NHS correspondence review puts safety first | Letters

Your leading article (1 March) was wrong to suggest the government has not prioritised patient safety in the handling of a serious failure by NHS Shared Business Services to deliver patient correspondence. We set up a national incident team immediately, reviewed every piece of correspondence and have nearly completed a second clinical review of all the higher-risk cases. So far no patient harm has been identified. I was advised last March not to make the issue public because it could have led to GP surgeries being deluged with queries by patients, slowing down the vital work of going through the higher-risk cases. I then chose, against advice, to highlight the issue in a statement to parliament before summer recess as I felt it was important that MPs were informed – and far from minimising the issue, it was described as a serious incident in my department’s annual report and accounts.

But where your article was right was in saying that improving patient safety cannot be a matter of rhetoric alone. The NHS deserves credit for making huge progress on patient safety over recent years. Since Mid Staffs, 31 trusts have been put into special measures, and 16 have come out – seven of them now with “good” ratings. MRSA rates have halved since 2010 – and are now lower than France, Germany or Spain. Stillbirths are down 10% and neonatal deaths down 14%. Your leader urged ministers to learn the lessons on safety taught by the airline industry – and we are. Next month, we will launch the Healthcare Safety Investigations Branch to give the NHS independent safety reports modelled on the way air crashes are investigated. And today we are publishing plans to reform the litigation process when children suffer a brain injury at birth so we get earlier compensation to families and avoid legal processes which prevent appropriate lessons being learned.

My ambition as health secretary is simple: I want our NHS to be the safest and highest-quality healthcare system in the world. That this progress is happening despite significant pressures on the frontline is a tribute to NHS staff working very hard in exceptionally tough circumstances.
Jeremy Hunt MP
Health secretary

NHS correspondence review puts safety first | Letters

Midsomer Murders review – like Bake Off with bunnies, but more menacing

‘Welcome to the Bellville Hall Small Pets Show,” reads the banner. Oh dear. It may not be spattered with blood and guinea-pig fluff, but give it time. Entering this impending crime scene – a sort of Bake Off with bunnies – things get more creepy. I mean, cosy. Pets are persuaded over teeny-weeny hurdles. A strange man called Tim kisses Hercules, “the greatest rabbit who ever hopped the Earth”, on the lips. Everything is bucolic and mildly menacing in a clap-your-slippers-together way. Midsomer Murders (ITV, 8pm) openings don’t get more Midsomery than this.

Of course, the point of such long-running detective dramas is to up the ante, slowly, sneakily – in this case over 19 increasingly preposterous series – until a body festooned with bouncing bunnies seems totally plausible and fun. To be more Midsomery, self-parodic, silly. To churn out more romantically situated homes with more period features, more petty vendettas, more ad breaks and, above all, more murders.

Onwards to the body count, which in this season finale is disappointingly low. Only two in two hours … well, two and a half, because the final victim is rescued from a concrete mixer at the last minute. First to be bumped off is posh estate agent Seb Huntington, found in the rabbit tent dripping with blood and cloaked with prize bunnies. Did he rumble someone letting all the pets out of their cages in the middle of the night? Or is he the pet-show saboteur? After all, he wanted to get his hands on Belville Hall, a crumbling stately home where historical romance novelist Delphi Hartley lives with her French lop rabbit, who is “anybody’s for a cherry tomato”.

Don’t dwell on the details. DCI Barnaby and his sidekick, DS Winter, certainly don’t. In spite of their unparalleled experience, their interrogation technique involves asking someone a question and, as soon as they surmise they are lying, saying thank you and walking off. No wonder it takes two hours to sort out the mess. Anyway, the point is … what’s the point? Ah, yes, the properties are lovely. This episode, centred around dodgy dealings at a local estate agent, provides the ideal Midsomer marriage of bloody corpses and bonnie cottages.

Everything else is filler: vintage furs are stolen, Hercules is kidnapped, even Bernie, the stuffed toy badger Sarah Barnaby brought home from her daughter’s nursery, is ravaged by the dog. By the time the murderer is revealed, I have an urge to check out some schedules for Buckinghamshire cottages. According to the Midsomer effect, which is an actual thing, if a property has featured in the series, it increases in value. Someone always benefits from bloodshed, I guess.

Hospital (BBC2, 9pm) is profoundly upsetting and frustrating, “the story of the NHS in unprecedented times”. We know about this “humanitarian crisis”, as the British Red Cross termed it earlier this month, from the daily updates, the personal experience of operations cancelled and long waits for beds. But no amount of knowing makes this six-part series, edited and broadcast within weeks of filming, any less shocking. And, appallingly, no amount of knowing seems to change anything.

To take a single sorry tale, Peter Lai, a 60-year-old retired software engineer, is in St Mary’s, Paddington, for one of the biggest surgeries the major acute hospital will perform in a year: an operation to remove an aortic aneurysm in his chest that at any moment could rupture with fatal consequences.

Fourteen people are required in theatre to carry out the operation. It takes two months to co-ordinate diaries. On Tuesday, Lai – a calm, kind man, who never once shows a moment’s despair – waits patiently for a bed. By the evening, he gets one, only to be told that a bed in the intensive care unit might not be available after his operation. This is an acute hospital at full capacity after all. It is what happens.

On Wednesday, Lai is wheeled into theatre, while his consultant, Colin Bicknell, one of the country’s foremost vascular surgeons, runs around St Mary’s looking for a bed. There isn’t one. The operation is cancelled and Lai, literally waiting on the operating table, is sent home.

I would love to say that everything works out in the end, because everyone is trying their utmost and everyone deserves it to, but this is real life, and a real crisis.

Midsomer Murders review – like Bake Off with bunnies, but more menacing

Hospital review – shining a light on an NHS at breaking point

Morning at St Mary’s hospital, London; who’s for a game of musical beds? There is no flu epidemic, no norovirus, it’s not midwinter, just an average Monday last October. But the hospital is on red alert, meaning parts of it are full to capacity. Such as intensive care, where there is only one bed left.

Prof George Hanna will need it after an operation to remove a cancerous tumour from the oesophagus of his patient, Simon, 67. Simon has already had one operation cancelled because of a red-bed situation, and the operating window after his chemo isn’t going to stay open for long. The trouble is that 78-year-old Janice, being blue-lighted down from Norwich for an emergency op on a ruptured aneurysm in her aorta, will also need the bed if she survives the touch-and-go journey, and if vascular surgeon Richard Gibbs operates successfully. If Simon’s wife looks as if she’s not entirely wishing Janice a safe arrival, then it’s understandable. Is via Buckingham Palace really the quickest route from Norfolk to Paddington, though? Maybe the satnav says it is. Unless Janice isn’t really in that ambulance and it’s just library footage.

Oh, and then another trauma comes in, an attempted hanging. He may need the bed as well. It could be a three-into-one-doesn’t-go problem for Simon Ashworth, the consultant in charge of the ICU and whose difficult decision it is. “It does feel to me like the elastic is a bit nearer to breaking now than perhaps it ever was,” he says, gloomily.

Former nurse, now site manager Lesley Powls has the job of trying to ensure the entire hospital doesn’t grind to a halt. She tries to keep her teams motivated, uses appropriate management speak such as “going forward” and could be played by Joanna Scanlan if she wasn’t playing herself.

Hospital (BBC2) does often feel like satire, doing for a part of the NHS what The Thick of It did for government or what W1A did for the BBC, as wobbly cameras chase bad-tempered doctors, moaning about not being able to do their jobs properly, along busy hospital corridors. The bicycle Richard arrives on is racier than Beeb head of values Ian Fletcher’s folding one; that’s why he also takes it up to his office. “We’re aware of the problems,” director of medicine Tim Orchard tells an assembled group of senior managers, with a nervous little laugh. “Anybody got a solution?”

