Editors' Blog

After Lord Ara Darzi's last-minute pull from the RCGP conference last week, the medical community was wondering what could have possibly happened that prevented him from giving one of his most anticipated speeches this year.

But two days later Lord Darzi showed that in a crisis he's always on call when he was sent by No 10, after an emergency call, to Peter Mandelson's home in the early hours. The new Business Secretary apparently fell ill on Sunday - after his first day at work - and made the emergency call to Downing Street at around 3am.

According to media reports, Lord Darzi even drove Mandelson to a London hospital where the politician was diagnosed with kidney stones. Well there's personal treatment for you.

Mandelson, who was a surprise appointment as business minister in Prime Minister Gordon Brown's cabinet reshuffle a few days ago,  didn't let this health scare get in the way of his new duties as he managed to attend the first meeting of the National Economic Council - the Prime Minister's finance 'war cabinet', the next morning.

He then returned to St Mary's hospital where he underwent a procedure to treat the small kidney stone.

According to the Daily Mail, Mandelson had dinner on Sunday evening with Lord Darzi in a London restaurant before complaining of feeling unwell yesterday. Perhaps our polyclinics whiz was feeling responsible/guilty hence the rush to Mandelson's home in the middle of the night. Who knows.

News reports say Mandelson's spokesperson confirmed the minister was treated as an NHS patient. I am not sure why but I am struggling to believe this. Perhaps it's the fact that a health minister drove him in the middle of the night in his own car to the hospital where he practices as a surgeon... or perhaps it's the fact that Mandelson was treated for his kidney stone - where surgery is usually the final option - in less than 12 hours in a country where some people can't get an appointment with their GP within two weeks. I am also highly dubious about the £3.5m Mandelson's house is reported to be worth...

But that's just because I am too cynical. Let's see the positive side of the story: at least we finally know where Lord Darzi is...

Arriving at the European Respiratory Conference in Berlin has so far involved plenty of running around in the rain. Fortunately, I don't have a chronic respiratory disease to contend with and therefore was able to rush from my hotel to the conference centre in record time when my delayed flight left me with no time to spare.

The reason for the rush was to make sure I didn't miss the much anticipated UPLIFT trial results - chaired by none other than BBC Breakfast's very own GP Dr Rosemary Leonard.

The emphasis was very much on what a global problem COPD is, and the extent to which it impacts the lives of those who have it.
 
After watching a short video of people with COPD describing their symptoms and lifestyles, to experience what it feels like to have COPD we were all asked to stand up and hold our breath. While maintaining the held breath we were then asked to breathe lightly, walk on the spot and then pick up an imaginary grandchild. It demonstrated the point well, even if I did feel slightly silly participating in a group breathing exercise in a darkened room full of journalists.

The conference itself is bustling with respiratory physiologists and physicians alike, and the congress centre certainly is huge - I think the organisers have done this deliberately to ensure that we all get at least some aerobic exercise as we power walk from one presentation to the next.
 
In keeping with the hectic theme so far, it's auf wiedersehen from me for now as I rush off for a tour of the exhibition

That was one of the questions on the lips of the 800 delegates at the RCGP annual conference in Bournemouth yesterday.

The health minister and surgeon, whose name has come to represent almost everything that so many GPs loathe about Labour's health policies, pulled the plug on his keynote speech hours before he was due to take to the stage.

Darzi's taped replacement two-minute video address was perhaps notable only for the health minister's erroneous referral to the RCGP's chairman Professor Steve Field as its president.

‘At least it was a slip of the tongue, rather than the scalpel,' quipped host and BBC TV medical correspondent Fergus Walsh.

Most memorable anecdote was probably Walsh's. He said former colleague turned unlikely Strictly Come Dancing hero John Sargeant had, apparently, told him that there were only three questions journalists ever needed to ask: ‘How bad is it? How bad can it get? And what can be done about it?'

