Category A calls should be responded to within eight minutes.
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Ambulance services have been too focused on response times and not enough on patient care, according to the National Audit Office (NAO).
A NAO report said patients’ emergency care was being delayed, with ambulances forced to queue outside hospitals and unable to respond to other calls.
The health minister Simon Burns blamed the previous Labour government’s “perverse fixation” with targets.
Some targets have since been removed by the coalition government.
Under current guidelines, category A ambulance calls – which include the most serious life-threatening conditions – should be responded to within eight minutes.
In April 2011 the government removed the 19 minute target for category B – or not immediately life threatening – calls and replaced it with measures of the quality of care.
Auditor General Amyas Morse, said: “The time taken to respond to calls has until recently been the be-all-and-end-all of measuring the performance of ambulance services.
“Illustrating the principle that, what gets measured gets done, the result has been a rapid response to urgent and emergency calls.
“However, this led to an increase in the number of multiple responses to incidents equating to millions of unnecessary ambulance journeys.”
The report said more than one in five patients had to wait more than the recommended 15 minutes before being accepted by the hospital.
This can lead to queues of ambulances outside hospital unable to go to other emergencies, the report adds.
Mr Morse said: “It is welcome that the Department of Health has now introduced new measures and a new broader performance regime, but improvements to the whole urgent and emergency care system will depend on its working more coherently.”
Christina McAnea, Unison’s Head of Health, said: “The NAO report shows that the most cost effective response to 999 calls is to get the right people, with the right skills to patients first.
“Time-driven targets has led to the ratio of clinical to non-clinical staff going down and trusts need to reverse this damaging trend.”
Health Minister Simon Burns said: “This report is clear evidence that Labour’s perverse fixation with bureaucratic targets distorted clinical priorities and undermined patient care.
“During their 13 years in power, Labour never bothered to consider the outcomes of NHS treatment for patients.
“Instead, they left the NHS with a bloated bureaucracy and doctors and nurses tied up in red tape.
“We’re pleased the National Audit Office has endorsed our approach of focussing on a wider range of patient outcomes – not just arbitrary targets.”
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
Nicotine in cigarettes decreases food intake and body weight by acting on particular neurons.
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Scientists have identified a group of neurons in the brain responsible for smokers’ lack of appetite.
In an article in the journal Science, Yale University researchers describe experiments on mice which found nicotine activates neurons to send signals the body has had enough to eat.
However they are not the same neurons which trigger a craving for tobacco.
As a result, the researchers say nicotine-based treatments could help control obesity.
A research team from Yale University School of Medicine and Baylor College of Medicine in Houston performed a combination of molecular, pharmacological, behavioural and genetic experiments on mice.
They found that nicotine influences a collection of central nervous system circuits, known as the body’s hypothalamic melanocortin system, by activating certain receptors.
These receptors, in turn, increase the activity of pro-opiomelanocortin (POMC) neurons, known for their effects on obesity in humans and animals.
When subjected to nicotine, mice lacking the POMC pathway did not lose weight, but mice with the pathway did.
The researchers also found that these receptors were of a different type to those known to trigger tobacco craving in smokers.
“It could perhaps motivate smokers who are afraid to quit because of fears of putting on weight.”
Prof Marina Piccioto Yale University
Marina Picciotto, senior study researcher and professor of psychiatry at Yale University, said the research could be beneficial.
“Imagine a nicotine-based medicine which could only target those cells which stop eating and not trigger the need for tobacco,” she said.
“This suggests it is possible to get the effect of appetite suppression without also triggering the brain’s reward centres.”
Prof Picciotto cautioned that the impact of a nicotine-based medication would be limited because smokers who are leaner when they give up smoking only gain 2.5 kilos of weight on average.
Clinical trials in humans would also be necessary to explore the side effects on blood pressure.
She said: “It could perhaps motivate smokers who are afraid to quit because of fears of putting on weight.”
And it could also have an impact on other groups, she says.
“There are some groups of people who take up smoking to control their weight. It is tragic to think people would take up smoking for this reason.”
Amanda Sandford, research manager for ASH, Action on Smoking and Health, said it was already known that pure nicotine could be safely used to wean smokers off their tobacco habit.
