US baby boomers in Hep C warning

US baby boomers are advised to get tested for the liver-destroying virus hepatitis C, in a move health officials say could save 120,000 lives.

Today in healthcare: Monday 21 May

News, comment, blogposts and tweets across the sector

2.18pm: Clare Horton writes

London Ambulance Service has announced that it received a record number of 999 calls between in the year to March 2012. It says more than 1.6m calls where made for an ambulance last year – an increase of nearly 112,000. But interestingly, the service attended fewer incidents last year, sending an ambulance to 1,041,739 patients – meaning 16,393 fewer ambulance journeys than the year before.

Paul Woodrow, the service’s deputy director of operations, said:

Not everyone who dials 999 will be sent an ambulance. Callers with less serious illnesses or injuries may be referred to NHSDirect or given clinical advice over the phone.
Patients with minor illnesses will be better cared for by their GPs, pharmacists and walk- in healthcare centres.

2.11pm: Clare Horton writes

Our Guardian government computing colleagues have published a story on the NHS information strategy, reporting the King’s Fund’s comments that it raises technical and financial challenges and will rely on the pace and scale of local take up.

Today’s Patient from Hell column on the strategy has received some interesting comments, including one from Professor Iain Carpenter, Associate Director, RCP Health Informatics Unit, who writes:

The Royal College of Physicians’ Health Informatics Unit began developing medical records standards a few years ago (involving patients at every step), and the first were approved and published in 2008 by the Academy of Medical Royal Colleges. The standards are being used in some hospitals and by software developers, but need to be embedded in a national strategy against which care is commissioned. My colleague Professor John Williams and I are no longer swimming against the tide, as the standards are gaining ground with clinicians and patients and we hope that the strategy published today will help us implement the established and developing standards everywhere.

12.36pm: Jessica Fuhl writes

There’s a lot going on in healthcare today, so here’s this lunchtime’s round up of news and comment from around the web…

The King’s Fund: Response to the publication of the information strategy for health and social care

Whose Shoes blog: Dementia awareness week… walking in my shoes…

iHealthBeat: A look at social media in healthcare

BBC: NHS hospital food will improve, says Andrew Lansley

The Nuffield Trust blog: Health policy after the Bill: what now for Labour?

The Telegraph: Lansley says online appointments will make NHS ‘hassle free’

11.33am: Jessica Fuhl writes…

Patient Opinion have launched a new part of their website today that shares comments and feedback in a unique way.

‘Patientstori‘ pulls in comments from the main site via keywords such as ‘respect’, ‘compassion’, ‘dignity’ and ‘care’.

It’s a site inspired by twistori.com, and is a new way to visualise patient feedback.

11.07am: Jessica Fuhl writes

A hospital trust is planning to extend a scheme under which dozens of unpaid jobseekers help deliver patient care in its wards. Shiv Malik writes:

The trust said all participants in the initial pilot were CRB-checked and received two weeks of training at Sandwell College before carrying out their tasks in hospital wards, involving “general tidying, welcoming visitors, serving drinks to patients, running errands, reading to patients and assisting with feeding patients”.

Union representatives confirmed they had been consulted , and had initially consented to, plans that meant unemployed people could gain experience of work at the hospital.

But they said they had not agreed that the jobseekers would “play a direct role in patient care” and said they were very worried about the prospect of this happening.

10.33am: Lizzi Easterbrook writes

This week is Dementia Awareness Week 2012. The Alzheimers Society have created this video encouraging people to remember the person as well as plenty of ideas to help raise awareness and fundraising tips.

This blog from D4Dementia also highlights the importance of continuity of care for dementia sufferers. Discussing her father’s experiences, she saw first hand the benefits of receiving the majority of care from a small group of people.

This carer became dad’s best friend, and as my father’s dementia progressed, he became the voice dad didn’t have, spotting what he wanted and needed in the times we weren’t at the home, and crucially also providing a link between dad and his family during those periods.

10.07am: Clare Horton writes

This week is the first NHS-wide equality, diversity and human rights week.

The Telegraph reports that patients’ groups have criticised the health service for funding places on conferences and workshops at a time when services and jobs are under threat.

But the NHS Employers site has put together a mythbusting page about equality and diversity.

Find out more about what’s happening around the country to mark the week via Twitter, using the hashtag #EW2012.

9.56am: Clare Horton writes

The NHS information strategy is being launched today by the health secretary, Andrew Lansley. The BBC reports that patients in England will be able to book GP appointments and get test results online within three years, and E-Health Insider says a national ‘portal’ will be created as the definitive source of trusted information on health and social care by 2013.

Here’s a quick recap of some of the weekend’s health stories:
• Observer: Jamie Oliver urges MPs to end academy junk food exemption
• Guardian: Young people ‘will be put off studying medicine by £70,000 student debts’
• BBC: Risk to patients revealed in Cumbria hospitals’ staff logs
• Telegraph: Up to 1,000 new doctors could face unemployment

8.57am: Clare Horton writes

Good morning and welcome to the daily blog from the Guardian’s healthcare network. We’ll be bringing you the pick of the news and comment from across the sector throughout the day.

