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WHAT important event with global significance for health happened 30 years ago? In 1977, the then Secretary of State for Health and Social Security, David Ennals, set up the working group on inequalities in health under the chairmanship of Professor Douglas Black, which produced the landmark Black Report, in August 1980. This initiated the movement that has now put the issue of inequalities in health centre stage on the global public health agenda. Other notable events included the publication by the four home health departments of Prevention and Health: Everybody’s Business, a call to take prevention seriously, which remains to be fully heeded 30 years later; the first case of Legionnaires’ disease in this country in Nottingham – a harbinger of outbreaks to come; and the establishment, by Barbara Castle, of the Health Services Board charged with phasing out private practice in the NHS – a radical move which did not survive the change in government in 1979. But the event I want to focus on is the launch of the Health for All 2000 movement by the World Health Organisation (WHO) at its assembly meeting in Alma Ata. It is probably fair to say that the WHO, an arm of the United Nations bureaucracy, is not a body which means much to us in the UK. If the person on the Clapham Omnibus had heard of it at all they would probably associate it with the health problems of the third world, not with what happens in developed countries like ours. In this they would be about right. In 1997, in its Alma Ata declaration, WHO identified reducing inequalities in health in the developing and developed worlds as a key aim, and highlighted the importance for its attainment of two factors – intersectoral collaboration and primary care. Intersectoral collaboration is a bit of a mouthful, which basically means that health is not the sole responsibility of one agency but the joint responsibility of many agencies, which must work together in partnership to make it happen. Today we recognise this as a self-evident truth, but in 1977 this was an important new insight the impact of which it is difficult to overstate. Prior to 1977, collaboration between “health” agencies in the UK was restricted to two areas – social services and education – where it was acknowledged that, for example, the care of the mentally ill and the education of handicapped children required close working between the health service, social services and education departments. A specific mechanism, the Joint Consultative Committee was set up in each locality to promote such collaboration. After 1977, in the wake of the Alma Ata declaration, the ambitious Health for All 2000 movement was launched which quickly manifested itself in a growing number of projects around the world, and in the UK, where local agencies came together to look at how they could improve the health and reduce the health inequalities in their populations. In the course of time, the number of agencies involved grew as evidence accumulated that health was affected by what came to be known as the wider determinants, namely a wide range of social, economic and environmental factors. More recently Wales has institutionalised intersectoral collaboration through its innovative health, social care and wellbeing agenda, which recognises that health and wellbeing is everybody’s business and that all agencies need to work together to deliver it. With our own well developed primary care system this element of the Alma Ata declaration seemed to offer little new, but for many countries this was not the case because the delivery of health care tended to be equated with secondary care that is hospital services. So a message only for the developing world one might think. But this was not in fact the case. For it was implicit in the WHO’s singling out of primary care that this also had a key role to play in preventing ill health as well as in treating it. This message has taken much longer to take root than the intersectoral collaboration one, for only now is the crucial role of GPs and their primary care team colleagues in promoting the health and wellbeing of their registered populations beginning to be recognised.
Archive for November 5th, 2007
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The needs of disabled children and young people in Cornwall will be top of the agenda at a Conference being staged by Cornwall’s Local Safeguarding Children Board at County Hall on Tuesday, November 13th. The Conference – “Disability – The Challenges of Safeguarding – improving the outcomes for disabled children and the children of disabled parents” will look at how disabled children and young people are protected in Cornwall. This is the second Conference to be staged by the county’s Local Safeguarding Children Board (LSCB), a multi agency statutory organisation containing representatives of all the key agencies working with children, young people and families. The Board, which replaces the former Area Child Protection Committee, has an independent Chair and is responsible for ensuring that all local agencies and organisations work together effectively to safeguard and protect children in Cornwall. Its membership includes representatives of Health, Education, Children’s Social Care, Probation, Police, Youth Offending Team, Connexions, District Councils, Child and Family Court Advisory Service, Adult Social Care, the Crown Prosecution Service and the NSPCC. Delegates at the Conference will include representatives from all the key agencies who work with children, young people and their families and, particularly, with disabled children and their families. Parents of disabled children in Cornwall and disabled children and young people themselves will also be taking part in the day. They will be welcomed by Terry Lello ( Lib Dem), the County Council’s Lead Member for Children, Young People and Families. “Cornwall has been at the forefront in recognising that Disabled Children’s needs are a priority” said Terry Lello. “We signed up to the Every Disabled Child Matters Charter to ensure that a structure was in place to deliver the very best service for each and every child” . “Delivering that structure is a challenge, and we are working with all partners to ensure that disabled children, their parents and carers receive the support, advice and information on the range of services available to them.” “Disabled children and young people want fun things to do, they want to change negative attitudes to disability and they want the right to a good education. Parents would like not to have to fight for support, to be included in their communities and to find educational provision that meets their children’s needs. I am looking forward to this conference that will inform and stimulate debate and will be a positive move forward in meeting the needs of all children in Cornwall”. There will also be a display of art work by children from Curnow School, and a not to be missed demonstration by power chair football team Celtic Storm during the lunch break. The event will be chaired by Ruby Parry, Assistant Director for Social Care and Family Services for Cornwall’s Children’s Services Authority. “Historically disabled children and young people have not been afforded the same rights to protection as non disabled children” she said. “Nationally there are few accurate figures about how many children are identified as being at risk. What we do know, however, is that disable children are under-represented on child protection registers as we would expect higher numbers given their vulnerability. This Conference will enable us to consider why this is the case and discuss ways of improving the current situation. “
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What exactly is the British National Health Service? Professor Marcus Longley believes that it is a collection of absurdities
I WANT to explore what exactly the British National Health Service is, in all its marvellous absurdity.
