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Archive for the ‘Health’ Category

Thursday
Jun 18,2009

I see that two Scottish Health Boards are to be directly elected.  This is a pilot announced by the Scottish (SNP) Health Secretary.  The pilot will be evaluated after two years.  What would have been even more interesting would have been to run a parallel pilot in which the functions of two Health Boards were taken over by the relevant local authorities.

If people are really committed to the concept of local democracy and local accountability, then the answer is to make local councils genuinely all-purpose and equip them fully to represent the interests of their communities.

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Tuesday
May 26,2009

There seems to be a media response to the current anger about Parliamentary expenses that says that what is needed is wholesale constitutional reform.  I tend to agree that many of the constitutional reforms suggested might be quite a good idea, but I am not sure that they are the response  that the public are looking for.  Tom Harris has it right when he suggests (with considerable humour) that this may be something of a diversion away from the real issue that has grabbed the attention of the public.

I suspect that the public will not be satisfied until there is a substantial change in personnel in all of the established political parties with those who are felt to have abused the spirit of the expenses system being exiled from Parliament.

However, having said that, if there is a mood for there to be constitutional reform as well, then that is no bad thing.  So here is my personal list of seven reforms to add to the pot:

  • fixed term Parliaments with general elections every five years;
  • retaining single member constituencies in the Commons but with elections on the alternative vote system;
  • a power to recall individual MPs if more than a certain proportion of the electorate (probably at least a third of the number who cast their vote in the previous election) formally request a fresh election;
  • powerful subject-based Select Committees that not only hold inquiries but scrutinise and amend Bills before they are passed into legislation and go through departmental budgets;
  • directly-elected regional governors with powers over transport, economic development, major planning issues, further education and skills training, health provision, policing resources etc;
  • a shift of taxation-raising powers with far more being raised by local and regional government than is currently the case (with proportionately less being raised centrally); and
  • a power of general competence for local government.

I deliberately haven’t mentioned the House of Lords – partly because I can hardly be described as disinterested, but also because I think there has to be some prior debate about what the Second Chamber is for.

Anyway, there is more than enough in what I have written for people to disagree with ….

Wednesday
Apr 29,2009

I have been told that senior personnel in London Primary Care Trusts have been told to clear their diaries for June and July.  My informant guessed that this was when senior Department of Health officials expected the pandemic of swine flu to peak in the Capital.  I am not so sure.  My own guess is that this is when the Strategic Health Authority is planning to announce a major programme of mergers of health bodies in London.  It is not clear that the current number of hospital trusts in London will remain viable as the planned 130 polyclinics start to come onstream across the metropolis.  Get the pain out of the way quickly – particularly as large parts of London Health are in budget deficit.  I don’t know what it all means or even if my informant’s story is correct.  Someone out there must know.

Sunday
Apr 26,2009

The outbreak of a new strain of flu in Mexico – a cross between ordinary human flu, swine flu and avian flu – is provoking alerts that we may finally be on the brink of the flu pandemic public health experts have been warning about for years.  In the UK we are probably as well prepared as any other country.

However, that doesn’t mean things will be easy if this does turn out to be the big one.  In January 2009, the British Medical Association, the Royal College of General Practitioners and the Department of Health issued joint guidance on “Preparing for Pandemic Influenza”.  This suggests that an outbreak might take as little as two to four weeks to build from a few to 1000 cases and so far 1300 people have been admitted to hospital in Mexico City since 13th April.  It goes on to suggest that it could reach the UK in another two to four weeks – there are already two individuals with suspicious symptoms in Glasgow and no doubt a plane full of people who were breathing in their germs who have not yet fallen ill. 

The Guidance suggests that once in the UK, it is likely to spread to all major population centres within one or two weeks with its peak possibly only 50 days from initial entry.  In previous pandemics between a quarter and a third of the population were infected.  Estimates suggest that 4% of those infected will need hospital treatment with possibly up to 2% of those infected dying.  Depending on the severity and nature of the epidemic, it is estimated that between 50,000 and 750,000 might die.  Don’t even think what that will do to the already troubled forecasts for the economy.

Those who become ill will be advised not to visit their GPs but to call a special helpline.  There will be advice to avoid crowded places – so that is commuting in London done for then.  People will be advised not to come into work if they are ill – this will typically cause the worst havoc in organisations like the police where the norm is often for people to struggle in (being ill is a sign of weakness – the senior echelons of the Metropolitan Police seemed all to be suffering in the mini-outbreak of flu before Christmas – it is after all one of the wonders of air conditioning systems that they spread infections more quickly).  Many organisations may find that up to half of their employees cannot come to work because they are ill, are caring for someone who is ill, or because their normal means of transport to work are no longer working.

