Archives for October 2008

The great challenge for the BBC is to retain broad appeal. Its charter talks of the need to serve "audiences" plural, to represent all the communities of the UK.

That is why corporation executives get so exercised about how many 60-year-old black women in Wales are tuning in. The argument for a publicly funded broadcaster may be fatally undermined if it can be demonstrated that it only pleases some of the people some of the time.

The "prank-call row" (as we now seem agreed to call it) is what happens when that search for broad appeal goes horribly wrong.

The BBC knows that its future depends on connecting with the next generation of potential licence payers. But young audiences are particularly hard to reach once they have grown out of C-Beebies.

Since Tony Blackburn introduced "Flowers in the Rain" on Radio 1 four decades ago, Auntie has tried to find ways of connecting with youth - but without alienating her core audience.

It is a mighty difficult trick to pull off because the demands of young and mature audiences are often contradictory.

Evidence of this is the broad support for Ross and Brand among the BBC's younger audience, contrasting with general dissatisfaction among the core.

Youth programming needs edge. It must feel a little dangerous.The older we get, the more risk averse we become. That is why Chris Moyles and Alan Titchmarsh don't do a double-header (although it might be quite interesting).

Before you all write in to tell me you're 83 and can't get enough of Crissy Criss on Radio 1 Xtra, my point is a general one.The attitudes and sensibilities of those entitled to a young person's railcard are different from those carrying their pensioner's bus pass.

For the BBC, the job of connecting with both groups simultaneously is made infinitely harder by the digital age. Niche broadcasting is most effective among those who are most comfortable scrolling down to channel 453 in search of entertainment and stimulation. New technology is just technology to a generation which has never known anything different.

If the Beeb cannot keep enough young people on board, it is sunk. The challenge is true for many organisations - big multinationals also need to ensure their market doesn't simply die off. But the pressure on the Corporation to appeal to youth is, effectively, enshrined in its Royal Charter. And it has a licence fee to justify.

If you want to know why Jonathon Ross or Simon Cowell command such rich rewards, it is because they are deemed to possess a rare talent: they appeal to young people and older people at the same time.

Finding the tone of voice and format to achieve broad penetration in a fragmenting media world is what every mogul seeks. Such personalities possess the X-factor.
They may not be your cup of tea and I am sure some of you will tell me so, but their careers live and die by the numbers. And until now, Jonathon Ross's numbers have been good.

Sometimes, however, the plate-spinning trick doesn't come off.The crash of breaking crockery still echoes around Broadcasting House this morning.

There has been surprise expressed that this affair should have blown up inside Radio 2 - the' easy listening' station as some see it. But that is to misunderstand its role. If Radio 1 is firmly on one side of the generational divide and Radios 3 and 4 are located on the other, it is Radio 2 that attempts to span the gap. It is all about broad appeal.

In committing the "gross lapse of taste" identified by the BBC Director General, Ross and Brand showed what happens when broad is not broad enough.

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Since almost everyone is affected directly or indirectly by the painful consequences of clinical depression and anxiety, I thought I would post some good news.

The new psychological therapies which are being rolled out in England appear to be having a remarkable impact.

Look at the 'before and after' table below.

The proportion of patients exhibiting severe depression is halved. The moderate categories have been reduced by three-quarters. The proportion of patients with no depression or anxiety has increased ten-fold.

And this impressive result has been achieved, for the most part, using the existing stock of therapists. Some of the eleven "pathfinder" sites which provided the data believe that recruiting and training new staff will bring even better results. You can see the full report here:

No-one pretends that talking therapies such as cognitive behavioural therapy (CBT) are a panacea, but for millions of people who suffer with depression and stress, they do offer a potential route to recovery. If it was in pill form, people would have no hesitation in saying it was, for many, a cure.

What CBT and other talking therapies do is teach people how to eradicate irrational negative thoughts - patients effectively learn how to 're-plumb' their own brains so they can escape their spiral of anxiety or depression.

Yesterday, at an NHS conference on the therapy programme, I met Antony - a young man from Stoke who had been to hell and back. Work problems had led to a breakdown which his GP knew could not be fixed with pills.

Fortunately, one of the new psychological therapy programmes was operating in his area and he was able to get access to the kind of help which has been, and still is, missing in much of the country.

In an emotional address to the health workers gearing up for the expansion of such services, Antony revealed how CBT had transformed his life in a matter of weeks.

From being unable to work or even leave his house, he now has the confidence to make a speech to a few hundred mental health professionals in a London hotel. Describing his life before therapy he told them: "I was so bad I thought daytime television was good".

The government has agreed to spend increasing sums on this kind of help: by 2010 the budget will be more than £170 million. But even this will only provide services to about half the population in England and if we are not careful we could end up with a 'post-code lottery' in terms of provision.

I understand the Department of Health may be about to announce which areas will get the next wave of psychological support services. Ministers have been persuaded that every penny spent will save them money in Incapacity Benefit and health care costs.

Coincidentally, the NHS today published some new statistics on mental health services in England.

The data reveals how increasing numbers were accessing help even before the push to expand the use of psychological therapies.

As you may know, I like maps and today's release includes one which shows the use of mental health services in England.

It is hard to know quite what to make of it to be honest. Does increased levels of use imply worse mental health or better services? Certainly, it appears that it is in urban areas that one sees the highest proportions accessing such help. But then, for reasons that elude me, Leeds / Bradford appears to have a very low number of patients getting care.

I would, as ever, be grateful for your thoughts.

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Reactions to the Russ-Ross affair reveal a generational divide. On last night's BBC News at Ten, my colleague David Sillito demonstrated it beautifully when asking the views of people queuing for the Alan Titchmarsh TV show and others lining up to see 'Never Mind the Buzzcocks'.

The former were outraged by the antics of the Radio 2 presenters. The latter, broadly, felt we should all get a life. "I think it's quite funny - I think everyone should lighten up", said one young woman.

Analysis of the texts and emails sent to Radio 1Xtra echoes the point. Four out of five responses were in support of the pair. A more general sample of the audience online saw the findings reversed.

We should not be surprised, but I wonder if this generation gap is exposed because we are increasingly witness to people trying to close it.

The young have always taken to shocking their elders. It is an arc within the circle of life - the bit where one finds green hair, loud music and loose morals.

The occupants of this territory imagine they are the first settlers, that their behaviour is more outrageous than any that has gone before.

Little do they realise that their "challenge to the very fabric of society" is but a phase - they will almost all conform eventually. They will grow out of it, as my mum used to say.

We need young people to behave like this, to stir things up. Society could calcify and seize up without a little agitation.

But what happens if the maturation process stops? Imagine legions of callow youths still determinedly trying to shock as they enter middle age. It would be an offence to nature.

The youth market is necessarily mercurial. People who once understood it intimately wake up one day to realise they are baffled.

And yet in our media and in business 30, 40 and sometimes even 50-somethings are expected to appeal to this generation.

The answer often is to reach, metaphorically, for the green hair dye, whether that is chefs who swear, jocks who shock or simply men, (and women) behaving badly.

