Standards of care in hospitals

I was interested in the recent Radio 4 edition of More or Less which looked at the use of statistics in assessing the performance of hospitals. Inevitably Mid Staffordshire came up, particularly the question of the accuracy of the newspaper reporting that said 400 or more patients died due to poor standards of care.
Many people, including many journalists, thought that the figures came from the report of the Healthcare Commission, but they didn’t. The report was damning about some standards in some parts of the hospital at some times. But it didn’t make any claim that sub-standard care resulted in a particular number of deaths.
This claim was made in a newspaper headline shortly before the report was published.
As More or Less explained, the figures used came about by projecting a death rate from a statistic produced by the private business Dr. Foster. Dr. Foster produces “standardised mortality ratios” to enable the comparison of rates of death of patients in different hospitals after adjustments for variables such as patient intake, seriousness of incoming patients’ conditions and so on. The Radio 4 programme featured an expert in statistics who explained the limitation of these standardised mortality ratios and their weaknesses. As a result, he said it would be wrong to make claims about numbers of avoidable deaths in hospitals based solely on the Dr. Foster statistics.
Now the BMJ has published a report again making this point. You can find a report of the BMJ coverage at http://imi.announce.ie/hospital-dr/more/621/612

World of work

When I was not re-elected to parliament on 6 May 2010, there was one consolation. I really did have more time to spend with my family. After thirteen years of living most weeks away from my wife Elaine, I had, truly, great pleasure in being at home with Elaine. She was still out at work every day, getting home quite late. I was glad to be able to cook meals which were ready for eating as soon as she came in through the front door.
Of course I had to search for a new job and I set to with a will. I had helped enough constituents who found themselves jobless in their 50’s to know that it was going to be tough. I was willing to be flexible as to the kind of work I was willing to do. But being honest with myself, I really wanted a job to do with the environment and sustainable development.
I found there were few jobs advertised that fitted with my passion for all things green and so I applied also for many jobs in other areas that interest me – for example, law jobs involving speaking up for children in public law proceedings like care proceedings and I remember a job advertised about raising awareness of issues around autism in the criminal justice system.
Most of the jobs I applied for were located in Staffordshire and the West Midlands more widely.
I applied for just one job located in London – and guess what, that’s the job I’ve got!
So now I am head of policy for the Chartered Institute of Environmental Health. My office is in SE1.
Yes, it has the same down-side of parting me from Elaine for much of each week. But it has, which is why I love it, the scope for me to achieve good things for other people, especially in relation to many green issues.
To start with, everyone who works at the CIEH is friendly and helpful. This makes the work environment great. Then just consider the areas of life environmental health affects – air quality and protection from pollution, food safety and nutrition, health and safety at work, housing conditions and the wider public health agenda.
The coalition government has said it will set up a new Public Health Service in 2012 and we at the CIEH believe that this offers us a once-in-a-generation opportunity to ensure that Environmental Health considerations, and Environmental Health Practitioners in particular, will be an integral part of the new Service.
You see we believe that sometimes there is a narrow view that public health is a subset of “health” seen through the prism of what the NHS does. Yet in reality, good public health requires a healthy natural environment, clean air and water, good drainage, healthy food, a balanced diet and plenty of physical exercise, a home that is warm and properly maintained, a safe working environment – and increasingly, planning for the coming effects of climate change.
Climate change is already happening: temperatures are rising, there are more unpredictable severe weather events like intense heatwaves and excessive sudden rainfall causing flooding. It is necessary to adapt to the claimate change we can no longer stop completely and this means better flood protection for homes, coastal areas and critical infrastructure. It means planning for saving lives from both excessive cold and excessive heat. It means expecting the unexpected.
Then beyond adapting to existing climate change, we’ve got to go much further in taking action to prevent – mitigate is the word everyone uses because it isn’t realistic to stop climate change in its tracks -further climate change. In this case “we” most definitely refers to the entire global population. We cannot do this solely as one country in the world, although we can act directly to reduce our 2 per cent or so contribution to carbon emissions.
In the case of the Environmental Health professionals, we can also see that with climate change will come new health challenges in the UK for citizens, for animals and for plantlife. More temperate winters, wetter winters, and hotter, drier summers, will change the patterns of health threats to all species. It’s up to us to warn, advise and prepare.
So once again in my career, I face one big down-side in working away from home. But I face plenty of challenges to keep me occupied and energised in my day job. And that, at any rate, is something I relish.