On the network today our columnist Dick Vinegar, aka the Patient from Hell, looks ahead to the NHS information strategy and makes his own suggestions:

My first aim is for all communications between me and my GP, my GP and the many hospitals where I receive treatment, between these local hospitals, and with any centralised NHS databases, to be carried out at electronic speeds, ie instantaneously. The technology has been there for years. The rest of the world does it. Why not the NHS?

The Guardian reports that the Advisory Council on the Misuse of Drugs is calling for an antidote to heroin overdoses to be made widely available without prescription.

Making headlines elsewhere this morning, the Telegraph reports that cholesterol-busting statins may reduce the risk of cancer in heart transplant patients.

A survey of GPs reveals that almost two-thirds admit they are not properly taught to recognise the signs of dementia, says the Independent.

‘Bionic’ woman in new challenge

A paralysed Leicestershire woman plans to cycle from London to Paris, after she became the first person to complete a marathon in a “bionic” suit.

Model speaks out over PIP implants

Gemma Garrett says women should get all the facts before choosing bigger breasts after her own PIP implants ruptured.

Two patients get eye stem cells

Two people in Scotland have stem cells transplanted into their eyes as part of a clinical trial to restore their sight.

Unpaid jobseekers to deliver patient care in three hospitals

Sandwell and West Birmingham hospitals trust to extend unpaid work experience scheme after successful pilot

A hospital trust is planning to extend a scheme under which dozens of unpaid jobseekers help deliver patient care in its wards.

After a pilot involving six unemployed people working unpaid for eight weeks to help feed patients and clean wards, Sandwell and West Birmingham hospitals trust said it was aiming to extend the government work experience programme to all three of its hospitals.

The trust said all participants in the initial pilot were CRB-checked and received two weeks of training at Sandwell College before carrying out their tasks in hospital wards, involving “general tidying, welcoming visitors, serving drinks to patients, running errands, reading to patients and assisting with feeding patients”.

Union representatives confirmed they had been consulted , and had initially consented to, plans that meant unemployed people could gain experience of work at the hospital.

But they said they had not agreed that the jobseekers would “play a direct role in patient care” and said they were very worried about the prospect of this happening.

After protests over the work experience scheme earlier this year, ministers changed the rules to make it possible for jobseekers to pull out of their placements without having their benefits docked.

A later freedom of information request uncovered that the rule change now applies to three out of the five schemes that are not explicitly mandatory.

The hospital trust said the eight-week placements were “not nursing roles” but would instead “support patients through their hospital experience”.

“We are situated in a deprived area with high unemployment and we think it is important to help get people back into work. The project gave participants the opportunity to gain confidence, training and experience, under supervision,” a trust statement said.

It added that two participants were offered jobs after taking part, but clarified that these jobs were outside the NHS.

“The pilot is now complete and, after further consultation with trade unions and managers, we are aiming to run similar programmes across our three hospitals: City hospital in Birmingham, Sandwell hospital and Rowley Regis hospital,” the statement said.

A Unison spokesperson described the move as “a worrying glimpse of the future”, saying that feeding patients and helping them to drink were skilled aspects of patient care and required people with the “right experience”.

Ravi Subramanian, the head of Unison, West Midlands, said: “Far from Tory claims to protect the NHS, Birmingham and Sandwell hospital trust is being forced to find savings of £125m over the next five years.

“Thousands of staff are facing the prospect of losing their jobs and wards are closing. Now the hospital is making moves to deliver healthcare on the cheap, by using people on work experience to help with patient care. Patients and staff will rightly be very worried about the standard of patient care as this scheme is rolled out.”

Test case could outlaw critical threshold for adult care

Councils could be prevented from restricting adult social care to meeting people’s ‘critical’ care needs by a legal challenge brought on behalf of five disabled people.

Book GP visit online ‘by 2015′

Patients in England will be able to book GP appointments and get test results online within three years, ministers are promising.

No NHS information strategy will work until attitudes change

As the health service awaits an information strategy launch, the patient from hell comes up with his own suggestions

Katie Davis, director general and managing director NHS informatics at the Department of Health, will be launching her NHS information strategy “real soon”. This launch was originally planned for the end of 2010. I can understand that it is difficult to create an information strategy that makes sense right now. May I pre-empt her with a few principles that seem relevant to a geriatric patient who has spent his life in the IT industry?

As I am just a simple patient, my information strategy would like to achieve very simple things. My first aim is for all communications between me and my GP, my GP and the many hospitals where I receive treatment, between these local hospitals, and with any centralised NHS databases, to be carried out at electronic speeds, ie instantaneously. The technology has been there for years. The rest of the world does it. Why not the NHS?

