Obama Rally on November 4th Essay Example | Topics and Well Written Essays - 500 words

Obama Rally on November 4th - Essay Example For sure, the likes of this campaign are such that they will probably never be repeated in history. Over $600 million dollars was spent by President-Elect Obama in his bid for the White House. However, his decision not to take public financing paid off. The fact that he counted on three million donors who gave an average of $86 dollars, mainly on the Internet-accounted for most of his war chest. This allowed him to outspend his rival, Sen. John McCain. In doing so, he was able to be more competitive in traditionally Republican-voting "red" states such as Florida, Virginia, Indiana, and North Carolina, Colorado, and New Mexico-which Obama won handily. The other, but more important historical factor of note is that we will have, for the first time in the history of our nation, an African-American President. This is significant for a number of reasons. The struggle that many black leaders have encountered over the years in the Civil Rights Movement, and the sacrifices that some gave wit h their lives, including Dr. King, Jr., and Medgar Evers, for example-are testaments to the many difficulties that African-Americans have suffered through the years, for the right to vote, for the rights to live in a desegregated society, and the right to live lives of dignity within their own communities. President-Elect Obama's speech encapsulated a heaviness as well, as it was a somber speech.

Declining Fish Stocks in Oceans Essay Example for Free

Declining Fish Stocks in Oceans Essay There is an inherent ocean fish stocks decline causing sustainability to be at risk. Specifically, there have been a notable decrease in â€Å"Atlantic cod stock off Newfoundland in 1992 and the poor state of the southern bluefin tuna stocks in the Southern ocean. † (Williams, 2005) This problem on declining fish stocks is a predicament that goes mainly with a growing human population together with many other factors. If the trend continues, where the population constantly grows and the oceans’ size remain the same, the fish population and fish supply can be totally consumed by humans and sustainability would not exist. This means that in the long-run, not only the fish risks of being extinct and depleted but humans as well when there would be lesser food to it. II. Living and Non-Living Organisms Causing the Problem The decline in the fish supply or stocks of fish in the ocean, or in any other bodies of water are brought about by many factors. These factors however, can be both independent or dependent of each other. This means that one factor might lead to another factor and so on. However, as previously mentioned, the first cause is the growing human population. Aside from food consumption in the form of fishing, other ocean activities that are not directly related to fish consumption are nowadays possible and actually ongoing due to growing human existence. These are the activities that disturbs and/or destroys fish habitats in the ocean as well as damaging the ocean itself preventing fishes to multiply or reproduce normally. Following are the factors, both direct and indirect, both dependent and independent that cause a decline in fish stocks in the ocean: a. ) the growing population with growing demand on food consumption; b. ) a greater demand for transferring from traditional small-scale fishing to commercialized large ocean vessel fishing; c. ) a growing move from coastal waters fishing into fishing from international bodies of water; d. ) lack of time for various fish species to hatch and breed due to continuous catching/fishing; e. ) growing human activities both from other bodies of water and in the oceans itself where toxics and pollutants are involved and disturbance of the habitat of the fish in the ocean are caused by these human activities such as ocean floor exploration, oil rigging, etc. ; f. ) Other natural factors such as natural predator-prey process, where the fishes are preys to other ocean organisms coupled by natural calamities and natural causes that result to fishes’ deaths such as global warming, etc. III. Living and Non-Living Organisms Affected by the Problem The reason why humans must be concerned about the declining fish stocks in the ocean is due to the fact that humanity is also at stake when sustainability in fish supplies cannot be attained. The most obvious of these reasons is on food supply. However, the problem does not stop there when and if ever fish supply would be depleted. Other stakeholders affected by the problem on declining fish stocks in the ocean include the environment and the ecosystems themselves and if there would be not enough fish, the balance of life forms in the ocean would be destroyed. As previously mentioned, one problem causes another and in this way, calamities can be expected to happen and it can be said that without fishes and other organisms and when a lot creatures dying in it, a body of water can be a â€Å"dead body of water† or, in case of the oceans, a â€Å"dead ocean†. IV. Positive and/or Negative Human Impacts With a strict judgment, it is difficult to say that a declining fish stock in the ocean will result to any positive effect to humans. Aside from lack of food supply, or difficulty of hunting for fish, the problem leads to expensive fish products and suffering health. Reciprocally, so far humans are only causing negative effects to the ocean and they are the main cause of declining fish stocks in there, be it a direct or indirect cause. With a growing human population, everything happens, from overfishing to water pollution, to water and ocean floor exploration leading to fish habitat destruction or demolition, to other environment balance destruction leading to global warming and other nature abuse or excesses. Global warming affect fish supply because Even though the effect of humans to fish stocks are negative, a move to lessen it in order to attain sustainability in terms of fish supply would improve the current situation. This however, involves a lot of sacrifice and discipline in the part of the humanity but in the long-run, it will be a big benefit as to human existence itself. V. Evaluation of Current Sustainability Strategies and Solutions The overall goal of any current or future sustainability strategies and solutions is, naturally, for sustainable fishing. Sustainable fishing looks at the long-term and overall fishing activity and tries to maintain the stocks of fish wherein the future generation can have their own share in the entire fish supply the ocean and other bodies of water offer. To evaluate the current strategies and solutions geared toward sustainability, it is first important to note some of them. One of the existing strategies is the implemented 1976 Magnuson-Stevens Fishery to be unpredictable whether it would make relaxed enforcement of annual catch limits for each fishery or impose strict limits. (Senate Entwined in Debate, 2006, p. A02) Thus, the total control is on the side of the implementing body which is the government. The public however has the right to criticize it and be vocal if it is too lax in its imposition. Another good strategy in the process is the individual fishing quota (IFQ) system that limit fishing operations by allocating the total allowable catch to participants based on historical catch and fishing effort (Sanchirico Hanna, 2004) In fact, this is a brilliant idea only if implemented strictly. Overall, the existing strategies have noble intentions with them. The only problem is on the implementation side. VI. Plan to Reach Sustainability Since it is easier said than done, a plan is easy to make. It is however, very important to practice what is planned to actually reach sustainability. A mere plan is not enough but the implementation is the most important aspect of attaining the aim of having sustainable fishing. The following plans to reach sustainability may or may not be in existence already. The plan would involve fishing that is not solely reliant from the ocean but as well as in other bodies of water or even inland. This means that fish farms and fish ponds would be developed all throughout every nation. Government promotion and support in each country is very essential in attaining this project. Aside from funding, the governing body of a country/nation as well needs to deal with the existing fishing companies who have already invested much to sail their fishing ships in the depths of the ocean for greater catch and for greater chunks of fishy profits. This also includes providing incentives to those who are dedicated in making the project successful. Setting quotas/limits to ocean fishing large vessels owned by commercial companies would be part of the plan. This would lead to discouragement of excesses in fishing by levying very expensive fines and taxes if the mentioned quotas or limits would be surpassed. Although penalties are on the punitive side of the plan and not on the preventive side, it is still useful to enforce penalties, stricter and harsher ones, to poaching fishing vessels who fish and violates and cross some fishing boundaries in the international context is also part of the plan. Moreover, the plan includes massive public information dissemination as to the future effect if fish supply would be depleted and encouraging the public to boycott any brand or any company that violates the rules on sustainable fishing or any company that pollutes the ocean causing fishes to die or companies that are greatly hindering fishes’ reproduction process. Lastly and more importantly, the public must know that the main stakeholders as to the availability of fish, which is at risk if drastic disciplines on fishing and other ocean activities would not be imposed, are human beings. The general public, or the humanity of this earth must be aware that without fish, it is them that will suffer the most and that educating them to prevent this harsh happening is to make positive actions and be disciplined so that the aim for sustainable fishing would be attained. Moreover, humans should be educated that fish supply depletion means hunger, health crisis and in the long-run, can as well result to human depletion! VII. Benefits and Challenges of the Plan As to the benefits of the plan, there is none unless it is fully implemented. The benefits start to take effect right after such plans are strictly implemented in many countries in the world. This means that right after such implementation, the following may take into view: a. ) a disciplined and sustainable approach to fishing; b. ) an educated and well aware public that helps to the attainment of the goal which is sustainable fishing; c. ) restoration of fish stocks in the ocean for they could start to hatch and breed normally and naturally; d. ) a cleaner and calmer ocean where balance is maintained; e. ) a sustainable fishing is attained; and more importantly f. ) humans would be at ease in terms of fish/food supply with reasonable prices, healthy catch, a continuous supply and fish meals that are life and health supporting. A sustainable human existence starts here as well. Naturally, the plan is not as smooth as anyone can wish it could be. It will be full of challenges and difficulties as to the attainment of its goal. It would be difficult to implement considering the selfishness of humans. Funding would not be easy to find and produce as to the plan of giving incentives to those who make coastal and inland fish farms and ponds. Additionally, each person in the government have their own sets of constituents and more often than not, they are more afraid to hurt the financing constituents such as the owners of large commercial fishing ships and fishing and fish processing companies than to be more concerned about declining fish supplies. Nowadays, profit maximizations seems to be the biggest goal of the majority and very little notice the suffering nature. A plan to have sustainable fishing would be far buried to the current issues that always make their way to be sensational. These include the issues on war and peace processes, terrorism, hunger, scandals, and political issues, among others. Lucky enough when environmental concerns get noticed without something bad, such as calamities happening and hurting a lot of people. Humans are such selfish beings and even though lessons are already sent their way, they still find it difficult to take care of nature, even for their own ends. VIII. Required Government, Societal and Global Support The move to have sustainable fishing would never be successful, or, would not even start without the initiative and leadership of the government. In the first place, any rules and laws regarding fishing starts in the congress or the legislative body. The same is true with the desired implementation of such rules where government bodies are, again, the major role players, such as in the case of coast guards and ocean police. Moreover, the funding starts with the government. Although there might be concerned groups making donations and a lot of volunteering, the main tasks are still laid out in the hands of the government to look for enough funds to encourage the public. The government has also the power to run ads or public notices in various media entities encouraging the public to help reach the goal. The public or the society on the other hand, are required to give their full cooperation when it comes to the success of a certain government projects. Without societies’ support and cooperation, the government cannot make it alone. In this case, the government may offer large amount for developing inland fish ponds but there are times that the public are simply uninterested or simply take the things for granted, receive the funds and do not work for the purpose the fund should be spent at. This can happen when the public is aware that the government is too loose on its policies, too corrupt, too desperate or too helpless. Finally, the global community is the extension of each little society. The same support is required towards their corresponding government but globally, governments of each countries may not agree themselves. In this case, their own cooperation is also required. There are a lot of cases where fishing vessels of another country poaches from the oceans of another territory. Thus, only if selfishness is set aside this plan to have sustainable fishing can be attained. Globally, this would be a great challenge because in many ways, countries are found to be not in agreement with each other especially because fishing on the high seas was a feature of societies long before large areas of the worlds seas were claimed by nation states. (Williams, 2005) In fact wars are happening spending lives when countries disagree with each other. Thus, it would be a great wish to enable each country to unite for the survival of humanity through sustainable agriculture, sustainable development, sustainable fishing and the rest of human activities to be sustainable. Everyone have their own purposes, selfish motives and plans. There is still hope though. This happens when humanity is faced with unforgettable lessons with regards to taking care of nature at their own risks!