In fact, this six-part documentary series is a timely slice of the reality behind the headlines. A reality in which exasperated surgeons are spending as much time trying to unblock blockages in the arteries of the system as they are unblocking actual arteries in their patients. A reality which itself is on the point of massive – and terminal – cardiac arrest. It makes a change from the usual stories of heroism you get in shows such as 24 Hours in A&E. I suspect a lot of people who work in hospitals will find this more familiar.

Janice’s operation is fun, though. Richard has opened her up. “Don’t touch the haematoma whatever you do,” he says to his team. “What I mean is, it might blow at any minute, I mean it really might do, literally … Don’t press it too hard, this is going to go, so we need to get a wiggle on.”

There’s no music in the theatre, unfortunately, otherwise it’s straight out of Green Wing. They approach the crux of the procedure. “The difficult bit’s just about to start,” says Richard, impressively. “Everybody do it slowly, diaphragm away from us … so just go gentle … the last bit and then we’re there … relax, let go, let me just do this … fuck, fuck fuck fuck fuck fuck.”

“Pressure’s just gone,” someone says. “What! Has it completely gone?” asks Richard, sounding properly alarmed.

The pressure comes back, and amazingly – brilliantly – Janice is all right. The operation is a success, she’s stitched up, and goes into the ICU to recover. Yes, Janice got the bed, because without it she would have died.

Simon is sent home, again. But he’s in the next day for his operation, which is successful, and he responds well. “It really is as if we’ve been in a thick fog, and now we can see the sunshine,” says his wife. Happy outcomes all round, in spite of the red alerts and the pressure problems (not enough inside Janice, too much everywhere else).

But then a sad postscript. A few weeks later, at home, Simon developed a rare syndrome and died. A reminder that it’s not all about budgets and beds and targets, it’s also about human life.

Hospital review – shining a light on an NHS at breaking point

GPs: Behind Closed Doors review – depressed about the NHS yet?

Meet Ricky. He has a knee injury, a stiff neck and a cough. He missed a consultant appointment because he is terrified of going to hospital. “I’m scared,” he confesses to Dr Jiwanji at Farnham Road Surgery in Slough. “I’m not going.” Meanwhile, his knee pain worsens. Also, he lives in a “disgusting” house. Someone keeps urinating in the hallway. Dr Jiwanji asks him what he needs. “A knee support and some physio,” Ricky replies. In a broken system, this is how a broken patient’s complex needs must be distilled.

Except, Dr Jiwanji explains: “We don’t provide knee supports. You have to buy them.”

“I’m on benefits,” Ricky replies. “I can’t afford it.”

So Ricky gives up on a knee support and Dr Jiwanji writes another referral letter explaining that Ricky will only be operated on under general anaesthetic. Welcome to a typical exchange in GPs: Behind Closed Doors (Channel 5, 8pm). Here’s another: a beleaguered receptionist listens to a woman’s complaint that her legs are killing her. “I might as well just sit in bed and die,” she announces. The receptionist continues to look at her screen. “Can you come tomorrow at 11.40am?” she eventually asks without looking up. The woman is delighted. She has hit the jackpot: a next-day appointment.

And so on, ad infinitum. This might be the most depressing programme on television. What is the point of it? To chill our hearts? Frighten hypochondriacs? Remind us that GPs, like the musicians on the Titanic, are doing their best in a bad situation? We know this, that the NHS, the last bastion of civilised life in this shattered country, is being dismantled even as each new episode airs and we repeat-dial our surgeries in the hope of a phone consultation. We don’t need to see a doctor examining a lump on Colleen’s hand to prove it.

Nevertheless, it continues. The GPs see a baby with eczema, a young woman experiencing seizures whose mum has recorded them on her phone, a man with concussion following a head injury, and another with a swollen leg that might be the result of fatal internal bleeding. Then there’s Leslie, who has hypersensitivity pneumonitis, otherwise known as bird-fancier’s lung. He used to keep 500 birds but is now so ill he has got rid of 300 rare species that were in his house. And got himself some squirrels instead. “No feathers,” he explains between sputum-laden coughs.

The dishy doctor of the practice – because there must be one – is Dr James. “He’s the delicious-looking doctor here,” Beryl giggles as she awaits a steroid injection, which she declares to be lovely. “I’m not sure about that,” Dr James quips. “Everyone here says I look like David Cameron.” This is pretty much the only heartwarming moment – and it features David Cameron.

By the time the programme finishes with a spoof-like update on the patients – Colleen’s lump has been removed, Sean’s potentially fatal swollen leg turned out to be muscle strain – I have figured out the potential of this excruciating show. It will become a government-endorsed project, on endless repeat on an obscure channel, allowing viewers to self-diagnose from the sofa and save NHS resources. Either that, or it is a good basis for an episode of Black Mirror.

Kids On The Edge (Channel 4, 9pm) is also a fly-on-the-wall series about an NHS service but with genuine heart and soul. A thoughtful and moving documentary following the specialised work of the Tavistock trust, the second episode takes us inside Gloucester House, an NHS-run primary school for children with severe mental, social and emotional health issues. Its 18 pupils have all been expelled. Gloucester House represents the end of the line, and like many such places, it turns out to be filled with rage, resolve, patience and hope.

The most moving story features its longest standing pupil Josh, 11, who has a history of appalling abuse and neglect: at the age of three he was scavenging food for his two younger brothers. Adopted when he was five by a a lovely, tender gay couple called Stig and Phil, Josh is overwhelmed by rage and struggles to feel remorse. Josh’s behaviour deteriorates towards the end of term. He runs away on a school trip and says he feels as if he is going to burst. But the commitment of the workers, therapists, teachers, parents and children is nothing short of miraculous. “We’re fighting for Josh to have a future,” says Stig. And it doesn’t get more hopeful than that.

GPs: Behind Closed Doors review – depressed about the NHS yet?

AA Gill opens restaurant review with cancer diagnosis

Restaurant critic AA Gill has been diagnosed with “an embarrassment of cancer, the full English”, breaking the news in his regular “Table Talk” dining column.

The 62-year-old Sunday Times writer said he was alerting readers who follow his restaurant recommendations and who ought to know if there were “any fundamental, gastro, epicurean personal changes that would affect my judgment”.

Gill, a father of four, also announced he is to marry his long-term partner, Nicola Formby, after 23 years together.

Describing how the disease, diagnosed in the summer, had spread, he wrote: “There is barely a morsel of offal that is not included. I have a trucker’s gut-buster, gimpy, malevolent, meaty, malignancy”.

Gill, who was married to home secretary Amber Rudd during the 1990s, is the latest of a number of high-profile journalists and celebrities to have chosen to go public about cancer and chronicle their journeys.

Early pioneers to have written newspaper diaries about their cancer include Ruth Picardie, journalist and mother of two, whose Observer column was published as the memoir Before I Say Goodbye after her death in 1997 aged 33 from breast cancer. Broadcaster and journalist John Diamond, husband of Nigella Lawson, who died after being diagnosed with throat cancer in 2001 aged 47, won a What the Papers Say award for his weekly column.

The Vanity Fair columns written by author, essayist and journalist Christopher Hitchens, who died aged 62 in 2011 from esophageal cancer, were published at book length entitled Mortality after his death.

Sun columnist Jane Moore, a friend of Gill, told the Andrew Marr show she had urged him to write about his illness “because I thought it would be the definitive article on having cancer”.