The Guidance advises GP surgeries to develop photo-ID libraries of their staff so they can access any supplies that are rationed, such as fuel for home visits, and to set up an emergency box with torches, paper forms and other items that will be needed if mains electricity or computers go down.

Existing hospital capacity may only meet 20% to 25% of expected demand at the peak.  Intensive care is likely to be overwhelmed.  Prioritisation of all patients will be necessary on an individual basis.

Separate guidance advises Primary Care Trusts to ensure they have security on their doors to maintain order amongst those trying to access the (limited) supplies of anti-viral medicine.

I think I’ll go to bed with a hot water bottle now …..

Sunday
Mar 1,2009

I had recently come to the view that my comments on this blog were receiving more attention than anything I might say in the chamber of the House of the Lords.

So I suppose I should be flattered that the debate I initiated in the Lords on young people and social networking sites should have got a full half-page of coverage in today’s Observer.

Catherine Bennett certainly seems to have got the measure of the effects of being in the Lords on some of my colleagues (I hope not me, but you never know ….) when she writes:

“Given what we now know about the human brain, it is clear that prolonged exposure to an unnatural environment like the House of Lords must have a damaging effect. If the ageing brain is artificially denied stimulation over a long period, it might lead to a condition almost indistinguishable from idiocy.  The effects on communication have been documented for years. Now some leading neuro-scientists are suggesting that flashing lights and bells be fitted to go off regularly in the chamber, in order to induce in members something resembling an average attention span.”

She then weighs in to attack the comments of Baroness Susan Greenfield for her contribution to the debate analysing the impact of social networking and online phenomena like Twitter from her standpoint as a neuro-scientist.  It is a fine polemic and yes the comments from Susan Greenfield were rather tangential to the purpose of my debate which was intended to explore whether more safeguards were needed to protect the interests of children and young people online.

However, the comments (and the whole debate can be read here) were of interest and do deserve some serious discussion.  Twitter and Twittering seems a largely pointless exercise to many and as Catherine Bennett puts it:

“Twitter emphasises its desirability by being unfathomable to anyone a bit inflexible or busy who is neither a self-promoter nor an exhibitionist.”

Now I don’t feel that Susan Greenfield’s speech detracted from the rest of the debate – it is part of the way that the House of Lords operates that colleagues bring their various experiences and expertise to bear on the topics under discussion.  And it certainly didn’t “hijack” the debate as Catherine Bennett suggests.

Catherine Bennett was kind enough to say that “The Lords are right to want to protect vulnerable users from exploitation and from the inadvertent creation of an indelible archive of social networking follies.”  So, if that is so, and she wants to avoid the debate being hijacked, perhaps she might have devoted more than just three lines of her article to the rest of the  debate and what she rightly regarded as its main substance.

Or perhaps I’m missing something ….

Monday
Feb 23,2009

Over the last year or so I have become increasingly exasperated by the failure of the Labour Group Leadership on Waltham Forest Council to respond effectively to the widening concerns about how Neighbourhood Renewal Fund monies have been used in the Borough.

In February of last year, I asked a series of Parliamentary Questions about the concerns that were being raised: firstly about the use of money by EduAction who were at that time running the Borough’s education service, then to what extent Government Offices properly monitor the use of Neighbourhood Renewal Funds (checking the outcomes claimed) and whether the Government was satisfied with the work done by Dr Foster Intelligence for Waltham Forest (using central government monies), and finally about whether the Government Office for London was happy that money intended for five wards with high deprivation had been spent elsewhere.

These questions related to information passed to me from local residents that suggested that outcomes relating to non-existent children had been claimed in respect of the Youth at Risk programme, that £47,000 had been paid for a health needs assessment of the area that had not been reclaimed despite the organisation that provided the assessment acknowledging that the work concerned was inadequate and broke its own standards for accuracy, and that money had been diverted away from the areas targetted towards other pet projects.  The answers I received suggested that there was no formal process by which Government Offices checked whether the outcomes claimed for particular projects funded by them as the individual local authorities were the accountable bodies for the expenditure.  The Government Office confined itself to monitoring the progress of the local authority as a whole towards theoverall targets set.

