Friday 15 October 2010

Why care home drug errors happen

Why care home drug errors happen

By Hannah Goff
BBC News health reporter

When inspectors said thousands of care home residents were being given the wrong medication - the image of a grotty, poorly run nursing home reared its stereotypical head.

How could something so simple as giving a patient their daily dose of tablets be going so wrong, so many times over?

Care worker with an elderly resident
There is concern about over-use of sedatives on elderly patients

But according to care professionals, management of residents' medication is one of the most complex areas of running a nursing home.

And unless fail-safe practices are adhered to, the results can be very damaging to both the resident and the care worker.

Adrian Webb, who runs a specialist mental health unit for elderly mentally ill people in central Manchester, says the main problem is that there are so many people in the chain.

An ordinary patient would take their GPs' prescription to the pharmacist and then, presumably, take the medication in the advised dose.

Each stage of the process there is potential for error.
Adrian Webb

In the case of a care or nursing home resident, there are so many more people inputting into the system.

The prescription might be written by a GP or consultant.

The pharmacist then has to make it up, then it will go to the staff in the home for storage and then a number of different people may be involved in the issuing the medication to patients.

Mr Webb, who is a registered nurse and oversees the distribution of drugs in the Victoria Park Nursing Home, says: "At each stage of the process there is potential for error.

"It has been known for prescriptions to come from doctors that are incorrect.

"But it's very easy for someone to type 100 instead of 10, for example."

Spotting errors

In the Victoria Park Nursing Home, which he runs with his wife, he checks every prescription that arrives from the doctor and pharmacist for errors.

And because he is a registered nurse, he has some knowledge of the kind of doses that ought to be expected and the drugs that are used.

He recalls one instance of receiving a batch of drugs which came from the pharmacist in the wrong dose.

The only way he knew it was incorrect was because he happened to know the higher dose pills were a different colour.

Here, it was his nursing experience which allowed him to spot the error.

But in a care home, where the administering of medicine is not carried out by a nurse, it is questionable whether a mistake such as that would have been noticed.

'Do not disturb'

"If you have not trained as a nurse are you really going to have the confidence to challenge the doctor or pharmacist about his prescription?," asks Mr Webb.

He also says the fact that a nurse could potentially lose his or her job over a medication error tends to focus the mind.

But Laura, a care assistant in the North West, who has worked in three homes for the elderly and one for people with learning disabilities over the past four years, says medication issues are taken extremely seriously indeed.

She said she spent the majority of her breaks drinking her coffee in front of a poster detailing what to do if a drug error occurs.

There are sheets for everybody coming into the home whether they are there for long or short term care and careful records of what medication is distributed, she says.

"The team leader is responsible for handing out the medication.

"There's a sign on the trolleys saying do not disturb while giving out medication and they are not disturbed," she said.

It's using the so-called chemical cosh instead of more skilled techniques to look after someone
Clive Evers
Alzheimer's Society

As in Mr Webb's nursing home, Miss Bates says the person giving out medication is focussed on that job and is not allowed to run off and answer a phone, for example.

But director of information at the Alzheimer's Society, Clive Evers argues the high turnover of staff and their limited training can been the odds are stacked against good practice.

"The workforce is very under-resourced and under-recognised. There is very limited training of staff.

"This is a workforce that would not be allowed to operate with children but they are allowed to work with adults in this way."

With up to 70% of people in care homes suffering from some form dementia, one might expect staff to have training in how to deal with their symptoms.

Elderly care home residents
Care staff say drugs are closely monitored

But guidelines have only recently been adopted by the watchdog, the Commission for Social Care Inspection.

One of the other key worries in care homes is the over-use of anti-psychotic drugs and sedatives.

Over-medication is something that Mr Webb fights against in his nursing home for elderly patients with challenging behaviour.

Patients can take months to get over the heavy sedatives they are given during a visit to hospital, he says.

Good working relationships with GPs and consultants however allows his staff a certain level of control over what the patient is given.

"We give the minimum amount that is needed and it is reviewed regularly.

"We favour as little medication as possible to allow people to be themselves. The more medication people are on - the more problems they have."

But according to Mr Evers, not all homes have even this limited control over what their residents are prescribed.

"Neuroleptics (drugs) are used to limit behaviour that the care workers are not trained to deal with.

"It's using the so-called chemical cosh instead of more skilled techniques to look after someone. And unfortunately we know that this is still happening."

Thursday 14 October 2010

Public 'misled' by drug trial claims

Public 'misled' by drug trial claims

Tablets Drugs need to undergo extensive testing in trials before approval

Doctors and patients are being misled about the effectiveness of some drugs because negative trial results are not published, experts have warned.

Writing in the British Medical Journal, they say that pharmaceutical companies should be forced to publish all data, not just positive findings.

The German team give the example of the antidepressant reboxetine, saying publications have failed to show the drug in a true light.

Pfizer maintains its drug is effective.

Related stories

Reboxetine (Edronax), made by Pfizer, is used in many European countries, including the UK.

But its rejection by US drug regulators raised doubts about its effectiveness, and led some to hunt for missing data.

This is not the first time a large drug company has come under fire about its published drug trial data.

Trial information

Pharmaceutical giant GlaxoSmithKline (GSK) was criticised for failing to raise the alarm on the risk of suicidal behaviour associated with its antidepressant Seroxat.

GSK rejected claims that it improperly withheld drug trial information.

Start Quote

Our findings underline the urgent need for mandatory publication of trial data”

End Quote The research authors

But GSK has also been forced to defend itself over allegations about hiding negative data regarding another of its drugs, Avandia, which is used to treat diabetes.

