Monday, 25 October 2010

He also said a patient who had a biopsy on his prostate which was positive for cancer had to wait six months to be seen by a consultant.

Three senior NHS staff in London claim they have been suspended for whistle-blowing after raising concerns about the hospitals they work in.

Three senior NHS staff in London claim they have been suspended for whistle-blowing after raising concerns about the hospitals they work in, but have been given other reasons for keeping them off work.

As NHS staff they are entitled to protection under the Public Disclosure Act 1998 from dismissal or victimisation if they have concerns about misconduct and malpractice.

But the three health trusts concerned have denied suspending them for speaking out.

The trio became whistle-blowers because of fears about standards of care, they told BBC London's Inside Out programme.

Ramon Niekrash, a surgeon at Queen Elizabeth Hospital in Woolwich, south London, said he complained to his manager because he did not believe local health services were "adequate" or "safe".

"The concerns related to staffing levels" and the number of clinical nurse specialists for cancer, he said.


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"I was escorted to the chief executive's room," he said

"They basically said that a number of concerns had been raised [about me] and that I was to be suspended."

Mr Niekrash subsequently won a legal battle to be reinstated but had to pay a £140,000 legal bill.

The South London NHS Trust said: "We believe that the process of events which happened to Mr Neikrash would not happen now.

"We are working with clinicians… to get better reporting and processes in place so that genuine concerns about patient safety are heard, considered properly and appropriate action taken to correct problems."

'Stunned and humiliated'

Radiologist Sharmila Chowdhury was the imaging services manager in charge of 60 staff when she was "marched off the premises" at Ealing Hospital in west London.

She claimed to have discovered what she believed were "anomalies" in her department's budget.

"My main role was to manage the budget, day in, day out. I was concerned because I wasn't sure I hadn't got it wrong.

"When I found anomalies I did raise the issues with the line manager and senior managers."

She said she was "stunned and humiliated" by her treatment.

Ealing Hospital NHS Trust said there was "an ongoing internal process" regarding her case and it would not comment further "at this stage".

'Clear my desk'

Henry Fernandez, a nurse with the Kent and Medway NHS Trust, received a £70,000 settlement before a tribunal was due to take place, after he made complaints about his department.

He said he was told "to go back to my office, clear my desk and get off the premises".

In Mr Fernandez's case the Trust did not accept he was penalised for whistle-blowing and said that "an out-of-court settlement was discussed with Henry Fernandez for unfair dismissal but no agreement was reached".

An ambulance Several NHS staff told Inside Out they were suspended for highlighting concerns

"We do not consider the Public Disclosure Act to apply in this case as Henry Fernandez was not an NHS whistle-blower," it added.

Inside Out has spoken to other NHS staff who said they had been suspended for highlighting concerns at work.

They said they were still being paid by their employers but had not been allowed to return to work.

A Freedom of Information (FoI) request by the programme discovered nearly 600 NHS staff in London were suspended in 2009/10.

A total of 56 of London's 71 hospitals responded to the FoI request asking how many staff were suspended last year.

There were 514 staff, plus 84 doctors and dentists who are being were paid to stay away from work.

The cost of their wages reached a figure of £3m.

However these figures cover suspensions for reasons which include illness, "gardening leave" between jobs and those who have been suspended but claim the action taken against them was for whistle-blowing.

You can see more on this story on Inside Out on BBC One in London at 1930 BST on Monday 25 October.

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The economic benefits of preserving the natural world

Nature's gift: The economic benefits of preserving the natural world


A man tending wild bees Forests and the insects than live in them provide huge economic benefits
Slowing down the destruction of the Earth's natural resources is essential if the global economy, and the businesses that drive it, are to prosper long term.
The current rate of destruction is estimated to cost the world trillions of dollars every year, and the damage will only get get worse unless wide-ranging measures are taken to stop it.
The reason is simple - population growth is the main driver behind those factors that are causing biodiversity loss.


