Zainab al-Khawaja says plight of her detained father is better highlighted if she used her voice to support protest movement Zainab al-Khawaja, the Bahraini human rights activist who witnessed her father, husband and brother-in-law being beaten and imprisoned by masked soldiers earlier this month has ended her hunger strike. The 27-year-old mother of one told the Guardian she had decided to stop her 10-day fast after becoming convinced that “being silent in a tomb and not able to speak is not in the interests of my family”. Her decision follows pressure from human rights groups who tried to persuade her to use her voice in support of the protest movement, arguing that the Bahraini government would rather she were dead than alive. Meanwhile, Khawaja’s hopes of seeing her family again was given a major boost, after relatives received phonecalls from the authorities on Wednesday indicating that the three men were alive. Khawaja’s husband, Wafi Almajed, called his mother while in custody and asked for his father to bring clothes, a toothbrush and shampoo for him to the fort in Manama. Officials also called making the same request on behalf of Khawaja’s brother-in-law, Hussein Ahmed, and asked the family to bring essentials to the military court on behalf of Abdulhadi al-Khawaja, 50, Zainab’s father and a prominent critic of the regime who was targeted after he called for the king of Bahrain to face trial. It is thought that Almajed and Ahmed were seized because they were with him at the time. “We feel so happy,” she said. “A few hours ago we were worried if they were dead. At least we know they are OK now. We had very little hope yesterday, so today is a great day.” Khawaja began her hunger strike on 17 April after she described how her father was seized in a violent raid on her home. In the early hours of 10 April, he was “grabbed by the neck, dragged down a flight of stairs and then beaten unconscious in front of me” by at least a dozen masked special forces. “He never raised his hand to resist them, and the only words he said were: ‘I can’t breathe,’” she wrote. “Even after he was unconscious, the masked men kept kicking and beating him while cursing and saying that they were going to kill him.” Almost 500 people in Bahrain and around the world have since made pledges to join her in a three-day solidarity hunger strike which was due to end on Wednesday. Bahrain’s ministry of information has failed to answer questions about what had happened to the men for the sixth day running. Following visits from human rights groups who wanted her to call off the hunger strike, Khawaja started drinking fruit juice and ate a little yoghurt on Wednesday. The decision came after her health had deteriorated on Monday and Tuesday, but she stressed this was not the reason for her decision to stop her action. “Over the last few days my situation was very bad,” she said. “I started collapsing every now and then and I had a difficult t ime speaking. My heart beat very, very fast and I felt I couldn’t breathe.” Speaking before she called off the hunger strike, Nabeel Rajab, president of the Bahrain Centre for Human Rights said he was among those had tried to persuade her to stop. “I said we don’t want people dying and suffering,” he said. “We are already in misery here and we don’t want to see more people lose their life. The government can do that. We are trying to convince her to stop. Her life is too important to us.” Khawaja said she was convinced by international human rights groups to campaign for her family and said she now planned to act as a spokesman for Bahrain’s civil and human rights movement. Bahrain Middle East Arab and Middle East unrest Robert Booth guardian.co.uk
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For the top dog in British book awards, it’s remarkably uncertain of its authority Now that Booker’s Bainbridge beano is over, the plaster has stopped falling from the ceiling, and the revellers have moved on, it’s a good moment to ask the question, Why? What profound institutional insecurity is it that provokes a respectable book prize to focus less on its main responsibility (the annual selection of a readable shortlist) and more on involving itself in the kind of diversions that make many regular book lovers shake their heads in disbelief. My informal straw poll of friends and co-workers finds almost universal dismay at Booker’s recent antics. The Beryl Bainbridge saga, which has come to a close with the selection of Master Georgie, is the latest in a sequence of stunts whose chief justification must be “all publicity is good publicity”. This suggests that, somewhere in its collective psyche, Booker has a deep sense of inferiority, and feels it has to justify its place in the world. But does this add up? Booker is routinely said (by people like me) to be the UK’s ” premier literary prize “. It’s hard to dispute this. From a massive field of competing trophies, only Orange and Costa (formerly Whitbread) come close. Internationally, too, thanks to the clever promotional skills of Colman Getty, Booker has become a global brand. Booker night is celebrated throughout the English-speaking world. Significantly, not one US prize (neither Pulitzer nor National Critics’ Circle) can rival it. If that’s not enough, then perhaps the Booker’s record of nominations is suspect. That, after all, is the unspoken admission of the Bainbridge prize. Possibly, this explains Booker’s self-doubt. In fact, Booker’s track record stands up quite well to scrutiny. There have been some truly great years, a lot of middling winners, and a few outright duds. Generally, however, the prize has done what it sets out to do, which is promote good new fiction to the reading public. More than that, the so-called “Booker novel” has become almost a genre in its own right. You can deplore this if you want (loads of people do), but you can’t escape either Booker’s power or its influence. So why the Bainbridge-style side-shows? The answer, I think, lies in the recent evolution of the literary marketplace. Book prizes, like publishing, reflect cultural change. In the 40-something years since Booker started, the literary scene has morphed from serious to showbiz, from prose-conscious to promotion-savvy. That’s simply The Way We Live Now. However, as a leader in its field, perhaps the time has come for Booker to show a bit of responsibility and become slightly more grown-up. Mind you, I’m not sure Beryl Bainbridge, wherever she is, would approve. I remember that she always treated Booker night as basically a terrific party. Which it used to be, when she was around. Booker prize Fiction Awards and prizes Robert McCrum guardian.co.uk
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Iranian director imprisoned for six years for criticising the country’s ruling regime awarded prize for courage The jailed Iranian director Jafar Panahi is to win the Carrosse d’Or at this year’s Cannes film festival. Panahi, who won the Camera d’Or at Cannes in 1995 for The White Balloon, was convicted of making propaganda against the ruling regime in Iran last December. He was jailed for six years and banned from directing films for 20 years. A prominent supporter of the protests that followed Iran’s disputed presidential election in 2009, Panahi was arrested for joining in mourning for demonstrators killed in July that year. He was subsequently released but barred from leaving Iran. In February 2010 he was arrested along with his family and colleagues and taken to Tehran’s Evin prison. He was released on bail three months later after starting a hunger strike, but was later convicted of the propaganda offence . In her best actress acceptance speech at Cannes last year, Juliette Binoche criticised the Iranian regime for holding Panahi. His place on the jury for this year’s Berlin film festival was kept empty in protest at his incarceration. In a similar gesture, Cannes will keep a seat empty in the middle of the orchestra at the Croisette theatre, the screening venue for the festival’s Directors’ Fortnight. The Carrosse d’Or (or Golden Coach), awarded by the Société des Réalisateurs de Films (SRF), is rewarding film-makers’ courage and independence of thought. Previous recipients include Clint Eastwood, Nanni Moretti, David Cronenberg and Jim Jarmusch. Panahi’s 2005 film Offside, about a female fan who attends a football match disguised as a boy and is arrested, will be screened at Cannes on 12 May. The following day there will be a press conference to raise awareness of Panahi’s situation. The SRF said: “Because no film-maker, no author can remain indifferent to the violence of such a decision, the SRF has promised to break the silence imposed on Panahi, for freedom of expression.” Jafar Panahi Awards and prizes Festivals Iran Freedom of speech Protest Ian J Griffiths guardian.co.uk
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Catholic church unlawfully sacked Resurrección Galera from school for marrying divorcee, Spain’s constitutional court rules Spain’s Roman Catholic church has lost control over the personal lives of religion teachers in state schools after the country’s highest court ruled that they cannot be sacked for disobeying Vatican rules on marriage. In an historic decision, the constitutional court ruled that Resurrección Galera could not be fired for marrying a divorcee. The decision prevents the church, which controls the hiring and firing of religion teachers in Spain, from dismissing teachers who do not follow Catholic precepts in their relationships. The ruling that Galera’s marriage bore “no relation to the plaintiff’s work as a teacher” overturned the decisions of lower courts who backed the church. “The truly important thing is that these men cannot get away with this and treat people as if they were in the age of the inquisition,” Galera, a practising Catholic who was referring to the country’s bishops, told El País. Several hundred teachers of religion have reportedly been fired for similar reasons over the past decade. Some have won court cases against the church, with either the Spanish state or the church itself forced to pay compensation. The constitutional court’s decision establishes a precedent for the lower courts in similar cases. “We have been informed that you are living with a married man. That is an unsustainable situation,” officials from the diocese of Almería told Galera when she was sacked in 2001 after seven years teaching at a state school in Los Llanos de la Cañada, south-east Spain. In fact, she had married a divorced Catholic who was waiting for an annulment of his previous marriage. For the past decade she has had to find other work, and set up a country guest house with her German husband. A lower court must now rule on whether she should be reinstated and receive compensation. Spain’s bishops enjoy control over the hiring of religion teachers, whose classes are optional, after an agreement signed with the Vatican in 1979. About 70% of Spanish families opt for their children to study what the church defines as “religion and catholic morals”, though numbers are declining. “The least one can ask of a teacher of the Roman Catholic religion is that she should believe in what she teaches,” the partly church-owned COPE radio station said in an editorial. Spain Catholicism Divorce Christianity Religion Europe Giles Tremlett guardian.co.uk