The task is simple; just implement the necessary data and content standards, and we’re away. There is however, an elephant in the room, or rather several elephants, which are all cultural, not technological. They are about attitude. The first one is that it has seldom occurred to hospital clinicians that, if I am being treated by two or more hospitals, that what the other hospital is doing to me has any relevance to it. It seems all too obvious to me, the patient, that this attitude is both dangerous and wasteful. I am encouraged by the feeling that patients commenting on this blog may agree with me.

The second elephant is related. Hospitals consider an electronic patient record to be something to be designed and used just in the hospital – a secret garden. They have no concept of the records being useful for other parts of the NHS, like GPs – or patients. Nor do they see any benefit in sending timely discharge letters and outpatient reports to GPs (or patients) within 24 hours. The idea of an EPR following a patient through life is quite foreign to them.

And, of course, they reject any idea of data and content standards for patient records across the NHS. They look at any common standards as nasty top-down stuff promulgated by evil people like Richard Grainger and Connecting for Health, when, according to them, every sane person knows that every hospital is different – and very often every department of every hospital needs its own patient record standard. Nor do they seem to be aware that, even if they cannot agree an all-singing, all-dancing unitary EPR, there has been loads of middleware, XML and stuff, around for about 10 years, which can link to some extent the incompatible EPRs together.

The first thing any information strategy should do is to explode these attitudes, somehow. Until they change, no information strategy will work. It will be even more difficult in the Lansley world of localised commissioning by clinicians than it was in the pre-Lansley top-down “bureaucratic” era. The Department of Health cannot create this culture shift among clinicians. It has to come from the clinicians own trade associations, the Royal Colleges and the BMA. But first, someone has to persuade these deeply conservative bodies that medicine cannot move on without digitalisation and data standards. I hope, rather desperately, that the impetus will come from within their ranks, because they never seem to listen to anybody else.

I was encouraged, and amazed, at the HC2012 conference by a speaker, Professor John Williams from the Royal College of Physicians, who was arguing that present EPRs were not comprehensive or “clinically rich enough”. He wanted something more all-embracing. I had thought that this kind of “thinking differently” had gone out of the window with the 2010 general election. And he claimed that he was getting a sympathetic response from other his colleagues in other Royal Colleges. He is, of course, only one thinker in a sea of cynics. Maybe, miracles will happen, and digitalisation will spring fully formed from the least likely bodies, the royal colleges. I doubt whether it will result from an “information strategy” coming from the DH. I see the information strategy when it finally appears, gathering dust very soon on a DH shelf, like the National Plan for IT before it.

This article is published by Guardian Professional. Join the healthcare network to receive regular emails and exclusive offers.

Actress aids dementia awareness

Carey Mulligan backs a call for dementia awareness as a poll highlights the impact on families and friends.

Calls to mental health lines rise

Mental health charities say they have seen a surge in calls to their helplines since the start of the recession.

Musical therapy

A song-and-dance show about obesity and mental illness? Epidemic could pull in big audiences – and improve their health

In a chilly, high-windowed room, a young man is being pursued by four black dogs. They circle him, ready to pounce; he runs among them, attaching leads to them and strains to pull them to heel. Eventually, the dogs manage to get away; the man watches them go, stumbling, exhausted. The room echoes with the sound of applause.

Welcome to the world of Epidemic – a community musical produced by Old Vic New Voices, the education and outreach arm of London’s Old Vic Theatre. In each of the past three years the company has put together a major new show, performed and stage-managed entirely by volunteers from across London, and written to reflect concerns raised by the local community.

If that sounds rather worthy, it isn’t. Epidemic has bravely taken two key public health issues as its central themes – obesity and mental health – weaving them into a Technicolor tale that is both serious and exuberantly over-the-top.

The main character is Marlon Huxley, whose psychotic depression is giving him disturbing hallucinations (the black dogs, played by dancers). When he hijacks a mobility bus, he makes unlikely allies of Iris, an elderly woman trying to avoid being put in a home; and Lawrence, a morbidly obese man fed up with being nannied by his carers. As the trio make their bid for freedom, sensationalist newspaper headlines and tweets (#busnutter) track their every move.

Joey Ellis – a 24-year-old drama-school graduate, and one of just a handful of professional actors in the cast – plays Marlon. Taking part in the production has, he tells me during a break in rehearsals, been a real eye-opener. “Before, I was completely ignorant about mental health. Now, I’ve learned something about what it’s like to have a mental illness – and it certainly isn’t easy.”

The show’s writers, Suzy Davies and Morgan Lloyd Malcolm, and producers have been scrupulous about their research: health professionals have been consulted, and the show has the backing of the Wellcome Trust. But they actually arrived at the show’s public health theme quite by accident.

“We spent a year talking to people, going from pensioners’ rice-and-peas mornings to Zumba classes,” says Steve Winter, director of Old Vic New Voices. “I started out with an idea about the ‘epidemic of opinion’: that every day my email inbox is filled with opinions on things people don’t necessarily know much about. From there, overwhelmingly, our discussions turned to health, and obesity and mental health in particular. There was a perception that these two issues have reached epidemic proportions.”