Role Expansion of Support Staff in the NHS

Role Expansion of Support Staff in the NHS Abstract In this dissertation we examine the various aspects of role expansion of support staff within the confines of the NHS. We consider it on both a broad front and also make specific examination of those issues that concern staff connected with the operating theatres. We consider the background and political pressures that make role expansion desirable and possible. We also consider the implications of expansion in the NHS on both a professional and practical level. The issues are discussed in both specific and general terms. We illustrate three types of role expansion by reference to specific professional examples. One example is of the expansion from a caring role to that of the specialist provider, the second can be considered an example of role extension within a professional setting and the third is a natural expansion of the role which is required as technology and practice evolve. Methodology The methodology of this exploration was primarily by literature research. Progressive lines of enquiry were identified, researched and recorded. New lines of enquiry were identified as research progressed, and these were also examined for relevance and researched if considered appropriate to the theme of the dissertation. The literature search was mainly from library facilities. Local University, Post-Graduate hospital and public library facilities were extensively used together with some Internet based investigation. Some personal email enquiries were made from individuals who had experienced professional expansion and advice was taken in regard to both literature and direction of research. Introduction There is little doubt that the role of support staff has changed within the working lifetime of professionals currently working in the NHS. The thrust of this dissertation is to examine the means, the mechanisms and the degrees by which their role has changed. It barely needs stating that the NHS has changed. The political climate in which it operates has seen the NHS occupy varying positions of political prominence. Politicians are frequently seen publicly promising various sums of money for various projects of modernisation, expansion or generally to improve services. Every so often there is a major structural realignment of the management focus and mechanisms which, inevitably percolate through the tiers of control until the changes are felt at the level of the worker. In addition to this there are the technological changes which are largely independent of the politicians and the management structure. The rate of change in techniques, technology, support equipment and expertise appears to be increasing at an exponential rate. It clearly follows that the professional requirements of the support staff must keep pace with these changes and the training that they receive must inevitably reflect the needs of the ever changing working environment. (Ashburner L et al 1996) Evidence of change In any rational discussion, it is vital to work from a firm and secure evidence base. (EHC 1999). This requires careful and critical appraisal of the evidence and a decision as to just how applicable it is to the situation under consideration. In this dissertation we shall therefore be presenting evidence to support this evidence base together with appropriate assessments and judgements as to its validity. Most professionals working in the NHS would attest, if asked, to a perception of a continuous pace of change. Such anecdotal evidence, although interesting, is of little value to any form of critical appraisal. There are a number of reasonably â€Å"hard† statistics that give us much firmer evidence of change in the NHS. Let us consider some of the employment statistics published by the Department of Health for the NHS (whole of UK) and refers to non-medical staff. In 1997 the total number of NHS hospital and community based staff was 935,000. Of these 67% were direct care staff and 33% were management staff. The 67% direct care staff could be broken down into 330,620 nursing, midwifery and health visiting staff (246,010 being qualified) 100,440 scientific, therapeutic and technical staff 17,940 healthcare assistants 21,430 were managers the rest were estates, clerical and administrative staff 79% were women and 6% were from ethnic minorities (NSO 1998) If we compare this with the situation in 2000 by looking at the same parameters we can see: 346,180 nursing, midwifery and health visitor staff (256,280 were qualified). 110,410 scientific, therapeutic and technical staff 62,870 support staff and 23,140 healthcare assistants. 68% were direct care staff and 32% were management and support staff. 79% were women and 7% from the ethnic minorities (NSO 2001) And in 2001 we find a further difference, which is rather more dramatic: 458, 580 nursing, midwifery and health visitor staff (330,540 were qualified) 139,050 scientific, therapeutic and technical staff 23,140 healthcare assistants. 82% were women and 6% from the ethnic minorities (NSO 2002) If we go further back we can find evidence of 93,950 scientific, therapeutic and technical staff were employed, and there were 13,090 healthcare assistants in 1995 (NSO 1996) If we consider the documented trends in support staff we can trace 1995 93,950 1997 100,440 2000 110,410 2001 139,050 Over a comparatively short time there has clearly been a demonstrable increase in terms of numbers employed , nearly a 50% increase on the 1995 levels in six years. Reasons for change In opening this dissertation we made anecdotal reference to the political agenda that shaped the NHS. The NHS has historically been high in the public’s perception of a tangible measure of a Government’s success in delivering its regularly promised higher standard of living. It is partly for this reason, that successive governments have felt it politically expedient to invest increasing sums of money in measures for both expansion and improvement together with various drives aimed at increasing efficiency. (Ham C 1999) In the recent past there have been a raft of measures that have been produced which have all played their part in the evolution of the NHS to its current configuration and in doing so have expanded the role of not only the support worker but virtually all of the workers in the NHS at the same time. One of the first measures which was an overt indication of the forthcoming changes in working practice was the introduction of the performance indicators (Beecham L 1994) These were progressively introduced form 1992 onwards and in some respects could be considered the forerunner of the move towards National Service Frameworks. The original performance indicators imposed a duty or obligation on Trusts to carry out certain procedures within a specified maximum time. For example the indicators introduced in 1994-5 were on waiting times for first outpatient appointment and also for charters in General Practice. Although there were clear obligations on medical and nursing staff to make available sufficient sessions in order to see the patients, it is clear that the increased throughput of patients would clearly impact on the working practices (and work load) of the support staff. To a large extent, this can be seen from the figures presented at the beginning of this work. The 50% increase in staffing levels amongst the support staff reflects, in a large part, the changes that were consequent on the imposition of the performance indicators. The initial indicators proved to be quite onerous in terms of achieving compliance even though the later ones gave tighter requirements still. For example the 1994 indicators set a target of 90% of patients seen by a consultant within 26 weeks of a written referral letter being received from the General Practitioner in the major specialities of general medicine, general surgery and dermatology. (Editor BMJ 1994) It follows that this target is not quite as innocuous as it might at first appear. If we accept the fact that a substantial number of patients were already waiting for considerably longer than 26 weeks it represented a major shift in working practices to meet this particular deadline. Once the patients were seen it followed that they then had to have whatever treatment was thought to be appropriate. An increase in outpatients seen inevitably means an increase in patients waiting for inpatient treatment. So either the waiting lists go up further for inpatient treatment, or there is also a change of working practice to accommodate an increase in demand. This inevitably also impacts on the support staff as much as it does on the medical staff. (Langham S et al 1997) We shall consider this particular phenomenon in greater depth later when we consider the expansion of the nurse to specialist endoscopist and the running of one-stop clinics. Some novel methods were invoked to try to accommodate this shift in demand. There was a substantial increase in the frequency of day case surgery. Not only were a greater variety of surgical procedures being routinely carried out as day cases but it also resulted in more patients being assessed as suitable to undergo day case surgery. (HSE 2001) The same phenomenon of knock on effects arose form some of the other performance indicators. One of the original indicators was the percentage of patients seen within 5 mins of entering the casualty department. It follows that as hospitals strove to increase their performance indicators and the percentage of patients seen promptly rose, having been seen they then had to be treated and the same argument applies. Either there is an increase in the number of patients awaiting treatment in the A E departments, or there is a change in working practice to accommodate them and also to get them treated sooner. The organisation and efficiency of this system falls heavily on the support staff who clearly had to be able to accommodate this increased demand. (Langham S et al 1997) The indicators eventually began to involve inpatient statistics as well as outpatient ones. One, introduced in 1996, was on the number and availability of emergency operating theatres. More evidence of the reasons for this change comes from a paper by Scally and Donaldson (1998). We note that it was actually written by Liam Donaldson when he was a Regional Director of the NHS before he subsequently became Secretary of State for Health, so his comments can be taken with suitable gravitas. A critical analysis of the paper shows that it makes a number of points that are really overtly political, but it outlines the trend of change of emphasis where the improvements expected through clinical governance will not only be an â€Å"ideal goal† but will become a statutory requirement. This clearly pre-empts the changes prescribed in the NHS Plan. The paper outlines new goals â€Å"in which financial control, service performance, and clinical quality are fully integrated at every level† are behind the major thrust of the piece. Careful reading of the paper strongly suggests that inherent in the restructuring plans is a change in emphasis onto expansion of professional roles and greater working flexibility between professions which is fundamental to our considerations here. (Gray C 2005). We also note that the â€Å"stage was being set† for the potential role change of healthcare professionals in general and the four main precepts of this paper impact on that belief, namely: Clinical governance is to be the main vehicle for continuously improving the quality of patient care and developing the capacity of the NHS in England to maintain high standards (including dealing with poor professional performance) It requires an organisation-wide transformation; clinical leadership and positive organisational cultures are particularly important Professional self regulation will be the key to dealing with the complex problems of poor performance among clinicians New approaches are needed to enable the recognition and replication of good clinical practice to ensure that lessons are reliably learned from failures in standards of care It is clearly significant that all of these points were implemented and indeed, expanded, when Donaldson was appointed to the office of Secretary of State for Health and they can be seen as both enhancing and reinforcing the points that we have presented relating to the guidance from the Nursing Midwifery Council about the expansion of professional roles. Because of their seminal importance in the examination of our subject, let us consider the background to these points further. We note that Donaldson was originally recruited from a business background and the record shows that he has chosen to apply a great many sound and proven business principles to both the structuring and the workings of the NHS. Many of his strategies and perhaps ideas, have a clear ancestry in the Cadbury Report (1992) which effectively analysed the overall impact of governance and issues of changing working practices and consequent responsibility in the business world. The report focused on the issues surrounding an expansion of responsibility and a consequent failure to take responsibility for one’s actions, frequently passing on the implied responsibility to another employee in the same company. It found this practice to be both counterproductive and inefficient and frequently would lead to defensive stances and attitudes being adopted. When