We are going to need lots more green skills

Taking part yesterday evening in a debate on our country’s skills needs for a low carbon future, I drew two conclusions.
The first is that we need to make the intellectual case for equpping our workforce with skills for jobs which in many cases do not yet exist. Traditionally, employers look for business opportunities and when they see a market for their goods and services they skill up for that trade. Yet if we wait for the markets to open up for low carbon goods and services we will find that progress will be hampered by skills shortages. When these markets open up, they will be global – that’s global in the opportunities for business and global in exposure to competition.
So for once, we need to skill up in advance of being able to see the markets. The obvious challenge is therefore to convince employers, and convince students and workers who will invest time and money is gaining qualifications, that these markets will then be present by the time the skilling process has been completed.
This is the difficult bit. But I say look at the Climate Change Act, look at the EU’s position on tackling climate change through saving energy, cutting carbon emissions and building up renewable energy sources and look at the growing international support for the partial deal done at Copenhagen. What all these steps tell us is that in this single decade there will be a massive shift from a carbon-based global economy to a low carbon economy. This political priority will quickly turn into an economic necessity. It doesn’t matter whether the motivation is a desire to tackle climate change or to diversify away from a dependence on finite supplies of carbon fuels or to keep energy costs affordable over the long term – whichever motive dominates, the answer is rapid transformation to a low carbon economy.
So it is vital that we make the case that the jobs will be there, in every walk of life, for people who now take the plunge and acquire green skills. Jobs in finance (green deals, carbon trading), in management (project management, procurement), in manufacturing (advanced manufacturing, low carbon solutions), in services (energy and waste systems management, district heating, combined heat & power), in sales (feed-in tariffs, follow-up maintenance) and so on.
The second conclusion I drew from yesterday’s debate is the pressing need for cultural change. Without doubt the firm foundation for this revolution in skills has to be a major increase in the pupils, students and graduates possessing STEM skills – that’s skills in sciences, technologies, engineering and maths. But our “me first” society and our obsession with celebrities has in the past made these subjects very un-cool. It’s time to break down the walls that obstruct progress – by our young people in particular – towards careers in areas of our economy where STEM skills are very valuable.
I was listening to a radio programme recently in which a man was asked why he now worked abroad rather than in his native UK. He said he was an engineer and in his host country his profession was respected but in the UK it was not. We have come to a pretty pass if this is true and we must work hard, and work urgently, to ensure that over the coming decade this is not a true statement of our society’s esteem for those with STEM qualifications.
By 2020, a successful national economy will be one that has led the way to a low carbon, resource efficient reality. Leading is important to secure the full fruits of the transformation – in terms of jobs at home and exports abroad as well as in terms of improved quality of life, energy security and affordable heat and light.
Some habits have to be broken, some existing values challenged. But the prize could be immense: a clean, green and prosperous future for UK plc.

Affordable housing – the co-operative way

Stafford has a small but enthusiastic housing co-operative. I’m a member and supportive but not as active as I should be. Others, like Lisa and Tony Pearce, are doing the heavy lifting. And it’s getting us somewhere. Staffordshire County Council owns blighted properties in Castletown. They are blighted because of a highway protected route once published by the same County Council. The properties, potentially good homes, are long-term empty as a result. Our co-op has a plan to buy them, make them habitable once more, and rent them out. Finance for the purchase has been negotiated. We just need the Council to abandon the protected route (for a road that is never going to be built on that line) and sell the homes to the co-op.

This is a great example of a small number of committed people making a difference by taking the initative. There is a role for this kind of work, especially when it comes to bringing empty homes back into use.

