Rationing of Hip and knee surgery could become ‘routine’
Rationing of hip and knee operations will become “routine” and waits get longer and longer unless radical changes are made to the way NHS orthopaedic surgery is organised, claims a leading surgeon.
The NHS faces being snowed under by an “avalanche” of demand for orthopaedic care, caused by Britain’s ageing and increasingly overweight population, said Professor Tim Briggs.
Some health authorities are already restricting access to hip and knee replacement operations, by making patients wait until they are less mobile and in greater pain.
Prof Briggs, former medical director of Stanmore orthopaedic hospital, said: “ If we are going to give patients the care they need, when they need it, we are going to have to do things very differently. If not, then rationing is going to become routine.”
The number of orthopaedic operations had increased from 47,000 in 2004 to 179,000 in 2011, according to the National Joint Registry, he said.
Patients were too often not being referred soon enough or to the right specialist, he continued, meaning there were many instances when “we are not getting it right first time”.
Infection rates for orthopaedic operations – which lead to prolonged stays on wards and sometimes revision operations – were also too high in some hospitals.
At the best, just two in 1,000 orthopaedic patients acquired infections but in the worst the rate was 20 times higher, he said.
“If we brought the rate down to 0.2 per cent across the board he could save the NHS up to £300 million, which would allow us to do 60,000 extra joint replacements a year,” he argued.
Prof Briggs is highlighting his concerns today (Tuesday) at a parliamentary reception hosted by Stephen Dorrell, the Conservative MP and chairman of the Health Select Committee.
Meanwhile, a separate report has found the situation is improving for patients who have suffered hip fracture.
The National Hip fracture Audit found quicker access to surgery after a fall and better care management has led to shorter hospital stays. Now the average stay is 20.2 days, down a day on last year, saving the NHS £14 million.
Prof Briggs welcomed the audit, saying it was the result of focusing on problems in trauma care.
But he said: “Now with the numbers coming through for planned operations, we need a serious focus on elective orthopaedics.”
A Department of Health spokesman said: “A DH spokesperson said: “Waiting times for orthopaedic treatment are low. The figures for the first six months of 2012 show that the number of patients who waited longer than 18 weeks before starting treatment has fallen by nearly 9,000 compared with the same period in 2011.
“Last year we made it clear that it is unacceptable for the NHS to impose blanket bans for treatment on the basis of costs. This is particularly true for patients in pain. That is why we banned primary care trusts from putting caps on the number of people who could have certain operations.”
Student hi-jinks at Oxbridge too
Rather refreshing in the frantically “correct” atmosphere of Britain
For 800 years Oxford and Cambridge have been bywords for academic excellence. Now a dossier of student misdemeanours obtained by The Daily Telegraph suggests their undergraduates take an equally vigorous approach to high jinks.
It charts hundreds of incidents of drunken bad behaviour in the past two years, including dozens of episodes where police and paramedics were called to usually cerebral colleges.
In one instance, a college boat club was banned from drinking at future dinners after parading their newly elected captain naked around a city centre supermarket. Others were giving tickings off for throwing curry and beer in a restaurant, urinating and vomiting “copiously”.
The incidents are disclosed in dozens of discipline reports since 2010 released by 15 of the universities’ colleges under Freedom of Information legislation.
They form a colourful account of life at the elite institutions that have moulded 41 prime ministers, including David Cameron.
Students were fined more than £14,000 and made to complete hundreds of hours of community service for the transgressions. College authorities also issued more creative punishments such as banning students from the rugby team and preventing them wearing society insignia.
Cambridge’s Sidney Sussex appeared to have the most outlandish students, or at least the most assiduous record keepers.
Their records charted 44 instances of indiscipline over the period, including students setting off fireworks at 4am and “pennying”, a game played in gowns at a formal dinner that requires undergraduates to down their drink when a coin is thrown into the glass.
The 500-year-old college, which has schooled Oliver Cromwell, Lord Owen and former Countdown presenter Carol Vorderman, also investigated complaints a student had drunkenly assaulted and been “aggressively rude” to a member of staff.
