Almost 3,000 people in England and Wales will die this winter because they cannot afford to heat their homes, a report suggests – more than the number killed in traffic accidents each year.

Commissioned by the government, the Hills Fuel Poverty Review found that if just 10% of UK winter deaths are caused by fuel poverty – a conservative estimate it claims – 2,700 people will perish as a direct result of being fuel poor.

The report also found that between 2004 and 2009 the “fuel poverty gap” (the extra amount those with badly insulated homes and poor heating systems would need to spend to keep warm) increased by 50% to £1.1bn as a result of rising fuel prices.

By the end of 2011, 4.1 million households in England are expected to be in fuel poverty. Households are considered fuel poor if they need to spend more than 10% of their income on fuel use to heat a home to an adequate standard of warmth, generally defined as 21C in the living room and 18C in other occupied rooms.

In October 2010, the government announced it would commission an independent review of fuel poverty, investigating how to better define and measure it and tackle the underlying problems that lead to it.

The interim report from the review, written by John Hills, director of the Centre for Analysis of Social Exclusion at the London School of Economics, leaves the government in no doubt as to the breadth and depth of the fuel poverty problem engulfing many of the UK’s most vulnerable households.

The report, which backed the current definition of fuel poverty, found that living in cold homes has a series of effects on illness and mental health, but the most serious is its contribution to Britain’s unusually high rates of “excess winter deaths”.

In the report, Hills writes: “There are many contributors to this problem, but even if only a 10th of them are due directly to fuel poverty, that means that 2,700 people in England and Wales are dying each year as a result – more than the number killed in traffic accidents.”

Hills also found that while it is essential that the energy efficiency of the UK’s housing stock is improved, those on low incomes in the worst housing cannot afford to pay for it and “need assistance from elsewhere”.

He said: “The evidence shows how serious the problem of fuel poverty is, increasing health risks and hardship for millions of people and hampering urgent action to reduce energy waste and carbon emissions.

“This review confirms that the way in which the problem is currently described in law is correct: people are affected by fuel poverty if they are ‘living on a lower income in a home which cannot be kept warm at reasonable cost’.”

The Warm Homes and Energy Conservation Act 2000 stated that fuel poverty should be eradicated “as far as reasonably practicable” by 2016, but while fuel poverty in England fell by four-fifths between 1996 and 2004 (from 5.1 million households to 1.2 million households) it has more than trebled since.

‘Urgent action must start today’

Derek Lickorish, chair of the government’s Fuel Poverty Advisory Group, welcomed the report, and said it should “set an alarm bell ringing very loudly for government, Ofgem, suppliers and society as a whole”.

“This disgrace is further compounded with the conclusion that households in or near the margins of poverty were faced with additional costs of some £1.1bn at 2009 price levels to keep warm compared to more affluent households. That figure will be even more after the recent round of energy price increases.

“Urgent action must start today to mitigate the impact of high energy bills, including reviewing the way in which costs are recovered through energy bills to decarbonise our energy.”

Fuel poverty charity National Energy Action, which stated in September 2011 that there had been a relentless increase in the scale of fuel poverty across the UK, said the report vindicated 30 years of building awareness and tackling the causes and symptoms of fuel poverty.

Chief executive Jenny Saunders said: “The report clearly indicates that however we define fuel poverty or formulate remedial policies, the scale of the problem is vast. We now need to rapidly adapt public policy to improve the health, financial security and wellbeing of fuel-poor households in order to do what is necessary to eradicate fuel poverty by the statutory target date of 2016.”

Michelle Mitchell, charity director at Age UK, added: “People are cutting back on heating or food to help make ends meet at a time of escalating fuel prices. This increases the risk of many older people becoming seriously ill. We need more immediate clarity and detail on what help will be available through the [government's proposed] Green Deal, particularly for people on low incomes, and a sensible long-term way of reducing energy.”

