WHEN Dr. José Batlle met his 93-year-old patient in her small Bronx apartment, she didn’t have much furniture beyond a small TV, a sofa and a wheelchair. What she did have in abundance were pills — 15 types from a variety of doctors, including a pulmonologist, a cardiologist and a gerontologist. He discovered that some medicines had expired, others were unnecessary and some were dangerous if taken together.
Sitting with his patient and her son, Dr. Batlle cut the number of her medicines to four. He also gave the family his personal cellphone number.
Before coming to see him, the woman had endured several emergency-room visits and hospital stays. With Dr. Batlle, she was able to avoid all of that.
Calling a doctor on his cell? No waiting for an appointment? It’s the type of service that Dr. Batlle tries to offer to all of his 1,500 patients. “I prefer to keep them healthy than treat them when they are sick,” he says.
The efforts of Dr. Batlle and other primary care physicians may get a boost at the federal level. The Obama administration is considering ways to persuade medical students to pursue careers in primary care by raising their pay, and is channeling them to work in underserved rural areas. And the White House has already set aside $2 billion for community health centers through the economic stimulus package.
But more far-reaching health care reform remains an uncertainty, and in the interim a small but growing number of doctors are trying to take matters into their own hands.
By stepping off the big-clinic treadmill, where doctors are sometimes asked to see a different patient every 15 minutes, Dr. Batlle has joined the vanguard of physicians trying to redefine health care. These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.
In many cases, this kind of care can reduce a patient’s medical bills. That’s more crucial than ever: according to a study published online by the American Journal of Medicine, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs.
Exact numbers are hard to come by, but doctors involved in this movement, called “patient centered” practices, say its popularity is growing.
“I travel to a lot of medical conferences, and I’m meeting more and more doctors embarking on this path,” said Dr. L. Gordon Moore, who runs IdealMedicalPractices.org, a program to help small practices become more innovative and efficient. The Web site IdealMedicalHome.org has about 800 doctors who post and trade ideas, while more than 700 physicians have adopted methods from HowsYourHealth.org. Many of these doctors see fewer patients per day than they did before.
To make personalized care possible in an era when compensation is often tied to the number of patients they see, doctors use technology to streamline processes and reduce administrative costs. Dr. Batlle, for example, uses online appointment scheduling and manages his medical records electronically. He prescribes medications from his computer and offers virtual visits by phone and e-mail.
It cost Dr. Batlle about $25,000 to buy the technology to make all of this possible, but he estimates that he saves close to $100,000 a year in salaries and billing costs. And he has made enough money to begin renovations on a new office in Washington Heights in Manhattan.
The model seems to be working, according to a 2008 study by Dr. John H. Wasson at Dartmouth Medical School. His research showed that patients in patient-centered practices were more likely to say they were informed about how to manage chronic diseases and got the care they needed, compared with those in a national sample of medical practices. They also were less likely to say they had to wait for an appointment.
“If the goal is to deliver patient care when and how they want and need it, this is the way to go,” Dr. Wasson said.
Of course, even doctors in this movement acknowledge that it is not a panacea for the country’s health care problems. Privacy advocates warn that electronic patient records can be breached, and computer glitches can make patient records inaccessible for hours. Big clinics can be better for people who have several health problems and need easy access to a variety of specialists. Moreover, some doctors may not want to leave a big clinic because they feel they lack the technical or business skills they need — or because a salaried job there may be more stable in this economy.
And while the patient-centered movement is growing, the nation may not be able to afford to have all its primary care doctors reduce the number of patients they see. Across the country, primary care physicians are in short supply, in part because average salaries for family practitioners are the lowest of any medical specialty. According to a 2008 survey of physician salaries by the American Medical Group Association, their average annual salary is $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon.
“Medical school loans can be so high, you need to be a specialist to pay them back,” Dr. Batlle said. “But our country doesn’t need yet another sleep apnea specialist.”
LILI SACKS, a primary care doctor in Seattle, says she began thinking differently about her work on the day she realized she was beginning each appointment with the words, “Sorry I’m late.”
Scheduled to see as many as 25 patients a day at a large clinic, she lacked the time for thorough examinations and discussions. Because of this, she said, primary care doctors are often forced to order tests and send patients to specialists.
“Could I have helped some people without specialists and tests? Absolutely,” said Dr. Sacks. “Would it have saved the patient and the insurance company both money? Absolutely. Is the system set up for the best care and cost efficiency? Absolutely not.”
Dr. Sacks said she worried that seeing so many patients would lead to errors. Last year, she moved to a clinic that focuses on longer patient appointments, 30 to 60 minutes. This translates to 10 to 12 patients a day. Patients also communicate directly with her by phone or e-mail.
During those longer appointments, Dr. Sacks can perform basic lab tests and simple procedures, so patients see fewer specialists.
“I probably head off a handful of emergency-room visits and hospital stays every month because patients can see me as soon as they have a problem, and I can be thorough rather than rushed,” she said.
One patient who avoided the emergency room was Todd Martin, a store manager in Seattle who went to Dr. Sacks’s clinic on a Saturday.
“I couldn’t stop coughing and was having trouble breathing,” Mr. Martin said. “They were able to see me and give me a chest X-ray.”
Mr. Martin said he spent $40 for the resulting prescription but the rest was covered by a monthly fee he pays Dr. Sacks. “A weekend visit to the E.R. would have easily cost $1,000,” he said.
Dr. Sacks charges patients a direct monthly fee of $54 to $129 based on age, and she doesn’t take insurance. Her office calls its philosophy “direct practice” because it’s a direct contract between doctor and patient. But she advises patients to obtain insurance plans to cover large, unexpected health costs like those to treat cancer or a heart attack.
“We say it’s like having a car and paying for your own oil changes and tuneups, but getting insurance in case you need a big repair,” she said.