‘John said he once made it through a whole Today programme just asking those three questions.'

Mr Walsh added that when he recently interviewed Darzi, he was given only two minutes and told Darzi's press advisor: ‘Don't worry I've only got three questions.'

But where was the Lord?

The DoH insisted it was ‘ministerial commitments' rather than the expected governmental reshuffle preoccupying him, without actually specifying what they were. Delegates were unimpressed. Professor Field called it a ‘missed opportunity', adding: ‘I'd like one day to get a minister here, although they might be Conservative.'

National primary care director Dr David Colin-Thomé had postponed a family holiday to fill Lord Darzi's shoes and frankly it looked like he'd been given short notice when he stumbled into the conference centre unshaven and scruffy at 8.30 yesterday morning.

He was in complete contrast to actual RCGP president Professor David Haslam, who was spotted limbering up for an early morning jog along the seafront in the conference hotel car park some 90 minutes earlier.

The surprise for me about day one of the conference was how unhappy young GPs are about the lack of partnerships. It's something that GP and Healthcare Republic has reported extensively on recently but it's another thing to hear it from the mouths of quite so many unhappy youngsters at the start of their careers.

Hit of the first day was probably Donald Berwick's (president and chief executive officer of the US-based Institute for Healthcare Improvement) who earned a standing ovation and touched many a chord with his speech about the values of the NHS.

Some GPs unwound last night at a GP Jammin Session during which they took to the Bournemouth International Centre stage to play instruments and sing. Day two of the conference programme is about to begin as I write.

But whatever happened to Lord Darzi? Do let us know if you know what detained him yesterday.

neil.durham@haymarket.com

The RCGP's annual conference kicks off today in Bournemouth and Healthcare Republic and GP newspaper will have unrivalled coverage of what's happening at the event.

Over the next three days, we are producing a special daily edition of GP for conference delegates and we have a team of journalists reporting on what the key speakers have to say and the issues raised at fringe events.

In this week's GP we preview the event with an exclusive interview with RCGP chairman Professor Steve Field, who talks about his first year in post and Lord Darzi's proposals to reform the NHS. However, there are also signs that the college is concerned about how NHS reforms are being implemented.

GPs unable to attend the conference will be able to keep up with all the latest news by logging onto Healthcare Republic, where we'll be posting all the key stories over the next two days.

Highlights to look out for include a keynote address from Lord Ara Darzi this afternoon, followed by a discussion between Lord Darzi and Professor Field, plus a panel debate between the chief medical officers for Wales and Northern Ireland, the NHS medical director for England, Dr Richard Vautrey from the GPC and Sir Ian Carruthers, chief executive of South West SHA, which takes place tomorrow morning.

At the conference today, GP and the RCGP will also unveil the 2009 GP Enterprise Awards, which are supported by the MDU.

The awards aim to recognise the wealth of innovation in general practice and showcase new ways of working that can be replicated by other practices. There are seven award categories that practices can enter and readers of GP will be invited to vote for an overall winner from the category winners. The overall winner will receive a prize of £4,000.

If you think that your practice has come up with an innovative way of working, or you have a particular achievement that you feel is worth promoting more widely, you can find all of the details on how to enter here. There will also be much more information about the awards, including profiles of past winners, in GP over the coming months.

If you happen to be at the RCGP conference today or tomorrow, you can stop by to meet members of the GP team at our stand (stand 18), where you can also pick up an entry form for the Enterprise Awards or a copy of our daily paper.

They are a serious threat to the nation's health. A burden on the NHS. A source of torment to women (and a few men) all over the country.

Killer heels are costing British wearers £29 million a year in corrective foot surgery according to a study by shoe brand MBT. And presumably the NHS is picking up a hefty proportion of this staggering (sorry) bill.