Citizens Advice chief executive Gillian Guy said: “It is horrifying that so many people are dying each year because they can’t afford to heat their home. Hills is right to stick by the current definition of fuel poverty because it focuses attention on the right people. Today’s report is yet another reminder that fuel costs just have to come down.”

guardian.co.uk © Guardian News & Media Limited 2010

Published via the Guardian News Feed plugin for WordPress.

Little did Lisa Willis know that overcoming her fear of flying would help her become a better manager. The positive behaviour techniques she learned at a management conference have not only helped to improve her performance in meetings, but enabled her to go on foreign trips without being overwhelmed by panic and anxiety attacks.

“It’s amazing,” she says. “Whenever I am feeling stressed, all I have to do is touch a spot above my right knee and take a deep breath. I immediately feel relaxed and in control of the situation.”

Willis, a workforce development leader in Hampshire, is one of 44 managers and aspiring leaders drawn from across the county’s children’s services department who have benefited from the four-day specialist training programme. With its concentration on personal development and communication skills, frontline managers and team leaders in Hampshire say the programme has strengthened their leadership skills at a time when social work management nationally is under huge pressure.

Details of the scheme are contained in a new report that outlines a strategy of guiding principles on leadership development and a proposed “pathway of leadership progression”. Aimed at giving managers the confidence to lead through change and hold staff to account, it is being seen as a model for other local authorities.

The report, by Bournemouth University and Learn to Care, the professional association representing heads of social care education and workforce development in England, has been published in response to a new government requirement that frontline and aspiring managers should receive dedicated training and support as part of a root-and-branch reform of social work.

The Social Work Reform Board has been tasked with overseeing the change programme, ordered in the wake of the Baby Peter scandal in Haringey, north London, in response to the recommendations of a government-appointed taskforce. One of the taskforce’s central conclusions was that measures were needed to strengthen frontline managers through greatly improved training arrangements.

Professor Keith Brown, co-author of the new report, says while a plethora of courses and management programmes exist, few are aimed at the specific needs of social work managers. Until now, many team leaders or aspiring managers have relied on corporate training programmes or generalised business courses such as MBAs or diplomas in management studies. However, these often do not take into account the unique nature of the profession.

“Effective leadership is the fundamental bedrock of the profession. Arguably, getting supervision right is a specialist professional remit rather than a generalist one,” says Brown, director of Bournemouth University’s centre for post-qualifying social work. “It is vital to have leadership development for managers, who need to be able to challenge decisions and have a professional responsibility to individuals and communities as well as to their employers. Currently, there is a lot of training out there but it is not assessed – and does not make a difference to frontline practice.”

For Willis, a former youth worker who has climbed the management ranks and has a master’s degree in education, the Hampshire course has led to an improvement in working relationships. “The whole course centred on self-awareness and self-development,” she says. “We had to look at our behaviour and reflect on what we would do differently in two assessments totalling 7,000 words. I happened to mention my fear of flying, and my tutor spent some time focusing on that. I was taught to relax and picture myself on a beach when I started to panic about flying. The result? I am more considered in everything I do and manage conflict situations better. I am also much happier flying.”

Steph How, a children’s social work team manager based in Basingstoke, also went on the course. She describes the insight it has given her as “invaluable”. “I was taught how to turn negative things around and feel positive,” she says. “I think my whole team have benefited. At one time we were four social workers down, but we managed to maintain our level of performance. We have also had two outstanding Ofsted inspections.”

Local flexibility

The Hampshire pilot may soon be replicated – or adapted – by other local authorities. Copies of the report, Leadership and Management Development for Social Work and Social Care, are being sent to workforce developers across England over the next month. Among its key learning points is an emphasis on local flexibility.

Research for the report was carried out in collaboration with the National Skills Academy for Social Care, the employer-led organisation dedicated to raising standards in social care, and Skills for Care, the sector skills council, which has published a separate national framework aimed at supporting the learning of frontline social work managers in adult care.

Based on examples of good practice at 11 sites, the framework aims to provide the tools needed by commissioners, training providers and senior managers to develop support for managers working in adult social services.