Dr Thomas Kabir, a research coordinator at the Institute of Psychiatry, addressed a debate organised by Old Vic New Voices at the Wellcome Trust during the show’s gestation period. He believes this perception of an epidemic is rooted in fact. “There’s a lot of evidence,” he says, “that in the current economic climate, more and more people are experiencing mental health problems, and often they’re going untreated. A show like this, which allows people to confront the issue face-to-face rather than just reading or hearing about it, can have a big role to play in addressing the problem.”

Public information is a key aim of the show, and operates on two levels: by encouraging audiences to think about these health issues; and by enhancing the cast and crew’s own understanding of their health, through workshops and discussions. Nutritionist Jo Lewin ran a healthy-eating seminar during rehearsals, and participants are encouraged to share their own experiences of mental illness and obesity.

Becky Brown, a 25-year-old bio-ethics PhD student and volunteer stage manager, thinks Epidemic is succeeding on both fronts. “At first, a musical about health seemed really bonkers,” she says. “But there’s only so much that people take away from the usual public health campaigns. I’m not saying this is a completely accurate portrayal of what it’s like to live with mental-health issues or obesity, but it’s a humanising one.”

None of this comes, however, at the expense of hard work, commitment and, above all, fun: the rehearsal I watch, if still wobbly in places, is pretty slick, and the show’s big numbers (covering everything from unhelpful media sensationalism in reporting mental health, to an Italian-style ballad about Lawrence’s love affair with fattening food) are performed with infectious enthusiasm.

For Winter, if the show encourages just one person to confront health problems that they were previously too afraid to tackle, then all the hard work and enthusiasm will have paid off.

“During rehearsals, we’ve been talking about wellbeing,” he says. “A lot of people said they hadn’t thought about it much before. We want people taking part to feel healthier; to have greater self-esteem. As for audiences – if they do recognise any of the health problems they see on stage, I hope they will be inspired to go and seek help.”

• Epidemic is at the Old Vic Tunnels, London SE1, until 27 May. Tickets are free, but must be booked at oldvictunnels.com

Cheap dysentery drug ‘promising’

A cheap drug, which is already prescribed for arthritis, could fight amoebic dysentery, according to researchers in the US.

Use ‘overdose cure’ naloxone more widely, drugs advisory council urges

Call for health minister to make potentially lifesaving treatment available without prescription prompts fears in some quarters that addicts will be tempted into riskier habits

An antidote to heroin overdoses should be made widely available without prescription, according to controversial advice from the government’s drugs advisory body.

Critics claim that the distribution of naloxone would create a “safety net” for drug users and potentially encourage greater use of class A drugs. But the Advisory Council on the Misuse of Drugs (ACMD) has written to health minister Anne Milton to argue that people working with the UK’s estimated 300,000 heroin addicts will be able to save lives if they are given access to the drug.

When a heroin user has an overdose, one injection of naloxone revives them from unconsciousness and gives them enough time for medical help to arrive. It is already used by ambulance crews, casualty staff and out-of-hours GPs.

But the drug is only available on prescription, which means people working with drug users cannot keep stocks or carry them in case of emergency.

The government will be under pressure to ignore the advice, with some claiming naloxone encourages users to indulge in even riskier drug-taking. Others have warned that up to 3% of those receiving naloxone suffer potentially life-threatening side-effects and even that it can be used as a weapon in fights between users.

However, the chairman of the advisory council, Professor Les Iversen, told Milton: “The ACMD is not aware of any significant body of evidence that naloxone provision encourages increased heroin use.

“The ACMD concludes that naloxone provision is an evidence-based intervention, which can save lives. Naloxone provision fits with other measures to promote recovery by encouraging drug users to engage with treatment services, and, ultimately, keep them alive until they are in recovery.”

Mike Pattinson, a former probation officer and now the director of operations at the Brighton-based health and social care charity CRI, said: “We know that if people in constant contact with heroin users are able to carry this drug that they will save lives. We would hope that the government acts on this advice because it is compelling.”

Trevor Ball, 40, a recovering heroin addict, said he had been saved by naloxone when paramedics had been called but believed others could have been rescued from overdoses if it had been more widely accessible. He said: “Drug users don’t think about life and death when they take heroin. It is a case of ‘it will never happen to me”, so the idea that access to naloxone will encourage drug use is a nonsense. I have been saved by it and I have seen others go blue, go over, and been saved by it.”

Regulations concerning the distribution of naloxone have already been relaxed in Scotland, where the devolved government is funding the distribution of 10,000 units.

Migraines: they are all in the head

They start with a spinning black penny, retch-inducing smells, impaired thought and speech. But migraines bring odd pleasures with their pain

The first time it happened I was in bed with a book, aged maybe 10. And I remember going over the same line again and again, with rising levels of panic, as I realised I had forgotten how to read. I didn’t think it was something you could just forget. Something that, having picked up, you could then one day drop again. I see now it was my first migraine.