Now researchers from The German Institute for Quality and Efficiency in Health Care say there is unpublished trial data for Pfizer's antidepressant reboxetine that should be made public because it could change views about the drug.

Dr Beate Wieseler and colleagues carried out their own assessment of reboxetine, looking at the results of 13 trials, including eight previously unpublished trials from the manufacturer Pfizer.

They found the drug was no better than a placebo in terms of remission and response rates. And its benefit was inferior when compared with other similar antidepressants.

Furthermore, a higher rate of patients had side effects with reboxetine than with placebo. And more stopped taking the drug because of side effects compared with those taking a placebo or a different antidepressant.

Biased picture

The researchers said there has been a publication bias and this had overestimated the benefit of reboxetine and underestimated potential harm. And, they said, it was a widespread problem that applied to many of the drugs in use today.

"Our findings underline the urgent need for mandatory publication of trial data," they say in the BMJ.

They warn that the lack of all information means policy makers are unable to make informed decisions.

In the US, it is already a requirement that all data - both positive and negative - is published. The UK is also striving to achieve this.

The UK's regulator, the MHRA, said: "There is a European initiative to provide public access to the results of clinical trials. The currently planned timeline is that this information could become available in late 2011/early 2012."

A spokeswoman for Pfizer said: "In the UK, Pfizer's reboxetine is licensed for the acute treatment of depressive illness/major depression and for maintaining the clinical improvement in patients initially responding to treatment.

"This medicine presents an effective treatment option to clinicians for the use in patients suffering from these conditions.

"Pfizer discloses the results of its clinical trials to regulatory authorities all around the world. These regulatory authorities carefully balance the risks and benefits of each medication, and reflect all important safety and efficacy information in the approved product labelling.

"Pfizer will review the meta-analysis relating to reboxetine published in the British Medical Journal on 13th October 2010 in detail and will provide further comment after completing the review."

Others lay at least some of the blame with the medical journals that publish drug trial data.

In response, the BMJ has promised to devote an entire issue to the topic next year.

BMJ Editors Dr Fiona Godlee and Dr Elizabeth Loder said: "It is time to demonstrate a shared commitment to set the record straight."

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Sunday 10 October 2010

Salt and fat content 'too high' in child hospital meals


Salt and fat content 'too high' in child hospital meals

A boy eating food in hospital Salt and saturated fat levels in food should be kept low to guard against the risk of diseases, campaigners say

There is too much salt and fat in the food served to children in hospital, a survey suggests.

Research from Consensus Action on Salt and Health (Cash) found 85 of the 189 child hospital meals tested would be too unhealthy to be served in schools.

The meals exceeded salt and fat limits for school lunches introduced in 2008.

Campaigners want ministers to bring in nutritional guidelines for hospital food. The Department of Health said it was concerned about the findings.

The research also found that one in three of all 451 meals surveyed would be classified as "red" for saturated fat or salt, according to the Food Standards Agency's traffic light labelling scheme.

A chicken tikka masala and rice served in a hospital, for example, was found to contain 14 times more salt (2.2g) and 8.5 times more saturated fat (6g) than a chicken and vegetable balti with rice, served in a school.

Start Quote

When such great progress has been made on what pupils are eating in school it is shocking that children in hospitals are being ignored”

End Quote Professor Graham McGregor Wolfson Institute of Preventive Medicine

A hospital lasagne contained nearly six times more salt than a lasagne served in schools - 3.2g compared with 0.57g.

The survey found that pizza in hospital contained nearly double the amount of salt of a school version (2.43g compared with 1.35g per portion).

A sticky toffee sponge pudding with butterscotch was also 6 times higher in saturated fat than a similar pudding served in a school (19g compared with 3g per portion).

Diet-related diseases

The findings came from a survey carried out by Cash and campaign group Sustain, which looked at the nutritional content of meals which were provided by leading hospital food suppliers across the UK.

They then compared them with the nutritional standards set out for schools - which set out limits for particular meals.

Professor Graham McGregor, from the Wolfson Institute of Preventive Medicine and chairman of Cash, said: "With everything we know about the risk of children developing high blood pressure and diet-related diseases such as obesity, it is vital to keep their consumption of salt and saturated fat as low as possible, while still being appetising."

Diet guidelines

  • No more than 6g salt a day
  • Men - no more than 30g saturated fat a day
  • Women - no more than 20g saturated fat a day

Source: NHS

"When such great progress has been made on what pupils are eating in school it is shocking that children in hospitals are being ignored."

The government introduced mandatory school nutritional guidelines in 2008 to try to make sure that children were given the right mix of energy and nutrients in their school lunches.

A survey by the School Food Trust this year shows that 41% of primary school pupils now eat school lunches, an increase of 2.1% on 2008-09.

MP Joan Walley believes there should be legal nutritional standards for food served in all public sector institutions, like hospitals, care homes, universities and in the armed forces - not just schools.

She said: "It is really important that children are served food in hospital which they like, but we must also make sure that it is nourishing and healthy for them to eat."

She has introduced a bill to Parliament and says the onus is now on the government to accept it.

A Department of Health spokesman said they were concerned about the survey's findings.

"We recognise the importance of good quality food for patients of all ages, both in terms of improving their health and in relation to their overall experience of services.

"Tools are available to support caterers in assessing the nutritional content of meals."

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Saturday 9 October 2010

NHS errors mean 57 patients had ops on wrong body part

NHS errors mean 57 patients had ops on wrong body part

In an operating theatre That was the right patient wasn't it?