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As Britain experiences declining wealth for the first time in 16 years and the IMF looks to bail out Ukraine and Hungary, I thought it might be interesting to offer some global perspective.

My map of the week comes from the newly published "Atlas of the Real World" and, fittingly perhaps, (as some ponder on the drawbacks of the global free market system) looks at what Adam Smith described as "the wealth of nations".

What we see are two rather odd-looking maps which twist and stretch the world so we see countries in terms of increasing or declining wealth.

The size of each territory in the first map shows the growth of GDP from 1975 to 2002, adjusted for local purchasing power. Two-thirds of the territories in the world experienced increases in their wealth over this period. China saw the biggest increase, followed by the United States, Japan, India and Germany. China and India do well mainly because of their very large populations: they experienced relatively small increases in GDP per person over the 27 years, but those translate into large growth in GDP when multiplied by the population size.

The second map shows the decline in GDP over the same period, also adjusted for local purchasing power. More than half of the territories that became poorer over this period were in Eastern Europe. Ukraine, Russia, Poland and Saudi Arabia experienced the largest declines with Ukraine registering a decline more than twice that undergone by any other territory.

Another way of looking at this phenomenon is in terms of increases and decreases in wealth per person in different countries over the same period.

Largest Increases in GDP per person 1975-2002 (US$)

1. Luxembourg 39,968
2. Equatorial Guinea 28,600
3. Ireland 24,991
4. Norway 19,235
5. Hong Kong (China) 18,496
6. Singapore 17,601
7. United States 14,805
8. South Korea 13,523
9. Japan 13,468
10. Cyprus 12,898
15. United Kingdom 11,230

Largest Decreases in GDP per person 1975-2002 (US$)

1. Ukraine 25,903
2. United Arab Emirates 25,847
3. Slovenia 17,826
4. Czech Republic 15,172
5. Saudi Arabia 12,409
6. Poland 10,153
7. Turkmenistan 10,073
8. Lithuania 9,922
9. Croatia 9,845
10. Tajikistan 8,608

I have to admit, the story revealed by the maps comes as something of a surprise. The economic decline of Eastern Europe after the collapse of the Soviet Union - albeit that the situation may have improved since 2002 - was not a story that got much play in the British media.

No wonder Ukraine finds itself so exposed today.
I would also appreciate any observations on the lists of countries which saw the largest increases and decreases in wealth per person.

The discovery of oil in Equatorial Guinea explains its place at number two in the increasing wealth table but the statistics hide a tragic story of corruption and brutality. Most of the country's population barely survive on an income of less than $1 a day with sewage running through the streets of the capital.

"The Atlas of the Real World" by Daniel Dorling, Mark Newman and Anna Barford is published by Thames and Hudson.

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It must be the perverse part of my nature, but when asked to go somewhere that illustrated the looming recession, I chose the place analysts had identified as the most immune to the downturn.

Corby in Northamptonshire is regarded as a boom town: huge expansion is under way - a new shopping centre, railway station, Olympic swimming pool and thousands of houses. But there is no hiding place from the cold winds heading Britain's way.

New Labour's anthem from the mid-90s promised "Things Can Only Get Better". And Corby has been living that dream. It still is - riding the wave of consumerism that has transformed Britain. But now people are glancing at the small print warning how things can go down as well as up.

I met 15-year-old Leanne Noonan learning how to lay bricks as part of a construction course at a local college. After leaving school she hopes to join the local building boom. Talk of recession takes her into scary, uncharted territory: since her very conception, Britain and Corby has always been getting richer.

"There's always something better coming out that you can get," she tells me. Like many of her generation, Leanne inhabits a world where status and self-worth are measured by brands and shopping choices - a culture of materialism built on brittle plastic foundations.

"When you go out shopping you just get a thrill and you want to buy everything. But if you haven't got the money and you've got no clothes and no trainers people will be looking at you dead weird," she admits.

"If I was to wear two-stripe trainers then people would be like - 'hah! what are you wearing?'" Leanne explained to me. If you are teenager, the number of stripes on your trainers can make a difference.

Leanne's school, a brand new Norman Foster-designed academy, was commissioned as a beacon for an expanding, confident Corby. But all is not well. Hundreds of family homes should be under construction just beyond the school gates. Work has come to an abrupt halt.

We looked out of the school window at the empty acres. "That", I told her, "is what a recession looks like." "My future's just going to end up like that if this carries on," she replied.

Corby was once defined by its steel industry. When that died, it reinvented itself as a service-based economy - echoing the changes across Britain. Today huge warehouses circle a town which has become a logistics hub for a nation addicted to shopping.

Janita Mackin was born, bred and is now a successful accountant in Corby.
"Like most girls in this country I was definitely born to shop," she tells me as we walk around the shiny new shopping centre. "In the past we had to go outside of the town to get any kind of variety, but now the shops have come to us and that's fantastic news."

The chain stores which have chosen to open in Corby represent feathers in the cap of a 21st Century British town. "It's quite nice to be able to look through and see some new shops, brand names that we've all wanted for such a long time" Janita says.

A huge Primark superstore will soon open its doors, bringing kudos and, perhaps, a lifeline in troubled times. Janita knows that Corby cannot escape the changing economic climate.

"It's lovely to have all these things, buy the house you want and fill it with all the things that you want. But it can't go on for ever it would be almost wishful thinking."

When the out-of-town shopping experience came to Corby, the town felt a wave of self-confidence. But for Janita's father, Frank Black, the giant Asda tells a more poignant story.

"Literally where we are at this moment was the blast furnaces of the steel plant", he told me as we walked the central aisle of the store.

From steel-making to shopping. From manufacturing to retail.That spot sums up the change in Corby and Britain.

Frank has photographs documenting the moment the furnace crashed. With its destruction, he became a statistic in a town with 30% unemployment. Frank understands what the word recession means.

"At that time there wasn't credit cards to run up bills and hope for the future - we struggled, simple as that." There was a sense of community in Corby which saw people through. Most of the residents were in the same boat, families relocated from Scotland to provide the labour for an industry that had died. This time, Frank fears, the social glue is much weaker.

"There's a lot of immigrants come into Corby - they've been welcomed - I haven't heard anybody speak against them," Frank says. "I just wonder, when people start losing their jobs and the immigrants have got work, I wonder if there'll be any response to that. That does concern me."

He also describes a generation of young people who don't know what it means to tighten belts and go without. He predicts difficult times ahead - but he is not fatalistic.

"We've just got on the bandwagon and enjoyed life. I really think, in a daft sort of way, this might help to save us.Make us see sense."

Corby cannot escape the cold winds of recession, however optimistic the analysts may be. But it is a town that has been through adversity more than once and found ways to reinvent itself. I wonder how different Corby and Britain will be two or three years from now.

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It is an almighty embarrassment and will give ammunition to those who argue that the crime figures have been fiddled. But today's statistical fiasco does not demonstrate that serious crime is soaring whatever you may read in the papers. If anything, serious violence in England and Wales is probably stable or even falling.

