government plans to end the “something for nothing” welfare culture.
The plans are the first step toward establishing a “contributory” benefits system, where only those who have put something into society can expect payouts.
Chris Grayling, the work minister, and Boris Johnson, the Mayor of London, announced a pilot scheme which will involve about 6,000 people who have not worked for six months being forced to gain job experience.
The scheme will be rolled out nationwide next year. Mr Grayling said: “Many other countries don’t allow young people to claim any benefits at all until they have made contributions through a job.
“This trial will give a clear idea of the impact of an approach that says, effectively, you can’t get something back until you have put something in.”
He added: “Its time to look at a different way in Britain. A ‘something for nothing’ culture does no one any favours. It makes those who are doing the right thing cynical. And for those who head straight into the welfare state, it sets them out in life on precisely the wrong footing.”
Areas that were hit by riots last summer, including Croydon and Haringey, will be among the first where the scheme is tested. Currently, people can claim benefits for at least six months before being pushed into back-to-work programmes. Unemployment benefit is worth £56 a week but claimants also qualify for a range of other handouts.
The Conservatives are expected to make further toughening of the welfare system the centrepiece of their next election manifesto.
Ministers are studying foreign benefits payments which often limit how long people can claim state payouts, or which attach other onerous conditions.
Official figures are expected to show that there are still hundreds of thousands of British households where no one has ever worked.
Teenagers from these homes often sign on to benefits as soon as they leave school, with little prospect of ever entering the workplace.
Under the new pilot scheme, those aged between 18 and 24 with less than six months history of paid work will have to complete 30 hours a week of work experience for three months. They will also be given training on writing a CV and interview technique. They will not receive benefits unless they attend the placements.
Boris Johnson said: “It’s no secret that work experience can be the key that opens the door to a successful career and more young Londoners need to be given the opportunity to do it.
“Right now, it’s a tough labour market out there and we have to ensure that all young people get the skills they need to succeed and for which employers are crying out.”
The Government recently won a legal case after young unemployed people objected to being asked to complete voluntary work experience schemes. A judge dismissed claims that the schemes amounted to “slave labour”.
Marmite: the latest superfood?
Marmite — and a similar Australian product — Vegemite — is a complete mystery to Americans, who generally find it revolting. But in much of the British Commonwealth it has a huge and dedicated following. I enjoy the stuff myself. I always have a large jar of Vegemite in the fridge. That’s almost a patriotic duty in Australia. And it has always been clear that it has some useful nutrients in it. I doubt that the concentration of niacin is high enough for relevance to the mouse study mentioned below, however
Five months ago, crisis struck in New Zealand. Earthquake damage to a factory in Christchurch halted production of a staple foodstuff, crippling supply chains nationwide. Supermarket shelves were stripped bare and store cupboards emptied. Consumers started panic buying, hoarding secret supplies and auctioning half-full containers online for extortionate amounts.
They called it “Marmageddon”. The foodstuff? Marmite. That sticky, gloopy, salty spread, made from yeast extract. It’s so popular on the other side of the world that when Sanitarium, its main manufacturer in New Zealand, shut down, the prime minister appeared on television urging the public to stay calm. Now, Marmite could become just as in demand in Britain, after scientists labelled it the latest “superfood”, capable of helping our bodies fight off life-threatening infections.
According to research in the Journal of Clinical Investigation, high doses of niacin (or vitamin B3), one of the main ingredients in Marmite, help boost the body’s defences against staphylococcus bacteria. In tests, concentrated niacin – which produces neutrophils, a white blood cell that fights bacteria – increased our immune system’s ability to kill different strains of the bugs by up to 1,000 times. This could mark a turning point in the battle against antibiotic-resistant superbugs, such as MRSA, the deadly strain that poses a threat in hospitals.
As the saying goes, you either love Marmite or you hate it. On one side are devoted fans who worship “black gold” and would pour it on their cornflakes if they could. On the other are those who hate its yeasty, bitter tang. I’m one of the latter: for me, Marmite has the taste of stale, acrid sardines and the texture of cold treacle. They say the best things for you often taste the worst – such as cabbage, lentils and green tea – but I’d need a lot more convincing before spreading Marmite on my toast.
This isn’t the first time it has been billed as a superfood. First produced in Burton-on-Trent in Staffordshire in 1902, Marmite contains concentrated brewer’s yeast, salt, spices and celery. Due to its high nutritional value, it was part of soldiers’ ration packs during the First World War, and in the Thirties, English scientist Lucy Wills found that the folic acid in Marmite could be used to treat anaemia. Its high vitamin B content also reportedly makes the spread an effective mosquito repellent.
“Marmite helps my pregnant clients get over morning sickness and it’s great for elderly people who have lost their sense of taste,” explains nutritionist Melanie Brown. “I would recommend it to vegetarians, who miss out on vitamin B12, and children who don’t eat much wholegrain bread.”
But not everyone agrees. Concerns have been raised over the high salt content of Marmite (11g per 100g), which led the local council in Ceredigion, Wales, to ban it in primary schools in 2008. More recently, the Danish Veterinary and Food Administration declared Marmite illegal because of its large quantities of additives – it hasn’t been sold in Denmark since May last year.
So before you start lathering yourself in the sticky spread, be warned: indeed, scientists from Oregon State University, who carried out the latest research, have urged people not to take high doses without medical supervision. Our recommended daily intake of niacin is 17mg (13mg for women), and excessive quantities can cause skin flushes and liver damage.
For all those Marmite obsessives out there, the experts recommend a spoonful at a time. “A thin layer is all you need, not piled on your toast like chocolate spread,” says Brown. “A little of what you love won’t do you any harm.”