Superbugs, Special needs pupils and others

Superbugs bring back the Victorian fear of going into hospital

Superbugs bring back the Victorian fear of going into hospital

Sir: It is no surprise to hear of further problems with "hospital infection". Contracted-out cleaning and catering were introduced in the late 1980's, a government directive to cut costs. I remember my colleagues being utterly opposed to this measure on the grounds of lack of supervision and low standards. Patients are now fearful of hospitals, as in Victorian times: a place were you caught an infection and died.

Prior to the antibiotic era cleanliness and godliness were bedfellows. The bedfellows now are the next patient waiting for the previous one to be discharged or dying with no time to clean the bed and its surroundings. Government targets, hospitals ruled by accountants and a disregard for professional advice are all contributing factors along with antibiotic usage.

When I trained more than 40 years ago straightforward appendicitis was not given antibiotics. Their use was confined to the few with generalised peritonitis. Proper surgical technique was the essence. When I retired antimicrobials were given to all just to reduce the number of readmissions resulting in part from the early discharge policy.

CHRIS SMALLWOOD

(RETIRED SURGEON, STOKE MANDEVILLE HOSPITAL), CHAGFORD, DEVON

Sir: I read with interest your article on 6 June, in which you reported on the outbreak of the superbug Clostridium difficile. At the National Patient Safety Agency (NPSA ), we are running a cleanyourhands campaign across all acute NHS trusts in England and Wales, aimed at reducing the incidence of MRSA and other healthcare associated infections (HCAIs).

You state that "alcohol gels used by medical staff to clean their hands between patients are ineffective against its [Clostridium difficile] spores". Clostridium difficile is indeed a spore-forming organism and neither alcohol nor the other common hand disinfectants will work against vegetative spores. However, there is some evidence that alcohol does have an impact against the spread of this bug and there is anecdotal evidence that where alcohol has been introduced and staff are using it, Clostridium difficile rates go down.

However the main strategy for preventing the spread of any diarrhoeal illness is a range of measures including high standards of cleaning and the appropriate use of gloves to protect the hands from faeces. These measures coupled with the continued use of alcohol gels for routine decontamination of non-soiled hands will help protect patients from infection in hospital. This is what the NPSA recommends.

The World Health Organisation (WHO) draft guidelines on hand hygiene promote alcohol-based handrubs as the gold standard for decontamination of non-soiled hands. Promotion of alcohol-based handrubs will continue to be the main strategy for minimising risks to patients of HCAI spread by hands. Hand hygiene is one important weapon, which can be improved, to tackle HCAIs, but in isolation it will not have the desired effect and the NPSA are working with others to address all aspects of hygiene and safety in hospitals.

JULIE STORR

CLEANYOURHANDS PROJECT MANAGER, NATIONAL PATIENT SAFETY AGENCY, LONDON W1

Special needs pupils denied their rights

Sir: David Cameron is absolutely right in the substance of his article ("My personal crusade to save special schools", 8 June), particularly as regards excessive and thoughtless moves towards inclusion in all circumstances, although he spoils it with some partisan comments.

Like him, I am the father of a son with "profound and multiple learning difficulties". Like him, I am involved in politics. Like him, I had enormous difficulty persuading my local education authority (Conservative-controlled, if I may make the point!) to provide proper facilities - indeed, I had to commence tribunal proceedings before I got anywhere.

The inconvenient truths are as follows. First, most parents of children with these handicaps do not have his (or my) abilities to battle the system to meet their children's needs, or even know that they have legal rights. Too often they are fobbed off with less than their entitlements. Second, LEAs too often resist legitimate parental demands, often prioritising less by need than by the ability of the parents concerned to fight their case. Third, no government, of any political hue, has ever funded LEAs sufficiently for this purpose.

I look forward to Mr Cameron's advocacy on the last point.