Dr. Garrison Bliss, who in 2007 founded the group where Dr. Sacks works, has offered direct-practice services since 1997. He says patients can save 15 to 40 percent of their medical costs by using this model, based on his examination of insurance rates and his belief that good primary care can fill most of a patient’s needs.
Insurance plans that cover every little thing can be very expensive, Dr. Bliss said. He said that a patient who paid an annual fee at his clinic and took out a higher-deductible insurance plan would usually come out ahead, even if the patient’s health needs meant that he or she had to pay the entire deductible.
Dr. Bliss’s office operates with just two administrative employees for seven doctors. He estimates that if he took insurance, one or two administrative workers would be needed per doctor.
Insurance administration costs can take a big bite out of a practice’s revenue. A recent Weill Cornell Medical College study found that a third of the money received by primary care physicians pays for interactions between a doctor’s practice and patients’ health plans.
Patricia Rogers Caroselli, a retired assistant principal who is a patient of Dr. Sacks, dreaded going to her former clinic. “The waiting room was always noisy and crowded,” she said. In the examining room, she felt that she should “get in and out and not waste the doctor’s time with questions,” she said.
In contrast, she said, she appreciates the friendly calm of Dr. Sacks’s new surroundings and the personal attention. “Everyone should have this kind of patient care,” she said.
Dr. Sacks said the financial mechanics of the direct-practice model match her medical goals. When she was compensated based on insurance, she was paid every time she saw a patient. Now, if she can use education and prevention to reduce office visits, she and her patients benefit, she said.
“Having more time to sit with each patient has made me a better doctor,” she said. “I had a disabled patient that I saw for 13 years. Until she came to my new clinic, I never had the time to learn the details of her accident and the resulting complications. I was always treating whatever the immediate concern was.”
TECHNOLOGY has helped many doctors reduce costs. Dr. Batlle says he has been building his arsenal of technology solutions one by one, with “lots of trial and error,” for eight years.
Recently, he saw a 52-year-old patient with hypertension. As he examined the patient, noting blood pressure and other vital signs, he entered the information into his laptop computer to add to the patient’s electronic medical record. He also typed in the codes for billing and insurance.
The patient wondered if he was due for a prescription refill, so Dr. Batlle checked his computer again, found that he was, and hit a button to send the refill request to the pharmacy. As the patient left, Dr. Batlle hit the keyboard to send the bill electronically to the insurance company.
“He’ll even go to the Web to schedule his follow-up appointment,” Dr. Batlle said. “I don’t pay a receptionist to sit and answer phones.”
Dr. Batlle says other doctors could outfit an office for less than the $25,000 he spent on technology.
“Most doctors think they need to hire two receptionists, a billing person and two nurses to run a primary care office,” he said. “But they can learn about these technologies from other doctors, and the software salespeople do some training.”
Some physicians hire consultants to find and install the right equipment. Doctors who want to switch to electronic health records may also receive financial support from the government through the stimulus package.
By using new technology and streamlining processes, small primary care practices can reduce their costs to half of what a typical practice pays, from about 60 percent of income down to 30 percent, Dr. Wasson said. He said that doctors who focus on reducing their costs can see fewer patients without sacrificing income. Dr. Sacks said she and her colleagues didn’t have to take a pay cut when they moved to Dr. Bliss’s practice.
As Congress and the Obama administration begin to focus more closely on health care, some primary care doctors are weighing in. Dr. Bliss, for instance, has been to Washington twice in the last month to share his ideas with legislators. He knows he’s in a debate with powerful voices, especially insurance companies and hospitals. So he and other doctors are encouraging patients to speak up as well.
“We need to bring the patients to the barricades with us,” Dr. Batlle says
Sunday, June 7, 2009
For China-U.S. Talks on Climate, Issues Old and New
For months the United States and China, by far the world’s two biggest emitters of greenhouse gases, have been warily circling each other in hopes of breaking a long impasse on global warming policy.
They are, as President Obama’s chief climate negotiator puts it, “the two gorillas in the room,” and if they do not reach some sort of truce, there is no chance of forging a meaningful international treaty in Copenhagen later this year to restrict emissions.
As a senior American team arrived in Beijing on Sunday for climate talks, the standoff was taking on the trappings of cold-war arms control negotiations, with gigatons of greenhouse gas emissions replacing megatons of nuclear might as a looming risk for people across the globe.
Both sides are demanding mutually assured reductions of emissions that are, in the current jargon, “measurable, verifiable and reportable.” In the background hover threats of massive retaliation in the form of tariffs or other trade barriers if one nation does not agree to ceilings on emissions.
“This is going to be one of the most complex diplomatic negotiations in the history of the world,” said Representative Edward J. Markey, Democrat of Massachusetts, the co-sponsor of an energy bill being debated in the House, who just returned from a week in China.
Many take the simple fact that the two nations, jointly responsible for more than 40 percent of the world’s greenhouse gas emissions, are even talking seriously to each other about the issue as a propitious sign after years of mutual distrust.
But there is cause for profound skepticism as well. The Chinese continue to resist mandatory ceilings on their emissions and are making financial and environmental demands on the United States that are political roadblocks.
The United States, despite optimistic words from the White House and Congress, has yet to enact any binding targets on greenhouse-gas emissions. The energy bill now before Congress proposes emissions targets that are far short of what China and other nations say they expect of the United States.
Compounding the difficulty is the fact that both countries are struggling economically and the Chinese and American publics appear far more interested in jobs than in tackling environmental problems, a task that would necessarily be costly.
The main product of the discussions with Beijing so far has therefore been agreement to hold more discussions.
