UK’s oldest living kidney donor, 83, gives his organ to stranger

Nicholas Crace praised for altruism after donating his kidney to a patient on NHS waiting-list that he does not know

An 83-year-old man has become the oldest living kidney donor in the UK and the oldest person in the country to give a kidney to a stranger.

Nicholas Crace is the latest member of an exclusive club known as altruistic donors – someone who gives a kidney to somebody on the NHS waiting list whom they do not know.

The former charity director, from Overton, Hampshire, said: “I knew that 7,000 people are waiting for a kidney and that one person dies almost every day while waiting.

“I couldn’t have lived with myself with the knowledge that I had had the chance of changing someone’s life and turned it down.”

The operation, which took three hours, was carried out recently at the Queen Alexandra Hospital, Portsmouth.

Tests at the hospital revealed that the widower’s kidneys functioned as well as those of someone in their 40s.

Crace said: “The surgeon congratulated me on the perfection of my kidneys.

“In fact, given a halter, he would gladly have led me into the winner’s enclosure at the Smithfield Show to have a rosette pinned on.”

Annabel Ferriman, chairwoman of Give a Kidney – One’s Enough, a charity dedicated to raising awareness of altruistic donation, said: “Altruistic donors are very special people.

“They have the imagination to understand the suffering that people go through on dialysis while waiting for a transplant and the courage and generosity to do something about it.”

Crace explained that his thoughts turned to donating a kidney after his wife Brigid died last summer.

He also realised he was too old to be a bone marrow or blood donor, having given blood 57 times previously.

Crace, who is a volunteer driver for a local hospice, said: “I cannot remember quite what put the idea of being a living kidney donor into my mind but in September 2011 I thought that it might be worth investigating.

“After all, I was in good health, had no dependants and had plenty of time at my disposal.

“Giving a small part of me to someone else will make little difference to my life but a huge difference to someone else’s – it was an easy decision for me to make.

“I was lucky to be in a position to help someone else less fortunate than myself.”

The process involved Crace undergoing a number of tests during 14 hospital visits in a six-month period.

Consultant surgeon Sam Dutta, who performed the operation, said: “We know from numerous studies that a living donor kidney performs better, works quicker and lasts longer than one from a deceased donor.

“All the detrimental factors related to being on dialysis are completely taken care of by a good, functioning kidney.

“An altruistic donor coming forward is an amazing thing for us. The recipient just gets a new lease of life.”

Almost 100 people have donated a kidney since the altruistic living donor scheme was launched in the UK in 2006 and in 2011 a further 1,000 people gave a kidney to a relative or friend.

Cannabis laws ‘need changing’

Growing small amounts of cannabis should be treated like a speeding ticket with a fine and no criminal record, according to a UK drugs charity.

Diabetes patients at risk from medication mistakes

One in three hospital patients with condition affected by errors that could lead to dangerously high or low blood glucose levels

Nearly one in three hospital patients with diabetes are affected by medication mistakes that can lead to dangerously high or low blood glucose levels, checks have revealed. Hospitals in England and Wales made at least one error in the treatment of 3,700 people with diabetes during just one week, according to an audit covering nearly 13,000 patients at 230 hospitals. This represented a small improvement on previous figures for England alone, but Diabetes UK, the main charity in the field, said the overall picture was an “indictment” on NHS care for those with the condition.

Its chief executive, Barbara Young, said: “The fact that there are so many mistakes, and that for some people a stay in hospital means they get worse, should simply not be happening.

“Poor blood glucose management, caused by errors in hospital treatment, is leading to severe and dangerous consequences for too many people. For example, there are a number of recorded episodes of diabetic ketoacidosis, the result of extremely high blood glucose levels caused by a lack of insulin.”

The audit was managed by the NHS’s Health and Social Care Information Centre and Diabetes UK and commissioned by the Healthcare Quality Improvement Partnership, a body led by medical and nursing royal colleges and National Voices, formerly the Long-term Conditions Alliance.

Patients with medication errors suffered more than double the number of severe hypoglycaemic – “hypo” – episodes than patients without errors. These happen when blood glucose levels drop dangerously low and, if left untreated, can lead to seizures, coma or death.

In addition, 68 patients developed diabetic ketoacidosis (DKA) during their stay in hospital. DKA occurs when blood glucose levels are consistently high, which suggests that insulin treatment was not administered for a significant period. DKA can be fatal if not treated.

