one of Shia Islam's most respected theologians

Ahmadinejad's theological foes

By Edward Stourton Analysis, BBC Radio 4

Grand Ayatollah Montazeri is one of Mahmoud Ahmadinejad's fiercest critics

It is not often you find an email from a Grand Ayatollah in your inbox - especially not when the Ayatollah in question is a pivotal figure in one of the great dramas currently unfolding on the world stage.

Grand Ayatollah Hoseyn Ali Montazeri is one of Shia Islam's most respected theologians - he was a moving spirit behind the revolution which gave birth to an Islamic state in Iran 30 years ago, and at one stage he was designated to succeed Ayatollah Khomeini in the role of Iran's Supreme Leader.

The month after this summer's disputed presidential election he issued a fatwa condemning President Mahmoud Ahmadinejad's government.

The Grand Ayatollah lives in Qom and does not often give interviews, but we thought we would take a punt by submitting some questions via his website.

The current decisions, which are being taken by the minority faction that is in power, are mainly against the interests of the country, and are not in keeping with Islamic principles and values Grand Ayatollah Montazeri Full text: Montazeri's email Who's who in Iran Visiting Iran's ayatollahs at Qom

The answers that came fizzing back make very strong copy indeed.

Montazeri tells Iran's clerics that they "can and must" act to bring about reform. They should, he declares, "be in step with the people" and tell them about their rights. He warns of dire consequences for Iran's religious authorities if they fail; the clerics' popular standing will, he says "become weaker and shakier".

It is to all intents and purposes an exhortation to take on the government.

Crackdown

The Grand Ayatollah's comments reflect a hugely significant shift in the dynamic driving events in post-election Iran. Mr Ahmadinejad does seem to have succeeded in suppressing the demonstrations which filled the streets of Tehran in the immediate aftermath of the vote.

But the popular anger that fired them has not gone away, and some of the most serious opposition to the regime now comes from the most unexpected source; many of the country's mainstream clergy and theologians want him to go.

Thousands of people protested against the result of the June poll

Because state and religion are presented as one and the same in the Islamic Republic, the sins of the state are tarnishing religion's reputation.

The problem has been growing for a while now; opposition journalists say all sorts of social ills, from drug addiction and prostitution to unemployment, are blamed on religion.

But with the election it has acquired a new dimension. Professor Ali Ansari of the Institute of Iranian Studies at St Andrew's University says that people were especially badly shaken by the fact that the violent post-election crackdown was carried out "in the name of Islam".

He cites the case of a minister's daughter who stopped praying because she was so shocked by what she had seen.

To many clergy it looks as if the actions taken by the president of the Islamic Republic are undermining support for the very religion the Republic was meant to serve.

Eccentric behaviour

And the clergy have another, more personal reason to fear the President; Mahmoud Ahmadinejad belongs to a minority sect of Shia Islam with a pronounced strain of anti-clericalism.

FIND OUT MORE... Analysis: Ayatollogy is on BBC Radio 4 on Monday 19 October at 2030 BST, and Sunday 25 October at 2130 BST Or hear it later on the iPlayer Or download the podcast

One of the mainstream teachings of Shia Islam is that the Prophet Mohammed's authority was inherited by a line of spiritual leaders known as Imams, and that in the 10th century the last of them, the 12th Imam, went into what's known as occultation - that is to say he didn't die, but he has been hidden from humanity ever since.

One day, the teaching goes, he will return, ushering in an age of justice and peace and, shortly thereafter, the end of times.

It is very like the Christian doctrine of the Second Coming, and most Shia Muslims understand it in a similar way - as something that will happen in God's good time.

But Mr Ahmadinejad belongs to a minority sect called the Hasteners; they believe that it is the duty of the faithful to prepare the way for the return of the Hidden Imam - or Mahdi - and perhaps even to create propitious conditions.

Professor Ansari says this has led to some eccentric behaviour by the president's entourage.

They have meals where they leave a place at the table in case the Imam appears, they have spent large amounts of money refurbishing a well at a shrine where it is thought the Imam may appear, and, Professor Ansari says, "they've even had fanciful notions of, when they write their cabinet proposals, taking a note and dropped it down the well so the imam can be aware of it".

Many Iranians find this kind of behaviour eccentric, and most orthodox clerics regard it as something akin to heresy. But beyond that it is accompanied by some inflammatory anti-clerical language.