problems arose, they were therefore far more difficult to actively solve. (Lakhani M 2005) Donaldson was instrumental in applying this strategy to a clinical setting within the working practices of the NHS. This particular paper takes the view that by promoting individual professional responsibility he would be encouraging a system that would allow:- NHS organisations to be accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. By implication this argument extends to the expansion and role realignment in general terms throughout the NHS. We shall consider the elements in this paper which are of relevance to these arguments. Staff self-esteem is of great value to an organisation. Frequently this is associated with increased responsibility and a firm professional footing. (Davies HTO et al. 2000). Donaldson and Scally clearly espouse the virtue of professional responsibility at all levels in an organisation and encourage staff to take, rather than to devolve responsibility for their actions and indeed seek to ideally provide a ambience that is conducive to expansion of responsibility which therefore generally benefits the whole organisation. Tools of change Although we are primarily considering the support worker in this dissertation we must first broaden the agenda in order to set our examination in an appropriate context. There have been a number of Government White Papers, consultative documents and advisory initiatives that have concerned the workings of the NHS. Some have greater practical significance than others. There appear to have been significantly more in the last decade than previously and anecdotal and observational evidence would seem to suggest that these too, are increasing at an exponential rate. One of the landmark plans in recent years has been the NHS Plan. It has been compared by some commentators as being on comparative magnitude as the original inception of the NHS in 1948 (Shortell SM et al 1998). It is quite possible that a cynical appraisal of the Plan would see it is little more than the result of political rhetoric and pre-emptive manoeuvring as a response to the perceived public disquiet about the state of the NHS. On the other extreme the optimist might view it as a positive plan for major improvement. (Moss et al 1995). Having the benefit of hindsight, there is no doubt that it has been the catalyst for a number of significant changes in the NHS, it is, of course, totally dependent upon your own particular viewpoint as to whether these changes are regarded as beneficial or otherwise. One has to be extremely careful in evaluating such comments as clearly it depends on the criteria chosen for evaluation as to whether the reform will appear to be positive or negative. (Bilsberry J. 1996) One only has to consider the debacle which ensued after the introduction of the Griffiths Report in the 1980s (Griffiths Report 1983). This was considered to be a major reform of the management structure of the NHS. There was general agreement that the management had become to unwieldy, detached and inefficient with too many layers of management. (Davies,C et al. 2000), The Griffiths Report was commissioned with the specific purpose of streamlining the management profile and was charged with the specific responsibility of improving both efficiency and accountability. The subsequent plan was unveiled and introduced piecemeal. In the words of the Government appointed reviewer of the episode :- These were a set of reforms that were designed to â€Å"streamline the administration â€Å" of the NHS. It involved a major change in emphasis in the way that the NHS was run, and in short, it was badly conceived, patchily implemented and introduced piecemeal. By any critical analysis it proved to be a complete disaster. (Davidmann 1988) It is not actually possible to pass judgement on whether the plan would have been successful or not as its method of introduction was generally seen to be its downfall. In essence, its introduction was not managed in any contemporary sense of the word, it was simply imposed and the chaos that ensued prompted the government to institute another report to glean what lessons it could form the whole affair. (Davidmann 1988). It is fair to comment that the majority of reforms that have been introduced since that time have been far more professionally managed and their introduction (whatever their eventual outcome) have generally been comparatively smooth and uneventful (Bennis et al 1999) The area of change management as a science and discipline is both extremely involved and complex. Changing the structure of a massive and established organisation such as the NHS is clearly difficult with established attitudes, working practices and inherent inertia. The lessons learned from the Griffiths Report appear to have been successfully applied to the introduction of the NHS Plan (Bryant 2005) In specific consideration of the NHS plan we should note that the specific stated aims of the plan were to:- Increase funding and reform Aim to redress geographical inequalities, Improve service standards, Extend patient choice. These aims have been, to some extent translated into reality. Let us examine each in detail. The increased funding was specifically delivered in the March 2000 budget settlement and has been honoured in successive budgets since. The Chancellor of the Exchequer stated that the money made available would ensure that the NHS would grow by one half in cash terms and by one third in real terms in just five years. Our examination of staffing levels (above) would seem to suggest that this trend has been successfully established. In addition, he promised a  £500 million â€Å"performance fund† for specific areas which were to be identified by separate investigation as being in particular need of assistance. (Halligan et al 2001) This certainly directly impinges upon our considerations of support staff and we shall return to this point later. The geographical inequalities and service standards are specifically addressed in the introduction of the National Service Frameworks which are mechanisms for specifically addressing inequalities and setting of both targets and goals of performance and excellence on a National rather than a local level, (Rouse et al 2001) and have been progressively rolled out across the country. These measures have been established in collaboration with assistance and guidance from bodies such as the National Institute for Clinical Excellence (NICE) which has a remit to examine both practices and facilities with the specific aim of achieving national standards. ( viz. NICE 2004) (NHS KSF 2004) It has made a number of recommendations which appear to have a firm evidence base. (Berwick D 2005) We should perhaps take this opportunity to note that the Institute, although undoubtedly set up in response to a worthy ideal, is already finding itself short of funding to do the job that it was originally conceived for. Spokesmen have already commented that it is short of money to achieve the research necessary to justify its continued activity (Shannon 2003) Patient choice is a far more complex issue that it might originally appear. Initial examination might suggest that to give patients the freedom to go where they wish to get their medical care is a fine objective, but closer examination of the issue would reveal that it has numerous pitfalls. In the specific terms of the NHS plan, it actually means that the patient’s primary healthcare team has a more wide-reaching choice of where they choose to refer the patient. (Wierzbicki et al 2001). A patient may consider any number of factors which may influence their choice of hospital including such factors as the general look of the buildings, the geographical site in relation to their friends and family and what they have read or heard anecdotally about the hospital. None of these factors have any major bearing on the treatment that they will receive. It may be that they will discover that the waiting list is shorter at hospital A than hospital B. what may well be less obvious to the patient is that hospital A may have a shorter waiting list because the local primary healthcare teams know that it has a number of serious shortcomings and so they tend to refer their patients to hospital B which consequently has a longer waiting list. Of course , we mustn’t ignore the possibility that hospital A is actually more efficient that hospital B or that hospital C provides a more comprehensive, courteous and efficient service with greater expertise than hospital D, but the primary healthcare teams are generally best placed to see the outcomes of their local hospitals and will generally know where their patients are served better in each individual circumstance. (after Donaldson L 2001) In the context of our examination here, all four of these aims have potential impact on our subject as each of these objectives are effectively resolved by expanding, and in some cases changing, the roles of staff within the NHS. Clearly the impact will vary between different disciplines and indeed, different geographical areas, but the overall objective of improving the efficiency and introduction of patient orientated goals has largely been met by the three expedients of: a) making more money available b) adopting progressive management strategies c) increasing staffing levels and redefining some roles within the NHS ( after Dixon et al 2003) It is perhaps useful to consider the whole of the NHS Plan as part of a reform continuum which has shaped the evolution of the NHS since its inception. We have already highlighted the Griffiths Reforms, but other landmark reforms that impact upon our considerations of change must include the Agenda for Change (2004) which is primarily staff and employment orientated and is concerned with a number of measures including staffing levels, staff role descriptions and staff pay levels. It has only recently been implemented (September 2005) and, for our purposes here, should be viewed in conjunction with another Government White Paper which is the complimentary NHS Knowledge and Skills Framework (KSF 2004). This particular paper targets the need for both recognising and rewarding specific speciality orientated enhancement of both skills and knowledge that are actually relevant to professional performance in both designated areas and in professional performance generally. Reading of the provisions reveals that the general provision of  £280 million over a three year period to â€Å"develop specific designated staff skills†. One of the proposed mechanisms is to set up individual learning accounts which will be worth  £150 per year. It is not yet clear what the impact will yet be on support staff in either specific or general terms. The impact of these reforms seems to be felt on many levels. There appears to be a move towards the redesignation of roles, flexible working, skill mix and the redesignation of professional boundaries. The NHS Plan itself calls for a number of changes to be made in working practices, both general (conceptual) and specific. It also calls for a change in the actual roles of some healthcare professionals, including support staff. It goes into great detail about the need for some of these changes need to be established but it also has to be observed that there is actually very little detail in the Plan as to how these changes are either to be introduced or managed. It refers to the changes in general terms, there is actually very little detail relating to what it expects these changes to actually be in reality. (Krogstad et al 2002) If one were to produce an analysis of the pre-2000 structure of the NHS one could conclude that it had three major problems which were not consistent with the function, structure and organisation of a typical 21st century industry a lack of national standards old-fashioned demarcations between staff and barriers between services a lack of clear incentives and levers to improve performance over-centralisation and disempowered patients. (Nickols 2004) One observation that is also relevant to our considerations here is the phrase â€Å"seamless interface† appears very frequently throughout the document. Although it is primarily applied to the interface between primary and secondary care, it is also, both explicitly and by implication, applied to the interface between different groups of professionals within both aspects of the service. (Rudd et al 1997) In direct consideration of our subject, we can take this to mean that there is a requirement for seamless interaction between all factions of the operating theatre staff and between them and the other professionals in the hospital. (Dixon et al 2003) Other significant milestones in the changes in the role of support staff were the introduction of the National Service Framework. These are a series of recommendations, stipulations and targets which are designed to raise the performance to the level of the best across the nation rather than to have pockets of excellence surrounded by a sea of mediocrity (White M 2005). The issues surrounding the National Service Frameworks are huge, as they collectively cover most of the major therapeutic areas in medicine. The reason for their inclusion in this particular consideration, is because of their collective impact on the role of the support staff, who have to expand their role and skills in order to comply with their requirements. It is completely impractical