Category Archives: Cancer

‘Life is precious’: Donegal quietly defiant after voting no in referendum

In Donegal town on Sunday, it was not immediately apparent that Ireland had just held one of the most significant votes in its history.

The morning after it emerged that Ireland had voted by a landslide to liberalise abortion laws, the campaign posters still blanketing the rest of the country had already been taken down in the town centre and the badges that were so prominent in other counties were nowhere to be seen.

Donegal stood out on Saturday as the only constituency in Ireland to have voted against repealing the eighth amendment, which had given equal legal status to the lives of a foetus and the woman carrying it.

The country overall voted with a two-thirds majority: 66.4% yes to 33.6% no. In Donegal, the result was 48.13% yes and 51.87% no – with just 2,532 votes making the difference.

map

But yes campaigners in Donegal town were taking heart in the result. “We had said as a campaign team that 40% was a victory,” said John Campbell, an independent councillor. “So the result here takes a little bit of shine off the national result. But I don’t think anyone is too disappointed.”

In 1983, when the constitution was amended, only 18% of people in Donegal – then two constituencies – voted against it. The result this time showed a big shift in attitudes. “For a county that was in the church’s vice, we did fantastically well,” said Sinéad Stewart from the campaign Donegal Together for Yes.

The town of Donegal bucked the county trend by voting yes on Friday. At mass in St Patrick’s church, the priest mentioned the result, locals said, but there was no condemnation.

Few residents were willing to talk about the referendum. Many of those who did speak to the Guardian, and had voted no, did not want to be named.

“I don’t like murder,” one woman said, when asked why she voted against the change. “I know you have to consider cases like rape and young girls, but I think that should have been legislated for separately. I feel very sad about this as I think the next thing they will do will be euthanasia. They will stick a needle in us and we’ll be gone.”

She said she did not want to named because she worried about the backlash from others. “I don’t know what way other people think,” she said.

Q&A

Abortion in Ireland – what happens next?

Abortion will not immediately be available to women within Ireland.

The eighth amendment – article 40.3.3 of the Irish constitution – which prohibited abortion, will be replaced with a clause stating: “Provision may be made by law for the regulation of termination of pregnancy.”

The Irish government is planning to bring legislation before the Dáil, providing for abortion on request up to the 12th week of pregnancy, with a three-day “cooling off” period before medication is administered.

The prime minister, Leo Varadkar, said he wanted the new law to be enacted by the end of the year.

Between 12 and 24 weeks, abortion will be available only in cases of fatal foetal abnormality, a risk to a woman’s life or a risk of serious harm to the health of the mother. After 24 weeks, termination will be possible in cases of fatal foetal abnormality.

There will be provision for conscientious objection among medical practitioners, although doctors will be obliged to transfer care of the pregnant woman to another doctor.

A resident of the town said Donegal’s vote against the change made him feel proud of the area.

“There are special cases, like when a girl has been raped,” he said. “But at the same time I just think life is precious and now they’re just throwing it all away. I know that might be kind of a silly attitude, but I think life is precious.

“I wouldn’t tell a lot of people that I voted no because a lot of people have a one-track mind. The government will do what it wants to do. If it hadn’t been a yes vote they would have had another referendum down the road in six months’ time.”

As well as a low turnout in Donegal, the small margin for no could be partly attributable to geography. The remote location means many young people have left to work and study, and taken their votes with them. According to the 2016 census the under-35s account for 26% of the population, compared with 30% nationally.

The area was also particularly affected by austerity measures after the recession. “People left to [go to] Dublin and the cities, and they’re still there,” said Stewart. “They see themselves as being from Donegal but their vote is registered elsewhere. I have about 15 cousins who moved out of Donegal. They would all have voted yes here.”

Campbell said: “One of the effects of not having those young people here is that conversations with parents that swayed votes were less likely to happen. That could be one factor that explains the result.”

Ciara Haley is one of those students who moved her vote. “I [am] massively disappointed in Donegal’s response, but I am also not surprised. Religion is such a prominent part of our local communities and I think a lot of pressure came from the church,” she said.

“I often feel like Donegal is forgotten about – in this sense it’s quite an isolated county. The infrastructure is seriously lacking. It’s important to remember these issues when criticising Donegal for its ‘backwardness’.”

Ireland abortion referendum: close result expected in historic vote

The people of Ireland are voting on Friday in a historic referendum on whether to repeal or retain a constitutional clause protecting the rights of the unborn that has produced one of the most restrictive abortion regimes in the world.

Polling stations across Ireland opened at 7am and close at 10pm. At 6.55am in Dublin, voters were already waiting in the entrance of Our Lady’s Clonskeagh Parish secondary school.