Mehdi Khalaji, a Shia theologian now teaching in the United States, quotes a warning from one of the president's close aides; when the Hidden Imam returns, he said, "the first thing he does is to behead the clerics because... they've been corrupted by money and politics".

Whether clerical discontent with Mr Ahmadinejad will harden into real and effective political opposition is still very much an open question, but it does seem very likely that religion will play a central role in what now happens in Iran - just as it did during the country's last great political upheaval thirty years ago.

Noah

Ancient Mediterranean flood mystery solved

By Victoria Gill Science reporter, BBC News

The team made a reconstruction of the Mediterranean during the "megaflood"

Research has revealed details of the catastrophic Zanclean flood that refilled the Mediterranean Sea more than five million years ago.

The flood occurred when Atlantic waters found their way into the cut-off and desiccated Mediterranean basin.

The researchers say that a 200km channel across the Gibraltar strait was carved out by the floodwaters.

Their findings, published in Nature, show that the resulting flood could have filled the basin within two years.

The team was led by Daniel Garcia-Castellanos from the Research Council of Spain (CSIC).

He explained that he and his colleagues laid the foundations for this study by working on tectonic lakes.

This... may have involved peak rates of sea level rise in the Mediterranean of more than 10m per day Daniel Garcia-Castellanos Research Council of Spain

They developed a model of how the mountain lakes quickly "cease to exist" when erosion produces "outlet rivers" that drain them.

This same principle, Dr Garcia-Castellanos said, could be used to explain the Zanclean flood that reconnected the Mediterranean with the rest of the World's oceans.

"We could for the first time link the amount of water crossing the channel with the amount of erosion causing it to grow over time," he told BBC News.

New approach

Using existing borehole and seismic data, his team showed how the flood would have begun with water spilling over a sill.

The water would have gradually eroded a channel into the strait, eventually triggering a catastrophic flood, Dr Garcia-Castellanos explained.

He and his colleagues created a computer model to estimate the duration of the flood, and found that, when the "incision channel" reached a critical depth, the water flow sped up.

In a period ranging from a few months to two years, the scientists say that 90% of the water was transferred into the basin.

"This extremely abrupt flood may have involved peak rates of sea level rise in the Mediterranean of more than 10m per day," he and his colleagues wrote in the Nature paper.

Previous estimates of the duration of the flood were very variable, said Dr Garcia-Castellanos, because scientists "had to assume the size of the channel" rather than measure it.

Some estimates suggested that the flood continued for as long as 10,000 years.

Rob Govers, a geoscientist from Utrecht University in the Netherlands, who was not involved in this study, said that the findings were important.

"I think the authors have been very creative using existing data and making sense of it in a completely new way," he said.

Dr Govers said the next important step would be to measure the volume of breccia, or ancient eroded material, in the strait, to confirm whether there was enough material there to have filled the flood channel.

could offer Parkinson's clue

Worm could offer Parkinson's clue

Scientists will study the C. elegans worm for clues to Parkinson's Disease

Scientists believe that worms could hold the key to why some people develop Parkinson's Disease.

Worms share 50% of their genes with humans, including those involved with inherited Parkinson's.

Dundee University researchers will study a simple worm called C. elegans to try to work out why the condition causes patient's brain cells to die.

The Parkinson's Disease Society has given the university £190,000 to carry out the research.

Eventual cure

There are about 120,000 people with Parkinson's in the UK. In up to 5% of those cases, the disease is believed to be directly inherited.

Parkinson's is a progressive neurological condition affecting movements such as walking, talking and writing. It occurs as a result of a loss of nerve cells in the brain.

Dr Anton Gartner, who is leading the study, said: "Research leading to an eventual cure for Parkinson' s disease is a daunting task and requires a very broad and multidisciplinary approach.

"I am grateful to the Parkinson's society to recognise this and to so generously support our research."

It's fascinating that such a simple animal as a worm can be an excellent model for Parkinson's researchers Dr Kieran Breen Parkinson's Disease Society

Worms will be used in the study as they are one of the simplest organisms with a nervous system.

The way worms' nerve cells communicate with each other is also similar to how it works in humans.

Several genes, including one known as LRRK2, have been linked to the hereditary form of Parkinson's Disease.