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‘We’re allowing too much, maybe, free speech,’ says Washington lobbyist for company Facebook could block content in some countries, a Washington lobbyist for the company has said, adding that it has faced uncomfortable positions over “too much, maybe, free speech”. The comments come amid increasing speculation that the company plans to enter the Chinese market, probably in collaboration with a local partner. “Maybe we will block content in some countries, but not others,” Adam Conner told the Wall Street Journal (WSJ).”We are occasionally held in uncomfortable positions because now we’re allowing too much, maybe, free speech in countries that haven’t experienced it before.” Asked whether Facebook stood by the remarks, a spokeswoman confirmed Conner, 25, worked for the company but said she could not offer further comment. The company’s position on user content is attracting renewed attention because of its perceived role in the uprisings in the Middle East – especially after Egypt blocked social media sites in an attempt to foil pro-democracy protests. Activist Wael Ghonim, asked what came after Tunisia and Egypt, replied: “Ask Facebook”. Facebook is blocked in China, but Bloomberg reported this month that it has held talks with potential partners about entering the market . It would have to comply with China’s extensive internet censorship system to do so and would face strong competition from domestic rivals such as Kaixin and Renren. Facebook founder Mark Zuckerberg is thought to have been interested in the Chinese market for a long time, with rumours of an impending launch picking up when he visited China late last year and was pictured with Robin Li, CEO of search site Baidu. Chinese media claimed recently that Facebook has reached a deal to create a standalone China service, citing unnamed employees of the Beijing firm, but a Baidu spokesman declined to comment. Baidu dominates search services in China – with about two-thirds of the market – but is keen to expand its into other areas. “Right now we’re studying and learning about China but have made no decisions about if, or how, we will approach it,” Debbie Frost, Facebook’s director of international communications, told the WSJ. If Facebook established a service in China it would be legally required to hand user data to Chinese authorities. Bill Bishop, a digital media entrepreneur in Beijing, said: “Google said, ‘We’re not going to launch any services that require user information’. They could do that with search and maps and music. But Facebook has a problem that is more complicated by an order of magnitude. “It is inevitable that to comply with Chinese laws they or their partner are going to have to turn over data. The day that happens they should expect a call from Congress.” In 2007 Yahoo apologised to the families of two jailed Chinese journalists for turning over their email records, after a dramatic congressional hearing in which the firm was accused of ” morally [being] pygmies “. It had already handed control of its mainland operations to China’s Alibaba.com, in which it had bought a 40% stake. Bishop said: “It is an incredibly mature, incredibly competitive market. People don’t lack for social networking services. They will get a huge amount of grief overseas [if they come here] … Is it really worth the risk of significant brand damage and regulatory and political scrutiny overseas to be an also-ran?” Facebook Social networking China United States Internet Censorship Freedom of speech Wall Street Journal Mark Zuckerberg Tania Branigan guardian.co.uk
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Sheriff principal says management of fire safety at Rosepark was ‘systematically and seriously defective’ Fire safety procedures at a care home for the elderly where an electrical fire claimed the lives of 14 residents were “systematically and seriously defective”, a fatal accident inquiry has ruled. In a 1,000 page report published after Scotland’s longest running FAI, sheriff principal Brian Lockhart detailed a series of safety defects at the Rosepark care home in Uddingston, Lanarkshire, that he said contributed to the deaths of the 14 elderly residents in January 2004. Some or all of the deaths could have been prevented if the home had had a suitable fire safety plan in place, he found. The fire broke out in a cupboard of the care home. Ten of the residents died at the scene, and four subsequently died in hospital. The eldest was 98 and the youngest 75. In his report the sheriff principal said staff at the home had not been properly trained in fire safety and fire drills, the maintenance of the electrical installation where the fire broke out was defective, and the management of fire safety at the home was “systematically and seriously defective”. Three of the staff on duty on the night of the fire had been shown a fire safety video once but apart from that none of the staff on duty had received any fire training or experienced a fire drill at the home, and none had been trained to use a fire extinguisher. The sheriff principal said: “The way the staff responded on the night of 31 January 2004 was just what might be expected of staff who had not received adequate fire training and who had, by reason of exposure to false alarms, become complacent. Had the staff been properly trained in a matter consonant with the task that would face them in that emergency situation, they would have behaved quite differently and that, either on its own, or in conjunction with other changes which would have been put in place had the system of fire safety management not been defective, would have avoided some or all of the deaths.” The report noted that vital time was lost when staff took nine minutes to call the fire brigade. The home’s practice meant a member of staff had to find the source of the blaze