We do, however, need national policies to support the provision of sufficient affordable homes. There are young, first-time buyers who cannot afford today’s asking prices, family members living in over-crowded homes because they cannot get a home at a rent they can afford and increasing numbers of residents who need homes that offer additionally an element of personal social care.

It’s legitimate for the new Con Dem coalition government to pursue a different approach, but will its policies result in more affordable homes? Step one surely has to be to get supply and demand closer to balance. Currently too many would-be buyers chase too few homes for sale and for rent. The result is rising prices. Existing homeowners like rising prices and they often don’t like new house-building near their homes. So for them, abandoning Labour’s pressure on councils to provide more land for new house-building is often quite welcome. But at the same time, they probably share the concern for young people who cannot afford to buy their first home. Their own sons and daughters may be caught in just this trap. They may be concerned about people who are homeless, living in cramped conditions or occupying unregulated, unsafe rented properties.

The Con Dem coalition government is offering councils incentives to provide land for homes, they can keep the council tax receipts from the new homes for a while. Labour ran a similar scheme to promote new business start-ups under which councils could keep the new business rates for a period. It was called LABGI. It was reasonably successful. But crucially, will this incentive be generous enough to tempt councils to take on the NIMBYs? Will there be any special incentive for new developments to include high proportions of affordable homes (after all, higher council tax receipts will come from more expensive homes)?

These are tests and challenges for policy-makers and the councils who implement the policies. The outcome measure that will tell us whether we successfully increase the supply of homes, especially affordable homes, will be the number of new homes appearing. The people who will feel the effects of this success or failure are the first-time buyers and the would-be tenants who need help if they are to find their own homes of the future. Typically, they are hard-working and hard-pressed. We should want to help them succeed and we can help them – in small, constructive ways – through community efforts like housing co-ops and through pressing central and local government to do the right thing by them.

Too many cuts will crash the economy

To be clear, the worst global recession in my lifetime required extraordinary responses from governments and peoples all around the world. In part this meant spending more money nationally despite falling revenues and so of course borrowing went up. In each case where a national government could afford a “fiscal stimulus” this is what was done.
In the UK, additional public spending brought work into a seriously depressed construction industry. It steadied a teetering car industry thanks to the scrappage scheme. And jobs were found for young people through the Future Jobs Fund. And the result? Lower unemployment than in the recession of the 1990’s even though the challenges in the 1990s were less severe. Similarly, home repossessions this time were at half the rate of the 1990s. This time, what we did was civilised, humane and affordable.
Governments that took part – and no government argued against the strategy – expected to have to make serious efforts to repay this extra borrowing afterwards. Most judged that a combination of lower public spending, higher taxes and, crucially, the return of economic growth would restore their public finances to health within a reasonable time.
Across the EU, the subsequent discovery of Greece’s shambolic finances spooked the markets and changed sentiment. At the same time, in the UK the one party to withhold endorsement of the fiscal stimulus – the Conservatives who had urged us to let the recession take its course – now won a senior place in government. Using the Greek experience deftly, they have returned to their “cuts, cuts and more cuts” agenda. It worries me that they make cuts, slash public services, with such evident relish.
Of course a Labour win at the election would also have resulted in cuts in spending. We had said so in our Budget in March and we had legislated to halve the deficit in the national finances in 4 years. But we were not planning a second, emergency budget in 2010 nor a swingeing increase in VAT.
Contrary to some claims by coalition government Ministers, there are no new shocks in the public finances that they have “discovered” upon opening the books.
UK debt as a proportion of GDP was the second lowest of the G7 countries when the global recession struck. Prior to this global meltdown, we met our own rule for keeping this proportion at or below 40% of GDP. Remember when we got in much more than expected from auctioning the third generation mobile phone services licences? We used the receipts to pay down debt even though some argued for additional public spending.
Now the ConDem coalition government’s Budget Red Book puts this proportion at 61.9%. Back in 1932, Neville Chamberlain was criticised for introducing a deflationary budget (there followed a disastrous depression for years) when the proportion of public debt was 177%.
Today, the UK is top of the league when it comes to the time before its debt has to be refinanced. The “average maturity” of the UK’s debt is 14 years. By comparison, other leading industrial countries, including the USA and Germany, have maturities under 9 years. And we are less dependent on overseas finance than other countries. Non-residents hold 70% of Greek government debt, just under 50% of US government debt – but below 30% of UK government debt.
Our ConDem coalition government is offering us bigger cuts in public services, unfairer taxes and putting at risk the economic growth we need. Don’t get carried away by the constant rhetoric about cutting the deficit. Concentrate instead on the size of the risks our ConDems are contemplating taking.