to consider all of the implications of the National Service Frameworks so, as a representative â€Å"sample† we will consider just one, the National Service Framework for the elderly. In distinct contrast to our comments in relation to the Griffiths Report earlier in this piece, the introduction of the National Service Frameworks could be considered nothing short of exemplary. There have been consultation periods, pre-implementation pilots and possibly most importantly, a well publicised and staged National roll-out programme which was designed to implement each of the strategies in a graded and controlled fashion with the intention of trying to ensure smooth implementation across the country. (Nickols F.2004). If we consider as an exploratory example, a small portion of the National Service Framework for the elderly Standard Two, this states that it should ensure that: Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries. One could perhaps reasonably hope that such aspirations would have been unnecessary, but behind the actual words are a number of other concepts that are central to our consideration to the expanding role of the support staff. The concept of â€Å"Person Centred Care† is a central precept of the Standard Two. It is described with the intention of trying to allow the elderly to feel entitled to be treated as individuals and also to allow them to retain responsibility for their own choices for their own care. The expansions of the roles of the support staff comes primarily in the adoption of the main tenet of the concept of Person Centred Care and that is the introduction of the Single Assessment Process (SAP). This recognises that there are effectively a great number of support agencies that potential can be involved to look after the needs of the elderly, both in hospital and after discharge. Prior to the introduction of the National Service Framework, it was common practice for each agency to separately make contact with the patient and make their own assessment in terms of their own distinct considerations. We shall discuss this point later in the context of insularity of specialities. The end result of this process was the fact that, very commonly, the same (or similar) facts are repeatedly elicited on different occasions with all the implications that this type of duplication has on inefficient working and waste of resources. (Fatchett A. 1998). The SAP is designed so that any member of the health care team can assemble the information in such a way and in such a format that it will be of use to the other members of the team, or for that matter any of the agencies who might have a legitimate need for the information. This particular role expansion is designed to assist in reducing the amount of red tape that appears to be an inevitable encumbrance of many of the measures that are designed to assist the elderly patient, and only appears to finish up by hampering them. (Gott M 2000). The adoption of the Single Assessment Process is no more than one example, perhaps not so much of an expansion of the role, but a realignment of the role of support staff. It is still a fairly new concept and is central to the aims of the National Service Framework that the needs and wishes of the patient should be at the heart of the whole process. Because it is new, the extent to which it can accommodate these aims and aspirations alongside the day to day practicalities of service provision still has yet to be fully assessed. (Mannion R et al 2005) In some ways, this new role expansion can be viewed in parallel with the concepts of seamless interfacing and multidisciplinary team working which we have examined elsewhere in this dissertation. Given the fact that the Single Assessment Process has only been operational since April 2004, but the move towards multidisciplinary team working and the concept of the seamless interface has been apparent and espoused for some years (Mason et al 2003). The latter were effectively translated into reality without major upheaval, one can be reasonably confident that the same will eventually be said for both the Single Assessment Process and its implications for both staff and patients. We have described this particular example of role expansion more as a realignment because, at first sight, its implications are quite subtle when compared to other examples that we shall be considering, but equally they are quite fundamental, as they impinge upon the role Role Expansion of Support Staff in the NHS Role Expansion of Support Staff in the NHS Abstract In this dissertation we examine the various aspects of role expansion of support staff within the confines of the NHS. We consider it on both a broad front and also make specific examination of those issues that concern staff connected with the operating theatres. We consider the background and political pressures that make role expansion desirable and possible. We also consider the implications of expansion in the NHS on both a professional and practical level. The issues are discussed in both specific and general terms. We illustrate three types of role expansion by reference to specific professional examples. One example is of the expansion from a caring role to that of the specialist provider, the second can be considered an example of role extension within a professional setting and the third is a natural expansion of the role which is required as technology and practice evolve. Methodology The methodology of this exploration was primarily by literature research. Progressive lines of enquiry were identified, researched and recorded. New lines of enquiry were identified as research progressed, and these were also examined for relevance and researched if considered appropriate to the theme of the dissertation. The literature search was mainly from library facilities. Local University, Post-Graduate hospital and public library facilities were extensively used together with some Internet based investigation. Some personal email enquiries were made from individuals who had experienced professional expansion and advice was taken in regard to both literature and direction of research. Introduction There is little doubt that the role of support staff has changed within the working lifetime of professionals currently working in the NHS. The thrust of this dissertation is to examine the means, the mechanisms and the degrees by which their role has changed. It barely needs stating that the NHS has changed. The political climate in which it operates has seen the NHS occupy varying positions of political prominence. Politicians are frequently seen publicly promising various sums of money for various projects of modernisation, expansion or generally to improve services. Every so often there is a major structural realignment of the management focus and mechanisms which, inevitably percolate through the tiers of control until the changes are felt at the level of the worker. In addition to this there are the technological changes which are largely independent of the politicians and the management structure. The rate of change in techniques, technology, support equipment and expertise appears to be increasing at an exponential rate. It clearly follows that the professional requirements of the support staff must keep pace with these changes and the training that they receive must inevitably reflect the needs of the ever changing working environment. (Ashburner L et al 1996) Evidence of change In any rational discussion, it is vital to work from a firm and secure evidence base. (EHC 1999). This requires careful and critical appraisal of the evidence and a decision as to just how applicable it is to the situation under consideration. In this dissertation we shall therefore be presenting evidence to support this evidence base together with appropriate assessments and judgements as to its validity. Most professionals working in the NHS would attest, if asked, to a perception of a continuous pace of change. Such anecdotal evidence, although interesting, is of little value to any form of critical appraisal. There are a number of reasonably â€Å"hard† statistics that give us much firmer evidence of change in the NHS. Let us consider some of the employment statistics published by the Department of Health for the NHS (whole of UK) and refers to non-medical staff. In 1997 the total number of NHS hospital and community based staff was 935,000. Of these 67% were direct care staff and 33% were management staff. The 67% direct care staff could be broken down into 330,620 nursing, midwifery and health visiting staff (246,010 being qualified) 100,440 scientific, therapeutic and technical staff 17,940 healthcare assistants 21,430 were managers the rest were estates, clerical and administrative staff 79% were women and 6% were from ethnic minorities (NSO 1998) If we compare this with the situation in 2000 by looking at the same parameters we can see: 346,180 nursing, midwifery and health visitor staff (256,280 were qualified). 110,410 scientific, therapeutic and technical staff 62,870 support staff and 23,140 healthcare assistants. 68% were direct care staff and 32% were management and support staff. 79% were women and 7% from the ethnic minorities (NSO 2001) And in 2001 we find a further difference, which is rather more dramatic: 458, 580 nursing, midwifery and health visitor staff (330,540 were qualified) 139,050 scientific, therapeutic and technical staff 23,140 healthcare assistants. 82% were women and 6% from the ethnic minorities (NSO 2002) If we go further back we can find evidence of 93,950 scientific, therapeutic and technical staff were employed, and there were 13,090 healthcare assistants in 1995 (NSO 1996) If we consider the documented trends in support staff we can trace 1995 93,950 1997 100,440 2000 110,410 2001 139,050 Over a comparatively short time there has clearly been a demonstrable increase in terms of numbers employed , nearly a 50% increase on the 1995 levels in six years. Reasons for change In opening this dissertation we made anecdotal reference to the political agenda that shaped the NHS. The NHS has historically been high in the public’s perception of a tangible measure of a Government’s success in delivering its regularly promised higher standard of living. It is partly for this reason, that successive governments have felt it politically expedient to invest increasing sums of money in measures for both expansion and improvement together with various drives aimed at increasing efficiency. (Ham C 1999) In the recent past there have been a raft of measures that have been produced which have all played their part in the evolution of the NHS to its current configuration and in doing so have expanded the role of not only the support worker but virtually all of the workers in the NHS at the same time. One of the first measures which was an overt indication of the forthcoming changes in working practice was the introduction of the performance indicators (Beecham L 1994) These were progressively introduced form 1992 onwards and in some respects could be considered the forerunner of the move towards National Service Frameworks. The original performance indicators imposed a duty or obligation on Trusts to carry out certain procedures within a specified maximum time. For example the indicators introduced in 1994-5 were on waiting times for first outpatient appointment and also for charters in General Practice. Although there were clear obligations on medical and nursing staff to make available sufficient sessions in order to see the patients, it is clear that the increased throughput of patients would clearly impact on the working practices (and work load) of the support staff. To a large extent, this can be seen from the figures presented at the beginning of this work. The 50% increase in staffing levels amongst the support staff reflects, in a large part, the changes that were consequent on the imposition of the performance indicators. The initial indicators proved to be quite onerous in terms of achieving compliance even though the later ones gave tighter requirements still. For example the 1994 indicators set a target of 90% of patients seen by a consultant within 26 weeks of a written referral letter being received from the General Practitioner in the major specialities of general medicine, general surgery and dermatology. (Editor BMJ 1994) It follows that this target is not quite as innocuous as it might at first appear. If we accept the fact that a substantial number of patients were already waiting for considerably longer than 26 weeks it represented a major shift in working practices to meet this particular deadline. Once the patients were seen it followed that they then had to have whatever treatment was thought to be appropriate. An increase in outpatients seen inevitably means an increase in patients waiting for inpatient treatment. So either the waiting lists go up further for inpatient treatment, or there is also a change of working practice to accommodate an increase in demand. This inevitably also impacts on the support staff as much as it does on the medical staff. (Langham S et al 1997) We shall consider this particular phenomenon in greater depth later when we consider the expansion of the nurse to specialist endoscopist and the running of one-stop clinics. Some novel methods were invoked to try to accommodate this shift in demand. There was a substantial increase in the frequency of day case