During the week of the checks, 68 patients had developed DKA, a potentially life-threatening condition, after admission to hospital. The audit also revealed that hospitals did not have enough staff expert in diabetes, especially those who understood the importance of foot care. About 100 people with diabetes undergo leg, foot or toe amputations each week in England, many of which could be prevented, according to Diabetes UK. Foot ulcers are also common.

Two-thirds of the patients included in the audit were admitted to hospital for reasons other than their diabetes. They tended to be older than other inpatients.

Gerry Rayman, a consultant physician and head of service at Ipswich Hospital Trust’s diabetes and endocrine centre, who was clinical lead for the audit, said there was a long way to go for diabetes care. Most hospital doctors and ward nurses still did not have basic training in insulin management and glucose control, he said.

“Training needs to be mandatory to improve diabetes control and reduce the frequency of severe hypoglycaemia. It is also needed to prevent diabetic ketosis occurring in hospital, for which there can be no excuse; its occurrence is negligent and should never happen.”

Rayman said controlling diabetes could be difficult in some patients, more so if they were ill and unable to eat and drink. “This is why the knowledge, experience and skills of diabetes specialist staff are so important. There is no doubt that big improvements in care and patient safety can happen by ensuring hospitals are adequately staffed with inpatient diabetes specialist teams, who can provide leadership, governance and training to other hospital staff.”

The audit took place last autumn. The first was conducted in 2010 in England only.

Statins could benefit health of millions

Medical journal says cholesterol-lowering pills can reduce the risk of heart problems, especially in the over-50s

Millions of over-50s could safeguard their health by taking statins, according to a study that found the drugs benefit healthy people with no heart problems.

The findings could lead to a change in policy by the NHS, which currently restricts cholesterol-lowering statins to those who either have heart disease or have at least a 20% risk of suffering a “major vascular event”, such as a non-fatal heart attack, stroke or surgery on damaged arteries, within the next decade.

But a big study of statins’ effectiveness, published in the online version of the Lancet medical journal, challenges that policy and concludes that even for people with no record of heart problems, taking statins can reduce their risk by a fifth.

The international criteria for who should receive statins should be reviewed and extended, the authors say. As many as 20 million Britons could be offered them, which would add up to £240m to the NHS’s annual drugs bill.

“If we want to prevent heart attacks and strokes that come out of the blue in people with no previous evidence of problems – and about half such events happen in the absence of any prior history of disease – then we have to identify and treat people who are currently healthy but are known to be at increased risk of developing heart disease,” said Professor Colin Baigent of Oxford University, co-author of the study.

The researchers reviewed 175,000 patients who took part in 27 previous randomised trials. They divided the participants into five groups, each with a different five-year risk of a major vascular event. They found that taking statins reduced the risk of such events by 21% for each unit reduction achieved in someone’s level of harmful low density lipoprotein (LDL) cholesterol. The benefit applied even in the patients deemed at lowest risk, they concluded.

“This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered.” they said. The research also found no evidence that that statins increased incidence of cancer or deaths from non-vascular causes.

June Davison, senior cardiac nurse at the British Heart Foundation, which part-funded the study, said: “Those who already have heart disease, or are at high risk, are offered statins because it’s well established they help to lower cholesterol and reduce the risk of heart disease. This large-scale research found that even people at low risk of heart disease could benefit from statin therapy. The findings will help to inform policy and treatment guidelines in the future.”

A Department of Health spokesman said: “We keep all new research under consideration. Nice [National Institute for Health and Clinical Excellence, which assesses the cost-effectiveness of treatments] regularly reviews its published guidance in order to take account of new evidence.”

Oldest living kidney donor at 83

An 83-year-old man becomes the oldest person in the UK to donate a kidney while still alive, the NHS Blood and Transplant service says.

Statins ‘benefit healthy people’

Thousands of heart attacks and strokes could be prevented if the cholesterol-lowering drugs, statins, were more widely prescribed, research suggests.

Robotic arm controlled by thought

Two patients who are paralysed from the neck down are able to control a robotic arm using their thoughts.

Brain implant allows paralysed woman to control a robot with her thoughts

The BrainGate implant can decode a patient’s brain signals and instruct a robotic arm to reach and grasp objects

A woman who lost the use of her limbs after a devastating stroke nearly 15 years ago has taken a sip of coffee by guiding a robotic arm with her thoughts.