We need a renewable heat incentive

As a Minister I was proud to have been involved in the design and launch of the UK’s “Feed in Tariffs”, rewarding small-scale generators for electricity they produce by their own efforts. The scheme only went live in April and already sales of solar panels are up and the Solar PV market is growing fast. This means rising investment in the technology and new green jobs – as well as helping householders, small businesses and community groups cut their carbon footprints and cut their energy costs. I’m sure other technologies that help us cut carbon emissions will also benefit.

We also designed a “Renewable Heat Incentive” and announced we would introduce this in April 2011. Heat is the biggest use of energy in the UK, responsible for almost half of UK emissions. We definitely need a strong and vibrant renewable heat industry especially when you consider that today only 1% of the UK’s heat energy comes from renewable sources.

The legislation for Tariffs for renewable heat was established with strong cross-party support in the Energy Act 2008, alongside the Feed-In Tariffs for electricity generated from renewable sources. However, we needed more time to design the Tariffs for renewable heat because there is no other scheme like it in the world today (whereas feed in tariffs for electricity generation are in use in several other countries). We did however develop our design before the last election and our proposals were broadly welcomed. The Low Carbon Building Programme, which provided part grant-finance to a range of renewable heat technologies, was intended to bridge the gap until the introduction of the Heat tariff in April 2011.

The ConDem coalition government now needs to commit to bring in Tariffs for renewable heat on time, that is, by April 2011. The Renewable Heat Incentive has to be fairly funded and complement both the Feed in Tariffs for electricity generation and policies to encourage greater energy efficiency.

It’s important to stay focused on energy efficiency. It’s a great way to help people keep warm while cutting their carbon footprints and cutting their costs of energy consumption. For example, a simple but comprehensive loft lagging scheme by Kirkless Council is estimated to have saved households an average of £200 on energy bills every year. London’s ’10 easy measures’ initiative saves a similar amount, after just 2 hours of work.

Renewable Heat technologies, too, can contribute to tackling fuel poverty, including in off-gas areas where heating options are more limited. Many schemes are also particularly cost-effective at the community-scale, where combined heat and power and district heating systems offer exciting opportunities for new or retrofit schemes, not least for social landlords.

I can only see costs for traditional, carbon-based sources of energy going up and up in future years. So the shift to renewable energy sources, alongside measures to conserve energy and use less, makes economic sense. In this context, renewable heat offers value for money as well as a significant contribution to meeting our targets for renewable energy and reducing carbon emissions. Delaying or seeking to scale back the Labour Government’s plans now on cost-cutting grounds would only increase the costs in the long run.

Is the West Midlands a region?

I’m not a flag-waver for Advantage West Midlands, the Regional Development Agency spending huge sums of taxpayers’ money in an effort to improve the region’s economy. However, I do think that we, the residents of the various local government areas within the West Midlands, should all give some thought to the consequences of the coalition government’s intention to abolish Regional Development Agencies.

An immediate aspect of abolition is the accountability and transparency of the public spending that will either be transferred to other bodies in the region or completely withdrawn. Presumably some withdrawal of funding is inevitable given the government’s stated plans for cutting the deficit in the public accounts more quickly than the previous government. But in his emergency budget the Chancellor did say that the existing capital programme will not be cut. So it’s important that we see that the region retains its fair share of capital spending overall and that we see the full consequences for the component parts of our region of the withdrawal of revenue spending. Obviously there will directly be job losses at Advantage West Midlands and probably other job losses in projects that the Regional Development Agency was supporting but whose backing is now in doubt.

