Rob Shorrock

Today the series case review into the events surrounding the murder of 54 day old Jessica Randall by her father in 2006 was published. Jessica was seen by over 30 staff at the hospital trust and other professionals who visited at home. No one assessed her as a child at risk and triggered the procedures which may have saved her life. 

There is an intriguing sentence in the executive summary:

10a) Information was held in several different systems - G.P., H.V., Hospitals, Keydoc, NHS Direct, A&E, and Specialist Care - but was not collated, or not collated urgently.

b) There appeared to be no process by which anyone took responsibility for decisions about the urgency, collation and analysis of information from different sources.

The old chestnut of information storage and retrieval in health and social care again. The review identifies that professionals only had access to certain bits of information at certain time, depending on which information system they used or was available to them. Because of this fragmented information structure, it is suggested a full picture of Jessica and her family could not be fully constructed.

Lord Laming who conducted the inquiry following the death of Victoria Climbie said that information sharing was key. The government is currently pressing ahead with a national database of all 11 million children called ContactPoint. The idea is that this will enable professionals to see what other organisations the child has been in contact with and aid the swift identification of any risks. However, there are real concerns about this, particularly beacause it another large scale government IT project, and it seems we have lost all faith in them - and there are important issues about confidentiality and consent that an integrated database raises. This issue is considered by Hilary Searing in the submission to a government consultation on Contact Point, and she makes a powerful observation:

 "The principle of informed consent requires professionals to obtain consent from clients before disclosing confidential information, including information on whether the client is known to the agency. Information sharing between different professionals often leads to better assessments but in the past this was only done without the consent of the child or parents where there were serious child protection concerns. It now seems that other concerns, such as risk of offending or living in an impoverished family/community, are also being considered serious enough to justify dispensing with consent. This represents a significant shift in thinking and the erosion of an important principle of good professional practice."

There is an important debate here. Is the desire to protect children, especially under the searing light of a tragedy, enough to justify a central database that can effectively accessed without consent? What implications does this have for the rest of us?

Christopher Hitchins and Tim Jackson debating 'God is Not Great' at Emory University last year. Hitchens debunking of intelligent design is great - If this is the way God made us why do we allow circumcision? Also good to hear the debate about tyranny and Hitchen's case that the methods and roll out are all inspired by religous authoritarianism even if the perpetrators claim to be secular.

Last year my friend Anna Heywood, a student in Newcastle, was entered for the Observers Ethical Awards and managed to get short-listed alongside Al Gore and George Monbiot.

I'd like to ask a massive favour which is to spend a couple of minutes of your time voting for her as Observer Environmental Campaigner of the Year. We got the feeling last year that we caused a bit of an upset in that the Observer had been hoping for another star nominee.

There is rumour that she could be up against Leonardo Di Caprio for his film the 11^th Hour and Sheherazade Goldsmith for her book ‘A slice of Green Life'.

She was voted last year for her work in setting up the Sound Impact Awards an environmental awards scheme for Students' Unions. Over 60 Students' Unions are signed up. To enter the yearly award, unions have to set up and adhere to a strict set of environmental criteria. She set them up after ticking her students union off for using Pizza boxes and finding out that they and a large number of students didn't care. She thought that an awards ceremony and a bit of competition might do the job and it has. To give you an idea of the numbers involved, over 1 million students this year would have seen some of the environmental best practice in place as a result of these awards and over a five year period that then becomes about at least 5 % of the UK population.

The Observer has just launched their third ethical awards and I and a number of others have started voting for Anna for SECTION 3 -Environmental Campaigner of the year.

If you could vote for Anna that would be great and please pass it on to your friends so we can perhaps see a local campaigner in place this year.

We know that there were just over 6000 votes last year so we really need all hands on deck.

Even by coming in the top 3, the exposure has meant that more publicity has been gained for the awards resulting in an increase in attention and support for them and the Sound Impact Awards now has it's own full time staff member,

To vote for Anna is very easy and takes 2 mins max , go to http://observer.guardian.co.uk/ethicalawards/

You don't have to fill in all questions and can just click next, go to question 3 and type in: Anna Heywood and put Sound Impact Awards as the reason and click next etc through the other ten questions.

You do have to fill in your details to make the vote count but I promise it takes less than two minutes.

Deadline is March 2nd 2008.

Thanks for you support

With over 90% of GP's no longer providing out of hours services, Alan Johnnson is abolutely right to push for a service that reflects the needs of society rather than self-interest of the profession. The BMA stance is all the more objectionable given that GP's have sucked up a sizeable chunk of the NHS budget and have the most lucrative contracts since the inception of the NHS.

The BMA is parading a farcical survey that suggests that 80% of users are happy with the current arrangments and therefore there is no need for evening and weekend opening. The survey was carried out with patients who happen to be using GP's surgeries during the day and so it is no suprise that this group of people are happy, by and large, with the service!

The BMA is also trying to argue that introducing weekend and evening cover will mean a reduction in services during the day, hitting the most vulnerable groups in our society. This is a specious claim and bears little merit when subject to scrutiny. Good planning with surgery clusters will enable access to services, even under the present arrangements.

The real problem at the heart of this issue is that GPs are contracted to supply services to the NHS. This effectively creates a barrier to reform, change or the introduction of efficiencies. For example, in some PCTs attempting to introduce an integrated patient information system could only happen if the GP surgeries were paid to use the software!

The current contract relationship is expensive and the government needs to look at taking the next big step and fully nationalising the NHS.

The news that SKDC are considering controlled drinking zones comes as no surprise. There has been a strong push for this for some time. However, there is little evidence to indicate that they actually work in reducing alcohol related anti-social behaviour and therefore it is suprising how many local authorities have gone ahead and implemented them.

One of the arguments given for controlled drinking zones is that the police do not have the power to remove alcohol from people who are drunk and acting in an anti-social way, implying that they are powerless to deal with the problem. This is just not true:  People who are drunk and causing anti-social behaviour can already be arrested as drunk and disorderly, drunk in a highway or causing harassment, alarm or distress under section 5 of the Public Order Act 1986. In fact, under the Local Government Act 1972, local authorities can apply to the civil courts for injunctions to restrain anti-social behaviour that constitutes a public nuisance. Also, anti-social behaviour orders can already be applied for, and exclusion orders can be granted by the courts for offenders convicted of serious offences.

So given this armoury of measures that the police and council already have, why do we need controlled drinking zones? The answer is in the details of the powers this gives the police. A police officer can request that an individual stops drinking and hands over any alcohol if they believe that its consumption may lead to anti-social behaviour, whether or not an offence is being committed. This gives a power which could be used arbitrarily and the citizen has limited rights of challenge without the risk of being arrested.

The local authority has a duty to set out the boundary of the controlled drinking zone and SKDC are drawing it very wide to try and deal with displacement problems. Yet as part of the order they must be able to demonstrate that nuisance or annoyance to members of the public, or disorder has been associated with the consumption of alcohol in all of these areas. It is not legitimate in framing the order to just include the whole of the district in the order.

My sense is that controlled alcohol zones are another diversion from the issues and results in police powers that have a high potential to infringe the liberties of the innocent, law abiding citizen.