Thursday 25 November 2010

Care homes 'closed' for poor standards remain open

Can the newly relaunched inspectorate protect elderly care home residents from neglect?

Failing care homes which were officially closed down have been allowed to continue operating.

The Care Quality Commission (CQC) claimed 93 homes and agencies were shut in the past year due to poor ratings.

Home care worker comforting elderly woman in wheelchair

But a BBC investigation has found a dozen were still open under the same ownership.
The CQC admitted errors, but said it was determined to clamp down on providers where there is a risk of neglect or abuse.
In some cases the regulator had allowed homes to close and then reopen on the same day, if the home applied to do so, which they can under the current rules. Damning reports about their past records were then removed from the CQC's website, so potential residents and their relatives could no longer read them.
Some of the homes said they were not even aware the regulator had placed them on an official list of providers which had closed.
The CQC announced the closures in September, saying it demonstrated a new determination to "get tougher". It said 42 providers had shut because of enforcement action, and the rest closed voluntarily after receiving poor reports.
Clean slate
But the BBC found some were actually allowed to remain open despite concerns about standards, while others had never been rated "poor" at all.
When reporters visited the Wykenhurst care home in Hereford, the owners admitted social services had tried to remove some of their residents last year.

Amanda Sherlock,director of operations of the CQC

Amanda Sherlock admits the CQC made mistakes

Inspectors had previously expressed fears that the home was ill-equipped to deal with very frail residents, that nutritional standards were poor and that some residents were at risk of falls.
The owners of Wykenhurst pointed out that since the official closing and reopening, they had been visited more recently by inspectors who found their service to be "adequate".
The home had officially been unregistered and then re-registered on one day in November 2009. Subsequently, its previous history of poor inspection reports was wiped from the CQC's website.
To a family looking for a home for a relative, the home looked as if it was newly opened. Several other providers closed by the CQC had in fact been allowed to do the same.
Eileen Chubb, founder of the Compassion in Care charity, was the first to raise questions about the CQC's "tough" stance.
"Basically they were given a clean slate and people weren't told," she said. "That's totally wrong and totally dishonest. There's nobody out there looking for the vulnerable residents in these homes."
'Mistakes'
Amanda Sherlock, director of operations for the Care Quality Commission, admitted mistakes had been made. But she said the homes' histories should have remained on the commission's website, and promised to look into it.

"I don't think it's inaccurate that we're getting tough on poor services," she said.

"Indeed only this week we have got two organisations that are being escalated up into formal enforcement activity. There are a variety of activities and actions the CQC is following up on a daily basis."
Wykenhurst Care Home said in a statement that it had been unaware of the CQC's database error until it was informed of it by the BBC: "We explained to you that we had changed our systems to more in-depth personal care plans, as did many other homes in the last year.
"All identified previous issues raised by CQC were addressed to the satisfaction of CQC and the local authority."
Lighter touch
The revelation comes at a turbulent time for the regulator, which was launched in April last year. In October it introduced a new, lighter-touch inspection system which it believes will allow it to focus on providers which are causing concern. There will be fewer inspections in well-run care homes where there is no cause for concern, so inspectors can concentrate on those where there may be a problem.
But charities and inspectors have claimed the system is unable to cope with such radical change.

“Start Quote

It's inevitable something will happen which will shake the system. You just hope it isn't one of your cases”

End Quote Inspector (anonymous) Care Quality Commission

The CQC has taken on extra responsibility for regulating health as well as social care, despite job cuts which have seen inspector numbers reduced by nearly 50% from 1400 under the old regulator - which had different responsibilities - to 800 now.

One inspector, who wished to remain anonymous, told the BBC he expected the situation to get much worse, because the remaining inspectors were due to begin regulating dentists as well. Inspectors would use self-assessment forms and other paper-based evidence rather than going out to visit providers, he said.
"As far as I'm aware there are no plans for any additional staff, so the chances of inspectors getting out on visits seem more remote than ever.
"The biggest concern for everyone is there's going to be a major incident in a home, as we're not in there as often seeing for ourselves.
"Inspectors know it's going to happen somewhere. It's inevitable something will happen which will shake the system. You just hope it isn't one of your cases."

70 major amputations a week carried out on type 2 diabetes patients

25 November 2010 Last updated at 01:33

Variation in amputation rate 'shocking'

Seventy amputations a week take place on diabetic patients in England

Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.

Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East.

The Diabetes UK charity says the majority could be prevented.

The government says it is publishing the information, which also covers other conditions and has been dubbed an "atlas of care", to help improve care.

The amputation difference is one of the most striking revealed in a series of 34 "maps" of healthcare produced.

Treatment of last resort

It also looks at key treatments for some of the most serious conditions including stroke, heart disease and asthma.

There are more than 70 major amputations a week carried out on type 2 diabetes patients in England. It is thought 80% of amputations are potentially preventable.

“Start Quote

Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else”

End Quote Sir Muir Gray

Diabetes can lead to a loss of sensation in the feet so minor injuries can become badly infected without the patient noticing.

If the infection becomes too severe, amputation of a foot or the leg below the knee becomes the treatment of last resort.

Barbara Young, the chief executive of Diabetes UK, said "The existing situation around foot care and amputations is shocking, given the that the majority of amputations can be prevented."

The atlas also reveals a big variation in the percentage of people with diabetes who are receiving all the essential checks to monitor their condition.

This includes the simple foot checks which can help prevent amputation.

While some geographical differences would be expected, researchers say unwarranted variation is a cause for concern. They adjusted their data to take account of different populations in different areas.

Sir Muir Gray, the public health academic who led the research within the Department of Health, said: "Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else.

"The atlas is now going, for the first time, to give them a clear idea of where they are. "

Unwarranted variation

This is particularly true in areas of care where the evidence is clear. Patients with a suspected mini-stroke are at higher risk of a major stroke. The national guidelines recommend they should have specialist tests within 24 hours.

The atlas shows a greater than 10-fold difference in the percentage of patients who are getting that gold standard treatment.

A handful of areas are managing for all the patients at risk but in many parts of England that falls to fewer than half.

Some experts believe reducing the variations to give priority to treatments backed by evidence could help find the savings it needs.