surgery. Not only were a greater variety of surgical procedures being routinely carried out as day cases but it also resulted in more patients being assessed as suitable to undergo day case surgery. (HSE 2001) The same phenomenon of knock on effects arose form some of the other performance indicators. One of the original indicators was the percentage of patients seen within 5 mins of entering the casualty department. It follows that as hospitals strove to increase their performance indicators and the percentage of patients seen promptly rose, having been seen they then had to be treated and the same argument applies. Either there is an increase in the number of patients awaiting treatment in the A E departments, or there is a change in working practice to accommodate them and also to get them treated sooner. The organisation and efficiency of this system falls heavily on the support staff who clearly had to be able to accommodate this increased demand. (Langham S et al 1997) The indicators eventually began to involve inpatient statistics as well as outpatient ones. One, introduced in 1996, was on the number and availability of emergency operating theatres. More evidence of the reasons for this change comes from a paper by Scally and Donaldson (1998). We note that it was actually written by Liam Donaldson when he was a Regional Director of the NHS before he subsequently became Secretary of State for Health, so his comments can be taken with suitable gravitas. A critical analysis of the paper shows that it makes a number of points that are really overtly political, but it outlines the trend of change of emphasis where the improvements expected through clinical governance will not only be an â€Å"ideal goal† but will become a statutory requirement. This clearly pre-empts the changes prescribed in the NHS Plan. The paper outlines new goals â€Å"in which financial control, service performance, and clinical quality are fully integrated at every level† are behind the major thrust of the piece. Careful reading of the paper strongly suggests that inherent in the restructuring plans is a change in emphasis onto expansion of professional roles and greater working flexibility between professions which is fundamental to our considerations here. (Gray C 2005). We also note that the â€Å"stage was being set† for the potential role change of healthcare professionals in general and the four main precepts of this paper impact on that belief, namely: Clinical governance is to be the main vehicle for continuously improving the quality of patient care and developing the capacity of the NHS in England to maintain high standards (including dealing with poor professional performance) It requires an organisation-wide transformation; clinical leadership and positive organisational cultures are particularly important Professional self regulation will be the key to dealing with the complex problems of poor performance among clinicians New approaches are needed to enable the recognition and replication of good clinical practice to ensure that lessons are reliably learned from failures in standards of care It is clearly significant that all of these points were implemented and indeed, expanded, when Donaldson was appointed to the office of Secretary of State for Health and they can be seen as both enhancing and reinforcing the points that we have presented relating to the guidance from the Nursing Midwifery Council about the expansion of professional roles. Because of their seminal importance in the examination of our subject, let us consider the background to these points further. We note that Donaldson was originally recruited from a business background and the record shows that he has chosen to apply a great many sound and proven business principles to both the structuring and the workings of the NHS. Many of his strategies and perhaps ideas, have a clear ancestry in the Cadbury Report (1992) which effectively analysed the overall impact of governance and issues of changing working practices and consequent responsibility in the business world. The report focused on the issues surrounding an expansion of responsibility and a consequent failure to take responsibility for one’s actions, frequently passing on the implied responsibility to another employee in the same company. It found this practice to be both counterproductive and inefficient and frequently would lead to defensive stances and attitudes being adopted. When problems arose, they were therefore far more difficult to actively solve. (Lakhani M 2005) Donaldson was instrumental in applying this strategy to a clinical setting within the working practices of the NHS. This particular paper takes the view that by promoting individual professional responsibility he would be encouraging a system that would allow:- NHS organisations to be accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. By implication this argument extends to the expansion and role realignment in general terms throughout the NHS. We shall consider the elements in this paper which are of relevance to these arguments. Staff self-esteem is of great value to an organisation. Frequently this is associated with increased responsibility and a firm professional footing. (Davies HTO et al. 2000). Donaldson and Scally clearly espouse the virtue of professional responsibility at all levels in an organisation and encourage staff to take, rather than to devolve responsibility for their actions and indeed seek to ideally provide a ambience that is conducive to expansion of responsibility which therefore generally benefits the whole organisation. Tools of change Although we are primarily considering the support worker in this dissertation we must first broaden the agenda in order to set our examination in an appropriate context. There have been a number of Government White Papers, consultative documents and advisory initiatives that have concerned the workings of the NHS. Some have greater practical significance than others. There appear to have been significantly more in the last decade than previously and anecdotal and observational evidence would seem to suggest that these too, are increasing at an exponential rate. One of the landmark plans in recent years has been the NHS Plan. It has been compared by some commentators as being on comparative magnitude as the original inception of the NHS in 1948 (Shortell SM et al 1998). It is quite possible that a cynical appraisal of the Plan would see it is little more than the result of political rhetoric and pre-emptive manoeuvring as a response to the perceived public disquiet about the state of the NHS. On the other extreme the optimist might view it as a positive plan for major improvement. (Moss et al 1995). Having the benefit of hindsight, there is no doubt that it has been the catalyst for a number of significant changes in the NHS, it is, of course, totally dependent upon your own particular viewpoint as to whether these changes are regarded as beneficial or otherwise. One has to be extremely careful in evaluating such comments as clearly it depends on the criteria chosen for evaluation as to whether the reform will appear to be positive or negative. (Bilsberry J. 1996) One only has to consider the debacle which ensued after the introduction of the Griffiths Report in the 1980s (Griffiths Report 1983). This was considered to be a major reform of the management structure of the NHS. There was general agreement that the management had become to unwieldy, detached and inefficient with too many layers of management. (Davies,C et al. 2000), The Griffiths Report was commissioned with the specific purpose of streamlining the management profile and was charged with the specific responsibility of improving both efficiency and accountability. The subsequent plan was unveiled and introduced piecemeal. In the words of the Government appointed reviewer of the episode :- These were a set of reforms that were designed to â€Å"streamline the administration â€Å" of the NHS. It involved a major change in emphasis in the way that the NHS was run, and in short, it was badly conceived, patchily implemented and introduced piecemeal. By any critical analysis it proved to be a complete disaster. (Davidmann 1988) It is not actually possible to pass judgement on whether the plan would have been successful or not as its method of introduction was generally seen to be its downfall. In essence, its introduction was not managed in any contemporary sense of the word, it was simply imposed and the chaos that ensued prompted the government to institute another report to glean what lessons it could form the whole affair. (Davidmann 1988). It is fair to comment that the majority of reforms that have been introduced since that time have been far more professionally managed and their introduction (whatever their eventual outcome) have generally been comparatively smooth and uneventful (Bennis et al 1999) The area of change management as a science and discipline is both extremely involved and complex. Changing the structure of a massive and established organisation such as the NHS is clearly difficult with established attitudes, working practices and inherent inertia. The lessons learned from the Griffiths Report appear to have been successfully applied to the introduction of the NHS Plan (Bryant 2005) In specific consideration of the NHS plan we should note that the specific stated aims of the plan were to:- Increase funding and reform Aim to redress geographical inequalities, Improve service standards, Extend patient choice. These aims have been, to some extent translated into reality. Let us examine each in detail. The increased funding was specifically delivered in the March 2000 budget settlement and has been honoured in successive budgets since. The Chancellor of the Exchequer stated that the money made available would ensure that the NHS would grow by one half in cash terms and by one third in real terms in just five years. Our examination of staffing levels (above) would seem to suggest that this trend has been successfully established. In addition, he promised a  £500 million â€Å"performance fund† for specific areas which were to be identified by separate investigation as being in particular need of assistance. (Halligan et al 2001) This certainly directly impinges upon our considerations of support staff and we shall return to this point later. The geographical inequalities and service standards are specifically addressed in the introduction of the National Service Frameworks which are mechanisms for specifically addressing inequalities and setting of both targets and goals of performance and excellence on a National rather than a local level, (Rouse et al 2001) and have been progressively rolled out across the country. These measures have been established in collaboration with assistance and guidance from bodies such as the National Institute for Clinical Excellence (NICE) which has a remit to examine both practices and facilities with the specific aim of achieving national standards. ( viz. NICE 2004) (NHS KSF 2004) It has made a number of recommendations which appear to have a firm evidence base. (Berwick D 2005) We should perhaps take this opportunity to note that the Institute, although undoubtedly set up in response to a worthy ideal, is already finding itself short of funding to do the job that it was originally conceived for. Spokesmen have already commented that it is short of money to achieve the research necessary to justify its continued activity (Shannon 2003) Patient choice is a far more complex issue that it might originally appear. Initial examination might suggest that to give patients the freedom to go where they wish to get their medical care is a fine objective, but closer examination of the issue would reveal that it has numerous pitfalls. In the specific terms of the NHS plan, it actually means that the patient’s primary healthcare team has a more wide-reaching choice of where they choose to refer the patient. (Wierzbicki et al 2001). A patient may consider any number of factors which may influence their choice of hospital including such factors as the general look of the buildings, the geographical site in relation to their friends and family and what they have read or heard anecdotally about the hospital. None of these factors have any major bearing on the treatment that they will receive. It may be that they will discover that the waiting list is shorter at hospital A than hospital B. what may well be less obvious to the patient is that hospital A may have a shorter waiting list because the local primary healthcare teams know that it has a number of serious shortcomings and so they tend to refer their patients to hospital B which consequently has a longer waiting list. Of course , we mustn’t ignore the possibility that hospital A is actually more efficient that hospital B or that hospital C provides a more comprehensive, courteous and efficient service with greater expertise than hospital D, but the primary healthcare teams are generally best placed to see the outcomes of their local hospitals and will generally know where their patients are served better in each individual circumstance. (after Donaldson L 2001) In the context of our examination here, all four of these aims have potential impact on our subject as each of these objectives are effectively resolved by expanding, and in some cases changing, the roles of staff within the NHS. Clearly