Dr Gartner's team want to understand how changes or mutations in this gene lead to the development of Parkinson's - and how drugs could stop the damage that these mutations cause to nerve cells.

Dr Kieran Breen, from the Parkinson's Disease Society, said: "It's fascinating that such a simple animal as a worm can be an excellent model for Parkinson's researchers to study what happens in specific nerve cells.

"We are delighted to be funding this research with Dr Gartner in Dundee. It will help us to understand better what causes nerve cells to die in Parkinson's, and will help us to develop new treatments for the condition."

Benefits earnings limit hits jobless

Benefits earnings limit hits jobless, campaign says

UK unemployment stood at 2.4m in September

The weekly amount unemployed people can earn from part-time work without losing benefits should be raised to £50, a group of charities and unions has said.

The Need Not Greed coalition says the £5 cap on Jobseekers Allowance claims discourages the building of a career.

It says the limit - in place since the 1980s - pushes many people on benefits to take undeclared cash-in-hand work.

The Department for Work and Pensions says it is investing £5bn on grants and training to help people back to work.

It added that by not declaring earnings money intended for the most vulnerable people was being given to "benefit thieves".

System an 'obstacle'

Need not Greed's members include Oxfam, End Child Poverty, the TUC and east London charity Community Links.

Its campaign argues that allowing jobseekers to keep more money from short-term or part-time work would held them build up a CV as they look for permanent employment.

One unnamed trained plumber, from the south coast, told the BBC he is forced to do short-term work cash-in-hand, which he does not declare, because he can not survive without the full Jobseekers Allowance.

He said the current system is an "obstacle" to formally starting up his own business.

"I'd much rather be legitimate but there's no system in place for me to make the transition from being unemployed to going into full-time work," he said.

The latest figures from the Office for National Statistics show UK unemployment totalled 2.46 million in September.

'Show Your Working': What 'ClimateGate' means

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.

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 Harrabin: Rethinking the IPCC

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.

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.

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.

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.

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'

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 Scrubbing Up: Pharmacists spot errors in medication

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'

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

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

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 'Care insurance' planned for old

"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

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: --Please select-- All Barking and Dagenham Barnet Barnsley Bath & North East Somerset Bedford Borough Council Bedfordshire Bexley Birmingham Blackburn with Darwen Blackpool Bolton Bournemouth Bracknell Forest Bradford Brent Brighton and Hove Bristol City Bromley Buckinghamshire Bury Calderdale Cambridgeshire Camden Central Bedfordshire Council Cheshire Cheshire East Cheshire West and Chester City of London Cornwall Coventry Croydon Cumbria Darlington Derby City Derbyshire Devon Doncaster Dorset Dudley Durham Ealing East Riding of Yorkshire East Sussex Enfield Essex Gateshead Gloucestershire Greenwich Hackney Halton Hammersmith & Fulham Hampshire Haringey Harrow Hartlepool Havering Herefordshire Hertfordshire Hillingdon Hounslow Isle of Wight Isles of Scilly Islington Kensington and Chelsea Kent Kingston upon Hull Kingston upon Thames Kirklees Knowsley Lambeth Lancashire Leeds Leicester City Leicestershire Lewisham Lincolnshire Liverpool Luton Manchester Medway Merton Middlesbrough Milton Keynes Newcastle upon Tyne Newham Norfolk North East Lincolnshire North Lincolnshire North Somerset North Tyneside North Yorkshire Northamptonshire Northumberland Nottingham City Nottinghamshire Oldham Oxfordshire Peterborough Plymouth Poole Portsmouth Reading Redbridge Redcar & Cleveland Richmond upon Thames Rochdale Rotherham Rutland Salford Sandwell Sefton Sheffield Shropshire Slough Solihull Somerset South Gloucestershire South Tyneside Southampton Southend on Sea Southwark St. Helens Staffordshire Stockport Stockton on Tees Stoke-on-Trent Suffolk Sunderland Surrey Sutton Swindon Tameside Tameside MBC Telford & Wrekin Thurrock Torbay Tower Hamlets Trafford Wakefield Walsall Waltham Forest Wandsworth Warrington Warwickshire West Berkshire West Sussex Westminster Wigan Wiltshire Windsor and Maidenhead Wirral Wokingham Wolverhampton Worcestershire York 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'

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."