READING PASSAGE 2

You should spend about 20 minutes on Questions 14-26, which are based on Reading Passage 2 below.

Changing Rules for Health Treatment

People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs.The National Institute for Health and Clinical Excellence (NICE), which advises on the clinical and cost effectiveness of treatments for the National Health Service (NHS) in the UK, said that in some cases the 'self-inflicted' nature of an illness should be taken into account.

NICE stressed that people should not be discriminated against by doctors simply because they smoked or were overweight. Its ruling should apply only if the treatment was likely to be less effective, or not work because of an unhealthy habit.The agency also insisted that its decision was not an edict for the whole NHS but guidance for its own appraisal committees when reaching judgements on new drugs or procedures. But the effect is likely to be the same.

NICE is a powerful body and the cause of much controversy. It is seen by some as a new way of rationing NHS treatment. Across the UK, primary care trusts (PCTs) regularly wait for many months for a NICE decision before agreeing to fund a new treatment. One group of primary care trusts is ahead of NICE.Three PCTs in east Suffolk have already decided that obese people would not be entitled to have hip or knee replacements unless they lost weight. The group said the risks of operating on them were greater, the surgery may be less successful and the joints would wear out sooner. It was acknowledged that the decision would also save money.

NICE said no priority should be given to patients based on income, social class or social roles at different ages when considering the cost effectiveness of a treatment. Patients should not be discriminated against on the grounds of age either, unless age has a direct relevance to the condition. NICE has already ruled that IVF should be available on the NHS to women aged 23 to 39 as the treatment has less chance of success in older women. It also recommends that flu drugs should be available to over-65s, as older people are more vulnerable.

But NICE also said that if self-inflicted factors meant that drugs or treatment would be less clinically and cost effective, this may need to be considered when producing advice for the NHS. They state that 'if the self-inflicted cause of the condition will influence the likely outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances:They acknowledge that it can be difficult to decide whether an illness such as a heart attack was self-inflicted in a smoker.'A patient's individual circumstances may only be taken into account when there will be an impact on the clinical and cost effectiveness of the treatment:

Prof Sir Michael Rawlins, the chairman of NICE, said:'On age we are very clear - our advisory groups should not make recommendations that depend on people's ages when they are considering the use of a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups. Even then, age should only be mentioned when it provides the only practical 'marker' of risk or benefit. NICE values people, equally, at all ages:

But Steve Webb, the Liberal Democrat health spokesman, said there was a danger of primary care trusts following the same course of action.'There is no excuse for cash-strapped hospitals denying treatment to people whose lifestyle they disapprove of; he said.'Treatment decisions involving people's lifestyle should be based on clinical reasons, not grounds of cost. The NHS is there to keep people healthy, not to sit in judgement on individual lifestyles:

A spokesman for NICE said:'We want to reassure people that in producing our guidance we are not going to take into consideration whether or not a particular condition was or is self-inflicted.The only circumstances where that may be taken into account is where that treatment may be less effective because of lifestyle choices:

Jonathan Ellis, the policy manager at Help the Aged, said it was pleased NICE had finally shown an understanding of the importance of tackling age discrimination.'While this is a major feat, there is still some way to go to banish the evident inherent age discrimination that exists within health care services; he said.'The NHS now has much to learn. It will ensure a fairer deal all round for older people using the NHS:

READING PASSAGE 3

You should spend about 20 minutes on Questions 27-40, which are based on Reading Passage 3 below.

The Romantic Poets

One of the most evocative eras in the history of poetry must surely be that of the Romantic Movement. During the late eighteenth and early nineteenth centuries a group of poets created a new mood in literary objectives, casting off their predecessors' styles in favour of a gripping and forceful art which endures with us to this day.

Five poets emerged as the main constituents of this movement - William Wordsworth, Samuel Taylor Coleridge, George Gordon Byron, Percy Bysshe Shelley and John Keats. The strength of their works lies undoubtedly in the power of their imagination. Indeed, imagination was the most critical attribute of the Romantic poets. Each poet had the ability to portray remarkable images and visions, although differing to a certain degree in their intensity and presentation. Nature, mythology and emotion were of great importance and were used to explore the feelings of the poet himself.

The lives of the poets often overlapped and tragedy was typical in most of them. Byron was born in London in 1788.The family moved to Aberdeen soon after, where Byron was brought up until he inherited the family seat of Newstead Abbey in Nottinghamshire from his great uncle. He graduated from Cambridge University in 1808 and left England the following year to embark on a tour of the Mediterranean. During this tour, he developed a passion for Greece which would later lead to his death in 1824. He left for Switzerland in 1816 where he was introduced to Shelley.

Shelley was born to a wealthy family in 1792. He was educated at Eton and then went on to Oxford. Shelley was not happy in England, where his colourful lifestyle and unorthodox beliefs made him unpopular with the establishment. In 1818 he left for Italy, where he was reunited with Byron. However, the friendship was tragically brought to an end in July 1822, when Shelley was drowned in a boating accident off the Italian coast. In somewhat dramatic form, Shelley's body was cremated on the beach, witnessed by a small group of friends, including Byron.

Historically, Shelley and Byron are considered to have been the most outspoken and radical of the Romantic poets. By contrast, Wordsworth appears to have been of a pleasant and acceptable personality, even receiving the status of Poet Laureate in 1843. He was born in 1770 in Cockermouth, Cumbria. By the time he entered his early teens, both his parents had died. As he grew older, Wordsworth developed a passion for writing.

In 1798 Wordsworth published a collection of poems with Coleridge, whom he had met, a few years earlier, when he settled in Somerset with his sister Dorothy. He married in 1802 and, as time passed, he deserted his former political views and became increasingly acceptable to popular society. Indeed, at the time of his death in the spring of 1850, he had become one of the most sought-after poets of his time.

Wordsworth shared some of the years at Dove Cottage in Somerset with his friend and poetical contemporary, Coleridge. Coleridge was born in Devon in 1772. He was a bright young scholar but never achieved the same prolific output of his fellow Romantic poets. In 1804 he left for a position in Malta for three years. On his return he separated from his wife and went to live with the Wordsworths, where he produced a regular periodical.

With failing health, he later moved to London. In 1816 he went to stay with a doctor and his family. He remained with them until his death in 1834. During these latter years, his poetry was abandoned for other forms of writing equally outstanding in their own right.

Perhaps the most tragic of the Romantic poets was Keats. Keats was born in London in 1795. Similar to Wordsworth, both his parents had died by his early teens. He studied as a surgeon, qualifying in 1816. However, poetry was his great passion and he decided to devote himself to writing. For much of his adult life Keats was in poor health and fell gravely ill in early 1820. He knew he was dying and in the September of that year he left for Rome hoping that the more agreeable climate might ease his suffering. Keats died of consumption in February 1821 at the age of twenty-five.

It is sad that such tragedy often accompanies those of outstanding artistic genius. We can only wonder at the possible outcome had they all lived to an old age. Perhaps even Byron and Shelley would have mellowed with the years, like Wordsworth. However, the contribution to poetry by all five writers is immeasurable.They introduced the concepts of individualism and imagination, allowing us to explore our own visions of beauty without retribution. We are not now required to restrain our thoughts and poetry to that of the socially acceptable.