Ruth Shaw, who was second in the queue, had changed a flight to New York so she could cast a vote, accompanied by her nine-year-old daughter Simi. “Its really important [to be here],” she said. “I’ve got two daughters.”

The outcome of the vote, expected to be close following a polarised and often acrimonious campaign, will either confirm Ireland on its journey from a conservative Catholic country to a socially liberal one, or indicate that social reforms over recent decades have reached their limit.

Leo Varadkar, Ireland’s taoiseach, has said the referendum is a “once in a generation decision”. If the proposal to repeal the constitutional clause is defeated, it is likely to be at least 35 years before voters get another say on the matter, he said this week.

At stake is article 40.3.3 of the Irish constitution, known as the eighth amendment. In place since 1983, it puts the “right to life of the unborn” on an equal status with the life of a pregnant woman. It underpins a near-total ban on abortion in Ireland, even in cases of rape, incest or fatal foetal abnormality.

Seeking or providing an abortion is punishable by up to 14 years in prison. There has been an exception for when a mother’s life is at risk only since 2013, when a woman died from septicaemia following a drawn-out miscarriage.

As a result of the stringent controls on abortion, each year about 3,500 women travel abroad, mostly to the UK, to terminate their pregnancies – and an estimated 2,000 women illegally procure abortion pills online and self-administer them with no medical supervision.

My budget flight to get an abortion: the story no one in Ireland wants to tell – video

If the vote is in favour of repeal, the government plans to introduce legislation permitting unrestricted abortion during the first 12 weeks of pregnancy. Abortions up to the 23rd week will be permitted when a woman’s health is threatened and in cases of a fatal foetal abnormality.

Voting has already closed on some of the islands on the west and south of Ireland, with 2,151 people entitled to vote yesterday on the Donegal, Galway and Mayo islands and another 460 voting in the Cork islands.

Counting will begin on Saturday morning, with the final result expected to be formally announced in the late afternoon. However, the outcome may be clear earlier as results come in from key constituencies. Dublin is expected to be strongly yes-voting, and rural areas more inclined to vote no.

Campaign literature is officially banned in polling stations, but at least one person had come to Our Lady’s Clonskeagh Parish school wearing a yes badge hidden under her sweater, a symbolic tribute to the campaign she supported.

Aisling, 31, came just as the polls opened to cast her vote for yes before going to the gym. “I really don’t know [which side will win],” she said. “It’s very divisive and probably no is a bit controversial, a lot of people won’t speak out [if they are voting that way].”

The votes of thousands of Irish expatriates travelling home to take part in the referendum could be significant. Some reported on social media that they were coming from as far away as Los Angeles, Australia, Vietnam and Argentina in order to cast their votes.

Lauryn Canny tweeted:

Lauryn Canny (@LaurynCanny)

I’m coming #HomeToVote ! Will be traveling 5,169 miles from LA to Dublin and will be thinking of every Irish woman who has had to travel to access healthcare that should be available in their own country. Let’s do this, Ireland! #repealthe8th #VoteYes pic.twitter.com/fZDxUIGrs9

May 23, 2018

Colette Kelleher tweeted:

Colette Kelleher (@ColetteKelleher)

My lovely son is coming #hometovote. This poor student used his birthday money to buy plane ticket home. Just messaged me “we will get you to the Emerald City on Friday” ❤️ He will #voteyes with his Dad. For his sister, his Mum & women of Ireland #togetherforyes @Men4Yes

May 22, 2018

The latest opinion polls indicate a majority for repeal, although undecided voters – estimated at between 14% and 20% of the total – could hold sway. Two polls published this week showed small increases in the yes vote, with one putting it at 56% and another at 52%.

One poll also used a technique known as “wisdom of the crowds”, asking people to estimate the result of the referendum. The outcome was 56-44% in favour of yes.

Private polling for Fianna Fáil, whose parliamentary representatives are divided on the referendum, is believed to predict a similar outcome.

Friday’s referendum comes three years after Ireland became the first country in the world to back same-sex marriage in a popular vote, confirming a profound shift in Ireland’s social attitudes. Twenty years earlier, Ireland voted by the tightest of margins in a referendum to allow divorce, which was previously banned under the constitution.

Changes in social attitudes have been in lockstep with the declining influence of the Catholic church, once the dominant voice in Ireland and a crucial player in the drive to add an abortion ban to the constitution.

But revelations of sexual abuse and cover-up by priests in recent years have shaken Ireland’s faith in the church, and the internet and social media have challenged the authority of the pulpit.

Although 78% of the population still identified as Catholic in 2016, the proportion is significantly smaller among people under the age of 35. Between 1972 and 2011, weekly church attendance fell from 91% to 30%. In Dublin, it dropped to 14%.