Experts have long applauded those who share their experiences publicly for helping break the taboo of talking openly about the disease. Martin Ledwick, Cancer Research UK’s head nurse, said: Although over recent years attitudes have begun to change, cancer is still a subject that people find difficult to discuss. When people in the public eye are open about their cancer diagnosis it can be extremely helpful in demonstrating that it is OK to talk about it”.

Broadcaster and journalist Steve Hewlett, 58, who earlier this year was diagnosed with cancer of the oesophagus, charts his journey through broadcast interviews and an Observer column. He said his decision to go public came after deciding to be entirely open with his family, especially his children. By doing so, he allowed them to find support networks they might not otherwise have found, he said.

Writing about it also helped him stay in control, and not mired in a negative mindset. “I have something of a public profile anyway. I am naturally drawn to storytelling,” he said. “I didn’t go into it expecting to generate any reaction. I just thought it really interested me. My own case began to interest me as a story very early on.”

In his quest for information about his illness and treatment, he stumbled across things he thought others might need to know and wanted to share. “There remains for some people, and it is not irrational, a significant taboo about discussing cancer.

“The reaction has been absolutely extraordinary,” he said. “I honestly had no idea what to expect, but I certainly didn’t expect what happened. I have been contacted by well over 3,000 people, offering help, or support, people sharing their own stories, and a lot just saying ‘thank goodness someone is doing this’,” he said.

“I have come to the conclusion that it is helping people. It is extraordinary that it has touched.”

In an interview in the Sunday Times, Gill, said he had no regrets about his diagnosis. “I realise I don’t have a bucket list; I don’t feel I’ve been cheated of anything. I’d like to have gone to Timbuktu, and there are places I will be sorry not to see again,” he said.

Gill, who gave up alcohol when he was 30, added: “But actually, because of the nature of my life and the nature of what happened to me in my early life – my [alcohol] addiction, I know I have been very lucky.”

AA Gill opens restaurant review with cancer diagnosis

Kids on the Edge review – an antidote to the hysteria around gender identity

What a timely programme Kids on the Edge: The Gender Clinic (Channel 4) has proven itself to be. The first of a three-part series that will look at the mental health of children in the UK, this episode focuses in on the work of the Tavistock and Portman NHS Trust’s gender identity development services in London. These services are now greatly in demand: the clinic has gone from 40 referrals a year a decade ago to 1,400 in 2015. This rapid expansion of parents seeking help and advice has, depressingly, led to a kind of small-scale hysteria in recent times about what it means when children might be trans, bringing with it rabid front pages about them being “damaged” or “confused” by a TV show featuring a transgender character, for example.

I hope the people who rage about such things might also find the time to watch The Gender Clinic, which does a steady job of dismantling many of the panicked, inaccurate fears around what is clearly a complex process. In it, we follow two families discussing the possibility of hormone blockers for their children, which would pause puberty until, in time, a bigger decision can be made. There is Ashley, a headstrong young girl who was born a boy called Ashton, and her mum Terri, who is attempting to keep her daughter safe from bullying at school. And there is Matilda, who has an autistic spectrum disorder and whose gender identity is less defined, though by the end of the programme he is Matt at school. Rachel, Matt’s mother, is supportive but terrified of making the wrong decision for her child in either direction.

As a documentary, this is courageous enough to do what online discussion is often incapable of: explore the subtleties that get lost in the vicious polemics that can dominate the public reporting of such stories. Part of its effectiveness is down to director Peter Beard, who approaches the families with an obvious tenderness. He tells Terri – who is wondering whether to move the whole family again, to better serve Ash’s needs – that “there’s no instruction manual, is there?” His way with the kids is easy and kind. To get to the heart of what Ash is going through, he asks a simple question, made all the more devastating by the response. “What would be the best thing ever?” he asks her, as she plays. “Not being how I am,” she replies, casually, still playing.

It does not shy away from the trickier parts of the picture. Consultant psychiatrist Polly Carmichael explains that often, people are seeking certainty, and the reality is that in the case of hormone blockers, there is no certainty; research in this area is not far-reaching yet. The Tavistock’s staff sit cautiously in the middle of the many areas of debate. She talks about the impact of social media on young people seeking answers or reassurance. Ash, who declares that she will go to Sweden to get a womb transplant and then have a caesarian, Googles everything, says her mother. Carmichael says her patients understand the ideas but not the implications. Part of her role is to explain that “physical intervention is not the panacea to all things”.

There is a grotesque exaggeration perpetuated by some that the doctors and psychiatrists who treat children questioning their identities are trigger-happy gender-abolitionists, ready to strike every tomboy with a shot of testosterone if they so much as hint at cropping their hair. The reality is that the Tavistock’s team are articulate and circumspect. They deal with impossibly tough situations with a gentle level-headedness. This documentary makes clear that when a child is referred to their care, the process is thorough, considered and done in the best interests of both the child and the family.

What contributes to the wider hysteria about gender identity (a hysteria that can be fatal; I am thinking of the death of Lucy Meadows, the teacher who killed herself in 2013 after her gender reassignment became national news) is, in part, a desperate lack of empathy and knowledge. In showing its complicated workings, in showing that professional decisions may take in many different voices over many years, in telling stories that correct misconceptions simply by giving them a human face, perhaps The Gender Clinic might start to redress the balance. Carmichael ends the documentary by admitting that, right now, this is “an evolving picture”. But, she says, she knows one thing: that the young people who have taken this route feel it was right for them.

Kids on the Edge review – an antidote to the hysteria around gender identity

Tomorrow I Was Always a Lion review – ingenious journey inside mental illness

Just over a decade ago, Belarus Free Theatre began its extraordinary existence with a production of Sarah Kane’s 4.48 Psychosis. Now it returns to the subject of mental health with Vladimir Shcherban’s adaptation and staging of a memoir by a Norwegian psychologist, Arnhild Lauveng, recording her own experience of schizophrenia. It is performed with the company’s usual physical expressiveness, yet it also left me wondering if theatre is the ideal medium for recapturing a prolonged curative process.

Five actors sit in a circle and take turns in embodying Lauveng’s experiences. As a schoolgirl, she shows all the symptoms of mental disturbance: she imagines jumping off tall towers, sees wolves in the hallway, suffers a crisis of identity and hears voices. In one of the most telling passages, she records the presence of another self she calls “The Captain”, who rebukes her for her failings, physically attacks her and squats on her back as she tries to go about her daily life.

Emily Houghton in Tomorrow I Was Always a Lion. Photograph: Tristram Kenton for the Guardian

When Lauveng talks of the fog that surrounds her, the actors blow smoke rings that slowly envelop her

One advantage of theatre is that it can make Lauveng’s experiences manifest: when she talks of the fog that surrounds her, the actors blow smoke rings that slowly envelop her, and the images that fill her head are ingeniously projected on to a screen through a copy of the very memoir she has written. When Lauveng is institutionalised, we also get a vivid idea of her initial resistance to much of the treatment: the morning workouts, the confinement to an isolation ward, the meaningless tasks that, at one point, involve her in routinely rolling earplugs.

All this is graphically and imaginatively shown. But the production also raises several questions. The story has a positive note in that Lauveng eventually overcomes the illness (today describing herself as a “former schizophrenic”) and fulfils her dream of becoming a psychologist. But in an 80-minute show it is difficult to record every stage of the curative treatment and Lauveng’s leap from afflicted patient to qualified expert is sudden and only partly explained. The production also seems intended to stir us into action on patients’ rights. At the end we are invited to sign postcards protesting at the increased use of physical restraints against mental health patients. That seems entirely just. But, since Lauveng explicitly says she wouldn’t be alive today if force had not been used to prevent her from harming herself, it is difficult for the layman to know at what point restraint is appropriate.