At one level, the answer might seem obvious – it is the organisation, which provides most of the healthcare for the people of this country, from womb to tomb, without regard to means or merit, whatever condition you may have.
Well not really, actually. Is it one organisation? I reckon that there are at least 38 separate bits of the Welsh NHS alone, not to mention the Welsh Assembly Government and its various progeny, Nice (National Institute for Health and Clinical Excellence), NLIAH (National Leadership and Innovation Agency for Healthcare), HCW (Health Commission Wales) and the rest of the alphabet soup.
Second, from womb to tomb? Antenatal care is pretty ubiquitous, but end-of-life care depends heavily on the voluntary sector, and many aspects of healthcare that people actually seem to want – chiropractic, osteopathy, acupuncture, even dentistry in some places – are hard to come by on the NHS.
Without regard to means or merit? Try telling that to people in many of the communities around here. Finally, whatever condition you may have? Well, don’t make the mistake of misusing substances in the wrong part of Wales, or being a child with mental health problems, or needing infertility treatment, having prostate cancer or even having a stroke.
One survey placed the UK ninth in the world for overall health system achievement and 18th in terms of overall efficiency.
The point I want to make is simply this – the NHS is actually a pretty odd beast. It is full of contradictions. For many, particularly perhaps Gordon Brown, it’s the essence of Britishness – compassionate, egalitarian, indefatigable and yet it is absurd – a monopoly in a globalised world; paternalistic in the age of consumerism; trying to manage a million professionals.
Is the NHS charmingly paradoxical or approaching paralysis? On July 5, 2008, it will be 60. Is it fit for immortality or retirement?
We still have a folk memory, – albeit fading now with time – of a grim Britain before the NHS, where social injustice was multiplied in people’s health. There still exists today, I think, a notion that while unequal incomes may be acceptable, there is nevertheless something deeply offensive about the idea that people can suffer ill health and disability just because they are poor.
Health seems to have a different moral status to some of the other qualities which money can buy. We really don’t like the idea that money should change hands so visibly when professionals provide care.
In fact, there has been a very strongly felt, almost visceral objection to private practice in healthcare in Britain since the beginning of the NHS.
In part it is because it reminds us of the fundamental inequity of differential access to good quality healthcare, but in part, it’s an affront to a core value – an expression of our solidarity which demands that all of us at least receive good healthcare when we need it, rich and poor alike in the same queue, even though other inequalities may be tolerated.
It is one of the main reasons why we really don’t like Nice and other organisations trying to tell us what we can and can’t have on our NHS. We much prefer it when money doesn’t come into the equation.
This NHS has three defining characteristics, which have barely changed in the last 60 years – funded from taxation, available to all, with very few defined limits to the range of treatments which it offers.
All of those are anomalous inter- nationally. There are few healthcare systems around the world funded from taxation – especially since the collapse of the Soviet Union.
Most countries of the developed world have either a system based on social insurance, or one also based on private payment and private insurance. These embody, in various ways, the notion of “earned entitlement”, with supplementary payment providing enhanced service.
They also tend to have much clearer boundaries around what services are – and are not – available.
Which approach is better is a subject of endless debate. But the foreigners’ approach at least provides some options when it comes to another of those ubiquitous problems facing healthcare in developed countries – the fact demand always exceeds supply. The British NHS seems ill equipped to deal with it.