Fifty-seven patients underwent operations on the wrong part of their body last year due to NHS errors, figures show.

The National Patient Safety Agency says these were some of the 111 so-called "never events" in 2009-2010.

These are very serious, preventable patient safety incidents which the government says should not occur.

The Department of Health has added 14 other kinds of incidents to the official list, taking it to 22.

The list includes medical instruments and swabs left in the body after surgery, the wrong route of administration of chemotherapy, death or injury resulting from the transfusion of the wrong blood type and death by falls from unrestricted windows in places such as mental health hospitals.

Hospitals can have funding withheld if a never event occurs.

Wrong-site surgery refers to an operation on the wrong limb or organ (for example wrong knee, wrong eye, wrong kidney) or on the wrong person.

Start Quote

No one wants these to happen, therefore we will not pay hospitals when these events occur. ”

End Quote Professor Sir Bruce Keogh NHS Medical Director

After wrong-site surgery, the second highest number of never events (41) related to misplaced feeding tubes in adults and children.

This puts patients at risk of being fed directly into the respiratory tract.

'Unsafe care'

Data on never events from previous years was collected differently and cannot be compared, according to the National Patient Safety Agency (NPSA).

Health minister Simon Burns said that unsafe care must not be tolerated.

"We are committed to extending the system of 'never events'. We will introduce clear disincentives through non-payments, just as there will be clear incentives for quality.

"Across the NHS there must be a culture of patient safety above all else. These measures will help to protect patients and give commissioners the powers to take action if unacceptable mistakes happen."

NHS Medical Director, Professor Sir Bruce Keogh, agreed: "Never events by their very name should never occur in a modern NHS.

"The proposed list includes avoidable incidents with serious adverse consequences for patients. No one wants these to happen, therefore we will not pay hospitals when these events occur.

"This will send a strong signal to leaders of the organisation to learn from their mistakes so they don't happen again," he said.

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Friday 8 October 2010

'Concern' over Scarborough and Bridlington hospitals

'Concern' over Scarborough and Bridlington hospitals

Scarborough hospital sign The hospital met only one of the 16 essential standards of safety and quality

Serious breaches of safety and quality standards have been found at Scarborough and Bridlington hospitals, the health service regulator has said.

The Care Quality Commission (CQC) said patients were at greater risk of receiving poor care at the hospitals.

Although there was no evidence of harm to patients, "the high number of breaches presented a serious concern".

The NHS trust said safety was "an absolute priority" and it was already working to make improvements.

However, it said it was working against a background of "extremely complex" financial and recruitment problems.

Related stories

The CQC warned the trust it could face enforcement action if swift improvements were not made.

Under a new system of regulation introduced in April the CQC can issue a fixed penalty of up to £50,000 for each serious breach of a standard.

At Scarborough Hospital, inspectors found the trust was fully compliant with only one of the 16 essential standards of quality and safety and at Bridlington Hospital with six of the 16 standards.

The regulator has now given the trust 14 days to produce its plans to show how it intends to achieve compliance.

Inspectors will return unannounced to check whether the necessary improvements have been made and to decide whether it needs to initiate formal enforcement action.

Jo Dent, regional director of CQC for Yorkshire and Humber, said: "No hospital will ever be risk-free, but risks can be minimised by meeting CQC's essential standards of quality and safety.

"We have no evidence of people being harmed as a result of the breaches at either Scarborough or Bridlington hospitals.

Start Quote

We have had a legacy of financial difficulties which we are still working to overcome”

End Quote Scarborough & NE Yorkshire NHS Trust statement

"But we want people to be aware that the risk of receiving poor care is greater in these hospitals because standards are not being met.

"When nurses don't keep proper records on patients or when staff aren't trained to protect vulnerable people from abuse, the consequences can be serious.

"If staffing falls below safe levels, or if staff are stretched too thinly, then people cut corners and mistakes can be made."

At Scarborough Hospital, the most significant concerns included incomplete records kept by nurses, a lack of training in adult safeguarding and staff shortages among nursing staff.

At Bridlington Hospital, the most significant concern related to training in safeguarding vulnerable people, which inspectors said was in place but most staff had not yet had.

A Scarborough and North East Yorkshire NHS Trust spokesman said: "Improvement actions are already happening across all standards however our improvement pathway is not yet complete.

"We have had a legacy of financial difficulties which we are still working to overcome.

"In addition, we have inherited an old, outdated and difficult-to-maintain hospital estate and due to our geographic location and demographic make-up, we also have recruitment difficulties.

"These issues are extremely complex and resolving them requires an intensive, long-term improvement programme, together with significant investment. "

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Thursday 7 October 2010

In February 2007, depending on what newspaper you read, you might have seen an article detailing a "controversial new theory" of global warming.



Sun seen through spider web. Image: Getty
A web of theory has been spun around the Sun's climate influence
In February 2007, depending on what newspaper you read, you might have seen an article detailing a "controversial new theory" of global warming.

The idea was that variations in cosmic rays penetrating the Earth's atmosphere would change the amount of cloud cover, in turn changing our planet's reflectivity, and so the temperature at its surface.

This, it was said, could be the reason why temperatures have been seen to be varying so much over the Earth's history, and why they are rising now.

The theory was detailed in a book, The Chilling Stars, written by Danish scientist Henrik Svensmark and British science writer Nigel Calder, which appeared on the shelves a week after the Intergovernmental Panel on Climate Change (IPCC) had published its landmark report concluding it was more than 90% likely that humankind's emissions of greenhouse gases were warming the planet.