Meet the people fighting to keep Ireland’s abortion ban – video

Social media has been an important battleground for both sides of the campaign. Earlier this month, Google announced a ban on all ads relating to the referendum and Facebook announced that it was blocking all foreign referendum advertising.

But there has also been an intense ground battle, with campaigners for both sides canvassing door-to-door, holding public rallies and meetings, and handing out leaflets on the streets in an attempt to win over undecided voters.

The yes campaign has focused on the argument that abortion is a reality for thousands of Irish woman, but the constitutional ban merely exports the issue at huge emotional, physical and financial cost to a woman in a crisis situation.

The no campaign has repeatedly said “extremist” legislation would follow repeal. In fact, the government’s proposals would bring Ireland into line with most of Europe.

Is help finally at hand for suicide crisis on America’s farms?

In early May, Kansas farmer John Blaske is waiting for the rain to stop so he can begin planting. From the front door of his farmhouse, a green yard decorated with bird feeders slopes down to a series of fields where the corn will be planted. Beyond the fields, there’s a tree line and a small bridge with a creek running below. It’s peaceful here, and mostly quiet, except for the sound of the occasional car or tractor, or the cows calling from the paddock.

The waiting makes him restless, he tells me. And it’s not just the rain. He’s also waiting desperately for the opportunity to talk to fellow agrarians or to legislators about the stress, depression and suicidal ideation he experiences as a farmer.

We have been talking by phone for well over a year now, and last fall, when the summer heat was just beginning to lift, I visited his farm in the tiny town of Onaga.

My conversations with Blaske became part of a story, published in December in the Guardian, about the high rate of farmer suicide. According to a 2016 report, people who work in agriculture take their lives at a rate higher than any other occupation, and at twice the rate of military veterans.

The story reached the computer screens of over a million readers, even landing on the desks of legislators. But Blaske himself could not access it. Without a computer or the internet, he was unaware of theconversations, media coverage, and legislation provoked in part by his story.

I’ve done my best to keep him updated, with phone calls and print-outs of articles mailed to his home. But behind the scenes of this story is a stark digital divide, which highlights the isolation experienced by rural America and the feeling that – even in a farm bill year – farmers have been forgotten.

I’ve got good news about bad news

John Blaske at home. Blaske doesn’t have a computer or Internet access, but he’s keen to talk about mental health with other farmers.


John Blaske at home. Blaske doesn’t have a computer or internet access, but he’s keen to talk about mental health with other farmers. Photograph: Audra Mulkern for the Guardian

I’ve become fond of the phrase, “I’ve got good news about bad news,” and I’ve been saying it a lot lately.

Just weeks after the article was published, Washington state representative and fourth generation farmer JT Wilcox immediately responded by introducing a farmer suicide prevention bill into the state legislature.

It passed unanimously through both the House and Senate, and just three months after the article was published, it was signed into law by Governor Jay Inslee.

And recently, two bills aimed at addressing the farmer suicide crisis (The Stress Act and The Farmers First Act), were introduced into the US House and Senate for inclusion into the 2018 federal farm bill.

Both bills would reauthorize the Farm and Ranch Stress Assistance Network (FRSAN), a program which would provide federal grants to create crisis lines, provide counseling for farmers and train rural behavioral health professionals.

Both of these bills now have strong bipartisan support, as well as endorsements from a slew of progressive and conservative rural and farmer organizations. One key difference is that only the Farmers First Act comes with funding – a proposed $ 50m over five years.

As arduous as it is to pass federal legislation, it’s all the more so within something as politically divisive as the $ 867bn farm bill. While some farm groups voiced support for the House version of the farm bill, many farm and rural organizations loudly opposed it, arguing that while it contains some positive elements (including language from the Stress Act), the overall bill would harm family farmers by gutting conservation programs and local food initiatives, decreasing access to credit for small and mid-sized farms, and failing to provide a safety net for struggling farmers.

Indeed, the farm economy is in crisis. Net farm income has decreased by 50% since 2013, and recently, the farmer’s share of the US food dollar fell to 14.8 cents, the lowest since the USDA began tracking the statistic in 1993. Milk prices are so far below the cost of production that dairy cooperative Agri-Mark recently sent out suicide hotline numbers along with the milk checks. Add in the Trump Administration’s see-sawing statements about a trade war with China, which would impact up to 94 agricultural products, and the potential for financial losses is being felt industry-wide.

Because of the plight of farmers, there is increased scrutiny on the farm bill. On 18 May, the House voted down its final version of the farm bill, with 30 Republicans joining 183 Democrats in defeating the bill. While the House will attempt to rebuild the bill and bring it back for a vote in late June, public focus will largely shift to the Senate, which is drafting its own farm bill, projected to be released in June.

