Proper training could end these tragic, avoidable, hospital deaths
Sir: Following a similar incident in our hospital to the tragedy described by Martin Bromiley (14 November) , in which nurses knew what the clinical problem was but were not empowered to override a doctors' actions, we have set up a one-day training course in human factors, on such subjects as situational awareness, leadership, teamworking and empowerment.
One of our intensive-care physicians is married to an airline pilot, hence our awareness of the training in the airline industry. Our course has had recognition nationally and internationally. The airline industry only started training seriously when legislation made it mandatory, and I suspect the same will be needed in the health sector.
Meanwhile, the argument that such a serious event as an unexpected death would not routinely be investigated is (hopefully) no longer true as all such incidents (and indeed all adverse events) should be reported within a hospital's adverse incident reporting system.
CONSULTANT ANAESTHETIST, DOVERIDGE, ASHBOURNE
Sir: The issues raised in your article concerning the failure of the NHS to act in a correct and timely manner are not new. The Government highlighted all the system failures that occurred in the sad death of Elaine Bromiley in a Department of Health document published in 2000 called "An organisation with a memory". Unfortunately, identifying the problem and curing it are very different.
Inevitably, the culture in an organisation as complex as the NHS will be resistant to change, but after nearly 40 years working with the NHS I believe there are two major stumbling blocks. Firstly, the need to find someone to blame for mistakes which maintains the "blame and shame culture" and prevents good error reporting. Secondly, the Government constantly looks at problems on a cost basis. It adds up the errors in the NHS from the standpoint of their cost to the public purse rather than their cost in human suffering.
MICHAEL CHARVONIA MRPHARMS
Climate Bill must include targets
Sir: We welcome the Government's inclusion of a Climate Bill in the Queen's Speech. However, we believe that the absence of annual targets as highlighted in your excellent front page article (15 November) is a serious flaw in the current Bill.
Without targets it will be very difficult to assess the Government's commitment to reducing the UK's carbon emissions. The Government's record on reducing carbon emissions has, until now, lagged behind its rhetoric: carbon emissions have in fact gone up since 1997.
Without the discipline and transparency of fixed and public domestic targets it will be difficult for the Government to claim "leadership" on climate change, and the UK government's ability to push for an effective international agreement to succeed the Kyoto Protocol will be undermined.
We believe that any bill to reduce carbon emissions must incorporate targets founded on the latest and best scientific evidence available. Not on those targets which are politically expedient.
Further, we favour a statutory panel to monitor and report on carbon emissions; this should include scientists and representatives of civil society organisations with a record of campaigning on this issue, as we believe this would bolster its public credibility as truly independent.
MICHAEL MEACHER MP, NORMAN BAKER MP, GEORGE GALLOWAY MP, DR CAROLINE LUCAS MEP, ILANA RAPAPORT (PRESIDENT OF THE NUS), MARK LYNAS, GEORGE MONBIOT, PHIL THORNHILL (NATIONAL COORDINATOR, CCC), BILLY HAYES (GENERAL SECRETARY OF CWU)
CAMPAIGN AGAINST CLIMATE CHANGE, LONDON N1
Sir: The Energy Savings Trust estimates the average home emits six tonnes of CO2 equivalent a year (13 November). The Chair of the RSA tells us (RSA Journal, October 2006) that he has discovered that his personal emissions for the next year "total a horrifying 25 tonnes of carbon dioxide equivalent" and he tells us of his and the RSA's aim to reduce personal emissions to five tonnes within five years' time through a combination of energy-saving measures and reduced consumption and behaviour change.
The Lord Mayor's Show in London, a relatively low-tech event, said in its free guide that it would produce 220 tonnes of greenhouse-gas emissions in one day. That's an annual equivalent of 13 tonnes for every one of the estimated 6,000 participants.
These figures suggest that it is our regular collective activities that produce far more emissions per person than our domestic activities; yet most of the focus is on the impact of aeroplanes and on the personal action that can be taken in our domestic lives.
Sir: Here in Cambridgeshire we are doing our bit for climate change. There are three main east-west roads across the county, and all but a few miles are being widened to either four or six lanes; and one will have a busy 10-mile section duplicated. Within five years there will be 16 lanes running across the county and at 8.30 am they will all be congested.
There are two parallel rail routes, both disused: one is being converted to a guided bus system that seems to have no purpose and was objected to by 3,000 people; the other is unprotected against development.
There are no plans to improve existing rail services. In the rural areas, bus services have been cut and my village has now only a two-hourly service. As you can see, we are fully behind the Government's action on climate change, and most other English counties have a similar policy.
ST NEOTS, CAMBRIDGESHIRE
Sir: Further to your survey of MPs (15 November), I wanted to draw your readers' attention to their full responses, which also address the question of what Britain should do to combat climate change. These can be viewed online at roughguides.com/MPs.
The responses show an enouraging consensus on the need for action to cut carbon emissions - but (on the Labour side, mostly) a complacency that Britain is already making significant progress. I don't think that is the case: we are ahead of our Kyoto commitment mainly due to the closure of coal-fired power stations in the early 1990s, and in the past three years our emissions have been going up, not down.
The MPs are short on specifics. For example, almost everyone agrees that flying needs to be curbed, but nobody says how.
So here is my idea: introduce a tax of £100 for (return) flights to Europe and Africa, £200 for the rest of the world, and make sure nobody need miss out on a holiday by issuing three £100 vouchers to each UK resident. The vouchers would be traded within days, on eBay and elsewhere.
And as for the funds raised? Money from green taxes must be used for green schemes.