The college’s boat club was a recurrent scourge of the authorities. Last year students were reported to the dean after “general drunken behaviour” at the society’s dinner led to a member collapsing into his own vomit.
The next year the society was asked to draw up a code of conduct after “parading” their captain naked around a branch of Sainsbury’s, ignoring complaints from the college porter and a security guard.
The college’s rugby team also behaved “inexcusably”, after a dozen members stood on tables in a city restaurant, chanting abuse and hurling curry and naan at other customers, “it being a rugby outing”.
They also threw drink at the walls and ceiling before making a hurried exit when they felt “our time in the restaurant was up”.
The party ran back to college where they were questioned by police officers. The college later investigated accusations they threw a bottle of cider at a waiter.
“It apparently never occurred to students that there was something fundamentally wrong with their behaviour,” the report noted.
In other incidents, police were called after two students broke a table in a fight in the college bar, while students were asked to write a letter of apology after being accused of urinating in another college master’s garden.
And an unfortunate student was sent to hospital after impaling his foot on a spike trying to clamber back into the college at 1am in his first week at the university.
At St John’s, Cambridge, 14 students were drunk “to incapacity” in a single year, with three dealt with by paramedics. One was found urinating on the wall outside while police were called at 4.15am when another abused ambulance staff after “vomiting copiously”.
Oxford’s Merton College also suffered “alcohol-induced bad behaviour” including an incident involving the Myrmidons, a notorious dining society founded in 1865, that led officials to ban their summer garden party.
An Oxford University spokeswoman said: “Oxford and Cambridge between them account for tens of thousands of young people, so it is not entirely surprising that incidents of stupid and inappropriate behaviour do come up. When they go too far, they face the consequences.”
More on the doubtful historicity of the Quran
Film-maker Tom Holland responds to the programme’s critics
Channel 4 has received a number of criticisms over my documentary, Islam: The Untold Story. This is a brief response.
The origins of Islam are a legitimate subject of historical enquiry and this film is wholly in keeping with other series and programmes on Channel 4 where the historical context of world religions has been examined, such as The Bible: A History. A considered exploration of the tensions that inevitably arise when historical method is applied to articles of faith was central to the film. We were of course aware when making the programme that we were touching deeply-held sensitivities and went to every effort to ensure that the moral and civilizational power of Islam was acknowledged in our film, and the perspective of Muslim faith represented, both in the persons of ordinary Bedouin in the desert, and one of the greatest modern scholars of Islam, Seyyed Hossein Nasr.
It is important to stress as we do in the film that this is a historical endeavour and is not a critique of one of the major monotheistic religions. It was commissioned as part of Channel 4’s remit to support and stimulate well-informed debate on a wide range of issues, by providing access to information and views from around the world and by challenging established views.
As a non-Muslim historian I tried to examine, within a historical framework, the rise of a new civilisation and empire that arose in the late antique world as the two great ancient empires of Rome and Persia were in decline. The themes in the programme have been previously written about extensively by many other historians including: Patricia Crone, Professor at Princeton; Gerald Hawting, Professor at SOAS; and Fred Donner, Professor at Chicago all of whom lent their support to the programme. The themes it explores are currently the focus of intense and escalating academic debate.
An accusation laid against the film is one of bias and, although I believe that absolute objectivity is a chimera, what was incumbent upon us, in making the film, was to be up-front about my own ideological background and presumptions, and to acknowledge the very different perspective that Muslim faith provides. If the film was about the origins of Islam, then it was also about the tensions between two differing world-views. Whether one accepts or rejects the truth of the tradition is ultimately dependent upon the philosophical presumptions that one brings to the analysis of the sources.
To answer some other substantive points:
1. It has been suggested that I say in the film that Mecca is not mentioned in the Qu’ran. In fact, I say that Mecca is mentioned once in the Qu’ran. As a historian I have to rely on original texts and although later tradition (as brought to us through the hadith) has come to accept that other names are synonymous with Mecca, the fact is that there is only one mention of Mecca in the Qu’ran(although due to an unwarranted interpolation, a second one does appear in the Pickthall translation).
