The Wedding

My brother Pete and sister-in-law Paula finally, after many many years, married on August 8th. Now back from honeymooning here I see the first two wedding photos. Kezia looks perturbed.

Plan and Consult, Consult and Plan II

Started my second reading of the Darzi report High Quality Care for All (of which more anon) last night. Seemingly only the PCTs and SHAs (see the NHS Glossary) have to consult - other trusts (Acute Hospitals etc) don't. Our own SHA's (North West) consultation goes under the jolly title of Healthier Horizons.

Modernising Medical Careers

Well, gals and guys, I'm finally coming to the end of the Darzi report High Quality Care for All.

What a lot of piffle ... but watch out my medical friends! Amongst all the new organisations and acronyms is one that should give the junior doctors some cause for concern ...

Medical Education England is to be established by the end of this year to advise the DoH on the training of doctors, dentists, pharmacists and "healthcare scientists".

An NHS Glossary

For the sake of both UK and overseas readers I will develop here a glossary of National Health Service abbreviations and terms and will link to this post right so I don't have to explain every bit of jargon or abbreviation every time I post on UK medical matters or politics. Here is a start and I will expand upon it as I come across more acronyms ...

A & E - Accident and Emergency. Where you rush off to or are rushed off to after after car accident/call the emergency services or just feel bad, out-of- hours etc etc.

ACUTE HOSPITALS TRUST - the trusts that run our general hospitals. Confusingly, an acute hospitals trust as I have explained before, is not often not called an acute hospitals trust. Fortunately, the trust running our local general hospital is called the Pennine Acute Hospitals Trust. Not that it made any difference to trust services when the Strategic Health Authority (the next rung up the bureaucracy - see below) decided to "rationalse" the hospital services in our own part of its region.

BMA - the British Medical Association. It is sometimes called the "trade union" of UK doctors. Many UK doctors consider it as as being totally pathetic in representing the interests of UK doctors (see Remedy UK below).

DoH - Department of Health. In the UK we don't always call a "Ministry" a Ministry, Thus we have a Ministry of Defense but a Home Office administrating internal affairs and a Department of Health covering health services both pubic and private. And although the head of the DoH has a positition in the Prime Minister's cabinet, he is not known as a Minister, but as a Secretary of State.

FOUNDATION TRUST - a new form of the administrative unit known as a trust which has more control of how it spends its budget allocation. A Foundation Trust features a Board of Governors with wide participation from non-NHS entities including Jane and Joe Public. The RMCH (see below), where Kezia is being treated, is part of a trust in the process of transforming into a Foundation Trust.

GMC - General Medical Council, the regulatory body that decides whether you are fit to be a Doctor or not. If a Doctor commits a misdemeanour, it can also place limitations on what that Doctor is allowed to do or, in extreme cases strike off him/her from the central register of Doctors.

GP - General Practioner. Your family doctor. In many countries of the world such a thing as a dedicated family doctor does not exist - one turns up at the local health post and sees whoever is on duty. In the UK one registers with a local General Practice, and with a specific General Practioner. That does not mean to say you won't see another GP at the same practice if your own GP is on holiday, or that if you are travelling within the UK, then you cannot visit another GP practice. GP practices are private but are contracted by the local Primary Care Trust to provide primary care services. The advantage of the GP system is that your GP knows you and your health personally. Current UK government plans are for you to be able to walk-in to a "polyclinic" where there is a general clinician paid a salary by a multinational company who cannot access your medical records over the so-far failure of a centralised IT system.

MENTAL HEALTH TRUSTS - self-evident ?

MMC – Modernising Medical Careers. Both this and the next entry are a reform plan for postgraduate doctor training introduced from 2005 onwards. MTAS was, an online application process was introduced in 2007. The whole reform process and its implementation have come under heavy criticism. I will refer you to the Wikipedia entries on the subject (here and here) as it is a complex issue.

MTAS – Medical Training Application Scheme. See above.

NAO - National Audit Office. Audits the workings and spending of government departments.

NHS CHOICES - lets us choose where we want to receive treatment anywhere in England. Most patients would choose their local hospital so family and friend can visit them.