What has happened is that crimes recorded in a box marked "other violence against the person" should have been put in a box marked "most serious violence against the person". By correcting the situation we see a year-on-year rise in most serious violence from 4,500 crimes to 5,500 crimes.

Yes, this whole row is over the labelling of 1,000 crimes out of total of 237,000 violent offences and over 5 million recorded crimes in England and Wales.

One would expect, therefore, to see a fall in the number of crimes in the "other" box. And indeed we do. There were 116,000 crimes recorded in that category in April to June last year and there were 105,000 during the same period this year - a fall of more than 11,000.

For me, the real question is what this means in terms of the risk from violent crime. Does the re-labelling mean attacks are really going up? Well, almost certainly no.

The British Crime Survey, which asks people about their experience of crime, has consistently been documenting falls in violent crime since the mid-nineties and the latest round of interviews shows levels of violent crime to be stable compared with the year to June 2007.

Today's quarterly stats show overall violence recorded DOWN 7%. Recorded firearm offences DOWN 22%. Recorded robbery DOWN a whopping 16%.

Further evidence on trends in serious violent crime is provided by the Violence and Society Research Group at Cardiff University. They looked at what was happening in 29 Accident and Emergency departments in England and Wales.

They found an overall fall of 12 per cent in serious violence in 2007 compared with2006, continuing an overall downward trend observed between 2000 and 2006.

The real disaster with this is that it will increase people's distrust of the data and millions will go on believing they are at increased risk of violence.

Their lives will be blighted - not by real guns and knives - but by fear of them.

Our society can be a dangerous place. But statistics don't beat people up.

PS. It is worth adding that the categorisation problems do not mean that violent criminals are getting away with it. The Crown Prosecution Service in England and Wales will look at the facts of each incident in deciding for what someone should be prosecuted.

Even if police described an incident as ABH, if there was clear intent to cause injury, the crime should come to court as "wounding/causing grievous bodily harm with intent, contrary to section 18 Offences Against the Person Act 1861".

What it apparently comes down to is this: if a drunk attacks someone with a bottle and misses, that crime should be categorised as GBH with intent - even though no injury resulted. Police forces have, in some cases, described that kind of incident as ABH or another lesser crime not included in the "most serious violence" category.

However, if the system works properly, our drunk would still get prosecuted for the more serious crime.

Update: 16:22

A further update following the post from wallacehorse. Thank you for that - you highlight another bizarre feature of this whole affair.

The way the police record a particular incident is different from the way the prosecutors are instructed to deal with it.

The police recording rules say that if someone intends to commit GBH but doesn't cause any or only minor injury it should be categorised as 'GBH with intent' - a 'most serious' violent crime. However, the Crown Prosecution Service requires that for someone to be prosecuted for 'GBH with intent', the crime must actually cause wounding or grievous bodily harm.

The definitions can be found here

What this means is that while police move such incidents from one box to another, making it appear that serious violence is soaring, the courts have largely been treating such crimes as ABH or minor assault.

I am told that further confusion arises because different local CPS prosecutors have their own views on this point. What a mess!

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Is it government's job to make us feel happy? Today a ground-breaking independent report published by the Government Office for Science answers with a clear 'yes': "Government polices and choices need...to nurture the mental capital and wellbeing in the wider population, so that everyone can flourish throughout their lives."

Even more radically, the Foresight Mental Capital and Wellbeing Project suggests politicians might develop "an over-arching mental capital and wellbeing measure" based around targets for every government department.

This is a huge idea - putting emotional well-being at the heart of everything government does.

In layman's terms, this influential group of scientific advisors is arguing that Britain needs to measure how happy/unhappy we are and develop a strategy to get more of the former and less of the latter.

Politicians find all of this very uncomfortable.The last thing they need right now is a headline to the effect: "As Britain heads for recession, the politicians tell us we must be happy."

That is why cabinet minister John Denham sounds so wary in his introduction to today's report. "Mental capital and wellbeing are in many ways very personal concepts" he writes, "but Government has a role in creating an environment in which everyone has the opportunity to flourish."

A 'role in creating an environment' is a long way from the kind of interventionist, policy driven agenda the advisors envisage.

They are clear that there is a clear economic case for significant government intervention.

Improving mental capital and wellbeing could have "very high economic and social returns" they suggest. Indeed, their report reckons there are a whole range of measures government could take in which "the economic and social benefits are likely to significantly exceed the costs involved."

When it comes to happiness, they are arguing, we are able to eat our cake and have it too.

Before we dismiss all this as unworkable, unachievable or undesirable, let us look at the price of unhappiness. The report does the sums and calculates that depression costs the economy £9 billion a year in lost production through absence from work.

Mental ill-health's impact on the wider economy is put at £77 billion in England. And they suggest those costs are about to rocket. Within thirty years, dementia alone will cost the UK £50 billion a year.

I guess people feel a lot less uncomfortable about politicians reducing suffering than the idea that they might dream up some Whitehall plan to have us all smiling benignly so they hit their happiness targets.

But it is arguable that social policy is all about creating contented, prosperous, happier communities. Targets to reduce people's fear of crime or satisfaction surveys about traffic calming, anti-social behaviour or pollution are surely measures of people's quality of life. The health service is looking to do more than cure people of disease - it is about improving the physical and mental well-being of the population.

In any case, government has been flirting with the happiness agenda for years.

In 2002, government strategists published a pamphlet entitled "Life Satisfaction: the state of knowledge and implications for government". It was circulated the following month and clearly stamped: "This is not a statement of Government Policy."

Its conclusion was that "there is a case for state intervention to boost life satisfaction". Who could argue with that? But the statement implied a redefinition of political purpose. Instead of simply making us richer, politicians should aim to make Britain happier.

"Government has got to rethink it's priorities", insisted Lord Layard - Labour peer and LSE economics professor. "I am hoping that each department will review its objectives and see how closely they are in line with the idea of promoting the happiness of the people."

The 'new utilitarians' have been nudging government towards a well-being agenda ever since. Local authorities in England now have a duty "to promote well-being" enshrined in legislation. There was a committee called the Whitehall Well-Being Working Group (aka W3G) which was a cell of happy evangelists beavering away close to the heart of government.

More recently mental health professionals at the Department of Health have been working on a well-being strategy which includes ideas on how government might promote "meaning and purpose" in people's lives through 'creativity, coherence and flow'.

To some this stuff is simply common sense. To others it is a dangerous expansion of the role of the state.

As ever, I would be interested in your thoughts.

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It must have been a surprise for Mali-born kora player Toumani Diabate to discover that one of his songs has forced corporate giant Sony Computer Entertainment to tear up the timetable for the launch of its newest video game.

Toumani is a devout Muslim with a prayer room next to his office. He describes his songs as "my way to attract and inspire people towards Islam". But such is the fear of causing offence that Sony has withdrawn all copies of its LittleBigPlanet game after discovering a background music track by the Grammy-award winning world musician includes two lines from the Koran.

Political correctness gone mad or refreshing corporate sensitivity? Probably neither. This is almost certainly a hard-headed business decision. Sony don't want to take unnecessary risks with a product seen as vital in reversing the flagging fortunes of its PlayStation console.