2. On the broad perspective some complaints assert unequivocally, as is often said, that Islam was “born in the full light of history unlike the ancient faiths”. That may have been the belief of Western scholars back in the days of Ernest Renan, but it is most certainly not the academic consensus today. One leading authority, Professor Fred Donner, who appears in the film, has written:
“We have to admit collectively that we simply do not know some very basic things about the Qur’an – things so basic that the knowledge of them is usually taken for granted by scholars dealing with other texts. They include such questions as: How did the Qur’an originate? Where did it come from, and when did it first appear? How was it first written? In what kind of language was – is – it written? What form did it first take? Who constituted its first audience? How was it transmitted from one generation to another, especially in its early years? When, how, and by whom was it codified? Those familiar with the Qur’an and the scholarship on it will know that to ask even one of these questions immediately plunges us into realms of grave uncertainty, and has the potential to spark intense debate.”
This summary may fairly be said to represent the current state of play in the academic debate.
3. It has also wrongly been suggested that we said there is no historical evidence for the seventh century origins of Islam. What I actually said in the film was that I had expected to find contemporaneous Muslim evidence – “but there’s nothing there.” And the Qur’an aside, the first mention of the prophet Muhammad’s name in Arabic is on the coin that we featured in Part Five, and on the Dome of the Rock, which we also featured prominently. The evidence provided by Christian contemporaries was mentioned in Part Three, and is dealt with at greater length in the book.
Obviously in a film of only 74 minutes, which opens up very rich and complex arguments and brings to light detailed academic scholarship, which has been going on for over forty years, it is impossible to articulate all the resonances and implications of every argument. Much more detail, with full citation of sources, will be found in my book In the Shadow of the Sword: The Battle for Global Empire and the End of the Ancient World. All the film can hope to do is to introduce this fascinating (but until now, largely academic) debate with careful contextualising to a larger television audience. The subject, it should be said, is advancing and changing all the time as new discoveries are made, and new insights are gained. That is precisely what makes it such a fascinating area of research, and an entirely valid topic for a documentary.
Retired Anglican archbishop blasts British PM for going back on his promise as UK lawyers fight for a ban on crosses at work
A former Archbishop of Canterbury yesterday accused David Cameron of going back on his promise to support the rights of Christians to wear a cross in the workplace.
Just five months ago the Prime Minister insisted that Christians should be allowed to display a token of their faith, yet his Government lawyers are now preparing to tell European human rights judges the opposite.
They will call on the European Court of Human Rights to reject the arguments of former British Airways check-in clerk Nadia Eweida and NHS hospital nurse Shirley Chaplin, who have asked the court to rule that they should have been allowed to wear a cross with their uniforms.
Lord Carey, who stepped down from Lambeth Palace in 2002, said yesterday: ‘Sadly, the Government has passed up its opportunity to support the right of Christians to express their faith and have a reasonable accommodation in the law for freedom of conscience.
‘It is now down to the European Court. In these cases, Christians are not seeking special rights but merely trying to overturn unfair verdicts which create a hierarchy of rights in which Christians are at the bottom of the pile.’
Mr Cameron told a gathering of Christian leaders in April that ‘the values of Christianity are the values that we need’ and Downing Street added that ‘the Prime Minister has made it clear that his view is that people should be able to wear crosses.’
Lawyers briefed by the Government’s Equality Minister Lynne Featherstone are to speak against the right to wear the cross in this week’s Strasbourg test case which concerns the rights of four Christians to follow their faith at work.
Alongside the cases of Miss Eweida and Mrs Chaplin, the European judges will also hear the cases of Lilian Ladele, who was sacked from her job as a registrar because she declined to conduct civil partnership ceremonies, and Gary McFarlane, who was sacked as a Relate counsellor because he declined to give sex therapy to gay couples.
Both say that to help gay couples would run against their beliefs. All four have lost their pleas in British courts and tribunals.
