Friday, 4 December 2009

'Show Your Working': What 'ClimateGate' means

'Show Your Working': What 'ClimateGate' means

Mike Hulme and Jerome Ravetz
VIEWPOINT
Mike Hulme and Jerome Ravetz

The "ClimateGate" affair - the publication of e-mails and documents hacked or leaked from one of the world's leading climate research institutions - is being intensely debated on the web. But what does it imply for climate science? Here, Mike Hulme and Jerome Ravetz say it shows that we need a more concerted effort to explain and engage the public in understanding the processes and practices of science and scientists.

Robot
Practising scientists know that they do not simply follow a rulebook to do their science, otherwise it could be done by a robot

As the repercussions of ClimateGate reverberate around the virtual community of global citizens, we believe it is both important and urgent to reflect on what this moment is telling us about the practice of science in the 21st Century.

In particular, what is it telling us about the social status and perceived authority of scientific claims about climate change?

We argue that the evolving practice of science in the contemporary world must be different from the classic view of disinterested - almost robotic - humans establishing objective claims to universal truth.

Climate change policies are claimed to be grounded in scientific knowledge about physical cause and effect and about reliable projections of the future.

As opposed to other ways of knowing the world around us - through intuition, inherited belief, myth - such scientific knowledge retains its authority by widespread trust in science's reassuring norms of objectivity, universality and disinterestedness.

These perceived norms work to guarantee to the public trustworthy scientific knowledge, and allow such knowledge to claim high authority in political deliberation and argumentation; this, at least, is what historically has been argued in the case of climate change.

What distinguishes science from other forms of knowledge?

On what basis does scientific knowledge earn its high status and authority?

What are the minimum standards of scientific practice that ensure it is trustworthy?

For an open, enquiring and participative society, these are questions that have become much more important in the wake of ClimateGate.

They are also questions that scientists should continually be asking of themselves as the political and cultural worlds within which they do their work rapidly change.

Doing science in 2010 demands something rather different from scientists than did science in 1960, or even in 1985.

How science has evolved

The understanding of science as a social activity has changed quite radically in the last 50 years.

The classic virtues of scientific objectivity, universality and disinterestedness can no longer be claimed to be automatically effective as the essential properties of scientific knowledge.

Instead, warranted knowledge - knowledge that is authoritative, reliable and guaranteed on the basis of how it has been acquired - has become more sought after than the ideal of some ultimately true and objective knowledge.

The public... may not be able to describe fluid dynamics using mathematics, but they can recognise evasiveness when they see it

Warranted knowledge places great weight on ensuring that the authenticating roles of socially-agreed norms and practices in science are adequately fulfilled - what in other fields is called quality assurance.

And science earns its status in society from strict adherence to such norms.

For climate change, this may mean the adequate operation of professional peer review, the sharing of empirical data, the open acknowledgement of errors, and openness about one's funders.

Crucially, the idea of warranted knowledge also recognises that these internal norms and practices will change over time in response to external changes in political culture, science funding and communication technologies.

In certain areas of research - and climate change is certainly one of these - the authenticating of scientific knowledge now demands two further things: an engagement with expertise outside the laboratory, and responsiveness to the natural scepticism and desire for scrutiny of an educated public.

The public may not be able to follow radiation physics, but they can follow an argument; they may not be able to describe fluid dynamics using mathematics, but they can recognise evasiveness when they see it.

Where claims of scientific knowledge provide the basis of significant public policy, demands for what has been called "extended peer review" and "the democratisation of science" become overwhelming.

Albert Einstein
Science has changed a lot since Einstein's day - and so has society

Extended peer review is an idea that can take many forms.

It may mean the involvement of a wider range of professionals than just scientists.

The Intergovernmental Panel on Climate Change (IPCC), for example, included individuals from industry, environmental organisations and government officials as peer reviewers of early drafts of their assessments.

More radically, some have suggested that opening up expert knowledge to the scrutiny of the wider public is also warranted.

While there will always be a unique function for expert scientific reviewers to play in authenticating knowledge, this need not exclude other interested and motivated citizens from being active.

These demands for more openness in science are intensified by the embedding of the internet and Web 2.0 media as central features of many people's social exchanges.

It is no longer tenable to believe that warranted and trusted scientific knowledge can come into existence inside laboratories that are hermetically sealed from such demands.