Professor Chris Ham, chief executive of the King's Fund, said "If performance across the NHS can be brought up to the level achieved by the best, then much of the pressure on local NHS budgets can be relieved without having to cut services for patients."

The data in the atlas predates the coalition government but ministers have supported its publication.

Health minister Lord Howe said: "Making this information available will help to identify and address unwarranted variation to better meet the needs of their local populations."

Monday 22 November 2010

Carbon emissions fell in 2009 due to the recession therefore can we conclude

2009 carbon emissions fall smaller than expectedBy Richard Black Environment correspondent, BBC News

Coal use in developing economies tends to make them less “carbon-efficient”

Continue reading the main story

More on This Story

The government is planning the biggest ever shake-up in the history of the NHS in England.

Shaking up the NHS

By Sarah Montague
Today programme

Doctors will soon be prescribing the future of the NHS

The government is planning the biggest ever shake-up in the history of the NHS in England. Will it work?

It wants GPs, rather than managers, to decide how and where to spend money for their patients and it will hand them £80bn of the NHS's £100bn budget.

The existing management layers will be scrapped and all this will happen within the next couple of years.

In the village of Ramsey in East Anglia, it is already happening. The Ramsay health centre is one of 10 surgeries in Huntingdonshire that make up the Hunts Health Consortium. It's one of the first GP groups to take over control of a real budget from their Primary Care Trust (PCT).

Paul Zollinger-Read, the head of the PCT in Cambridge, told me that a year ago he realised that if they carried on doing what they were doing then in three years time they would be £100m in debt.

He decided to work with local GPs because GPs write the prescriptions, make the referrals and are responsible for the majority of NHS expenditure.

"So put them in charge of making decisions and you have a much better model of healthcare," he told me.

His aim is to do himself and his colleagues out of a job because, he admitted, they were getting in the way and "frustrating the changes GPs could make".

The GP in charge of Hunts Health Consortium and who now controls the purse strings is Simon Brown.

The change, he told me, is revolutionary - it used to be difficult to get innovation which GPs see as obvious through, but now they can make "logical decisions from the patients perspective".

He and his colleagues will set guidelines for all 10 surgeries - what they think is the best and cheapest drug to prescribe for different conditions, what they consider the most effective way to treat conditions like diabetes and how they want to manage - and prevent - the particular health care problems that crop up in their area.

If a surgery wants to join their group they have to sign up to their way of doing things.

He says that it should mean fewer hospital admissions. Where patients are admitted, it should be for shorter periods.

Many in the NHS have been taken by surprise by how radical it is and the scale of it

Nigel Edwards, NHS Confederation

Not all GPs are so keen. A short drive away, the surgery at Alconbury and Brampton has decided not to join the consortium yet.

The personal view Dr Duncan Outram, of one of the GPs there, is that it will damage the doctors' relationships with their patients.

At the moment, he argued, GPs are patients' advocates. But if consortia go ahead, then patients may start to worry about whether their GP is acting in their best interest or trying to balance a budget.

He also thinks patients will end up blaming their doctors for cuts that otherwise would have been seen as the responsibility of government.

It is a point Simon Brown is willing to acknowledge, but argues that at least, with GPs making the cuts, the decisions will be made "in rational ways".

Healthy debate

Hunts health consortium is ahead of the game. But over the next few months every single doctors' surgery in England is expected to make plans to join a consortium so the new system can be up and running by April 2013.

Some fear NHS reform will open the door to a privatised health service

It's reckoned there will be about 500 consortia. That should allow some GPs to take a back seat while other have a more active role running the finances.

The planned changes represent a huge shift of power to GPs.

Many support the thinking behind it, but there is concern about how it will work in practice.

A BBC survey of more than 800 doctors found that less than a quarter thought the changes would lead to a noticeable improvement for patients.

Chris Ham, chief executive of health think-tank the Kings Fund, has cautioned about the pace of change.

"It's quite risky to move from the current system to the new system at this speed and pace," he told me.

Others have voiced concerns about whether GPs have the necessary skills.

Paul Jenkins, chief executive of the mental health charity Rethink, has warned that people with mental illness don't necessarily get a particularly good deal now.

In 10 years' time, shareholders in a large American-style healthcare company could have more influence over what services are provided by whom than a citizen

Sarah Gorton, Unison

GPs themselves say that they are a lot less comfortable in treating mental illness than they are treating physical conditions.

He questions whether GPs have the skills, knowledge and interest in mental illness to make it a priority in the new world.

GPs may also decide that they'd rather spend their budgets on some conditions and not on others. Those decisions will vary across the country.

So, says Michael Dixon who chairs the NHS Alliance, you could be turned down for treatment at one surgery for something like IVF, when a neighbouring consortium is offering it to its patients because, for example, they have prioritised heart disease or cancer.

"That's the sort of flexible arrangement you can't have at the moment," he says.

"Ultimately what each consortium is doing is trying to make the best of the money it's got and therefore there will be winners and there will be losers.

Layers of management are to be stripped from health care provision

"But the main thing is that the clinicians and the local population feel corporate responsibility for what they decide."

And that is the aim of the reorganisation - to put the patient, with their GP, in the driving seat. It's a far cry from the way the NHS has worked over the years.

Since it was launched 62 years ago, such have been the demands on the service that it has turned into one of the biggest employers in the world.

As patients have wanted, and needed, more, the number of front-line staff has grown and so has the number of managers.

The government says the changes will cut management costs by 45% over four years.

Out goes all the existing architecture: Primary Care Trusts, Strategic Health Authorities and much of the power of the secretary of state.

It is, says Michael Dixon, "a fantastically brave and fantastically good option" and something that both GPs and their patient would embrace "very wholeheartedly".

Private concern

There are those, however, who fear it won't be long before big business muscles in.

"You can very quickly envisage a situation where the GPs aren't actually doing the commissioning themselves," warns Sarah Gorton of the union Unison.

"They're setting the criteria but they are handing over the commissioning - which isn't just about contract management, it's about identifying what the needs of the population are and then identifying who's going to be the potential provider for that and then awarding and managing the contract.

Many people in the NHS have been taken by surprise by how radical it is and the scale of it

Nigel Edwards, NHS Confederation

"There is a danger that we could see a creep to handing this over to the private sector.