the impact will vary between different disciplines and indeed, different geographical areas, but the overall objective of improving the efficiency and introduction of patient orientated goals has largely been met by the three expedients of: a) making more money available b) adopting progressive management strategies c) increasing staffing levels and redefining some roles within the NHS ( after Dixon et al 2003) It is perhaps useful to consider the whole of the NHS Plan as part of a reform continuum which has shaped the evolution of the NHS since its inception. We have already highlighted the Griffiths Reforms, but other landmark reforms that impact upon our considerations of change must include the Agenda for Change (2004) which is primarily staff and employment orientated and is concerned with a number of measures including staffing levels, staff role descriptions and staff pay levels. It has only recently been implemented (September 2005) and, for our purposes here, should be viewed in conjunction with another Government White Paper which is the complimentary NHS Knowledge and Skills Framework (KSF 2004). This particular paper targets the need for both recognising and rewarding specific speciality orientated enhancement of both skills and knowledge that are actually relevant to professional performance in both designated areas and in professional performance generally. Reading of the provisions reveals that the general provision of  £280 million over a three year period to â€Å"develop specific designated staff skills†. One of the proposed mechanisms is to set up individual learning accounts which will be worth  £150 per year. It is not yet clear what the impact will yet be on support staff in either specific or general terms. The impact of these reforms seems to be felt on many levels. There appears to be a move towards the redesignation of roles, flexible working, skill mix and the redesignation of professional boundaries. The NHS Plan itself calls for a number of changes to be made in working practices, both general (conceptual) and specific. It also calls for a change in the actual roles of some healthcare professionals, including support staff. It goes into great detail about the need for some of these changes need to be established but it also has to be observed that there is actually very little detail in the Plan as to how these changes are either to be introduced or managed. It refers to the changes in general terms, there is actually very little detail relating to what it expects these changes to actually be in reality. (Krogstad et al 2002) If one were to produce an analysis of the pre-2000 structure of the NHS one could conclude that it had three major problems which were not consistent with the function, structure and organisation of a typical 21st century industry a lack of national standards old-fashioned demarcations between staff and barriers between services a lack of clear incentives and levers to improve performance over-centralisation and disempowered patients. (Nickols 2004) One observation that is also relevant to our considerations here is the phrase â€Å"seamless interface† appears very frequently throughout the document. Although it is primarily applied to the interface between primary and secondary care, it is also, both explicitly and by implication, applied to the interface between different groups of professionals within both aspects of the service. (Rudd et al 1997) In direct consideration of our subject, we can take this to mean that there is a requirement for seamless interaction between all factions of the operating theatre staff and between them and the other professionals in the hospital. (Dixon et al 2003) Other significant milestones in the changes in the role of support staff were the introduction of the National Service Framework. These are a series of recommendations, stipulations and targets which are designed to raise the performance to the level of the best across the nation rather than to have pockets of excellence surrounded by a sea of mediocrity (White M 2005). The issues surrounding the National Service Frameworks are huge, as they collectively cover most of the major therapeutic areas in medicine. The reason for their inclusion in this particular consideration, is because of their collective impact on the role of the support staff, who have to expand their role and skills in order to comply with their requirements. It is completely impractical to consider all of the implications of the National Service Frameworks so, as a representative â€Å"sample† we will consider just one, the National Service Framework for the elderly. In distinct contrast to our comments in relation to the Griffiths Report earlier in this piece, the introduction of the National Service Frameworks could be considered nothing short of exemplary. There have been consultation periods, pre-implementation pilots and possibly most importantly, a well publicised and staged National roll-out programme which was designed to implement each of the strategies in a graded and controlled fashion with the intention of trying to ensure smooth implementation across the country. (Nickols F.2004). If we consider as an exploratory example, a small portion of the National Service Framework for the elderly Standard Two, this states that it should ensure that: Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries. One could perhaps reasonably hope that such aspirations would have been unnecessary, but behind the actual words are a number of other concepts that are central to our consideration to the expanding role of the support staff. The concept of â€Å"Person Centred Care† is a central precept of the Standard Two. It is described with the intention of trying to allow the elderly to feel entitled to be treated as individuals and also to allow them to retain responsibility for their own choices for their own care. The expansions of the roles of the support staff comes primarily in the adoption of the main tenet of the concept of Person Centred Care and that is the introduction of the Single Assessment Process (SAP). This recognises that there are effectively a great number of support agencies that potential can be involved to look after the needs of the elderly, both in hospital and after discharge. Prior to the introduction of the National Service Framework, it was common practice for each agency to separately make contact with the patient and make their own assessment in terms of their own distinct considerations. We shall discuss this point later in the context of insularity of specialities. The end result of this process was the fact that, very commonly, the same (or similar) facts are repeatedly elicited on different occasions with all the implications that this type of duplication has on inefficient working and waste of resources. (Fatchett A. 1998). The SAP is designed so that any member of the health care team can assemble the information in such a way and in such a format that it will be of use to the other members of the team, or for that matter any of the agencies who might have a legitimate need for the information. This particular role expansion is designed to assist in reducing the amount of red tape that appears to be an inevitable encumbrance of many of the measures that are designed to assist the elderly patient, and only appears to finish up by hampering them. (Gott M 2000). The adoption of the Single Assessment Process is no more than one example, perhaps not so much of an expansion of the role, but a realignment of the role of support staff. It is still a fairly new concept and is central to the aims of the National Service Framework that the needs and wishes of the patient should be at the heart of the whole process. Because it is new, the extent to which it can accommodate these aims and aspirations alongside the day to day practicalities of service provision still has yet to be fully assessed. (Mannion R et al 2005) In some ways, this new role expansion can be viewed in parallel with the concepts of seamless interfacing and multidisciplinary team working which we have examined elsewhere in this dissertation. Given the fact that the Single Assessment Process has only been operational since April 2004, but the move towards multidisciplinary team working and the concept of the seamless interface has been apparent and espoused for some years (Mason et al 2003). The latter were effectively translated into reality without major upheaval, one can be reasonably confident that the same will eventually be said for both the Single Assessment Process and its implications for both staff and patients. We have described this particular example of role expansion more as a realignment because, at first sight, its implications are quite subtle when compared to other examples that we shall be considering, but equally they are quite fundamental, as they impinge upon the role

The Dark Evil of Racism :: essays research papers

It is much easier to confront the racism of the 1960s than the racial and economic injustices of today. While I'm happy that racist vigilantes such as Edgar Ray Killen have finally been called upon to pay for their crimes, we have work to do in the here and now. Killen's conviction is one of several historical reckonings. In 1994, Byron de la Beckwith was convicted of murdering civil-rights leader Medgar Evers in 1963. Then, just last year, the FBI reopened the 1955 Emmett Till case after finding that as many as 10 more people may have been involved in his abduction and murder. And now Killen will likely go to prison for the rest of his life for his part in the brutal 1964 murders of civil-rights activists Michael Schwerner, Andrew Goodman and James Chaney. These murder cases stayed unsolved for decades, and their resolution may give some sense of closure to the long-suffering families of the victims. But these triumphs are largely symbolic. By congratulating ourselves too much for them, we risk neglecting the challenges of the present. ''There's justice for all in Mississippi,'' state Attorney General James Hood said after the Killen conviction. But the reality on the ground belies Hood's rosy scenario. The lives of black Mississippians, 41 years after the civil-rights murders of 1964, are still mired in poverty and inequality. Yes, there are black elected officials now, but the economic prospects for black people -- and many whites -- is grim. The state suffers one of the nation's highest illiteracy rates. More than 38 percent of the state's black families live in poverty, in contrast to 14 percent of whites, according to the Kaiser Foundation. This doesn't sound like justice to me. Killen and his ilk carried out their crimes under white hoods and the darkness of night.

Medieval baghdad

Europe there was the Saxons, the Vikings and the franks, these were the three sides of conflict. Europe was filled with violence, illiterate people, superstition and no medical knowledge. They still believed that disease was caused by evil spirits or god(s).. The Islamic empire can reveal a respect for knowledge from all cultures; this made it significant. In their hospitals and pharmacies they would let anyone practice as a doctor. Also they would let anyone be a patient no matter what culture, country or religion. This reveals that the Islamic empire was religiously tolerant.It also is remarkable as the scholars were the first people to build hospitals with different wards for different illnesses. The scholars also collected knowledge from all countries and religions because it didn't what race you are, if you have new knowledge it was valuable. They collected knowledge from India, china, Greece, Italy, all over the empire: in fact it would take someone a whole year to go from one side of the empire to the other. This shows that they were willing to give up at least a year of their time to collect knowledge.Medieval Baghdad should be remembered for the contribution it made to our lives today. The scholars discoveries in medicine are still relevant today as they were the first people to do complicated surgeries. This includes cesareans and eye surgeries. What was remarkable was the fact that they had a 60% success rate on the eye surgeries. Our knowledge of medicinal practices would not be advanced if it were not for them. The scholars gathered information like a new way of writing numbers. This meant that they could write all the numbers from O to infinity with only 10 humbly.The person who did this was called AAA-Swarming. In fact we would not have any computerized technology without the numbers O or 1. This resulted in change as they found a whole new way Of writing numbers which actually made calculations easier. The layout of the city of Baghdad which had double walls and only certain places that you could enter inspired the design of the castles in Europe. Our castle would not the same in any way, shape or form if it were not for the architects designing the city of Baghdad.Also they would not have defended s well if it were not for them either. The reason we do not remember Baghdad for what it used to be is because there is no record of the books they wrote or that they collected the knowledge. Baghdad lost power over its empire as the smaller caliphs decided that they did not want to know more about science, math or astronomy. People called the Mongols destroyed the library which had held all of the books and knowledge that they had spent so long collecting.