A revolution in science

So we have a three-fold revolution in the demands that are placed on scientific knowledge claims as they apply to investigations such as climate change:

  • To be warranted, knowledge must emerge from a respectful process in which science's own internal social norms and practices are adhered to
  • To be validated, knowledge must also be subject to the scrutiny of an extended community of citizens who have legitimate stakes in the significance of what is being claimed
  • And to be empowered for use in public deliberation and policy-making, knowledge must be fully exposed to the proliferating new communication media by which such extended peer scrutiny takes place.

The opportunity that lies at the centre of these more open practices of science is to secure the gold standard of trust.

And it is public trust in climate change science that has potentially been damaged as a result of the exposure of e-mails between researchers at the University of East Anglia's Climatic Research Unit (CRU) and their peers elsewhere.

President Sarkozy
Policy-makers are looking for reliable projections from climate scientists

The disclosure and content of these private exchanges is only the latest in a long line of instances that point to the need for major changes in the relationship between science and the public.

By this, we mean a more concerted effort to explain and engage the public in understanding the processes and practices of science and scientists, as much as explaining the substance of their knowledge and how (un)certain it is.

How well does the public understand professional peer review, for example, or the role of a workshop, a seminar and a conference in science?

Does the public understand how scientists go about resolving differences of opinion or reaching consensus about an important question when the uncertainties are large?

We don't mean the "textbook" answers to such things; all practising scientists know that they do not simply follow a rulebook to do their science, otherwise it could be done by a robot.

Science is a deeply human activity, and we need to be more honest about what this entails. Rather than undermining science, it would actually allow the public to place their trust more appropriately in the various types of knowledge that scientists can offer.

What should be done?

At the very least, the publication of private CRU e-mail correspondence should be seen as a wake-up call for scientists - and especially for climate scientists.

The key lesson to be learnt is that not only must scientific knowledge about climate change be publicly owned - the IPCC does a fair job of this according to its own terms - but that in the new century of digital communication and an active citizenry, the very practices of scientific enquiry must also be publicly owned.

Rajendra Pachauri, IPCC chairman
The IPCC has won a Nobel Prize - but does it need a rethink?

Unsettling as this may be for scientists, the combination of "post-normal science" and an internet-driven democratisation of knowledge demands a new professional and public ethos in science.

And there is no better place to start this revolution than with climate science.

After all, it is claimed, there is no more pressing global political challenge than this.

But might this episode signify something more in the unfolding story of climate change - maybe the start of a process of re-structuring scientific knowledge?

It is possible that some areas of climate science have become sclerotic, that its scientific practices have become too partisan, that its funding - whether from private or public sectors - has compromised scientists.

The tribalism that some of the e-mails reveal suggests a form of social organisation that is now all too familiar in some sections of business and government.

Public trust in science, which was damaged in the BSE scandal 13 years ago, risks being affected by this latest episode.

A Citizen's Panel on Climate Change (CPCC)?

It is also possible that the institutional innovation that has been the IPCC has now largely run its course.

Perhaps, through its structural tendency to politicise climate change science, it has helped to foster a more authoritarian and exclusive form of knowledge production - just at a time when a globalising and wired cosmopolitan culture is demanding of science something much more open and inclusive.

City street
A number of social issues need attention, the writers argue

The IPCC was designed by the UN in the Cold War era, before the internet and before GoogleWave.

Maybe we should think about how a Citizen's Panel on Climate Change might work in today's world, as well as a less centralising series of IPCC-like expert assessments.

If there are serious ecological and social issues to be attended to because of the way the world's climates are changing - as the authors of this article believe - then scientists need to take a long hard look at how they are creating, validating and mobilising scientific knowledge about climate change.

Climate science alters the way we think about humanity and its possible futures.

It is not the case that the science is somehow now "finished" and that we now should simply get on with implementing it.

We have decades ahead when there will be interplay between evolving scientific knowledge with persisting uncertainty and ignorance, new ways of understanding our place in the world, and new ways of being in it.

A more open and a better understood science process will mean more trusted science, and will increase the chances of both "good science" and "good policy".

"Show your working" is the imperative given to scientists when preparing for publication to peers.

There, it refers to techniques.

Now, with the public as partner in the creation and implementation of scientific knowledge in the policy domain, the injunction has a new and enhanced meaning.