"In 10 years' time, shareholders in a large American-style healthcare company could have more influence over what services are provided by whom than a citizen, a taxpayer, in a community in England."

Even Michael Dixon accepts that this is a threat. The way to ensure it doesn't happen, he says, is for GPs to embrace the change wholeheartedly, take ownership of it and make sure that they get their managers in to do the job.

It's not just the fear of privatisation in the commissioning of healthcare - some fear the increasing privatisation of those who provide health care services.

Chand Nagpaul, a GP with the British Medical Association, says one of their big concerns is that the government's ideological attachment to competition "permeates the NHS".

In particular he points to the setting up of a new body, Monitor, whose role is to promote competition within the NHS and intervene if it believes anti-competitive behaviour is taking place.

Dr Nagpaul asks if, as a GP, he decides to work with his local hospital to develop services, would that be anti-competitive and will Monitor tell his surgery to refer instead to private providers and the independent sector?

He warns such an arrangement would fragment care and undermine the efforts of GPs to serve their local communities with their local hospital.

Monitor will work alongside a new independent commissioning board whose job is to divide money up between the consortia and oversee what they do.

Much is unknown - not least exactly who is responsible for what and what happens when things go wrong.

Nigel Edwards, acting chief executive of the NHS Confederation, which represents most of the organisations that make up the health service, says that if GPs make decisions that they're not going to provide certain types of treatment, it's not clear who holds them to account.

He points out that if a hospital is not being successful in the market for orthopaedics and decides it wants to stop, under the new system it can do so unless it's an essential service.

"It can just exit the market in the way a shop might leave a town," he told me.

Health Secretary Andrew Lansley knows the NHS inside out after spending six and a half years shadowing his current role. This is his idea.

In opposition he talked about giving more power to GPs but the full scale of what he would propose was not clear.

One senior NHS figure said that this is the sort of change that takes 10 years in times of plenty and we are being asked to do it over 18 months while cutting budgets.

That David Cameron decided to sign off on it could be seen as a huge political gamble.

"I think many people in the NHS have been taken by surprise by how radical it is and the scale of it," says Nigel Edwards.

"It's a complete intellectual system which looks very much like the way gas and telecoms were deregulated in the 1980s rather than a healthcare reform.

"So we've been confronted with what looks like a very elegantly constructed piece of machinery with lots of cogs and levers and things connecting but we've absolutely no idea what will happen when you switch it on."

Friday 19 November 2010

I don't care.

Thought you might like to read this letter to the editor of a British national newspaper. Ever notice how some people just seem to know how to write a letter?

Here is a woman who should run for Prime Minister!
Written by a housewife, to her daily newspaper. This is one ticked off lady.

'Are we fighting a war on terror or aren't we? Was it or was it not started by Islamic people who brought it to our shores on 7 July 2002, and in New York on 11 Sept 2001 and have continually threatened to do so since?

Were people from all over the world, not brutally murdered that day in London, and in downtown Manhattan and in a field in Pennsylvania ?

Did nearly three thousand men, women and children die a horrible, burning or crushing death that day, or didn't they?

And I'm supposed to care that a few Taliban were claiming to be tortured by a justice system of the nation they come from and are fighting against in a brutal insurgency.

I'll start caring when Osama bin Laden turns himself in and repents for incinerating all those innocent people on 9/11 and 7/7.

I'll care about the Koran when the fanatics in the Middle East start caring about the Holy Bible, the mere belief of which is a crime punishable by beheading in Afghanistan

I'll care when these thugs tell the world they are sorry for hacking off Nick Berg's head while Berg screamed through his gurgling slashed throat.

I'll care when the cowardly so-called 'insurgents' in Afghanistan come out and fight like men instead of disrespecting their own religion by hiding in mosques and behind women and children.

I'll care when the mindless zealots who blow themselves up in search of Nirvana care about the innocent children within range of their suicide bombs.

I'll care when the British media stops pretending that their freedom of speech on stories is more important than the lives of the soldiers on the ground or their families waiting at home to hear about them when something happens.

In the meantime, when I hear a story about a British soldier roughing up an Insurgent terrorist to obtain information, know this:

I don't care.

When I see a wounded terrorist get shot in the head when he is told not to move because he might be booby-trapped, you can take this to the bank:

I don't care.

When I hear that a prisoner - who was issued a Koran and a prayer mat, and 'fed special food' that is paid for by my taxes - is complaining that his holy book is being 'mishandled,' you can absolutely believe in your heart of hearts:

I don't care.

And oh, by the way, I've noticed that sometimes it's spelled 'Koran' and other times 'Quran.' Well, believe me!! you guessed it .......

I don't care!!

If you agree with this viewpoint, pass this on to all your E-mail friends. Sooner or later, it'll get to the people responsible for this ridiculous behaviour!

If you don't agree, then by all means hit the delete button. Should you choose the latter, then please don't complain when more atrocities committed by radical Muslims happen here in our great country! And may I add:

'Some people spend an entire lifetime wondering if they made a difference in the world. Our soldiers don't have that problem.'

I have another quote that I would like to add, AND........I hope you forward all this.

Only five defining forces have ever offered to die for you:

1. Jesus Christ

2. The British Soldier.

3. The Australian Soldier.

4. The US Soldier.

5. The Canadian Soldier.

One died for your soul, the other 4 for your freedom.

YOU MIGHT WANT TO PASS THIS ON, AS MANY SEEM TO FORGET ABOUT ALL OF THEM.

AMEN!

ECOLI INFECTION LINKED TO LONG TERM HEALTH PROBLEMS

Local Scientists publish additional results from Walkerton Health Study

LONDON, Ontario – People who contract gastroenteritis from drinking water contaminated with

E coli are at an increased risk of developing high blood pressure, kidney problems and heart

disease in later life, finds a study published on bmj.com today.

The findings underline the importance of ensuring a safe food and water supply and the need

for regular monitoring for those affected.

It is estimated that E coli O157:H7 infections cause up to 120,000 gastro-enteric illnesses

annually in the US alone, resulting in over 2,000 hospitalizations and 60 deaths. However, the

long term health effects of E coli infection in adults are largely unknown.

A team of researchers from Lawson Health Research Institute (Lawson) and The University of

Western Ontario (Western) assessed the risk for hypertension, renal impairment and

cardiovascular disease within eight years of gastroenteritis from drinking contaminated water.