I think the Sun is the major driver of climate change
Henrik Svensmark
In truth, the theory was not new; Dr Svensmark's team had proposed it a decade earlier, while the idea of a cosmic ray influence on weather dates back to 1959 and US researcher Edward Ney.

The bigger question is whether it amounts to a theory of global warming at all.

Small change

Over the course of the Earth's history, the main factor driving changes in its climate has been that the amount of energy from the Sun varies, either because of wobbles in the Earth's orbit or because the Sun's power output changes.

Most noticeably, it changes with the 11-year solar cycle, first identified in the mid-1800s by astronomers who noticed periodic variations in the number of sunspots.

If it varied enough, it could change the Earth's surface temperature markedly. So is it?

Clouds. Image: Getty
Cosmic rays appear to influence the formation of clouds
"Across the solar cycle, the Sun's energy output varies only by about 0.1%," says Sami Solanki from the Max-Planck Institute for Solar System Research in Germany.

"When you look across much longer timescales, you also see changes only of about 0.1%. So just considering directly variations in energy coming from the Sun, this is not enough to explain the climatic changes we have seen and are seeing now."

This is why scientists have been investigating mechanisms which could amplify the changes in solar output, scaling up the 0.1% variation into an effect that could explain the temperature rise of almost half a degree Celsius that we have seen at the Earth's surface in just the last few decades.

One is Joanna Haigh from Imperial College, London, UK. She realised that although the Sun's overall energy output changes by 0.1%, it changes much more in the ultraviolet part of the spectrum.

"The changes in the UV are much larger, between 1% and 10%," she says.

"And that primarily has an impact in the stratosphere (the upper atmosphere) - UV is absorbed by ozone in the stratosphere and also produces ozone, and this warms the air."

FEELING THE HEAT
Three theories on how the Sun could be causing climate change

In graphics
Using computer models of climate, Dr Haigh's team showed that warming in the stratosphere could change the way energy is distributed across the troposphere, the lower atmosphere, changing wind and weather patterns. But not by much.

"We found it might raise temperatures by a maximum of half to one Celsius in certain regions," she says. "But in terms of an impact on the global average temperature, it's small, maybe about 0.2C."

Which is not enough to explain the warming that has occurred since the late 1970s.

Crash test

Henrik Svensmark and his collaborators at the Danish National Space Center (DNSC) believe the missing link between small solar variations and large temperature changes on Earth are cosmic rays.

"I think the Sun is the major driver of climate change," he says, "and the reason I'm saying that is that if you look at historical temperature data and then solar activity and cosmic ray activity, it actually fits very beautifully.

Proponents of this mechanism have tended to extrapolate their results beyond what is reasonable from the evidence
Joanna Haigh
"If CO2 is a very important climate driver then you would expect to see its effect on all timescales; and for example when you look at the last 500 million years, or the last 10,000 years, the correlation between changes in CO2 and climate are very poor."

When hugely energetic galactic cosmic rays - actually particles - crash into the top of the atmosphere, they set in train a sequence of events which leads to the production of ions in the lower atmosphere.

The theory is that this encourages the growth of tiny aerosol particles around which water vapour can condense, eventually aiding the formation of clouds.

And the link to the Sun? It is because cosmic rays are partially deflected by the solar wind, the stream of charged particles rushing away from the Sun, and the magnetic field it carries. A weaker solar wind means more cosmic rays penetrating the atmosphere, hence more clouds and a cooler Earth.

Maximum power

The theory makes some intuitive sense because over the last century the Sun has been unusually active - which means fewer cosmic rays, and a warmer climate on Earth.

"We reconstructed solar activity going back 11,000 years," relates Sami Solanki.

The Sky experiment. Image: Henrik Svensmark / DNSC
The Sky experiment showed ions could influence aerosol formation
"And across this period, the level of activity we are seeing now is very high - we coined the term 'grand maximum' to describe it. We still have the 11-year modulation on top of the long-term trend, but on average the Sun has been brighter and the cosmic ray flux lower."

There is evidence too that cosmic rays and climate have been intertwined over timescales of millennia in the Earth's past.

And the theory received some experimental backing when in October 2006, Henrik Svensmark's team published laboratory research showing that as the concentration of negative ions rose in air, so did the concentration of particles which could eventually become condensation nuclei.

Other scientists, meanwhile, had started putting the idea to the test in the real world.

Seeing the light

In 1947, British meteorologists began deploying instruments in various sites across the country to measure sunlight.

Whether through foresight or luck, they included one feature which was to prove very useful; the capacity to measure the relative amounts of direct and diffuse light.

It is the difference between a sunny day, when light streams directly from above, and a cloudy day, when it seems to struggle in from everywhere, and photographers give up and go home.

Giles Harrison from Reading University realised that the UK Met Office's record of hourly readings from its sunlight stations could be used to plot the extent of cloud cover over a period going back more than 50 years; the larger the ratio of diffuse to direct light, the cloudier the skies.

There is some double-speak going on
Giles Harrison
By chance, cosmic rays have been recorded continuously over almost exactly the same period. So Dr Harrison's team compared the two records, looking for a correlation between more intense cosmic rays and more clouds.

"We concluded that there is an effect, but that it is small - 'small but significant' was how we described it," he recalls.

"It varied UK cloud cover only by about 2%, although we suggested it would have a larger effect on centennial timescales; and it's difficult to assess what effect this would have on global surface temperature."

He concludes it would be premature to lay global warming at the door of cosmic rays. Perhaps surprisingly, you will find no references to his work in The Chilling Stars.