Mike Hulme is professor of climate change in the School of Environmental Sciences at the University of East Anglia, and author of Why We Disagree About Climate Change

Dr Jerome Ravetz is an independent scholar affiliated to the Institute for Science, Innovation and Society (InSIS) at Oxford University

The Green Room is a series of opinion articles on environmental topics running weekly on the BBC News website

Nearly one in 10 hospital prescriptions contain a mistake,

Nearly one in 10 hospital prescriptions 'have mistakes'

Pills
Few errors would have caused any serious harm to the patient

Nearly one in 10 hospital prescriptions contain a mistake, ranging from the minor to the potentially lethal, research has found.

But the study, commissioned by the General Medical Council, found very few errors would have caused serious harm.

It also found that, contrary to belief, novice doctors were no more responsible for mistakes than the more experienced.

To eliminate one area of confusion, the GMC is calling for a UK-wide standard prescription chart as exists in Wales.

The research team led by Professor Tim Dornan of the University of Manchester, examined the issue amid rising fears inexperienced doctors were making prescription errors which could, at worst, result in a patient dying.

They examined 124,260 prescriptions across 19 hospitals - and found just under 9% contained errors.

Of these 11,077 errors, overwhelmingly intercepted and corrected before reaching the patient, about 2% contained potentially lethal instructions - such as failing to take account of a patient's allergies.

It would certainly help if there was greater uniformity in the prescription forms used in the NHS and the BMA would encourage prescribing procedures to be kept as simple as possible
Dr Hamish Meldrum, BMA

More than half involved errors in which a patient's medication was not prescribed on admission, during a rewrite of a prescription, or when the patient was sent home.

Another 40% were accounted for by prescriptions where the writing was illegible or the wording ambiguous.

Very few of these mistakes caused actual harm to a patient because on the whole they were stopped by senior doctors, nurses - and in particular pharmacists.

There were however concerns that so effective was this safety net, some doctors relied on it to pick up their mistake.

'Off the hook'

But the study did not find doctors fresh out of medical school were making the most mistakes - as has often been suggested.

I am dismayed at the suggestion that improved education and training is not a central part of the solution
Professor Simon Maxwell, British Pharmacological Society
BPS

Doctors in their first year of medical training in fact made slightly fewer mistakes than the average, although that rose slightly in their second year. However at 8.3% their rate was the same as registrars. Consultants made the fewest, with 5.9%.

While the curriculum at medical schools could always be improved, it was clearly not at the root of the problem, the team concluded - noting many factors - from fatigue to unfamiliarity with a prescription form - produced errors.

"The research shows the complexity of the circumstances in which errors occur and argues against education as a single quick-fix solution.

"Education can always be improved but it must be very practically oriented and include all phases of a doctor's career as well as the undergraduate stage," said Professor Dornan.

The chairman of the GMC, Professor Peter Rubin, said: "Prescribing decisions in a hospital setting often have to be made quickly, so it is important that a procedure is as simple as possible to minimise the chance of an error being made.

To avoid confusion as doctors move between hospitals with very different prescribing forms - including paper and electronic - the GMC wants to see a standardised system across the UK. Wales introduced this in 2004.

Education matters

A Department of Health spokesman said it would continue to look into the benefits of electronic prescribing systems, "taking into account the evidence gained where standardisation of the paper chart has been successfully implemented."

Dr Hamish Meldrum, of the doctors' union, the BMA, said: "It would certainly help if there was greater uniformity in the prescription forms used in the NHS and the BMA would encourage prescribing procedures to be kept as simple as possible."

Joyce Robins, Co-Director of Patient Concern commented: "For patients, one of the most astonishing and frightening findings is that so many errors happen because doctors are confused by widely differing prescription forms, both paper and electronic.

'Wales has had a standard prescription form throughout the service for five years but in England we continue to rate patient safety as less important than the sensitivities of hospital managers, who are allowed to operate their own independent little fiefdoms."

Professor Simon Maxwell, of the British Pharmacological Society said: "Like everyone else, I am extremely concerned by this error rate but I am dismayed at the suggestion that improved education and training is not a central part of the solution.

"There is plenty of evidence from around the world to show that when appropriate education and training are delivered, prescribing improves."

He said no credible observer would say this was the sole answer but that it must play a role.