The team used data from the Walkerton Health Study, the first study to evaluate long term

health after an outbreak of gastroenteritis in May 2000 when a municipal water system became

contaminated with E coli O157:H7 and Campylobacter bacteria.

Study participants were surveyed annually and underwent a physical examination and

laboratory assessment to track their long term health.

Of 1,977 adult participants, 1,067 (54%) experienced acute gastroenteritis, of which 378 sought

medical attention.

Compared with participants who were not ill or only mildly ill during the outbreak, participants

who experienced acute gastroenteritis were 1.3 times more likely to develop hypertension, 3.4

times more likely to develop renal impairment, and 2.1 times more likely to have a

cardiovascular event, such as a heart attack or stroke.

“Our findings underline the need for following up individual cases of food or water poisoning by

E coli O157:H7 to prevent or reduce silent progressive vascular injury,” says Dr. William Clark,

Scientist at Lawson, Nephrologist at London Health Sciences Centre and Professor of

Nephrology at Western. “These long term consequences emphasize the importance of

ensuring safe food and water supply as a cornerstone of public health.”

Thursday 18 November 2010

Social care 'everyone's responsibility'

16 November 2010 Last updated at 12:03

Social care 'everyone's responsibility'

Thousands of frail and vulnerable people rely on home care services

Social care should no longer be seen as a right from the state but instead "everyone's responsibility", the government says.

The attempt to change the perception of the sector was made as ministers set out new plans for England.

To achieve this, they promised more support for carers, an increase in personal budgets and a greater role for the voluntary sector.

It comes as an independent commission is looking at social care funding.

Councils are increasingly struggling to provide services such as home help and care home placements because of growing demands.

“Start Quote

Social care is everyone's responsibility. It is not about getting care on the cheap”

End Quote Paul Burstow Care services minister

Send your comments

It is hoped a new system of funding - social care is currently means-tested - could alleviate some of the problems.

Funding

But whatever conclusions are reached next year, councils are still bracing themselves for making funds stretch further and further in the future.

The policy paper unveiled by the government on Tuesday effectively paves the way for this by attempting to change the image of social care.

Richard Jones, the president of the Association of Directors of Adult Social Services, said the sector was facing a "significant funding challenge".

"It is about a shift in perception and helping people understand there is a partnership between the individual, families and the state.

"In the public mindset, people still think you get it free."

The plans set out include an extra £400m over four years for providing more breaks for carers and a £3m fund next year to help invigorate the voluntary sector.

Social care: The sums

The social care budget in England this year stands at £16.6bn - the equivalent of about half of all the spending by councils.

Just over £2bn of the sum comes from personal contributions as social care is means-tested which means everyone with assets of below £23,500 pay some or all of their costs.

In October's spending review, ministers said social care would get an extra £2bn by 2014. The NHS will contribute £1bn of this and the rest will come in the form of a grant from central government.

But with the overall local government pot falling by a quarter, councils and campaigners fear it will prove impossible to fully protect social care budgets.

The government cited projects such as befriending schemes to help tackle social isolation and handy man services for preventing fractures from falls when elderly people try to do DIY as a way community-based schemes could help.

It also set councils a target of achieving full roll-out of personal care budgets by 2013.

Just over a tenth of those eligible currently have the budgets, which allow individuals to decide how their state allocation is spent.

Personal budgets are seen as a prime lever in which to promote greater involvement as they establish a clear agreement about what the state can do to help.

Care services minister Paul Burstow admitted people needed to be more aware of the realities of social care.

But he added: "Social care is everyone's responsibility. It is not about getting care on the cheap."

Wednesday 17 November 2010

The release of climate-science e-mails last November ripped apart Phil Jones's life.

Climate: The hottest year

The release of climate-science e-mails last November ripped apart Phil Jones's life. He's now trying to patch it back together.

"I like to think the worst is over, but it's coming up to the first anniversary and it's something I'll always remember at this time of year, when the nights close in. This is the time it happened."
Twelve months ago, Phil Jones was a productive, if not particularly outspoken, climate scientist. That was the way he liked it. Head of the Climatic Research Unit (CRU) at the University of East Anglia (UEA), UK, Jones worked with the Met Office to compile data from weather stations around the world into a monthly series showing global average temperature. He had much on his mind — not least a puzzling drop in North Atlantic sea surface temperatures during the mid-twentieth century that he had recently helped to discover. It was a curious finding, but Jones would soon have bigger things to ponder.
On 19 November 2009, someone released roughly 1,000 e-mail messages and documents stolen from a server at the CRU. Many of them contained Jones's private correspondence, which sometimes showed him in an unflattering light.
He gloated about the death of a prominent climate sceptic, and suggested to colleagues they should delete e-mails to keep sceptics from gaining access to information. Most famously, he boasted that he had used a "trick" to "hide the decline" in a temperature chart.
Very soon, members of the sceptic community had pounced on these messages as evidence that Jones and others had concealed flaws in their temperature data and abused the peer-review system to gag critics of climate researchers. Jones faced a storm of accusations that ranged from scientific misconduct to plans to install an autocratic world government through the spread of false hysteria about global warming. He received some 200 abusive or threatening e-mails, the most troubling of which targeted him and his family. "Someone, somewhere, will hunt you down," read one. "You are now blacklisted," read another. "Expect us at your door to say hello."
The e-mails also triggered several official investigations, including one by the UK Parliament, which ultimately determined that Jones had not committed any serious offences. Case closed.

Phil Jones.J. McDonald/Getty

Not for Jones, who still faces attacks from critics and is trying to cope with unwanted memories as the anniversary approaches (see 'A career by degrees'). Never comfortable with the media, Jones has given few interviews since the controversy began. But as part of an attempt to put the past year behind him, he agreed to show Nature around the CRU earlier this month and to talk at length about his experience. He proved largely unrepentant.