Cosmic flaw

In July, Mike Lockwood from the UK's Rutherford-Appleton Laboratory attempted a definitive answer to the question with what appeared to be a simple method. He simply looked at the changing cosmic ray activity over the last 30 years, and asked whether it could explain the rising temperatures.

His conclusion was that it could not. Since about 1985, he found, the cosmic ray count had been increasing, which should have led to a temperature fall if the theory is correct - instead, the Earth has been warming.

"This should settle the debate," he told me at the time.

Graphs of cosmic ray activity and temperature

'No Sun link' to warming
It has not. Last month Dr Svensmark posted a paper on the DNSC website that claimed to be a comprehensive rebuttal.

"The argument that Mike Lockwood put forward was that they didn't see any solar signal in the surface temperature data," he says.

"And when you look at [temperatures in] the troposphere or the oceans, then you do see a solar signal, it's very clear."

Dr Lockwood disagrees; he says he has re-analysed the issue using atmospheric temperatures, and his previous conclusion stands. And he thinks the Svensmark team has been guilty of poor practice by not publishing their argument in a peer-reviewed scientific journal.

"Lots of people have been asking me how I respond to it; but how should I respond to something which is just posted on a research institute's website?" he asks.

"This isn't on, because the report title says it is a 'comprehensive rebuttal'; if it were that, then it would be his duty to publish it in a scientific journal and clean up the literature - that's how science filters out what is incorrect, and how it comes to a consensus view as to what is correct."

Droplets of doubt

This dispute presumably has some distance to run.

But Mike Lockwood's larger conclusion that current warming has nothing to do with solar changes is backed up by others - notably the IPCC, which concluded earlier this year that since temperatures began rising rapidly in the 1970s, the contribution of humankind's greenhouse gas emissions has outweighed that of the Sun by a factor of about 13 to one.

Even though misguided journalists have sometimes mistaken his work as implying a solar cause to modern-day warming, Sami Solanki agrees with the IPCC verdict.

"Since 1970, the cosmic ray flux has not changed markedly while the global temperature has shown a rapid rise," he says. "And that lack of correlation is proof that the Sun doesn't cause the warming we are seeing now."

Even to prove that the link between cosmic rays and cloud cover matters in the real world needs a lot more work, observes Joanna Haigh.

Sunset. Image: AP
A weakening Sun could soon see the issue die down
"You need to demonstrate a whole long chain of events - that the atmosphere is ionised, then that the ionised particles act to nucleate the condensation of water vapour, then that you form droplets, and then that you get clouds; and you have to show it's important in comparison to other sources of nucleation.

"And that hasn't been demonstrated. Proponents of this mechanism have tended to extrapolate their results beyond what is reasonable from the evidence."

And Giles Harrison believes climate sceptics need to apply the same scepticism to the cosmic ray theory as they do to greenhouse warming - particularly those who say there are too many holes in our understanding of how clouds behave in the man-made greenhouse.

"There is some double-speak going on, as uncertainties apply to many aspects of clouds," he says.

"If clouds have to be understood better to understand greenhouse warming, then, as we have only an emerging understanding of the electrical aspects of aerosols and non-thunderstorm clouds, that is probably also true of any effect of cosmic rays on clouds."

Dr Svensmark agrees it would be wrong for anyone to claim the case has been proved.

"If anyone said that there is proof that the Sun or greenhouse gases alone are responsible for the present-day warming, then that would be a wrong statement because we don't really have proofs as such in the natural sciences," he says.

Waned world

Two events loom on the horizon that might settle the issue once and for all; one shaped by human hands, one entirely natural.

At Cern, the giant European physics facility, an experiment called Cloud is being constructed which will research the notion that cosmic rays can stimulate the formation of droplets and clouds. There may be some results within three or four years.

By then, observations suggest that the Sun's output may have started to wane from its "grand maximum".

If it does, and if Henrik Svensmark is right, we should then see cosmic rays increase and global temperatures start to fall; if that happens, he can expect to see a Nobel Prize and thousands of red-faced former IPCC members queuing up to hand back the one they have just received.

But if the Sun wanes and temperatures on our planet continue to rise, as the vast majority of scientists in the field believe, the solar-cosmic ray concept of global warming can be laid to eternal rest.

And if humankind has done nothing to stem the rise in greenhouse gas emissions by then, it will be even harder to begin the task.

Monday 4 October 2010

Child benefit to be scrapped for higher taxpayers

Child benefit to be scrapped for higher taxpayers

Chancellor George Osborne on "tough but fair" welfare state

Child benefit is to be axed for higher-rate taxpayers from 2013, Chancellor George Osborne has announced.

He told the Conservative conference the "tough but fair" move - affecting couples where one parent earns about £44,000 - would save £1bn a year.

Labour said the benefit should remain universal and the families who wanted to "get on" were being penalised.

Mr Osborne also revealed the total state benefits one family can claim in future will be capped at about £26,000.

This will mean that no family on welfare will be better off than one earning an average income from work, the chancellor said.

He outlined the steps in a major speech in which he defended the government's austerity measures as cuts "not for their own sake" but savings "to secure our future".

About 7.7 million families with children currently get child benefit, costing about £12bn a year.

'Not super-rich'

Ministers estimate the change will affect about 1.2 million families.

The coalition says big reductions in expenditure are needed in nearly all areas of government if it is to bring down the budget deficit.

As recently as a year ago, Mr Osborne said the Tories would preserve child benefit as it was "valued by millions".