Plymouth's Derriford Hospital has admitted a series of failings

Hospital admits death 'failings'

Derriford Hospital
The hospital trust said it would be "unfair" to speak ahead of an inquest

Plymouth's Derriford Hospital has admitted a series of failings in the run up to the death of a patient.

Cecil Barnes, from Plymouth, was admitted to the hospital in July 2008 to undergo bladder surgery.

The 79-year-old collapsed on his return to the ward but equipment used to resuscitate him was either faulty or not used properly. He later died.

An internal investigation was carried out and 17 recommendations made to improve patient safety.

When Mr Barnes collapsed and was violently sick, the first machine staff used to try to clear his airway to resuscitate him was faulty, the investigation found.

'Civil action'

Different equipment was brought in, but staff were not familiar with its use and it was not properly switched on.

Yet another machine was tried, but its oxygen supply was not turned on because staff, again, were not experienced in its use.

The hospital's recommendations include better checks of equipment, improved labelling of equipment and better staff training.

The Crown Prosecution Service has said no-one from Derriford will face charges in relation to Mr Barnes' death, however Mitchelmores Solicitors said the family now intended to sue the hospital.

"They're still deeply distressed by the circumstances," solicitor Laurence Vick said.

"They're very keen to get to the bottom of exactly what happened."

Plymouth Hospitals NHS Trust declined to be interviewed.

In a statement it said the matter would soon be the subject of a public inquest in which all the evidence and information would be heard in open court.

It would be "inappropriate and unfair" to go into the evidence in such a complex case prior to that inquest, a spokesperson added.

Continuing care 'lottery' in NHS

Continuing care 'lottery' in NHS
Elderly person
Access to care varies widely around the country
Huge variations in access to continuing care on the NHS are "unjustifiable", a leading charity has warned.

Age Concern said government figures showed people in some areas of England are 160 times more likely to get continuing care than others.

The postcode lottery faced by those needing care was due to differences in local criteria for who was eligible.

But a national framework to be launched in October should increase access for thousands, the government said.

Continuing health care - where the NHS is responsible for, and fully funds care outside of hospital when a person no longer needs acute inpatient care - mainly affects very ill patients in nursing homes.

There can be no justification for such huge variations in access to care
Gordon Lishman, Age Concern

It is hoped the framework, unveiled in June, will standardise decisions on who is eligible, making the process faster, fairer and more simple to understand.

Age Concern welcomed the measures, which they estimated would increase the numbers of people receiving continuing care by about 7,000 - at a cost of £220 million.

But they warned around 60,000 people would still be missing out on the continuing care they are legally entitled to.

And they stressed that the framework would not cover social or personal care, which includes help with washing, feeding and dressing.

Care lottery

Figures obtained by the charity from the Department of Health show that the number of people receiving continuing care vary dramatically around the country.

In March this year Derby City PCT was giving just seven people continuing care, a rate of 0.26 people per 10,000.

By comparison, Harrow PCT was giving 826 people continuing care - a rate of 41.75 per 10,000 people.

This is despite Harrow having 75,000 fewer people and a younger population.

Gordon Lishman, director general of Age Concern, said they were fearful that the new framework alone would not result in the cultural change in PCTs needed to reduce the variation.

"These new figures beggar belief.

"Individuals face a postcode lottery in getting NHS continuing care.

"There can be no justification for such huge variations in access to care."

He said the framework needed to be monitored carefully to assess its impact in stamping out the "unfair practice".

Care services Minister, Ivan Lewis said: "We are aware of the variation which is exactly why we published the National Framework for NHS Continuing Healthcare only two weeks ago.

"The new framework will help ensure that all the people who are eligible for NHS Continuing Healthcare or NHS-funded nursing care will receive the care they need."

He added they would be monitoring the situation closely to make sure that individuals are not missing out.

Andrew Chidgey, head of policy and campaigns at the Alzheimer's Society said: "Many people with dementia struggle to get NHS continuing care funding because the system is confusing, complicated and unfair.

"It is vital that we establish a more transparent and equitable system, which provides the best possible care for people with dementia, and hope this will become a reality in the near future."

'Giving up memories' to pay for care

'Giving up memories' to pay for care

Elderly woman's hands doing cross word
In England assets of £23,500 or more rule people out of state funding

As ministers prepare to lay out proposed reforms to the funding of social care, one elderly woman spoke to BBC Radio 4's Today programme about her concerns for funding her care in a nursing home in the future.