Yet the clock is ticking. Only six months remain before the opening of United Nations-sponsored talks in Copenhagen to produce a climate change treaty to replace the 1997 Kyoto Protocol. Without the full participation of the United States and China, most negotiators believe that any agreement is doomed to fail. Congress and two American presidents refused to accept the Kyoto accord, which expires in 2012, because it imposed no pollution limits on China or other developing countries. The American refusal to ratify the treaty and the lack of participation by China and other developing nations have left the pact all but toothless.
“China may not be the alpha and omega of the international negotiations, but it is close,” said Todd D. Stern, the top American climate negotiator at the three-day talks in Beijing. “Certainly no deal will be possible if we don’t find a way forward with China.”
The Obama administration has pledged to be a leader in the talks that culminate in December in Copenhagen, although it is far from clear that Congress has the will to approve emissions targets and furnish enough aid to developing countries to satisfy the Europeans, Chinese, Indians, Brazilians and other major participants. Mr. Stern described the demands from China and other countries as “not serious,” and said the United States was “jumping as high as the political system will tolerate.”
As a measure of how far apart the two nations are, China says the United States should reduce its greenhouse gas emissions by 40 percent below 1990 levels by 2020. The bill before Congress, which could be further weakened, now calls for less than a 4 percent reduction over that period.
The Chinese have begun to consider a series of unilateral actions to reduce carbon dioxide emissions, stepping up production of renewable electricity and increasing the efficiency of their manufacturing, buildings and vehicles. But Beijing insists it will not sacrifice China’s economy to meet the demands of outsiders, particularly those in the developed world that are responsible for the vast majority of human-caused carbon dioxide already in the atmosphere.
“What they are saying right now is, ‘We can do a lot of things, but we don’t want to commit to any targets,’ ” said Jin Jiaman, executive director of the Global Environmental Institute, based in Beijing, which has helped pave the way for the current talks. “They want to preserve their right to develop.”
One of China’s senior climate negotiators, Su Wei, has said that although China will not accept absolute limits on its emissions, officials have begun to consider putting in place their own domestic targets to significantly reduce the carbon intensity of its heaviest-emitting industries. Under the current official five-year plan, China is trying to reduce the amount of energy emitted per unit of gross domestic product by approximately 20 percent by 2010, a goal it may or may not meet. Some experts question the accuracy of China’s official reports, and say it will be impossible to monitor the nation’s progress without a better system for tracking greenhouse gas pollution.
In a tough speech in Washington last week, Mr. Stern said that such modest reductions would do little to affect atmospheric concentrations of climate-altering gases. He also noted that China emitted four times as much carbon dioxide as the United States and six times as much as the European Union or Japan for every unit of gross domestic product.
“China and other developing countries do not need to take the same actions that developed countries are taking,” Mr. Stern said, “but they do need to take significant national actions that they commit to — internationally — that they quantify, and that are ambitious enough to be broadly consistent with the levels of science.”
The House speaker, Nancy Pelosi of California, who led a delegation of lawmakers to China at the end of May, said in an interview that she was hopeful about the dialogue between the two countries, but fearful that they would fall into the old trap of hiding behind each other.
“They told us if we’re not going to do something, they’re not going to do anything,” she said. “Some of the people we talked to there said we should do more. I think we should do more, too. But we all have to go down this path together.”
They are, as President Obama’s chief climate negotiator puts it, “the two gorillas in the room,” and if they do not reach some sort of truce, there is no chance of forging a meaningful international treaty in Copenhagen later this year to restrict emissions.
As a senior American team arrived in Beijing on Sunday for climate talks, the standoff was taking on the trappings of cold-war arms control negotiations, with gigatons of greenhouse gas emissions replacing megatons of nuclear might as a looming risk for people across the globe.
Both sides are demanding mutually assured reductions of emissions that are, in the current jargon, “measurable, verifiable and reportable.” In the background hover threats of massive retaliation in the form of tariffs or other trade barriers if one nation does not agree to ceilings on emissions.
“This is going to be one of the most complex diplomatic negotiations in the history of the world,” said Representative Edward J. Markey, Democrat of Massachusetts, the co-sponsor of an energy bill being debated in the House, who just returned from a week in China.
Many take the simple fact that the two nations, jointly responsible for more than 40 percent of the world’s greenhouse gas emissions, are even talking seriously to each other about the issue as a propitious sign after years of mutual distrust.
But there is cause for profound skepticism as well. The Chinese continue to resist mandatory ceilings on their emissions and are making financial and environmental demands on the United States that are political roadblocks.
The United States, despite optimistic words from the White House and Congress, has yet to enact any binding targets on greenhouse-gas emissions. The energy bill now before Congress proposes emissions targets that are far short of what China and other nations say they expect of the United States.
Compounding the difficulty is the fact that both countries are struggling economically and the Chinese and American publics appear far more interested in jobs than in tackling environmental problems, a task that would necessarily be costly.
The main product of the discussions with Beijing so far has therefore been agreement to hold more discussions.
Yet the clock is ticking. Only six months remain before the opening of United Nations-sponsored talks in Copenhagen to produce a climate change treaty to replace the 1997 Kyoto Protocol. Without the full participation of the United States and China, most negotiators believe that any agreement is doomed to fail. Congress and two American presidents refused to accept the Kyoto accord, which expires in 2012, because it imposed no pollution limits on China or other developing countries. The American refusal to ratify the treaty and the lack of participation by China and other developing nations have left the pact all but toothless.
“China may not be the alpha and omega of the international negotiations, but it is close,” said Todd D. Stern, the top American climate negotiator at the three-day talks in Beijing. “Certainly no deal will be possible if we don’t find a way forward with China.”
The Obama administration has pledged to be a leader in the talks that culminate in December in Copenhagen, although it is far from clear that Congress has the will to approve emissions targets and furnish enough aid to developing countries to satisfy the Europeans, Chinese, Indians, Brazilians and other major participants. Mr. Stern described the demands from China and other countries as “not serious,” and said the United States was “jumping as high as the political system will tolerate.”