Still, there remains hope among farmers and advocates who have long worked to advance suicide prevention resources. “I am more hopeful than I have been in my 38 years of working in this arena that behavioral health supports will be funded as part of the farm bill,” wrote Dr Mike Rosmann, an Iowa farmer and psychologist, in an email.

‘Some people can’t hang on that long’

Ginnie Peters lost her husband to suicide in 2011. This is his working bench.


Ginnie Peters lost her husband to suicide in 2011. This is his working bench. Photograph: Audra Mulkren for the Guardian

When I call Blaske to update him on the legislation, he says the provision of extra federal grants for crisis lines and counselling would be a positive outcome that would provide life-saving resources to farmers. But he says struggling farmers can’t wait. “Some people can’t hang on that long,” he says. “I mean, farmers are out there busting their butts just trying to make a nickel or a dollar or a dime.”

If there has been any criticism of farmer suicide legislation, it is that it doesn’t address the root causes of the behavioral health issues sweeping across farm country, including the negative farm economy. A recent Mother Jones article was titled: “We wouldn’t need the suicide hotline if dairy farmers were getting paid what they deserve.”

But while economic conditions are absolutely part of why farmer suicide rates are so high, other contributing factors exist, including rural isolation, unpredictable weather, lack of rural health services, and a stigma surrounding mental health issues. Thus, even if the farm economy improves, people working in agriculture will benefit from a system of behavioral health resources.

“Agricultural behavioral health assistance is needed more than at any time since the 1980s, and will continue to be needed as an investment in healthy agricultural producers,” wrote Rosmann in a 4 May article in Iowa Farmer Today. He maintains that while natural resources are often considered elements such as topsoil, water, or seeds, farmers are the most critical agricultural natural resource we have. As such, he says, the health and wellbeing of farmers is essential to a functional food and agriculture system.

Matt Perdue, a fifth generation farmer from North Dakota and the government relations representative for NFU, says the farmer suicide legislation addresses an immediate need for the group’s 200,000 members. He also says the need for such support goes beyond the current farm financial crisis.

“When we look at the farm economy as a whole, we’re not taking into account specific situations,” says Perdue. “A farmer might be experiencing severe drought or getting hit with a hailstorm while the rest of the economy is strong. The industry has so much uncertainty in it, so we need to be providing mental health support to farmers and ranchers at all times.”

‘While economic conditions are part of why suicide rates are so high, other contributing factors exist.’


‘While economic conditions are part of why suicide rates are so high, other contributing factors exist.’ Photograph: Audra Mulkern for the Guardian

On 9 May, NFU’s Roger Johnson sent a letter to Secretary of Agriculture Sonny Perdue urging him to address the crisis. “We call on the United States Department of Agriculture (USDA) to serve a critical role in providing support to farmers and ranchers in crisis,” he wrote. He notes that net farm income is projected to drop by 6.7% in 2018 (to negative $ 1,316), the lowest since 2006, and the fact that 60% of rural residents live in areas with a shortage of mental health professionals.

“This is something we think requires a holistic response,” says Perdue. “Federal legislation is just one way to address the issue. We also need to be talking about this at the state level and the local level. It’s going to take as many different avenues as we can find.”

A simple idea: a big picnic

In Kansas, Blaske has been thinking about those different avenues. “I think that we need to have get-togethers – like a big picnic, where farmers let their feelings out and learn to not hold everything inside, because that’s when it all blows up,” he says.

It’s a simple but effective idea, and one that echoes the farmer gatherings through the 1980s farm crisis, when farmers took to community spaces to organize and take care of one another.

During that time, Dr Rosmann took on the role of gathering Iowa farmers and their families. Upwards of 200 hundred farmers would gather in a church or school for community prayer, candid conversation about their struggles, and various presentations: an attorney explaining the stages of bankruptcy, a banker discussing financial management, Rosmann speaking about stress and behavioral health.

When I tell Blaske about Rosmann’s gatherings from years ago, he says: “I’d go in a heartbeat. But so far, the opportunity hasn’t been presented. Nobody’s ever called and asked me to do anything like that, but that’s what I’d love to do.”

So he waits – to begin planting, for a phone call, for the mail, for something to change. “You asked me what I hoped would come from this story,” he said to me on the phone recently. “I want to be seen. I want to be heard.” Then his voice broke, and he abruptly finished our call.

‘I felt like farming killed my husband’

Ginnie Peters at home.


Ginnie Peters at home. Her husband, Matt, a farmer, died of suicide in 2011 at the age of 55. Photograph: Audra Mulkren/Audra Mulkern

Last October, I sat at a kitchen table in Iowa and listened to Ginnie Peters talk about her husband, Matt, a farmer who died of suicide in 2011 at the age of 55. As we spoke, she thumbed through the journal she has kept since Matt died. The entries are short and poem-like:

You were in my dreams again last night. We were out in the front yard in the dark.