Types of Fallacies

FALLACIES OF RELEVANCE 1. Appeal to Force If you suppose that terrorizing your opponent is giving him a reason for believing that you are correct, then you are using a scare tactic and reasoning fallaciously. Example: David: My father owns the department store that gives your newspaper fifteen percent of all its advertising revenue, so I’m sure you won’t want to publish any story of my arrest for spray painting the college. Newspaper editor: Yes, David, I see your point. The story really isn’t newsworthy.David has given the editor a financial reason not to publish, but he has not given a relevant reason why the story is not newsworthy. David’s tactics are scaring the editor, but it’s the editor who commits the scare tactic fallacy, not David. David has merely used a scare tactic. This fallacy’s name emphasizes the cause of the fallacy rather than the error itself. 2. Appeal to Pity You commit the fallacy of appeal to emotions when someoneâ₠¬â„¢s appeal to you to accept their claim is accepted merely because the appeal arouses your feelings of anger, fear, grief, love, outrage, pity, pride, sexuality, sympathy, relief, and so forth.Example of appeal to relief from grief: [The speaker knows he is talking to an aggrieved person whose house is worth much more than $100,000. ] You had a great job and didn’t deserve to lose it. I wish I could help somehow. I do have one idea. Now your family needs financial security even more. You need cash. I can help you. Here is a check for $100,000. Just sign this standard sales agreement, and we can skip the realtors and all the headaches they would create at this critical time in your life.There is nothing wrong with using emotions when you argue, but it’s a mistake to use emotions as the key premises or as tools to downplay relevant information. Regarding the fallacy of  appeal to pity, it is proper to pity people who have had misfortunes, but if as the person’ s history instructor you accept Max’s claim that he earned an A on the history quiz because he broke his wrist while playing in your college’s last basketball game, then you’ve committed the fallacy of  appeal to pity. *Appeal to Snobbery 3. Ad HominemYou commit this fallacy if you make an irrelevant attack on the arguer and suggest that this attack undermines the argument itself. It is a form of the  Genetic Fallacy. Example: What she says about Johannes Kepler’s astronomy of the 1600? s must be just so much garbage. Do you realize she’s only fourteen years old? This attack may undermine the arguer’s credibility as a scientific authority, but it does not undermine her reasoning. That reasoning should stand or fall on the scientific evidence, not on the arguer’s age or anything else about her personally.If the fallacious reasoner points out irrelevant circumstances that the reasoner is in, the fallacy is a circumstantial ad homine m. Tu Quoque  and  Two Wrongs Make a Right  are other types of the ad hominem fallacy. The major difficulty with labeling a piece of reasoning as an ad hominem fallacy is deciding whether the personal attack is relevant. For example, attacks on a person for their actually immoral sexual conduct are irrelevant to the quality of their mathematical reasoning, but they are relevant to arguments promoting the person for a leadership position in the church.Unfortunately, many attacks are not so easy to classify, such as an attack pointing out that the candidate for church leadership, while in the tenth grade, intentionally tripped a fellow student and broke his collar bone. *Ad Hominem Circumstantial Guilt by association is a version of the  ad hominem  fallacy in which a person is said to be guilty of error because of the group he or she associates with. The fallacy occurs when we unfairly try to change the issue to be about the speaker’s circumstances rather than about the speaker’s actual argument. Also called â€Å"Ad Hominem, Circumstantial. Example: Secretary of State Dean Acheson is too soft on communism, as you can see by his inviting so many fuzzy-headed liberals to his White House cocktail parties. Has any evidence been presented here that Acheson’s actions are inappropriate in regards to communism? This sort of reasoning is an example of McCarthyism, the technique of smearing liberal Democrats that was so effectively used by the late Senator Joe McCarthy in the early 1950s. In fact, Acheson was strongly anti-communist and the architect of President Truman’s firm policy of containing Soviet power. 4. Appeal to the PeopleIf you suggest too strongly that someone’s claim or argument is correct simply because it’s what most everyone believes, then you’ve committed the fallacy of appeal to the people. Similarly, if you suggest too strongly that someone’s claim or argument is mistaken simply beca use it’s not what most everyone believes, then you’ve also committed the fallacy. Agreement with popular opinion is not necessarily a reliable sign of truth, and deviation from popular opinion is not necessarily a reliable sign of error, but if you assume it is and do so with enthusiasm, then you’re guilty of committing this fallacy.It is essentially the same as the fallacies of ad numerum, appeal to the gallery, appeal to the masses, argument from popularity, argumentum ad populum, common practice, mob appeal, past practice, peer pressure, traditional wisdom. The â€Å"too strongly† mentioned above is important in the description of the fallacy because what most everyone believes is, for that reason, somewhat likely to be true, all things considered. However, the fallacy occurs when this degree of support is overestimated. Example: You should turn to channel 6. It’s the most watched channel this year.This is fallacious because of its implicitly ac cepting the questionable premise that the most watched channel this year is, for that reason alone, the best channel for you. If you stress the idea of appealing to a  new  idea of the gallery, masses, mob, peers, people, and so forth, then it is a bandwagon fallacy. *Bandwagon If you suggest that someone’s claim is correct simply because it’s what most everyone is coming to believe, then you’re committing the bandwagon fallacy. Get up here with us on the wagon where the band is playing, and go where we go, and don’t think too much about the reasons.The Latin term for this fallacy of appeal to novelty is Argumentum ad Novitatem. Example: [Advertisement] More and more people are buying sports utility vehicles. Isn’t it time you bought one, too? [You commit the fallacy if you buy the vehicle solely because of this advertisement. ] Like its close cousin, the fallacy of appeal to the people, the bandwagon fallacy needs to be carefully distinguished from properly defending a claim by pointing out that many people have studied the claim and have come to a reasoned conclusion that it is correct.What most everyone believes is likely to be true, all things considered, and if one defends a claim on those grounds, this is not a fallacious inference. What is fallacious is to be swept up by the excitement of a new idea or new fad and to unquestionably give it too high a degree of your belief solely on the grounds of its new popularity, perhaps thinking simply that ‘new is better. ’ The key ingredient that is missing from a bandwagon fallacy is knowledge that an item is popular because of its high quality. Appeal to Past People (â€Å"You too†) 5. Accident We often arrive at a generalization but don’t or can’t list all the exceptions. When we reason with the generalization as if it has no exceptions, we commit the fallacy of accident. This fallacy is sometimes called the â€Å"fallacy of sweeping gene ralization. † Example: People should keep their promises, right? I loaned Dwayne my knife, and he said he’d return it. Now he is refusing to give it back, but I need it right now to slash up my neighbors who disrespected me.People should keep their promises, but there are exceptions to this generaliztion as in this case of the psychopath who wants Dwayne to keep his promise to return the knife. 6. Straw Man You commit the straw man fallacy whenever you attribute an easily refuted position to your opponent, one that the opponent wouldn’t endorse, and then proceed to attack the easily refuted position (the straw man) believing you have undermined the opponent’s actual position. If the misrepresentation is on purpose, then the straw man fallacy is caused by lying.Example (a debate before the city council): Opponent: Because of the killing and suffering of Indians that followed Columbus’s discovery of America, the City of Berkeley should declare that Co lumbus Day will no longer be observed in our city. Speaker: This is ridiculous, fellow members of the city council. It’s not true that everybody who ever came to America from another country somehow oppressed the Indians. I say we should continue to observe Columbus Day, and vote down this resolution that will make the City of Berkeley the laughing stock of the nation.The speaker has twisted what his opponent said; the opponent never said, nor even indirectly suggested, that everybody who ever came to America from another country somehow oppressed the Indians. The critical thinker will respond to the fallacy by saying, â€Å"Let’s get back to the original issue of whether we have a good reason to discontinue observing Columbus Day. † 7. Missing the Point The conclusion that is drawn is irrelevant to the premises; it misses the point. Example: In court, Thompson testifies that the defendant is a honorable person, who wouldn’t harm a flea.The defense attorn ey commits the fallacy by rising to say that Thompson’s testimony shows once again that his client was not near the murder scene. The testimony of Thompson may be relevant to a request for leniency, but it is irrelevant to any claim about the defendant not being near the murder scene. 8. Red Herring A red herring is a smelly fish that would distract even a bloodhound. It is also a digression that leads the reasoner off the track of considering only relevant information. Example: Will the new tax in Senate Bill 47 unfairly hurt business?One of the provisions of the bill is that the tax is higher for large employers (fifty or more employees) as opposed to small employers (six to forty-nine employees). To decide on the fairness of the bill, we must first determine whether employees who work for large employers have better working conditions than employees who work for small employers. Bringing up the issue of working conditions is the red herring. FALLACIES OF PRESUMPTION 9. Beg ging the Question A form of  circular reasoning  in which a conclusion is derived from premises that presuppose the conclusion.Normally, the point of good reasoning is to start out at one place and end up somewhere new, namely having reached the goal of increasing the degree of reasonable belief in the conclusion. The point is to make progress, but in cases of begging the question there is no progress. Example: â€Å"Women have rights,† said the Bullfighters Association president. â€Å"But women shouldn’t fight bulls because a bullfighter is and should be a man. † The president is saying basically that women shouldn’t fight bulls because women shouldn’t fight bulls. This reasoning isn’t making any progress.Insofar as the conclusion of a deductively valid argument is â€Å"contained† in the premises from which it is deduced, this containing might seem to be a case of presupposing, and thus any deductively valid argument might seem to be begging the question. It is still an open question among logicians as to why some deductively valid arguments are considered to be begging the question and others are not. Some logicians suggest that, in informal reasoning with a deductively valid argument, if the conclusion is psychologically new insofar as the premises are concerned, then the argument isn’t an example of the fallacy.Other logicians suggest that we need to look instead to surrounding circumstances, not to the psychology of the reasoner, in order to assess the quality of the argument. For example, we need to look to the reasons that the reasoner used to accept the premises. Was the premise justified on the basis of accepting the conclusion? A third group of logicians say that, in deciding whether the fallacy is committed, we need more. We must determine whether any premise that is key to deducing the conclusion is adopted rather blindly or instead is a reasonable assumption made by someone accepting th eir burden of proof.The premise would here be termed reasonable if the arguer could defend it independently of accepting the conclusion that is at issue. 