Don’t get sick at the weekend in Britain
Cripes! I hate to imagine what would have happened if I had been in Britain when I was suddenly stricken with a VERY painful kidney stone. At my PRIVATE hospital in Australia (with all costs covered by my health insurance) I was under the CT scanner within an hour of arriving and was in theatre that night!
The risk of dying in an NHS hospital at the weekend is up to 40 per cent higher for some illnesses, new data claims.
According to the latest analysis, the death rate for emergency treatment of some conditions can increase from about two out of 10 patients during the working week to about three out of 10 on Saturday and Sunday.
The worst illness to be admitted with at the weekend is thickening of the arteries, a type of heart disease. The relative risk of dying on a Saturday or Sunday is 40 per cent higher than on a weekday.
In absolute terms, the risk of dying in hospital after being admitted on a weekday as an emergency for atherosclerosis – thickening of the arteries that can lead to a heart attack – is 20 per cent. The comparable in-hospital death rate for weekend admissions is 28 per cent.
That is an absolute rise of eight percentage points, but relatively speaking it is a 40 per cent increase.
For those being treated for abdominal aneurysms – where a major artery has burst or is about to do so – the risk of dying in hospital after a weekday admission is 27 per cent. For weekend admissions the rate rises to 37 per cent. That is an absolute rise of 10 percentage points, but a relative increase of 26 per cent.
For pancreatic cancer, the in-hospital death rate after weekday admission is 25 per cent. That rises to 34 per cent for weekend admissions – a nine percentage point rise, but a relative increase of 36 per cent.
The mortality rates, calculated by the health care information provider Dr Foster Intelligence and based on NHS data, seem to show the effects of fewer consultants and other staff at the weekend.
Another reason could be the lack of available testing and scanning at the weekend.
Dr Foster Intelligence first voiced concern about the higher risk in out-of-hours care in its last annual Hospital Guide in November 2011, which revealed increased weekend death rates for all patients needing unplanned treatment.
The research organisation has released these latest data to highlight the risk for individual conditions and to help hospitals identify which of their patients are more likely to die at the weekend.
Each NHS trust will be able to probe its own weekend mortality figures as Dr Foster Intelligence launches its new hospital quality benchmarking tool, Quality Investigator.
By sharing this new data with hospitals it is hoped that they can pinpoint the areas most affected by weekend working arrangements.
Reasons for higher hospital death rates at weekends will vary by condition. Support for people to die at home or in a hospice are sometimes not available at weekends, which can be a factor particularly for patients with cancer.
In other cases, lack of staff and services in hospital at weekends will affect the quality of care available.
Speaking about the weekend mortality figures, Dr Foster Intelligence’s director of research, Roger Taylor, said: “Other industries have adopted effective weekend operating so these mortality figures are a worrying sign of the NHS’ failure to modernise its working practices.
“As well as clearly improving the quality of care, seven-day working can help trusts run more efficiently.”
Hospital spends just 73 pennies a meal on patients – less than is put aside to feed prisoners
Hospitals are spending as little as 73p on patients’ meals, less than is put aside to feed prisoners, officials have admitted.
Newham University Hospital Trust in East London allows only £2.19 for breakfast, lunch and dinner, while another 16 hospital trusts spend £5 a day or less on feeding each patient.
At the top of the scale is Barts and the London NHS trust, which sets aside £15.65 a day, an average of £5.22 a meal.
Only this week, new Health Secretary Jeremy Hunt promised to overhaul hospital food and send in teams of inspectors to check kitchens. Yet the latest figures from the Department of Health show that rather than investing more in meals, several trusts are slashing costs.
Newham – the lowest spending trust – has shaved £2 off its daily meal budget and now sets aside 1p less than the Prison Service pays to feed inmates.
Moorfields Eye Hospital in London has halved its spending in the last year from £7.80 to £3.35, while Shrewsbury and Telford NHS trust has cut it from £7.23 to £3.65.
Katherine Murphy, chief executive of the Patients Association, said: ‘For a hospital to spend under £1 on a mealtime is an absolute insult. ‘Access to tasty, nutritional and quality food is a vital contributor to a patient’s health and well-being.’
The Department of Health said that in the last two years overall spending on hospital food had increased by 10 per cent, although there was ‘significant’ variation.