The 58-year-old used a brain implant to control the robot and bring a flask of the coffee to her lips, the first time she had picked up anything since she was paralysed and left unable to speak by a catastrophic brain stem stroke.

Doctors hailed the feat as the first demonstration of an implant that directly controls a reaching and gripping robotic arm by sensing and decoding the patient’s brain signals.

The work is part of a US clinical trial of an experimental implant called BrainGate that doctors see as a first step towards devices that can bypass damage to the nervous system and allow paralysed people to regain control of their limbs or amputees to move prosthetics.

“At the very beginning I had to concentrate and focus on the muscles I would use to perform certain functions,” the woman said. “BrainGate felt natural and comfortable, so I quickly got accustomed to the trial.”

Writing in the journal Nature, researchers described trials in which the woman, known only as S3, and a 66-year-old man referred to as T2, used the implant to control two different designs of robotic arm. The pill-sized device is surgically implanted a few millimetres into the motor cortex on the surface of the brain, where its 96 hair-thin electrodes pick up the patient’s neural activity.

In a series of sessions, the patients learned to control the robot arm and pick up foam balls by imagining moving their own arm and hand. Neither patient could control the robotic arm as well as natural arm movements, but doctors were still delighted with their progress.

“These results are the first peer-reviewed demonstration of a three-dimensional reaching and grasping task using direct brain control of a robotic device,” said Leigh Hochberg, a neuroengineer at Brown University in Rhode Island.

“One of the participants was also able to use the investigational BrainGate system to pick up a bottle of coffee and drink from it. This was the first time in nearly 15 years that she had been able to pick up anything solely of her own volition. The smile on her face when she did this is something that I and our whole research team will never forget,” he added.

The man who took part in the trial had a brain stem stroke in 2006. Describing the experience afterwards – by spelling out letters with his gaze – he said: “I just imagined moving my own arm and [the robotic] arm moved where I wanted it to go.”

The BrainGate device plugs directly into the brain, but protrudes through the skull where it is connected to a computer by a cable. More advanced devices are planned that can operate wirelessly and be implanted out of sight, beneath the skin.

One concern with brain implants is that they steadily lose their ability to sense neural signals as scar tissue forms around the ultrafine electrodes. An encouraging sign from the latest trial is that doctors could still record useful signals from the woman’s brain five years after her implant was fitted.

John Donoghue, a co-author on the paper, and director of the Brain Institute at Brown University, said there was still much work to do. “We’ll have truly met our goal when someone who lost mobility to neurological injury or disease can truly interact with their environment without anyone knowing that they are employing a brain-computer interface,” he said.

In an accompanying article, Andrew Jackson at the Institute of Neuroscience at Newcastle University, said the study underlined how basic research was a crucial driver for such technological advances. In previous years, patients have used BrainGate to control a cursor on a computer screen and clench the outstretched fingers of a prosthetic hand into a fist.

“At a time when experimentation using nonhuman primates is increasingly controversial, it is worth noting that the results reported … draw directly on previous neural interface demonstrations in monkeys and on decades of basic research into the control of arm movements,” Jackson writes.

“Although robotic arms may be of practical assistance, restoring movements of the patients’ own limbs should remain the ultimate goal,” he adds.

Mind-controlled robotic arm – video

Researchers have reached a milestone in ‘mind control’ by creating a robot arm that can be controlled by a brain implant. A woman paralysed for the past 15 years has learned to use the system to serve herself coffee

Ambulance change ‘to save lives’

At least 150 lives will be saved and thousands of wasted ambulance journeys avoided by a change in 999 response practices, NHS chiefs believe.

John Sculley: the future of our health is in the cloud

The Newton was two decades ahead of its time, says the former Apple chief executive – and the future of healthcare will be driven by cloud computing

John Sculley – the man who as Apple chief executive gave the world the Newton, which was the first glimpse of the “personal digital assistant” in the 1980s – can see a number of possibilities opening up before us.

A world without work for millions who want it? A world where we can diagnose strokes or heart attacks well before they happen? A world of machines talking to machines? All are possible, even likely, because of cloud computing, which he sees as the next driver of huge social change.

And he also has a clear idea of what the Newton really needed to succeed – and which of Apple’s visions from the time really matches what we’re seeing now.