The study reveals that common operations such as bunion and corn removal, which cost £4,000 each, add up to £13.8 million a year, while more complex surgery like toe straightening (around £1,200 per operation) comes to £10.4 million. A further £3.3 million a year is spent on big toe joint replacement; £2 million removing trapped nerves;and £200,000 correcting ingrowing toenails.

Meanwhile, the long-term health of teenagers is at risk, thanks to the growing number of under 18s wearing high heels before their bodies have fully developed. Current teenagers are apparently 50 times more likely to have hip trouble than their mothers (storing up future trouble for the health service!) while the number of girls suffering from back problems has also increased ten-fold in the last generation.

It has even been reported that 5 inch heels might cause fertility problems in women due to the excess pressure on the abdomen and pelvis.

With warnings like these, I wonder if it's time to threaten stiletto addicts with the sort of sanctions handed out to compulsive eaters and smokers: wear sensible shoes or expect to be denied NHS treatment!

After all, experts are not telling women never to wear heels, simply to mix and match their choices of footwear to give their bodies ‘time to recover'. How hard can that be?

Well, quite hard actually since podiatrists claim that ballet pumps are as problematic as heels, offering no foot support at all, while even Croc-wearing has been vitoed - for nurses at least.

The truth is that if we value our toes; hips; backs; and fertility we've all got to stop being so vain and - temporarily at least - swap our leg-lengthening killer heels for comfortable clogs, complete with ‘elastic goring along the sides for flexibility and comfort; leather uppers; breathable linings; removable, moulded footbeds; shock absorbent midsoles; and anti-slip rubber soles.'

Apparently, our feet will thank us for wearing them. Even if our boyfriends do not.

I am attending the Primary Care Live conference today at the swanky ExCel Centre in east London and I am not disappointed.

I managed to get here on time despite going into the Courier & Parcel Logistics Expo 2008 by mistake which is taking place in the same venue. This kind of thing usually happens before I have my morning coffee.

The exhibition village at the heart of Primary Care Live is filled with charities, healthcare organisations and companies all here to showcase their products/services/fancy stands for GPs, nurses and healthcare professionals.  

There are also sixteen conference streams over the two days of the conference, covering everything from managing diabetes to an analysis of the future landscape of primary care. The effects of the credit crunch are definitely felt with seminars on managing shrinking budgets in general practice.

Although some organisations such as NHS Choices don’t seem to be affected at all by the current global economy turmoil – I just walked by their stand and almost got blinded by the opulence of fluorescent lights, flat screens and lit floor. I am not even getting started on the glamorous hostesses (I can’t believe they are actually NHS staff) helping conference attendees make their way through Choose and Book…

I haven’t had chance to attend any of the sessions yet as I spent the past hour trying to get connected to the world wide web - something that’s proven highly challenging at the ExCel Centre.

I was also too busy participating in the CPR Challenge organised by a health training company where participants have to perform CPR on a silicone mannequin for two minutes to get a chance to win an iPod. A computer analyses the rhythm and depth of the compressions to select the winner. There was a queue forming before the conference had even started…

I have to go as I realise it’s time for my Indian head massage on the Federation of Holistic Therapists’ stand… Sorry I mean I am almost late for the session on the NHS next stage review…

This week there will be hundreds, nay thousands, of GPs from around the country travelling to two of the biggest conference dates in the primary care calendar.

Primary Care Live starts tomorrow in London, before moving to Manchester next month, and the RCGP's annual conference kicks off in Bournemouth on Thursday.

For those of us reporting on the highlights - so that the few people left staffing surgeries do not lose out on any key learning points - it's going to be a very busy week.
And with the government sending along some of its leading lights in to speak in London and Bournemouth, it will be interesting to compare the messages.

At Primary Care Live, we have Dr David Colin-Thomé, the national director for primary care commissioning, giving his thoughts on what the NHS Next Stage Review means for GPs.

Just a few days later, Lord Darzi himself will be doing a similar job on stage at the seaside. Will they have agreed the details beforehand? Will the audience tease out some new information? Will either of them turn up? Who knows?