Aged 58, Jones looks far better than during the darkest days of last winter, when he was spiralling downhill and even contemplated suicide. Colleagues were stunned by his decline. Jones was never an extrovert, but he withdrew further and his mental collapse was mirrored by a rapid loss of weight.
In March, when a frail and hesitant Jones answered questions before an investigating parliamentary committee, his appearance reminded many of the distressing 2003 case of David Kelly. Kelly was the UK weapons inspector outed as the source of a media story about government exaggeration of Iraqi weapons of mass destruction. He was also questioned by a parliamentary committee — and subsequently killed himself. "I made the connection," Jones says about the Kelly case. "But I didn't talk about it."
Jones has regained much of the lost weight, and he no longer takes the medications that kept him calm during the day and asleep at night. He is back in charge of the CRU (he stood aside for some eight months while enquiries were pending). So, how have events of the past 12 months changed him?
"I'm a little more guarded about what I say in e-mails now," he says. "One thing in particular I'm doing is not responding so quickly. I might have got an e-mail in the past and responded with an instant thought in the next 10 to 15 minutes, whereas now I might leave it a day."

“I did wonder why supportive scientists didn’t go to the media.”

Jones admitted in the parliamentary inquiry to sending some "awful e-mails", but defends the right of scientists to express themselves in what they consider personal communications. "People would be saying much the same things at scientific meetings and discussed [them] over dinner. But in an e-mail, it is recorded. People have probably forgotten what you said after a night out."
Although other scientists were quick to defend the reality of man-made global warming, public support for Jones was harder to find. Officially, senior figures in the UK science establishment say this was because they did not want to prejudice ongoing enquiries. Privately, they say that the e-mails looked bad, and should the CRU scientists have been found guilty of misconduct, they did not want to get dragged down with them.
"I was getting lots of messages of support from my fellow scientists," Jones says. "And I did wonder why they didn't go to the media and say the same things they were saying to me."
The CRU server that held the stolen information was seized long ago as evidence from the cluttered desk where it sat in one of the unit's cramped offices. The unit itself is housed in a curious four-storey cylindrical tower at the heart of the busy UEA campus, and it brings to mind a Norman keep within a medieval castle. An appropriate analogy, considering that its occupants have weathered an extended siege that left visible scars on the tower's exterior. Its doorbell was removed to shield the scientists inside from the incessant ringing of journalists and film crews.
Outsiders are often surprised at how small the unit is, with just three full-time staff scientists. Jones's office is on the top floor, where the computer on which he typed many of the e-mails sits amid a carpet of scientific reports and papers. Keith Briffa, a tree-ring specialist, has an office across the landing. Climate researcher Tim Osborn is next door, struggling with a familiar problem. "My inbox is full and I need to delete some e-mails." Then, with a thin smile: "But I'm not allowed to now, am I?"
Temperature data analysed by these researchers serve as the foundation for countless studies, which have steadily identified and analysed the signal of global warming caused by human activities. The growing importance of this work made Jones and other CRU scientists a target for Internet bloggers sceptical of their methods and the conclusions drawn from them. Long before the e-mail scandal, Jones and his team found themselves fielding enquiries about their research from outside the conventional scientific community.
An independent inquiry headed by former senior civil servant Alastair Muir Russell examined many aspects of the work done at the CRU, looking specifically to see if the centre had committed fraud or some other type of scientific misbehaviour. The investigation found no reason to doubt the honesty and integrity of the CRU scientists, but it did criticize the way those scientists responded to information requests, or in some cases, failed to respond. The report said there had been a "consistent pattern of failing to display the proper degree of openness".
Some scientists echo these conclusions. Mike Hulme, a climate researcher at the UEA who worked at the CRU from 1988 to 2000, said that certain aspects of the culture in the research unit were "unwise and unhealthy". He notes in particular that the CRU was slow and inconsistent in responding to data requests, and says it suffered from "intense tribalism". But Hulme says the work at the CRU "was not fraudulent, and certainly did not justify the personalization of the attacks subsequently made on them".
In his defence, Jones says he wrestled with how open scientists should be to requests for information. "I started responding to those back in 2003 and 2004, but they just asked more and more questions and it was just a drain on resources. That's when things probably went awry." He claims he changed tack when he saw that the information he supplied was not used by those who demanded it. Rather, each response simply triggered more questions. "I just realized it was taking up too much time," he says.
By failing to answer all requests properly, Jones says he wasn't acting any differently from other researchers. "There are some people I have sent requests to, other scientists, who have never replied. I've asked people for data and reprints of papers and I've never got a response. So I think I responded quite well and the CRU responded quite well."

“I don’t know that I can offer advice. Whatever you try to do, the goalposts keep moving.”

Jones complains frequently about distractions from his research. "The amount of time we get to do research just seems to be less and less, and you see things that take away that research time, or you find yourself working at weekends or in the evenings to the annoyance of your family." Autumn is a "bad time" because his teaching load increases. He got frustrated with meetings with university officials to discuss freedom of information requests because "it takes away your research time". And he rarely agrees to peer review scientific papers. "If you start doing lots of reviews, you find that your quality research time also goes."
When he did review papers, the stolen e-mails revealed, he told colleagues he "went to town" to make sure that those manuscripts he did not like were not published. The Muir Russell report found there was no abuse of peer review and said such robust exchanges were typical in science. Jones says he learned long ago that he needed to be absolutely clear with editors, because in the past he had written what he thought were critical reviews only to see the papers in question get published. "I realized that to make sure an editor rejects a paper you have to go a bit stronger in the review."
He adds: "The whole point about trying to pervert the peer-review process is that it is impossible to do it. There are so many journals and if people are persistent enough, they can get their papers published."

Another allegation was over his use of data from weather stations in China for a 1990 paper on the impact of urbanization on temperature. The paper¹, published in Nature, stated that data were used from stations where there had been few, if any, changes in instrumentation, location or observation times. When critics later uncovered the fact that many of the stations had moved, they cried fraud; earlier this year, Jones said in a separate interview with Nature² that he was considering a correction.