NHS DIRECT/ NHS 24 – the former in England and Wales, the latter in Scotland. When the GP contract was renegotiated in 2004, GPs were no longer obliged to provide Out-of-Hours Services. The DoH believed the the NHS could pick up the slack through a new service called NHS 24 whereby a non-medically member of staff evaluates over the phone whether you need emergency care or not ... or suggests you visit your GP in the morning.

NHS Next Stage Review (NSR) - a "consultation exercise " commissioned by the Department of Health and led by surgeon on minister Lord Darzi on the future of the NHS.

NICE - the National Institute for Health and Clinical Excellence. It evaluates drugs and treatments. It does not evaluate their clinical effectiveness (that is the reponsibility of a European medical authority) but on their cost-effectiveness. Trusts are not legally obliged to follow NICE guidelines but most often do until legally challenged in the judicial system

QOF – Quality and Outcomes Framework. When the government introduced the new GP contract in 2004, it set performance targets under the Quality and Outcomes Framework whereby 120+ critera applied and for each one achieved, the GP Practice is financally rewarded by the PCT. The truth has been that the OOF targets have been so easy to achieve - thus the GP Practices have been raking the money in, leaading to enor,ous media and political criticism of GPs but not of the government that drew up the QOF and forced the contract on the GPs.

OOH - Out-of-Hours service. When the government renogiated and enforced the contract between GP practices and the NHS in 2004, it decided it could provide "emercency" care more cost-effectively through NHS Direct/NHS24, A & E and and Ambulance Services than through GP call-outs. But now the government is turning around and wants the GPs to provide OOH again as A & E, NHS 24 and the ambulance trusts cannot cope

PCT - Primary Care Trusts. Self-evident really. The administrative units of the NHS that commisson the GP Practices etc to provide non-hospital based healthcare to the community.

POST-CODE LOTTERY - the UK postal system is based on post-codes - much like US zip codes. I can write snail-mail to Nanda with just her name, a post-code and a country. Depending upon your postcode, you will fall under this or that NHS trust, Some NHS trusts will provide you treatment options strictly along the lines of the NICE guidelines (non-legally-binding but described above). Other trusts will be challenged in the Courts for the trust to provide the drug/treatment to be provided and yet other trusts will automatically provide the drug/treatment. It will all depend under which your post-code falls.

REFORM UK - an association of junior doctors (i.e. not yet consultants and "so-to-speak" still in post-graduate training), which amongst other things, has led the campaign protesting MMC/MTAS. It is highly critical of the current government's NHS reforms and has also been critical of the BMA's responses to government reforms.

RMCH - the Royal Manchester Children's Hospital - where our daughter, Kezia, is being treated for T-cell Acute Lymphoblastic Leukaemia - and which is fuckin' marvellous!

SHA - Strategic Health Authority. This is the next level up in the NHS bureaucracy from the Trusts whether an Ambulance Trust, a PCT, an acute hospital trust, a mental health trust etc etc. Thus England has a North-West Stragetic Health Authoritiy covering every trust from Cheshire up to the Scottish border.

Baldy's Book

Adrian Sudbury's blog is to be published in book form. It can be purchased online here. All profits to the Anthony Nolan Trust which maintains one of the two UK Bone Marrow Donation Registries.

Adrian Sudbury

Adrian Sudbury of Baldy's Blog, who led a massive campaign for bone marrow donation education, died from leukaemia last night. A Book of Remembrance can be signed here.

The Carrot and the Stick

The government has recently stated it wants to increase primary care services in under-privileged areas with the justifiable and statistically-proven reasoning that those living in such areas are more likely to suffer ill-health.

It has also stated that it will increase funding to those Primary Care Trusts (and, therefore, knock-on to the primary care providers such as General Practitioners, community care services etc) which excel, fulfilling or exceeding quality-of-care standards, many of which are measured by clinical outcomes. Those that fail to meet the standards will receive less money.

I don't understand ... I must be stupid ...