Whatever happens, let's hope the sparks fly. Though I note that the RCGP have thoughtfully balanced their keynote speakers over the three days of the conference.

Lord Darzi sets out his multi-provider vision on Thursday, Professor Allyson Pollock attacks the commercialisation of general practice on Friday, and UN peacekeeper Major Phil Ashby is called in on Saturday to calm things down before everyone heads back home.

Don't worry, you don't have to miss a thing. We'll have staff at both events, so expect lots of news and analysis in GP and Independent Nurse, and every day on Healthcare Republic.

It might finally happen here in England. What we see in Hollywood movies when someone is involved in an accident, gets attacked/shot/killed, has what looks like a heart attack or just simply faints on the street, and suddenly the hero of the movie or even just a passer by screams "Someone call 911"! (They never say call an ambulance for some reason, do they?).

It is simple there in America, you have an emergency – whatever that is – you call one emergency number. You don't have to think for a couple of minutes whether it is truly an emergency and if you should call A&E, or is it urgent but not a question of life or death in which case should you should call a GP? An out-of-hours service? Or NHS Direct?

Well, this conundrum could be a thing of the past if the big hats at the Healthcare Commission have it their way. The health watchdog has just published a report which found that NHS emergency services are not providing the swift, integrated care that patients should expect.

The report also found that the transition between services can be difficult and people are often confused about which services to use. According to the watchdog, the government should support the integration of services and simplify the way services are accessed, for example, through piloting of a single telephone number for urgent care services.

"A single telephone number has the potential to ensure fewer people attend the wrong services," said the report.

In a statement released this morning, the DoH said: "As announced in Lord Darzi's review of the NHS, we are looking at the benefits of a national number and will outline the next steps for this later in the year."

The Healthcare Commission review examined out-of-hours GP services, A&E services, urgent care centres, and emergency ambulance services.
(Un)surprisingly, London was one of the worst offenders as urgent and emergency care services in the capital were found to be lagging behind those in other areas, according to the report. Half of the 28 PCTs designated ‘least well performing' by the Healthcare Commission were in London.

By contrast, services in the north of England scored much better with 42 per cent of the 48 PCTs designated as 'best performing' in the north of the country, with those in the north east performing particularly well.

But it's not all as bad as it sounds. The review found that the majority of services are performing well, with 60 per cent of PCT areas scoring the top two ratings.

It is the first time the quality of urgent and emergency care services has been examined from the perspective of the patient rather than according to which organisation provided the care.

I might start practicing my "Someone please call 911" line, Mary J Blige style…

You can find out about each PCT's scores on the Healthcare Commission website.

This week, GP reveals that the flu jab programme looks set to be extended to pregnant women after a study, published in the New England Journal of Medicine, found there was a 63 per cent reduction in influenza illness among infants born to women who were vaccinated while pregnant.

The story, published in tomorrow's GP, received extensive coverage in the national newspapers this morning, including the front-page lead in the Telegraph, and articles in the Daily Mail, the Guardian and the Express.

While the team at GP always write for our audience of general practitioners, every now and again some of our stories have national significance and will be of interest to the general public. In some cases these will be about organisational or political issues, for example polyclinics or extended hours, and in others they have a clinical focus, such as this flu jab story.

And, while it's not our main aim to get ‘picked up by the nationals', there is something extremely satisfying about seeing one of our stories appear in the papers - particularly if it makes the front page.

Of course, the reason this story is of interest to the newspapers is that it is about a change in health policy - and one that will have a big impact on both general practice and the wider public.

In 2006, the Joint Committee on Immunisation and Vaccination recommended that pregnant women in their second or third trimester be given the flu vaccine. However the government, concerned about the cost implications, asked the committee to reassess the evidence.