As a measure of how far apart the two nations are, China says the United States should reduce its greenhouse gas emissions by 40 percent below 1990 levels by 2020. The bill before Congress, which could be further weakened, now calls for less than a 4 percent reduction over that period.
The Chinese have begun to consider a series of unilateral actions to reduce carbon dioxide emissions, stepping up production of renewable electricity and increasing the efficiency of their manufacturing, buildings and vehicles. But Beijing insists it will not sacrifice China’s economy to meet the demands of outsiders, particularly those in the developed world that are responsible for the vast majority of human-caused carbon dioxide already in the atmosphere.
“What they are saying right now is, ‘We can do a lot of things, but we don’t want to commit to any targets,’ ” said Jin Jiaman, executive director of the Global Environmental Institute, based in Beijing, which has helped pave the way for the current talks. “They want to preserve their right to develop.”
One of China’s senior climate negotiators, Su Wei, has said that although China will not accept absolute limits on its emissions, officials have begun to consider putting in place their own domestic targets to significantly reduce the carbon intensity of its heaviest-emitting industries. Under the current official five-year plan, China is trying to reduce the amount of energy emitted per unit of gross domestic product by approximately 20 percent by 2010, a goal it may or may not meet. Some experts question the accuracy of China’s official reports, and say it will be impossible to monitor the nation’s progress without a better system for tracking greenhouse gas pollution.
In a tough speech in Washington last week, Mr. Stern said that such modest reductions would do little to affect atmospheric concentrations of climate-altering gases. He also noted that China emitted four times as much carbon dioxide as the United States and six times as much as the European Union or Japan for every unit of gross domestic product.
“China and other developing countries do not need to take the same actions that developed countries are taking,” Mr. Stern said, “but they do need to take significant national actions that they commit to — internationally — that they quantify, and that are ambitious enough to be broadly consistent with the levels of science.”
The House speaker, Nancy Pelosi of California, who led a delegation of lawmakers to China at the end of May, said in an interview that she was hopeful about the dialogue between the two countries, but fearful that they would fall into the old trap of hiding behind each other.
“They told us if we’re not going to do something, they’re not going to do anything,” she said. “Some of the people we talked to there said we should do more. I think we should do more, too. But we all have to go down this path together.”
Strike ballot follows breakdown in foreign worker talks
More than 20,000 construction staff are to be balloted on industrial action by trade union leaders in an escalation of the row over the use of foreign workers.
Unite, the country's largest union, will start organising a poll of members at power stations and petrochemical sites tomorrow after a breakdown in talks with the Engineering Construction Industry Association.
Among the energy projects that could be hit by strikes are the South Hook liquefied natural gas terminal in Pembrokeshire, the Lindsey oil hub in Lincolnshire and the Stanlow refinery on Merseyside.
The bitter and growing argument over the use of foreign labour has led to a spate of unofficial strikes and walkouts as the recession produces increased fears about job security. The ballot shows unions are now putting their formal stamp on the dispute.
"Construction employers have rejected reasonable and just demands which would have delivered long-term stability and fairness in an industry that has been plagued by instability and numerous injustices," said Unite's national officer Tom Hardacre. "We now have no other choice but to ballot our members for official industrial action. A yes vote will disrupt many of the UK's major construction projects and petrochemical sites."
Unite is anxious not to be seen to be stoking up any racial tensions and denies the dispute is specifically about the use of foreign staff. It is merely an attempt to ensure fair play for everyone, regardless of nationality, the union says. Employers have claimed they have turned to Poles or other European staff only where they have been unable to hire locally.
Unite and the GMB union are convinced that many employers are deliberately taking advantage of recent European court judgments that appear to allow workers from across the European Union to be hired at different rates. Unite asked the Engineering Construction Industry Association to amend the national agreement to ensure equalisation of pay and benefits between local and foreign workers, but the two sides failed to agree.
The employers were not available for comment today, while the unions were pressing home their arguments. "The unions have set out to introduce a posted workers directive for the construction industry on the basis one has not been implemented properly in the UK," Hardacre said. "Instead employers are attempting to dilute a national agreement and turn it into a code of practice. With so much bad practice in the industry this approach from the employers beggars belief."
The failed attempt at national talks follows unofficial strike action last month by workers in GMB and Unite against the Dutch-based employer Hertel over the use of 40 Polish workers at South Hook, the Milford Haven oil terminal owned by ExxonMobil and Total of France.
Industrial action quickly spread to Aberthaw power station in the Vale of Glamorgan, then Fiddlers Ferry power station near Widnes in Cheshire and three other energy plants. Action was also planned at the Sellafield nuclear complex in Cumbria.
The conflict previously flared in January when foreign workers were brought in to work on the Lindsey oil terminal, which is also controlled by Total of France.
Paul Kenny, general secretary of the GMB, said at the time that though the South Hook dispute was resolved when Hertel withdrew the Polish contingent, the wider problem of undercutting national deals had not disappeared.
"Although we have been able to settle the dispute at Lindsey and South Hook, the problem has not gone away," he said. "We fear it will all flare up again because there are two jockeys on the horse."
There was no specific allegation at South Hook that the Poles were being paid less than local workers, just an accusation that local labour was being ignored. Hertel had always denied this, saying it had been unable to find qualified locals when it was first recruiting but has since been able to do so.
Unite, the country's largest union, will start organising a poll of members at power stations and petrochemical sites tomorrow after a breakdown in talks with the Engineering Construction Industry Association.
Among the energy projects that could be hit by strikes are the South Hook liquefied natural gas terminal in Pembrokeshire, the Lindsey oil hub in Lincolnshire and the Stanlow refinery on Merseyside.