For example, a GP practice in an under-privileged area is less likely to perform as well as a practice in a privilged area due to the higher levels of ill-health in the under-privileged area. To achieve the quality-of-care standards demanded of it will require more resources rather than less.

The English Colonial Gentleman's Larder - HP Sauce

There are three things one may put on your chips in the UK ("french fries" to you Americans and a pathetic imitation of a chip) - salt and vinegar, Heinz Tomato Ketchup or HP Sauce.

The recipe for this brown sauce was invented by a Nottingham grocer, who upon hearing it had been introduced to the restaurant of the Houses of Parliament, named it HP Sauce.

However, other apocryphal stories about the origin of its name exist (see the wikipedia entry) but it is to be noted that an illustration of the Houses of Parliament still appears on the bottle's label.

Alan Davidson's Encyclopedia of Food notes its derivation from earlier ketchups and Worcester Sauce.

Other versions of this brown source existed in the '50s-'70s including PK Sauce - hence my brother, Pete, was named Kevin Peter to avoid the inevitable piss-taking of P. K. ... but that was before the invention of KP Peanuts. With a surname such as Gascoigne, and forenames Angus Robin, the opportunities for name-calling were not lacking (penny in the meter ...).

HP Sauce was taken over by Heinz in 2005 and its UK factory closed down the following year with operations moved to the Netherlands.

(As an aside, I am also rather partial to tahini or soy sauce on my chips).

Bugs

It appears that our local Acute Hospitals Trust, which runs four hospitals in the area including our own local general hospital, has the fourth worst pest infestation problem in the country. The local Patients' Association chair-person firmly blames this on the privatisation of hospital cleaning services.

"If you went back 15 years, the Matron was on the ward and cleaners were employed by the hospital and there seemed to be a lot of pride on the ward ... Contracts then went out to the private sector and cleaners are now earning the minimum wage ... They are not being encouraged or motivated to take their jobs seriously. There's a high turnover of staff and that needs to be examined."

The term Matron does tend to conjure up images of Hattie Jacques in the Carry On movies, but at the RMCH (part of another trust) where Kezia is being treated, our Ward Manager, Alison, was ever-present and, although somewhat aloof and not on the clinical frontline, appeared to be most concerned at running an efficient operation. I assume most of her time is taken up by ward management - ensuring nurse rosters are in place, that the ward is clean, that kids get the entertainment they need, that parent accomodation on the ward is in order, that meals turn up on time, that the ward/parents kitchen is in order, that records are kept, that the ward complies with hospital, NHS, DoH bureaucracy. And our ward (contract, minimum wage, Filippina) cleaner was included on the photo-board at the entrance to the ward whilst there were notable absences of photos of some of the consultants!

Anyhow, our local Liberal Member of Parliament is concerned and calls for an urgent enquiry, the Trust spokesperson denies there is a problem and makes excuses, and the local Labour parliamentary candidate (toeing the party line) defends government policy.

For those interested in hospital fauna 80% of NHS Trusts reported problems with ants (shurely non-contracted unpaid cleaners - I have never heard of ants as disease vectors?), 66% with rats, 77% with mice, 59% with cockroaches, 65% with fleas or other biting insects and 24% with bed bugs

Plan and Consult, Consult and Plan

Our government promises to consult with us and then make its plans.

The Darzi "consultation" counted on members-of-the-public-with-nothing-else-to-do - and paid them.

The Darzi "consultation" has now charged the SHAs, and so, down-the-line, the PCTs etc, to consult and plan or ... oh sorry, plan and consult.

The SHAs have hastily planned, the PCTs etc have hastily planned ... and only now are we being consulted?

Lucia was meant to meet the children's director of the Central Manchester and Manchester Children's University Hospital Trust, a foundation trust, as a member of the trust's board of governors last week ... the meeting has been indefinitely postponed. It doesn't give initial confidence that foundation trust boards of citizen governors are nothing more than political lip-service to the concept of community participation in the governance of local health services.

Very confused!

The Hippocratic or Hypocritical Health Service?