PHILIP GOLDENBERG

WOKING, SURREY

Sir: I read David Cameron's heartfelt defence of special needs schools with growing rage. How dare the shadow Education Secretary adopt a Compassionate Conservative stance on this issue when the Tory party's flagship council, Wandsworth, voted last year to close down one of London's finest and rare special-needs secondary schools, Chartfield in west Putney?

My son Max - who suffers from an autistic spectrum disorder - is a student at Chartfield (scheduled for closure in July 2006). And as someone who took part in the fight to keep the school open, I can vouch for the fact that the Tory council were ruthless in their determination to close the school - riding roughshod over the entreaties of all the stakeholders in Chartfield (its staff, its students and their parents) - while also imposing a three-line whip on Conservative councillors to ensure its closure when it came to a vote.

Even by the standards of normal Tory hypocrisy, Mr Cameron's attempts to portray his party as bastions of empathy vis-a-vis children with special needs is nothing short of breathtaking.

DOUGLAS KENNEDY

LONDON SW12

Sir: I respect David Cameron's perspective on the loss of special needs schools. However, a major issue often overlooked in the debate about inclusion is its negative impact on the education of the vast majority of children without special needs. The level of resource required by a child with special needs is not remotely financed by the subsidy generated by a statement. Therefore the whole peer group are under-resourced.

DAVID BRACEY

CHESHAM BOIS, BUCKINGHAMSHIRE

Sir: David Cameron's comment piece on children with special educational needs calls on the Government to place a moratorium on local authorities closing special schools and start its SEN audit. In fact, the independent audit is already under way to give better comparative information to local authorities, heads and governors to help them plan SEN provision to meet local needs.

I share Mr Cameron's concern that parents' views should be a priority. We insist that local authorities listen to the views of parents when ensuring they have sufficient provision for pupils with SEN within their area and parents' wishes are always carefully considered when choosing the best option for each child.

The decision to close or open a special school is carried out by local authorities who will have the best picture of what is most suited to their area. The most important thing for children with special educational needs is the quality of education that they receive. We are fully committed to the right of parents to express a preference for a special school place where their child has need. Equally, where parents want a mainstream place, everything possible should be done to achieve this. Inclusion is not an agenda to close special schools.

ANDREW ADONIS

SCHOOLS MINISTER DEPARTMENT FOR EDUCATION AND SKILLS, LONDON SW1

Trees alone will not avert climate peril

Sir: Johann Hari (Opinion, 8 June) calls for air travellers to pay "the true environmental cost" by planting trees in Africa to "neutralise" their carbon emissions. The websites offering this service offer a step in the right direction, but we must not be fooled into thinking we have paid the true intergenerational cost.

The tonne of carbon released by the average flight has been trapped in a fossilised state for millions of years. The carbon sequestered in the African forest is trapped for a relatively minute time - the tree will die and rot and the carbon will be released by natural cycles on a timescale of tens or, at the most hundreds, of years. Such tree-planting may help save us now, but it is only carbon neutral in a transitory sense. In the long term, it is still best not to make the flight at all.

DR ANDREW BOSWELL

UNIVERSITY OF EAST ANGLIA NORWICH

Unmentioned cause of poverty in Africa

Sir: You have pages of worthy and informative stuff on the search for GDP growth per capita in Africa (The Africa Issue, 1 June), but observe the strict PC taboo on mentioning a central driver of the environmental, social, and economic problems, namely rapid population growth.

My late friend Bernard Chidzero, first and best Economy Minister for Zimbabwe in the early 1980s, told me testily, when I raised with him Zimbabwe's then very high population growth rate: "Of course I know that if our population is growing at 3.5 per cent per year, the economy has to grow at that rate just to stand still in per capita terms, year in, decade out; and of course I know that no African economy can possibly sustain that growth rate; so of course I know we will all get poorer until we bring our birth rate down. Don't tell me; tell the other idiots."

The most useful and cost-effective forms of aid for Africa are for comprehensive, free, good quality, reproductive family health care, female empowerment programmes, and dual-benefit Aids prevention (awareness, and condoms). With stable populations, any GDP growth would translate directly into per capita growth, and Africa could develop.