The bitter and growing argument over the use of foreign labour has led to a spate of unofficial strikes and walkouts as the recession produces increased fears about job security. The ballot shows unions are now putting their formal stamp on the dispute.
"Construction employers have rejected reasonable and just demands which would have delivered long-term stability and fairness in an industry that has been plagued by instability and numerous injustices," said Unite's national officer Tom Hardacre. "We now have no other choice but to ballot our members for official industrial action. A yes vote will disrupt many of the UK's major construction projects and petrochemical sites."
Unite is anxious not to be seen to be stoking up any racial tensions and denies the dispute is specifically about the use of foreign staff. It is merely an attempt to ensure fair play for everyone, regardless of nationality, the union says. Employers have claimed they have turned to Poles or other European staff only where they have been unable to hire locally.
Unite and the GMB union are convinced that many employers are deliberately taking advantage of recent European court judgments that appear to allow workers from across the European Union to be hired at different rates. Unite asked the Engineering Construction Industry Association to amend the national agreement to ensure equalisation of pay and benefits between local and foreign workers, but the two sides failed to agree.
The employers were not available for comment today, while the unions were pressing home their arguments. "The unions have set out to introduce a posted workers directive for the construction industry on the basis one has not been implemented properly in the UK," Hardacre said. "Instead employers are attempting to dilute a national agreement and turn it into a code of practice. With so much bad practice in the industry this approach from the employers beggars belief."
The failed attempt at national talks follows unofficial strike action last month by workers in GMB and Unite against the Dutch-based employer Hertel over the use of 40 Polish workers at South Hook, the Milford Haven oil terminal owned by ExxonMobil and Total of France.
Industrial action quickly spread to Aberthaw power station in the Vale of Glamorgan, then Fiddlers Ferry power station near Widnes in Cheshire and three other energy plants. Action was also planned at the Sellafield nuclear complex in Cumbria.
The conflict previously flared in January when foreign workers were brought in to work on the Lindsey oil terminal, which is also controlled by Total of France.
Paul Kenny, general secretary of the GMB, said at the time that though the South Hook dispute was resolved when Hertel withdrew the Polish contingent, the wider problem of undercutting national deals had not disappeared.
"Although we have been able to settle the dispute at Lindsey and South Hook, the problem has not gone away," he said. "We fear it will all flare up again because there are two jockeys on the horse."
There was no specific allegation at South Hook that the Poles were being paid less than local workers, just an accusation that local labour was being ignored. Hertel had always denied this, saying it had been unable to find qualified locals when it was first recruiting but has since been able to do so.
Levy on international air travel could fund climate change fight
Britain and other rich countries will be asked to accept a compulsory levy on international flight tickets and shipping fuel to raise billions of dollars to help the world's poorest countries adapt to combat climate change.
The suggestions come at the start of the second week in the latest round of UN climate talks in Bonn, where 192 countries are starting to negotiate a global agreement to limit and then reduce greenhouse gas emissions. The issue of funding for adaptation is critical to success but the hardest to agree.
The aviation levy, which is expected to increase the price of long-haul fares by less than 1%, would raise $10bn (£6.25bn) a year, it is said.
It has been proposed by the world's 50 least developed countries. It could be matched by a compulsory surcharge on all international shipping fuel, said Connie Hedegaard, the Danish environment and energy minister who will host the final UN climate summit in December.
"People are beginning to understand that innovative ideas could generate a lot of money. The Danish shipping industry, which is one of the world's largest, has said a that truly global system would work well. Denmark would endorse it," said Hedegaard.
In Bonn last week, a separate Mexican proposal to raise billions of dollars was gaining ground. The idea, known as the "green fund" plan, would oblige all countries to pay amounts according to a formula reflecting the size of their economy, their greenhouse gas emissions and the country's population. That could ensure that rich countries, which have the longest history of using of fossil fuels, pay the most to the fund.
Recently, the proposal won praise from 17 major-economy countries meeting in Paris as a possible mechanism to help finance a UN pact. The US special envoy for climate change, Todd Stern, called it "highly constructive".
The Bonn meeting is the first climate meeting at which countries are discussing texts. These cover greenhouse gas reduction and financing developing countries' efforts to combat climate change.
Analysts said last night that the talks were most likely to stall over money. Developing countries, backed by the UN, argue that they will need hundreds of billions of dollars a year to adapt themselves to climate-related disasters, loss of crops and water supplies, which they are already experiencing as temperatures around the world rise. Yet so far, as a Guardian investigation revealed back in February, rich countries have pledged only a few billion dollars and have provided only a few hundred million.
"Developing countries will no longer let themselves be sidelined. In the past, they have been brought on board [climate negotiations] by promises of financial support. But all they got was the creation of a couple of funds that stayed empty. Developing countries will not settle for more 'placebo funds'," said Benito Müller, director of Oxford University's institute for energy studies.
Saleemul Huq, of the International Institute for Environment and Development, said that until rich countries made serious pledges, the rest of the negotiations would suffer because it would be impossible to agree actions without knowing how they would be funded.
Last week, a US negotiator, Jonathan Pershing, said that the US had budgeted $400m to help poor countries adapt to climate change as an interim measure. But that amount was dismissed as inadequate by Bernarditas Muller of the Philippines, who is the co-ordinator of the G77 and China group of countries.
The suggestions come at the start of the second week in the latest round of UN climate talks in Bonn, where 192 countries are starting to negotiate a global agreement to limit and then reduce greenhouse gas emissions. The issue of funding for adaptation is critical to success but the hardest to agree.
The aviation levy, which is expected to increase the price of long-haul fares by less than 1%, would raise $10bn (£6.25bn) a year, it is said.