“I’m an optimist,” declares Sculley, now 73 but still deeply involved in technology. “You can’t be an entrepreneur if you’re not essentially an optimist, so I’m an optimist by nature.”

Cloud computing, has says, means that we’re shifting from the growth of Moore’s Law – a doubling every 18 months – to something even more exponential. “The curve is accelerating upwards, at a level that means that technologies are coming out that can do things that you couldn’t even envision even two or three years ago.”

Robust data storage costs are falling too, from around $5 (£3.14) per gigabyte a year ago to 25c now. “The speed at which a lot of this technology is commoditising is unprecedented,” Sculley says.

Even so, he sees some areas for concern. First, imagine a world where computers have driven humans out of all but the highest-skilled jobs – so that driverless cars, automated factories and similar processes mean that the middle class that has for years been happily thriving on jobs that couldn’t be done otherwise suddenly find themselves disenfranchised.

Sculley admits he’s not as optimistic about that. “The more we bring in these sophisticated technologies, the higher the skills of the people that are needed to be able to use it, and the fewer people we need in the workforce, so the issue is not about work moving to lower-cost workers, it’s about automation replacing many of the jobs that we had counted on, particularly for our middle class in the past.”

The political gridlock in the US – caused by the warring demands of the Tea Party, which thinks government and taxation is destroying jobs, and those of the Democratic Party, which has been trying to drive growth by boosting the money supply – is one example. Another is the Eurozone, where the tensions between Spanish, Greek, German and French voters and their leaders is coming into starker focus as unemployment rises.

“Those are the things that technology may not be able to solve, but it certainly is a consequence of technology, that the sophistication of automation is changing how work is done, and is changing the skill requirements of workers,” says Sculley. “In many cases jobs that used to be done by people are going to be able to be done through automation. I don’t have an answer to that. That’s one of the more perplexing problems of society.”

Even so, he does think that – as has happened previously – technology will throw up a solution. (In the early 1900s, the problems of horse manure in London streets threatened to overwhelm them; the car solved that – but, of course, eventually brought its own set of challenges.)

On a more optimistic note, Sculley – who now works as a venture capitalist, and has investments in companies looking at healthcare – things that cloud computing is going to make a colossal difference to the quality of our lives.

Healthcare in the US is a $2.6tn market, driven by insurers which pay doctors who often carry out procedures and expensive tests in order to avoid lawsuits. The problem is that healthcare costs are rising more quickly than inflation, incomes or tax receipts.

“Politicians are arguing among themselves as to who’s going to pay for it,” says Sculley. “It’s completely unaffordable at its current growth rates, and the more I get a chance to understand health care, the more convinced I am that the problem is very solvable, but it’s solvable through innovation, not through just governments trying to work out who pays for what.

“We see healthcare shifting from a procedure reimbursement where in this country doctors are reimbursed for how many procedures they conduct, to a world where people will be reimbursed for the outcomes – did the patient actually get better, and what was the total cost of the cycle of care. So it’s not just about taking cloud computing and automating the healthcare system we have today, it literally means innovating and reinventing the health care system to make it it much more patient-centric.”

“Big data analytics” – the analysis of colossal amounts of data which could amount to terabytes of information – will change healthcare, he forecasts, from one where doctors are paid to carry out procedures, to one where they’re paid based on keeping people well. (In that sense, it sounds like the longstanding Chinese principle where a doctor’s quality is measured on how infrequently patients get sick, not how quickly they’re cured.)

And helping that will be computing that will analyse everything – even the levels of proteins in our blood. “I’m working with a company right now where we’re doing this – you can track in real time peoples’ vital signs and take that data, you can imagine that’s massive amounts of data when you’re tracking each individual in real time, the vital signs – it could be their heart, could be how much they weigh, could be their fluid retention, could be even tracking proteomics, which are protein changes inside the body.

“If you can take that data and then be able to analyse it, it means that the future of medicine is going to be able to make predictions and measure outcomes of patient health improvement at a level of accuracy and a level of personalisation that we’ve never seen before.”

All this, he says, will rely on the computing power brought together by the cloud: “It isn’t just the compute power, it’s that you can enable the big data analytics, in a specialised way. That’s going to give us hope that what looked like insolvable problems like health care can be solved.”