Biodiversity: The threat to nature

There are currently about 6.7 billion people living on Earth, and this number is projected to grow to 9.2 billion by 2050 - that's roughly the population of the UK being added to the planet every year.
This means we'll need 70% more food, according to the United Nations (UN), just one of the many additional pressures on Earth's finite resources.
If left unchecked, these pressures will lead to the ever-faster destruction of nature, which could cost the world $28.6tn (£18.2tn), or 18% of global economic output, by 2050, according to the UN-backed Principles of Responsible Investment and corporate environmental research group Trucost.
That's about twice the current output of the US, the world's biggest economy.
Valuing nature
So what can be done?
A vital step has already been taken - for the first time in history, we now have at least a rough idea of the economic cost of depleting the earth's natural resources.
Shrimp farm The economic value of mangroves is often greater than the shrimp farms that replace them
This not only means that governments, businesses and consumers can understand the gravity of the problem, but it also means the value of nature can be factored into business decisions.
As Will Evison, environmental economist at PricewaterhouseCoopers (PwC), says: "No-one is saying we should just stop converting pristine land, just that the value of the environment is recognised".
For example, a study on the conversion of mangroves to commercial shrimp farms in southern Thailand estimated the net economic returns at $1,122 per hectare a year.
The conclusion, at least for the shrimp farmer, is clear - there is an economic benefit of converting the mangroves.
But once the wider costs of the conversion - what economists call externalities - are taken into account, a very different conclusion is reached.
Directors' bonuses don't have to be included [in company accounts] from a pure profit and loss point of view, but they are. Environmental externalities should be the same”
End Quote Pavan Sukhdev Teeb
The economic benefits from the mangroves of collecting wood, providing nurseries for offshore fisheries and protection against storms total $10,821 a hectare, far outweighing the benefits of converting them into a shrimp farm.
Damage limitation
There are a number of initiatives, some already introduced and some in the pipeline, that are specifically designed to ensure that the economic value of nature is recognised.
One example is reduced emissions from deforestation and forest degradation, or REDD, under which forest owners are paid not to cut down trees. A number of governments across the world have committed hundreds of millions of dollars to these projects.
Another is habitat banking, the market for which currently stands at around $3bn in the US, where companies that degrade natural areas are forced to restore nature elsewhere.
Trade in forest conservation obligations in Brazil and ground-water salinity credits in Australia have also proved successful.
Alongside these schemes and those like them, there are various compensation arrangements that make those causing environmental damage pay for it, just like carbon credits that currently exist.
Exemptions from these various taxes, charges and fees, as well as subsidies, are also used to encourage environmentally responsible behaviour.
There is also growing pressure for companies to begin incorporating the costs of the damage that they do to the Earth's natural resources into their profit and loss accounts.
Rainforest Governments have committed hundreds of millions of dollars to preserving rainforests
Only by incorporating these costs into their accounts, many argue, will companies be forced to reduce their impact on the natural world.
"Directors' bonuses don't have to be included [in company accounts] from a pure profit and loss point of view, but they are. Environmental externalities should be the same," says Pavan Sukhdev, a career banker and team leader of the United Nations' The Economics of Ecosystems and Biodiversity (Teeb) study.
"This is not a straightforward process and needs standard methodologies accepted by everyone, but it could be achieved within 10 years."
The next step would be to incorporate environmental assets into national accounts.
Protecting assets
But many companies already do acknowledge the costs of biodiversity loss.
A survey conducted by PwC earlier this year found that 27% of chief executives were either "extremely" or "somewhat" concerned about biodiversity loss, but there was a large disparity between those operating in developed economies and those in emerging markets.
Percentage of global chief executives concerned about biodiversity loss
Indeed many multinational companies have made significant investments in protecting the natural resources upon which their success depends.
These include investments to mitigate the impact of tighter regulation, such as shipping giant Swire's decision to buy up swathes of rainforest to offset the possible introduction of pollution taxes in the shipping industry.
Indeed those companies that are well prepared for more stringent regulation, and have made the necessary investment in protecting the natural assets that serve them, will gain an important competitive advantage.
But it's not just a question of risk mitigation - there are also opportunities for companies that act in an environmentally responsible manner.
Brewing giant SABMiller has made considerable investments in reforestation in Columbia and South Africa, as well as setting stringent targets for reducing water consumption - commitments, it says, that helped the company secure licences to brew in Australia, "because the authorities trust that we will be water efficient", says Andy Wales, the brewer's global head of sustainable development.
Contrast this with mining group Vedanta, which has been denied permission both to expand its aluminium operations and to mine bauxite in India after campaigners claimed the company had ignored the needs of indigenous peoples.
Consumer attitudes
Companies also recognise that they need to react to increasing customer awareness of environmental issues.
For example, another survey conducted by PwC in May found that more than half of UK consumers were willing to pay between 10% and 25% more for goods up to £100 to account for their impact on the natural world.
Recyclable water bottle More companies are investing in sustainable practices to meet consumer demand
Such changing consumer attitudes mean that more and more companies are investing in reducing their impact on nature.
For example, the world's biggest retailer Walmart has introduced sustainability criteria as part of its official product sourcing process.
Coffee giant Starbucks has also invested millions of dollars in protecting natural resources because "we know maintaining biodiversity makes a difference to our coffee drinkers" according to Tim McCoy, the company's head of communications.
Natura, the Brazilian cosmetics group with a turnover of $2.4bn, has committed to sourcing products sustainably from natural sources in order to appeal to consumers, while French energy group GDF Suez has invested in conserving biodiversity on its landfill sites purely as part of its "reputational risk management".
Google Maps has even launched a service that allows users to track changes in forest cover across the world.
Sub head
Not everything some companies say about their environmental commitments can be believed, but the fact that they are saying it at all is what's important, says Mr Sukhdev.
"Once you get away from denial, you pass through a phase of understanding and then one of empty rhetoric before you arrive at action. The stage of empty rhetoric is part of the process."
And those companies that do take action will win out in the long run.
The costs of failing to protect the Earth's natural resources and the services they provide, and the price of failing to grasp the opportunities that investing in nature present, are simply too great for those that do not.
The first looked at the full impact of the degradation of the natural world on the global economy - both on business and consumers.
The second looked at the direct costs to businesses, both large and small.