Katherine Dyton is a new resident at a nursing home for the elderly in Surrey.

Mrs Dyton is happy at the home - at 93 she is unable to live alone and needs help with every aspect of daily life - but finding the money to pay for it is a constant worry.

But she also says she has no choice, she simply could not live without 24-hour care.

She told BBC Radio 4's Today programme: "If I need to go to the loo, somebody has to take me and to help me into a chair and help me out again. So I'm quite reliant on other people for everything.


I was sad because you give up all your home and your memories and your possessions

Katherine Dyton

"I can't get into bed and out without somebody lifting my legs out and so-on."

Under the present system in England anyone with a home or savings of £23,500 or more is not given state funding for a care home.

Mrs Dyton says the only way to pay for the home and nursing care was to sell her flat, a decision she found very painful.

"I was sad because you give up all your home and your memories and your possessions. When you've had somewhere all your life it's a great wrench to leave it all.

"I couldn't cope and that was it, you just have to face up to it when the time comes."

But her daughter, Carol, is less stoical.

She bristles at the system that prevented her mother from getting any financial help with the care home's fees, all because she owned a flat. They had no choice but to sell it quickly.

Carol told BBC Radio 4: "This was a time when the market was depressed and we weren't going to get a very good price for it.

"I still thought I would have some time in hand and get some help at first, but no way, we had to pay the bills right from the start.

High cost of care

"For the first month's bill we had to use her savings and things were very tough, it took some months to actually sell the flat."

But even with the proceeds from her mother's flat, she is still worried she will not be able to continue paying the care home bills. They come to £1,100-a-week.

"This is the problem, she is in a very good Bupa home and we are very happy with it.

"But it is expensive because she does need nursing care and nursing care is significantly more than residential.

"The money will run out in less than four years and we will be faced with what to do then.

"That is what I think is very unfair because I do believe there should be much more choice.

"Intrinsically I'm not saying that you don't make any contribution towards your care - I think that if you have some assets then they should have to be looked at.

"But to be totally responsible, 100%, for the whole amount, knowing that it will run out, is just unfair on people."

And if it is difficult to make ends meet now, what does she see ahead for her own future?

"I think it will be absolutely impossible, because we are talking now at £1,100-a-week, this will go up.

"I don't think there will be the number of homes; I don't think it will be a viable proposition for people to run these sorts of homes.

"So frankly you can't afford to get ill, you can't afford to be immobile, you're going to have to keep going, otherwise it's going to be the good old bus trip to Switzerland."

Adult social care warning for eight areas of England

Adult social care warning for eight areas of England

Campaigner Pamela Wells: "The care staff actually didn't care"

Eight local authorities in England have been told they must urgently improve their social care services for adults.

The Care Quality Commission found overall improvement, with 95% of councils in the top two categories.

But its annual report rated one in four care homes for the elderly as being adequate at best and found large variations in areas and providers.

Poole, Cornwall, Solihull, Surrey, South Tyneside, Southwark, Peterborough and Bromley are to get extra support.

But Annie Shepperd, a chief executive of one of those councils, Southwark, said the Care Quality Commission (CQC) had made a mistake in rating her authority.

COUNCIL CARE SERVICES 2009
To find out more Care Quality Commission information on social care services for adults in England, select a council here:
This search goes to an external site

She said the CQC had judged them to be a low spending authority but the other regulator, the Audit Commission, had said they were a top quartile spending authority, "they can't both be right".

"Why have they refused to come and talk to me about this and why have they not given me the evidence when I've got mountains of contrary evidence that their findings are wrong."

The report covers independent providers of care services as well as an assessment of England's 148 local authorities.

It rated 95% of councils in the top two categories, which means they are performing well or excellently - and none was given the bottom "poor" rating.

'Raise the bar'

While the picture is of improvement, the commission said there are still too many vulnerable adults being failed by the system.

CARE QUALITY COMMISSION

The Care Quality Commission is the official regulator for health, social care and mental health

It only came into being in April 2009, bringing together the functions of three regulators - the Healthcare Commission, Commission for Social Care Inspection and Mental Health Act Commission

It is in charge of inspecting, rating and assessing NHS trusts, councils, private companies and charities involved in health and social care provision

Under new powers being phased in, it has the power to fine and close services that are failing and is demanding providers meet certain standards before they can even register with the regulator

And experts have suggested the top grades were achieved only because councils were providing care to fewer people.