He now says such a step is unnecessary and that he stands by the claims in the paper. He was on medication during the previous interview, he says, and felt under pressure then to publicly concede that he had made mistakes.
He says the description of weather-station movement "has been completely misinterpreted". The set of 84 Chinese stations referred to in the paper were drawn from a larger group of 265, for which the Chinese had location histories. Jones and his colleagues did not claim that none of the selected stations had moved, only that they picked out ones that had moved the least, he says.
Such shifts do not significantly affect results, Jones says, because there was no general pattern to the station relocation: on average, ones moving to colder places were balanced by ones moving to warmer spots. But the Chinese scientist who supplied the station information has now retired and the authorities there have not released the full station-history data — making it impossible for Jones, he says, to provide the evidence to support the statement.
One issue critics continue to badger Jones about is whether he deleted e-mails that had been requested through the freedom of information process. Jones insists he never did, as that would have qualified as an offence. What about deleting e-mails that could be requested by future freedom of information requests? Britain's Information Commissioner's Office, which adjudicates such cases, says it is allowed. However, the Muir Russell report said that this kind of pre-emptive deletion is not consistent with the "spirit and intent" of the law, and there is evidence that CRU scientists took that questionable approach. When Jones is now asked if he deleted such messages, he says: "No, I deleted e-mails as a matter of course just to keep them under control."
So why did he urge colleagues to delete messages in which they discussed, among other things, the preparation of a report for the Intergovernmental Panel on Climate Change? An attempt to thwart critics, perhaps? "That was probably just bravado at the time," he says. "We just thought if they're going to ask for more, we might as well not have them."
Then Muir Russell was correct? Had Jones broken the spirit of the law? "Not necessarily, if you've deleted them ahead of time," he says. "You can't second guess what's going to be requested." Jones goes back and forth on his motivations. Deleting e-mails would simplify his life if people requested them in the future, but that was not why he got rid of them, he says. "I deleted them based on their dates. It was to keep the e-mails under control," he repeats.
A source close to the CRU says it is almost impossible to determine who deleted what and when — much less why. More certain is the conclusion that the hack of the server was a sophisticated attack. Although the police and the university say only that the investigation is continuing, Nature understands that evidence has emerged effectively ruling out a leak from inside the CRU, as some have claimed. And other climate-research organizations are believed to have told police that their systems survived hack attempts at the same time.

Jones and others connected to the CRU fear the hackers may be sitting on more stolen e-mails, but Jones feels confident the worst is behind him. "It really is not somewhere I would like to go through again. But having been through it once, I think I am a bit hardened to it."
Can Jones offer any advice to research scientists who wake up one morning to find themselves the centre of a worldwide scientific scandal? "I don't know that I can. The thing to point out is that whatever you try to do, the goalposts keep moving." As soon as he responded to one criticism, another popped up.

Jones has steadily begun to piece together his professional as well as his personal life. The discovery of the sudden Atlantic cooling was recently published in Nature³ and he has started to attend conferences again. He agrees to pose for photographs outside the CRU building, gazing at the blue sky. Then he shuffles back into the relative calm of his unit: one scientist who now realizes his castle walls cannot completely shield him from the outside world.

Why garlic is good for the heart

The smell may be a healthy sign

Researchers have cracked the mystery of why eating garlic can help keep the heart healthy.

The key is allicin, which is broken down into the foul-smelling sulphur compounds which taint breath.

These compounds react with red blood cells and produce hydrogen sulphide which relaxes the blood vessels, and keeps blood flowing easily.

The University of Alabama at Birmingham research appears in Proceedings of the National Academy of Sciences.

Our results suggest garlic in the diet is a very good thing

Dr David Kraus
University of Alabama

However, UK experts warned taking garlic supplements could lead to side effects.

Hydrogen sulphide generates a smell of rotten eggs and is used to make stink bombs.

But at low concentrations it plays a vital role in helping cells to communicate with each other.

And within the blood vessels it stimulates the cells that form the lining to relax, causing the vessels to dilate.

This, in turn, reduces blood pressure, allowing the blood to carry more oxygen to essential organs, and reducing pressure on the heart.

The Alabama team bathed rat blood vessels in a bath containing juice from crushed garlic.

Striking results

This produced striking results - with tension within the vessels reduced by 72%.

The researchers also found that red blood cells exposed to minute amounts of juice extracted from supermarket garlic immediately began emitting hydrogen sulphide.

Further experiments showed that the chemical reaction took place mainly on the surface of the blood cells.

The researchers suggest that hydrogen sulphide production in red blood cells could be used to standardise dietary garlic supplements.

Lead researcher Dr David Kraus said: "Our results suggest garlic in the diet is a very good thing.

"Certainly in areas where garlic consumption is high, such as the Mediterranean and the Far East, there is a low incidence of cardiovascular disease."

Judy O'Sullivan, a cardiac nurse at the British Heart Foundation, said: "This interesting study suggests that garlic may provide some heart health benefits.

"However, there remains insufficient evidence to support the notion of eating garlic as medicine in order to reduce the risk of developing coronary heart disease.

"Having garlic as part of a varied diet is a matter of personal choice.

"It is important to note that large amounts in supplement form may interact with blood thinning drugs and could increase the risk of bleeding.

Garlic 'remedy for hypertension'

17 November 2010 Last updated at 01:48

Garlic 'remedy for hypertension'

By Helen Briggs Health reporter, BBC News

Some experts recommend taking a clove of garlic a day

Garlic may be useful in addition to medication to treat high blood pressure, a study suggests.

Australian doctors enrolled 50 patients in a trial to see if garlic supplements could help those whose blood pressure was high, despite medication.

Those given four capsules of garlic extract a day had lower blood pressure than those on placebo, they report in a scientific journal.

A UK heart charity said more research was needed.

Garlic has long been though to be good for the heart.

Garlic supplements have previously been shown to lower cholesterol and reduce high blood pressure in those with untreated hypertension.

In the latest study, researchers from the University of Adelaide, Australia, looked at the effects of four capsules a day of a supplement known as aged garlic for 12 weeks.

They found systolic blood pressure was around 10mmHg lower in the group given garlic compared with those given a placebo.

Researcher Karin Ried said: "Garlic supplements have been associated with a blood pressure lowering effect of clinical significance in patients with untreated hypertension.

"Our trial, however, is the first to assess the effect, tolerability and acceptability of aged garlic extract as an additional treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension."

Experts say garlic supplements should only be used after seeking medical advice, as garlic can thin the blood or interact with some medicines.

Ellen Mason, senior cardiac nurse at the British Heart Foundation, said using garlic for medicinal purposes dates back thousands of years, but it is essential that scientific research proves that garlic can help conditions such as raised blood pressure.