10. Complex Question You commit this fallacy when you frame a question so that some controversial presupposition is made by the wording of the question. Example: [Reporter's question] Mr. President: Are you going to continue your policy of wasting taxpayer’s money on missile defense? The question unfairly presumes the controversial claim that the policy really is a waste of money. The fallacy of complex question is a form of begging the question. 11. False DichotomyA reasoner who unfairly presents too few choices and then implies that a choice must be made among this short menu of choices commits the false dilemma fallacy, as does the person who accepts this faulty reasoning. Example: I want to go to Scotland from London. I overheard McTaggart say there are two roads to Scotland from London: the high road and the low road. I expect the high road would be too risky because it’s through the hills and that means dangerous curves. But it’s raining now, so both roads are probably slippery. I don’t like either choice, but I guess I should take the low road and be safer.This would be fine reasoning is you were limited to only two roads, but you’ve falsely gotten yourself into a dilemma with such reasoning. There are many other ways to get to Scotland. Don’t limit yourself to these two choices. You can take other roads, or go by boat or train or airplane. The fallacy is called the â€Å"False Dichotomy Fallacy† when the unfair menu contains only two choices. Think of the unpleasant choice between the two as being a charging bull. By demanding other choices beyond those on the unfairly limited menu, you thereby â€Å"go between the horns† of the dilemma, and are not gored. 12. Suppressed EvidenceIntentionally failing to use information suspected of being relevant and significant is committing the fallacy of suppressed evidence. This fallacy usually occurs when the information counts against one’s own conclusion. Perhaps the arguer is not mentioning that experts have recently objected to one of his premises. The fallacy is a kind of fallacy of  Selective Attention. Example: Buying the Cray Mac 11 computer for our company was the right thing to do. It meets our company’s needs; it runs the programs we want it to run; it will be delivered quickly; and it costs much less than what we had budgeted.This appears to be a good argument, but you’d change your assessment of the argument if you learned the speaker has intentionally suppressed the relevant evidence that the company’s Cray Mac 11 was purchased from his brother-in-law at a 30 percent higher price than it could have been purchased elsewhere, and if you learned that a recent unbiased analysis of ten comparable computers placed the Cray Mac 11 near the bottom of the list. FALLACIES OF WEAK INDUCTION 13. Appeal to Ignorance The fallacy of appeal to ignorance comes in two forms: (1) Not knowing that a certain statement is true is taken to be a proof that it is false. 2) Not knowing that a statement is false is taken to be a proof that it is true. The fallacy occurs in cases where absence of evidence is not good enough evidence of absence. The fallacy uses an unjustified attempt to shift the burden of proof. The fallacy is also called â€Å"Argument from Ignorance. † Example: Nobody has ever proved to me there’s a God, so I know there is no God. This kind of reasoning is generally fallacious. It would be proper reasoning only if the proof attempts were quite thorough, and it were the case that if God did exist, then there would be a discoverable proof of this.Another common example of the fallacy involves ignorance of a future event: People have been complaining about the danger of Xs ever since they were invented, but thereâ₠¬â„¢s never been any big problem with them, so there’s nothing to worry about. 14. Appeal to Unqualified Authority You appeal to authority if you back up your reasoning by saying that it is supported by what some authority says on the subject. Most reasoning of this kind is not fallacious, and much of our knowledge properly comes from listening to authorities.However, appealing to authority as a reason to believe something  is  fallacious whenever the authority appealed to is not really an authority in this particular subject, when the authority cannot be trusted to tell the truth, when authorities disagree on this subject (except for the occasional lone wolf), when the reasoner misquotes the authority, and so forth. Although spotting a fallacious appeal to authority often requires some background knowledge about the subject or the authority, in brief it can be said that it is fallacious to accept the words of a supposed authority when we should be suspicious of the autho rity’s words.Example: The moon is covered with dust because the president of our neighborhood association said so. This is a fallacious appeal to authority because, although the president is an authority on many neighborhood matters, you are given no reason to believe the president is an authority on the composition of the moon. It would be better to appeal to some astronomer or geologist. A TV commercial that gives you a testimonial from a famous film star who wears a Wilson watch and that suggests you, too, should wear that brand of watch is committing a fallacious appeal to authority.The film star is an authority on how to act, not on which watch is best for you. 15. Hasty Generalization A hasty generalization is a fallacy of  jumping to conclusions  in which the conclusion is a generalization. See also  Biased Statistics. Example: I’ve met two people in Nicaragua so far, and they were both nice to me. So, all people I will meet in Nicaragua will be nice to me . In any hasty generalization the key error is to overestimate the strength of an argument that is based on too small a sample for the implied confidence level or error margin.In this argument about Nicaragua, using the word â€Å"all† in the conclusion implies zero error margin. With zero error margin you’d need to sample every single person in Nicaragua, not just two people. 16. False Cause Improperly concluding that one thing is a cause of another. The Fallacy of Non Causa Pro Causa is another name for this fallacy. Its four principal kinds are the  Post Hoc Fallacy, the Fallacy of  Cum Hoc, Ergo Propter Hoc,  the  Regression  Fallacy, and the Fallacy of  Reversing Causation. Example: My psychic adviser says to expect bad things when Mars is aligned with Jupiter. Tomorrow Mars will be aligned with Jupiter.So, if a dog were to bite me tomorrow, it would be because of the alignment of Mars with Jupiter. 17. Slippery Slope Suppose someone claims that a firs t step (in a chain of causes and effects, or a chain of reasoning) will probably lead to a second step that in turn will probably lead to another step and so on until a final step ends in trouble. If the likelihood of the trouble occurring is exaggerated, the slippery slope fallacy is committed. Example: Mom: Those look like bags under your eyes. Are you getting enough sleep? Jeff: I had a test and stayed up late studying. Mom: You didn’t take any drugs, did you?Jeff: Just caffeine in my coffee, like I always do. Mom: Jeff! You know what happens when people take drugs! Pretty soon the caffeine won’t be strong enough. Then you will take something stronger, maybe someone’s diet pill. Then, something even stronger. Eventually, you will be doing cocaine. Then you will be a crack addict! So, don’t drink that coffee. The form of a slippery slope fallacy looks like this: A leads to B. B leads to C. C leads to D. †¦ Z leads to HELL. We don’t want to g o to HELL. So, don’t take that first step A. 18. Weak Analogy The problem is that the items in the analogy are too dissimilar.When reasoning by analogy, the fallacy occurs when the analogy is irrelevant or very weak or when there is a more relevant disanalogy. See also  Faulty Comparison. Example: The book  Investing for Dummies  really helped me understand my finances better. The bookChess for Dummies  was written by the same author, was published by the same press, and costs about the same amount. So, this chess book would probably help me understand my finances, too. FALLACIES OF AMBIGUITY 19. Accent The accent fallacy is a fallacy of ambiguity due to the different ways a word is emphasized or accented.Example: A member of Congress is asked by a reporter if she is in favor of the President’s new missile defense system, and she responds, â€Å"I’m in favor of a missile defense system that effectively defends America. † With an emphasis on the wo rd â€Å"favor,† her response is likely to  favor  the President’s missile defense system. With an emphasis, instead, on the words â€Å"effectively defends,† her remark is likely to be  againstthe President’s missile defense system. And by using neither emphasis, she can later claim that her response was on either side of the issue.Aristotle’s version of the fallacy of accent allowed only a shift in which syllable is accented within a word. 20. Amphiboly This is an error due to taking a grammatically ambiguous phrase in two different ways during the reasoning. Example: In a cartoon, two elephants are driving their car down the road in India. They say, â€Å"We’d better not get out here,† as they pass a sign saying: ELEPHANTS PLEASE STAY IN YOUR CAR Upon one interpretation of the grammar, the pronoun â€Å"YOUR† refers to the elephants in the car, but on another it refers to those humans who are driving cars in the vicini ty.Unlike  equivocation, which is due to multiple meanings of a phrase, amphiboly is due to syntactic ambiguity, ambiguity caused by multiple ways of understanding the grammar of the phrase. 21. Equivocation Equivocation is the illegitimate switching of the meaning of a term during the reasoning. Example: Brad is a nobody, but since nobody is perfect, Brad must be perfect, too. The term â€Å"nobody† changes its meaning without warning in the passage. So does the term â€Å"political jokes† in this joke: I don’t approve of political jokes. I’ve seen too many of them get elected. FALLACIES OF GRAMMATICAL ANALOGY 22.Composition The composition fallacy occurs when someone mistakenly assumes that a characteristic of some or all the individuals in a group is also a characteristic of the group itself, the group â€Å"composed† of those members. It is the converse of the  division  fallacy. Example: Each human cell is very lightweight, so a human be ing composed of cells is also very lightweight. 23. Division Merely because a group as a whole has a characteristic, it often doesn’t follow that individuals in the group have that characteristic. If you suppose that it does follow, when it doesn’t, you commit the fallacy of division.It is the converse of the  composition  fallacy. Example: Joshua’s soccer team is the best in the division because it had an undefeated season and shared the division title, so Joshua, who is their goalie, must be the best goalie in the division. 24. Figure of Speech or Parallel-word Construction A fallacy characterized by ambiguities due to the fact that different words in Greek (and in Latin) may have different cases or genders even though the case endings or gender endings are the same. Since this is not widespread in other languages or since it coincides with other fallacies (e. g. quivocation, see above) writers tend to interpret it very broadly. Examples: â€Å"Activists have been labeled as idealists, sadists, anarchists, communists, and just about any name that can come to mind ending in  -ist, like  samok-ist, saba-ist, bad-ist,  and of course, who could forgetdevil-ist? † (The writer has the unsaid argument that any name ending in  -ist  is viewed as â€Å"trouble-makers† by our society. ) An introductory book on philosophy has an appendix entitle â€Å"List of Isms† the proceeds to list the schools of thought in philosophy. (Not all words that end in  -ism  is a school of thought: take for example,  syllogism. )