But looking forwards, how shall we all have a say in the future well-being of our local area – and is the well-being of, say, Staffordshire, wrapped up in the future of the West Midlands as a whole or not? I think our futures in the different parts of the West Midlands are linked, though some links are stronger than others. Some links are geographic whereas others are sectoral – for example, the West Midlands remains the heart of the manufacuring economy of the UK. I know there are Eorusceptics who think any talk of regions is a plot by the EU to take control of our country. It’s whacky, but they get air time for saying so.

I just look back at developments like canals, railways and motorways. Developments like these require strategic decisions about funding, users and, crucially, routes. They couldn’t have gone ahead without some overview of where they would be laid down. You couldn’t have one local government area accepting a new canal/railway line/motorway and the neighbouring one not – or the neighbouring local authority insisting on a route that doesn’t join up with the rest of the development. Of course today big new infrastructure developments like these are likely to be few and far between. But modern life has changed in so many ways all aspects of economic, social and environmental decision-making, so that the range of issues to consider and the possible variants is much more complex. Think now not so much about a new canal. railway line or motorway but rather of broadband connections, affordable homes, regeneration of inner-city areas, jobs, climate change, organised crime, human trafficking and many more such issues.

I’m pleased that the Chancellor has announced a measure around National Insurance Contributions to try to stimulate economic activity in regions outside the South-East of England. It’s a step in the right direction. But at the same time, I think that if we simply abolish Regional Development Agencies this will be a backward step. No doubt work is being done right now on how to ensure that there is strategic planning and co-operation within a region on things that matter. There are some important judgement calls to be made about values here. Who is going to decide what matters and what does not? Who will be involved in decision-making in areas where a regional overview would be helpful? I would hope that sufficient time and commitment is given by both central government and our local authorities in the West Midlands to explain to us, the people who live and work in this region, what level of co-operation is going to be possible and how we might have our say on the design of any new systems to be put in place.

UK Youth Parliament

Last night the House of Commons finally voted to allow the UK Youth Parliament to debate in the Chamber when it meets for its annual session later this year. There was fierce opposition from a small number of MPs who felt that our tradition made this step unacceptable.

I didn’t speak in last night’s debate (I was chairing a meeting about the effects of the recession on rural economies at the time) but I had spoken briefly on this subject last Thursday. For me the decision to allow the hallowed Chamber to be used by today’s elected Members of the UK Youth Parliament is a welcome development in the promotion of citizenship teaching and citizenship awareness raising.

I was active in the campaign to make citizenship a curriculum subject in its own right, a campaign ably led by the late Bernard Crick. A campaign which was successful when, in 2001, citizenship became a compulsory curriculum for secondary schools and optional for primary schools.

I was also active on the House of Commons Modernisation Select Committee when we pressed for improvements in Parliament’s own contribution to helping schools deliver the new citizenship curriculum. I have been pleased to see expansions of the Parliamentary Education Service and Parliament’s website. The former has resulted in many more school children coming to Parliament to learn about our democracy and there is additionally an outreach service so that Parliament can be taken to schools, councils and other venues where young people learn about citizenship.

I wish the UK Youth Parliament a great debating session in the House of Commons Chamber. And I hope we all learn that our country will be in good hands if today’s talented and responsible young people become tomorrow’s active citizens.

Responding to Baby P’s death

Lord Laming’s report will be published tomorrow. It’s important to acknolweldge that society’s protection for a vulnerable child was once again found wanting when Baby P was wickedly killed. It’s also important we build upwards from this recognition and design systems for safeguarding children that are more effective in future.

I’m leading a group to see Secretary of State Ed Balls next week to offer some suggestions. I am doing this in my capacity as the MP who chairs the Associate Parliamentary Group for Looked after Children and Care leavers. The huge membership of this Group, which includes adults with past care experience and children and young people currently in care, thinks we have something to offer to the design of better safeguarding services.