British Airways suspended Miss Eweida, 61, of Twickenham, in 2006 for breaching its uniform code by wearing a cross.
Mrs Chaplin, 56, of Exeter, left her job with the Royal Devon and Exeter Foundation NHS Trust in 2009 after it ruled that her cross breached health and safety guidelines.
Government lawyers have deposited papers with the court, indicating they will say that wearing a cross is not something which Christian worship or faith demands but is a choice of the individual concerned.
Similarly, the lawyers will say that it is not necessary for Christians to demonstrate disapproval of gay relationships in order to maintain their faith.
They will also say that Christians who are told not to wear a cross at work can always find another job.
Utter bitch given only one year in jail by British judge
A “childminder” and thief who went very close to killing two children
A childminder has been jailed for locking two young children in a baking hot car while she went on a shoplifting spree.
When she was arrested for stealing from a supermarket, Anne Harries deliberately failed to mention the two-year-old girl and one-year-old boy to the police – condemning them to four hours alone in the sweltering vehicle.
The pair were only rescued after Harries’ husband arrived to collect her from the police station and asked her: ‘What have you done with the kids?’
On learning of the emergency, officers scrambled to find the youngsters. When they finally found Harries’ Vauxhall Vectra in the car park of the Co-Op supermarket in Wildwood, Stafford, the car’s windows were so steamed up with condensation it was impossible to see inside.
The police put a hole in one of the windows to allow the hot air to escape and to get inside. They found the two children drenched in sweat and red-faced from overheating. Paramedics immediately gave them fluid to rehydrate them before taking them to hospital. The little girl’s body temperature was almost three degrees above normal.
Harries, 51, an Ofsted-registered childminder of Cannock, Staffordshire, was jailed for one year after admitting two charges of child neglect and one of theft. Judge Simon Tonking also banned her from working with children indefinitely and described her act as a ‘gross breach of trust’.
He told her the offences were so grave he would be failing in his public duty not to impose an immediate prison sentence.
He said: ‘I accept your intention was to leave them for no more than a few minutes. ‘As it was, you didn’t return and minutes turned to hours and during that time, because there was no ventilation, that car became intolerably hot, so by the time they were rescued over four hours later, they were sweating profusely and dehydrated. The little girl’s temperature was abnormally high.
‘The effects were, fortunately, not lasting – the effect on their mothers was devastating.
‘Whilst you were at the police station, these mothers came to collect their children. Neither they nor you were there. ‘One mother described being sick with worry and they were shocked when told their children had been taken to hospital.’
Paul Farrow, prosecuting, told the court that Harries was arrested at the Co-Op on May 2 this year after being spotted stealing £13 worth of fruit and meat.
A constable asked her how she had travelled to the store and she said she had got a lift from a friend and would get the bus back.
She was taken to the police station, where a set of car keys was found on her and she said they were for a Vauxhall which she had left in the car park.
The custody sergeant spoke to her husband, expressing his concern and was told she was suffering from depression.
Only when her husband asked her what she had done with the children did Harries admit that she had left them in the car, but added: ‘It’s all right – they were asleep.’
When questioned, Harries said that when she got to the Co-Op, both children were fast asleep and she decided to ‘nip in’. She admitted stealing the items from the store, but thought she would be dealt with quickly.
Her mind went blank and she panicked and thought about the trouble she was in, finally apologising for what she did.
Mr Steven Bailey, defending, said Harries had written letters of apology to both sets of parents. ‘She knows it is not going to put things right,’ he said.
A medical report on Harries found that she was suffering from moderate to severe depression.
Deserted British husband snookers money-hungry ex-wife
After Scott Brown held his nerve to win £50,000 on Deal Or No Deal, he was determined that his estranged wife should not get a penny. But with only four months before the TV gameshow was screened and she found out about his windfall, the father-of-two knew he had to spend it fast.
The 33-year-old sign manufacturer and fitter said he used £15,000 to clear all the debts he and his wife Rachel, 29, had from credit card bills, loans and bank overdrafts.