It will cost millions to recall but billions are at stake. And the last thing Sony needs right now is for the product to be labelled 'offensive to Muslims'.

However, I note that the same company did not withdraw the ultra-violent game 'Resistance: The Fall of Man' last year despite Christian church leaders objection to the use of Manchester Cathedral as the setting.

The difference in attitude seems telling. Sony took a corporate risk to ride out any offence they might cause to Christians in juxtaposing a holy site with acts of extreme violence.

But before a single Muslim has even complained, the company tears up its launch timetable, recalls and destroys all copies of a game frankly dripping in syrupy family values.

Can we imagine Sony executives giving the green light to a shoot-em-up set in a mosque?

In a global market it makes sense not to alienate great chunks of your market by offending their religious beliefs. This is particularly true if the offence might trigger an angry global response.

Are there double standards here? Offending a religious group is fine so long as you can be confident they won't burn your corporate flag?

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My blog styles itself "the way we live". But this week's Map of the Week is all about "the way we die".

'The Grim Reaper's road map', published today, analyses almost 15 million death records for the years 1981 to 2004, exposing the patterns of death in modern Britain.
"There's nothing certain in a man's life except this: That he must lose it" as Aeschylus noted. But, of course, very few can be certain where or when their end will come.

If you want a clue, this week's maps offer just that. They show the most common cause of death for seventeen age groups in a thousand separate neighbourhoods over 23 years. And an extraordinary tale they tell.

The authors have selected nine causes of death - cardiovascular, cancer, respiratory, infections, mental disorder, transport, suicide or undetermined, and homicide. (Occasionally data is suppressed in places with very few deaths in a particular age band.)

The story begins in the first year of life when the most common cause of death is respiratory. But the second map for ages 1 to 4, reveals a much wider variety of causes of death groups. There is no obvious geographical patterning apart from transport being more prevalent as a cause of death in the north than the south.

For the next age group, 5-9, transport deaths dominate the northern half of the map even more, while childhood cancers are the most common causes of death in the southern parts of the country.

By the ages of 10 to 14, deaths from traffic are most common across even more of the country.

As we move on to the next age band, 15-19, the shades on the map change radically. In most places, the most common cause of death for older teenagers is transport but in many urban areas it is suicide or undetermined intent. Two neighbourhoods in Glasgow have homicide as the most common cause of death for this age group.

By the early twenties, transport and suicide or undetermined remain the most common groups but suicide or undetermined intent is much more prevalent, with almost all of the urban areas having this as the most common cause of death.

The Easterhouse neighbourhood of Glasgow is the only place where homicide was the leading cause of death in this period. (Homicide does not appear on any of the older age group maps, but appears somewhere on every map for every younger age group.)

As we move into the late twenties, we begin to see cancer creeping into the picture and by ages 30-34, the map colours change radically again, with cancer now dominant, particularly in rural areas. In other rural neighbourhoods we start to see cardiovascular causes appearing.

By the ages of 35-39 the map is dominated by cancer as the most common cause of death, but cardiovascular causes are now becoming evident in northern urban areas.
There then follows a series of maps covering the five-year age bands from 40-44 through to 70-74.

On all of these maps the most common causes of death are cardiovascular or cancer and they show the changing geographical variation across these years of age. At younger ages cardiovascular causes dominate in the northern parts of the country and London, and gradually extend southwards and eastwards.

By ages 65-69, cardiovascular is the most common cause of death across almost all of the country, apart from a ring in the south east around London where cancer dominates. At 70-74, only one neighbourhood,

Surrey Heath North, has cancer as the most common cause of death, the rest of Britain having cardiovascular as the main cause.

At ages 75 and over, the leading cause of death in every neighbourhood is cardiovascular and so the whole map is a single colour. I'd be delighted for you own observations on these maps. Does your neighbourhood have an unusual death pattern? What are the explanations?

The maps also expose misplaced priorities, it seems to me.While we obsess about knife crime and drugs, the real killers of our young are transport and suicide.

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It is sensitive territory but, if we are serious about trying to offer equality of opportunity to all in our multi-racial society, it strikes me as important to venture there.

By the age of five, ethnicity already appears to have a significant impact on a child's health, behaviour and cognitive abilities.

The latest batch of data from the Millennium Cohort Study (MCS) has been published following the lives of more than 15,000 children who were born in the two years after the millennium.

But it also involves their families. And through the reams of data we begin to get a picture of how different people live.

The MCS - set up by the Economic and Social Research Council and co-funded by government - is a remarkable piece of longitudinal research that has already published data on children of the new millennium aged nine months and three years.

In the latest batch of data, the comparisons which jumped out at me relate to five-year-olds from different ethnic backgrounds as they begin primary school - disparities which mean some groups are always playing catch up.

Separate figures published earlier this week show that at GCSE some (but not all) of the minorities are still performing less well.

On the five-year-old's first day in reception class, the cohort study already found "substantial differences in adjustment...between ethnic groups".

It may feel uncomfortable, but identifying areas of weakness means support and resources can be targeted appropriately.

One aspect the study looks at is problem behaviour among our 21st century five-year-olds.

It is measured by asking parents whether their child has conduct problems, hyperactivity, emotional symptoms, peer problems and so on. The higher the score, the more problems reported.

PROBLEM BEHAVIOUR
Indian: 6.5
Black African: 6.5
White: 6.6
Mixed: 7.4
Other: 8
Black Caribbean: 8.2
Bangladeshi: 8.2
Pakistani: 9.2
Source: Millennium Cohort Study

A separate measure of a child's cognitive abilities also finds marked ethnic variation. The British Ability Scales (BAS) measures a five-year-old's facility at naming vocabulary, picture similarities and pattern construction. The higher the score, the greater the cognitive development.

COGNITIVE DEVELOPMENT
White: 102.2
Mixed: 101.3
Indian: 98.3
Black Caribbean: 98
Other 95.7
Black African 91.4
Bangladeshi 88.6
Pakistani 87.4
Source: Millennium Cohort Study

"Bangladeshi and Pakistani children appear to show lower levels of cognitive ability at school entry, and their mothers report more behaviour problems", the researchers note, although they are quick to insert important health warnings.

"Data on minority groups are subject to greater sampling error", they say.

"The response rates of some non-white groups, cultural expectations, the importance of other languages spoken in the home, and the number of siblings are just some of the factors that have to be considered."

We do have to be careful, certainly before assuming cause. Poverty, parental education, language may all play a role. But the findings are so consistent that it appears we are looking at something real.

For instance, the Pakistani and Bangladeshi children are behind in their physical development, creative development and mathematical development too.

One possible factor which emerges from the data is the role of parents in different ethnic groups.

Take the role of fathers. On average,1.3% of dads say they never play with toys or games with their five-year-old child. The figure for Pakistanis and Bangladeshis is 9%.

The study finds, on average, 2.5% of dads never play sport with their five-year-old. Among Pakistanis and Bangladeshis it is almost 12%. (With Indian fathers it is 2.4%).

A big difference is found among mothers too. Just 1% of mums never read to their child. Among Pakistanis and Bangladeshis, the figures is 7.1%.