Maria Lagos, head of policy for Skills for Care, describes the model as a “live product”. It could, she says, even be adapted for use for managers working in children’s services. “It is very important to note that it is not prescriptive,” she says. ” It gives commissioners an idea of the sort of aspects they need to think about.”

Safeguarding good practice

A project aimed at improving managers’ knowledge of safeguarding and risk is highlighted in the new framework as one example of good national practice. Staff at Nottingham Trent University developed the course after being approached by five local authorities.

Jo Ward, lecturer in social work, says: “They felt there was a gap in knowledge, so we developed a course aimed at increasing skills. It involves group work, role play, and we get people to video themselves in a supervisory role. They then work with a critical friend and reflect on it.”

Nineteen managers working across adult and children’s services have already completed the course, which runs over five weeks and involves completing a 5,000-word assignment. A further 21 have signed up in a second cohort. Ward says the managers attending come from a wide range of backgrounds, with some outside social work. They include an occupational health therapist, a mental health nurse and a former police officer.

guardian.co.uk © Guardian News & Media Limited 2010

Published via the Guardian News Feed plugin for WordPress.

This article titled “Depression: Why pills are likely to be the first resort in northern England” was written by Sarah Boseley and James Ball, for The Guardian on Friday 4th March 2011 21.30 UTC

Depression, like deprivation and ill-health generally, hits the north of England harder than the south. But a Guardian investigation that reveals that northern areas such as Blackpool, Salford, and Redcar and Cleveland have antidepressant prescription rates that are at least three times higher than in Kensington and Chelsea, raises as many questions about treatment as it does about people’s state of mind.

Guidelines from the National Institute for Health and Clinical Excellence (Nice) state clearly that for mild to moderate depression, pills should not be the first resort. Talking therapies work better in the long-term and there are no risky side-effects.

“Unless you have got someone with severe depression, you should start off with self-help,” said Tim Kendall, joint director of the National Collaborating Centre for Mental Health and a consultant psychiatrist in Sheffield, who was one of the guideline’s authors. “Most people should be offered that as a first line.”

It doesn’t always have to be a person to talk to: computerised cognitive behaviour therapy works well for some. Others need sessions with a therapist.

A few years ago, there was a desperate shortage of therapists. A campaign spearheaded by Lord Layard led to a scheme to get more therapists into the NHS. IAPT – Improving Access to Psychological Therapies – was launched in May 2007. As well aiming to provide treatment for 900,000 people, it also had the economically attractive aimgoal of getting 25,000 off sickness benefits and into work.

Primary care trusts contacted by the Guardian all acknowledge that they have more therapists than in the past. However, some GPs may not be making the maximum use of their services.

Knowsley PCT was one of the pilot areas for IAPT. It has trained 16 therapists under the scheme – the number it was assessed to need in 2007-8. It has its full complement and yet is still near the top of the prescribing table.

Socio-economic circumstances are one reason for high levels of medication in the north, it said in a statement. It also has long-term antidepressant users who will be hard to wean off. “However work must also be done in raising awareness with medical practitioners about the available alternatives to anti-depressants. In the past prescribing has been the first treatment option, we should now see counselling as the first option. There is still some work to be done in changing the culture so that counselling options are considered before prescribing to patients … with common mental health problems.”

Salford, with 60 therapists, is also a high prescribing area. It says it is working on encouraging NHS staff to think through the options, educating GPs and practice nurses on therapy services and how to access them. “This campaign also sought to reinforce the Nice guidance on when medication may be needed and the most effective drugs to prescribe in certain scenarios. The aim of this is to ensure that the most appropriate choice of therapy is selected for a particular patient, whether that is medication, talking therapies or both.”

Camden and Brent in north London have substantial areas of deprivation and yet prescribing is low. Brent acknowledges that the figures may conceal a different problem: the reluctance to go to the GP.