before calling 999. There was an extra delay of just over four minutes when the fire brigade went to the wrong entrance to the home because the postal address was different. The elderly residents who died were: Dorothy McWee, 98, Tom Cook, 95, Isobel MacLachlan, 93, Julia McRoberts, 90, Annie Thompson, 84, Helen Crawford, 84, Margaret Lappin, 83, May Mullen, Helen Milne, Anna Stirrat, and Mary McKenner, all 82, Robina Burns, 89, Isabella MacLeod, 75, and Margaret Gow, 84. The sheriff principal said that since the fire the lessons of the tragedy had been taken on board by the management of the home and the deficiencies identified “substantially eradicated”. A spokesman for the owners of Rosepark care home said: “Our legal team is studying the determination issued by sheriff principal Brian Lockhart. We have nothing further to add at present.” An attempt to prosecute the home’s owners over alleged safety breaches collapsed in 2007 after a judge dismissed the charges. A second case raised in 2008 was also dropped. The report also found deficiencies in the working of Lanarkshire Health Board with regard to identifying fire risks at the home. The board was responsible for inspecting the Rosepark home between 1992 and 2002. In a statement, NHS Lanarkshire said it would need time to study the report and extended its deepest sympathies to the families and friends of those who died. “While we do not currently have any defined responsibility for fire safety within the independent care sector, in light of the determination we will ensure owners of establishments that we contract with are fully aware of their responsibilities in this area,” the statement added. Scotland Kirsty Scott guardian.co.uk
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Supermarket giant acquires 80% of video-on-demand firm in bid to take on services such as Amazon’s LoveFilm Tesco has entered the UK video-on-demand market, taking an 80% stake in BlinkBox and creating a formidable competitor for existing services such as Amazon’s LoveFilm. The supermarket giant, which on Tuesday reported profits of £3.8bn , said the acquisition of the five-year-old UK VoD business would help position the business for “the next stage in the internet-driven revolution in home entertainment”. Tesco has acquired its stake in BlinkBox, set up by former Channel 4 and Vodafone executives in 2006 and launched two years later, from Eden Ventures and Nordic Venture Partners for an undisclosed sum. BlinkBox offers a range of films and TV shows as free and paid-for downloads, with a catalogue including Shameless, Peep Show and Top Gear. The UK’s biggest retailer has a huge operation selling “physical” DVDs. However, Richard Brasher, chief executive of Tesco’s UK operation, admitted it needed to exploit the growing consumer demand for accessing VoD content online in multiple formats and on different devices. “Whether customers want to own the DVD, download a digital movie, stream a rental or all three, Tesco is committed to giving customers choice,” he said. “We want to allow them to decide how they access entertainment content and on which devices, whether it’s on PC, TV or tablet.” BlinkBox offers more than 9,000 films and TV shows available on devices including the PC, Macs, the PS3 console, tablets and internet-enabled TVs. The company has content licensing deals with broadcasters and producers such as BBC Worldwide, Channel 4, ALL3Media and FremantleMedia for shows including Peep Show, Shameless, How to Look Good Naked, Doctor Who, Baywatch, Danger Mouse and Count Duckula. BlinkBox also has deals with major US studios and networks including Warner Bros — two of the most watched shows are Gossip Girl and ER — Paramount, Discovery Networks, Universal and 20th Century Fox. “We are pleased that our partnership with Tesco allows us to bring the best in entertainment from our library of over 9,000 titles to even more people across the UK,” said BlinkBox founder Michael Comish. “This partnership represents another step forward, bringing the leading movie streaming service together with the UK’s biggest retailer.” Amazon acquired the 58% of LoveFilm, the DVD and online video rental company often dubbed “the Netflix of Europe”, it did not already own in January in a deal thought to value the business at £200m. Tesco’s BlinkBox deal has been compared to a similar move made by supermarket giant Walmart , which owns the Asda chain in the UK, which acquired US VoD service Vudu in February last year. Video on demand Amazon.com Digital media Media business Internet Tesco Television industry Television Television Mark Sweney guardian.co.uk
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Liberal Democrat leader’s comments come amid fears his unpopularity will hit support for alternative vote in 5 May referendum Nick Clegg has insisted people are not “daft” enough to oppose AV on the basis that they do not like him. The Liberal Democrat leader’s comments came amid fears that his unpopularity will hit support for the alternative vote in the 5 May referendum. With nine days to go until the poll, the no campaign – which is using imagery of Clegg in material to mobilise its vote – has taken a decisive lead . The latest YouGov poll for the Sun newspaper, published on Wednesday, shows a 16-point lead for the campaign against a switch to AV, with 5% of respondents saying they would vote no because a party or politician they dislike supports the change. Fears the referendum will be used to send a message to the Lib Dems – who are most strongly associated with it – prompted the Labour leader, Ed Miliband, a supporter of AV, to urge voters not to use the poll as an opportunity to give the deputy prime minister a “kicking”. “This referendum is not about Nick