Tetraplegic man's life support 'turned off by mistake'


Tetraplegic man's life support 'turned off by mistake'

Nurse Violetta Aylward was captured on film accidentally switching off her patient's ventilator, leaving him brain-damaged.
An agency nurse working for the NHS was filmed switching off her patient's life support machine by mistake.
Tetraplegic Jamie Merrett, 37, had a bedside camera set up at his home in Wiltshire, after becoming concerned about the care he was receiving.
Within days, it captured the moment Violetta Aylward switched off the ventilator, leaving him brain-damaged.
Ambition 24hours, which supplied her, said it could not comment as an internal investigation was continuing.
A confidential report by Wiltshire social services into the incident - leaked to the BBC's Inside Out programme - concluded the agency was fully aware it was required to supply a nurse with training in the use of a ventilator, but the company did not have adequate systems in place to check what training their staff had received.
Mr Merrett, from Devizes, has been cared for at home on a life-support machine since 2002 after being left paralysed from the neck downwards following a road accident.
Jamie Merrett in his wheelchair Despite being tetraplegic, Mr Merrett was able to use a wheelchair and a voice-activated computer
Despite his disabilities, he was able to talk, use a wheelchair and operate a computer using voice-activated technology.
His sister Karren Reynolds said he had become increasingly worried about serious errors involving nurses operating his ventilator, but claimed that health bosses did not act on e-mails of concern which he sent them.
In January 2009, he arranged to have a camera installed in his room. A few days later, the ventilator was switched off.
After 21 minutes, the machine was eventually restarted by paramedics but by then Mr Merrett had suffered serious brain damage.
Legal action
Ms Reynolds, who is considering legal action, said his level of understanding had dropped to that of a young child.
"His life is completely changed. He doesn't have a life now," she said.
"He has an existence but it's nowhere near what it was before. He is very brain damaged compared to what he was before. He was a highly intelligent man and you could have long in-depth conversations with him and now it tends to be more simplistic."
Violetta Aylward A review found the firm that supplied Ms Aylward did not have adequate systems to check staff training
The solicitor acting for Mr Merrett, Seamus Edney of SJ Edney in Swindon, said: "In my experience, this is the worst case of negligence on the part of a nurse.
"No-one has come forward to make any admission, so now almost two years after the event we are trying to get someone to admit liability for what has happened."
The NHS Wiltshire Primary Care Trust said in a statement: "[We have] put in place a series of actions to ensure that such an event will not occur again either for this patient or others. The incident is the subject of likely litigation so the PCT is restricted in what further it may say in public."
Ms Aylward has been suspended while the incident is investigated by the Nursing and Midwifery Council.
Their guidelines say a nurse should work within their level of competence and have the skills to undertake whatever care they are delivering.
Ms Aylward, who is from Reading, has not responded to requests for an interview.
The programme will be shown on Inside Out West and Inside Out South on BBC One at 1930 BST on Monday 25 October.

Company history

ambition part of the A24 group




1996
Established, 24 nursing, UK branches.
Ambition 24hours was launched in 1996 as a temporary staffing agency to meet for the first time the need for a 24-hour staffing service in the nursing sector. Following rapid growth, over the next decade the company expanded the service to cover locum doctors, allied health professionals, carers, social workers and teachers & lecturers, and we established a national network of UK branch offices.