More than 340,000 people in England receive care in their own home - a figure which has fallen by a fifth in the past eight years.

To cope with the demands they face, councils have been restricting who is eligible for free or subsidised care - social services is means-tested so that people with significant savings are excluded anyway.

The figures from the regulator showed seven in 10 councils only provide care to those with substantial needs - basically those who cannot do everyday tasks, such as washing, dressing and eating, without help.

It means there are thousands of people with so-called low or moderate needs who have been excluded from state support they would normally have been entitled to.

Despite the high ratings given to councils, the regulator recognised the problem.

It said it would be looking to "raise the bar" in the future and would pay particular attention to eligibility.

RATINGS ON THE RISE
95% of councils got an excellent or performing well grade - up from 87% last year
None got a poor rating - the fourth year in a row this has happened
Eight councils given an adequate grading were earmarked as a priority for improvement
More than three-quarters of private and voluntary sector providers also got an excellent or performing well grade
But one in six of the 24,000 providers were told they must improve
Care homes for the elderly were highlighted for their poor record of providing social contact and activities for residents

Social care - the next big issue?
Your comments on social care

The CQC also urged councils to do more to drive up standards in the voluntary and private sector.

From next year, changes to the ratings system will give more weight to the views of those using care services and fines will be able to be levied against providers the regulator considers are not providing a good enough service.

Most care homes and an increasingly significant amount of home care is delivered by 24,000 alternative providers.

Ratings for those showed one in six were ranked as poor or adequate - and the CQC warned they were risking fines or deregistration next year when the new system comes in place.

Care homes for older people were highlighted in particular for their poor record on providing social contact and activities for residents.

Councils purchase about half of the services provided by these groups and the CQC said they should look to focus their spending on only the best providers where possible.

CQC chief executive Cynthia Bower said the improvements in council services should be recognised, although they could still do much better on issues such as dignity and offering people more choice.

'Dignified lives'

Eligibility for care graphic

But she also warned she was "deeply concerned" the expected squeeze on public sector spending could lead to greater restrictions on access.

"We all know there are choppy waters ahead so the issue is how well the system responds to the situation.

"We plan to be particularly vigilant about this on behalf of people who use services."

Andrew Harrop, head of public policy for the newly-merged Age Concern and Help the Aged charity, said some care homes were clearly still "not up to scratch".

And on tightening eligibility criteria, he added: "Local councils continue to deny many older people the care they need to live dignified and independent lives."

But Councillor David Rogers, of the Local Government Association, said: "Councils deserve great credit for their continued good work."

Bromley cited pressures "in managing significant increases in demand for social care services".

Solihull Council said it was "utterly committed" to working to improve services, while a spokesperson for South Tyneside Council said: "We welcome this support to help us move forward with our modernisation of adult social care."

Monday, 30 November 2009

Doctors 'rely on chemo too much'

Patient having chemotherapy
Some 80,000 patients undergo chemotherapy each year

Doctors are being urged to re-think their approach to giving chemotherapy during care at the end of life.

A review of 600 cancer patients who died within 30 days of treatment found that in more than a quarter of cases it actually hastened or caused death.

The report by the National Confidential Enquiry into Patient Outcome and Death said doctors should consider reducing doses or not using chemotherapy at all.

England's cancer tsar Professor Mike Richards said he was "very concerned".

The group of patients the independent group was looking at represents 2% of the 80,000 people who receive chemotherapy each year.

This report provides very disturbing information about the safety of treatment for incurable cancer
Professor Jane Maher, of Macmillan Cancer Support

They were all severely-ill patients for which the chemotherapy was mostly being used to manage their condition rather than in an attempt to cure the cancer.

After examining case notes, the group said that 35% of patients received good care.

But it found that in 27% of cases it hastened or caused death - the toxic nature of the treatment can lead to a range of problems, the most serious of which is an infection called neutropenic sepsis.

Report co-author Dr Diana Mort said doctors should be more "cautious in prescribing chemotherapy for very sick patients".

And she added: "The process of consent may require more than one discussion.

"Patients must be made aware of the risks and side-effect of chemotherapy as well as the potential benefits."