This latest NEJM study demonstrates that the evidence is there to back this move. It is now up to the government to find the funding to implement a change that will have health benefits for new mothers and their babies

Flicking through the papers this morning, I was relieved to note that Supernanny returns to our screens tonight for the start of a new series. Jo Frost is just in the nick of time!

New NICE guidelines (covering England, Wales & N Ireland) state that attention-deficit hyperactivity disorder (ADHD) should be diagnosed in secondary care, and drugs such as Ritalin used ‘only as a last resort' and not given to the under-fives at all.

NICE recommends that drugs should be limited to children over five with severe ADHD (when other interventions haven't worked) and must be used alongside psychological therapy and support.

‘Support' includes parent training and education programmes, to be offered as a first-line treatment for hyperactivity, both for pre-school and school-age children, teaching parents how to create a structured home environment, encourage attentiveness and concentration and manage misbehaviour.

This sounds eminently sensible, particularly given the controversy surrounding the use of the ‘chemical cosh'. Googling ‘Ritalin' brings up stories questioning its efficacy, safety and long-term use, though it also highlights successes in children with genuine ADHD - a condition not to be confused with simple ‘bad behaviour'.

The aim is not to deny drugs to children with severe ADHD but to reduce the over-reliance on medication, points out Dr Tim Kendall, a consultant psychiatrist from Sheffield who is joint director of the National Collaborating Centre for Mental Health and helped draw up the guidelines. Numbers of prescriptions have apparently soared, almost tripling between 1993 and 2003.

However, whether there will be sufficient access to appropriate parent training and education programmes is highly questionable. Such resources must be tailored to the specific needs of ADHD patients, according to experts such as Andrea Bilbow, chief executive of the ADHD charity ADDISS. She warns that the courses mentioned by NICE are suitable for children with conduct disorder but not for those with hyperactivity.

The worry for health professionals is that they will be guided away from prescribing drugs to hyperactive children, but left without access to adequate alternatives.

If this is the case, we may find parents joining the hosts of unpaid carers unable to hold down jobs or look after their own physical or mental health needs, while Jo Frost and her many clones become permanent additions to our programming schedules.

At a distinctly uncivilized hour yesterday morning I found myself in a back room at the Labour conference in Manchester, listening to various techie types discussing government IT. There were around 30 of us listening, bleary eyed, as the man from Microsoft held forth on the potential computers had to transform public services.

Besides us another dozen or so were watching the meeting from the online virtual world Second Life. In this other reality, the meeting had been upgraded to the main conference hall, where politically minded avatars could watch proceedings on the screen and occasionally throw out questions to the participants.

A broadcast in this alternative reality seems oddly apt for a meeting that seemed to take place in a parallel universe. No one here is worried about cost over runs or repeatedly prolonged deadlines, and paranoia about data security was nothing but a barrier to progress. Any concerns people have about lost data discs are simply paranoia whipped up by the Daily Mail.

But then, the entire conference seems to be taking place in some other Britain. Here the party is united, despite the string of MPs calling for a leadership contest. Here the economy is strong, despite soaring food costs and banks dropping like flies. (In one faintly surreal incident Alastair Darling frantically tried to cut short his own standing ovation after 20 seconds, apparently petrified he'd look out of touch.)

The health debates, too, diverge startlingly from the GPC's agenda. A King's Fund debate on the state of the health service was packed out, but the issues uppermost in people's minds were dentists, top ups and prescription charges. In three days I have not heard a single reference to polyclinics, GP-led health centres or MPIG, and just one mention of Lord Darzi. The only sign that GPs aren't entirely contented with the way things are going is the solitary figure of Dr David Baker, hyperactively lobbying against the pharmacy White Paper.

The GPC, one suspects, would say this is no bad thing. They'd argue that the important conversations are the ones that happen with NHS Employers. It has limited time for political work, and schmoozing a party likely to be out of power within two years isn't the best way of using it.