“If nicotine could also be used to tackle obesity then it could be a valuable tool in tackling two of the most critical public health problems that we face today,” she said.
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
The deaths of five million children have been prevented thanks to vaccines.
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Save the Children is urging David Cameron and other world leaders to help fund the £2.3 billion cost of immunising the world’s poorest children over the next four years.
The Global Alliance for Vaccines and Immunisation (GAVI) would use the money to immunise 243 million children by 2015 and save four million more lives.
Nearly two million children die from vaccine-preventable diseases each year.
It is a “make-or-break” situation, says the charity.
GAVI leads worldwide efforts to improve access to vaccines, bringing together governments, international organisations and pharmaceutical companies to achieve its aims.
Since 2001, it has enabled 288 million children to be vaccinated and has already averted five million deaths.
But to introduce new vaccines in the poorest countries of the world, GAVI requires £4.2 billion, of which £1.9 billion is already pledged.
In a report called ‘Vaccines for All’, Save the Children is calling on developed countries to pledge donations at a conference in London on Monday 13 June.
Justin Forsyth, the charity’s chief executive, said that everyone has a part to play.
“World leaders have to find the funds, the private sector has to supply the vaccines at special discount prices, and developing world governments have to prioritise the delivery of vaccines, through their national health services, to help millions more children survive.”
Vaccines already save the lives of around 2.5 million children every year but Save the Children says they have the potential to save many, many more.
Statistics from Sierra Leone show that a child who receives all his or her basic immunisations is at least six times more likely to survive than a child with none.
Yet one-fifth of the world’s children – around 24 million – still do not receive any life-saving vaccines.
Most of the world’s unvaccinated children live in its poorest countries.
Chad has the highest percentage of unvaccinated children, at around 77%. Somalia, Equatorial Guinea and Nigeria are not far behind.
India has over nine million unvaccinated children – more than any other country.
“The private sector has to supply the vaccines at special discount prices.”
Justin Forsyth Save the Children
Save the Children says donors must commit enough money “to ensure that the true potential of vaccines is realised”.
Some of GAVI’s more recent activity has involved introducing new vaccines against major causes of pneumonia and diarrhoea – the two of the biggest killers of children under five.
But the alliance’s work also includes distributing and administering the vaccines, which means arranging for nurses and doctors to be trained, supported and paid.
Save the Children is also calling on vaccine manufacturers to work together to reduce the prices of new and existing vaccines.
Earlier this week drugs company GlaxoSmithKline (GSK) said it would cut the price of its vaccine for rotavirus by 67% to $2.50 (£1.50) a dose in poor countries.
Several other major drugs companies have announced big cuts to the amounts they charge for their vaccines in the developing world.
“That way, donors can buy more vaccines and poor countries can afford them long-term,” the charity says.
The UK government is currently GAVI’s largest government donor, contributing $360 million dollars over 20 years.
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
Arthur Darvill is making his debut on the open air stage at Shakespeare’s Globe
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Arthur Darvill, best known as Rory in Doctor Who, talks about secrecy on the show, his new stage role at Shakespeare’s Globe and why he spent his childhood surrounded by puppets.
For Arthur Darvill, last Saturday’s mid-season climax of Doctor Who came as something of a relief.
It means he can finally talk about the big revelation that Tardis companions Rory and Amy Pond are the parents of the enigmatic River Song, played by Alex Kingston.
“I forget what I can and can’t talk about, so I end up talking about nothing for hours – which has become quite a skill,” laughs Darvill when we meet two days later at the Globe theatre on London’s South Bank.
“My mum sent me a text straight after the episode saying: ‘Does this mean I’m Alex Kingston’s grandmother?’”
Arthur Darvill
“My mum sent me a text straight after the episode saying: ‘Does this mean I’m Alex Kingston’s grandmother?'”
Sporting a ginger beard, Darvill is deep in rehearsals for the Globe’s first production of Christopher Marlowe’s tragedy Doctor Faustus.
Darvill plays Mephistopheles opposite Paul Hilton as Faustus, the scholar who makes a pact with the Devil in exchange for knowledge.