Don’t expect overnight change, but do expect change: ” It may not be done in a few years,” Sculley warns. “it may take five or 10 or 15 years to see the impact, but there’s no question in my mind that it’s going to have as big an impact on things like healthcare as personal computers did in empowering individuals and really created the productivity we’ve had for 30 years with knowledge workers.”

The cloud doesn’t just stop with people, though. Imagine too a world where there are around 20bn internet-connected devices – but only around 7 billion people, as there are now. That’s the forecast from various research companies for 2020.

“Having 20bn connected devices means that the majority of those connected devices will be machine to machine,” Sculley explains. “It means we’re just at the beginning era of very powerful sensors that can be built into clothing, that can be used for tracking almost anything that one can conceive and doing that in real time and using cloud computing to manipulate data which is going to be many many orders of magnitude larger and more complex that anything we’ve ever considered before.”

Speaking of connected devices, might one of the flaws in the Newton have been it lack of connectivity – something that now exists through mobile broadband? Sculley has, of course, had a long time to reflect on this.

“Well, I think the idea [of Newton] was right, it was just 20 years ahead of its time. So actually, a lot of people were able to see where the industry’s going, the hardest part is to figure out when it’s going to happen.

“In the case of the PDA, the idea was right – that the content and communication and computing were going to converge – but I think we greatly underestimated that we needed broadband, that we need far more powerful devices, that we needed something a lot more powerful in the background which we now know as ‘cloud’ to be able to handle the tremendous amount of data, and connecting people up through social networking. So it was a good idea, but it was just several decades too early.”

Was it then one of those projects that simply gets out of hand, and acquires a momentum that can’t be stopped as it thunders into the market? “We never looked at Newton as being the seminal product. That was just one step along the way, You can get a much better view of the seminal experience if you go back – you can go to YouTube, i think it’s 1988 [in fact 1987], a concept video we created called Knowledge Navigator.”

Indeed, Knowledge Navigator ) – from the days when Apple made concept videos – has become famous for prefiguring many elements we’re now familiar with: tablet computing, internet search, voice control. It shows the internet as a graphical medium – predating the web, which hadn’t yet been invented – and suggests effortless interaction with digital “assistants”.

Knowledge Navigator, says Sculley, “is really something we couldn’t build at the time. But technically we could use special effects and be able to simulate what the experience would be like. That was 24 yeas ago and if you look at that, I think is pretty accurate, almost to the point of being uncanny as to what the experience of tablet computing and mobile devices have turned out to be like.”

Which leads to the obvious final question: how does he organise his computing life? Is he, to coin a phrase, post-PC? “I’m clearly post-PC,” he replies. “I carry an iPhone, a BlackBerry, a [Samsung] Galaxy Note, and I carry an iPad. When I’m in my home office I use a Mac, so I think I’m more typical than not in using many, many different devices.”

The post-PC era doesn’t mean the end of devices, he says: “It means you can be on any device that you happen to have, and everything basically is more and more connectible through the cloud.”

• John Sculley is giving the keynote address at the Cloud Computing World Forum in London on 12-13 June

Today in healthcare: Wednesday 16 May

News, comment, blogposts and tweets across the sector

3.04pm: Jessica Fuhl writes

The King’s Fund’s Chris Ham has blogged today on integrated care and why the NHS needs more deviant leaders. It follows a piece on the network today from his colleagues at the think tank John Clark and Nicola Hartley on why NHS leaders need to be more engaging.

Chris Ham says:

Local leaders – not for the first time – are ahead of the game, even if they risk incurring the wrath of the regulators in deviating from standard operating procedures. If integrated care is to emerge at scale and pace, the NHS needs more positive deviants, and the powers that be should learn to actively encourage them to show what can be delivered when they look out instead of up.

2.58pm: Clare Horton writes

Did you know that the NHS Confederation has compiled an acronym buster? It covers everything from ABHI to WTR (thanks to Sally Percy for sharing the link)

1.30pm: Lizzi Easterbrook writes

A quick round up of the lunchtime news.

This article on the BBC discusses a study from the University of Southern California which show that pollution has an impact on heart health. Researchers saw significant signs of improvements in health when pollution levels dropped in Beijing during the Olympic Games.

This piece on the New Statesman argues that the value of the NHS and BBC is immeasurable.

Our colleagues on Guardian Government Computing have this piece about My Health Box, the patient-held electronic health record being introduced by South London and Maudsley Foundation Trust. The system hopes to put patients at the centre of their care and enables them to be actively involved in decisions about their treatment.