However, officials said that lower spending trusts did not necessarily provide worse quality food, and might simply have negotiated a cheaper contract.
Options on the dinner menu at Newham NHS trust include a sandwich with ‘chicken-style slices’ [chicken STYLE! The mind boggles. Sawdust?], while pudding choices include a lemon whirl — believed to be a type of mousse.
Staff said ready meals were shipped in from a factory in Colchester, nearly 60 miles away, run by catering firm Anglia Crown.
The figures also show that some trusts are throwing away more than a fifth of their meals.
Health Secretary Jeremy Hunt said: ‘The figures show while the NHS is spending more on food, costs vary wildly across the country.’
The benefits of a classical music education at what was once a British sink school
But would it work with less dedicated and enthusiastic teachers? Almost anything works if the teachers believe in it
Daniel Olorunfemi didn’t even know what a tuba was until three years ago, when he started at Highbury Grove School in Islington, north London. In the past 12 months, though, thanks to this inner-city comprehensive’s ground-breaking classical music programme, he has been on stage at the Royal Albert Hall playing the lowest-pitched of all brass instruments in front of 5,000 people.
Quite an achievement? “I was a bit too nervous to take it all in,” the 13-year-old confesses. “But it was amazing, wasn’t it,” chips in his more confident classmate and fellow orchestra member, Melissa Bolat. She, too, only picked up a double bass for the first time when she arrived at Highbury Grove.
A third member and contemporary, Joe Monk, wasn’t quite such a novice. “I’d played a bit of guitar before I got here,” he says. At Highbury Grove, though, every child is given an instrument to learn, and they offered him the clarinet. He hasn’t looked back. “It is just what everyone does here,” he reports matter-of-factly. “It’s the same as doing English or maths.”
Which may be the case in many independent schools, where parents and governors have the resources to fund one-to-one tuition from peripatetic music teachers and to purchase expensive violins, violas and cellos – but it is rare indeed in the state sector. Music and playing instruments is usually an optional extra, available only to those whose parents can foot at least part of the bill. A modest scheme called Wider Opportunities, launched under the last government to allow all primary schoolchildren a limited window in which to learn an orchestral instrument, is aimed principally at giving them a taster. Ambitions at Highbury Grove School, though, are longer-term. For many of its pupils, drawn from a catchment area with pockets of social deprivation (70 per cent qualify for free school meals), that first introduction to an instrument they might never otherwise have had can be a life-changing moment. Last year’s head girl, whom the school started on the flute at 14, has just begun a music degree at Oxford.
Highbury Grove has had a bit of a topsy-turvy history, admits its director of music, Pierce Brown. When it opened as a brand-new all-boys’ comprehensive in the late 1960s, its head was the bewhiskered Rhodes Boyson, later a high-profile education minister under Margaret Thatcher. He turned the school into a fortress against all progressive teaching methods – defending corporal punishment at a time when everywhere else was phasing it out.
In the 1990s standards fell, and by the turn-of-the-century, thanks to an undercover TV reporter posing as a supply teacher, the school, by now mixed, became a byword for failure. “Ten years ago, it was appalling,” says Brown candidly. “And that wasn’t just what Ofsted said, it was what the local community felt. Parents would do anything rather than allow their children to come here.”
That was when the fightback began. As part of her widely acclaimed efforts to turn this failing school around – which included rehousing it in new premises – the head teacher, Truda White, had an idea. The 1,300 pupils at the school speak 50 different languages as their mother tongue. Music, she felt, could act as a common language to unite them and mould them into one community.
And she took that one stage further. Rather than embracing the musical enthusiasms of the children, she decided upon something more timeless – the classical canon. One inspiration was the Simón Bolívar Orchestra from Venezuela, the internationally renowned face and sound of a nationwide social programme (“El Sistema”) that has run since 1975 in the Latin American country, which recruits, trains and equips classical musicians from among the poorest youngsters.
With the ongoing support of the Charles Wolfson Charitable Trust, which provides the instruments and covers the extra costs that otherwise would be beyond the standard state school educational budget, Highbury Grove has been working away to build up this radical programme for six years. “At first, our performances could be a bit hit or miss, and it still isn’t perfect,” says Brown, an Australian who joined four years ago. “But we now feel confident enough to start talking about it publicly.”