We know that healthcare has the potential to grow almost without limit, meeting new demands, which it creates itself, and able to absorb perhaps twice what we currently pay for it, and to come back for more.
Yet we have a healthcare system which knows no boundaries on entitlement, and no limits to the scope of treatment, and which relies almost exclusively on one source of revenue – the taxpayer.
When the service tries to say “no” to a new drug or intervention – through the voice of Nice or HCW – it is rarely praised for improving the quality of patient care.
During the past few years, the NHS has seen real terms growth of something like 7% per year – 50% since the start of the decade.
This is certainly marvellous, astounding even, but as an approach to the future, is it also absurd? Some will argue the taxpayer has paid so far, and will continue to do so.
The NHS is hugely popular, and the principle of “from each according to ability, to each according to need” is cherished by us all. But this period of growth is almost without precedent, and is already coming to an end.
For the future, we have Labour MP Frank Field’s stark warning. He said politicians in his party who argue that the middle class will forever support redistribution to the poor are a “public menace, distracting from the real task”.
The fact that we have this problem is, if not absurd, at least a bit odd. Here we have a hugely popular service that we clearly desire more of. There are elements of it we are happy to pay for – witness complementary medicine, which people are paying millions for every year, voluntarily. And yet we seem very reluctant to allow ourselves to buy more of the mainstream variety, allowing the NHS a near-monopoly, and setting it a budget well short of our desires.
It’s not that we can’t afford to have more – other similar countries manage to spend more on healthcare than we do – just that the mechanism of funding through taxation seems – if we believe Frank Field – to have natural limits beyond which we cannot go.
And why is the NHS so unresponsive to the needs of its patients? That may seem an unfair question – how can an organisation imbued with professional ethos, which does nothing but care for millions of patients every year, be accused of unresponsiveness?
I do not mean to criticise individuals. But just as the police service has been accused of institutional racism, I wonder whether in the NHS we may have a touch of “institutional indifference”?
In a general hospital not far from here there is a busy urology clinic, treating people with a variety of problems associated with the urinary system. Within easy reach is just one disabled parking space.
Disabled patients attending the clinic therefore have a choice. They can turn up 20 minutes before their appointment and risk finding the space full. Or they can turn up early enough to ensure they get the space.
This can mean for a 10.30am appointment, turning up by 8am. If they get it wrong, they have a long way to push the wheelchair.
One disabled parking space. Contrast this with your average Tesco supermarket, which will have a bank of disabled spaces right by the entrance, and a virtual guarantee of availability at any time.
Why the difference? Is it that Tesco managers are brighter than their NHS counte
rparts? Or that Tesco can afford the few pounds needed to paint some yellow lines on the car park, but the NHS can’t?
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Forty-six people in the UK have been arrested over the past five months as part of an operation to smash a global paedophile ring. More than 20 police forces have been involved in co-ordinating the UK response to an Italian-based website that had more than 2,500 customers in 19 countries. The website sold tailor-made videos of children being abused, the Child Exploitation and Online Protection (Ceop) Centre said. The investigation, codenamed Operation Koala, began in 2006 when a child abuse video made in Belgium was discovered in Australia. The video was traced back to a 42-year-old Italian who was running a website selling more than 150 self-made, sexually explicit videos of young girls. Police discovered the business had been running for 18 months and generated considerable profits from up to 2,500 customers worldwide. The abusive material was mainly produced in the man’s private studio with some material filmed in Belgium and the Netherlands. One of the videos sold by the Italian suspect showed a father sexually abusing his daughters aged nine and 11, a Ceop spokesman said. Some customers even travelled to the studio to watch and record the abuse and make their own videos. After the man was arrested, the Italian authorities uncovered a hoard of customer details that were forwarded to other European forces. The evidence was examined by experts at Ceop’s London headquarters and details of suspects were sent to UK forces.