2004
Expanding into South Africa.
In 2004, Ambition 24hours – the A24 Group - expanded into South Africa, opening back-office facilities for the UK and SA markets. We also launched an £11 million ($17.25 million), three year investment plan in South Africa, based at 130,000 sq ft (12,000 m²) freehold premises acquired in Cape Town. We also initialised locum and nursing agency services in South Africa: 2004 marked the launch of domiciliary home care services, to provide private nursing and care giver directly to people at home for post-operative, geriatric, paediatric and other care.


2006
Our first major acquisition: NSSA.
In 2006, the company made its first major acquisition: that of South African agency NSSA (Nursing Services of South Africa), the largest provider of temporary nursing personnel in the country, supplying over 3,000 staff each month. A second office opened at 50 on Long Street, Cape Town.


2009
More service agencies & offices.
In 2009, Nursing Services of the UK and Locum Services of the UK, the UK divisions of The Nursing Services of South Africa which operates through its UK branch NS Health Staffing, was launched.
Today Ambition 24hours is a multi-million dollar medical staff recruitment and management organisation operating with multiple brands in the United Kingdom and South Africa.
The A24 Group has interviewers based nationally throughout the two countries and employs over 300 office staff across the world, with 27,500 personnel on its books - locum doctors, nurses, allied health professionals, care givers, teachers and social workers for major institutional service providers in two continents.


2010
We expand even more...
Arabella Health Staffing Ltd - a wholly-owned subsidiary of the A24 Group – acquired BNA, The British Nursing Association, and its associated nursing agency brands Grosvenor Nursing and Mayfair Specialist Nursing. Pinnacle Staffing Group Plc, the owner of BNA, accepted an offer for a consideration in cash of £2,750,000.

Sunday, 24 October 2010

Hospital beds in England may fill up with the elderly and vulnerable because of cuts to local authority social care funding, a top NHS figure has warn

Hospital ward Councils in England face a big cut in central government funding over the next four years

Hospital beds in England may fill up with the elderly and vulnerable because of cuts to local authority social care funding, a top NHS figure has warned.

The claim came from the head of the NHS Confederation, Nigel Edwards, in a letter to the Daily Telegraph.

Mr Edwards said people who needed medical treatment may be denied a hospital bed as a result of the cuts.

The Department for Health responded that an extra £2bn was being allocated to protect social care.

Health spending was ring-fenced in Chancellor George Osborne's Spending Review.

However, councils in England are facing a 27% cut in central government funding over the next four years.

Mr Edwards, whose organisation represents health service bodies in England, said the £2bn "interim solution to social care funding" announced in the Spending Review would be a "welcome relief to many"

Bur he said the funding squeeze could still have a "knock-on effect" on the health service.

In his letter to the Telegraph, Mr Edwards said: "Less support from council services will quickly lead to increased pressure on emergency services and hospitals.

"Hospital beds will be blocked for those who badly need care because the support services the elderly require after discharge will not be available."

Spending Review: Key measures

• £81bn cut from public spending over four years

• 19% average departmental cuts - less than the 25% expected

• £7bn extra welfare cuts, including changes to incapacity, housing benefit and tax credits

• £1.8bn increase in public sector pension employee contributions by 2014

• Rise in state pension age brought forward

• 7% cut for local councils from April next year

• Permanent bank levy

• Rail fares to rise 3% above inflation from 2012

He added: "When it comes to the care of the most vulnerable in our society, it really is essential that the NHS and local authorities are in it together."

The Department of Health said it understood that "social care can impact on NHS demands".

A spokeswoman said: "That's why we are strengthening programmes like re-ablement and the 30-day re-admission tariff, which will integrate hospital care with care in the community.

"We have allocated an additional £2bn by 2014-15 - this extra boost, alongside an ambitious programme of efficiency, will ensure that there is enough funding available both to protect people's access to services and deliver new approaches to improve quality and outcomes.

"We expect local health and social care professionals will work together to ensure that the funding is spent on joint health and social care priorities and improve outcomes for everyone."

Councillor David Rogers, from the Local Government Association, said the extra £2bn would not go very far.

"Of course that is very welcome, but as part of what councils said to the government before the Spending Review, there's likely to be a gap over that same time of about £6bn.

"So, there are still going to be difficulties. But I think that the important thing is to ensure that both councils and the NHS locally work increasingly closely together to provide the best service to our residents."