Symptoms … Grace Andrews in Tomorrow I Was Always a Lion. Photograph: Tristram Kenton for the Guardian

This is the first Belarus Free Theatre production to use an all-British cast and the five actors involved perform with exemplary lack of inhibition. Emily Houghton, Grace Andrews, Samantha Pearl, Oliver Bennett and Alex Robertson all switch easily from representing Lauveng herself to the doctors and staff who attend her. But, while the show enhances our awareness and understanding of schizophrenia, it also disturbs one in another sense. By condensing the treatment into a limited time, can theatre ever convey the arduousness of treating mental illness? And, as spectators, are we equipped to make instant ethical judgments on practical issues? Vibrant as this show is, I remain deeply unsure.

Tomorrow I Was Always a Lion review – ingenious journey inside mental illness

NHS access to innovative drugs could be cut by four years, says review

Patients could get drugs and treatment sooner under an “ambitious” plan, according to a new report.

The UK has been known to be slower than other countries when it comes to providing life-changing treatments as soon as they are available, officials said. Making the newest treatments available more quickly is among the recommendations in the Accelerated Access Review.

The report, commissioned by the government, suggests patients could have medications four years sooner than at present if NHS processes were streamlined. Officials said the report will help the UK “embrace new opportunities” as it prepares to leave the European Union.

The review said patients and medical staff become frustrated as they wait for much-needed treatments and said innovators have to “navigate multiple processes” to get their products to the market.

Chair of the Accelerated Access Review, Sir Hugh Taylor, said: “This ambitious plan will prepare the health system for an exciting era in medical innovation. We’ve listened to the views of the NHS, patients, clinicians, the life sciences industries and academia – and it is clear we need to act now to make the most of the tidal wave of new drugs and technologies that are being developed.”

NHS England chief executive, Simon Stevens, said the review could help create opportunities as Brexit approaches. “Across the NHS we’re going to create headroom for faster and wider uptake of important new patient treatments. In doing so we’re going to create new opportunities in the run-up to Brexit for our globally successful UK life sciences sector. If we get this right there are huge gains within our grasp, for patients across the NHS and for the wider success of our country.”

Health charities have welcomed the recommendations. Cancer Research UK’s chief executive, Harpal Kumar, said: “The voices of patients have been crucial to this review. They have a critical role in advising how research priorities should be set and how they would like to be involved in developing new treatments to meet their needs.”

Hilary Evans, chief executive of Alzheimer’s Research UK, said the review has come at a “crucial” time for thousands of dementia patients awaiting the results of trials of a number of potential new treatments. “If these are shown to be positive then the recommendations in this report, including the creation of a new strategic commercial unit, could help these treatments get to patients more rapidly, while ensuring that appropriate reimbursement to innovators is balanced against good value to the NHS.”

NHS access to innovative drugs could be cut by four years, says review

A Pacifist"s Guide to the War on Cancer review – bold musical demystifies the disease

A musical about cancer? I see no reason why not. For much of its length this show, co-presented with Complicite Associates and written by Bryony Kimmings and Brian Lobel with a score by Tom Parkinson, offers a robust demystification of it subject. Only in its later stages does it turn from a piece of theatre into a dubious form of group therapy.

The premise is simple. Emily, a single mum, takes baby Owen into hospital for a series of scans. We share her helpless anxiety as her son is taken from her and she follows the stories of a group of cancer patients. They include a radical feminist, a pregnant 18-year-old, a woman seeking a miracle cure for a terminal condition, a defiant working-class smoker and a young man with a testicular problem who is accompanied everywhere by his mother. They are a representative bunch, all, we later discover, based on real-life cases.

Clearly the point of the show is to sabotage cliche responses to cancer: not just the vocabulary of “struggle” that surrounds it but also, as one character says, the “aggressive sorrow” and special “cancer face”, assumed by friends. The advantage of the music is that it gives each patient his or her moment in the spotlight while showing collective attitudes. Purloining a phrase from Susan Sontag, Kingdom of the Sick is a jaunty choral number capturing the sense that cancer patients are part of a large, ever-growing club. But we are also reminded that each case is different: Mark, the heavy smoker pining for his estranged daughter, sings a Willie Nelson-type cowboy song while Laura, destined for a hospice because of ovarian cancer, rips off her clothes to launch into a shake-it-all-about 70s rock routine.

Battering at an open door … A Pacifist’s Guide to the War on Cancer. Photograph: Tristram Kenton for the Guardian

But, as the show proceeded, my reservations started to mount. It increasingly seems to be battering at an open door. Far from being reticent in speaking about illness or death, I would say we have never been more open about it: I am at an age when any social occasion is prefaced by what a friend calls “the organ recital” and, when I was diagnosed with a kidney tumour three years ago, I saw no need to hide the fact. Although I welcome the show’s candour about cancer, it also lapses at the end into an extraordinary form of self-display: as cast and audience are invited to shout aloud the names of patients they know, I felt I was attending a secular revivalist meeting.

Kimmings herself directs with great verve and there are good performances from Amanda Hadingue as the distressed single mum, Golda Rosheuvel as the miracle-seeking Laura, Rose Shalloo as the teenager facing genetic issues and Naana Agyei-Ampadu as a tough American who wisecracks her way through trouble. The show is bold in confronting cancer with ebullient music rather than hushed reverence but when Kimmings, in a climactic voiceover, endorses the point, it comes dangerously close to self-congratulation.

• At the Dorfman theatre, London, until 29 November. Box office: 020-7452 3000.

A Pacifist"s Guide to the War on Cancer review – bold musical demystifies the disease

Victoria to overhaul health system after hospital safety review over baby deaths

Victoria’s health department is not giving quality and safety in healthcare the attention it needs to protect patients from harm, a hard-hitting review of hospital safety, published on Friday, has said.

The findings have prompted Victoria’s health minister, Jill Hennessy, to announce an overhaul of the state’s health system.

The review was led by the health program director at the Grattan Institute, Stephen Duckett, and was ordered after 11 newborn and stillborn deaths at Bacchus Marsh hospital were found to have been potentially avoidable.

The hospital’s maternity ward had a higher than average perinatal mortality rate despite catering for low-risk births, a previous review of the deaths and Djerriwarrh health services, which managed the hospital, found.

“Basically, we need a change in the culture and approach to monitoring safety and quality in Victoria,” Duckett told Guardian Australia.

“The health department in the past has left the safety and quality issue primarily to individual hospitals, and this meant many hospitals were left reinventing the wheel when it came to issues, and there was also a lack of support to those hospitals from the department.”

Duckett’s review found that many safety and quality issues identified across the state were due to cumulative budget cuts over time that had “gutted many departmental functions”.

“While the cuts were portrayed as improving government efficiency, the decline in the department’s ability to perform its core functions was lost to public view,” the report found.

Duckett said the cluster of baby deaths that prompted the review were harrowing and that his team’s recommendations, some of which have already been implemented, would help the department’s goal of eliminating avoidable harm to patients.

“When my daughter was born I cried for joy,” he said. “I can’t imagine what it must be like to lose a baby and then be told that death was potentially avoidable. The premise of this review was really to make sure we learn as much from those deaths as possible.”

Hennessy said on Friday the government accepted all recommendations made by the review. She announced a series of reforms, among them a new health information agency to overhaul the way data and information is shared across the health system; the creation of a Victorian Clinical Council to provide clinical expertise to government and health services; and that consultation would begin on a “duty of candour” law which would see health services made to apologise to any person harmed while receiving care and to explain what went wrong and what action would be taken.

Many of the reforms will be implemented within 12 months.

“We want to do everything we can to reduce avoidable harm in our hospitals, and make them as safe as they can possibly be,” Hennessy said.