Illiteracy rates may play big a part in this, as may differences in the way ethnic groups answer such questions.

Or the explanation may simply be that different cultures rear children in different ways.

It is not just in their mental development that we see big variation between ethnic groups. There are already apparent health disparities among the five-year-olds arriving at school.

For example, black children are three times as likely to be obese as a classmate from an Indian background and twice as likely as a white youngster.

OBESITY
Average: 5.3%
Indian: 4.1%
Other: 4.8%
White: 4.9%
Mixed: 7.1%
Pakistani/Bangladeshi: 8%
Black: 12.5%
Source: Millennium Cohort Study

The data does not distinguish between black children of African or Caribbean origin but the researchers conclude that "dietary differences are likely to be important here, and genetics may also play a role".

Indeed, there is evidence of a generational legacy.

Like their children, Afro-Caribbean mothers are almost three times as likely to be obese as an Indian mother.

These findings suggest public health campaigns might benefit from further targeting their effort towards different ethnic groups.

Other health issues affect ethnic groups in different ways.

The cohort parents were asked whether their five-year-old had any longstanding health problem. On this measure, it is white and mixed race youngsters who are reported to have the greatest level of chronic illness by their parents.

LONGSTANDING HEALTH PROBLEM
Average: 19.5%
Indian: 13%
Black: 14.5%
Pakistani/Bangladeshi: 16%
Other: 18.3%
White: 19.8%
Mixed: 23.9%
Source: Millennium Cohort Study

Why? Well, one important factor may be the proportion of mums who smoke.

MOTHERS WHO SMOKE
Bangladeshi: 4.1%
Indian: 5.2%
Pakistani: 7.5%
Black African: 7.8%
Other: 11.3%
White: 29.8%
Black Caribbean: 34%
Mixed: 38%
Source: Millennium Cohort Study

One sort of knows it, but when you look at the bald statistics it is quite startling to see the difference between ethnic groups.

Seven times as many white five-year-olds have mothers who smoke compared to their Bangladeshi class-mates.

I was also struck by the difference in smoking rates between black African and Caribbean mothers.

The researchers conclude that the relatively low level of longstanding health problems reported among Asian children "may reflect their lesser exposure to smoking in pregnancy and the higher rate at which they were breastfed in infancy".

Everyone has possible lessons to learn from the data.

A final observation: the differences in how ethnic groups regard themselves as parents. Asked how they felt they did as a parent, here are the proportions for mums who thought they did a "very good" job.

VERY GOOD MOTHER
White: 29.7%
Mixed: 33.6%
Indian: 39.3%
Other 42.3%
Pakistani / Bangladeshi: 47.8%
Black: 50.4%
Source: Millennium Cohort Study

And dads who thought they did a great job?

VERY GOOD FATHER
White: 34.2%
Mixed: 36.7%
Indian: 45.2%
Pakistani / Bangladeshi: 47.7%
Other 51%
Black: 55.5%
Source: Millennium Cohort Study

This is, I think, a warning we should heed before anyone leaps in and lectures parents from whatever ethnic background on how to bring up their children. No-one has a monopoly on wisdom.

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I can already hear the response of many English taxpayers to the idea: "Are you having a laugh?"

I am in Edinburgh where this afternoon Scotland's first minister will formally ask Westminster for a billion quid.

But this is no joke. It is feared that tens of thousands of jobs will be lost before Christmas north of the border pushing unemployment up by a third. An economy built upon banking and financial services is in deep trouble.

Alex Salmond heads a special economic cabinet meeting at which he will tell colleagues that Scotland is "facing extraordinary and highly volatile circumstances".

"Everything must be done to protect jobs, investment and household incomes" the SNP leader will argue.

Mr Salmond, in pleading for financial assistance, will claim that he is only asking for what his nation is owed. "It makes every sense for the tight and unfair Westminster controls on Scotland's budget to be relaxed - so that we can invest in a package to support the real economy and stave off the threat of recession", his spokesman has said.

The dread phrase 'Barnett formula' shall issue forth and ancient argument and enmity shall flow.

The formula is used to calculate how much UK money should be allocated to Scotland - a complex sum that results in Scotland receiving more public cash per head than the English.

However, Mr Salmond claims that the arithmetic is unfair because money for the London Olympics, prison building and police and fire service costs are not included in the computation.

Some creative maths arrives at a total owing of 963 million. Throw in a bit for Auld Lang Syne and you get the justification for the Scottish government's request for a one billion pound 'reflationary package'.

Unemployment figures out tomorrow are expected to show a sharp rise in the UK's jobless figure with analysts predicting a million on the dole before all the leaves have dropped from the trees. The banking crisis is beginning to infect the 'real economy' we are told. But in Scotland the banks have been the real economy for nearly 300 years.

Chancellor Alistair Darling has said he is "extremely concerned" about local jobs with predictions of large-scale redundancies if Lloyds TSB buys HBOS. Between them HBOS and RBS employ more than 34,000 people in Scotland. All will be extremely anxious right now.

But the crisis goes beyond the life-blood of jobs into the bone-marrow of Scottish pride.

The Scotsman newspaper this morning reports on the 'dark day as centuries of tradition come to an end'.

The Daily Telegraph predicts the "Scots dream of independence may lie in ruins".

It quotes Doug McWilliams, chief executive of the Centre for Economics and Business Research as saying: "Political independence was never very likely but this makes it pretty much impossible".

The SNP regard this as "nonsense" but Alex Salmond's vision of an independent Scotland joining Iceland, Ireland and Norway in an 'arc of prosperity' has been ridiculed by opponents.

Other economists, however, are not so quick to write off the SNP's ambition of independence. Neil Blake from the consultancy Oxford Economics tells the Telegraph: "Scotland has a successful fund management and pensions industry which will not be affected in the same way as the banks, so I think the Scots could still have got through this as an independent nation".

Nevertheless, today's crisis meeting at Holyrood is required because the fundamentals have shifted.

Scotland's relationship with the rest of the UK just got a whole lot more complicated.

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As I stumbled down the stairs this morning, I discovered I had been invaded by aliens. In the interests of science, I pulled out a camera and took a photo of them for you.

It is that time of year when the ladybirds move in, squeezing under windows and around doors hoping to find warm and safe living quarters to see them through to Spring.

But my snap of just a few of the uninvited guests reveals that this is not a case of British homes for British bugs.

These are Harlequin ladybirds, unwelcome foreigners who are making life increasingly precarious for the indigenous coccinellids.

Fresh off the presses, my map of the week this week documents the latest information on the spread of the Harlequin from its first known arrival in Britain in 2004.

Native to Asia, Harmonia axyridis (Pallas) was widely introduced into Europe from 1995 as a biological way to control aphids. (Will we ever learn!) Sold by various biological control companies in France, Belgium and the Netherlands, it was also intentionally released in at least nine other countries.

While the black and red harlequin has a suitably diabolic colour-scheme, don't be fooled. The more common type of harlequin is orange with black spots - easily mistaken for our native types.