Today migraines are in the news and they’re in my head, tightening around my crown like an alice band. The NHS is considering offering Botox to patients with chronic migraines. They don’t know quite how it helps, but they’ve decided it does. The blocking of muscle contraction, which is what the botulinum toxin does to those stunning their wrinkles, hasn’t been proved to relieve headaches, but two clinical trials did conclude that it led to a 10% reduction in the number of patients’ headachey days. In addition, I imagine, to a laboratory paved with clingfilmed foreheads.

I’m writing now through day four of this month’s headache, one that began (as do many) with a flickering blind spot in the centre of my vision. It starts small, a spinning black penny in the middle of a page. I slump in my seat as it spreads darkly over my sight like jam, and I can’t see, or think, or entirely understand speech. It’s the film melting in my projector – it’s a bit like falling. Smells slay me. Noise, fine, but smells – Angel perfume in a lift, for instance, or that dirty spitting rain you get in cities, the kind that smells of apocalypse – will make me retch. And minutes later the headache comes.

The author Siri Hustvedt wrote about a migraine aura phenomenon called Alice in Wonderland syndrome – the migraineur feels parts of their body ballooning or shrinking. For me it’s often my hand. I’ll lie in bed and under my cheek it’ll swell to the size of a football, or a room, or shrink until it’s dust. These episodes when my reality wobbles are not entirely unpleasant.

I half-enjoy the days preceding a migraine when everything feels like déjà vu. When walking home, a series of sights – a smoking schoolgirl, a chained-up bike – are overwhelming in their impact. Everything I see reminds me of something else, but something just out of reach. It reminds me that it’s reminding me, but not what it’s reminding me of. In its un-graspableness, this feeling is similar to one of the factors that brings these migraines on – the reflections from the Regent’s Canal that play on the ceiling above my desk. Ripples of light lead to ripples in my reality, this warm tightness behind my eyes, a grim ache in my jaw.

The pain is sometimes awful, but more often it’s medicated and so simply… saddening. I take these lovely painkillers, so it’s rare I’ll feel the blinding sharpness. Rather than being slammed into a wall, it feels as if my head is stuck in a closing door. It’s the dull agony of a deadline looming, of a nagging phobia, of going up in a lift as your vertigo builds. But I miss stuff. Parties, dinners, often meanings – I’ll be interviewing somebody in a brightly lit room and will find myself two thoughts behind, my eyes scrunched in concentration, praising Olympus for the reliability of its dictaphones.

I realise, though, that it’s these vibrations on the drum skin of my life that make me me. I see the world through a smoky, migrainous filter. And like somebody teetering on the edge of a depressive episode, not yet fallen, I’m able to stand outside it and look around, curiously. Medicating with Botox seems like an apt metaphor – in ironing out the migraineur’s wrinkles, the doctor smooths their reality. No more hands the size of houses. No more fainting as an effect of sunlight spearing through dark trees. So I’ve learned to embrace this gentle madness. In succumbing to a migraine, I get to test what’s real.

Jamie Oliver urges MPs to end academy junk food exemption

Chef Jamie Oliver and health experts have been left baffled by education secretary Michael Gove’s decision

An exasperated Jamie Oliver has written to every MP demanding a U-turn over nutrition rules in schools after education secretary Michael Gove refused to act on a report that found nine out of 10 academies were selling junk food.

Announcing the move on his website, the TV chef, whose campaign for better food in state schools has lifted standards for millions of pupils, told voters that if their MPs did not act “you can safely assume that they don’t care about the wellbeing of our children and the future of our country”.

Oliver’s move came as public health officials and doctors joined a growing number of education and food organisations in criticising the education secretary. In a move that astonished experts, Gove insisted that he would not apply the nutrition standards that cover all other state schools to academies and free schools – even after a report by the School Food Trust charity found last week that many were selling sub-standard products.

The investigations, initially requested by Gove, showed that 89 out of 100 academies surveyed were selling at least one of the snack foods high in sugar, salt or fat that have been banned in vending machines in other state schools.

Gove insists that academies, which enjoy greater freedom than other state schools, should be left to determine their own nutritional standards because they are run by responsible head teachers.

However, of the 100 academies questioned by the trust, 31 were found to be selling one type of banned fattening food, 33 were selling two and 15 were selling three. Also 82 of the academies sold sweetened fruit juices, which often contain only a small amount of juice and would therefore be banned in maintained schools. The national school food standards stipulate that such products must contain at least 50% fruit juice.

The trust, which was called in after Oliver and others raised concerns last year, concluded that the nutritional standards introduced in 2008 under the Labour government should now cover academies and free schools.

A spokeswoman for the Department for Education said that despite the report there was no prospect of a change of policy. In a statement the department said: “We trust teachers – the professionals on the frontline – to do what is best for their pupils. Many academies go over and above the minimum requirements and are offering their pupils high-quality, nutritional food.”

However, Oliver, urging MPs to back a Commons early day motion from Tory MP Zac Goldsmith which says that academies should be covered by the rules, says in his letter that the government’s approach threatens a “massive erosion of everything we have achieved”.