It has been proposed by the world's 50 least developed countries. It could be matched by a compulsory surcharge on all international shipping fuel, said Connie Hedegaard, the Danish environment and energy minister who will host the final UN climate summit in December.
"People are beginning to understand that innovative ideas could generate a lot of money. The Danish shipping industry, which is one of the world's largest, has said a that truly global system would work well. Denmark would endorse it," said Hedegaard.
In Bonn last week, a separate Mexican proposal to raise billions of dollars was gaining ground. The idea, known as the "green fund" plan, would oblige all countries to pay amounts according to a formula reflecting the size of their economy, their greenhouse gas emissions and the country's population. That could ensure that rich countries, which have the longest history of using of fossil fuels, pay the most to the fund.
Recently, the proposal won praise from 17 major-economy countries meeting in Paris as a possible mechanism to help finance a UN pact. The US special envoy for climate change, Todd Stern, called it "highly constructive".
The Bonn meeting is the first climate meeting at which countries are discussing texts. These cover greenhouse gas reduction and financing developing countries' efforts to combat climate change.
Analysts said last night that the talks were most likely to stall over money. Developing countries, backed by the UN, argue that they will need hundreds of billions of dollars a year to adapt themselves to climate-related disasters, loss of crops and water supplies, which they are already experiencing as temperatures around the world rise. Yet so far, as a Guardian investigation revealed back in February, rich countries have pledged only a few billion dollars and have provided only a few hundred million.
"Developing countries will no longer let themselves be sidelined. In the past, they have been brought on board [climate negotiations] by promises of financial support. But all they got was the creation of a couple of funds that stayed empty. Developing countries will not settle for more 'placebo funds'," said Benito Müller, director of Oxford University's institute for energy studies.
Saleemul Huq, of the International Institute for Environment and Development, said that until rich countries made serious pledges, the rest of the negotiations would suffer because it would be impossible to agree actions without knowing how they would be funded.
Last week, a US negotiator, Jonathan Pershing, said that the US had budgeted $400m to help poor countries adapt to climate change as an interim measure. But that amount was dismissed as inadequate by Bernarditas Muller of the Philippines, who is the co-ordinator of the G77 and China group of countries.
Gordon Brown faces leadership battle as Labour suffers European elections battering
Gordon Brown today faces a make or break challenge to his leadership after Labour looked set to slump to just 16% of the national vote in the European elections.
The far-right British National party won its first ever seat in Europe, and the Conservatives topped the polls in Wales.
Another dismal night for Labour saw it pushed into fourth and sometimes fifth place across large swaths of the country.
Early projections suggested the Conservatives would come first, with just under 30% of the vote, the United Kingdom Independence party second, with around 20%, and Labour and the Liberal Democrats would battle it out for third and fourth place.
The BNP won 10% of the vote – more than 120,000 votes – in Yorkshire and the Humber, giving it its first ever foothold in the European parliament. In Wales, Labour lost 12% of the vote, allowing the Conservatives to emerge as the overall winners for the first time since 1918.
In the North East, the first UK region to declare, the state of the parties remained the same, with one seat going to Labour, one to the Conservatives and one to the Liberal Democrats.
Labour's share of the vote was down 9%, the Tories were up 1% and the Lib Dems saw no change.
The state of the parties also remained static in the East of England, with the Conservatives returning three MEPs, Ukip two and Labour and the Lib Dems one each.
However, Labour's share of the vote was down 6%.
Harriet Harman, the Labour deputy leader, described tonight's results as "dismal" for the party, which was pushed into fifth place in the South East with half the votes counted.
Official EU projections indicated that the centre-right parties would emerge as the largest grouping in the European parliament.
Hours before the crucial Euro results were due to be announced, Brown's hopes of survival suffered a further setback when the former lord chancellor, Lord Falconer, became the most senior figure yet to call for a leadership contest.
The peer – once Tony Blair's flatmate – warned that potential candidates were waiting in the wings, ready to mount a challenge, if Brown was not prepared to stand down as prime minister.
Meanwhile, Tessa Jowell became the first member of the cabinet to speculate openly that Brown could be prepared to step aside if he believed he had become an "obstacle" to Labour winning the next general election.
If Labour were to end up coming fourth behind the Liberal Democrats, it could be the catalyst for plotters behind the so-called "peasants' revolt" to show their hand when MPs return to Westminster tomorrow.
Brown sought to rally support with a televised address to a hastily arranged gathering of sympathetic Labour party activists in east London earlier today.
He said the public would not understand if the government gave up at a time when it was faced with tackling the recession and cleaning up parliament.
"What would they think of us if ever we walked away from them at a time of need? We are sticking with them," he said.
"We have a purpose, we have a mission, we have a task ahead. We are going to get on with that task of building a better Britain."
Falconer's call for a leadership contest was swiftly rejected by the newly promoted home secretary, Alan Johnson, who is widely regarded as the most likely successor to Brown if the prime minister is ousted.
"I don't agree that regicide gives you a unified party," he told the Politics Show. "I think that Gordon Brown is the best man for the job."
Earlier, the business secretary, Lord Mandelson, cast doubt on the ability of the plotters to put up a credible candidate against Brown.
"It would require somebody to stand against him, somebody who is raising their standard and saying that they could do a better job ... we don't have that person," he said.
He told rebels to "stop taking shots" at the prime minister and warned that they faced the prospect of having to fight an immediate general election if Brown went.
However, Nick Raynsford, another former minister who has been calling on Brown to stand down, said the party could not carry on as it was.
The flashpoint could come as soon as tomorrow's weekly meeting of the parliamentary Labour party at Westminster, when Brown is expected to address his backbench MPs.
It will be followed almost immediately afterwards by a debate on Labour's future, addressed by the former Europe minister Caroline Flint – who resigned from the government on Friday – and the arch-Blairite Stephen Byers.