“A goal of zero avoidable harm is an ambitious target, but one we have an obligation to do everything we can to achieve.”

She announced an additional $ 13m to fund the reforms, and the formation of a new agency, Safer Care Victoria, tasked with monitoring and improving quality and safety in the health system. The agency will be headed by world-leading clinician and researcher Prof Euan Wallace.

Victoria to overhaul health system after hospital safety review over baby deaths

A World Without Down’s Syndrome? review – straight from the heart, and that’s the problem

‘This is Olly, my son,” says actor and writer Sally Phillips, over footage of her grinning 11-year-old cracking jokes to his siblings at the dinner table. Aside from being an amateur standup, paint-flinger and epic hugger, Olly has Down’s syndrome, a condition he was diagnosed with at 10 days old. Phillips wants to talk about a new test offered on the NHS that will give expectant mothers a non-invasive, 99% indication of the Down’s status of their unborn baby. Other countries using the test have had an increase in the rate of post-positive-result terminations. As it stands, nine out of 10 British women choose abortion if their baby is diagnosed in utero.

In her documentary, A World Without Down’s Syndrome? (BBC2), Phillips hopes to kick off a debate on the wisdom of introducing the test, which she fears will cause the number of terminations to go up here, too.

She goes to considerable lengths to take in all aspects of the subject, meeting parents, experts, educators and scientists in places as far apart as Iceland and California. But she is both the perfect person to give an account of Down’s syndrome and the worst possible person to present this documentary about the pros and cons of screening.

How could anyone look at Phillips’s son and say they wouldn’t want their child to be like him? This is the nub of programme, the undeniable foundation on which her argument is built. Now take that out into the world, this image of Phillips metaphorically clutching a picture of lovely, funny, warm, wonderful Olly in her hands and try to get a sensible conversation going about the pros and cons of screening. It isn’t possible for the other side of the debate to flow freely under these circumstances.

What I get instead of an even-handed discussion is at least a light shined on something that has only ever been in my peripheral vision. Phillips is right that the subject needs raising because the way a pregnant woman is spoken to about a Down’s diagnosis undeniably needs to change. “I expected tragedy and got comedy,” is how she puts it. A long list of potential health problems, as currently provided in NHS leaflets, isn’t enough to go on when you’re deciding whether or not to bring a life into the world. She has so much insight and intelligence to bring to this, but her interactions with experts and parents on the other side of this debate often leave her tearful and frustrated.

Producer/director Clare Richards does try to keep a careful hand on the tiller, often framing setups with Phillips’s own disclaimers about being a novice film-maker, and occasional questions about whether she is getting it right. Phillips herself said in an interview (on ITV’s This Morning) that she wanted someone else to make this film, someone with documentary experience. Presumably, her celebrity status made her a more appealing prospect for the broadcaster than a scientist or journalist with that degree of distance.

As she treads on ever more tricky territory, you can see why she was reluctant. The most difficult scene is her interview with Kate, an expectant mum who terminated a pregnancy after a positive Down’s diagnosis. As she describes aborting her 25-week-old foetus, Phillips tears up and bows her head. She acknowledges Kate’s bravery in talking about such a hard choice, but then she takes out an iPad and shows Kate a video clip of a young American gymnast called Chelsea, who also has the condition. Phillips’s smile seems to be urging Kate to see what she can plainly see: that their lives are no less valid. That people with Down’s can go on to great things.

“Do you mind if I ask you the really difficult question?” Phillips says, in the most direct confrontation of the programme. “So, you think her life would have been better not happening?” she asks tentatively. Kate takes a moment, then says that she thinks it should be up to each mother to decide.

“Kate didn’t want a child like mine,” says Phillips in voiceover after their interview. That wholly emotional summary of what we’ve just seen is why this doesn’t work as a documentary. When a subject is so close to the presenter’s heart that it is indivisible from it, the result is impassioned but not impartial.

As Phillips herself says, this is “a film that asks the question – what kind of society do we want to live in?” The answer here is unequivocal from minute one: a society that cares about everyone, no matter what their chromosomal makeup. Who could disagree?

A World Without Down’s Syndrome? review – straight from the heart, and that’s the problem

The Mystery of Being Human: God, Freedom and the NHS – review

Raymond Tallis is that under-represented phenomenon in British culture – a serious polymath. For 40 years a consultant NHS physician and medical researcher, he is also a poet, a novelist and a philosopher, and he has written on matters as various as post-structuralism, Parmenides, epilepsy and hunger. In this collection of sparklingly intelligent essays, he brings his voracious mind to bear on, among other deep matters, God, consciousness and the NHS.

Strange bedfellows, you might say of topics rescued from potential tedium by Tallis’s often wickedly witty and subversive prose. He defends the essay form against any charge of magpie trivialism, and makes good his claim by exploring these seemingly disparate subjects with a passion that reveals their interconnected relevance.

One of Tallis’s talents is for the biting aside and irreverent nomenclature, a gift from which he does not exclude himself as an occasional target. He likes to say he is an “infidel”, having been since adolescence quite without belief in any deity. More soberly, he also describes himself as a “secular humanist”, in order to avoid the negative connotations of “atheist”. In God and Eternity for Infidels, he unravels his own dissatisfaction with an address he gave to the Ahmadiyya Muslim community (“the website address of the community – loveforallhatredfornone.org – made the invitation irresistible”). Here, he rehearses cogent arguments against the existence of God but, unlike many convinced non-believers, he is sensitive to the limits of secularism, reflecting that “the ideas of God and eternity” can seem uniquely to address “a seriousness without which life is in danger of being two-dimensional”.

He is so withering about Jeremy Hunt I almost felt sorry for the man left holding the ailing NHS baby. Almost, but not

This proclivity for seeing the other sides to large questions is typical. In the fine opening essay justifying his humanism, he writes: “Any attempt to do justice to our humanity must take into account religious beliefs: to dismiss something profound and constant in our humanity would be a strange attitude for a humanist.”

Nor is he one of those physicalists who maintain that we are “identical with our evolved brains”. For Tallis we humans are “neither spirits entirely divorced from the natural, material world, nor a heap of atoms” but something more subtly refined.

In the winningly titled On Being Thanked By a Paper Bag, Tallis develops this more nuanced idea of the mystery of human makeup in his account of current theories of consciousness. Again, his disavowal of the cynics’ reductive perspective, and his use of the “powerful myth of Christ’s passion” to illustrate “the strange process whereby human beings transform naturally occurring events into actively generated symbols”, conveys his ultimate optimism about the generative communal capacity of consciousness.

Tallis’s belief that our salvation lies in an evolving communion of intellectual advances and resources is most vividly apparent in the central essay of the collection, Lord Howe’s Wicked Dream, a ferocious attack on what he perceives as a long-hatched Tory mission to undo the NHS and deliver it into the dodgy hands of private enterprise. Taking aim first at Geoffrey Howe, Tallis dismantles the thinking and the character of various enemies of state-funded health care, most prominently Andrew Lansley, “the swivel-eyed visionary” who “conceived a plan so cunning [the 2012 Health and Social Care Act] that … if you had put a tail on it you could have made it Professor of Cunning at Oxford University”. And then there is Jeremy Hunt, about whom he is so withering that I felt almost sorry for the man left holding the ailing NHS baby today. Almost, but not. For the “failed marmalade salesman”, as Tallis, in one of his wittiest broadsides, calls him, is rightly dismissed as one who has “passed his adult life in a world where the aim is to sell as much product as possible and to maximise the profit margin”.