The spruce tree has been planted where the oak tree had been.

I will love you forever, guy.

“For a long time I felt like farming killed my husband,” Ginnie said.

Outside the door of their farmhouse was a cistern where Matt would sit before coming inside for the night, and a young ash tree with branches still low enough to reach. Ginnie would tell him to touch the tree, to leave all his stress there in the leaves. They kept a crisis hotline number by the phone throughout the hard years of the 1980s, but by 2011, “when Matt really needed it, it was gone”.

Recently, Senator Joni Ernst – a sponsor of the Farmers First Act – called Ginnie to talk about the federal legislation. “I’m grateful that someone is finally paying attention,” Ginnie told me on the phone. “This could be the difference between life and death for many.”

“We were able to get through the 1980s farm crisis, but I couldn’t get through my farmer in crisis,” Ginnie told Ernst. “If the Farm and Ranch Stress Assistance Network had been funded in 2008, Matt might still be alive.”

The GPs offering a lifeline to homeless patients | Patrick Greenfield

At least 56 homeless people have died on the streets and in temporary accommodation in the UK so far this year. It brings the total recorded to almost 300 since 2013, according to research by the Guardian and the Bureau of Investigative Journalism. The true figure is likely much higher as no official figures are collected, making it hard for health professionals to respond to the increasing number of deaths.

“Very often people are dying prematurely, and it’s just being put down as: well, they were homeless,” says Dr Tim Worthley, who is one of three specialist GPs at homeless surgery Arch Healthcare in Brighton, East Sussex. In 2011, he started to record how many homeless people who attended his practice died. “People would just die, and that was that. The least I thought I could do was to start keeping lists,” he says. During 2017, he recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Of these, 14 were men, and three were women. The average age at death was just 46.

Rough sleepers and those in emergency or temporary accommodation do not typically die of exposure or other direct effects of homelessness, according to international research by the US-based National Health Care for the Homeless Council. Instead, they mainly die as a result of treatable conditions such as liver and gastrointestinal diseases, respiratory problems and the consequences of drug and alcohol addiction. But accessing treatment at an early stage in the UK can be very difficult for homeless people, who face bureaucratic barriers including needing a proof of address to register at a GP surgery when they are also often in personal crisis.

Although a lot of guidance on commissioning primary healthcare for homeless people has been issued since the 1990s, access varies greatly from region to region. A recent King’s College London study found that only 43% of homelessness projects were linked to a specialist healthcare service like Arch, with particular gaps in small towns and rural areas.


The more you push people to the margins, the more they fall out of the system and end up on the streets

Rough sleeping has more than doubled nationally since 2010, with thousands bedding down outside every night, while the numbers of homeless people in temporary accommodation has grown by 61% since 2010. Homeless patients often arrive at A&E with a combination of physical and mental health and addiction problems, and therefore spend much longer in hospital than the average patient.

“Because of the huge pressure on services, I see healthcare – especially GP surgeries and hospitals – as a conveyor belt that’s moving increasingly quickly, says Worthley. “In order to access healthcare, you need to be able to jump on at the beginning at the right place and you need to keep pace with it all. You need to play the game, get to your appointments, and you get treated.

“If you get on at the wrong point, or are limping too much, or can’t cope with the pace, or say no because you’re scared or whatever, then you fall off and don’t get the care. There are all these people falling by the wayside and not getting the care they need. And homeless people are absolutely among them.”

From October, key parts of the NHS, including A&E and all inpatient treatment centres, will be obliged to refer patients who are homeless or threatened with homelessness to a local housing authority as part of the Homelessness Reduction Act that came into force in April. However, GP surgeries are exempt, and with hospitals not being allowed to record a patient’s housing status on admission, there are concerns over how the new rules will work.

Dr Tim Worthley with a patient


During 2017, Dr Tim Worthley recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Photograph: Martin Godwin for the Guardian

Some charities are taking matters into their own hands. Pathway has set up teams of specialist GPs, nurses and community workers in 11 hospitals in Bradford, London, Brighton, Manchester and Leeds to use hospital admission as a chance to help patients turn their lives around. The small charity, currently funded through private grants, has also created gold standard commissioning guidelines for homeless care.

It was set up in 2009 following the death of a rough sleeper shortly after he was discharged from University College hospital in London. The first Pathway team consisted of a senior GP, a specialist nurse and a practitioner with knowledge of the welfare system. Whenever a homeless person was admitted to the hospital, a member of the Pathway team was called to help guide both staff and the patient.