The far-right British National party won its first ever seat in Europe, and the Conservatives topped the polls in Wales.
Another dismal night for Labour saw it pushed into fourth and sometimes fifth place across large swaths of the country.
Early projections suggested the Conservatives would come first, with just under 30% of the vote, the United Kingdom Independence party second, with around 20%, and Labour and the Liberal Democrats would battle it out for third and fourth place.
The BNP won 10% of the vote – more than 120,000 votes – in Yorkshire and the Humber, giving it its first ever foothold in the European parliament. In Wales, Labour lost 12% of the vote, allowing the Conservatives to emerge as the overall winners for the first time since 1918.
In the North East, the first UK region to declare, the state of the parties remained the same, with one seat going to Labour, one to the Conservatives and one to the Liberal Democrats.
Labour's share of the vote was down 9%, the Tories were up 1% and the Lib Dems saw no change.
The state of the parties also remained static in the East of England, with the Conservatives returning three MEPs, Ukip two and Labour and the Lib Dems one each.
However, Labour's share of the vote was down 6%.
Harriet Harman, the Labour deputy leader, described tonight's results as "dismal" for the party, which was pushed into fifth place in the South East with half the votes counted.
Official EU projections indicated that the centre-right parties would emerge as the largest grouping in the European parliament.
Hours before the crucial Euro results were due to be announced, Brown's hopes of survival suffered a further setback when the former lord chancellor, Lord Falconer, became the most senior figure yet to call for a leadership contest.
The peer – once Tony Blair's flatmate – warned that potential candidates were waiting in the wings, ready to mount a challenge, if Brown was not prepared to stand down as prime minister.
Meanwhile, Tessa Jowell became the first member of the cabinet to speculate openly that Brown could be prepared to step aside if he believed he had become an "obstacle" to Labour winning the next general election.
If Labour were to end up coming fourth behind the Liberal Democrats, it could be the catalyst for plotters behind the so-called "peasants' revolt" to show their hand when MPs return to Westminster tomorrow.
Brown sought to rally support with a televised address to a hastily arranged gathering of sympathetic Labour party activists in east London earlier today.
He said the public would not understand if the government gave up at a time when it was faced with tackling the recession and cleaning up parliament.
"What would they think of us if ever we walked away from them at a time of need? We are sticking with them," he said.
"We have a purpose, we have a mission, we have a task ahead. We are going to get on with that task of building a better Britain."
Falconer's call for a leadership contest was swiftly rejected by the newly promoted home secretary, Alan Johnson, who is widely regarded as the most likely successor to Brown if the prime minister is ousted.
"I don't agree that regicide gives you a unified party," he told the Politics Show. "I think that Gordon Brown is the best man for the job."
Earlier, the business secretary, Lord Mandelson, cast doubt on the ability of the plotters to put up a credible candidate against Brown.
"It would require somebody to stand against him, somebody who is raising their standard and saying that they could do a better job ... we don't have that person," he said.
He told rebels to "stop taking shots" at the prime minister and warned that they faced the prospect of having to fight an immediate general election if Brown went.
However, Nick Raynsford, another former minister who has been calling on Brown to stand down, said the party could not carry on as it was.
The flashpoint could come as soon as tomorrow's weekly meeting of the parliamentary Labour party at Westminster, when Brown is expected to address his backbench MPs.
It will be followed almost immediately afterwards by a debate on Labour's future, addressed by the former Europe minister Caroline Flint – who resigned from the government on Friday – and the arch-Blairite Stephen Byers.
Early rocks to reveal their ages
A new technique has been helping scientists piece together how the Earth's continents were arranged 2.5 billion years ago.
The novel method allows scientists to recover rare minerals from rocks.
By analysing the composition of these minerals, researchers can precisely date ancient volcanic rocks for the first time.
By aligning rocks that have a similar age and orientation, the early landmasses can be pieced together.
This will aid the discovery of rocks rich in ore and oil deposits, say the scientists. The approach has already shown that Canada once bordered Zimbabwe, helping the mining industry identify new areas for exploration.
Dr Wouter Bleeker, from the Geological Survey of Canada, explained that much of the geology that exists today formed around 300 million years ago when the supercontinent Pangea existed.
"We really don't understand the [Earth's] history prior to Pangea," he told a recent meeting of the American Geophysical Union in Toronto.
Early landmasses
Analysis of rocks that formed when continents drifted apart can help geologists reconstruct early landmasses.
Dr Richard Ernst, a geologist from the University of Ottawa, explained that molten magma fills the cracks formed by shifting continental plates.
The magma cools to form long veins of basalt - a volcanic rock - that has a "distinct magnetic signature" revealing the rock's orientation and latitude when it formed.
By combining this "magnetic signature" with the ages of these rocks, researchers can tell whether rocks on different continents were once part of the same volcanic up-welling.
But until now, researchers have been unable to determine the ages of many of these ancient rocks because of the difficulty in extracting the minerals used to date them.
The researchers are dealing with such small mineral crystals - typically much less than 100 microns long - that grains are far smaller than the width of a human hair.
But with the development of new techniques, minerals - such as baddeleyite - can now be successfully recovered.
Baddeleyite is useful because it incorporates large amounts of uranium into its crystal-structure, and because uranium naturally decays to lead.
Scientists also know the rate at which this happens, so they can use these minerals as radioactive "clocks".
They then need to measure the amounts of uranium and lead very precisely.
In a large, international project, researchers hope to collect and date 250 rocks from around the world, and use this information to reconstruct how these continental fragments were once together to form giant landmasses that existed 2.5 billion years ago.
The novel method allows scientists to recover rare minerals from rocks.
By analysing the composition of these minerals, researchers can precisely date ancient volcanic rocks for the first time.