Clegg, it’s not about David Cameron, it’s not about me,” Miliband said. “It is a chance to have a better politics in Britain.” Speaking two days after Miliband’s remarks, Clegg dismissed the suggestion that people’s decision on whether to back a switch from first past the post to AV will come down to him. He told BBC Breakfast: “I really don’t think that people are so daft that, when they’re asked to have this once in a generation opportunity to change the electoral system, they’re going to do it based on what they think about one party or one politician.” Another issue plaguing Clegg is his comment that AV is a “miserable little compromise” – made before the Lib Dems secured the AV referendum in their coalition deal with the Conservatives in May. To the frustration of the yes campaign, the claim has repeatedly been quoted by opponents of change to the voting system, including Cameron. Clegg claimed his remark did not refer to the voting system itself but to the previous Labour’s government’s attempt to shoehorn in a promise of AV that had little chance of being delivered. He said: “I’ve had this a lot. What I was actually referring to was Gordon Brown’s suggestion, very late in the day in his government, of making changes that everyone knew would not come into effect … “I was talking about the Labour party’s offer in the latter days of its government which it had no way of implementing.” On AV, Clegg said the use of different kinds of preferential voting system had been adopted by the Conservative party itself – the bulk of whom are in the no camp. “If it’s good enough for them, why is it not good enough for the rest of the country?” Clegg asked. He said he “flatly” disagreed with the argument put forward by the no campaign that AV was favoured by the Lib Dems because they would be the party most likely to benefit from the system. “It’s impossible to tell how millions of people across the country will vote when they’re given more choice,” he added. Seeking to spell out AV’s merits, he said: “It’s a very simple idea that you order your preferences. “If you can’t get your number one choice, at least you get to have a say about which other one might still go forward. “It’s about increasing people’s voice – at the moment, millions of people are ignored. “It’s a simple statement of principle that, in a democracy, you should make your MPs work harder for your vote and try and get at least majority support in their local election. That, in a nutshell, is what AV does.” Clegg made his comments amid deepening tensions between the coalition parties ahead of the referendum for AV. Lord Ashdown, the Lib Dem peer and former party leader, said the way Clegg was being singled out in a “deeply and appallingly personal” way by a no campaign funded by the Conservative party was “very damaging”. “It must be making Liberal Democrats fighting furious, and I am certainly one of those,” he said. Nick Clegg Alternative vote AV referendum Electoral reform Liberal Democrats Ed Miliband Labour Conservatives David Cameron Hélène Mulholland guardian.co.uk
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• Blow to ministers as watchdog announces universities’ plans • Guardian figures put average fees at more than £8,600 • Datablog: what are the universities charging? Ministers have suffered a major blow to their tuition-fee reforms after the government’s access watchdog revealed that all universities intend to charge at least £6,000 a year. The Office for Fair Access (Offa) announced that every one of the 123 universities and university colleges in England intend to charge £6,000 or more to full-time undergraduates from autumn 2012. A further 17 further-education colleges – out of 124 – want to charge fees of more than £6,000. Universities had until midnight on Tuesday to submit their plans to the watchdog. Offa would not say how many of the institutions want to charge the maximum fee of £9,000. However, research by the Guardian has revealed that almost three-quarters of English universities and university colleges intend to charge this amount for at least some of their courses. The figures will come as an embarrassment to David Willetts, the universities minister, who predicted that universities would charge different levels of fees and that the average would be £7,500. He later revised that to £7,500-£8,000. The Guardian’s figures show the average fee of those that have made their plans public currently stands at £8,629.73. Some 49 of the 73 universities intend to charge a flat rate of £9,000. Some 56 institutions intend to charge £9,000 for at least some of its courses. MPs voted in December to raise tuition fees for full-time undergraduates from £3,350 a year to £6,000 in 2012 and up to £9,000 in “exceptional cases”. But new and old universities have announced plans to charge £9,000. In the last few days Bradford, Bristol and Hull universities have said they want to charge the maximum. Oxford Brookes and University of East London – neither of which are in the top 40 universities according to the Guardian’s university league table – intend to charge a flat-rate of £9,000. The University Centre at Blackburn College has decided to set its fees at £7,000. Some 73 out of 123 universities or university colleges have now publicly declared their fees. Some 50 others have given their proposals to Offa privately. The Treasury is faced with a funding black hole because the initial cost of students’ fees is borne by the government. It pays the fee for each student in the form of a loan. The government then recovers its money once a student has graduated and is earning more than £21,000. Labour said on Tuesday that one way for the government to claw back the higher upfront cost would be to cut student numbers. Ed