Tallis movingly describes how his anger at the attack on the NHS propelled him from his study on to the streets, “interrupting busy people on busy days; being dismissed as wrong or naive; or simply ignored or brushed aside”. As he says in the same essay: “Truth has become so scarce that speaking it seems at best eccentric.” We badly need “eccentrics” like Raymond Tallis, brave enough and committed enough, to speak aloud such truths.

The Mystery of Being Human is published by Notting Hill Editions (£14.99). Click here to buy it for £12.29

The Mystery of Being Human: God, Freedom and the NHS – review

Rachel Parris review – laughing in the face of depression

You can tell something’s in the air at this year’s fringe when you see a comic hitherto associated with jolly parody songs and even she is reciting her recent correspondence with the Samaritans. Lots of comedians have mental-health shows at Edinburgh but if we’re drowning in the tears of clowns then Rachel Parris throws in tears of laughter too. Her Samaritans emails feel tweaked for comic effect, her conclusion a mite too easily engineered for uplift – but this remains a compelling hour, as Parris fronts up about feelings on which women are usually obliged to put a brave face.

Best Laid Plans is about the grown-up Parris expected to be when she was six – house, car, husband, kids – and how real life has refused to play ball. “I’m not married, but on the plus side I do get to go to a lot of weddings,” she says, through gritted teeth. There’s forthright material on the female orgasm, culminating in Parris’s answer to the faux-sexy Flight of the Conchords song Business Time. Another number eschews lyrical invention in favour of gloating “I went to the gym” against a soaring melodic backdrop.

At the show’s tender heart, though, is an account of Parris’s recent breakup, which pitched her for the first time into depression. She’s endearingly frank and funny about the experience, even if the sometime jauntiness of her Samaritans correspondence sits uneasily with the air of emotional candour. But it’s all beautifully crafted and performed.

Rachel Parris review – laughing in the face of depression

Breast Cancer Chemotherapy Varies Broadly: Review Raises Concerns About Early Remedy Alternatives

Final month, the Journal of Clinical Oncology reported that 6 chemotherapy regimens generally provided to patients with early-stage breast cancer vary extensively in their side effects. The researchers identified that some drug combinations are much more very likely to lead to hospitalization than others.

The discovering, whilst hardly surprising, points to the value of sufferers and physicians obtaining fuller discussions about chemotherapy alternatives. An accompanying editorial emphasizes that most individuals are probably to live for a long time after preliminary treatment for breast cancer, and possibilities abound, chemotherapy selections need to be much more granular than is normal in practice.

The takeaway is that major differences exist between chemotherapy therapy regimens that are routinely provided to sufferers with early-stage breast cancer. Taking “it,” chemotherapy, is not an all-or-none choice.

This issues simply because above 230,000 men and women – practically fully, but not solely females – will get a new breast cancer diagnosis this 12 months in the United States. Most will have early-stage disease. And even though numerous of individuals folks will consider if they ought to have chemotherapy, or not, extremely few will ask their oncologists details about particular drug combinations.

Their hesitation is understandable. The chemotherapy regimen names sound like gobbledygook, acronyms loaded with A’s for Adriamycin (aka doxorubicin), C’s (cyclophosphamide), T’s (docetaxel, a taxane most usually branded as Taxotere) and P’s (paclitaxel, one more taxane, aka Taxol). Yes, it gets confusing. The medicines can be offered in distinct combinations, at distinct doses and frequencies, this kind of as each two weeks, or each three weeks. There are several permutations. This is the sort of issue that oncologists examine, and sufferers seldom know considerably about just before starting treatment.

But perhaps they should. Current posts point to the fact that sufferers may be legitimately concerned about the fees of a variety of cancer therapy options. Some recommend that medical professionals ought to by some means know or discover the answers to their sensible financial inquiries. But what about the physical, health-relevant side effects of the medication?

The new research looked at a variety of combinations of what’s called adjuvant – or extra – therapy for breast cancer following surgical treatment. As reviewed in the paper, several randomized controlled studies have established that providing chemotherapy to a newly-diagnosed breast cancer patient, soon after surgical procedure for invasive tumors of at least a specified size, lowers the probabilities that the tumor will spread or otherwise recur.

The major finding was that for females under age 65 with early-stage breast cancer, the fee of hospitalization for chemotherapy-related problems ranged among six and 10 percent. The differences between regimens have been statistically considerable. In older females the hospitalization charges have been drastically greater for all regimens evaluated, ranging among about 13 and 24 percent.

As the authors contemplate, the probability that patients will develop side results may be predicted, in part, by their age and other health problems, in addition to which medicines they’re prescribed and the doses given. Taxotere, for instance, has turn into a much more well-liked drug in current many years and tends to trigger neuropathy. Adriamycin, an older drug used for treating many cancer varieties, might lead to heart issues and lower blood counts, sometimes dangerously. Like other chemotherapy drugs in its class, Adriamycin slightly raises the recipient’s probabilities of developing leukemia later on on, specifically if it’s offered in mixture with radiation therapy.

6 bottles of distinct types of cancer drugs (source: Wikipedia, adapted from a National Institutes of Wellness picture)

To carry out this retrospective examination, which was admittedly constrained in its scope, the investigators culled information for patients with Stage I, II or III breast cancer found amongst 2003 and 2007. They used two databases: one particular for those more than age 65 (a Medicare-linked registry) and these underneath 65 years (MarketScan). Based on coding for diagnoses, chemotherapy drug bills and hospitalizations, the researchers established when patients who acquired certain drug combinations entered the hospital inside of 6 months of remedy.

Hospitalization, per se, is usually a brief-phrase side impact and was the only measured end result in this examine. Neutropenia, meaning a reduced white blood count accompanied by fever, is another quick toxicity of some chemotherapy regimens that can be relatively easy to assess. Mouth sores and hair reduction, and nausea, occur during treatment method and then go away. But things like frailty, or depression, or extended-term cognitive defects, neuropathy – these can be tougher to measure and know.

This paper does not cover newer medicines normally offered in Her2 positive cases, at times in blend with the older “A” “C” and “T”-like chemotherapies. And it is worth noting a shift in latest years toward prescribing endocrine treatment, occasionally with out chemotherapy, for girls with hormonally- sensitive small tumors. The examine does not examine toxicities of anti-estrogens, like Tamoxifen, or aromatase inhibitors, of which there are a number of on the marketplace. But they, also, have considerable side effects, some subtle, which warrant detailed evaluation.

Regardless of whether a patient gets “AC,” as I did eleven years ago, or “T+AC,” or “dose-dense AC + P” or a newer routine may possibly seem like a trivial decision to an oncologist who provides these medication to ladies with early-stage breast cancer like butter on bread, algorithmically primarily based on his or her community’s neighborhood practice. But the variations in outcomes – in excess of the long and short phrase – are worth examining additional.

My conclusion is that this retrospective examination doesn’t offer ample details, in itself, to manual any woman’s selection about chemotherapy. Or a doctor’s guidance. But it suggests that we need to collect much more nuanced information, above years and decades, about how girls fare after remedy for early-stage breast cancer.

Breast Cancer Chemotherapy Varies Broadly: Review Raises Concerns About Early Remedy Alternatives

Review Provides Tiny Support for an Previous Drug

Digoxin is one of the oldest drugs in the cardiovascular arsenal, derived from the foxglove plant and initial described in the 18th century by William Withering. It is often employed in individuals with heart failure (HF) and with atrial fibrillation (AF). The few trials supporting its use have been performed in HF individuals before newer treatments arrived. There have been no good trials in AF.