Perhaps. But Dr Baker's cautious optimism suggests that a few quiet words with the right people might do wonders to redirect the government  away from painful policies. The next time you find yourself furious that the Labour party doesn't understand general practice, you might wonder when anyone last tried to explain it to them.

jonn.elledge@haymarket.com

It's understandably difficult to be on the receiving end of a patient complaint and still see it as something positive and valuable to behold.

But that's exactly what the Patients Association is suggesting that health professionals and managers should be doing.

Of course, if you feel that you are doing a good job, often against the odds, and you simply can't see why the patient should be upset, then their complaint seems little more than an irritating interruption that is wasting your time and that of other patients.

The Patients Association's assertion that complaints should be treasured is not a new concept, and probably litters the NHS regulations on handling grievances.

But its survey of 500-or-so members, of whom 68 per cent felt that making a complaint had been 'pointless', should be heeded as a warning by health professionals who will soon be undergoing revalidation.

For GPs, at least, this will involve 360-degree appraisals, taking the views of patients in to account when deciding whether to renew their licence to practice.

And it's worth remembering that most of the complaints received by the GMC involve the doctor's communication skills.

They are not necessarily the root of the complaint, but they quickly become relevant when the grievance is raised and the doctor is required to confront the issue.

Their handling of the initial complaint often becomes the reason for a second complaint, and is also likely to make the patient even more determined to succeed in their action.

All of us expect to be treated fairly and respectfully by the companies and organisations we deal with in our daily lives, and especially our public services.

This survey by the Patients Association is a wake-up call for those in the NHS who think of complaints simply as an interruption to ‘normal services'.

In the increasingly competitive environment of healthcare provision, the providers who offer a responsive, customer-focused service will be the ones who prosper. And who can complain about that?

In this week's GP, we reveal the results of our Valuing General Practice campaign survey. Sadly, some of the figures make for depressing reading.

One in seven of the 276 practices that responded said they were threatened with closure or relocation to a polyclinic.

There was also widespread opposition to government reform, with 90 per cent saying it will damage continuity of care and 92 per cent saying the DoH's polyclinic plans should be abandoned until they have been piloted.

But it was not all bad news. On a more positive note, 3,980 patients signed petitions backing the aims and objectives of our campaign, and many included statements explaining why they valued general practice.

The results of this aspect of the campaign, which are also published in this week's GP, are heartening - and will not be any surprise to those who work in general practice.

Whether it is because the practice treats them as an individual, or because they have good relationships with the doctors, nurses and support staff, or simply because it is just down the road and therefore more accessible, the statements show that patients really do value the care and support they receive.

Polyclinics appeared to be particularly unpopular among the elderly and those with young families - perhaps unsurprisingly, because these are the people who use general practice most frequently. What these groups want is a local surgery, that is easy to get to and familiar faces.

Any GP, practice nurse, receptionist or practice manager knows that this is the case. But the government just doesn't seem to get it. It has fixated on access, seeing it as more important than anything else. But, as our petition suggests, this isn't the most important issue for patients.

Yes, many members of the public might want to see a doctor or nurse more quickly, but this does not make the case for rushing wholesale towards establishing a network of polyclinics. There are other ways improved access could be achieved.

It seems that the DoH has already cottoned onto the fact that ‘polyclinics' are unpopular among health professionals and patients alike. According to GPC chairman Dr Laurence Buckman the term has been barred from the NHS. ‘The word has gone out from Number 10 never to use the word,' he says. ‘It's seen as a vote loser.'

If that's the case, perhaps it is time that prime minister Gordon Brown reviewed the whole policy and started to value the fantastic job that general practices across the UK do every day.

Despite expensive government campaigns and the best efforts of Jamie Oliver, Britons are still missing their ‘five-a-day' fruit and veg targets. A study of the consumer habits (entitled 'Health of Britain - Perspective on Nutrition 2008' ) revealed that just 12 per cent of the population eats the recommended five portions of fruit and vegetables per day. Another 12 per cent do not eat any fruit and vegetables at all.