Miliband, the leader of the Labour party, warned that at least 10% of university places for undergraduates would have to be cut to fund the coalition’s “unravelling” tuition fee reforms. This is the equivalent of removing 36,000 full-time places each year. Universities that want to charge more than £6,000 had to tell Offa what their targets were to widen their pool of students beyond white middle-class teenagers. These must be agreed by the watchdog. Offa has the power to tell universities that they cannot charge more than £6,000 and will be able to tell institutions next year that they must lower their fees because they have not fulfilled their targets. The government has recommended that universities spend £1,000 out of every £9,000 received in fees on support for students. The watchdog will announce in July whether it has accepted each university’s plans for 2012. Some universities, such as Coventry, intend to charge variable fees based on the cost of delivering their courses. Coventry wants to charge £7,500 for classroom-based degrees; £7,900 for studio and field trip-based degrees; £8,300 for lab-based degrees and £9,000 for specialist degrees such as engineering, fashion and automotive and transport design. Meanwhile, it has emerged that overseas universities are redoubling their efforts to recruit English students to their universities. Paul Loftus, managing director of i-studentgroup, which helps universities in the UK, Australia, Canada, the US and New Zealand with their recruitment, said foreign universities were targeting the UK. “If overseas universities haven’t started lifting their recruitment efforts to try to get British students, they are now.” Loftus said more British students than in the past were considering going abroad for university, in part because of higher fees. “Although the Australian dollar is strong, many British teenagers are enrolling on courses in Australia, Canada and New Zealand in particular.” Aaron Porter, the NUS president, predicted that 10% of university applicants would be put off studying for a degree because of the higher fees. “Sadly we are hearing that some students are deciding not to apply already. We hope this sends out an urgent message to the government that their tuition fee policy is in disarray.” The number of students who want to travel or work abroad for a year before going to university has dropped by almost half, The Times has reported. Tuition fees University funding Higher education Students Education policy Jessica Shepherd guardian.co.uk
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A King’s Fund report shows waiting times are up, providing another challenging day for the government as it struggles to sell its controversial health reforms 1.36pm: foxtrotdelta asks: Is there evidence that patients really want choice beyond being treated at the most local hospital which has the best trained staff to deal with their condition/ailment? John Appleby replies: Various British Social Attitudes Surveys suggest that a majority of people do want choice of hospital. But they also want a good hospital on their doorstep, and they are not hugely happy with choice if it leads to less popular hospitals being closed. I think choice is good (try putting “no” in front of choice). But good not necessarily in an economic context but from point of view that this is a good thing for people in its own right. Also worth noting that there are many points in someone’s care/treatment where choice is a good thing – from the most basic level (consent for treatment) to things like choice of treatment etc. Choice in an economic context in healthcare is more problematic if we hope that through choices patients will start to alter the behaviour and practice of hospitals for the good. I do not think there is strong evidence so far that patients, through the choices they make, have had much impact on the quality of care provided by hospitals. 1.26pm: Randeep Ramesh, the co-author of this blog asks: Who can patients take action against if, as the NHS constitution makes clear, the health service does not take “all reasonable steps to offer you a range of alternative providers” if it is not possible to meet the 18-week target? From what David Flory was saying it seems that the government are happy with 10% of people made to wait longer but the department’s own figures show in some specialities one in five are waiting longer than 18 weeks. John Appleby replies: I do not know (any lawyers out there?) – but my assumption would be that the constitution offers a legal right and that redress is therefore through the courts. Along with patient choice (in particular – that patients won’t choose long wait hospitals and therefore hospitals have an incentive to keep waiting times short), the constitution is quoted by the Department of Health as the prime way waiting times will be kept short now that targets have in essence been abolished. Well, we’ll see. I think the constitution/choice incentives are relatively weaker than the target incentive. 1.21pm: Arkadiev asks: Are waiting time targets a good thing? John Appleby replies: I think the reason the NHS has been so successful in reducing waiting times over the last decade is partly down to extra funding, partly [to] practical help for hospitals in how to reduce waiting times and partly due to tough targets. Managers were sacked in the past for failing to meet targets – a strong incentive to meet targets! But I recognise that there is a balance between the terror tactics of targets and pushing so hard that for example managers start fiddling the figures or that other things get neglected. It’s a tricky balance. But let’s not forget how bad waiting times once were in the NHS and the huge value the public and patients placed on reducing them (more value, I suspect, than many consultants). 