Also, the Department of Health has asked for your ideas for a new health app. You can let them know what you think of the ideas here.

11.46am: Clare Horton writes

Fascinating fact of the day, tweeted by Nice:

It’s day two of the Nice annual conference today, follow it on Twitter via the hashtag #NICE2012

10.20am: Jessica Fuhl writes

On the healthcare network this morning Debbie Andalo explores the role of school nurses, arguing that the “Nitty Nora image of the school nurse does not match the reality of today’s professional“.

Elsewhere on the network, John Clark and Nicola Hartley from The King’s Fund explain why quality leadership is more important than ever.

They argue:

The new national structures, such as the NHS Commissioning Board and Leadership Academy, will have a key role to play in developing leadership across the systems but, importantly, local NHS bodies and local authorities will be instrumental in embedding it throughout the system.

10.01am: Clare Horton writes

The health secretary, Andrew Lansley, is today speaking at a conference on “high quality healthcare”, organised by the Reform thinktank. John Clarke tweets:

The conference will also be addressed by former health minister Lord Warner; Dr Charles Alessi, who chairs the National Association of Primary Care; David Dalton, chief executive of Salford Royal NHS foundation trust; and Mike Farrar, chief executive of the NHS Confederation.

9.18am: Clare Horton writes

Also making headlines this morning:

The Telegraph says patients are waiting up to nine years for drugs to treat life-threatening conditions to become available through the NHS.

And the BBC previews Sir Keith Pearson’s speech to the RCN congress. It says he will call for new nurses to be judged on their compassion, not just their skills. Follow all the speeches and debate from the conference via Twitter, using the hashtag #RCNcongress

9.07am: 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.

The Guardian today reports that mothers are to receive one-to-one care from a named midwife during labour and birth as part of government plans to combat postnatal depression.

There’s also news that watchdog Nice has reversed its guidance on prostate cancer drug abiraterone.

The RCN congress continues in Harrogate with a keynote speech from Sir Keith Pearson, chair of the NHS Confederation and co-chair of the Commission on Dignity in Care. The college has published a study today which finds that inconsistent levels of care are putting the lives of people with learning disabilities in danger, and are being exacerbated by budget cuts.

And Denis Campbell reports that research published in the British Medical Journal finds that “fat taxes” would have to increase the price of unhealthy food and drinks by as much as 20% in order to cut consumption by enough to reduce obesity and other diet-related diseases. The report’s authors suggest that such levies should be accompanied by subsidies on healthy foods such as fruit and vegetables to help encourage a significant shift in dietary habits.

Care home criticised after mentally ill resident is jailed for killing schoolboy

Judge questions systems at Ashness House home after jailing resident Serif Aslan for murder of 15-year-old Kasey Gordon

A private care home has been criticised by a judge as he sentenced a mentally ill resident to life for killing a schoolboy.

Serif Aslan had not been taking his anti-psychotic medication and said he had kept a knife in his room for about a week.

As he walked past a school to go to his favourite cafe, Aslan made a remark about a girl and got into a fight with a schoolboy.

Kasey Gordon, 15, went to help the boy and was stabbed through the heart and died on the pavement.

Three other boys were injured in what was described as “a scene of carnage” in West Green Road, Tottenham, north London, in January, last year.

Aslan, 34, was found guilty of murder at the Old Bailey and sentenced to life with a minimum term of 20 years.

He was given concurrent sentences of up to seven years for injuring the three other boys with the knife.

Aslan had lived in the nearby care-in-the-community Ashness House home for six years.

Staff were meant to ensure he took his medication twice a day and conduct random searches of his room, where knives had been found twice before.

Aslan, who had been arrested in the past for criminal offences including indecent assault and having an offensive weapon, suffered from paranoid schizophrenia.

Judge Richard Marks told him: “It seems to me that better supervision may well have avoided the tragic events.

“It is plain that the systems in place at Ashness House to see that you took your medication were plainly wholly inadequate, certainly in the way they were implemented in your case.”

The judge said if Aslan had been taking his medication, the amount in his blood would have been four to six times higher, indicating he may not have taken his tablets for a week.

In the previous month, he had become seriously ill with psychotic symptoms and paranoid ideas, leading to suspicions that he had twice not swallowed his pill after rushing to his room.