But the chancellor told delegates in Birmingham that in the current financial climate, he could no longer continue to spend £1bn a year in child support to those who were better off.

"Believe me, I understand that most higher-rate taxpayers are not the super-rich. It is very difficult to justify taxing people on low incomes to pay for the child benefit of those earning so much more than them," he told delegates.

Describing the measure as "tough but fair", he added: "These days we really have to focus the resources on where they are most needed.


Start Quote

I will have to go to my boss and ask for a pay cut. I'm absolutely fizzing”

End Quote Iain from Basildon

"When the debts left by Labour threaten our economy, where our welfare costs are out of control, this measure makes sense."

What it means

At the moment, parents are paid £20.30 a week for the eldest child and £13.40 for subsequent children, with payments continuing until the age of 19 for those in full-time education.

Families with three children who will no longer be eligible to receive child benefit face being £2,500 a year worse off.

Mr Osborne confirmed the cut would hit homes with a single or two high earners but families with two parents on incomes up to £44,000 - which might add up together to over £80,000 - would keep the benefit.

The chancellor defended this by saying his plan was "the most straightforward" option - which would avoid across-the-board means testing.

The alternative was to introduce a "complex" system of means testing where all households had their incomes assessed, he said.

Analysis

George Osborne's decision to cut child benefit for higher-rate taxpayers is as political as it financial.

Yes, it will save £1bn a year to help pay off the deficit. Yes, it will be relatively simple to enact. And yes, many people will think it is a fair hit on the better off.

But there will be squeals.

Middle England will protest that it unfairly hits single-earner families hardest, that it acts as a disincentive to earn more, that it breaches the principle of universal benefits, that it is an attack on the family, that it is a breach of Mr Osborne's promise last year to "preserve" child benefit.

But the chancellor will not mind this. Why?

Because the vocal middle-class anguish - led by vocal middle-class media types - will give him political cover for other cuts that will affect the less well off.

This is only the start of a process that will see benefits and spending cut across the piece. Mr Osborne says we are all in this together and he has slaughtered one of welfare's sacred cows to prove it.

People will be expected to declare on their tax returns whether they fall within the 40% and 50% tax brackets and the money will then be clawed back through the tax system.

However, Mr Osborne urged top-rate taxpayers to stop claiming child benefit altogether, saying this would be the "most sensible" thing to do.

The chancellor insisted this was a "one-off" measure and did not mark the end of the principle of universal benefits which have underpinned the welfare state for decades.

BBC political editor Nick Robinson said the government's move amounted to a middle-class tax rise that would directly hit most delegates at the Conservative conference.

He said that this reflected the contradiction that, while the party was delighted to be back in government, it was having to come to terms with the reality of the painful decisions facing the country if it was to meet its objective of eliminating the structural deficit within five years.

But critics say the move - coming on top of the three-year freeze in child benefit announced in June's budget - will put even more of a squeeze on average families.

'Unfair'

"We support child benefit for all children and all families," said shadow work and pensions secretary Yvette Cooper.

"Of course there are difficult choices to make and we need more welfare reform, but it's better to get the economy growing faster and raise more tax from the banks than to cut support for children in middle-income families.

Spending review branding

A special BBC News season examining the approaching cuts to public sector spending

"Whatever people's income, it is families with children who are paying most - through cuts in child tax credit, maternity allowance, child benefit and housing benefit."

Trade union leaders said no-one was now safe from what it said were precipitous budget cuts.

"This is a big blow to the principle that has served Britain well for decades that welfare should be available to all, not just the poorest," said TUC general secretary Brendan Barber

The Child Poverty Action Group said it was "unfair" that families should be paying the price for a debt crisis not of their making.

Lib Dem leader Nick Clegg has said child benefit costs should be looked at but some party members are likely to be alarmed, having passed a motion at their conference last month to ring-fence child benefit from austerity measures.

Miranda Whitehead, vice-chair of the Women Liberal Democrats, told the BBC she was "disappointed" by the announcement, as child benefit guaranteed families a certain amount of money even if their circumstances changed.

Saturday 2 October 2010

Vulnerable elderly 'forced to pay for medical care'

Vulnerable elderly 'forced to pay for medical care'

Elderly woman Patients can apply for NHS funding through the continuing care system

Vulnerable elderly people are being unfairly forced to pay for health care, the new chairman of the House of Commons health committee says.

Stephen Dorrell said patients with conditions such as dementia used to get free care in NHS geriatric hospitals.

But the number of places has fallen by nearly 80% in the UK over the past 20 years - despite the ageing population.

He said this had pushed people into the means-tested social care system where they were often charged for treatment.

In an interview with the BBC, he said the redrawing of the boundaries had been allowed to creep in without proper debate or scrutiny and urged politicians to face up to the issue.

An expert commission has already been set up by the government to look into the issue of social care funding in England.

But Mr Dorrell was speaking about a specific group of patients whom he believes the NHS has turned its back on.

Ignored

As well as dementia patients this includes people such as stroke victims and those with Parkinson's disease who struggle to get the NHS to pay for medical treatment they receive.

Mr Dorrell, who was health secretary towards the end of John Major's time as prime minister, said: "People are being charged for care that they would have got free from the NHS 20 or 30 years ago.

"In effect there has been a change in the definition of what constitutes NHS care and that has happened without proper debate.

"Unfortunately, it has been ignored because both politically and financially it is tricky for politicians to face up to it. But because it has not been done in a planned way there is great unfairness in the system. We see examples of cost shunting and bureaucracy that cause individuals problems.