She said: "This study demonstrated a slight blood pressure reduction after using aged garlic supplements but it's not significant enough or in a large enough group of people to currently recommend it instead of medication.

"It's a concern that so many people in the UK have poorly controlled blood pressure, with an increased risk of stroke and heart disease as a consequence. So enjoy garlic as part of your diet but don't stop taking your blood pressure medication."

The study is reported in the journal Maturitas.

Monday 15 November 2010

Cosmetic surgeon concerned over 'guinea pig' patients

14 November 2010 Last updated at 07:45

Cosmetic surgeon concerned over 'guinea pig' patients

By Adrian Goldberg Presenter, 5 live Investigates

surgeon working on patient with hip x-ray in background.

Some medical devices and implants used in the UK do not have to undergo independent clinical trials

A leading UK cosmetic surgeon claims patients are treated like "guinea pigs" because medical implants do not need to undergo independent clinical trials.

Nigel Mercer spoke out after complaints about problematic breast implants and hip replacements.

Speaking to BBC 5 live he described current regulation as weak, saying the regulator needed to "have teeth".

The Medicines and Healthcare Products Regulatory Agency (MHRA) said it takes its role "very seriously".

Mr Mercer, who is a former president of the British Association of Aesthetic and Plastic Surgeons, says one of the key areas of concern is a breast enhancer called a Poly Implant Prosthesis (PIP). This has been fitted to more than 50,000 women in the UK since it was introduced in 2004.

PIP implants are no longer recommended for use in Britain amid growing evidence that it is prone to rupture, leaving patients in pain and uncertain about the long-term effects.

“Start Quote

I have to live with that in my body for the rest of my life. No-one can actually tell me if that's going to be a problem in the future or not”

End Quote Catherine Kydd Breast implant patient

Catherine Kydd, from Dartford in Kent, only realised her implant had split after being sent for a mammogram and ultrasound scan when she found a lump in her breast.

Her relief at being told she did not have cancer was tempered by anger at the discovery that the silicon in her implants had leaked and spread into her lymph nodes.

"I'm outraged and upset," she told the BBC's 5 live Investigates programme.

"I have to live with that in my body for the rest of my life. No-one can actually tell me if that's going to be a problem in the future or not."

Ms Kidd says she raised her concerns with the MHRA in 2009 but no action was taken at the time.

'Designed for mattresses'

It was only in April this year, after France banned PIP implants, that the MHRA followed suit and advised doctors in the UK not to use them.

The Poly Implant Prosthesis breast enhancement is no longer recommended for use in Britain

Since then, it has emerged that after winning approval for the implant, the manufacturer changed the gel inside the device to one designed for mattresses.

Tests have shown that the strength of the gel-filled shells is not up to standard, increasing the chance they could rupture.

For surgeon Nigel Mercer, this highlights the regulatory confusion surrounding medical devices - a broad-ranging category which includes orthopaedic beds, artificial joints and medicine bottles.

He says unlike drugs, which have a strict testing regime, companies making medical devices have to get a European CE safety mark, which then allows their products to be sold in Britain, often without independent clinical trials.

“Start Quote

The public are being used as guinea pigs”

End Quote Nigel Mercer Leading plastic surgeon

Mr Mercer said: "A medicine has to be tested very rigorously, it has to go through different levels of testing before it goes to market and that process can sometimes take years.

"It means at every step along the way it's tested for toxicity, to see if people are allergic and it's tested for how it's delivered and how good it is.

"That process costs tens of millions of pounds and takes years to do. With a medical device you go to the two bodies in Brussels who produce CE marks.

"There are existing standards as to how any medical device is produced. As long as you follow those standards, and you have that inspected, you produce that device and sell it."

The result, he says, is that, "the public are being used as guinea pigs."

The MHRA, which is responsible for the regulation of medical devices and equipment used in healthcare, as well as the investigation of harmful incidents, responded by saying:

"The MHRA takes its role very seriously and works with other member states to ensure that only compliant devices are placed on the market."

'Rotting away'

A similar row has also erupted over the use of a new kind of artificial hip manufactured by DePuy, a French subsidiary of the respected manufacturer Johnson and Johnson.

A new artificial hip used in the UK was not required to undergo independent clinical trials before use.

The DePuy ASR hip has now been withdrawn following reports that metal shards broke off and lodged themselves in patients' bodies after being fitted.

Charlotte Bird from Suffolk was one of those who suffered as a result: "It had been rotting away and I had been rotting away around it.

"I couldn't work. It never felt right. It just held me back completely.

"It was completely depressing. Friends were worried about me - it was misery and never getting better."

DePuy has told 5 live Investigates that it was not required to carry out a clinical trial, but says that its artificial hip was subjected to numerous laboratory tests.

These included tests on the materials used, as well as the product's performance using hip simulators which looked at how well the device wore over time.

LISTEN TO THE FULL REPORT

Hear the full report on 5 live Investigates, on Sunday 13 November at 2100 GMT on BBC Radio 5 live.

Since the product was launched, DePuy says it continued to evaluate the ASR hip system.

That is little comfort to Charlotte, who condemned the lack of vigilance among the regulators.

She said she was not told it had not been subject to independent clinical trials.

"I was just told it was marvellous and it was the new way of doing it," she said.

The MHRA says it investigates all reported adverse incidents involving medical devices, where there is a risk of death or serious injury to patients, and takes action when it becomes clear that there is a need to do so. In a statement, the MHRA said:

"We encourage everyone - the public and healthcare professionals, as well as the industry - to tell us about any problems with a medicine or medical device, so that we can investigate and take any necessary action."

However, surgeon Nigel Mercer says recent evidence relating to problems with a number of medical devices suggests this is not good enough:

"The regulator needs to have teeth and be able to regulate these businesses."

You can hear the full report on 5 live Investigates on Sunday, 14 November at 2100 GMT on BBC Radio 5 live.

You can also listen again on the BBC iPlayer or by downloading the 5 live Investigates podcast.

Send your comments and stories to 5 live Investigates

People 'denied' die at home wish

14 November 2010 Last updated at 13:40

People 'denied' die at home wish

A nurse helping a terminally ill patient put on some make-up

Two in five people who die in hospital are terminally ill and could be cared for elsewhere

Too many people are dying in hospitals and care homes, and not at home the way they want to, says a report from Demos.