After setting aside almost £2,000 to cover legal fees for his divorce, he bought clothing, toys and household items for their two young children.
Mr Brown also used some cash to ‘live off’, having being signed off from work because of ‘depression’. But he admits he spent most of the rest on ‘having a good time’, including an iPad, a holiday in Mexico and the outlay of £4,000 on a second-hand X-type Jaguar estate car.
The final part of his winnings went days before his own August 21 deadline to pay for an electrician’s course, so he could start a new career.
As it turned out, Mr Brown was right to suspect that his wife, who he says asked him for a divorce on Christmas Day last year when he allegedly found she had been having an affair with a truck driver she met over the internet, would want to cash in on his lucky break. As soon as the Channel 4 programme was broadcast, she went to court in a belated bid to ensure she received a share.
The case went before a district judge at Doncaster County Court last Thursday, when Mr Brown was ordered to detail in writing how the money was spent; an injunction imposed days earlier ordering him not to spend his winnings – if any remained – was kept in place; and the case was adjourned.
The couple, who are in the process of getting divorced, neither looked at or spoke to each other throughout the brief hearing.
Outside court, Mr Brown told the Daily Mail how the show, presented by Noel Edmonds, changed his life when he was at his lowest ebb, saying: ‘I was over the moon to have won that amount. I was told Rachel could lay claim to it so I decided, “She is not getting a penny”.’
Mr Brown married customer services adviser Rachel in the Dominican Republic in September 2009. The couple already had one child, now aged six, and decided to have another baby, now 22 months old.
The family moved to rent a bigger house near Doncaster but their debts began to mount.
Mr Brown said his wife told him late last year she ‘didn’t love him any more’ and by the time he found out he was going on the gameshow in April, Mr Brown had moved out and was sleeping on the floor of his cramped parents’ house.
He said he was ‘absolutely disgusted’ by his wife, saying: ‘How does she have the right to this money? My life has broken apart, I can’t see my kids every day any more and I have lost everything I have worked for over 11 years.’
Mrs Brown refused to comment.
How taking exercise can trigger a deadly food allergy
Eating vegetables and taking exercise are the cornerstones of healthy living advice. But for Traton Steven, these two innocuous sounding activities have a far from positive effect. In fact, he’s allergic to them.
Traton, 18, is one of half a million Britons who suffer from a condition called food-dependent exercise-induced anaphylaxis (FDEIA), where physical exercise sparks a severe and potentially fatal allergic reaction.
Indeed, it was only because of his father’s quick thinking that Traton survived his first attack at the age of 14. He was helping out at his parents’ garden centre two hours after eating a meal of cannelloni.
‘I’d always had hay fever and allergies to horses, but I suddenly got what I can only describe as really bad hay fever, terrible stomach ache and, without being too dramatic, a sense of doom,’ says Traton. ‘I went to wash my hands and change my clothes, which usually helps with my hay fever, but it got worse.’
Traton’s father put him in the car and rushed him to nearby Maidstone hospital.
By the time he arrived, 20 minutes after the reaction had started, the teenager’s face and eyes were so swollen he couldn’t see, his tongue was lolling out and he was having severe breathing problems.
He was suffering from anaphylaxis, a severe allergic reaction where the body’s immune system over-reacts to an allergen, triggering the release of the chemical histamine, which can affect the airways and mucous membranes (lips and eyes) and cardiovascular system.
The hospital administered adrenaline, steroids and oxygen, kept him in overnight and ran tests for peanut allergy, which came back clear.
Puzzled doctors released the teenager with an EpiPen — an adrenaline shot he can administer himself when the next reaction starts — and told him to be cautious.
Over the next three years, Traton had several more severe reactions, but allergy specialists could not explain why.
Finally, he was referred to Dr Stephen Till, a consultant in adult allergy at Guy’s and St Thomas’ NHS Foundation Trust in London, who diagnosed him as having FDEIA, brought on by a substance in green vegetables and salad called lipid-transfer protein.