ROGER MARTIN

(DEPUTY HIGH COMMISSIONER, HARARE, 1983-86) WELLS, SOMERSET

Labour gag on voting reform

Sir: It is not the legitimacy of the Labour government people are questioning ("Labour clamps down on politicians who speak out for electoral reform", 9 June). They were elected under the present law of the land. It is the moral authority of a government elected by only 35.2 per cent of those who voted. That has got to be wrong.

By trying to gag its own MPs and peers, the Government merely highlights the fact that it has few arguments to support the status quo. Ministers want people to "trust" politicians, and they talk a lot about "respect". To gain trust and respect, the Government must listen and take action.

The case for electoral reform is overwhelming. The Government must act to satisfy public concern on this issue, rather than try to stifle genuine debate.

DAVID ROLFE

DIPTON, CO DURHAM

Sir: According to your report "Labour will be defeated without PR, says ex-MP" (8 June), the former member for Cambridge, Anne Campbell, "said she would have held her constituency if the election had been held under PR".

How could she possibly know that? Leaving aside the fact that voting behaviour might well be different under a new electoral system, it is extremely unlikely that the Cambridge constituency she previously held would exist at all if proportional representation were in operation.

At minimum, the introduction of PR would require a reduction in the number of constituencies and the creation of new larger ones in order to free parliamentary seats for a top-up list. Alternatively, under the single transferable vote, the current constituencies would be merged into multi-member constituencies.

STEVE COOKE

STOCKTON-ON-TEES

The people's voice unheard on Europe

Sir: Your front page of 31 May neatly encapsulates, probably unintentionally, all that is wrong with the European project. Four possible future directions are illustrated for the European Union: against one is a UK flag, indicating that the UK is in favour of one of the options.

What you really mean is that the UK's ruling political class is in favour of this option: the British people have not had a chance for 30 years to voice any opinion on the aims and direction of Europe. The same is probably more or less true for the other member nations. All our decision-making in relation to the European project is deeply undemocratic, which is why, as someone well to the left of the political centre, I would welcome the chance for a referendum on the four possible options, plus of course an option for "None of the above".

SUE JAITEH

BANBURY, OXFORDSHIRE

Sounds of '-ough'

Sir: Dickon Snell (letter, 6 June) shows the wonderful variety of sounds that English requires from its "-ough". One can even make "rough" rhyme with "hire" - as in "Peterborough in Cambridgeshire".

KENNETH WILSON

WOLVERHAMPTON

Evidence of rape

Sir: Deborah Orr (Opinion, 7 June) says that it is the "culture of scepticism" that keeps rapists on the streets. Having served on a jury in a rape trial, I would suspect that it is lack of evidence. If it is one person's word against another's, however much one would like to find the defendant guilty, one cannot .

SANDRA BOUGHTON

SIDCUP, KENT

Source acknowledged

Sir: In your report on Orange Prize winners (31 May) you write that my "prize-winning novel ... found its way into the headlines, with accusations of using material from an academic text. Her publisher agreed to acknowledge the academic author." As The Independent reported at the time, I had already acknowledged the author in my original manuscript, the acknowledgment had been removed by the publisher and was subsequently reinstated.

LINDA GRANT

LONDON N8

The young of today

Sir: I was disgusted to see in your report (9 June) on a pocket money survey that the youngsters of today spend some 27 per cent of their money on sweets, snacks, and games. When I was a boy in the 1950s I spent all my pocket money on sweets, snacks and games. I would not have dreamed of squandering my cash on such fripperies as "clothing", "cultural activities" and "pets". What is the world coming to?

PHIL COOK

WESTBURY, WILTSHIRE

Armani Man mystery

Sir: I'd take the suit like a shot. Unfortunately I seem to be the only person in the UK who hasn't been approached by Armani Man. By the same token, despite visiting a great many pubs in my time, I have never met the fabled "man in a pub" who sells things cheap. Where am I going wrong?

JOHN SMURTHWAITE

LEEDS