Of the 500,000 people who die each year in the UK, the think tank found only 18% die at home, yet 60% of people surveyed would like to.

Investing in community-based end of life care would also save the NHS money in the long term, the report says.

The Department of Health is reviewing funding for England. Services in the rest of the UK are funded locally.

The report, entitled Dying for Change predicts that by 2030 more people will die in hospital (65%) and fewer people will die at home (just one in 10 people).

In 10 years, Demos predicts that 20% of people will die in care homes, a figure currently at 17%.

Yet a poll of 2,127 people carried out as part of the report shows that two in three people would prefer to die at home, surrounded by family and friends.

“Start Quote

People are dying over a longer period, losing first their memory and then their physical capacities...”

End Quote Charles Leadbetter Demos

This equates to more than 190,000 people dying in hospital each year when they would rather be at home.

Not everyone who dies in hospital knows they are going to, but many do.

Two in five people who die in hospital do not have curable conditions and most people will be ill for six years before they die.

It is estimated that 20% of hospital beds are currently taken up with caring for people who are dying.

Funding injection

The report says that investing £500m more a year would allow more of these people to die at home or with support in the community.

Setting up new places for people to die close to home, training volunteers to support the terminally ill, a 24-hour nursing support service and an "end of life telephone help line" are all suggestions the report makes on how this money could be spent.

It also proposes setting up a national "hospice at home" service to help support people dying at home.

More provision should be made for people to die in hospices and at home, the report says

Demos claims that making this investment would result in fewer and shorter hospital admissions, helping the NHS save money in the long term.

At present, around £20bn of NHS services is spent on end-of-life care.

This is forecast to rise to £25bn in 2030.

Charles Leadbeater, co-author of the Dying for Change report said: "It's not just that we're living longer; part of this means that people are dying over a longer period, losing first their memory and then their physical capacities in stages.

"If we put in the right kind of supports for people to cope at home, many tens of thousands of people could have a chance of achieving what they want at the end of life; to be close to their family and friends, to find a sense of meaning in death."

Care services minister Paul Burstow said the government wanted to ensure that the care people receive at the end of life is "compassionate, appropriate and gives people choices in where they die and how they are cared for".

"Identifying people approaching the end of life and advance care planning is an essential part of this," he said.

"We are consulting on extending patient choice and want to move towards a national choice offer that supports those who wish to die at home."

David Prailll, chief executive of the charity Help the Hospices, said the report would help to stimulate public debate.

"It also makes some very interesting suggestions about specific practical steps that could be taken at a national level and these merit deeper investigation."

"Seventy per cent of hospice care takes place in people's homes and a growing number of hospices - already over two-thirds - provide support to care homes to make sure residents get the palliative care they need," he said.

BBC News website readers have been sending in their reaction. Here is a selection of comments:

My husband was terminally ill with Angio Sarcoma at Guy's Hospital in August 2004. The doctor came to tell him that the cancer has spread to his other lung too. My husband said he would like to go home and yet the doctor made me feel that it would be more suitable if he stayed in the hospital. I did not understand why it would be more suitable for him to stay there. He died four days later. He was so sedated that he died without us getting a chance to say goodbye to him. I still keep worrying that I let him down by not insisting on him coming home. I still have not got over the way he died. It was so impersonal. Ranjna, London

My father died at home several years ago, which was his wish. He had been in and out of hospital and spent time in a local hospice, but it was at home where he wanted to be, and where my mother could best care for him. The GP was superb, there was a district nurse visiting regularly to help us prepare for his death, and although desperately sad for the family, it was what he and my mother wanted, and they were at peace with that. Penny, Dorset

I lost my mum and although she was totally dependant on me in the last years of her life, when it came to the end she died in hospital. I suppose because I couldn't bear to be alone when she died, not knowing if I was doing everything to make her going as painless as possible. I know in my heart that she would have forgiven me taking her in hospital but it is so hard for the loved ones to make that decision. We all, in an ideal world, would like to just go to sleep in our own bed at the end but real life isn't like that. Daisy, Reading

My mother died today in a care home. In her last few weeks she has needed continuous care and kindness to keep her clean, as she was incontinent. A hoist was needed to raise her weak body and a special bed was used to prevent bed sores and aid her in being fed. It is a nice idea that we should all die where we want to but life is not like that. My mother would also not have wanted to die in a care home but as it happens she had dementia and didn't know where she was. She had the very best of care, the bedroom was equivalent to her bedroom at home, so what is wrong with that? People would not get 24 hour care if they stayed in their own homes and the expense would be enormous if they privately hired a 24 hour a day carer. Christine, Portsmouth

I work for the NHS and it is very frustrating that patients can't die at home because of the paperwork. Sometimes it is also very dependent on your postcode. If your GP is in one PCT and you live in the next borough, you are not entitled to services as they do not receive from that borough. I speak from experience as I have recently had battles with two PCT's in getting services so that my patient could die at home. One solution given to me was that the patient changes his GP, but this is not always suitable when you have been with a particular GP and have built a relationship. As a health care professional I try very hard to give my patients the choice of dying at home. Suki, Harrow

My mum passed away only a couple of months ago and it was her wish to die in hospital. She was terrified of dying at home for many reasons. I have to say that the hospital was superb and cared for her wonderfully and I can also say she died feeling safe. Whilst many people do wish to die at home, it should be realised that many people feel safer in a medical situation, where there are nurses and doctors around to make them comfortable. Rob, Lancashire

My mother was able to die at home but only because of my persistence. She had a major stroke on 18 June and was in hospital for four days. She had signed a "Living Will" five years before and we knew her wishes, so she was not being artificially fed but just kept comfortable. When she indicated her wish to go home, the hospital made it appear an impossibility. Luckily I have friends in the NHS and was able to take their advice and through the "Fast Track for the terminally ill" was able to get her home within 24 hours. She had 36 hours in her own bedroom before dying. Jinny, Wales

Thursday 25 November 2010

Care homes 'closed' for poor standards remain open

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Monday 22 November 2010

Carbon emissions fell in 2009 due to the recession therefore can we conclude

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Friday 19 November 2010

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Wednesday 17 November 2010

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Monday 15 November 2010

Cosmetic surgeon concerned over 'guinea pig' patients

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