Music is at the heart of the curriculum. Every child in their first three years is given the chance to learn a stringed instrument. And, so that they don’t come to it blind, Highbury Grove now sends its music teachers out into six feeder primary schools locally to start pupils off before secondary transfer. Those who opt for music as their speciality on entering Highbury Grove are given a wider range of instrument choices, and for everyone there are orchestras, ensembles, bands and choirs.
But wouldn’t electric guitars, synthesisers and computer-generated sounds be more familiar, and perhaps more appealing, to the pupils than classical music and the traditional instruments of the orchestra? “It is about opening doors, giving them the chance to develop an interest and their own ability, and then we find the passion comes,” explains Brown. “There is nothing to match the vibrations that come through a raw, acoustic instrument.”
It is not, he stresses, that this is some prissy conservatory from which all contemporary sounds are banished as vulgar. There is too much of a buzz about Highbury Grove to make that possible, even if he wanted it. Some of the pupils, he says, have been working on a version of Pachelbel’s Canon that mixes Baroque 17th-century music with sampling from We Dance On by hip-hop crew N-Dubz (which included X Factor judge Tulisa). “We make classical music cool,” he jokes.
He is very serious, though, about the wider educational benefits that such a concentration on music has brought to the school. Every task in music is approached in the round. “So, as well as studying a piece of music, we will also study how the ear works in Biology, or sound waves in Science, or the history of the period when it was written. It all has a practical basis in the daily life of the school. We’re preparing pieces for Remembrance Sunday right now, and music again provides a way into understanding a commemoration that is very important in our culture, but a bit of a mystery for those of our pupils whose families have arrived in this country very recently.”
If it is all sounding too good to be true, you don’t just have to take Brown’s word – or those of the pupils – for the bigger benefits that music has brought to the school. Ofsted has visited, awarded Highbury Grove an “outstanding” rating and praised in particular the music programme for the sense of community it engendered with everyone working and learning together. Examination results are improving rapidly and the school is now heavily oversubscribed, with five candidates for every place. It is even beginning to attract applications from sections of the local community that previously would have given it the widest of berths. “It all goes to show,” Brown reflects, “that the skills involved in classical music are very transferable across the curriculum”.
If we are the new Elizabethans, then conservatives are the new Catholics
I recently read Ian Mortimer’s A Time Traveller’s Guide to Elizabethan England, which includes a chapter on religion in this period. It illustrates how during the 16th century the acceptable range of religious beliefs changed rapidly in a short space of time.
Anti-Catholic hostility steadily grew, inflamed by the Pope’s declarations against Queen Elizabeth. In 1571, Parliament passed a new act making it high treason to claim the Queen was “a heretic, schismatic, tyrant, infidel or usurper”. It became illegal to import papal bulls, crucifixes or rosary beads.
Just as in later secular regimes where the old religion was suppressed, ordinary people could end up in serious trouble if they said the wrong things. Essex tailors George and William Binkers were hauled before magistrates in 1577 for saying that the Host became “the very body, flesh and blood of Christ.” John Howard was also summoned to court for stating that “it was never merry in England since the scriptures were so commonly preached and talked upon.”
The situation intensified in 1580, when scholars from Douai set up an illegal printing press in Oxfordshire and 100 Jesuits arrived with the mission “to preserve and augment the faith of the Catholics in England.” From then on anyone trying to persuade people to join the Catholic Church was guilty of high treason and executed, whilst anyone missing an Anglican service was to be fined £20 per month.
After 1593, Catholics could travel no more than five miles from home without forfeiting all property, and had to register with local authorities in order to obtain a licence if they wished to go anywhere. Things had changed a lot since 1564, when half of all justices of the peace had hesitated to swear Oath of Supremacy.
I grew up in a mixed Anglican/Catholic household, but until adult life I probably held the standard Protestant Whig view of our history; that Protestantism freed the English from Papist tyranny, which is essentially alien and un-English.