“With people who have been on the streets for a long time, they’ve usually got a lot of medical conditions which may be interacting with each other. For example, the orthopaedic surgeon may not be great at thinking about how a patient’s diabetes is being managed in the context of a twisted ankle and long-term drug dependency,” says Alex Bax, chief executive of Pathway. “The orthopaedic surgeon might be under pressure to get you out because they’ve got an elective list, so the Pathway teams become clinically engaged, advocating for better, more coordinated care for patients.”

After their time in hospital, the Pathway team, which is often created using existing NHS budgets, helps homeless patients find hostel accommodation, supported living and care homes, ensures access to drug and alcohol addiction services, benefits and legal advice, and helps with lost paperwork.

“Homelessness is in part a problem with housing and part driven by government welfare reform. The overwhelming cause of homelessness now, which is a staggering change, is the ending of a shorthold tenancy, which effectively means it’s because they can’t pay the rent,” says Bax. “The more you push people to the margins, particularly vulnerable people, those who are a bit more troubled, a bit more chaotic, the more they fall out of the system and end up on the streets. That’s what’s happening. It’s the vulnerable who get pushed right to the edge and then fall off. The government’s policies are herding people to the edge of these cliffs, and a lot of people are clinging on to the top.”

According to Bax, in order to get value for money from a dedicated Pathway team, a hospital needs to have about 250 homeless patients per annum, – which means at any one time there might be six to 10 such inpatients.

Campaigners believe that if this model was extended to more hospitals, it could help prevent homeless people, such as a man known to locals as Ben, from dying on the streets. The week before Ben was found dead inside a tent in Retford, Nottinghamshire, he had been receiving treatment in hospital for pneumonia. When it was time to leave, the 53-year-old did not want to stay in temporary accommodation, so he was discharged on to the streets. A member of staff at the hospital drove Ben back to the doorway nearly an hour away where he had been sleeping all winter, and a shopkeeper met him with new camping gear and blankets to withstand the winter chill. Days later, freezing Siberian air engulfed the British Isles and Ben’s body was found on the morning of 27 February.

Back in Brighton, Worthley believes Arch Healthcare, which uses Pathway’s approach to support patients in temporary accommodation or on the street when they are discharged from hospital, is making a difference. The service was first commissioned by Brighton and Hove CCG after a successful pilot in 2013 recorded significant improvements in patients’ health and readmission rates.

“Although many of the problems remain and we have more homeless people with relatively fewer resources, now the different teams in Brighton work more collaboratively to give these women and men better support and more dignity,” says Worthley.

London hospitals to replace doctors and nurses with AI for some tasks

One of the country’s biggest hospitals has unveiled sweeping plans to use artificial intelligence to carry out tasks traditionally performed by doctors and nurses, from diagnosing cancer on CT scans to deciding which A&E patients are seen first.

The three-year partnership between University College London Hospitals (UCLH) and the Alan Turing Institute aims to bring the benefits of the machine learning revolution to the NHS on an unprecedented scale.

Prof Bryan Williams, director of research at University College London Hospitals NHS Foundation Trust, said that the move could have a major impact on patient outcomes, drawing parallels with the transformation of the consumer experience by companies such as Amazon and Google.

“It’s going to be a game-changer,” he said. “You can go on your phone and book an airline ticket, decide what movies you’re going to watch or order a pizza … it’s all about AI,” he said. “On the NHS, we’re nowhere near sophisticated enough. We’re still sending letters out, which is extraordinary.”

At the heart of the partnership, in which UCLH is investing a “substantial” but unnamed sum, is the belief that machine learning algorithms can provide new ways of diagnosing disease, identifying people at risk of illness and directing resources. In theory, doctors and nurses could be responsively deployed on wards, like Uber drivers gravitating to locations with the highest demand at certain times of day. But the move will also trigger concerns about privacy, cyber security and the shifting role of health professionals.

The first project will focus on improving the hospital’s accident and emergency department, which like many hospitals is failing to meet government waiting time targets.

“Our performance this year has fallen short of the four-hour wait, which is no reflection on the dedication and commitment of our staff,” said Prof Marcel Levi, UCLH chief executive. “[It’s] an indicator of some of the other things in the entire chain concerning the flow of acute patients in and out the hospital that are wrong.”

In March, just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March – the lowest proportion since records began in 2010.

Using data taken from thousands of presentations, a machine learning algorithm might indicate, for instance, whether a patient with abdomen pain was likely to be suffering from a severe problem, like intestinal perforation or a systemic infection, and fast-track those patients preventing their condition from becoming critical.

“Machines will never replace doctors, but the use of data, expertise and technology can radically change how we manage our services – for the better,” said Levi.

Another project, already underway, aims to identify patients who are are likely to fail to attend appointments. A consultant neurologist at the hospital, Parashkev Nachev, has used data including factors such as age, address and weather conditions to predict with 85% accuracy whether a patient will turn up for outpatient clinics and MRI scans.