A new observational examine published in the Journal of the American College of Cardiology now supplies the most comprehensive perspective on digoxin use in AF. Researchers examined information on a lot more than 122,000 individuals in the Veterans Affairs method who had newly diagnosed AF. During 350,000 patient-years of comply with-up, approximately 1-quarter of the sufferers died. Virtually 29,000 patients who acquired digoxin had been matched with an equal number of controls who did not. The risk for death was larger amid digoxin recipients than controls — a locating that remained significant right after multivariable adjustment (hazard ratio, one.21).

•     Unadjusted hazard ratio for digoxin sufferers: one.37 (CI one.33-1.40, p&lt0.001)


•     Multivariate adjustment: 1.26 (CI 1.23-one.29, p&lt0.001)

The authors acknowledged the limitations of observational studies but explained that their sensitivity analyses recommended that any effect of unmeasured confounders would not likely have resulted in a main modify in the findings.

Responding to a question from the editors of CardioExchange, the lead author of the review, Mintu Turakhia, suggested that clinicians use digoxin sparingly:  ”in light of the a lot of other medication that can be employed for charge control, clinicians need to ask whether or not digoxin ought to be the therapy of option for the patient in front of them when there are other, safer options.”

In an accompanying editorial, Matthew Reynolds praises the study but argues that since digoxin for AF is more most likely to be utilised in larger danger HF sufferers the “true” hazard ratio is probably to be reduced than reported. Offered the substantial charge of adverse events brought on by the drug, he suggests that digoxin ought to only be employed “selectively and with care in AF individuals.” But, he concludes, “for now, there are nevertheless clinical conditions (HF, tough fee control, lower blood stress) in which this previous herbal treatment remains useful.”

Harlan Krumholz said that “this review raises considerations about the safety of digoxin in the remedy of patients with AF. Offered the range of medications available, any use of digoxin in this setting need to demand specific justification indicating why the advantages outweigh the possible dangers. It’s time to pause on digoxin till research can assure that it is providing a net benefit to these sufferers.”

J Am Coll Cardiol. 2014 64(7): 660-668.

Review Provides Tiny Support for an Previous Drug

Review Demonstrates The Electrical power Of Social Influence: five Methods To Steer clear of The Herd Mentality

Mom was right when she stated, “Be cautious who you surround your self with.” Though individuals words of wisdom are usually handed out throughout adolescence, there is proof that suggests we want to follow that tips into adulthood. Apparently, we’re even now very easily influenced by these about us.

We’d like to think that each choice we make is based upon our independent evaluation and very best judgment. But, regrettably, that is not constantly the situation. Even as grownups we’re prone to becoming copycats, according to a new study in the Journal of Client Investigation called “Social Defaults: Observed Alternatives Grow to be Option Defaults.”

Even though other research have shown that we’re prone to copying the body language of a man or woman we’re speaking with, and some scientific studies have concluded we experience the identical feelings as the people close to us, this study exhibits we also mimic other people’s merchandise options.

What the Research Displays

A series of experiments concluded that when individuals didn’t have a powerful opinion about the selections presented to them, they merely mimicked the individuals all around them. Rather than asking inquiries, or paying time finding out about items, men and women deferred to the “social default.”

Participants in the examine chose merchandise that had been plainly inferior merely due to the fact they had been copying the men and women close to them. The authors concluded, “Our research demonstrates that automatic forms of social influence are much more pervasive than previously imagined. The automatic processes that underlie behavioral mimicry appear to not only influence nonverbal communication, feelings, and habits when individuals interact, but they adopt the identical preferences as other consumers.”

How to Stay away from the Herd Mentality

Reatailers and sales experts can undoubtedly use this details to their benefit. It gives credence to the substantial-pressure pitch that “Everyone’s carrying out it,” if you want a buyer to buy a certain item. But it’s essential to be conscious of our organic tendency to adopt the herd mentality when you’re on the getting end of a transaction as nicely.

Whether or not we’re speaking about which smartphone to acquire, or what software program system to use, picking a solution based on your observations of what other men and women are undertaking clearly might not be the wisest determination-making device. Right here are five methods to decrease the likelihood that you’ll just defer to the “social default,” when making selections:

one. Cease Currently being on Car-Pilot

When we do not cease and get the time to consider our choices, we go by means of the motions as if we’re on car-pilot. Alternatively of conducting our own analysis, we’ll look around at what others are carrying out and just copy what we see. Once you are aware conscious of the natural tendency to go with the “social default,” you can begin generating a lot more aware decisions for yourself.

two. Make a Conscious Hard work to Form Your Very own Opinion

Rather than basically saying, “I’ll have what he’s getting,” produce your personal viewpoint. Researchers identified that when individuals knew they would require to justify their alternatives, they have been a lot less probably to blindly mimic other individuals. Rather than adopt the herd mentality, educate by yourself about your selections so you can make a properly-informed decision.

three. Get Time to Make Decisions

Participants in the examine were a lot more likely to copy other individuals when they felt strain to hurry. Consider time to make decisions by asking queries and contemplating about your options – even if that means you risk seeking “stupid” or holding up the line. Just simply because every person else appears to be producing a quick determination doesn’t suggest they know greatest.

4. Be Mindful of Techniques in Which Pressure Impacts Your Selection Producing

Review Demonstrates The Electrical power Of Social Influence: five Methods To Steer clear of The Herd Mentality

US to perform key review into female genital mutilation

The Obama administration is to carry out a major study into female genital mutilation, in an effort to establish how many women are living with the consequences of FGM in the United States and how many girls are at risk.

The previous study was carried out in 1997 ,and new research is a central demand of a Guardian-backed campaign, led by Jaha Dukureh, which aims to put an end to the practice. Experts say that FGM, which involves the removal of a girl’s outer sexual organs and is often carried out without anaesthetic, often takes place during the summer holidays when American girls are taken out of the country for the purpose. A prevalence study is seen by campaigners as a vital first step in tackling FGM in the US.

Cathy Russell, the US ambassador for global women’s issues, confirmed that the study would be carried out by the US Department of Health and Human Services. Speaking to the Guardian at a major summit on FGM and child marriage in London, Russell praised the event for highlighting the issue. “This summit is important because it brings together government, civil society and activists who care and have been working on this issue,” she said.

FGM is carried out in 29 countries, and Unicef has estimated that more than 130 million women are living with the consequences, which include heavy bleeding, infections, infertility and death during childbirth. At least 228,000 American women and girls in the US are at risk of the practice, according to previous research from the African Women’s Health Center of the Brigham and Women’s Hospital, but the true number is thought to be much higher.

Young American women who were cut as girls and teenagers on trips back to their parents’ countries, a practice known as “vacation cutting”, told the Guardian that they had been left scarred physically and emotionally. Lesha, a 21-year-old from a southern state, said she and her sister were sent to Guinea when they were 11 and nine respectively. “I went to Africa to learn about my identity just to end up being scarred for life,” she said.

It also emerged that the Obama administration has set up a preliminary working group on FGM, as the first step to measuring the extent of the problem in the US and deciding how to tackle it. Russell said there had been an “initial meeting”‘, adding that the group would likely meet again to discuss developments at the London summit. “We’ve been engaged on this issue for a long time, and now we are trying it get a sense of where we stand”, she said.

It is understood the working group will look at how to fight FGM through education, and will also look at how to tackle “vacation cutting”.

Dukureh, whose petition calling for the new study on change.org has attracted more than 230,000 signatures, said the US had an opportunity to push for change in its own country and inspire change around the world.

“I’m so excited because this is exactly what we asked for,” she said. “It is a great success not just for me but for everyone who has fought for this. But it doesn’t stop here, we are not going away. This is a first step in ending FGM in the States, and where the US leads others might follow.”

Shelby Quast, policy advisor at Equality Now, which is working on the campaign, said the development was proof that people could make a difference.