1.15pm: ReidAJ asks: Are “efficiency savings” merely cuts? John Appleby replies: Well, they might be. The task for the NHS is not simply to “save £20bn”. If it were, that would be easy: simply stop doing some things to the value of £20bn. The task is much harder: to make every pound the NHS is given produce around £1.20 worth of extra benefits for patients by 2014. I would be worried if the NHS simply assumed that closing a ward was an efficiency gain. It would only be so if the money/resources saved were then spent on things that generated more value for patients than keeping the ward open would do. A big problem for the government is that measuring productivity in this way is very difficult. The NHS may get to 2014 and not really know if it has improved productivity by £20bn … 1.10pm: John Appleby of the King’s Fund has begun his live Q&A about his thinktank’s findings ( see 9.45am ) below the line. Please post any questions for him below. John begins with this statement: To start, just some quick context for our NHS performance report today. The NHS is facing its tightest funding settlement for decades plus a huge organisational reform, plus a drive to improve value for money at levels unprecedented in its history. The outcome of these pressures/challenges – on the NHS and its performance on things that matter to patients and the public – are uncertain. So, our performance briefing is the first of a quarterly look at some key indicators such as waiting times, hospital infections, delayed discharges, and redundancies. We also have a small (26 – not statistically valid) panel of NHS finance directors from whom we have responses to questions mainly about their organisations’ productivity pressures. With this information we hope to track performance over the coming few years. 12.50pm: James Ball has expanded his take on waiting times. He says using the government’s own figures waiting times have been creeping upwards. Excluding Wiltshire primary care trust, which had 11 surgeries, only one of which was within 18 weeks, you find that last February one in 12 patients was waiting more than 18 weeks. By January 2011 it had hit 9.9% (just under one in 10). The February 2011 number is 10.8%, which is actually nearer one in nine than one in 10 – but, yes, has definitely exceeded that limit. Especially damning when they’re doing less surgery, which is a new trend (January 2011 had 1,000 more operations than a year ago. February 2011 had 12,700 fewer). It’s also much worse when you break it down. In trauma and orthopaedics, it’s one in five. And the worst performing areas in England are: _ 12.39pm: Colin Leys, honorary professor at Goldsmiths College London, who has been studying and writing about the NHS since the late 1990s, is launching his new book with Stewart Player tonight, The Plot Against the NHS. In this Audioboo interview , he gives Rowenna a taste of his arguments: There was a project on the part of a small group of people to turn the NHS from a public, universal service and replace it with a healthcare market … That was in the minds of people like the Public Health Authority back in the 1990s. To call it a plot is: in pushing it through, everyone involved knew the public hadn’t been consulted and if they had been there would have been massive opposition because of the love of the NHS … So it was done as far as possible out of the public eye from 2000 onwards. _ 12.10pm: US healthcare giant UnitedHealth has sold off its network of GPs’ surgeries and pulled out of the UK primary care market in order to concentrate on offering GP commissioning support, according to Pulse, the magazine for health professionals : UnitedHealth now plans to refocus its UK business to concentrate solely on commissioning support, as it seeks to exploit the opportunities presented by the government’s NHS reforms. The move signals an end to UnitedHealth’s controversial tenure as a provider of GP services in the UK, with their take-over of practices in Derbyshire, Leicestershire and Camden in north London attracting vehement opposition from anti-privatisation campaigners. Instead, it plans to expand its commissioning support in areas such as data analytics, demand management and medicines management. It is already working with a number of PCTs and GP consortia, including pathfinders in Hounslow who recently signed a deal with the firm to run a major crackdown on GP referrals. 11.35am: Blogger Andy Cowper makes an intriguing point about the legal rights of patients under the NHS constitution ( see 10.38am ). He emails: My understanding is that, theoretically, the responsibility for funding care in event of an 18-week breach would lie directly with the commissioner of the patient’s care (currently, the primary care trust – PCT), and ultimately with the secretary of state for health, to whom the commissioner is accountable via line management by the strategic health authority (SHA) and the Department of Health. However, the NHS constitution is very clearly worded: “You have the right to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of alternative providers if this is not possible” ( see page five here ). Interesting lack of definition of “all reasonable steps”. 11.23am: At 1pm John Appleby , chief economist and health policy specialist at the King’s Fund, who led the research on waiting times out today, will be live online to answer your questions. John previously worked as an economist with the NHS in Birmingham and London and he is currently researching the impact of patient choice and payment by results. Please post your questions for John in the comments below. Here are a few suggestions: • Why are waiting times the highest they’ve been for three years? • Why does the government dispute the King’s Fund figures? • What’s likely to happen to waiting times if the government’s health reforms go through? • What is the impact of increased waiting times on patients and the health service? • What can we do to reduce waiting times? 