In the next phase, the department will trial interventions, such as sending reminder texts and allocating appointments to maximise chances of attendance.

“We’re going to test how well it goes,” said Williams. “Companies use this stuff to predict human behaviour all the time.”

Other projects include applying machine learning to the analysis of the CT scans of 25,000 former smokers who are being recruited as part of a research project and looking at whether the assessment of cervical smear tests can be automated. “There are people who have to look at those all day to see if it looks normal or abnormal,” said Williams.

Might staff resent ceding certain duties to computers – or even taking instructions from them? Prof Chris Holmes, director for health at the Alan Turing Institute, said the hope is that doctors and nurses will be freed up to spend more time with patients. “We want to take out the more mundane stuff which is purely information driven and allow time for things the human expert is best at,” he said.

When implementing new decision-making tools, the hospital will need to guard against “learned helplessness”, where people become so reliant on automated instructions that they abandon common sense. While an algorithm might be correct 99.9% of the time, according to Holmes, “once in a blue moon it makes a howler”. “You want to quantify the risk of that,” he added.

UCLH is aiming to circumvent privacy concerns that have overshadowed previous collaborations, including that of the Royal Free Hospital in London and Google’s DeepMind, in which the hospital inadvertently shared the health records of 1.6 million identifiable patients. Under the new partnership, algorithms will be trained on the hospital’s own servers to avoid any such breaches and private companies will not be involved, according to Holmes.

“We’re critically aware of patient sensitivity of data governance,” he said. “Any algorithms we develop will be purely in-house.”

Questions also remain about the day-to-day reality of integrating sophisticated AI software with hospital IT systems, which are already criticised for being clunky and outdated. And there will be concerns about whether the move to transfer decision-making powers to algorithms would make hospitals even more vulnerable to cyber attacks. Hospital IT systems were brought to a standstill last year after becoming victim to a global ransomware attack that resulted in operations being cancelled, ambulances being diverted and patient records being unavailable.

Williams acknowledged that adapting NHS IT systems would be a challenge, but added “if this works and we demonstrate we can dramatically change efficiency, the NHS will have to adapt.”

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

The new GCSE exams pile on pressure and kill off passion for learning | Keza MacDonald

Reading teachers’ and students’ accounts of the immense stress and mental health issues caused by the introduction of the new GCSE exams this year is heartbreaking. “The new GCSEs have broken my best students, left some with serious stress-induced illnesses, and isolated the majority, leaving them completely apathetic towards their own learning,” said one teacher. A student reports: “I have seen the mentally toughest people crack and it’s painful to watch. People crying over being unable to do a maths question. Is this what we want as a nation, to be put under this mental stress?”

Exams are not exactly known for making teenagers happy, but the misery should at least lead to something useful at the end of it. GCSEs as they previously stood were so forgiving that their usefulness was often called into question – but instead of reforming them, former secretary of state for education Michael Gove decided to take them back to the days of the O-level. The new GCSEs emphasise tough, stressful end-of-year examinations over coursework and regular testing: teacher friends tell me that even in subjects where the content of the syllabus hasn’t changed enormously, the way that students are tested on it has become much more stressful.

If the aim is to gift England’s young people with “the broad, deep and balanced education which will equip them to win in the global race”, as Gove claimed, then why are we returning to the educational principles of 30 years ago rather than teaching them the flexibility and resilience that they need to thrive in the modern world? Why are we asking them to sit three separate 75-minute geography exams and forcing them to revise until the early morning, instead of giving adolescents space and opportunities to develop the skills and talents that interest them?

The problem here is not that the new exams are harder. It is that they are all-consuming. Nobody of any age should be pulling 70-hour work weeks just to keep up. Where previously students were able to bring copies of set texts into the English examination, now they must memorise quotes from a couple of novels, a Shakespeare play and a selection of poems. What does this kind of memorisation actually teach people? In the age of Google, how is it useful outside of an exam room? Why test students on their ability to retain information rather than understand it?

There is another significant difference between O-levels and the new GCSEs: not everybody had to take O-levels. In the 1970s, many people left school for jobs at 16, and only 8.4% of the population attended university. Now we are destroying teenagers with stress at 16 and then again two years later with A-levels, with the aim of eventually getting them university degrees that are increasingly expensive and decreasingly useful.

Students don’t always discover their passions in the classroom. I was a textbook product of a nice middle-class high-achieving school: I worried sick over my exams, passed them all, but then ended up leaving school just before I turned 17 to work on a video games magazine because I had spent all my spare time playing games and making websites. My parents despaired – but ask any of my millennial peers whether the exams and qualifications that we were told to stress over were useful when the economy collapsed in 2008. To survive, we had to hustle – and the school system, as it was, emphatically did not teach us that.