Unsurprisingly, the study found that the groups most likely to meet the target are the wealthy and the over 45s, with children and the poor more likely to consume none at all.

This must be depressing for ministers, who have been immersing themselves in ‘youf culture' in order to encourage young people to eat healthily. Not only does the DoH's 5-a-day site offer ‘vegetable makeovers' and an interactive game called ‘sumo smoothies', the Food Standards Agency is bang on trend with its ‘Strictly Yum Dancing' feature, involving characters such as ‘Tina Tuna', ‘Barry Burger' and ‘Terri Tomato'. This is apparently based on the FSA's new live spectacle, performed at this year's BBC Good Food Show. The mind boggles.

Real life D-list celebrities are also helping out the Department, for example, EastEnder's Patsy Palmer provides a video message on healthy eating as does former glamour model Melinda Messenger.

However, even celebs are finding it a challenge to entice people away from their turkey twizzlers. Poor Jamie Oliver is reportedly fed up with mothers sabotaging his healthy school meals campaign and people generally giving him stick.

This is so much the case that (according to his mum) he is on the verge of abandoning his healthy eating crusades: his latest TV project, to revive home cooking skills in Rotherham, took him to the local football club..where he was the subject of ‘obscene chanting'.

Jamie is surely disappointed to hear that despite shaming ministers into funding healthier school meals, new figures show that kids in two thirds of schools shun canteen meals for unhealthy packed lunches or fast food from nearby outlets.

A separate survey by Babybel suggests that even those bringing in wholemeal sandwiches and carrot sticks may not be eating them. According to the poll, seven out of ten children regularly swap the contents of their lunchboxes, while one in five chucks them straight in the bin.

Celebrities may walk away, acknowledging defeat. However, for health professionals, the battle goes on and ministers too are faced with no alternative but to continue campaigning.

Their only other option would be to alter the target, a course of action health secretary Alan Johnson may well be advised to take. As he joked on the Politics Show: 

‘It's important to get the message that five-a-day isn't five bottles of wine, it's five portions of fruit and veg.'

If only it were five bottles of wine a day, binge boozing Britons would have a much better chance of hitting the jackpot!

 

Unless you've been leaving under a stone for the past few days, you'll have noticed the global panic following the bankruptcy of Lehman Brothers.

The bank, one of the oldest in America, which went bust on Sunday literally imploded leaving its 5,000 UK employees jobless - according to media reports, they might not even get paid for this week's work.

Yesterday, while I was looking at pictures of Lehman Brothers staff clearing their desks and leaving the building with all their belongings packed in card board boxes (so American...), it became clear that the amplified credit crunch was just the beginning of a big recession - some analysts are already comparing yesterday's stock exchange mayhem to 1929's Black Tuesday.

Although it is unlikely that direct consequences of the collapse of Lehman will be felt on British consumers, dramatic effects on the London Stock Exchange and therefore on the British economy as a whole are undeniable. And we certainly didn't need this...

I was sent a press release yesterday, and just the subject line made me shiver: "More than half of all health students consider quitting due to debt".

It's widely known that students get themselves into high levels of debt during their university years but it's quite scary to think that "50 per cent of students considered leaving their course due to financial difficulties, an increase of 7% since last year."

The grim findings are from Reaching Breaking Point - UNISON National Survey of Health Students, a report published today by the staff union.

I kept reading and it kept getting worse... Nursing diploma students start their careers owing an average of 40% of their annual salary. If they paid back £100 per month it would take them almost seven years to fully repay the debt, even before interest is taken into account, the report found.
 
90 per cent of health students are in debt, and average debt is £6,934, while almost a quarter of students have debts of over £10,000.

So what to do? Unison is calling on the government to "comprehensively review to the current bursary system, including considering a return to paying health students a salary."

Could this be the government's own version of Roosevelt's New Deal? Let's hope so.