“I passionately believe that this is taking a huge step in the wrong direction as far as taking care of our children and the future of this country is concerned,” Oliver writes. “His (Gove’s) decision means that the one million children attending academy schools no longer have any standards in place to protect the food they eat every day.

“I have written to all MPs asking them to sign Zac Goldsmith’s early day motion. If your MP does not support this motion, then you can safely assume that they don’t care about the wellbeing of our children and the future of our country.”

There are 1,283 secondary academies in England – 40% of the total of 3,261 secondary schools – and a further 10% have applied for academy status. Gove is pressing for still more to convert.

Dr Janet Atherton, president of the Association of Directors of Public Health, which represents England’s 150 directors of public health in the NHS, said: “The standards were brought in because catering standards in schools weren’t as good as they needed to be. They have brought about dramatic improvements in children’s nutrition and eating habits.

“They have been proven to be effective. You can see that in children’s diets. Some academies are following the standards, but that’s not across the board.

“I’m concerned that evidence shows that academies aren’t doing what Mr Gove said should happen. It feels that it’s moving back to before the standards came in, with confectionery and soft drinks available in schools. The standards should apply in all schools.”

Rob Rees, chairman of the School Food Trust and a well-known chef, said: “We have clear evidence that shows standards work for schools when it comes to food and cooking. For the last three years the number of children eating lunches has increased and many children are enjoying the hard work of so many cooks across the country.

“I hope that all schools will value the evidence and realise the benefit good food brings to performance, behaviour and social cohesion.”

Last month Gove told the education select committee that he saw no evidence of academies failing to comply with the standards. He said: “All the evidence seems to me to point in the other direction: that schools that have academy freedoms have improved the quality of food they offered children.”

The Department of Health said it was a matter for Gove.

Psychiatrist who championed ‘gay cure’ admits he was wrong

Dr Robert Spitzer apologises for ‘fatally flawed’ study, published in 2001, which claimed gay people could be ‘cured’ if properly motivated

One of the most influential figures in modern psychiatry has apologised to America’s gays for a scientific study which supported attempts to “cure” people of their homosexuality.

The survey, published in 2001, looked at “reparative therapy” and was hailed by religious and social conservatives in America as proof that gay people could successfully become straight if they were motivated to do so.

But Dr Robert Spitzer has now apologised in the same academic journal that published his original study, calling it “fatally flawed”. “I believe I owe the gay community an apology,” his letter said. “I also apologise to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works.”

Spitzer’s letter, which was leaked online before its publication in the Archives of Sexual Behaviour, is sure to cause delight among gay civil rights groups and stir up anger among social conservatives, who have used the study to combat the acceptance of homosexuality as a normal part of human society.

Reparative therapy is popular among Christian conservative groups, which run clinics and therapy sessions at which people try to become heterosexual through counselling. Gay rights activists condemn such practices as motivated by religious faith, not science, and call them “pray away the gay” groups.

Spitzer’s study looked at the experiences of 200 people undertaking the therapy, including subjects that had been provided by religious groups. He then asked each person the same set of questions, analysing their responses to the therapy and their feelings and sexual urges afterwards. He concluded that many of them reported feelings of changes in their sexual desires from homosexual to heterosexual.

Spitzer’s stance was notorious, because in 1973 he had been instrumental in getting the American Psychiatric Association to stop classifying homosexuality as a mental disorder in its diagnostic manual: a move seen at the time as a major victory for gay rights.

His 2001 study caused a huge stir because many people felt that it was not rigorous enough for publication. The central criticism was that Spitzer had not paid enough attention to the fact that subjects might lie about their feelings or be engaged in self-deception.

For more than a decade Spitzer shrugged off the attacks and stood by his work, but he has now admitted that his critics were right. “I offered several (unconvincing) reasons why it was reasonable to assume that the subject’s reports of change were credible and not self-deception or outright lying. But the simple fact is that there was no way to determine if the subject’s accounts of change were valid,” Spitzer wrote.

In an interview with the New York Times last week, Spitzer, who is 79 and suffers from Parkinson’s disease, described how he had written his letter of recantation in the middle of the night after agonising over the study’s impact.

He had also recently been visited by a gay magazine journalist, Gabriel Arana, who had described to him his own experience going through reparation therapy and how damaging it had been and how it had led to thoughts of suicide. “It’s the only regret I have; the only professional one,” Spitzer told the New York Times, which described him as being almost in tears as he talked about his decision to admit he was wrong.

“In the history of psychiatry I don’t know that I’ve ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologised to his readers. That’s something, don’t you think?” Spitzer told the newspaper.

Gay rights group Truth Wins Out published the full text of the letter on its website and hailed the moment as a major step forward. “Spitzer’s apology to the victims of ‘pray away the gay’ therapy … marks a watershed moment in the fight against the ‘ex-gay’ myth,” the group said.

‘Debt deterring would-be doctors’

The prospect of high student debt and increased pension contributions could discourage young people from entering medicine, a senior doctor warns.