On Thursday, critics expressed concerns over whether the £2bn earmarked for social care, half of which is to come from a direct grant to local government, would reach its intended target.

Jennifer Dixon, chief executive of the Nuffield Trust think tank, said: "The reality is that local authority budgets will be stretched and funds for social care are not ring-fenced, so the extra £1bn per year is by no means certain."

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Friday, 22 October 2010

Spending Review: Clegg attacks IFS 'unfair' cuts claim

Spending Review: Clegg attacks IFS 'unfair' cuts claim

Nick Clegg Nick Clegg said ministers "fundamentally disagreed" with the IFS

Deputy Prime Minister Nick Clegg has launched a direct attack on a leading think tank after it branded the government's Spending Review "unfair".

The Institute for Fiscal Studies has said poorer families with children will be the "biggest losers" of the cuts.

But Mr Clegg told the Guardian newspaper that the IFS's definition of fairness was "complete nonsense".

He said it took account only of tax and welfare and ignored factors like access to public services and social mobility.

Labour has called the planned £81bn over four years a "reckless gamble" with the economy that leaves children "hardest hit".

It has been estimated that the cuts will lead to the loss of 490,000 public sector jobs.

On Thursday, at a public question-and-answer session, Mr Clegg called for a more "balanced" assessment of what the coalition was doing and accused some critics of its measures of "frightening people".

'One prism'

The IFS think tank argues that the Spending Review is "more regressive than progressive".

Excluding the wealthiest 2% of the population, who the IFS assesses will be the hardest hit, it says the poorest 10% of the population will, on average, lose about 5.5% of their net income compared with roughly 4.5% for the top 10%.

In a direct response to the think tank's criticisms, Mr Clegg told the Guardian that he and other ministers "fundamentally disagree with the IFS".

"It goes back to a culture of how you measure fairness that took root under Gordon Brown's time, where fairness was seen through one prism and one prism only, which was the tax and benefits system," he said.

"It is a complete nonsense to apply that measure, which is a slightly desiccated Treasury measure. People do not live only on the basis of the benefits they receive.

"They also depend on public services, such as childcare and social care. All of those things have been airbrushed out of the picture by the IFS."

KEY MEASURES

  • £81bn cut from public spending over four years
  • 19% average departmental cuts - less than the 25% expected
  • £7bn extra welfare cuts, including changes to incapacity, housing benefit and tax credits
  • £1.8bn increase in public sector pension employee contributions by 2014
  • Rise in state pension age brought forward
  • 7% cut for local councils from April next year
  • Permanent bank levy
  • Rail fares to rise 3% above inflation from 2012

He said "shrill allegations" that the state was going to be drastically shrunk were incorrect.

"We are going to spend 5% more of national income on the state at the end of this process than Tony Blair and Gordon [Brown] were in 1997. We are going to employ 200,000 more people in the public sector at the end of this process.

"I think it is a cavalier misrepresentation to claim somehow it is a scorched earth policy."

The Treasury had already rejected the IFS's claims, but BBC economics editor Stephanie Flanders said its analysis had excluded a third of the benefit changes being proposed and did not factor in the impact of all the changes right up to 2014-15.

'Unavoidable'

Another respected think tank, the OECD, has described the government's measures as "tough, necessary and courageous".

Meanwhile, a YouGov poll of 1,874 people for the Sun found that 58% felt the cuts were unavoidable, compared with 29% who thought they were avoidable.

Among the changes proposed are a time limit on some incapacity benefits and reforms to tax credits, housing benefit and child benefit.

The aim of many of the changes is to cut long-term welfare dependency and Work and Pensions Secretary Iain Duncan Smith told BBC Two's Newsnight that those out of work must make "reasonable efforts" to find employment.

"The truth is there are jobs. They may not be absolutely in the town that you're living in - and this is the key point - they may be in a neighbouring town," he said.

"My point [is that] we need to recognise that the jobs always don't come to you - sometimes you need to go to the jobs."

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Thursday, 21 October 2010

India malaria deaths hugely underestimated

India malaria deaths hugely underestimated, says report

A patient receives malaria treatment in a hospital in Mumbai Malaria can be cured easily if diagnosed and treated quickly

The number of people dying from malaria in India has been hugely underestimated, according to new research.

The data, published in the Lancet, suggests there are 13 times more malaria deaths in India than the World Health Organization (WHO) estimates.

The authors conclude that more than 200,000 deaths per year are caused by malaria.