"I would not want to see a return to the old system of geriatric hospitals - care is much better now - but you have to question whether it is fair that this group of people are being charged in this way?"

Evidence on the changes to the nursing care home and geriatric hospital sectors lend support to his view.

Case study

Mair Schwodler's family spent years fighting to get the NHS to pay for the care she needs - but to no avail.

The 84-year-old, who has Alzheimer's disease, has been immobile and incontinent since 2006.

She gets round-the-clock care in a £700-a-week nursing home in Bedford.

But despite her medical condition her family have been forced to sell her home to help pay for the specialist care she needs.

They say the pressure of her situation contributed to her husband, Bob, killing himself.

Mrs Schwodler's son-in-law Douglas Clegg, 68, says: "They worked hard all their lives and not to have health care paid for when the NHS is meant to be free is unbelievable."

Figures from analysts Laing and Buisson show that the number of geriatric beds fell from more than 80,000 in 1988 to 16,300 last year.

During the same period nursing home places more than doubled from 78,300 to 179,400. On top of that there are now nearly 300,000 residential care places, although these are less likely to have patients with severe medical conditions.

NHS funding is available to people with the most severe medical needs who are in care homes or living independently under a system called continuing care.

But campaigners claim the funding is too bureaucratic and difficult to qualify for. Little over 50,000 people currently get it.

Age UK policy adviser Stephen Lowe agreed Mr Dorrell was right to highlight the issue, saying the NHS had "unilaterally retreated" from its responsibilities.

Ruth Sutherland, interim chief executive of the Alzheimer's Society, added: "There are hundreds of thousands of people missing out on valuable financial help because they don't 'tick the right boxes'.

"People with dementia are some of the hardest hit by this deliberately tricky system. They have complex physical health needs which should often be covered by the NHS but arguments over funding see them denied this care.

"Instead they are forced to pay for social care which adds huge financial burden to people already under emotional and physical strain. Faced with exhaustion, they may not have the strength to challenge being turned down."

A Department of Health spokeswoman acknowledged there had been problems with people accessing NHS funding, but said the situation was now improving following new guidance to NHS trusts.

She added that recent data showed there had been an overall increase in the numbers of people getting continuing care funding.

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Friday 1 October 2010

Ancient giant penguin unearthed in Peru

Ancient giant penguin unearthed in Peru



Inkayacu paracasensis An artist's impression of the giant penguin
The fossil of a giant penguin that lived 36 million years ago has been discovered in Peru.
Scientists say the find shows that key features of the plumage were present quite early on in penguin evolution.
The team told Science magazine that the animal's feathers were brown and grey, distinct from the black "tuxedo" look of modern penguins.
It was about 1.5m (5ft) tall and nearly twice as heavy as an Emperor Penguin, the largest living species.
The bird, named Inkayacu paracasensis, or Water King, waddled the Earth during the late Eocene period.
It had a long, straight beak, much longer than that of its modern relatives.
'Pedro'
The fossil was found in Reserva Nacional de Paracas in Peru. The scientists nicknamed the penguin "Pedro" - after a scaly character in a Colombian TV series.
One of the highlights of the study was the presence of well-preserved feathers and scales.
"Before this fossil, we had no evidence about the feathers, colours and flipper shapes of ancient penguins," said Julia Clarke, a palaeontologist at the University of Texas, US, and lead author of the study.
"We had questions and this was our first chance to start answering them."
She explained to BBC News that the fossil also shows that penguins' main physical features evolved millions of years ago, but the colour of penguin feathers switched from reddish brown and grey to black-and-white quite recently.
Great divers
It is the particular shape of flippers and feathers that makes penguins such powerful swimmers.
During wing-propelled diving - the so-called aquatic flight - these birds are able to generate propulsive forces in an environment about 800 times denser and 70 times more viscous than air.
Julia Clarke The team excavated the fossil in Reserva Nacional de Paracas in Peru
"One thing that's interesting in living penguins is that how deep they dive correlates with body size," said Dr Clarke.
"The heavier the penguin, the deeper it dives. If that holds true for any penguins, then the dive depths achieved by these giant forms would've been very different."
To get an idea about the colour of the feathers of the long-dead penguin, the team examined melanosomes - microscopic structures in the fossil, whose size, shape and arrangement determine the colour of a bird's feathers.
"Insights into the colours of extinct organisms can reveal clues to their ecology and behaviour," said co-author Jakob Vinther of Yale University, US.
"But most of all, I think it is simply just cool to get a look at the colour of a remarkable extinct organism, such as a giant fossil penguin."
The researchers say that the find, together with some other recent discoveries from the same area, is just another evidence of a rich diversity of giant penguin species in the late Eocene period of low-latitude Peru.
"This is an extraordinary site to preserve evidence of structures like scales and feathers," said Dr Clarke.
"So there's incredible potential for new discoveries that can change our view not only of penguin evolution, but of other marine vertebrates."

Sunday 26 September 2010

Ed Miliband

Labour leader Ed Miliband makes vow to middle classes

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Ed Miliband: "You have put your trust in me and I am determined to repay that trust"

Ed Miliband has begun his first day as Labour leader with a vow to defend the "squeezed middle" of the country.

Mr Miliband won the leadership after beating brother David in a dramatic vote ahead of the party's conference.

Writing in the Sunday Telegraph, he said a "new generation was entrusted with transforming our party".

Mr Miliband also said Labour would now aim to "set out an alternative" but would support the coalition government "when it is right" on making cuts.

His victory comes as the Labour party conference starts in Manchester.