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No one can begrudge Foreign Secretary David Milliband the joy of adopting a second child from America. But as a Mail investigation reveales, there’s a much darker side to adopting. At first glance they look like dating websites; hundreds of happy couples captured in soft-focus photographs, waxing lyrical about their love for each other. But read on, and you quickly discover that these chocolate-box perfect husbands and wives have something far more serious on their minds. They are searching for babies – and in the U.S. that means big business for the thousands of private adoption agencies, which can easily procure a newborn for those prepared to pay up to $40,000. “The average cost of a new car is more than the cost of an adoption,” trumpets one Californian agency. “If adoption is your priority it can be designed to meet your budget and can indeed be affordable.” This week, Foreign Secretary David Miliband and his 46-year-old wife, Louise, announced they have adopted a second newborn baby boy from the U.S. And while there is no suggestion of anything in any way untoward in the Milibands’ case, their decision has thrown a spotlight on adoption procedures in the U.S. which differ vastly from the UK. In fact, here, where contraception is free, terminations are easily accessible and single motherhood is widespread, it is virtually impossible to adopt a healthy newborn baby. In America, however, which has a strong anti-abortion lobby and where the struggling welfare system makes raising a child almost impossible without a regular income, there is no shortage. In the U.S., around 30,000 such babies are adopted annually. In the UK, the figure is around 150. Of course, one can have nothing but admiration for families like the Milibands; unable to have children of their own, they will undoubtedly make loving parents and experience all the joys young children can bring. Yet an investigation by the Mail this week reveals the disturbing truth about some parts of America’s billion- dollar baby brokering industry. While state-run adoption agencies do exist, in the majority of cases, healthy, white, newborn babies are sourced by “adoption attorneys”, baby lawyers who – for a price – can make dreams come true for childless couples. There is no suggestion that the Milibands used anything but the most reputable methods to adopt their latest son, Jacob – but as our investigation reveals there are some states where, thanks to local laws, impoverished and pregnant young women can be offered generous “expenses” throughout their pregnancies, which can include luxury accommodation, maternity clothes, food and cars in return for handing over their new babies. These women are often drawn in via highlyemotive advertising. One website tells potential ‘birthmothers’ in its publicity blurb: “You deserve safe and comfortable housing.” Those who agree to have their babies adopted are housed in luxury apartments complete with swimming pools and gyms – all paid for, of course, by the adoptive parents. Then there’s a Baby From Heaven Adoption Service which promises: “You will be blessed for giving life to your child.” The website adds: “Giving up a baby for adoption is often described as an ‘honourable sacrifice’. “Although the adoption community sometimes overlooks your contribution and sacrifices, we want you to know that we understand your decision is an act of love. We believe adoption is a life-giving option.” Or the Alabama agency Adoptive families.com, which says: “The miracle of adoption is your choice.” Elsewhere, on the Facing an Unplanned Pregnancy? section of The Adoption Network Law Center website, it states: “Birthmothers are the generous women who have made a choice that will enrich a child’s life.”
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As a teenager Fran Lyon was treated for a mild mental illness but now 22 years old she is fully recovered and pregnant. She should be looking forward to the birth of her first child due in January. But instead, she is fighting for the right to keep her baby after Social Services have told her her child will be taken from her. This is because they believe she is likely to suffer from Munchausen’s Syndrome by Proxy (MSbP) – a condition that causes mothers to harm their children to get attention. As a result, Fran is currently fighting for the right to keep her baby. At the age of 14 Fran was subjected to a sexual assault and within two months she had started self-harming. She was admitted to a psychiatric hospital and was later treated for borderline personality disorder. Fran was transferred to a therapeutic unit and by the age of 16 she was discharged but continued to see a counsellor once a week for nine months. Fran explains: since then I have never needed any psychiatric help or medication – I have dealt with my childhood and moved on – I am fine.” Her case has been taken up by Lib-Dem MP John Hemming who has been campaigning against the adoption of babies. John Hemming says: The whole family court system, because of the secrecy which surrounds it, is vulnerable to bad practice. Social workers are under pressure not to lose cases.
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WATCH The ‘This Morning’ Interview! Opens In New Window!
As a teenager Fran Lyon was treated for a mild mental illness but now 22 years old she is fully recovered and pregnant. She should be looking forward to the birth of her first child due in January. But instead, she is fighting for the right to keep her baby after Social Services have told her her child will be taken from her. This is because they believe she is likely to suffer from Munchausen’s Syndrome by Proxy (MSbP) – a condition that causes mothers to harm their children to get attention. As a result, Fran is currently fighting for the right to keep her baby. At the age of 14 Fran was subjected to a sexual assault and within two months she had started self-harming. She was admitted to a psychiatric hospital and was later treated for borderline personality disorder. Fran was transferred to a therapeutic unit and by the age of 16 she was discharged but continued to see a counsellor once a week for nine months. Fran explains: since then I have never needed any psychiatric help or medication – I have dealt with my childhood and moved on – I am fine.” Her case has been taken up by Lib-Dem MP John Hemming who has been campaigning against the adoption of babies. John Hemming says: The whole family court system, because of the secrecy which surrounds it, is vulnerable to bad practice. Social workers are under pressure not to lose cases.
Full Stoty:
http://www.stopinjusticenow.com/News_0520.htm
WATCH The ‘This Morning’ Interview! Opens In New Window!