I followed this up with a long series of requests to the Council under the Freedom of Information Act, as did local residents and others.  Eventually, the Council was goaded into action and published some of the findings of its own internal auditors and commissioned external reviews of some of its processes. 

These raised even more concerns – such as, the £6,000 received by one external contractor although £66,000 had been paid to him according to the documentation in the accounts.  Significantly, one of the external inquiries found that the documents about how individual decisions on payment of specific grants were made, by whom and the purpose for which the grants had been made were missing in a large number of cases.

In respect of a number of these issues, local residents have asked the police to investigate.

Now, the Council’s new Chief Executive has proposed a further and broader inquiry that will look at ALL of the Council’s procurement processes.  As the local newspaper says:

Documents reveal a systemic failure within the council to correctly allocate, administer and monitor Neighbourhood Renewal Fund spending since 2004.

A police investigation is currently conducted into allegations that EduAction, the company which used to manage education in the borough, used NRF money to boost profits.

The Better Neighbourhood Initiative (BNI) was launched in an attempt to target NRF more effectively, but it later emerged that many BNI contracts, totalling millions of pounds, did not follow rules to prevent fraud.

Throughout the developing scandal, the leadership of the Labour Group in Waltham Forest seems to have been hoping that the problem would simply go away.  Initially, they declared themselves confident that all decisions had been properly taken.  They resisted further investigations – so much so, that the traditional questions of “What did they know and when did they know it?” started to be asked.

At one stage, I received a phone message from one of them, noting that I was asking all these questions and inviting me to “resolve it within the Party”.  I am afraid there are wider public interest questions at stake here and these matters need to be seen to be resolved openly and transparently.

Now they have an opportunity: the Chief Executive has proposed a further inquiry (I assume this is not intended as another delaying tactic), so when they discuss his recommendation tomorrow night, they should acknowledge that things have gone seriously wrong, commit themselves to being totally open about who was responsible, and put in place all the necessary steps to restore public confidence.  Nothing less will be sufficient.

Thursday
Feb 12,2009

My debate on social networking has just ended. 

In my opening speech, I set the context by citing the OFCOM research that found that virtually all (99%) of children and young people aged 8 to 17 use the internet.  In 2005 the average time spent on line by children was 7.1 hours per week.  By 2007, this had almost doubled to 13.8 hours per week.  And virtually half (49%) of those aged 8 to 17 have set up their own profile on a social networking site.

 

My thesis was that social networking and video sharing sites, online games, iPods and internet-enabled mobile phones are now an integral part of youth culture.  While many adults worry that their offspring are wasting precious hours online, children and young people themselves see online media as the means to extend friendships, explore interests, experiment with self-expression and develop their knowledge and skills.

 

However, in the same way that young children are taught how to cross the road and at the same time safety features are built into cars and traffic laws regulate unsafe driving, we need to make sure that our children and young people are protected when they make their way on the internet.

 

As we know, there are real perils for the unwary.  Children and young people have been the victims of sexual predators as a result of the information they have revealed about themselves on social networking sites; there are increasing problems of cyber-bullying; security weaknesses on sites have led to serious privacy infringements; and young people have discovered the hard way that the permanence of information posted in public cyber-space may not only be embarrassing in later life but may also mean that employment offers (or university places) are not forthcoming.

 

I went on to argue that:

 

·     Children throughout their education should be taught digital citizenship so that they can both make the most of the internet but also recognise and deal with any dangers they may encounter.  As most parents acknowledge that their children are more internet literate than they are, there should also be a serious effort in parallel to help parents (and indeed all adults) to keep up with the rapid development of the internet and social digital media.

 

·     At the same time, privacy laws ought to be strengthened with an age-related component, specifically giving enhanced protection to the data relating to or provided by children and young people.  The US Children Online Privacy Protection Act, whilst not perfect, provides a model that has required a number of US-based companies operating on the internet to improve their standards significantly.

 

·     There should also be higher expectations on those responsible for social networking sites – particularly those aimed at children or where there are a significant number of users who are children and young people.  These higher expectations should include:

o        Prominent and clear safety information, warning about potential dangers;

o        Simple systems for reporting abuse or inappropriate/threatening behaviour with appropriate links to the police and law enforcement;

o        Increased numbers of suitably-vetted moderators patrolling areas of sites frequented by young people;

o        User-friendly systems enabling people to ignore and erase unwanted comments and to erase permanently their own profiles; and

o    Increased server security to prevent hacking and unauthorised access to personal information.