It has spread very rapidly and is now regarded as established in thirteen European countries including, most recently, Norway and Sweden. But their continued spread in the UK spells bad news for our common native two-spot and seven-spot varieties.The Harlequins eat their babies and their food supply.

The map confirms the spread north of the Harlequin, but this year's real change will probably be far more obvious after the reports of sightings in the next week or so are recorded.

In the United States the Harlequin is known as the 'Halloween Ladybug' because it makes its presence felt at this time of year.

The mapping of the Harlequin is perhaps the first time a species has been tracked from its arrival in a country. If you see one and want to help the scientists keep tabs on the invasion, details of the project can be found here.

Publication of the new Harlequin map coincides with the BBC's Alien Invaders week. The stories of Japanese knotweed, Chinese mitten crabs and American crayfish will be narrated across the output in the next few days. The cost to the taxpayer and business of these invaders is significant - yet another example of how globalisation is changing the way we live.

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"It's coming", the crowd murmurs. We hear a distant rumble but, straining our eyes down the tracks, we can only make out a smudge of sooty smoke and a glint of metal. A man in a dark suit stands on a box to address the gathering. "It is going to be bad", he intones.
"Very bad." With a shake of his head he adds: "The end of certainty."

The small town of Certainty has grown fat and comfortable. For years, the population has barely noticed the thunderous clatter of the railway, the clouds of coal dust which blacken the washing on the line. It has been too busy getting richer.

But now there's something wrong with the engine. "What can we do?", a small boy asks his mother. "I don't know", she replies solemnly. "It's a problem in the works. Don't understand it myself. All I know it is bad and it is coming our way."

Reading the papers and listening to the news at the moment, there's not much room for people. The story being told is about numbers. Enormous, baffling numbers.

But beneath the high finance and international politics, there are millions of anxious, bewildered individuals. Thousands of British workers have been told they haven't got a job this week. Thousands of families are wondering how to pay the bills.

But such are the macro-economic distractions that you'd be hard pushed to find their stories.

We are so mesmerised by the darkening sky, we don't notice the rain on our face.

I met Eva yesterday. She is in her late sixties and lives alone in South West London. "It is extremely worrying. I am frightened", Eva admitted. Her eyes told me it was true. Surviving on a small pension, she is terrified her meagre income might be gobbled up by global forces she cannot comprehend.

Kaarina has been dreaming of running away. "London's become a horrible place and I just want to get away from it and get back to basics" she confides. "The last 20 years there's been this culture of self and materialism. It's almost like we're paying the price."

I met others who echoed the theme of retribution. "It's all about one word. Greed." Chris, an unemployed man who suffers from depression told me: "It feels very threatening.The world is closing in on us."

The conversations are held in a courtyard in East London packed with people in "Get Moving" t-shirts.The charity Mind is marking World Mental Health Day with a series of walks encouraging exercise as a way to counter depression and anxiety.

"I notice there's already been an increase in calls with people worried about their finances", says Bridget O'Connell who runs Mind's helpline.

The charity's website has also seen a surge of hits to its advice pages.
"They're just really anxious about how they're going to make ends meet and how they're going to look after themselves" Bridget says.

One psychologist recently described it as 'a perfect storm'. Anxiety feeds on helplessness and the speed, scale and complexity of the economic crisis has left many feeling powerless.

If we are not careful, helplessness can become hopelessness. The National Director for Mental Health in England, Professor Louis Appleby, is urging Ministers to consider how the country can best prepare for the psychological impact of the crisis.

"Despair is a dangerous state of mind, and preventing people going from being worried to being desperate is important - ensuring that they're resilient" he tells me.

"That's about people having practical solutions to their problems, it's about knowing where to get help, it's about seeing a positive outcome despite the difficulties, and that's where I think we have a responsibility to get the message right."

Professor Appleby stresses that there is nothing inevitable about economic blues inspiring clinical depression. But some mental health charities worry the government is being complacent.

"It's essential that the government supports people by making sure they've got the right information about how to look after themselves and that's really where government's failing at the moment" says Dr Andrew McCullough, Chief Executive of the Mental Health Foundation. "I'm not saying it's wrong to spend £10,000 per head on propping up the economy", he tells me. "but we're only spending 10p per adult on mental health promotion in England and I'm afraid that just isn't enough."

The MHF has just released an excellent television ad offering straightforward advice to those who feel overly-anxious or depressed.

But they haven't got the funds to broadcast it anywhere except East Anglia.
What worries experts is that economic turmoil in the1980s coincided with what's been described as an 'epidemic' in suicides involving young men.

Death rates among 15-24 year-olds shot up to record levels when recession hit and unemployment soared. As the economy stabilised and entered a long period of growth from 1992, suicide rates came down. (see graph)

Key factors are thought to be the levels of joblessness and relationship breakdown. Drug and alcohol abuse may also play an important part.

But in all these respects, Britain appears potentially vulnerable. And there has been a marked fall in community capital - the web of family and social connections that can act as a safety net when times get tough.

I sense a change in Britain's psyche.The trees are twitching as the winds pick up.The temperature has dropped sharply. But the rains have not yet fully arrived.

As we hurriedly prepare for the storm, we must not let our eyes become so hypnotised by numbers that we forget about people.

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It's a mystery that has got British law enforcement officials and others across the planet scratching their heads. Put bluntly, enough heroin to supply the world's demand for years has simply disappeared.

The United Nations Office on Drugs and Crime (UNODC) describes the situation as "a time bomb for public health and global security".

This week's Map of the Week comes courtesy of the UNODC. It shows their latest estimate of opium production in Afghanistan - another bumper year.

A crop of 7,700 tonnes will produce around 1,100 tonnes of heroin - it basically works on a 7:1 ratio.The mystery is that the global demand for heroin is less than half that. In other words, Afghanistan only needs to produce 3,500 tonnes to satisfy every known heroin user on the planet.

Look at the graph, though.

For the past three years, production has been running at almost twice the level of global demand.The numbers just don't add up.

There are two credible theories.

Theory 1: A large and undocumented market has opened up in countries which don't want to admit the problem. Russia has long been in denial over the scale of its heroin problem and the same may be true in emerging drug markets like Iran, Turkmenistan and Kazakhstan.

The Iranians are certainly increasingly anxious about the opium fields on their doorstep. Border guards and police have been involved in deadly shoot-outs with smugglers with experts suggesting that there are now a million heroin users in Iran.

But the over-supply is so great that it is hard to conceive of it all disappearing in to the blood-streams of new addicts in Tehran and Ashgabat.

Theory 2: Vast quantities of heroin and morphine are being stockpiled. Antonio Maria Costa, head of the UNODC is convinced that is the only explanation. In a recent bulletin he issues an urgent order: 'Find the missing opium.' "As a priority, intelligence services need to examine who holds this surplus, where it may go, and for what purpose" he says. "We know little about these stockpiles of drugs, besides that they are not in the hands of farmers."

Further credibility is given to the stockpiling theory in that 'farm-gate' prices for opium remain pretty stable at about $70 per kilo.

So where are the thousands of tonnes of drugs that the UNODC describe as a "time bomb"?