As a teenager Fran Lyon was treated for a mild mental illness but now 22 years old she is fully recovered and pregnant. She should be looking forward to the birth of her first child due in January. But instead, she is fighting for the right to keep her baby after Social Services have told her her child will be taken from her. This is because they believe she is likely to suffer from Munchausen’s Syndrome by Proxy (MSbP) – a condition that causes mothers to harm their children to get attention. As a result, Fran is currently fighting for the right to keep her baby. At the age of 14 Fran was subjected to a sexual assault and within two months she had started self-harming. She was admitted to a psychiatric hospital and was later treated for borderline personality disorder. Fran was transferred to a therapeutic unit and by the age of 16 she was discharged but continued to see a counsellor once a week for nine months. Fran explains: since then I have never needed any psychiatric help or medication – I have dealt with my childhood and moved on – I am fine.” Her case has been taken up by Lib-Dem MP John Hemming who has been campaigning against the adoption of babies. John Hemming says: The whole family court system, because of the secrecy which surrounds it, is vulnerable to bad practice. Social workers are under pressure not to lose cases.
Full Story:
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Jack Straw is to review the Government’s controversial policy of offering councils cash rewards to meet adoption targets. Critics claim the nationwide system, introduced seven years ago by Tony Blair, provides a ‘perverse financial incentive’ to remove children from their birth parents. Now the Justice Secretary has said he will rethink the Government’s position following a meeting with Norman Lamb. Mr Lamb, the Lib Dem MP for Norfolk North, wants social workers to keep more detailed records when they meet families whose children may be put up for adoption. He has also expressed his concern that the secrecy which surrounds proceedings in the family courts may work to parents’ disadvantage. His campaign was inspired by the plight of two of his constituents, Mark and Nicky Webster, whose case has been championed in The Mail on Sunday. The couple, from Cromer, won a landmark legal case last June to keep their fourth child, Brandon, after false allegations of child abuse meant their first three children were taken away in 2004. The older children have now been adopted and the Websters have been told they will not get them back. Mr Lamb said: ‘Theirs was an appalling miscarriage of justice and part of any proper discussion about this must mean rethinking social services’ adoption targets. It simply provides a perverse financial incentive. ‘It ought not to be a factor that taking children into adoption means the social services bringing in money from the Government.’ He added that he had discussed the Websters with Mr Straw. ‘I raised Mark and Nicky Webster’s experience as a powerful example of the horror that can come as a result of it all. ‘The deeply troubling fact is that they cannot be the only such example of the system failing.’ Mr Straw has given no official undertaking to open up the Family Court system. But Mr Lamb said he was ‘greatly encouraged’ by the meeting. He added: ‘Adoption targets were a subject of discussion as was the insufficient safeguarding of parents’ rights. The lack of case protocol in this area is breathtaking.
Full Story:
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Jack Straw is to review the Government’s controversial policy of offering councils cash rewards to meet adoption targets. Critics claim the nationwide system, introduced seven years ago by Tony Blair, provides a ‘perverse financial incentive’ to remove children from their birth parents. Now the Justice Secretary has said he will rethink the Government’s position following a meeting with Norman Lamb. Mr Lamb, the Lib Dem MP for Norfolk North, wants social workers to keep more detailed records when they meet families whose children may be put up for adoption. He has also expressed his concern that the secrecy which surrounds proceedings in the family courts may work to parents’ disadvantage. His campaign was inspired by the plight of two of his constituents, Mark and Nicky Webster, whose case has been championed in The Mail on Sunday. The couple, from Cromer, won a landmark legal case last June to keep their fourth child, Brandon, after false allegations of child abuse meant their first three children were taken away in 2004. The older children have now been adopted and the Websters have been told they will not get them back. Mr Lamb said: ‘Theirs was an appalling miscarriage of justice and part of any proper discussion about this must mean rethinking social services’ adoption targets. It simply provides a perverse financial incentive. ‘It ought not to be a factor that taking children into adoption means the social services bringing in money from the Government.’ He added that he had discussed the Websters with Mr Straw. ‘I raised Mark and Nicky Webster’s experience as a powerful example of the horror that can come as a result of it all. ‘The deeply troubling fact is that they cannot be the only such example of the system failing.’ Mr Straw has given no official undertaking to open up the Family Court system. But Mr Lamb said he was ‘greatly encouraged’ by the meeting. He added: ‘Adoption targets were a subject of discussion as was the insufficient safeguarding of parents’ rights. The lack of case protocol in this area is breathtaking.