 

·     Finally, there should be urgent work undertaken by internet and technology companies to find and agree a simple, efficient and cost-effective means of achieving age-verification on the internet, so as to prevent under-age people accessing inappropriate sites and older people passing themselves off as under-18.

 

In addition, other peers made a range of interesting points. 

There was a notable contribution from Baroness Susan Greenfield approaching the topic from the stand-point of neuro-physiology. 

Baroness Doreen Massey told the House about the Bill she is introducing on internet age verification and the Minister replying, Lord Bill Brett, almost gave a commitment on behalf of the Government to support it – although when I pressed him on it he entered the most enormous health warning about what he had said.  Nevertheless, it was clear that there was a lot of support in the House for the principle of such legislation.

Friday
Jan 9,2009

Last night was the annual dinner presided over by the Lord Mayor of London for the Governing Bodies of London.  The Lord Mayor is not, of course, Boris Johnson, who is the elected Mayor for all of London (not just the square mile administered by the Corporation of London).  This dinner packed several hundred of the capital’s politicians and administrators into an intimate dining room in the Mansion House, the Lord Mayor’s official residence.

The occasion importantly provides a platform for the elected Mayor to set out his views on the state of London and there was a bravura performance by Mayor Johnson, responding to a sober speech from the Lord Mayor on what is needed for London to survive the economic situation.  Essential the message was “times are tough” but “we are going to get through it”.  The package humorously presented (I suspect the audience would have been disappointed if Mayor Johnson’s style had been as straitlaced as the Lord Mayor’s) essentially boiled down to avoiding the over-regulation of bankers, some apprenticeships in tunnelling (building a “cloaca maxima” under the Thames), the new Routemaster (restoring every Londoner’s inalienable right to injure themselves jumping on and off a moving bus), the rent-a-cycle scheme (even if it’s wrong, we’re still going to do it), and a freeze on the Mayor’s precept on London Council Tax.

It was entertaining stuff, but on the day when the Bank of England had cut interest rates to their lowest level since the Bank was established in 1694 it all felt a bit light on substance.

Mayor Johnson was in many ways upstaged by Merrick Cockell, the Chair of London Councils (the umbrella body for the London Boroughs, which was known as the Association of London Government when I chaired it).  His speech set out what the Boroughs are and will do to help Londoners ride out the economic downturn and set out how the Boroughs, the Greater London Authority and central government should work together to deliver the most effective policies to enable London – the economic driver of the UK economy – to emerge stronger at the end of the current period and so best deliver a kick-start to the rest of the UK.

Merrick Cockell also got the best laugh of the evening, comparing the  GLA and London Councils with (among other things) Rod Hull and Emu with Mayor Johnson cast in the role of Emu

Strangely, Mayor Johnson referred to a couple of London Assembly members by name in his speech.  He highlighted the referral by Len Duvall of remarks made by the Mayor to the Standards Board (if the Conservatives are so confident that the issue is now going to go away following the decision to set up a “timely and proportionate” inquiry why mention it?) and he also made some remarks about how nice the Mansion House was and the sort of building appropriate for the style and status of an Assembly Member like Caroline Pidgeon – now what did he mean by singling her out?

The most shocking thing about Mayor Johnson’s performance was, however, his attitude to London itself.  He rightly said that 200 years ago London was the greatest city in the world.  Apparently, now, however, it is only “one of the greatest cities in the world” – can’t we expect a more upbeat attitude from our elected Mayor?

Tuesday
Jan 6,2009

Those who know me will be aware that I am not exactly a fitness fanatic (My exercise philosophy is “no pain, no pain”.), but I do like to go for a swim every so often.  For the last few years, however, I have always avoided going in January so as to avoid the crush of those who have bought gym memberships as part of a New Year’s resolution drive for fitness – by February or March most have stopped using their memberships (but the business model of the fitness club’s, of course, requires a year’s subscription …).  Today, because an appointment had been unexpectedly cancelled, I thought I would risk it.  The place I go to was virtually deserted with only one person there whom I had not seen before.   Clearly, the economic situation has focussed people’s New Year’s resolutions in a different direction this year, unless, of course, I was just lucky and everybody else had decided it was too cold …

Saturday
Dec 27,2008

After I wrote the last post, I was sorry to see from today’s ‘Independent’ that during the election Barack Obama also gave credence to the MMR health scare. (I wasn’t surprised by John McCain.) So another one for Ben Goldacre’s book …