Around 750,000 Britons are thought to have suffered an anaphylactic reaction — and a food allergy is one of the most common causes.
But in an estimated ten to 20 per cent of people with a food allergy, the reaction is only sparked when they exercise.
It typically occurs two to four hours after ingesting food, but in some people it can be as much as 12 hours later. Wheat and prawns are the most common culprits, but fruit, vegetables and nuts can also cause anaphylaxis.
The patient may go through life eating the food they are allergic to without any reaction, and it’s only when they exercise afterwards that the anaphylaxis strikes.
‘The exercise involved can be moderate — one patient suffered anaphylaxis when pushing her baby’s pram up a hill — and in many different forms, from labouring on a building site or dancing in a nightclub to taking a walk or going for a run,’ says Dr Till.
But it’s thought that the more the person exerts themselves, the stronger the reaction.
Diagnosis is based on a patient’s history, what they ate and when they ate it before exercise, plus blood tests commonly used to detect food allergies.
‘Classically, anaphylaxis will occur if the patient exercises two hours after eating the food, but sometimes it can be much longer,’ he says. ‘One patient, a triathlete, reacted to something she had eaten the night before a race.’
Allergy consultants estimate they see one or two patients with FDEIA a month, but all agree the number of undiagnosed sufferers is likely to be much higher.
Why exercise should spark anaphylaxis is unknown, but there are theories that it increases the permeability of the gut, changes the way the blood vessels react to allergens or has an effect on the body’s neuroendocrine cells (specialised nerve cells that produce hormones such as adrenaline).
Heat, alcohol, anxiety and mental stress are also thought to exacerbate the problem.
The first case of FDEIA was recorded in a marathon runner in 1979, who collapsed when he ran after eating prawns.
However, there has been no other research into the condition — due, in part, to the danger of inducing a potentially fatal condition.
But this year, doctors will begin a three-year study, funded by the Food Standards Agency, looking at the effects of exercise on food allergies.
Dr Andrew Clark, a consultant in paediatric allergy at Addenbrooke’s hospital in Cambridge, is leading the study that will involve 100 people with a peanut allergy. ‘Each will eat peanuts on four occasions and, under strictly controlled conditions, exercise on a static bike,’ he says. The researchers expect exercise to lower the threshold at which patients can tolerate peanuts before suffering a reaction.
They think that even people with a food allergy who do not have full-blown FDEIA, exercise may make reactions worse.
‘We will take blood tests to see if there are changes in the blood vessels, gut or allergy cells during exercise,’ says Dr Clark.
Whatever the causes, once a diagnosis is made, avoiding the food causing the reaction is often all that’s necessary for cure.
Alastair Lockhart, 70, from Oban, avoids wheat after an attack earlier this year. ‘For many years I would sometimes get “the itches” — hives and red blotches around my mouth — but thought nothing of it, until the day I walked a mile to the nearby village in the sunshine after a meal,’ he says.
‘I started to get itchy, so I stopped at the local shop to buy antihistamine. ‘But soon I was shaking and shivering and couldn’t keep still. I felt as if I was losing consciousness.’
Luckily, a builder in the shop spotted the signs of anaphylaxis and called the local GP, who administered adrenaline.
Alastair was referred to Professor Jonathan Brostoff at King’s College London, and was diagnosed with FDEIA with an allergy to wheat. ‘Working out what foods contain wheat has been tricky — even some whiskies do,’ he says.
As well as food avoidance, patients must have adrenaline with them at all times. If anaphylaxis strikes, Professor Brostoff advises them to lie down and raise their legs so blood goes back to the heart.
‘Take an antihistamine or adrenaline as soon as possible, call the doctor and, when you are better, ask your GP for a referral to an allergist,’ he says.
Some patients also need to work with a dietitian so they can identify the culprit food.
Since Traton was diagnosed, he avoids greens and salad. He feels healthy and works at the family garden centre part-time. ‘I can eat cauliflower, carrots and red cabbage as well as fruit,’ he says. ‘Luckily for me, I’m a meat and potatoes person, so I don’t mind.’