Well a clue, perhaps, comes from a senior law enforcement official who told me that British undercover teams in Afghanistan are reporting seizures of "enormous quantities of precursors".

Precursors are the chemicals required to turn base opium into heroin.The intelligence suggests that, rather than export opium to established drug laboratories in, for example, eastern Turkey, smugglers are processing the crop in Afghanistan.

The likelihood is that vast quantities of heroin are being warehoused somewhere close to the fields where the opium grows.

But there is another mystery surrounding the heroin market at the moment. If the international drug cartels are so awash with product that they are prepared to risk hiding billions of dollars worth, why are there shortages on some British streets?

That is the peculiar state of affairs revealed in Drugscope's recent trends survey.

"Some areas are experiencing outright shortages or shortages of good quality heroin. The quality of street heroin had dropped in 12 of the 20 town and cities surveyed, with five areas - Penzance, Cardiff, north London, Luton and Birmingham - noticing a shortage of the drug on the streets" the report says.

The field-work, conducted in July and August, finds shortages had typically been in place for two months - a longer stretch than is usual in a market well known for its peaks and troughs.

The Serious Organised Crime Agency (SOCA) believes the heroin shortage in some parts of the country could have been sparked by a rise in the price of UK wholesale heroin. "Current intelligence suggests that some criminal groups are having difficulty getting hold of what they perceive to be good quality heroin."

One theory is that smugglers are using new routes, increasingly distributing heroin through East Africa.The switch in tactics may have led to a temporary pause in supply which is being felt in the UK.

But very few would claim the shortages are the result of police activity. The Drugscope survey concludes that "street level drug enforcement had little long-term impact on illegal drug markets." At best, operations only disrupt the flow of drugs for a few days or weeks and merely displace drug use and drug dealing for a short time.

One serious anxiety is that the economic downturn will herald a new wave of drug misuse.The recession in the 80s coincided with the British heroin epidemic. In the US it was crack cocaine.

It is not just that people turn to drugs to blot out the misery of a downturn. If the crisis pushes up unemployment, it is likely that, deprived of a legitimate way to make a living, some may turn to an illegitimate source.

Perhaps a global downturn is what the drug cartels, with their huge stockpiles of heroin, have been waiting for.

Update: 16:10

Since posting this article the Serious Organised Crime Agency has been in touch.

SOCA has a number of undercover operatives in southern Afghanistan. They tell me this: "Whilst the cultivation and production of opium in Afghanistan is in decline, intelligence suggests there is considerable stockpiling of narcotics by Afghan criminal networks in order to control prices in the growing markets in Russia, China and within the local region."

I also understand that Nato's top operations commander is calling for more aggressive tactics against the opium trade in Afghanistan. US General John Craddock will tell Defence Ministers gathering in Budapest that troops should focus on "high-end" targets like drug dealers and laboratories.

Some Nato ministers, however, are concerned that any crackdown would prompt a violent backlash against allied troops.

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Sometimes it takes people on the outside to hold up the mirror and force us to realise how others see us.

The British pride themselves on their tolerance, their sense of fair play, their respect for the rule of law and human rights. So it is both humbling and galling when the United Nations tells us we suffer from a "general climate of intolerance and negative public attitudes towards children, especially adolescents".

It is almost as if the social services have arrived and informed us that we aren't suitable parents.The UN's Committee on the Rights of the Child has just published its 'concluding observations' on Britain's human rights record with regard to children.

It makes uncomfortable reading - 120 separate recommendations littered with "regrets" and "concerns" over our failure to protect our children.

It is not the first time the British government has got in the neck over its treatment of the young. The UN, the EU, the UK's four Children's Commissioners and a range of children's charities have regularly accused Ministers of failing to protect young people in the justice system, the immigration system, the mental health system and in the home.

Today's criticism from the committee in Geneva broadly comes down to a fundamental difference of opinion on how young people should be controlled and disciplined.

The UN wants an end to ASBOs. They are offended by the use of 'mosquito sprays' to disperse threatening groups of hoodies in shopping centres. The committee is opposed to any physical restraint of young offenders. And they demand an end to the use of smacking or any other physical punishment in the home.

Instead, the United Nations urges Britain to "actively promote positive and non-violent forms of discipline and respect for children's equal right to human dignity and physical integrity, with a view to raising public awareness of children's right to protection from all corporal punishment and to decreasing public acceptance of its use in childrearing".

Government ministers, while accepting the principle of always putting a child's best interests first, are not convinced that those interests are necessarily served by "going soft" - particularly around the issue of youth justice. It is certainly a view held by many of the people they want to vote for them.

A new poll of 6,000 teachers by the Times Educational Supplement found one in five thought it would be a good idea to bring back the cane - outlawed in state schools twenty years ago.

One supply teacher told researchers: "Children's behaviour is now absolutely outrageous in the majority of schools. There are too many anger management people and their ilk who give children the idea that it is their right to flounce out of lessons for time out because they have problems with their temper. They should be caned instead."

There are plenty of child psychologists who would say such attitudes reflect the failures of adults rather than the indiscretions of children.

Britain does find itself with an ignominious reputation for locking children up - around 3,000 behind bars today - a higher proportion than almost any other country in Europe.

The age of criminal responsibility, set at just 8 years in Scotland and 10 years for England, Wales and Northern Ireland, is among the lowest in the world. When we do incarcerate children, we find it impossible to prevent self-harm on a truly alarming scale.

Since the UN last reviewed Britain's treatment of children a year ago, six youngsters have succeeded in killing themselves while under lock and key.

The behaviour of our teenagers - under-age pregnancies, drug abuse, drunkenness, public disorder - finds the UK close to or at the top of European bad kids' league.

So something is clearly amiss. For many in Britain the answer is tougher discipline, a move away from the "my rights" attitudes that prevents parents, teachers and police from dealing with young miscreants in the way they want.

But the view from Geneva is rather different. They see a country which has become disconnected from its young: hostile to them, frightened of them and unable to keep control without resort to violence. Britain's adults are on the naughty step once again.

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Drug treatment officials were busy rubbishing my journalism yesterday afternoon, telling anyone who would listen that the man from the BBC had got his figures wrong. (Listen to my report on the Today programme)

I wouldn't burden you with details of the statistical spat, except I think the episode goes to the heart of the debate over what England's half a billion pounds a year drug treatment programme is for.

The National Treatment Agency (NTA) yesterday published its annual figures showing yet another big increase in the numbers of people who were on the drug treatment programme last year - 202,000 altogether. (Trebles all round - government target achieved in style.)

Not mentioned in the press notice, discretely lodged in a table near the bottom of the data release, was the number of people who left the treatment programme drug-free last year - 7,324

What I did, and what so infuriated the people at the NTA, was to compare the two. The arithmetic was pretty simple. Just 3.6% of those in treatment were discharged free of illegal drugs.

They didn't like that - not one bit. An email was sent out from the press office steering other journalists away from doing the same sum. "Just in case anyone is tempted to follow the BBC's 3.6% figure", warned Director of Communications Jon Hibbs, "we think this is a misleading way to interpret the data: it's like measuring a school's GCSE success by counting the number of A grades as proportion of the total school population".