“Civil society and survivors have raised their voices and the government has responded to that, she said. “This interagency meeting is a call from the president – it means he is bringing people together to talk about this issue. Now the Obama administration must ensure they get input from survivors like Jaha.”

US to perform key review into female genital mutilation

Champneys, ITV, review: "the bubble has burst "

Is there an English country mansion with a background far more rich than the Hertfordshire outpost of the wellness spa empire Champneys in Tring? It was built as a home for 1 lady, the Rothschild dowager her 54 servants moved in but she never ever did. Later, it was owned by Walter Rothschild, who filled the grounds with zebras and kangaroos and could typically be noticed riding a giant tortoise. Far more recently, it has hosted British royalty and played a minor role in the phone-hacking scandal thanks to its owner’s generosity in the direction of police chiefs and newspaper editors. Absolutely there is a fantastic documentary in right here somewhere?

Sadly, Champneys (ITV) wasn’t fairly it. In retaining with ITV’s recent obsession with providing us a peek behind the frayed velvet curtain of Britain’s luxury business (see final week’s Within Asprey: Luxury by Royal Appointment), this mildly amusing movie showed the Tring resort and celebrity haunt barely coping with a pile-up of dissatisfied visitors, internecine warfare amongst the employees, and competitors from wannabe spas that – as place-upon owner Stephen Purdew had it – are merely hotels with “a handful of poxy pictures of a pool” in the brochure.

Champneys, Purdew was at pains to stage out, is a overall health spa and not just another 5-star hotel. But the delights of the reiki treatment method rooms, the blood-freezing kriotherapy chamber and the healthier-residing menu seemed lost on numerous. One guest was most put out by the dimension of the portions and the lack of chocolate gateau, one more baffled by the daytime alcohol ban. The location appeared to be complete of girls there just for a dip in the scorching tub and a spot of flirting with the waiters.

A lot of the material here felt like something out of Small Britain: new recruit Bettina’s efforts to “Champney-fy” the reception staff’s phone manner housekeeper Irena, who kept hunting daggers at her superior and operations manager Lee’s very certain instructions for preparing a space for Arab royalty (covered floors and furniture, a Harrods catalogue, “citrus blush” soap in the bathroom).

It was brave – some may possibly say foolish – of Purdew to permit the cameras to present his valiant attempts to cease Champneys looking a lot more like Alan Partridge’s Travel Tavern than a five-star hotel. But this movie sorely lacked a touch of Champneys’ significantly-vaunted glamour. Daniel Craig and the Arab royal investing £250,000 have been talked about, but in no way observed. Who did we get as an alternative? Bobby Davro on a treadmill and a member of Ladies Aloud.

Champneys, ITV, review: "the bubble has burst "

The Shape We"re In review sobering reflections on the weight problems epidemic

Chuck it out: junk food, sugar and sloth have made the Uk excess fat. Photograph: Alamy

When the movie What’s Consuming Gilbert Grape was released in 1993, the plot – featuring Johnny Depp and Leonardo DiCaprio as sons to a mom too obese to be lifted out of the property – appeared rather uncommon, even unlikely. Two decades later on, as Sarah Boseley, the Guardian‘s overall health editor, documents in The Shape We’re In, Gilbert Grape situations are enjoying out up and down the United kingdom. In 2012, 400kg 19-yr-old Georgia Davis of Aberdare had to be carted out of her home on a specially reinforced stretcher after a wall was demolished and a bridge constructed to make way for her. Also that yr, a 5-12 months-outdated was taken into care in Newport simply because she weighed 65kg, far more than three instances the anticipated excess weight for a girl of her age.

Unhappy, surprising exceptions? Definitely, but reading through Boseley’s disturbing book will depart you in no doubt that the gloomiest predictions of a substantial, looming obesity epidemic have been realised: 60% of individuals in the Uk are overweight a quarter of us are obese.

Boseley has no time for the notion that fatness is basically a failure of private willpower, a situation of “eating as well considerably and performing too little”, rather she voices a cool, rational anger at the forces that swell the nation’s waistband. Britain’s laid-back frame of mind to junk meals was exhibited when Margaret Thatcher welcomed McDonald’s HQ to her constituency in 1982, and no government given that has had the guts to curb the rapacious profiteering of the junk foods barons, settling as an alternative for a series of utterly ineffective voluntary agreements on foods labelling and advertising and marketing to children, carved up by corporate lobbyists and civil servants. Enabling the junk foods industry to police itself is, she suggests, like putting Dracula in charge of a blood bank. As for this government’s “nudge” campaign to inspire the population to eat a lot more healthily, Boseley is scathing: “Change4Life’s jolly small household of blob-like faceless folks are very likely to evoke absolutely nothing much more than a yawn and a flick of the wrist to alter Television channels.”

Boseley also provides dieting brief shrift: “If they [diets] worked, the diet regime industry would go out of enterprise.” Although her common level is that men and women who want to be thinner want to alter their diets, not go on a diet regime, she weakens her attack by picking worst-case examples. The breatharian diet, for instance: who follows that close to-mythical regime?

The Shape We’re In is a sobering retailer of reflections and images of the weight problems epidemic. Boseley’s intention was to look into its leads to and consequences, and she succeeds a lot more with the latter than the former. She relies heavily on interviews with oft-quoted figures in the healthful eating establishment, and as a consequence, does not challenge its orthodoxy. She draws no distinction among the corrupted vegetable oils utilised to fry quickly foods, for instance, and the natural fats in meat and butter. “Excess fat is a difficulty,” she tells us bluntly, damning the lamb chop from grass-fed sheep along with the KFC chicken nugget.

It is a pity that Boseley did not seek the advice of a broader variety of overall health commentators. The anti-sat-fat consensus is melting. The really notion of calories as a useful measure of wholesome eating is underneath sustained assault. About time also: a high-calorie avocado is a good deal better for you than a can of diet cola and a unwanted fat-free bagel. Until this kind of different “eat genuine foods” thinking is enshrined in government healthier-eating suggestions, our form will carry on to deteriorate.

The Shape We"re In review sobering reflections on the weight problems epidemic

Complete siblings are far more violent to every other than half or stage siblings, review finds

Half and unrelated siblings, this kind of as step, fostered or adopted siblings, used significantly less violence with much less severity, it was uncovered.

In households created up of each blood-connected and unrelated siblings, people surveyed used much more violence in the direction of their relevant – total and half – brothers and sisters, even employing weapons such as heavy objects and knives, the research by Dr Roxanne Khan, Dr Vanlal Thanzami and Jennifer Bowling from University of Central Lancashire concluded.

“This research centered on the ‘Cinderella Effect’ that, according to evolutionary theories, suggests that stepchildren are far more most likely to encounter neglect or abuse than these related by blood. We wished to check out no matter whether this was the case amongst complete, half and unrelated siblings,” Dr Khan mentioned.

“Contrary to what we anticipated, this research did not help the ‘Cinderella Effect’ taking place within siblinghood.

“Sibling relationships are very complex so we assume a variety of other aspects could have influenced our outcomes.

“It could be the case that full siblings count on much less retaliation for using violence towards their blood brothers and sisters, in contrast to the uncertain revenge of half or unrelated siblings, and this could make clear the friction.”

The group asked to 315 brothers and sisters, aged 16 to fifty five, how they fought with their siblings and about the severity of the violence.

Participants supplied data about 456 complete siblings, 123 half siblings and 39 unrelated siblings.

The findings will be presented at the British Psychological Society Division of the Forensic Psychology annual conference in Glasgow on Friday, June 27.

Complete siblings are far more violent to every other than half or stage siblings, review finds