Transfer arrangements

The report also criticised the facilities made available to patients with nearly half being admitted to general medicine wards during the last 30 days of life rather than a specialist cancer unit.

The authors recommended where hospitals did not have specialist units they should put in place transfer arrangements to centres that did.

Professor Jane Maher, chief medical officer at Macmillan Cancer Support, said: "This report provides very disturbing information about the safety of treatment for incurable cancer.

"It shows that doctors and nurses need to be much better at helping patients understand the pros and cons of such powerful treatments in the last year of life."

Professor Richards said he was "very concerned".

"I am asking all chemotherapy service providers to consider these reports urgently and to reassess their own services immediately against the measures we have set nationally."

But Dr Peter Clark, of the Royal College of Physicians, said while lessons could be learnt it was important to remember that chemotherapy carried "substantial short and long-term benefit" for the majority who undergo the treatment.

News... Plymouth seeks small woman





small woman sought, in plymouth
Saturday, November 28, 2009

She has been seen in Staple Hill at the blue Sky cafe, she is being sought in relation to her activity with various men in the westcountry,
Mr. Colin Pugh said, "I would love to see this
woman get what she deserves.


Motorists stranded, homes flooded, roads closed as rains hit Plymouth

Motorists stranded, homes flooded, roads closed as rains hit Plymouth

Article Image

Saturday, November 28, 2009

PLYMOUTH is bracing itself for further downpours as it counts the cost of a weekend during which it was the wettest city in the UK.

More than 20mm of rain fell in a six-hour period on Saturday leaving shops and homes flooded and people stranded in their cars.

In...

(42)

Woman, 60, dies after falling into river

Woman, 60, dies after falling into river

Sunday, November 29, 2009

A WOMAN has died after falling into a river swollen by heavy rain that caused floods across the Westcountry over the weekend. Paula Deacon, 58, fell...

(9)

A38 closed after pedestrian is killed

A38 closed after pedestrian is killed

Saturday, November 28, 2009

A MAN was killed in an accident on the A38 at South Brent at the weekend. The incident happened at about 3.25am on Saturday by the South Brent...

Carbon offset schemes not working

Consumer carbon offset schemes do not lead people to change their behaviour, the first holiday firm to run such a scheme has argued.

Responsible Travel said they were a "distraction" from climate change's real urgency and is ending its scheme.

Such schemes involve individuals paying a premium for the emissions generated by certain choices, such as flying.

The International Carbon Reduction and Offset Alliance says offsetting has an impact, but governments must do more.

Carbon offset schemes also cover things like choosing to drive a car or choices around the way homes are heated.

'Assuage your guilt'

Money raised under the schemes is used to pay for carbon reduction projects in developing countries, such as installing solar power or capturing methane gas released by farm animals.

Some environmentalists argue that while these schemes bring some benefit, offsetting has not changed people's behaviour enough and emissions covered by such schemes should be avoided in the first place.

Justin Francis, founder of Responsible Travel, said: "It's perceived as this magic pill, this get out of jail free card if you like, that means you don't need to change your behaviour.

"You can go on flying just as much as you were before, you can run your hotel the way you were before, but through this magic pill somehow you can assuage your guilt.

People are using offsetting to take responsibility for their unavoidable emissions
Jonathan Shopley, International Carbon Reduction and Offset Alliance

"We need to be reducing the amount we pollute and I think carbon offsetting is a distraction from that."

Andy Atkins, director of Friends of the Earth, agreed that introducing offsetting alone allowed individuals and companies to continue with business as usual.

He said: "We understand why people wanted to offset in the belief that it was reducing their emissions, but it isn't working and we have to recognise now that the science says we have to cut our emissions really, at home.

"That means governments and individuals doing everything they can to reduce their genuine carbon impact and offsetting doesn't do that."

'Making a difference'

The body representing those who run the schemes insist they do bring real benefits to the developing world.

Jonathan Shopley, of the International Carbon Reduction and Offset Alliance, said: "It's not going to solve the climate change issue on its own, that's for sure. That needs government action, taxes.

"We need to stop doing certain things, but by the same account people are using offsetting to take responsibility for their unavoidable emissions and they need to understand that is a good thing and is making a difference."

Joan Ruddock, minister for the Department of Energy and Climate Change, said: "Of course [offsetting is] not a solution to climate change - it's a tiny contribution - but it does help people to think about what they are doing.