Young people ‘will be put off studying medicine by £70,000 student debts’

British Medical Association official says debts, rising pension contributions and salary freezes risk deterring potential doctors

Student debts of up to £70,000 and increased pension contributions could dissuade young people from entering medicine, a doctor has warned.

Tom Dolphin of the British Medical Association (BMA) told the Junior Doctors Conference that medical students paying the new £9,000 tuition fees, which come into force in September, will have debts of up to £70,000 by the time they graduate.

They will also face their salaries being eroded by inflation and increased pension contributions, which deter talented students from entering medicine, added Dolphin, chairman of the BMA’s Junior Doctor Committee.

In a speech which criticised the government’s health reforms, Dolphin encouraged delegates to back strike action to defend their pensions.

He told the conference: “At the moment, it is genuinely hard to find much cause for cheer.

“We need to put up a fight. Imagine for a moment you were applying for a place at medical school right now. With £9,000 tuition fees you will be facing debts on graduation of up to £70,000.

“When you start working, a big chunk of your salary will be used to repay these debts. With salaries frozen for many years, your starting salary will have been eroded by inflation.

“And on top of that you will be faced with increased pension contributions. The burden of austerity is falling too hard on the shoulders of the younger generation and we are seeing this in medicine, too.

“With a future like this, will medicine still be able to attract and retain some of the most talented young people? Would you still make the choice to study medicine?”

Ballot papers are being sent to 103,000 BMA members with the result due at the end of the month.

Should industrial action go ahead, it would be for the first time since the 1970s.

The BMA has ruled out a complete withdrawal of labour but if they vote in favour, doctors would not undertake duties that could safely be postponed.

The BMA argues higher paid NHS staff already pay proportionately more for their pensions than most other public sector workers, a disparity which it said increased in April when their contributions rose, and which is set to increase again.

By 2014, some doctors will see deductions of 14.5% from their pay for their pensions, compared to 7.35% for senior civil servants on similar salaries, to receive similar pensions, the BMA claims.

Doctors at the start of their careers would be hardest hit, having to pay hundreds of thousands of pounds extra – double what they would have paid – in lifetime pension contributions, according to the association.

Dolphin said: “The government wants us to pay more and work longer for what will probably be a worse pension.

“The extra contributions add up to more than £200,000 for many junior doctors.

“They won’t negotiate any more, even though their ‘final offer’ is patently unfair.”

A working life: the air ambulance paramedic

Taking to the skies to reach patients might seem glamorous, but for David Fletcher the focus is on care, as well as safety

As the bright red helicopter I’m sitting in shudders and shakes its way off the ground, I think to myself – David Fletcher has one hell of a company car. An air ambulance paramedic, Fletcher spends much of his day 1,500ft in the air, rushing to the scene of accidents and emergencies – making his working life a little like Casualty mixed with Airwolf.

On the day I visit the base of the North West Air Ambulance (NWAA) at Manchester city airport, the weather has finally cleared up enough for me to see Fletcher at work. But Bond Air Services, the company NWAA leases its helicopters from, has grounded its two vivid yellow Eurocopter EC135 vehicles (called Katie and Teddy) due to a fault in the rotors. It means I never get to see them in action, but instead experience an older helicopter that’s scrambled from elsewhere in the country.

The wait for it to arrive gives Fletcher a lengthy opportunity to talk about his work from the confines of an unassuming Portakabin at the airfield. Safety, I discover, is everything. “It is key to everything we do and runs throughout every task we perform. We have to plan for every eventuality …” he says, ” … including the weather. We can fly in anything up to 55 knots but we avoid thunderstorms and will not take any risks. The biggest thing that hinders us is fog.”

While the paramedics’ main objective is to treat injured or sick people, the charity’s pilots ensure the safety of the helicopter and the people inside. Fletcher says this arrangement works well – in other countries the pilots can be more patient-focused, leading to them taking risks in order to reach a destination and land quickly. “If it’s unsafe to fly or land, we won’t. We can’t treat patients if we’ve crashed ourselves, and losing a £2m aircraft will not help the people of the north west, either.”

Nevertheless, the air ambulance can respond much faster than a road ambulance. Each crew can treat and fly patients to a specialist hospital in record time – both helicopters have a maximum flying time of 10 minutes to the nearest appropriate hospital. It can save the lives of people with major trauma, particularly head or spinal injuries, and Fletcher says the charity receives countless thanks from people they have treated. “It’s very different from road paramedics, when you wonder what happened to a patient and never get the chance to find out. Here, people send letters of thanks and even pop in to thank you for saving their life. It’s lovely.”

The NWAA flies around 1,200 life-saving missions each year. The aircrew are often the first on the scene, whether it is a motorway pile-up or someone having a stroke. First, they assess a patient’s condition before giving treatment and transferring them to the nearest hospital.

When a helicopter takes off, the rotor generates three tons of air, which allows the craft to lift off the ground. Anyone in the near vicinity can be knocked off their feet by the force. “We need clearance of about two tennis courts next to each other to be able to safely land or take off,” Fletcher says. Despite that, wherever Fletcher and his crew go the helicopter draws close interest from the public: “At the scene of a rescue, we often get a lot of people watching and they do sometimes come a bit close. I have to be stern with them, for their own safety, of course.”