The WHO said the estimate produced by this study appears too high.

The research was funded by the US National Institutes of Health, the Canadian Institute of Health Research and the Li Ka Shing Knowledge Institute.

The new figures raise doubts over the total number of malaria deaths worldwide.

Difficult diagnosis

Calculating how many people die from malaria is extremely difficult. Most cases that are diagnosed and treated do not result in fatalities.

People who die of extremely high fevers in the community can be misdiagnosed and the cause of death can be attributed to other diseases and vice versa.

As most deaths in India occur at home, without medical intervention, cause of death is seldom medically certified.

There are about 1.3 million deaths from infectious diseases, where acute fever is the main symptom in rural areas in India.

In this study, trained field workers interviewed families, asking them to describe how their relative died. Two doctors then reviewed each description and decided if the death was caused by malaria. This method is called verbal autopsy.

Some 122,000 premature deaths between 2001 and 2003 were investigated.

The data suggests that 205,000 deaths before the age of 70, mainly in rural areas, are caused by malaria each year.

'Serious doubts'

The WHO estimated that malaria caused between 10,000-21,000 deaths in India in 2006.

Start Quote

Malaria kills not just children but adults too in surprisingly large numbers.”

End Quote Professor Prabhat Jha Centre for Global Health Research

The UN health agency welcomed new efforts to estimate the number of malaria deaths.

Dr Robert Newman, the director of its global malaria programme, said: "It is vital to evaluate cause of death correctly because different diseases require different strategies for control."

He concedes that WHO current evaluation methods have their limitations, but has serious doubts about the high estimates from this study.

Verbal autopsy, he said, was not a trustworthy method for counting malaria deaths because the symptoms of malaria are shared with many other common causes of acute fever.

This, he said, along with what the WHO called "implausibly high case incidence rates", indicates that the findings of this study cannot be accepted without further validation.

He added that the WHO is working closely with the Indian government in the fight against the disease.

Work needed

The authors say these figures, as well as global estimates, require urgent revision.

Professor Prabhat Jha, director of the Centre for Global Health Research in Toronto, Canada, is one of the study's lead authors.

He told BBC News: "Malaria kills not just children, but adults too in surprisingly large numbers.

"India is the most populous country where malaria is common, and it is a surprisingly common cause of death."

He added that there is a real need to reconsider how malaria deaths are calculated and that similar analysis needs to be done in other highly populated malaria endemic countries.

There may also be considerable under-reporting of malaria deaths in other highly populated countries like Bangladesh, Pakistan and Indonesia.

The authors say that aggressive malaria control programmes are needed, as well as scaling up treatment - particularly in adult rural populations.

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putting doctors ahead of patients

Ex BMA chief denies putting doctors ahead of patients

James Johnson Mr Johnson was BMA chairman from 2003 to 2007

A surgeon and ex head of the British Medical Association has denied putting representing doctors above patients.

James Johnson is facing a General Medical Council hearing over operations on 14 patients in Cheshire.

He is also alleged to have accidentally struck a needle into the forehead of a female doctor who was assisting him.

He told the hearing he did the same amount of surgery as his colleagues - despite working a "100-hour week most of the time" to include his BMA duties.

Time-consuming

Mr Johnson told the GMC panel in Manchester: "It was certainly a busy life.

"But colleagues at Halton hospital were used to my rather unusual way of life.

"I always made myself available. We had a well-honed system for dealing with problems.

"The work I did for various organisations was very time-consuming, but my first loyalty was and is to my patients.

"If I had to choose between them, without the slightest shadow of a doubt, I would have chosen the clinical work, which I always found rewarding and highly satisfactory."

Mr Johnson was BMA chairman from 2003 to 2007, when he resigned amid a row about a controversial new system for allocating junior doctors to training posts.

The panel has heard claims that the stresses on his time meant his patients missed out on care.

He was said to have behaved "like a caricature of surgical arrogance".

Mr Johnson, who has been a vascular surgeon since 1985, denies this and is continuing to give evidence in his defence.

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Galaxy is most distant object yet


Galaxy is most distant object yet

Hubble Ultra Deep Field with UDFy-38135539 inset (Nasa/Esa) The faintest of faint dots - a signal from the edge of the observable Universe
A tiny faint dot in a Hubble picture has been confirmed as the most distant galaxy ever detected in the Universe.