“It is possible that psycho-cultural factors play a great role here,” said Ricky Banarsee, lead on mental health. “We know, from transcultural psychiatry, that certain societies/cultural groups do not present with the classical ‘depression’ features and less so when talking to the GPs.

“Many of them have language difficulties and assessing the essential diagnostic clues/symptoms may be lost in translation through the interpreters. There are over 70 different languages spoken in Brent.”

But even in low-prescribing Brent, a recent audit found that “a significant proportion” of its GPs do not use the Nice guidelines to make a diagnosis, something which the psychiatrist leading the audit said “is not unusual for the rest of the UK”.

Camden, which also has low prescribing, has made major efforts to put therapy at the forefront of treatment for mild to moderate depression. It has “a highly successful service providing talking therapies for around 3,000 people a year in the borough in line with Nice recommendations”, it said. “Having been one of the first to implement IAPT, we have trained a significant number of staff .” Therapy sessions, it says, “are available within almost all surgeries”, making it easy for both GPs and patients to try therapy first.

There are worries that the money for IAPT will run out. Professor David Richards was sacked as an adviser to IAPT by the Department of Health for publicly challenging the coalition’s promise to put in a further £400m. It was not ring-fenced and would be used to pay other NHS bills, he warned.

Middlesbrough, Redcar and Cleveland stressed the burden of depression in the region and said the PCTs had more than trebled talking therapy staff at a cost of £3.7m over three years. “This has been a priority area and an important element of the local mental health and wellbeing strategy,” it said. It hoped to expand access for younger and older people and increase the range of talking therapies. “The pace and scale of this expansion will be dependent on funding,” it said.

Middlebrough pointed out that not all prescriptions are the same. In Redcar and Cleveland particularly, GPs prescribe 28 days of drugs, not 56 or 84 days as in some other areas. This could mean 13 prescriptions in a year rather than four to six.

Many PCTs have high rates of chronic illness such as heart disease, which are strongly associated with depression. Newcastle said that, as well as high relative deprivation and unemployment which were linked to depression, it had “high levels of patients who need support for chronic diseases, and in particular cardio vascular disease, diabetes etc”. These groups of patients are routinely screened for depression. And as a third wave IAPT site, its service has only just gone live.

Gateshead said the high prescribing rate could be due to a number of issues, including better treatment in primary care, chronic disease and social factors such as an ageing population.

“It is also important to note that antidepressants are not only used for patients with depression, but are being increasingly used for the treatment of a range of other conditions such as anxiety, obsessive compulsive disorder, treatment of phobias and in the management of neuropathic pain,” it said.

Blackpool objected to the “unrefined” methodology of the exercise. “We would never use such an over-simplified approach to bench-marking GPs as there are more accurate ways of comparing prescribing that take into account a variety of confounding issues,” it said.

It preferred to use a weighting factor called the prescribing unit, which takes into account the need of elderly people for more medicine. Its own weighted index, however, still showed Blackpool was well above average in England for antidepressant medication prescribing, although behind Middlesbrough and Redcar and Cleveland.

Most prescriptions

The primary care trusts that prescribed the most antidepressants in 09-10, and the number of prescriptions issued per hundred thousand of population

Blackpool 133,829

Salford 121,293

Redcar and Cleveland 120,137

Newcastle 117,165

Gateshead 116,900

Co Durham and Darlington 114,252

Knowsley 110,144

Middlesbrough 109,695

Barnsley 108,486

Halton and St Helens 107,742

guardian.co.uk © Guardian News & Media Limited 2010

Published via the Guardian News Feed plugin for WordPress.

This article titled “Thinner, faster, smarter… How Apple keeps us taking the tablets” was written by John Naughton, for The Observer on Sunday 6th March 2011 00.02 UTC

On Wednesday Apple released the second version of the iPad. Pardon me while I yawn: I know it’s rude to do it in public but what the hell? iPad 2 is thinner – down from 13.4mm to 8.8mm, if you please. (Who was it who said that you can never be too thin or too rich?) It’s faster too, courtesy of a dual-core A5 processor. And it’s got two cameras, no less, one front and one back, plus a gyroscope. If that doesn’t make your head spin, the news that iPad 2 is 15% lighter than its predecessor definitely will.