The NTA prefer to focus on the number in treatment and the number retained for 12 weeks - the government's measures of success. There is no target for getting people off drugs.

If pressed, they will argue that the data shows that those who left drug-free represent 11% of those who were discharged from treatment.

That looks a bit better. But do you see what they've done? They have ignored the tens of thousands of people who are in drug treatment but were not discharged.

People like Andrew Walters who I met in Sunderland this week who has spent ten years on methadone for his heroin addiction.

Andrew is supposedly part of the drug treatment success story. He has appeared in the statistics for a decade but he says no-one seems interested in trying to get him clean.

"It's like everyone's give up on you", he tells me. Andrew pleaded to be allowed to get into residential rehab, but each time he was turned down. "On five separate occasions I asked them. Five times. I just got put to one side."

Methadone may have helped him untangle some of the chaos in his life, but in his view it has got him no nearer getting off drugs. He's just been parked. "They like giving methadone out", he says. "If you ask to top up your methadone they'll put it up without any questions."

But he doesn't want to be on methadone - a "vile drug" he calls it. It has rotted his teeth and ruled his daily routine. "I was just topping off with heroin", he admits.

When I first pointed out the very small proportion of users who left England's treatment programme drug free on the BBC Today programme last year, in the words of one academic in the field, it set off a small nuclear explosion in the drugs world.

The system had been patting itself on the back for getting lots of people signed up for treatment but people had not noticed what happened afterwards. The focus was on inputs not outcomes.

A debate many had thought won and lost a decade ago was reopened. Should the aim of drug treatment be to reduce harm or get people off drugs?

The harm reductionists had long ruled the roost with a philosophy of helping people who misuse drugs get their lives straight so crime and health risks were reduced. It is a worthy aim but some in the drugs field believed the system needed to be more ambitious.

In a report sent to drug teams this week, the NTA itself bemoans the way that residential services are too often used "as a last resort rather than as a concerted attempt to achieve long-term abstinence earlier in a drug-using career."
"This has led to unsatisfactory outcomes for all involved", it notes.

It was more than 'unsatisfactory'; it was very nearly fatal for Andrew who attempted suicide after being turned down for rehab. "The only reason they found me was my room in the bedsit place was above the office and they heard me hit the floor" he tells me. "They come in and I still had the needle in my body."

If you look at the figures published yesterday you see that last year 79,619 people were in treatment for the whole year. One of those was Andrew. The vast majority will be heroin addicts who are on prescriptions for methadone or another substitute. They may be in treatment for a long time to come.

It is not easy to get someone off drugs. It can take years and there may well be many false dawns on the way. But that doesn't mean we shouldn't try.

Professor David Best, an internationally renowned expert on drugs, is about to publish new research into what helped a cohort of ex-addicts get clean. "The only type of formal treatment service that was often cited as being among 'the key things that finally helped you to become abstinent' was residential rehabilitation", he reports.

Professor Best goes on to criticise the lack of ambition in the system. "The experiences of this population are at odds with the 'chronic, relapsing condition' mantra which pervades UK drug services", he writes.

The latest figures show that 147,000 of the individuals in treatment were being given prescribed medication - 74% of all those on the programme. How many accessed residential rehab? The data shows it was less than 5,000 - around 2% of the treatment population.

So I make no apology for comparing the total number of people in treatment with the number who leave the system drug free. To do otherwise would be to ignore the plight of those, like Andrew, who want to get clean but are not given the help.

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It goes down very well with voters, but are free NHS prescriptions such an obvious boon?

I ask because this week it became clear that, within a couple of years, only patients in England will have to pay for their medicines after Northern Ireland's decision to follow Wales and Scotland and abolish prescription charges altogether

I can already hear the objections of English patients, furious at the unfairness of a supposedly national health service that is in UK terms, of course, nothing of the sort. But my question is not about British health equality. It is about the most effective use of limited public funds which, ultimately perhaps, should amount to the same thing.

Ask someone whether they would rather pay £7.10 or get something free and they will think it must be a trick question. But the problem with free stuff is that people don't value it. And the 'stuff' we are talking about in England alone is valued at £8.2 billion.

Let's look what has happened in Wales.They went first and abolished prescription charges in April 2007. A year on, an enterprising Liberal Democrat wrote to GPs to ask what they thought. It was a straw poll rather than anything you could hang your hat on, but almost two-thirds of 133 family doctors said they opposed free prescriptions.

Here are some of the responses;

"I think that patients frequently fail to value that which they receive cost free and I suspect this contributes to high levels of wastage of medicines."

"I'd much rather the money was used to reduce waiting list times which causes needless suffering and often worsening of conditions."

GPs revealed that patients were demanding prescriptions for what would normally be over-the-counter treatments. Among items they were asked to prescribe were "nit combs, vitamins, honey, aspirins, paracetamol, cough and cold remedies, antihistamines".

One respondent revealed how they were "inundated with requests for head lice preparations for whole families".

I am sure there are some people who are put off going to their GP for beneficial medicines because they are worried about the cost. But not many. Eighty-eight percent of prescriptions in England are free already. And that's before Gordon Brown's recent announcement that all cancer patients won't have to pay for their prescription drugs.

Income from prescriptions in England is expected to be about £435m this year - hardly peanuts but equally not a huge sum in the grand scheme of NHS finance.

The cost of administering the whole prescription system is only ten million quid so the bureaucracy is not really a factor.

You see, I wonder if it is the money that matters here. Is the relationship people have with their NHS more important? People abuse ambulance crews and A&E staff because they see themselves as disgruntled consumers rather than citizens with a shared responsibility for the system. They waste the valuable time of doctors and nurses by not bothering to turn up for appointments because there are no consequences.

As I was having a tooth drilled this morning, my NHS dentist told me that the patients who are most likely to miss their appointment are those who don't have to pay. Further journalistic inquiry was limited to dribbling I'm afraid, but she was convinced that if a service is free people don't respect it.

The NHS in England reckons patients waste prescriptions worth "at least £100m" a year. I suspect it is much more given Merseyside health trusts alone calculated the cost at £12 million.

Managers speculated as to whether putting the real prices of drugs on the packets would reduce wastage, make people think twice before they threw away valuable drugs. A focus group suggested this would have unintended consequences.

"If the cost of the medicine was very high, some people thought that they should not take it, because it was too expensive. If the cost was very low, people thought that they should have had a slightly more expensive drug" the NHS Chief Executive told MPs.

Prescription drugs have never been part of the "free at the point of delivery" contract that underpins the NHS, but one can see why abolishing charges appears to strengthen this principle. To some, the health service ideals are seen as a bulwark against the power of capitalist markets - a model for benign and universal state provision.

However, the NHS increasingly encourages patients to behave like customers. Internal markets designed to improve standards are driven by "patient choice".

The arguments over prescription charges quickly go to the heart of the relationship between citizen and state, patient and NHS. Would free medicines for all protect the health service? Or expose its weaknesses?

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