"But we do need emissions reductions on quite a different scale and that is why we have a Climate Change Act and absolute limits on our emissions in this country."

Sunday, 29 November 2009

calls for a 'greener' Hajj

Dr Mawil Izzi Dien describes a number of ways muslims can make celebrating Hajj greener

An Islamic expert is calling on Muslims to reduce the environmental impact of Hajj, the annual pilgrimage to Mecca.

Dr Mawil Izzidien of the University of Wales, Lampeter, says the event is beset by wasted and misused resources.

He has called on Muslims to avoid air travel to Saudi Arabia where possible and stay in less luxury while there.

The Muslim Council of Wales said avoiding air travel and good hotels was unrealistic but agreed "a practical look" at the event's future was needed.

Between 25-30 November around two million Muslims will converge on Mecca - the holiest place in Islam - to take part in an event which combines piety and passion.

One of the pillars of the Islamic faith, every adult Muslim must undertake Hajj at least once in their life if they can afford it and are physically able.

Dr Mawil Izzi Dien
There is a lot of wastage and there is a lot of misuse of the resources that are available to people while performing Hajj
Dr Mawil Izzidien

Many Muslims save for years in order to perform the pilgrimage, often having to travel thousands of miles to do so.

Dr Izzidien, a reader in Islamic Studies who has written about the environmental dimensions of the pilgrimage, said the main green issue surrounding Hajj was "to encourage Muslims to reduce the number of trips towards Mecca if they can."

He said: "Rather than travelling twice, or performing Hajj twice, if they have done the first one then there is no need to do the second one."

Funds to be used for a second Hajj would be better used helping other Muslims make the journey, or to tackle poverty in the world, he suggested.

Dr Izzidien also focused on the luxurious way in which he said many Muslims travel to, and stay in, Saudi Arabia.

"They travel by first class airplanes and when they arrive in Mecca they live like they are living in a five star hotel, and they pay lots of money to do that," he said.

"Hajj is really all about travelling with difficulty. It is encouraged within Islam that the best Hajj is that which is performed with difficulty. The more difficulty a person has, the more reward he will have.

"Of course we are not saying that to travel from Africa or from Europe to Mecca on foot, but to reduce the amount of cost and carbon footprint is in many ways important.

People need to be there for 10 days and if they spend two or three of these days travelling then that is a big problem
Saleem Qidwai, Muslim Council of Wales

"Maybe groups of pilgrims can perform Hajj by travelling by sea rather than by travelling by air. If they use a ship in order to travel from their location to Mecca, or to Jeddah and then to Mecca, that would reduce the environmental cost of Hajj."

The amount of food wasted during Hajj, and the wastage of meat from sacrificed sheep are other issues which need addressing, Dr Izzidien said, though he added that the local organisers were to be commended for their efforts so far to make the event more environmentally friendly.

'Realistic'

Saleem Qidwai, general secretary of the Muslim Council of Wales, said he agreed with many of Dr Izzidien's views but a practical view had to be taken on how Muslim pilgrims could lessen their carbon footprint.

"We have to be realistic," he said. "Time is short for everybody.

"People need to be there for 10 days and if they spend two or three of these days travelling then that is a big problem. Also, avoiding good hotels in Saudi Arabia is not always practical."

However Mr Qidwai said he agreed with other environmental concerns raised by Dr Izzidien.

"There is a lot of wastage at Hajj, particularly with regard to leftover plastic bags and bottles," he said.

"But let's look from a practical point of view at what we can do now to change things in the future."

Friday, 27 November 2009

CQC chair Baroness Young says that they inherited a rating system that is not fit for purpose and needs to be scrapped

Barbara Young

Barbara Young is the Chair of the Care Quality Commission.


Barbara YoungBarbara's early career was spent in public relations and health services management. She was Chairman then President of the Institute of Health Services Management from 1986-88, and a King's Fund International Fellow in 1985-86 and 1990-1991.

Prior to joining CQC Barbara was Chief Executive of the Environment Agency. She has also been Chairman of English Nature, Vice Chairman of the BBC, and Chief Executive of the RSPB.

She has roles in a number voluntary sector environment organisations, and is on the Policy Committee of the Institute of Public Policy Research.

Barbara Young is a non-affiliated Life Peer as Baroness Young of Old Scone

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