“Start Quote

If you look at the object in the Hubble image, it really isn't much”
End Quote Matt Lehnert Observatoire de Paris
This collection of stars is so far away its light has taken more than 13 billion years to arrive at Earth.
Astronomers used the Very Large Telescope in Chile to follow up the Hubble observation and make the necessary detailed measurements.
They tell the journal Nature that we are seeing the galaxy as it was just 600 million years after the Big Bang.
"If you look at the object in the Hubble image, it really isn't much," said Dr Matt Lehnert of the Observatoire de Paris, France, and lead author on the Nature paper
"We really don't know much about it, but it looks like it is quite small - much, much smaller than our own Milky Way Galaxy. It's probably got only a tenth to a hundredth of the stars in the Milky Way. And that's part of the difficulty in observing it - if it's not big, it's not bright," he told BBC News.
Astronauts service Hubble (Nasa) The Wide Field Camera 3 was fitted to Hubble during its last servicing mission
Scientists are very keen to probe these great distances because they will learn how the early Universe evolved, and that will help them explain why the cosmos looks the way it does now.
In particular, they want to see more evidence for the very first populations of stars. These hot, blue giants would have grown out of the cold neutral gas that pervaded the young cosmos.
These behemoths would have burnt brilliant but brief lives, producing the very first heavy elements.
They would also have "fried" the neutral gas around them - ripping electrons off atoms - to produce the diffuse intergalactic plasma we still detect between nearby stars today.
So, apart from its status as a record-breaker, the newly discovered Hubble galaxy, classified as UDFy-38135539, is of keen interest because it is embedded directly in this time period - the "epoch of re-ionisation", as astronomers call it.
The galaxy was one of several interesting candidates identified in the Hubble Ultra Deep Field (UDF) image of the Fornax Constellation acquired with the telescope's new Wide Field Camera 3 last year.
As a source of light, it barely registers on the Hubble picture which was made from an exposure lasting 48 hours.
VLT and Yepun (Sinfoni) The four 8.2m telescopes of the VLT. Yepun is the far-right unit. Sinfoni is circled at its base in the inset
Astronomers knew from the UDF data that the galaxy must be very far away, but it took some exquisite measurements using the Yepun Very Large Telescope unit on Mount Paranal in the Atacama Desert to determine the precise distance.
This was done using the Sinfoni instrument attached to Yepun. The spectrograph was able to pick apart the weak infrared light and establish the degree to which it had been stretched on its long journey through space and time by the expansion of the Universe.
Using this measure, known as redshift, the astronomers could confirm that UDFy-38135539 was more than 13 billion light-years distant (a redshift of 8.55).
Dr Andy Bunker from Oxford University, UK, worked with one of the Hubble teams that first spotted the galaxy. He said Lehnert and colleagues had made a compelling case for the object's great distance.
"These things are incredibly faint and far away," he commented. "You're talking about an emission line that's a small fraction of the brightness of the night sky and you have to be very careful in your measurement; but this group is careful. The result looks convincing," he said.
Sinfoni (Eso) It required the exquisite capabilities of the Sinfoni instrument to confirm the galaxy's great distance
A redshift of 8.55 puts the galaxy firmly within the epoch of re-ionisation.
At this early time, theory indicates, the Universe would not have been fully transparent. Much of it would have been filled with a hydrogen "fog" that absorbed the fierce ultraviolet light coming off the young galaxies.
Only as these galaxies ionised this neutral gas filling the space between them did their light sweep out across the cosmos.
One of the more puzzling aspects of the discovery is that the glow from UDFy-38135539 would not have been strong enough on its own to burrow a path through the opaque hydrogen fog.
This means there must be fainter, less massive galaxies - unseen in the Hubble UDF - helping to clear out the neighbourhood.
Professor Malcolm Bremer of Bristol University, UK, is a co-author on the Nature paper. He explained the importance of these distant objects to astronomy:
"They're beautiful probes of our understanding of galaxy formation because we're seeing them at their earliest stages and therefore, hopefully, at their simplest," he said.
"If we want to believe we understand galaxy formation and evolution, then we would want to be able to say that the observed properties in these early galaxies are what we've been predicting. We want to see the start of the process," he told BBC News.
These observations on both Hubble and the VLT push current technology to the limit.
Astronomers have other candidates of similar distance in the UDF they hope to confirm soon. However, the real breakthrough in observing the epoch of re-ionisation is probably going to have to wait until more powerful telescopes and techniques are established.
This next-generation astronomy will include Hubble's successor (the James Webb Space Telescope) and the Extremely Large Telescope (ELT) to be built near the VLT in Chile.
The ELT will catch the faintest starlight with a mirror some 42m across. That is five times the diameter of Yepun's primary mirror.