“It’s been a play that I’ve loved since I was quite young,” says Darvill.
“Mephistopheles is an agent of the Devil in human form. I find the relationship he has with Faustus and the people whose souls he collects quite fascinating.”
Arthur Darvill (left) plays opposite Paul Hilton in Doctor Faustus
The production, perfomed in Renaissance costumes, features giant dragon puppets and horned stilt walkers to bring to life the fantastical elements of Marlowe’s play.
It is familiar territory for Darvill, who grew up surrounded by puppets. His mother performed in a puppet theatre at the Midlands Arts Theatre in Birmingham.
“It was normal for me – I used to go on tour with her and help set up the puppets. Later on, my mum did children’s TV – she was the Why Bird on Play Days for 10 years.”
He adds: “There are puppets all over my house and I’ve got a ventriloquist’s dummy. I’m rubbish at doing it, but I really like it.”
Doctor Who effect
Across the river from the Globe, two former Tardis residents – David Tennant and Catherine Tate – recently took to the stage in Much Ado About Nothing at Wyndam’s Theatre.
And over at the Donmar Warehouse, Alex Kingston stars next week in Schiller’s Luise Miller.
Is Darvill expecting fans of the sci-fi show to flock to Faustus?
Alex Kingston is about to star in Schiller’s Luise Miller
“If people who wouldn’t normally come to the theatre come because they are fans of Doctor Who it can only be a good thing,” he says.
“Maybe it will inspire them to see other things. We’ve got such a brilliant theatrical tradition in this country.”
Darvill got hooked on the theatre during trips to the Edinburgh Festival and Stratford.
He trained at the Royal Academy of Dramatic Art, and his theatre credits include Swimming With Sharks in 2007 with Matt Smith – who was cast as BBC’s Time Lord two years later.
“When he got Doctor Who I didn’t have a clue I’d be doing it, so when I got the part of Rory it was great to turn up on the first day and work with someone who’s a good mate. It made things very much easier on such a big show.”
We return to the subject of Saturday’s episode, and the secrecy around the River Song revelation.
“The press have been really good at keeping things under wraps – otherwise it’s like watching a football match and knowing the result,” Darvill says.
“I suppose it’s testament to the show that people care about it so much. I’m so excited the second half of the series that’s coming up – what Steven [Moffat] has done is something quite brilliant – it’s really going to surprise people.”
A bigger surprise than Rory being River Song’s dad?
“Oh that’s nothing!” he laughs, and exits to resume his new persona as Satan’s servant.
Doctor Faustus by Christopher Marlowe, directed by Matthew Dunster, is at Shakespeare’s Globe from 18 June to 2 October.
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
WWI tunnel warfare
The yellow boxed area above, on the edge of the village of La Boisselle, is where the excavation will take place. Beneath the ground here lies a network of tunnels and trenches that have lain untouched since the war ended. As many as 28 British tunnellers remain entombed underground.
Fighting in World War I was dominated by trench warfare. Dug by hand, they stretched right across northern France. The excavation area has both German and British trenches. Historian Peter Barton, says the excavation site contains the “complete evolution of trench warfare”.
Fighting took place above and below ground. The tunnel networks, seen here extending far from the trench system to reach enemy territory were complex and extensive. Though they could not see each other, in places the two sides were just metres apart.
This cross section shows the depth and distance of the tunnels, some over 100m long. They needed to be deep enough so that the enemy did not detect the tunnellers. The underground chambers were packed with explosives which, when detonated, were capable of destroying the enemy’s trenches above.
This military map of the area dates from the time of the war. Clearly marked are the craters blasted into the earth by the tunnellers’ explosions. The German trenches are in blue, the British lines in red. The latter include names such as Fairmaid St, Scone St and Tay St.
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Archaeologists are beginning the most detailed ever study of a Western Front battlefield, an untouched site where 28 British tunnellers lie entombed after dying during brutal underground warfare. For WWI historians, it’s the “holy grail”.
When military historian Jeremy Banning stepped on to a patch of rough scrubland in northern France four months ago, the hairs on the back of his neck stood up.