And – get this – for a mere (£24) extra you can get a magnetised polyurethane cover which switches the device off when you lay it on top! Oooh: and the cover also cleans the smudge marks left by your greasy fingers on the touchscreen! Now I know what you’re thinking, dear reader: a subculture which thinks this stuff is hot news must be several bits short of a byte. And it’s hard to disagree.

On the other hand, there is the unpalatable fact that Mr Jobs’s ability to lure so many otherwise sane people on to his product-upgrade treadmill has made Apple the second most valuable company on the planet. And that’s definitely news. The logical next step for Apple fans will be to have their salaries (plus bonuses, naturally) paid directly to Steve Jobs, who will then supply them with regular kit upgrades plus food coupons in return.

The technology industry’s appetite for trivia never ceases to amaze one. Over in another corner of the forest, HP and RIM, two companies which are trying to play iPad catch-up, are sniping at one another. RIM’s device is called the BlackBerry PlayBook, while HP’s effort is called the TouchPad. They have different screen sizes but in some respects seem remarkably similar. “The BlackBerry Tablet operating system”, says Laptop magazine, “certainly looks as if RIM may have taken a page out of the webOS [ie HP] playbook.” For example, “both tablets render open programs as cards that you can easily swipe through for multitasking, and you can close apps using both OSes by swiping them off the screen”.

The magazine asked both companies for their reactions to these observations. “It’s a fast innovation cycle and a fast imitation cycle in this market,” said HP’s Jon Oakes, snootily, “so… we’ll keep innovating… and those guys hopefully will continue to see the value in it and keep following us by about a year.”

Stung by this, Jeff McDowell of RIM pointed out that “cars over time end up looking a lot alike because you put them through a wind tunnel, and when you’re trying to come up with the best coefficient to drag ratio, there’s one optimised shape that gets the best wind resistance, right? Well, when you’re trying to optimise user experience that juggles multitasking, multiple apps open at once, and on a small screen, you’re going to get people landing on similar kinds of designs.”

In other words, as American technology commentator John Paczkowski put it: “Our iPad challenger is more original than your iPad challenger.”

Neither man commented on the really interesting aspect of the story, namely that neither company had yet managed to actually ship a tablet, though both are coming real soon now.

While all this was going on, Apple and Microsoft were squabbling about capital letters. A while back, Apple attempted to trademark the phrase “App Store” – the name of its online store of downloadable programs. Microsoft objected, arguing that the term was too “generic”. (This from the company whose main products are Windows, Word, Office and Excel.) On Monday last, Apple struck back. “Having itself faced a decades-long genericness [sic] challenge to its claimed Windows mark,” it sniffed in a court filing, “Microsoft should be well aware that the focus in evaluating genericness is on the mark as a whole and requires a fact-intensive assessment of the primary significance of the term to a substantial majority of the relevant public.

“Yet, Microsoft, missing the forest for the trees, does not base its motion on a comprehensive evaluation of how the relevant public understands the term App Store as a whole. What it offers instead are out-of-context and misleading snippets of material printed by its outside counsel from the internet and allegations regarding how the public allegedly interprets the constituent parts of the term App Store, ie, ‘app’ and ‘store’.”

If this reminds you of two bald men arguing over a comb, then welcome to the club. You don’t have to be obsessive to work in the technology business, but it sure helps.

guardian.co.uk © Guardian News & Media Limited 2010

Published via the Guardian News Feed plugin for WordPress.

This article titled “It’s the tests that deceive, not the people claiming benefits” was written by Zoe Williams, for The Guardian on Thursday 10th March 2011 08.30 UTC

The coalition came into government with a firm belief that an army of shirkers was bleeding the state dry with fake disabilities. That much has always been clear from Cameron’s rhetoric: the benefits system, he says, has created a benefits culture. The Tories want to end this culture once and for all; in the case of the disability living allowance, by reassessing claimants. The last government introduced the work capability assessment for new claimants; the difference now is that all claimants have to be assessed.