Yet, a lot of that is myth. James I was as much an absolutist as any continental monarch, and absolutism was seen as the future. England’s constitutionalism may have been helped by some of the radical elements of Protestantism — and the literacy it encouraged — but it was formed in a Catholic country. The men who signed the Magna Carta then 40 years later held meetings that came to be known as Parliament were all Catholic. As for the Protestant work ethic, Flanders seems as hard-working as Holland, and Bavaria as Saxony. Would a Catholic England have been that different? The only difference in a world in which England had remained Catholic would have been, as someone once quipped, that Ireland would have been Protestant.
There are some parallels with our own time. Protestantism at the start of Elizabeth’s reign was a minority faith, and when Henry VIII had broken with Rome it was only practised by a small number of radicals around London and Cambridge. But they were a highly-motivated, disproportionately well-educated minority, and once given power were able to inflict a cultural whitewash on England’s Catholic heritage. This was physically manifested in Thomas Cromwell’s wrecking of the monasteries, an act of cultural vandalism that resembles the actions of the Taliban. The Protestant radicals, crucially, were better able to manipulate the medium of the day — print.
If you look at the present day, cultural changes that have occurred under the second Elizabeth have shifted the acceptable range of beliefs within a generation. A number of opinions that were almost universally held during the last London Olympics might get you sacked today, or possibly investigated by the police.
When bishops talk of the “persecution” of Christians they are being hyperbolic. Christians really are persecuted in places like Pakistan or Iran, but what they mean is that the Anglican supremacy has been replaced by an atheist one, and that people who don’t believe in its articles of faith, whether it be gay marriage or multiculturalism, face legal harassment and social handicaps.
Today’s new puritans maintain that they are fighting for equality rather than control, but this is as much of a delusion as the idea that they are “rational” (and people who think they’re rational and others aren’t can be quite dangerous). We could have “procedural” secularism, in which the state allows people to worship and does not have favour any religion in particular, but when two sets of beliefs — sexual equality and traditional Christianity — have such opposing belief systems, the state has to favour one. That’s what it has done on things such as adoption agencies; it’s not quite the same as being squashed underneath seven hundredweights of metal, but we live in more peaceful times, and no one wants to lose their job or funding, especially when the state is so much larger today.
Although most people are quite moderate on the “culture war” issues, just as in the 16th century the most fanatical are also the most vocal and determined; like in the 16th century they understand the media of the day, television and radio, better than conservatives. That is why, just as in the 16th century, it is used to spread relentless propaganda against the old society and faith. (Another parallel is the physical vandalism of the 20th century that tore down so many beautiful buildings that reminded people of another era.)
And just as in the 16th century, they use the law to exclude people with whom they disagree, people who do not swear the 21st century equivalent of the Oath of Supremacy – the Oath of Diversity.
Guardianista Monbiot doing his best to keep the flame of fear alive
He has actually learnt a lot by now but he still manages to think of a “what-if” that gives him a horn
I believe we might have made a mistake: a mistake whose consequences, if I am right, would be hard to overstate. I think the forecasts for world food production could be entirely wrong. Food prices are rising again, partly because of the damage done to crops in the northern hemisphere by ferocious weather. In the US, Russia and Ukraine, grain crops were clobbered by remarkable droughts. In parts of northern Europe, such as the UK, they were pummelled by endless rain.
Even so, this is not, as a report in the Guardian claimed last week, “one of the worst global harvests in years”. It’s one of the best. World grain production last year was the highest on record; this year’s crop is just 2.6% smaller. The problem is that, thanks to the combination of a rising population and the immoral diversion of so much grain into animal feed and biofuels, a new record must be set every year. Though 2012’s is the third biggest global harvest in history (after 2011 and 2008), this is also a year of food deficit, in which we will consume 28m tonnes more grain than farmers produced. If 2013’s harvest does not establish a new world record, the poor are in serious trouble.
So the question of how climate change might alter food production could not be more significant. It is also extremely hard to resolve, and relies on such daunting instruments as “multinomial endogenous switching regression models”. The problem is that there are so many factors involved. Will extra rainfall be cancelled out by extra evaporation? Will the fertilising effect of carbon dioxide be more powerful than the heat damage it causes? To what extent will farmers be able to adapt? Will new varieties of crops keep up with the changing weather?
But, to put it very broadly, the consensus is that climate change will hurt farmers in the tropics and help farmers in temperate countries. A famous paper published in 2005 concluded that if we follow the most extreme trajectory for greenhouse gas production (the one we happen to be on at the moment), global warming would raise harvests in the rich nations by 3% by the 2080s, and reduce them in the poor nations by 7%. This gives an overall reduction in the world’s food supply (by comparison to what would have happened without manmade climate change) of 5%.