We’re going to focus especially on three issues.

First, the crucial need for a stable and successful social care workforce. All that is being said now about training, support, skills mix and status matches precisely the views that have been expressed in the Associate Parliamentary Group. We would love to work with the social care teams, their managers and trainers to help improve these standards. Children in care and care-eperienced adults already take part in programmes that make a difference – programmes like “Total Respect” and LILAC.

Secondly, we want to stress how important it is to listen to the voices of children themselves and involve them in decisions about services that affect them. I’m personally very committed to this agenda. It’s why I’ve always been a supporter of a compulsory curriculum of citizenship education. It’s why I give time to encourage schools councils and youth councils in Stafford. In the Associate Parliamentary Group, it is our ethos that the children and young people who are encouraged to attend are given centre-stage positions in the meetings and invited to make presentations as well as to speak up from the audience. And the last meeting of the Group was completely given over to children and young people who planned the agenda, chaired and ran the meeting and gave the presentations – which were on the subject of the poor media image of children and young people, especially those in care and care leavers.

The third focus of our comments to Ed Balls will be the positive contribution that those with care experience can give back to help today’s children in care. I’ve mentioned some existing examples: Total Respect which involves people with care experience taking part in the training of new social workers; LILAC involving people with care expereince in the inspection of local authorities’ services. We think our society can go further in enlisting the help of peple with care experience to improve the experiences of today’s children in care.  We want a system for promoting befriending and mentoring as well as greater roles in training and decision-making for local authorities and others, including foster carers.

We will see tomorrow what Lord Laming has found during his further investigation and what steps he recommends. I will be interested to see if these three themes feature in his recommendations. I would also welcome your views on these very important matters. How we treat today’s children determines the kind of society we inherit tomorrow.

Best laid plans

This is a story about me away from my job as a Member of Parliament. Well, almost anyway. As you will see, an MP can be on duty at any time.

My story begins last Christmas when my Westminster Secretary bought me and my wife Elaine a present of two tickets for a performance of Carmen at the Royal Albert Hall.  Neither of us has ever been to the Royal Albert Hall and we have never before seen an opera, so we were thrilled. And although we haven’t been to an opera before, we both like Bizet’s music for Carmen and we have it on a CD at home.

We fixed a date of Friday 27 February to see Carmen and we decided to make a weekend of our being in London, which is an extremely rare treat for us.

But then I received an invitation to the home-coming parade in Stafford town centre of the 22 Signals Regiment after their tour of duty in Afghanistan. The date was Saturday 28 February.

There was no way I was going to miss this important event, so I had the tricky task of explaining to Elaine that when she came to London to be with me for the weekend, I was going to go back to Stafford for the day on Saturday.  I must say that Elaine received this news much more calmly than I was entitled to expect.

So Friday night sure enough we had a great evening together at the Royal Albert Hall enjoying Carmen sung in English. But Saturday morning I set off for Stafford.

I went to the church service at St. Mary’s Church. I went to Market Square for the medal ceremony and a march past. I went to MoD Stafford where I talked to soldiers back from Afghanistan and their families.

Then I got back on the train heading for London. A couple of things about the trains. Both trains were completely on time and very fast. And although I suppose that I could justify my journey as an MP’s travel expense, I paid for my rail tickets out of my own pocket.

Saturday night Elaine and I enjoyed another brilliant entertainment as we listened to Barb Jungr sing her very original arrangements of lots of Bob Dylan classics.

Sunday we had another great time visiting Kew Gardens in this year of the Gardens’ 250th anniversary. We saw super orchids, completed the mighty tree walk and strolled, relaxed and gently chuckled as we enjoyed each other’s company.

So a rare opportunity to be “off duty” didn’t quite work. My late dad, Neil, was a big fan of the poems of Robbie Burns.  I was reminded last weekend of his lines:

“The best-laid schemes o’ mice an’ men/ Gang aft agley”.