The privately-owned land in the sleepy rural village of La Boisselle had been practically untouched since fighting ceased in 1918, remaining one of the most poignant sites of the Battle of the Somme.
In his hand was a selection of grainy photographs of some of the British tunnellers killed in bloody subterranean battles there, and who lay permanently entombed directly under his feet.
When most people think of WWI, they think of trench warfare interrupted by occasional offensives, with men charging between the lines. But with the static nature of the war, military mining played a big part in the tactics on both sides.
The idea of digging underneath fortifications in order to undermine them goes back to classical times at least. But the use of high explosive in WWI gave it a new dimension.
One of the most notable episodes was at the Battle of Messines in 1917 where 455 tons of explosive placed in 21 tunnels that had taken more than a year to prepare created a huge explosion that killed an estimated 10,000 Germans.
La Boisselle: A village under siege
28 Sep 1914 – German advance on Amiens halted by French forces. Fierce fighting over the cemetery and farm buildingsDec 1914 – French begin mining to retake the farm. Intense struggle above and below groundAug 1915 – British take over the sector from the French with tunnels now at a depth of 40ft (12m)1 July 1916 – British launch disastrous Battle of Somme with village on main axis of attack. Two huge mines – Y Sap and Lochnagar – create massive craters, one 270ft (82m) wide by 70ft (21m) deep4 July 1916 – British capture village after further heavy fightingMarch 1918 – German troops overrun trenches in the village during Operation Michael, part of the huge Kaiserschlacht offensiveAug 1918 – Welsh troops liberate La Boisselle
What happened at La Boisselle in 1915-1916 is a classic example of mining and counter-mining, with both sides struggling desperately to destroy each other’s tunnels.
“When you stand on a spot and can look at a picture of a man still down there below you, it’s amazing,” Banning says.
“It just does something very strange to you, it makes the hairs stand up on the back of your neck.”
After six years of painstaking paper research by fellow historian Simon Jones, the researchers had built up detailed knowledge of the individual tragedies involved.
They knew the exact locations and depths at which each man was lost, the circumstances of their deaths, and almost all of their names.
And yet it was only when the owner of the site chose to open it up to research that they were able to finally connect the stories to the place.
The Lejeune family, who have owned the land since the 1920s, have a deep affinity with the site and have known many British veterans who served at La Boisselle.
But it was only after visiting the team’s excavations at nearby Mametz last May that they decided to offer their land up for historical study.
Archaeologists, historians and their French and German partners now aim to preserve the area – named the Glory Hole by British troops – as a permanent memorial to the fallen.
Digging does not start until October, but the first practical steps of mapping the tunnels and trenches using ground penetrating radar, and exploring the geophysics are under way.
Some open tunnel sections have already been entered and are considered remarkably well preserved.
The team intends to leave the bodies undisturbed in the collapsed tunnels, but any others found in trenches will be reburied in accordance with the Commonwealth War Graves Commission.
Bomb disposal experts will be on standby to negotiate the unexploded ordnance they will inevitably uncover.
Mining operations were often part of ground offensives
They also expect to find graffiti on the walls, poetry, bottles of drink, and all manner of artefacts untouched since the day fighting ceased. In short, they say, it’s a time capsule.
The long-term intention is to open the site to the public, and the whole project is expected to take five to 10 years.
For Jones, a former curator at the Royal Engineers Museum, the dig is about completing the stories of the two Tunnelling Companies (179th and 185th) who worked at the Glory Hole.
“Finding out about these men has become an obsession, and although we know a great deal about the lives of soldiers in WWI, these men have left very few clues as to their experience or feelings,” he says.
Mainly professional miners, they were sent from the collieries of Britain to the Western Front to tunnel beneath enemy lines and detonate explosive charges – while stopping the Germans doing the same.
It was perilous work in a hidden war, which remained a state secret for many years, meaning the men did not get the recognition they deserved.
By studying war diaries, tunnel plans, letters, maps and records, Mr Jones has identified 25 of the 28 British and all 10 French tunnellers at the Glory Hole. The number of Germans remains unclear.
Chris Lane, pictured inset alongside his great grandfather, says “it’s important to know your past”
The British were lost between August 1915 and April 1916, sometimes individually but more often two or more at a time.