The former energy secretary, who will be interviewed on BBC One's Andrew Marr Show later, wrote in the Telegraph: "My aim is to show that our party is on the side of the squeezed middle in our country and everyone who has worked hard and wants to get on.

"My aim is to return our party to power. This is a tough challenge. It is a long journey. But our party has made the first step in electing a leader from a new generation."

Mr Miliband pledged not to oppose every government cut, saying public services would need to learn to do more with less, and he suggested he wanted to replace tuition fees.

He added: "As well as setting out an alternative when the government gets it wrong, we will support it when it is right."

Referring to the leadership result, Mr Miliband said: "A new generation was entrusted with transforming our party and making sure that, once again, we stand up for the interests of families across Britain.

"We have a lot of ground to make up if we are to rebuild the broad coalition of support that swept us to power in 1997."

He said the party needed to accept it made mistakes in government and show it had changed, adding: "We must never again lose touch with the mainstream of our country."

Personnel decisions

Mr Miliband won the leadership by just over 1% from his brother after second, third and fourth preference votes came into play.

How Ed Miliband won

  • Round 1: David Miliband 37.78%, Ed Miliband 34.33% Diane Abbott eliminated
  • Round 2: David Miliband 38.89%, Ed Miliband 37.47%. Andy Burnham eliminated
  • Round 3: David Miliband 42.72%, Ed Miliband 41.26%, Ed Balls eliminated
  • Round 4: David Miliband 49.35%, Ed Miliband 50.65%. Ed Miliband wins

Ed Balls was third, Andy Burnham fourth and Diane Abbott last in the ballot of MPs, members and trade unionists.

In the first three rounds of voting David Miliband was ahead - it was only when votes were reallocated as the other candidates were knocked out that his younger brother was pushed over the winning line.

Prime Minister David Cameron called Mr Miliband from his Chequers country retreat to congratulate him on his victory.

In a three-minute conversation, he told the new leader of the opposition that people would tell him that his was "the worst job in the world" but that it was not that bad and promised to keep him in touch with matters of national security.

Ed and David Miliband Ed Miliband is the 20th person to take leadership of the Labour Party

Mr Miliband, 40, replaces acting leader Harriet Harman in the contest triggered by the resignation of Gordon Brown.

He has immediate questions of personnel as well as policy to address, chiefly whether his defeated older brother - whom he does not mention in his Sunday Telegraph article - will be willing to take a job on his front bench.

After the result, David Miliband told BBC News: "This is Ed's day, it's a big day for the Miliband family, not quite the day for the Miliband family that I would have wanted - the Miliband D family, rather than the Miliband E - but that's the way things go."

However, BBC Newsnight's political editor Michael Crick says a source in the Ed Miliband camp said the brothers held several secret meetings during the week, once it became clear Ed would win.

Our correspondent adds that the source says David will be offered the job of shadow chancellor, although the Ed Milliband team is not very confident he will accept it.

The new leader will not be short of advice from colleagues.

In the Independent on Sunday, shadow Home Secretary Alan Johnson warned him not to move to the left.

Analysis

By Michael Crick, political editor, BBC Newsnight

An MP in the Ed Miliband campaign tells me they had predicted exactly the parliamentary Labour party section vote, and quite closely the union and affiliates' section vote, but they were disappointed with the members' section vote, as their figures had shown them winning among ordinary party members.

This might explain why several senior Ed Miliband supporters I've bumped into have been looking pretty glum.

Not to have a majority of your MPs, or party members, and to depend on union votes, leaves Ed Miliband in a very exposed position.

Ironically, he'll have to spend much of the next few weeks distancing himself from the unions and showing he's not in their pocket.

Shadow Welsh Secretary Peter Hain said Mr Miliband should not rely solely on attacking the coalition, but focus on policies for the next election.

Conservative Party chairman Baroness Warsi congratulated Mr Miliband on becoming leader of the opposition, but she said he owed his victory to votes of trade unionists, which she feared would lead to an "abandonment of the centre ground" by Labour.

She said it was now time for Mr Miliband to "to tell us how he'd cut the deficit".

But the joint leader of the Unite union, Derek Simpson, said the new leader was no "blast from the past".

"We're not extremists at all, Ed's not an extremist, he knows how to unite the party, we don't expect him to write blank cheques for us on policies - why would he and why should he?"

Ed Miliband, who has been MP for Doncaster North since 2005 and was energy and climate change secretary until Labour's election defeat in May, is a former aide to Gordon Brown at the Treasury. He joined the Labour Party at the age of 17.

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Friday 24 September 2010

Unison withdraws claim of right to NHS judicial review





The government wants GPs to take on more responsibility
Unison has withdrawn its claim that it had won the right to seek a judicial review of government plans for changes to the NHS in England.
The union now says it is still waiting for a decision by a High Court judge.
StethoscopeUnison is seeking to challenge plans by the government to give GPs control of their own budgets, and abolish the existing local health trusts.
It says the proposals were not in the election manifestos of either the Conservatives or Liberal Democrats.
Unison put out the correction at 2120 BST, just under three hours after it had said its bid for a judicial review had been successful.
The government's plans for radical changes to the health service in England were published in a white paper in July.
The proposed abolition of primary care trusts came as a surprise to many within the NHS, as the coalition programme for government had envisaged a continuing role for the NHS organisations.
Unison argues that the public should have a legal right to be consulted on the changes, which it describes as "drastic".
The government says it is making every effort to listen to members of the public, unions, and NHS staff about the proposals.
It claims that the changes would mean greater choice and accountability, and it wants to see them completed across England by April 2013.


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