Papers published since then support this conclusion: they foresee hard times for farmers in Africa and south Asia, but a bonanza for farmers in the colder parts of the world, whose yields will rise just as developing countries become less able to feed themselves. Climate change is likely to be devastating for many of the world’s poor. If farmers in developing countries can’t compete, both their income and their food security will decline, and the number of permanently malnourished people could rise. The nations in which they live, much of whose growth was supposed to have come from food production, will have to import more of their food from abroad. But in terms of gross commodity flows the models do not predict an insuperable problem.
So here’s where the issue arises. The models used by most of these papers forecast the effects of changes in averaged conditions. They take no account of extreme weather events. Fair enough: they’re complicated enough already. But what if changes in the size of the global harvest are determined less by average conditions than by the extremes?
Cure or no cure, we’ll keep taking the tablets
Should echinacea fail against the common cold, a new ‘remedy’ will not be far away
By Theodore Dalrymple
A study by the Common Cold Centre in Cardiff has found that the popular cold remedy echinacea can not only prevent colds but also shorten them once they start. If you take three daily doses for four months, your chances of catching a cold and the length of time you spend with it declines by 26 per cent, or 60 per cent if you are particularly susceptible to colds. Whether the benefit is large enough for people to take echinacea three times a day for four months is something for each person to decide: no answer is right for everyone.
Actually, these findings are not unexpected. A study from the University of Connecticut published in 2007 found that people who took a preparation of echinacea reduced the number of colds from which they suffered by 60 per cent; and if they did catch cold, the illness lasted 1.4 days fewer than if they did not take the preparation. It is only honest to point out, however, that other trials – for example, one led by a researcher from the University of Virginia in 2005 – have been negative. As is almost always the case, further research is needed.
If it turns out that echinacea really is valuable both as a prophylactic and a treatment, there will be rejoicing, not to say crowing, among enthusiasts of alternative medicine, for it will vindicate folk wisdom as a source of medical knowledge. Echinacea is extracted from a North American genus of plants of that name. Apparently, it was used by native Indians as a cure for a variety of conditions including snakebite. According to Wallace Sampson, a physician at Stanford University with an interest in alternative medicines, echinacea was first marketed for use in colds by a Swiss herbalist who had been told (mistakenly) that American Indians took it for that purpose.
In fact, several medical advances have resulted from doctors conducting experiments on folk remedies about which they had heard. William Withering discovered the use of digitalis in this way, and Edward Jenner the use of cowpox innoculation – which eventually led to the elimination of smallpox. But it is science that is required to distinguish between folk wisdom and folk superstition.
Why can’t we be immunised against colds as we can against, say, measles or yellow fever? Colds are caused by hundreds of strains of viruses, and immunity against one strain does not confer immunity against the others – which is why, according to American immunological data, elementary schoolchildren suffer from three to eight colds a year, and adults two or three.
Let us suppose for a moment that further scientific tests on echinacea show that, contrary to the hopes raised, it really does not work either to prevent or to cure colds: will that be the end of its career?
By no means. We each – man, woman and child – spend about £10 a year on cold remedies, most of which we know perfectly well will not shorten the duration of our colds (which, incidentally, are responsible for about 50 per cent of time lost at work through illness, so that colds are more economically than medically significant). But we are temperamentally incapable of saying to ourselves when ill, “There is nothing I can do about it”, and some of the remedies give us symptomatic relief, if only by making us drowsy.
About a third of people in Britain take vitamin supplements, too; we feel, in our bones rather than with our minds, that there must be a diet that will keep us healthy and free of disease. In my childhood I was given various disgusting concoctions of hot milk and honey for my colds. These days I prefer pills – provided that I can’t taste them.
The desire to take medicine, said the great 19th-century physician Sir William Osler, is what best distinguishes man from the animals. This is despite the fact that his near contemporary, Oliver Wendell Holmes, said that if the whole of the pharmacopoiea were thrown into the sea, it would be better for humanity but worse for the fish. The mere uselessness, or even harmfulness, of medicine has never prevented mankind from taking it.