“Often men from the same pits preferred to work alongside one another and hence were lost together,” Mr Jones says.
One such miner was Sapper John Lane, 45, from Tipton in Staffordshire, a married father-of-four who left his colliery for the Western Front with four colleagues. None returned.
On 22 November 1915, he and four others were killed 80ft (24m) below when a German mine exploded, in turn detonating a British charge of 5,900lb (2,700kg).
For his great grandson Chris Lane, 45, from Redditch in Worcestershire, piecing together his relative’s story has been a fascinating process.
He says they knew he was killed in a mine, but prior to his research, his grandfather always thought it was in Ypres in Belgium.
“It’s important to know your past, one small incident for one family is history for lots of other people,” he says.
The new dig is only the second on the Western Front to be officially sanctioned by the French authorities.
Patches of untouched virgin battlefield are rare. Most have been ploughed over, cleared or developed, and private landowners have been reluctant to hand them over for research.
It’s a site of huge strategic importance. When the British launched the bloody Battle of the Somme on 1 July 1916, La Boisselle stood on the main axis of the attack.
Historians hope to discover more about Germany’s fallen soldiers
Of the 1.5m total casualties in the four-month campaign, 420,000 British soldiers were killed, wounded or missing having gained just two miles – a loss of two men per centimetre.
Fellow historian Peter Barton says La Boisselle is the “holy grail” for historians, containing the “complete evolution” of trench warfare.
“The site has got both sides of the line and the fourth dimension of underground warfare, making it a truly holistic project,” he says.
“These are not just holes in the ground, they’re homes – that was where you lived when you were holding the line.
“You became troglodytes. They designed, evolved and engineered a way of living and surviving, and had to go deeper and deeper as the shelling became more effective.”
Barton’s research took him to Munich and Stuttgart, where interpreters and translators have helped paint an even bigger picture.
“We’ll know the Germans who killed the British and French, and vice-versa – it’s the most supremely researched piece of battlefield on the Western Front,” he says.
“Connecting those men who suffered and gave their lives there with their present day relatives is probably the most meaningful part.”
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
The US soldiers’ role is to advise and assist Iraq’s security forces in fighting insurgents
Iraq will ask the US to keep a troop presence in the country beyond an end-of-2011 pullout deadline, the probable next US defence secretary has said.
Outgoing CIA director Leon Panetta said he had “every confidence that a request like that will be forthcoming”.
Mr Panetta was speaking at a US Senate committee considering his nomination.
The US currently has about 47,000 troops in Iraq, none in a combat role. Under a 2008 deal, they are expected to leave by 31 December 2011.
“It’s clear to me that Iraq is considering the possibility of making a request for some kind of (troop) presence to remain there (in Iraq),” Mr Panetta told the Senate Armed Services Committee (SASC) on Thursday.
Leon Panetta said the situation in Iraq remained “fragile”
He added that when Baghdad does make such a request, Washington should say “Yes”.
Mr Panetta did not say how many troops would be involved or what they would do.
He said there were still some 1,000 al-Qaeda members in Iraq, and the situation continues to be “fragile”.
“I believe that we should take whatever steps are necessary to make sure that we protect whatever progress we’ve made there,” Mr Panetta said.
The current US contingent is deployed in a training and advisory role.
In April, outgoing Defence Secretary Robert Gates also said that American troops could, if required by Iraq, stay in the country beyond the withdrawal date.
The BBC’s Andrew North in Washington says that it seems likely that the US has offered Iraq some inducements to maintain its troop presence.
But any suggestion that President Barack Obama will allow some American forces to remain behind is bound to be seen as backpeddling by both his opponents and supporters on his commitment to pull out entirely from Iraq by this year, our correspondent says.
He adds that it will be controversial in Iraq as well, where there has been an increase in attacks on US bases apparently aimed at derailing any moves to keep American troops on.
US fatalities in Iraq have been rare since Washington officially ended combat operations in the country last August.
But earlier this week, five American soldiers were killed in central Iraq, in what is believed to be the US military’s single most serious incident in the country in more than two years.
This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
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