This should have put those entrusted with his care “on notice” that there was a pressing need to ensure he was taking his medication.

“This clearly did not happen,” added the judge.

He said Kasey was a young boy who “happened to be in the wrong place at the wrong time”.

Judge Marks said: “The shocking nature of these terrible and tragic events, cannot be overstated.”

Aslan’s illness had contributed substantially to his actions and he was to be returned to a psychiatric hospital to serve his sentence.

Impact statements from Kasey’s family said they were devastated and would never get over his death.

His mother, Verona, said: “Kasey was the soul of my family. He was a born leader.” She said she was not seeking revenge, adding: “Nor do I have hatred in my heart for the man who took my son’s life if he is truly mad.”

The trial was told Aslan had been warned against carrying a knife and for his tendency to stare at young women.

He had been walking along the road with a £1.49 kitchen knife hidden in his hand with tissue paper, but he came upon the schoolchildren.

Richard Horwell QC, prosecuting, said: “This main part of the incident lasted about 30 seconds and, when it was over, the defendant calmly walked away.

“He left behind a scene of considerable carnage. The knife that he had carried – the knife he had been told not to carry – was used by him to devastating effect.”

The 16-year-old boyfriend, who like other surviving pupils cannot be identified, was stabbed in the chest but survived.

He told police in a video interview that Aslan told him: “Your girlfriend is very beautiful.”

The youth said: “I told him to move on. He pushed me and said ‘I will f*** you up’. I knew he had problems. He is always round my school. He is always looking at the girls, always making comments.”

A 14-year-old boy was stabbed near his right hip bone and another 14-year-old boy was treated for superficial cuts to the right side of his face.

Does job insecurity make you less likely to take sick leave? | Open thread

Sick days are on the decline and it has been suggested that recent falls are linked to the recession. Tell us your experiences

Good news for UK employers: employees are calling in sick less often. The Office of National Statistics reports that the average worker now takes just 4.5 days because of illness or injury, compared with 7.2 in 1993. A total of 131m work days were lost in 2011, down 6m on the year before. Londoners are least likely to take time off (1.3% of total working hours), whereas employees in Wales and north east England called in sick at the rate of 2.5% of total working hours.

Tell us how often you called in sick last year and whether you noticed any difference in your colleagues’ behaviour. Do you agree with the Work Foundation and the Chartered Institute of Personnel and Development, who say that “presenteeism” rises in recessions because employees worry that they’ll be first in line for redundancy if they take time off.

• Follow Comment is free on Twitter @commentisfree

State-funded elderly care ‘drop’

The number of elderly people in England getting council-funded care has fallen by 11% in the last two years and looks like it will fall further, figures obtained by Labour suggest.

Prostate cancer: health watchdog reverses NHS guidance on drug

Nice says advanced sufferers in England and Wales should get abiraterone after fresh information from manufacturer

A drug to treat advanced prostate cancer should be given to patients on the NHS, a health watchdog has said.

Abiraterone, marketed as Zytiga, can extend the lives of late-stage cancer sufferers by more than three months.

The National Institute for Health and Clinical Excellence (Nice) revised its recommendations after fresh information from the manufacturer, Janssen. Experts welcomed the draft guidance.

Professor Alan Ashworth, chief executive of the Institute of Cancer Research, said: “We are delighted by today’s decision to allow patients with advanced prostate cancer to receive abiraterone on the NHS.

“This drug was discovered at the Institute of Cancer Research and is the result of more than two decades of dedicated work by our scientists and collaborators.

“In clinical trials of men with advanced prostate cancer who have already tried chemotherapy, it has been shown to extend life by an average of four months and improve quality of life.”

Each year around 37,000 men in the UK are diagnosed with prostate cancer and 10,000 die from the disease. It is the second most common cause of cancer death in men, accounting for 13%.

Sir Andrew Dillon, chief executive of Nice, said: “During the consultation on the draft guidance Janssen submitted further information for the committee to consider.This included a revised patient access scheme, which involves providing the drug to the NHS at a discounted price, further information on which patients would benefit most and clarification on how many patients could receive the drug.

“These factors enabled the committee to revise its preliminary recommendation and now recommend the drug for use on the NHS.

“We are very pleased that Janssen’s submission to our consultation means that we are able to produce draft guidance recommending abiraterone. It is an effective treatment, potentially extending life by more than three months, and it also allows patients to be treated at home as it can be taken orally.”