On my beat covering the video games industry, most of the young people I meet developed the skills and talents that they need for their job – art, music, coding and game design – as a hobby, because school didn’t support them. Why, then, are they just making GCSEs harder instead of adapting them to teach things people need in the modern world? Why aren’t we broadening the range of subjects and adding more vocational options for students instead of getting them to memorise poems?

I’m not saying that adolescents should be spending their time in school doing whatever they want. But there should be time left outside of school to pursue other things, whether it’s music or video games or making YouTube videos or just being teens. Exams might be a necessary evil, but there should be time and space left over for young people to live their lives and discover their passions, instead of piling so much schoolwork on them that they are having panic attacks and migraines en masse.

Keza MacDonald is video games editor at the Guardian

I wanted to find out how my baby died. Instead I got dishonesty and hostility | James Titcombe

In November 2008 my nine-day-old son, Joshua, died in truly terrible circumstances, as a consequence of failures in his care at Furness general hospital, part of the University Hospitals of Morecambe Bay NHS foundation trust. Joshua’s death instantly turned my life upside down. But as I began to seek answers as to what exactly happened and why, nothing could have prepared me for the years of dishonesty, obfuscation and, at times, outright hostility that followed.

Critical records of Joshua’s care went missing, statements from staff were dishonest, investigations were superficial, the organisations that should have been taking action to ensure the maternity services at Morecambe Bay were safe instead acted to reassure each other that everything was OK.

In March 2015 an independent investigation, chaired by Dr Bill Kirkup, was published. The report found that there was a “lethal mix” of failures at the maternity unit where Joshua was born. The first opportunity the trust had to identify that things were starting to go badly wrong was the tragic death of a baby girl in 2004, yet this was effectively covered up. The family weren’t told the truth, and unsafe care at the unit continued. Between 2004 and 2013, 11 babies and one mother died avoidably.

Throughout this period, the Nursing and Midwifery Council (NMC), the regulator responsible for protecting the public by ensuring nurses and midwifes practise safely, appeared to take little action. In relation to Joshua’s care, the last hearings only took place in 2017, some eight years after Joshua’s death. Yesterday, a long awaited report from the Professional Standards Authority (PSA) finally provided some answers as to why. The report makes difficult and sad reading for me [full report here].

The PSA describes concerns about the evidence it was able to obtain from the NMC to assist its review. We are told that the standard of record-keeping was “very poor”, and that information relevant to the review wasn’t included in the NMC’s case files. The report recounts in heartbreaking detail the experience of many Morecambe Bay families who contacted the NMC. A clear pattern emerges of an organisation placing little onus on what these families were saying, and in some cases simply dismissing people’s concerns with little or no consideration.

In April 2012, Cumbria police met the NMC to given them a detailed list of cases at Furness general hospital about which they had significant worries. But the NMC took no action “for almost two years”. While this was ongoing, midwives under investigation continued to practise, and in some cases were involved in subsequent serious incidents involving avoidable harm and death.

It would be unrealistic to expect any large and complex organisation to get everything right all of the time, but any organisation with such an important public protection role must be open and transparent when things go wrong, so that the organisation can learn and improve and maintain public confidence and trust.

But the report highlights the continued failure of the NMC to be open, honest and transparent about its own actions, pointing to its misleading responses to families and the secretary of state, its failure to disclose external reports looking at learning from cases, and its failure to be open and transparent with information requests.

These are damning conclusions, and highlight an urgent need for change in the leadership and culture of the organisation.

But the response from the NMC this week can only be described as woefully inadequate. On Monday, Jackie Smith, the chief executive, announced her resignation but in doing so made no mention of the problems highlighted by the report, and instead spoke of her pride in all that the NMC had achieved. On Wednesday, the NMC did not put forward a single person to respond to media interview requests. There were, however, dozens of retweeted positive messages about the former chief executive on her own Twitter feed.

In addition, along with other families, I have received an impersonal and hollow letter from the NMC, along with some emails that the NMC should have disclosed to me following a personal data request from me (which they spent £240,000 responding to), but didn’t. One of the emails was between two NMC staff discussing visiting me in Cumbria in 2016 to take a statement about Joshua’s death. Upon seeing my surname the first person writes: “Is it wrong that my default position was to snigger at that name?”; “It’s not wrong it’s totally appropriate,” came the response.

These comments are puerile and silly, but also indicative of an organisational culture that has lost sight of its purpose, and the patients, mothers and babies it exists to protect.

The culture of an organisation stems from the action and behaviour of the people at the top. The response from the NMC so far, highlights an urgent and pressing need for change so it can properly do its job of protecting patients.

James Titcombe works for Patient Safety Learning