11.14am: The anti-cuts website False Economy has published this post this morning claiming that the prime minister has broken his promise to ringfence NHS funding, according to House of Commons data. “Richard Blogger” writes: David Cameron claims that NHS funding is ringfenced and will increase in real terms. But even if we take government figures at face value, NHS spending is set to grow at a slower rate than during the Thatcher years of chronic underinvestment and lengthening waiting times. 10.38am: The government has challenged the King’s Fund’s figures out today , but my colleague who specialises in data and investigations, James Ball, points out that waiting times have increased even by the government’s own figures: The government has challenged the King’s Fund, which claimed 15% of patients waited longer than 18 weeks for treatment. Ministers stated that under their preferred measure, which excludes patients who have delayed their own surgery, only 10.2% of patients wait longer than 18 weeks. But even the government’s favoured figures show the slide in waiting times: the latest figures, which cover February 2011, show the number of operations dropped by 13,000 versus the year before, while the number of people waiting over 18 weeks jumped 28%. In 23 NHS trusts, more than 20% of patients wait longer than 18 weeks for surgery. Royal Cornwall Hospitals NHS trust had the most long waits of any major NHS organisation, at 41.8% of patients. Trauma and orthopaedics was the sub-branch with the longest waits, with more than one in five patients waiting over 18 weeks on the government’s favoured measure. We will have more from James later – including a table of the longest waits in England. Under the NHS constitution, brought in by Labour and left in place by the coalition, patients have a a legal right for treatment within 18 weeks. The question is: who is liable if this is not met? Can anyone out there help? 10.31am: Will the health reforms undermine democracy in the NHS? My colleague Peter Hetherington has an article in today’s SocietyGuardian discussing the role of the new statutory health and wellbeing boards. He points out that if the boards are given sufficient powers over GP consortia, this could be an opportunity to give local councillors greater oversight over health services. Lib Dems see accountability as a “key concession to be dragged out of the prime minister” in the pause, but whether they get it remains to be seen. 9.45am: Good morning. Welcome to another day of our continuing coverage of the coalition’s controversial proposed health reforms. We have a great line-up for you today. With news out from the King’s Fund showing waiting times at their longest in three years , we’ll have chief economist and author of the report John Appleby (left) online between 1pm and 2pm to answer your questions. For now, here’s a round up of today’s news on the NHS reforms: Dominating the headlines is the news from the King’s Fund, which shows 15% of patients in February waiting more than 18 weeks for treatment – the highest level since 2008. The FT points out that this is partly due to a budget squeeze , but it is also a response to the health secretary’s decision to axe Labour’s waiting time targets last summer. The fund also interviewed 26 NHS finance directors, almost half of whom said that closing wards and reducing services were among the main ways they would make savings over the next year. Eighteen of them said that they were uncertain they would make the 4% efficiency target set for this financial year. Here’s James Meikle’s story on the report : With some hospital waiting times the worst for three years, A&E departments overstretched, and surgeons warning that patients are being denied key treatments, the first in a series of planned quarterly monitoring reports highlights “significant concern” among some of those responsible for contributing to £20bn of “efficiency savings” in the NHS over four years and for ensuring that new bodies taking over services in the next three years do not start with deficits. Most say they are unlikely to meet productivity targets this year. The challenging picture painted by the report, from a respected independent analyst of the health service, comes during the government’s two-month “pause ” in trying to push through its controversial legislation. Nigel Edwards, who runs the NHS Confederation, and David Flory, the NHS’s deputy chief executive, discussed how the £20bn of efficiency savings will be made to the protected NHS budget on BBC Radio 4′s Today programme this morning. The Times also has an interview with Steve Field , a GP and chairman of the “listening exercise” devised to rescue the reform programme. Field insisted that his report, to be completed in the first week of June, was entirely independent and had the full backing of David Cameron, whom he had already met four times. In his first interview since starting the job, Field said that the feedback had emphasised the need for greater protection against the “cherry-picking” of NHS services by private companies and “very strong” concerns about the protection of workforce training. He added that he would be going through the 6,000 responses to the white paper sent to the health secretary last year. We’ll post more details of our Q&A shortly. Health NHS Public sector cuts Public services policy Rowenna Davis Randeep Ramesh guardian.co.uk
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