The helicopters have bear paws at their base rather than a rail, meaning Fletcher and his pilot can land their ambulance in sodden marshes and boggy ground – useful in the region covered by the NWAA. The charity, which has a second base in Blackpool, will attend emergencies as far north as the top of Cumbria, down to south Cheshire and Stoke – an area of 5,500 square miles and a population of roughly eight million people. It makes every working day different.

“You never know what you’re going to get,” Fletcher says. “About four months ago we had an incident when a plane took off from right here, and crashed into some nearby flats. Even though it was just around the corner, we flew to the scene because we were able to take the injured man to a hospital more quickly than a road ambulance. We took him to the burns unit at Wythenshawe Hospital, but it didn’t have a happy outcome. Still, we bought him a little more time, if nothing else.”

Fletcher looks at the ground briefly, recalling the incident. But says he is unaffected by the things he sees and can switch off when he finishes work, even after a day of tragedy and drama: “I can treat an open femur fracture and be back at home later that day without even thinking about it.”

Fletcher’s stoicism is no doubt a byproduct of the familiarity of his work, but it may also be borne from nursing his father through a terminal illness when Fletcher was 16. “He had a brain tumour and would regularly have seizures, so I learned a lot while caring from him. It made me realise I enjoyed helping people, and ultimately made me want to be a paramedic.”

Fletcher is from Wolverhampton, where he performed a number of different jobs growing up. “I’ve been a holiday rep, a bingo caller and I even worked at a reptile house,” he laughs. A semi-professional footballer, Fletcher went to Manchester to study before becoming a paramedic in 2008. He is currently seconded from the NHS for a two-year term, at which point he will likely return to performing his duties out of a road ambulance, though he says he would be keen to try and stay in the air for longer.

We pop out to look at the grounded 135 helicopter. Up front, the inside is a riot of buttons, dials and lights; while Fletcher’s life-saving equipment is stored at the back: “We’ve got everything you get in a Mercedes Sprinter road ambulance, such as the defibrillator and ventilator, it’s just packed in a bit tighter.” Each helicopter can house the pilot and up to two paramedics plus a patient on a stretcher.

Once airborne, the paramedics will assist the pilot with navigation as well as “keeping constant track of other aircraft, liaising with the coastguard, speaking to the police, keeping in touch with air traffic control, speaking to hospitals – it’s never dull”. Once a patient is in the helicopter, the paramedics’ attention turns to treatment and care, leaving the pilot to find his own way to their destination – every hospital in the country has a dedicated landing site for an air ambulance.

I hear a distant rumbling and the signature sound of a helicopter’s blades gets louder, and Fletcher and I watch as it lands. The air ambulance crew also have to re-fuel the aircraft themselves which, on a busy summer day when they might be called out to job after job (“12 or 13 in one day sometimes”), must be done safely as well as efficiently.

While that is taken care of, I suit up and am given a safety briefing by pilot John Cutler. I’m asked by another paramedic if I’m nervous and pretend I’m not – in truth I’m a little jittery. I get in, put a helmet on and can hear the pilot talking to air traffic control. Once he has run through some pre-flight safety checks with Fletcher, we’re off. There’s a scene at the end of the Tom Tykwer film Heaven, where the two central protagonists ascend towards the heavens in a helicopter, sky filling the screen before fading to black. I think of this as the helicopter lifts off the ground and we fly towards Belmont Reservoir, north of Bolton – it feels like being in a movie.

But Fletcher tells me it’s routine for him: “People see it as a sexy role, but I’m as much of a paramedic as a road paramedic, I just have a different way of getting to people who need care. It’s a fantastic environment to work in, and has certainly added another string to my bow, but I don’t think of it as glamorous. Not many people know that the NWAA is a charity. Many people think it is paid for by the NHS, but it’s not and so I tend to try raise awareness if I’m talking to someone.”

There’s no actual emergency taking place on my flight, but the pilot circles a possible landing site to teach me what factors they would consider before landing (is the ground stable? Is there enough clearance? What other hazards are there?). Then we fly back to base, Bolton’s Reebok stadium visible from the craft, and my stomach finally settles – I can’t imagine doing that all day long without losing my lunch.

Fletcher laughs at this, explaining that air ambulance paramedics don’t always have time for lunch if they’re having a particularly busy day. “We do a nine-and-a-half hour shift, with 30 minutes for lunch, but we don’t always get to take it. I don’t mind because if we haven’t got time to eat it’s because we’re helping someone.”

Later, I tell a taxi driver that I’ve just been in a helicopter and he says my life is like a rock star’s. He couldn’t be more wrong, but Fletcher’s life may well be as exciting as any performer’s – though you’ll never find him boasting about it. Every time I hear that rotor noise, I’ll think of Fletcher humbly going about his work caring for the people of the north west, rather than wondering which celebrity is flying overhead.

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