In Burnley, the trial of the WCA has just ended. Its weaknesses are many and varied, but in a nutshell, the system is that you chuck as many people as you can into the deep end and whoever floats long enough to take you to tribunal, well, congratulations. Think of a 16th-century witchcraft trial, take away the transparency and public approval, and you have it about right.

The focus so far has been on the absurdities of the physical disabilities that have been discounted by the WCA: claimants have to score 15 points to stay on the full allowance. A person with multiple sclerosis scored zero, despite a surgeon’s letter stating he was too ill to work. Someone who was registered blind was found to have “mild visual impairment”. Charities warn that the coalition’s whole welfare reform bill penalises cancer patients.

But the assessment for those with mental illness is even more bafflingly inadequate. Atos, the company responsible for the assessments, does not require staff to have any training in or understanding of mental illness. There’s an anecdote about an assessor telling a claimant that because he wasn’t rocking or sitting in a corner, he obviously wasn’t unwell. Claimants are asked how they arrived at the appointment: if they managed to take public transport alone, and are presentably dressed, this counts strongly against them. Likewise, if they are articulate. So there’s no acknowledgement that mental illness fluctuates, and someone might be fine on one day, but incapacitated the next.

Sharon McConville, who has been diagnosed at different times with major depressive disorder, bipolar affective disorder and schizoaffective disorder, is unusual in speaking openly about the WCA’s inadequacy, as it applies to her personally: “There is huge variability in my condition – on a given day I may be depressed, hypomanic, psychotic or relatively well – and I find it hard to see how a face-to-face meeting at one point in time can accurately determine the level of support which is necessary to help me function as well as possible from week to week, month to month.”

At the same time, there’s no understanding of people whose illness has a high anxiety component, who might never even open their post, let alone be able to face an appointment. You’re damned if you do turn up, and damned if you don’t. There is no provision set for conditions in which the patient might have poor insight into his or her own illness. A survey by the mental health campaign Rethink of the people who have been reassessed so far showed that only 12% felt that the assessor had even understood their condition; 80% said the stress and anxiety had worsened their health. The WCA is so riven with faults that it’s hard to see what kind of mental illness would, under its terms, actually qualify someone for help.

So, typically, this might result in the treatment meted out to Man A (he wishes to remain anonymous) who has bipolar disorder, and suffers severe depressive episodes that can last up to two months, several times a year. He scored zero on his Atos test last March and his invalidity benefit was stopped. As a result he became stressed, his symptoms worsened and he had frequent suicidal thoughts. He had to wait 11 months for his appeal, at which the judge said he had no case to answer, and he will now receive his backdated benefits. He said after his appeal: “I am relieved the decision has gone in my favour, but I am also very angry. The result of my appeal just goes to show how flawed the current system is – with no political opposition.” This last point is vital: it’s rare for someone with severe mental illness to want to be identified, let alone have the stomach for a public meeting, still less a campaign. Political opposition to the WCA needs to be much more muscular.

But before you even consider the politics behind all this – whether removing benefits from anyone is a fair way to stimulate employment when there is a shortage of jobs – there’s a clear discrimination case to answer. The argument about whether or not mental illness counts as a “real illness” has been fought and won. To devise a test, therefore, that might (patchily) assess physical impairment but doesn’t, except in the crudest terms, address mental illness, is discriminatory.

Furthermore, if you have arthritis and your benefits are cut, your life will get worse but your arthritis won’t, necessarily. If you have depression and you are treated outrageously by a system that was apparently designed to reject your legitimate claim, then your depression very probably will worsen. Tribunals may sort out the injustice suffered by individuals, but what this situation demands is a class action against the discrimination that underpins it.

guardian.co.uk © Guardian News & Media Limited 2010

Published via the Guardian News Feed plugin for WordPress.