By aligning rocks that have a similar age and orientation, the early landmasses can be pieced together.
This will aid the discovery of rocks rich in ore and oil deposits, say the scientists. The approach has already shown that Canada once bordered Zimbabwe, helping the mining industry identify new areas for exploration.
Dr Wouter Bleeker, from the Geological Survey of Canada, explained that much of the geology that exists today formed around 300 million years ago when the supercontinent Pangea existed.
"We really don't understand the [Earth's] history prior to Pangea," he told a recent meeting of the American Geophysical Union in Toronto.
Early landmasses
Analysis of rocks that formed when continents drifted apart can help geologists reconstruct early landmasses.
Dr Richard Ernst, a geologist from the University of Ottawa, explained that molten magma fills the cracks formed by shifting continental plates.
The magma cools to form long veins of basalt - a volcanic rock - that has a "distinct magnetic signature" revealing the rock's orientation and latitude when it formed.
By combining this "magnetic signature" with the ages of these rocks, researchers can tell whether rocks on different continents were once part of the same volcanic up-welling.
But until now, researchers have been unable to determine the ages of many of these ancient rocks because of the difficulty in extracting the minerals used to date them.
The researchers are dealing with such small mineral crystals - typically much less than 100 microns long - that grains are far smaller than the width of a human hair.
But with the development of new techniques, minerals - such as baddeleyite - can now be successfully recovered.
Baddeleyite is useful because it incorporates large amounts of uranium into its crystal-structure, and because uranium naturally decays to lead.
Scientists also know the rate at which this happens, so they can use these minerals as radioactive "clocks".
They then need to measure the amounts of uranium and lead very precisely.
In a large, international project, researchers hope to collect and date 250 rocks from around the world, and use this information to reconstruct how these continental fragments were once together to form giant landmasses that existed 2.5 billion years ago.
Tourist clings to Australia train
A teenaged American tourist says he spent two hours clinging to the side of a long-distance train as it sped across the Australian outback in the night.
Chad Vance said he had to leap onto The Ghan as it left the station at Port Augusta, South Australia, after he had disembarked during a 40-minute stop.
He became cold and tired as the train reached speeds of up to 110km/h (68mph) on the journey to Alice Springs.
Engineer Marty Wells finally heard his yells and applied the emergency brake.
Mr Vance, quoted in the Herald Sun, said: "I feel very lucky to be alive."
'Instinctive' reaction
He thought he had timed his return to the station accurately, but as the train pulled away he ran after it along the tracks.
When it stopped soon afterwards, he said he spent five minutes trying to attract the attention of passengers on board by shouting and banging the windows.
People were looking at me but did nothing," he said.
With his luggage and passport on board, he decided to grab a handrail in a stairwell.
"Call it instinct, but I just went for it and I didn't even consider if I would be in any trouble."
Dressed in jeans, a T-shirt and boots, Mr Vance, 19, said he was worried "my hands would get so cold and numb that I might lose my grip and fall off".
After two hours, he saw one staff member inside and started banging and yelling.
"He heard me, but he didn't know where the noise was coming from, I could see him walking around and looking for me inside the train.
"He alerted other staff members but they couldn't find me either - I guess they didn't think someone could actually be outside the train!"
Describing the situation as "real scary", Mr Vance said he was relieved when ten minutes later Mr Wells spotted him and pulled the emergency brake.
"Marty was absolutely a life saver, he was amazing, I could have died without his help."
Mr Wells agreed.
"When we rescued him his skin was white and his lips were blue.
"We were still about three hours away from our next scheduled stop and in that time he could easily have died of hypothermia or lost his grip and fallen to his death," he was quoted as saying in the Sunday Territorian.
Mr Vance said he had not told his parents about the train escapade "because I don't want them to worry about me while I'm away."
The Ghan travels from Adelaide, Alice Springs and Darwin, taking two nights to cover 2,979km.
Chad Vance said he had to leap onto The Ghan as it left the station at Port Augusta, South Australia, after he had disembarked during a 40-minute stop.
He became cold and tired as the train reached speeds of up to 110km/h (68mph) on the journey to Alice Springs.
Engineer Marty Wells finally heard his yells and applied the emergency brake.
Mr Vance, quoted in the Herald Sun, said: "I feel very lucky to be alive."
'Instinctive' reaction
He thought he had timed his return to the station accurately, but as the train pulled away he ran after it along the tracks.
When it stopped soon afterwards, he said he spent five minutes trying to attract the attention of passengers on board by shouting and banging the windows.
People were looking at me but did nothing," he said.
With his luggage and passport on board, he decided to grab a handrail in a stairwell.
"Call it instinct, but I just went for it and I didn't even consider if I would be in any trouble."
Dressed in jeans, a T-shirt and boots, Mr Vance, 19, said he was worried "my hands would get so cold and numb that I might lose my grip and fall off".
After two hours, he saw one staff member inside and started banging and yelling.
"He heard me, but he didn't know where the noise was coming from, I could see him walking around and looking for me inside the train.
"He alerted other staff members but they couldn't find me either - I guess they didn't think someone could actually be outside the train!"
Describing the situation as "real scary", Mr Vance said he was relieved when ten minutes later Mr Wells spotted him and pulled the emergency brake.
"Marty was absolutely a life saver, he was amazing, I could have died without his help."
Mr Wells agreed.
"When we rescued him his skin was white and his lips were blue.
"We were still about three hours away from our next scheduled stop and in that time he could easily have died of hypothermia or lost his grip and fallen to his death," he was quoted as saying in the Sunday Territorian.
Mr Vance said he had not told his parents about the train escapade "because I don't want them to worry about me while I'm away."
The Ghan travels from Adelaide, Alice Springs and Darwin, taking two nights to cover 2,979km.
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