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women stay at home rearing children

Will the cuts change the role of women?

Mark Easton | 20:10 UK time, Wednesday, 20 October 2010

As my train was pulling into Birmingham New Street this morning, a woman in the carriage was on her mobile phone. She was offering sympathy to a friend who had just been told she had lost her job. I could only hear half the conversation, but there was talk of £100,000 worth of cuts to a budget and it was clear that the person on the other end of the line was profoundly upset and angry.

There will be many more conversations like that over the next few years and most of them will involve women.

The expansion of the public sector over the last few decades transformed work opportunities for millions of women. The new jobs, many in the caring professions, were often advertised as family-friendly, a good fit for those attempting to juggle children and a career.

For single mums it often made full-time work possible. For many more households, it provided a valuable second income. Today, twice as many women as men work in the public sector and 40% of all female workers are employed by the state.

Of the half a million public sector job cuts, more than 300,000 are likely to be women. TUC General Secretary Brendan Barber recently told me that the "disproportionate effect" will be unfair and said he has demanded the government conduct an equality impact assessment. So far, he says, he has had no reply.

Such a test, it might be argued, is too narrow. Men suffered more during the recession. Women may take a slightly bigger hit in the cuts. Swings and roundabouts.

But the counter-argument is that, while private sector jobs should return as the economy recovers, the plan is for the public sector to shrink permanently. What's more, there may be a double whammy for female workers. If working mums lose their jobs they will not need so much childcare - another industry very largely occupied by women.

I recently put this point to Jill Kirby, director of the influential Conservative think tank, the Centre for Policy Studies. "It may be better news for women not to spend money on childcare any more and to look after their own children and fit jobs into the child's day," she told me, pointing out that "women going out to do jobs to pay for childcare generates a type of work which then requires subsidy from the state".

"Are you saying women should be looking after their children at home?" I asked.
"For women who would like to be under less pressure to work, who would rather be at home, yes," she replied.

For some Conservatives, it would seem, the effect of the cuts on female workers is a useful nudge to changing the role of women in society. It is not a prospect, however, that enjoys support at the TUC.

"If there's a suggestion of reverting back to an early model of stay-at-home mums, I don't think that would be seen as socially progressive at all" says Mr Barber.

It is not just the direct effect of public sector job losses that may change the role of women. Some suspect that the foot-soldiers in David Cameron's "Big Society" will be predominantly female.

Geoff Mulgan, former strategy advisor to Tony Blair and now head of think tank the Young Foundation, says women will have to take responsibility as the state withdraws from childcare and elder-care.

"There's an assumption by politicians that women will be willing to bear this burden. But many will be pretty resentful that they have to go back into the home with the disappearance of large number of jobs in the public sector, all to pay for the mistakes of a rather well-paid group of men in London."

So, one of the consequences of the shrinking state outlined today may be that women stay at home rearing children and building the "Big Society" instead of going out to work. Whether that is a good thing, a bad thing or a "fair" thing will be hotly debated

'Unsafe' drug found in herbal tea

'Unsafe' drug found in herbal tea

herbal medicine Herbal medicine side-effects should be reported

Herbal medicines marketed as weight loss aids have been found to include a drug withdrawn in Europe and US on safety grounds.

Analysis of Payouji tea and Pai You Guo Slim capsules by the UK medicines watchdog revealed they contained diet drug sibutramine.

It was taken off the market in January 2010 over fears it increased the risk of heart attack and stroke.

Anyone taking the drug was urged to stop and consult their doctor.

Sibutramine was first approved as an anti-obesity drug in 1997, but data from recent studies suggests a higher rate of heart attacks and strokes among people taking it.

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While it was withdrawn in Europe in January, it was only withdrawn in the US earlier this month.

Various herbal products in the US have been recalled because they were found to contain the drug.

The Medicines and Healthcare Regulatory Authority, which oversees medicines in the UK, said that any product containing the drug was considered "harmful to human health".

They said that not only could it have side effects including high blood pressure, seizures, heart attacks or strokes, but could interfere with other prescription medicines.

Its head of herbal policy, Richard Woodfield, said: "People need to be aware that Payouji tea and Pai You Guo Slim Capsules are unlicensed herbal medicines and therefore have not met assured standards."

Anyone who experiences side-effects after taking a herbal medicine can report this to the MHRA using its Yellow Card Scheme.

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