Nice recommended the use of abiraterone, in combination with prednisone or prednisolone, for the treatment of castration-resistant metastatic prostate cancer that has progressed after one course of treatment with the drug docetaxel.

The Prostate Cancer Charity also welcomed the recommendation, but called for the guidance to be issued across the whole of the UK; Nice covers just England and Wales.

Owen Sharp, chief executive of the charity, said: “This announcement represents a resounding triumph for each of the thousands of men with advanced prostate cancer in England and Wales, who know just how much the prospect of precious extra time with their loved ones really means.

“We are delighted that Nice has overturned its earlier decision after reviewing the evidence. We are also pleased that the manufacturer responded to our call to deliver a further reduction in price.

“Although today marks a very welcome advancement, it has to be remembered that abiraterone remains out of reach to men in Scotland on the NHS. We need to see every man who needs this drug receive it on the NHS, regardless of where they live in the UK.”

Mothers to get ‘named midwife’ under plan to combat postnatal depression

One-to-one care during labour and birth part of government strategy to tackle condition that affects 10-15% of mothers

Mothers will receive one-to-one care from a named midwife during labour and birth as part of government plans to combat postnatal depression.

Women who have a miscarriage or stillbirth and parents who are forced to cope with the death of a baby will also be offered increased support from the NHS.

Under the plans, health workers will be given enhanced training so they can spot the early signs of postnatal depression.

The move was welcomed by the Royal College of Midwives (RCM) and parenting forums. Cathy Warwick, chief executive of the RCM, said the pledges were “very good news” for women and midwives.

“These are positive plans from the government targeting areas of maternity care that are under-prioritised and under-resourced,” she said.

“The impact of a miscarriage or a stillbirth can be devastating for the woman and her family and postnatal depression can be a crippling and sometimes fatal illness. Early detection and treatment is crucial.

“It is also excellent to see an intention to ensure that long-standing NHS commitments, such as one-to-one care in labour and choice about where and how women give birth, become a reality for all women.”

According to the RCM, 5,000 more midwives would be needed to deliver the care proposed.

Justine Roberts, co-founder of Mumsnet, welcomed the renewed support but said a sustained effort was needed to ensure mothers benefited from the changes.

“Sadly there are many experiences shared on Mumsnet of women not getting the best care when they need it,” she said.

“The announcement that services provided during miscarriage are to be monitored is a real advance towards identifying best and worst practice and therefore towards improving the care received.”

Sally Russell, co-founder of Netmums, also welcomed plans to address postnatal depression – a common condition that is often kept hidden.

“Most mums and dads find it difficult to admit they are suffering and yet it can be a blight on their lives,” she said. “Having better support from local services could make a big difference and we’re delighted that the government has identified this as a priority.”

Alongside beefed-up training for health visitors – who provide services for expectant and new parents after birth – the government has pledged to improve maternity care by ensuring women have one named midwife to oversee their care during pregnancy and after they have their baby, making sure every women has one-to-one midwife care and giving parents-to-be the choice over where and how they give birth.

The NHS will also be judged on how well it looks after parents who have miscarried, suffered a stillbirth or cot death, with patients asked to rate their care.

According to the Royal College of Psychiatrists, 10-15% of women who have a baby suffer from postnatal depression.

Several celebrities, including actor Gwyneth Paltrow, have spoken of their experience of the condition, which usually starts within a few months of birth. Around one in three women experience symptoms in pregnancy, which then continue. Treatment options depend on the severity of the depression, but include medication and counselling.

The health secretary, Andrew Lansley, said: “We have listened to the concerns of women about their experiences of maternity care, which is why we are putting in place a ‘named midwife’ policy to ensure consistency of care.

“Not least, we will focus on the quality of care given to mothers-to-be and measure women’s experience of their maternity care for the first time.”

Home HIV tests backed by US panel

Over-the-counter HIV tests, which would allow people in the US to check in the privacy of their homes if they have the virus, move a step closer.

U-turn on NHS prostate drug use

A drug for advanced prostate cancer, which can extend life by more than three months, is likely to be approved for NHS use in England and Wales after the medical watchdog reverses an earlier decision.

Nursing ‘needs more compassion’

New nurses should be judged on their compassion not just their skills, the NHS Confederation chairman is to say.