PUBLISHER, ROUGH GUIDES
Sir: I was astonished to read what I apparently said in response to Mark Ellingham's Climate Change survey of MPs (15 November).
I am a passionate supporter of investment in renewable energy and public transport, have always taken the train to London in 37 years of commuting and am planning to install solar panels at my home. I recycle wherever possible and collect rainwater for the garden.
I am also seeking to promote the development of a freight railway from Glasgow to the Channel Tunnel to take 5m lorry journeys off our roads every year thereby greatly reducing CO2 emissions and have called on several occasions for tidal barrages to be built across the Thames, Severn and other estuaries to generate electricity. I may not quite be an eco-warrior, but I do my bit...
KELVIN HOPKINS MP
(LUTON, LABOUR) HOUSE OF COMMONS LONDON SW1
Sir: Has anybody ever done a complete audit on recycling to demonstrate that it is carbon efficient? I suspect that: a) nobody has; and b) if anybody bothered to do so the result might be a surprise.
Buy your wine from the French grower
Sir: Andreas Whittam Smith recommends buying wine direct from the grower in France (13 November). My wife and I have been doing this for years. It offers excellent value, particularly around the £7-plus mark, though the advantage does tail off as wines become more expensive. He is a bit pessimistic about needing to ring up the grower in advance. We have never found any difficulty on the Côte de Beaune or the Mâconnais in Burgundy, on the Loire, in Bordeaux or in Cognac or Champagne country in finding well-organised growers with proper lists.
If you decide to start buying direct, do your homework: pick the less well-known communes and identify the best producers in better-known places, whose ordinary Burgundy, for instance, often offers unexpectedly good value.
JOHN PETER HUDSON MIDDLETON STONEY, OXFORDSHIRE
UK students are not fleeing to the US
Sir: This Government has introduced a new support package for students which is one of the best in the world. The suggestion that UK students are turning to the US over UK institutions ("Top-up fees force Britons to study at US universities", 10 November) does not ring true. There have been no significant rises in applications to US universities, nor has there been a significant drop in applications to UK institutions.
This is not to say that we don't welcome UK students studying abroad and gaining knowledge which will stand them in good stead in a global economy; we do, just as we welcome large numbers of international students to our universities. In fact, we have introduced a fairer system of Higher Education funding with the express aim of widening participation from students from poorer backgrounds. No student will have to pay upfront for Higher Education and will only start paying back loans after graduation and once they are earning over £15,000.
MINISTER OF STATE FOR LIFELONG LEARNING, FURTHER AND HIGHER EDUCATION, LONDON SW1
Nothing funny about a brutal education
Sir: Miles Kington might not find "killer nuns" so funny if he had ever had the misfortune to be a pupil at the kind of faith school he appears to be advocating (13 November). As a tutor of adults I have often had to work with the long-term consequences of that kind of schooling - a woman with a broken finger, still crooked decades later; people beaten daily as children for mistakes in writing, who as adults were diagnosed as dyslexic; people terrorised out of learning and left with the lifelong handicap of illiteracy.
Whether in a convent or a madrassa, literacy and positive social attitudes cannot be beaten into children any more than a love of God can.
A cure for coughs ... and vampires too
Sir: I have a cough remedy ("How to heal a cough", 14 November) that was given to me over 30 years ago by an Irish landlady. Crush plenty of garlic cloves, mix with honey and the juice of a lemon. Shake vigorously and take as much as possible as often as possible. My daughter and I swear by this remedy to suppress the most persistent coughs. I believe garlic has antiseptic properties so it may be more than just the placebo effect. It also probably prevents the spread of germs as people tend to avoid us when we are taking this!
Sir: The list of the "12 youngest post-war England debutants" in Sam Wallace's article (15 November) was very interesting but inexplicably did not include the best player I ever saw. Duncan Edwards made his debut in April 1955 at the age of 18 years 8 months in a 7-2 win over Scotland at Wembley.
A British Constitution?
Sir: Ian Campbell's proposal for a British Constitutional Convention (letter, 15 November) is laudable, although it is unclear what he means by representatives from "Ireland". Is the whole of that island to become part of a British federation?
An Irish Constitutional Convention should deal with that island's future first, before it deals with its relationship with this one.
Sir: When she called for a British Federation (Letters, 9 November) Margaret Macaulay neglected to mention Wessex which is the oldest county on the island of Great Britain.
PROVINCIAL SECRETARY FOR LOWER WESSEX, THE WESSEX PARTY WESTON-SUPER-MARE, NORTH SOMERSET
Sir: On 25 December we don't "celebrate the birth of Christ" (Letters, 15 November): we celebrate the winter solstice and the return of the unconquered sun. Hence the Yule log, holly and mistletoe; the giving of gifts, drinking and singing (saturnalia); the colourful lights, the magical Father Frost/ Santa Claus, and the evergreen tree.
The birthdays of various old gods like Mithras and Christ have, throughout the ages, been conveniently timetabled on the date of this ancient holiday.
LIVERPOOL Sir: It's official. We are now in the Christmas season. There were no hot cross buns in the supermarket today. PATRICK HERBERT UCKFIELD, EAST SUSSEX
Sir: In your otherwise excellent report "Norwich rated Britain's most eco-friendly place to live" (13 November), you somehow fail to mention the key reason why, which is that Norwich has the most Green Party City Councillors (nine, and they have held the balance of power on the Council for the last few years) of anywhere in Britain.
LEONARD G FLETCHER
A close call
Sir: Roger Jones is interested in the origin of the term "near miss" (letter, 13 November). It might help to recall that "near" retains the sense of "close", as well as the more recent sense of "almost". So, not "almost miss", but "close miss". As opposed to: "by a country mile miss".
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