Last year it was decided under the two NHS reviews in the Greater Manchester area ("Making it Better" and "Healthy Futures") to reduce or cut A & E, maternity and paediatric services at our local general hospital.

The final version of the Department of Health's Darzi report "High Quality Care for All" was published in June of this year, and was immediately followed by each Strategic Health Authority (SHA - 2nd tier of the health bureaucracy) publishing its own reform/consultation (Ed: shouldn't that be the other way round?) "strategic plan" within a month - the first appeared about a week after the publication of Darzi's report so they had obviously seen the report and been instructed before the public and Parliament had seen the Darzi report.

Now the SHAs have instructed the Primary Care Trusts (PCTs), Mental Healthcare Trusts, acute care hospital trusts, ambulance trusts etc etc (3rd tier of the health bureaucracy) to produce their own reform/consultation (Ed: shouldn't that be the other way round?) plans pronto.

I am happy my PCT has managed to produce a ("Speak Up, It's Your Health") website with an online questionnaire, a telephone hotline and a paper copy to every house in the borough in such quick time (something in NHS IT works?).

We have until 7 November to give our responses. Obviously not in the diverse linguistic communities of the borough - come on what is the point of putting a pamphlet in English that says "If you want a copy of this pamphlet in Urdu, then write to or telephone ..." through a letter-box in a part of town that is predominantly Urdu-speaking ?

In the last two years the local population clearly expressed its opinion in a community-led campaign "Hands Off Our Hospital" (a theme repeated up and down the country) about proposed cuts in A & E, maternity and paediatric services at our local general hospital. It even went to a final "independent" review. But maternity and paediatric services were 100 % cut and A & E is to become an "Urgent Care Centre". Admittedly, the local hospital is not the responsibility of the Primary Care Trust but another 3rd tier organisation, the Pennine Acute Hospitals Trust ...

I can only assume that they too will produce their reform/consultation plans to be popped through the letter-boxes of our town's confused residents.

What the hell is an "Urgent Care Centre" anyway?

Can it diagnose paediatric leukaemia on a Sunday afternoon?

Tech Talk - Autodesk TrueView 2009

I really hate to talk about IT business monopolies - unless to criticise.

As Microsoft is to Operating Systems and Office applications, Autodesk is to the world of Computer Assisted Design (CAD) through its very expensive software product, Autocad.

However, it does provide a free viewer so that you can view its CAD file format (.dwg) in Internet Explorer (note IE only and that there are no versions of Autocad for Mac or Linux). The viewer has run through various names and forms over the years - from Voloview to the current DWG TrueView 2009.

DWG TrueView 2008 and 2009 can be run as independent applications, or are meant to run integrated into the IE web browser (as the original Voloview did). As an independent application it runs fine. As an IE Add-On I (and many others it seems) get a "white screen of death" when we try to load a dwg file in IE.

My boss has charged me with putting all our technical drawings on our Intranet site as html links so, as many are in dwg format, I need a browser dwg viewer. A "white screen of death" is not going to encourage my clients to use digitised drawings.

DWG TrueView claims it will install an ActiveX control to IE to allow dwg drawings to be viewed. It doesn't. Even when I reduced all of IE's security settings to the minimum.

Installing/uninstalling TrueView, changing IE security settings, research on the web took me all day ...

Eventually, I found a partial solution which doesn't actually allow you to view the files in IE but allows a download and automatic opening of the dwg file in DWG TrueView,

Write the following script into a file that you name as a *.inf. Right click on the file and select Install. De- and then reinstall DWG TrueView 2009 if necessary.

[Version]
Signature = “$Windows NT$”

[DefaultInstall]
AddReg = addreg
;DelReg = delreg
;DelReg = nuke

[addreg]
HKLM,”SOFTWARE\Microsoft\Internet Explorer\ActiveX Compatibility\{6C7DC044-FB1E-4140-9223-052E5ABE7D24}”,”Compatibility Flags”,0×00010001,00,04,00,00
HKCR,”CLSID\{6C7DC044-FB1E-4140-9223-052E5ABE7D24}\InProcServer32″,”~~Disabled~~”,,”C:\Program Files\DWG TrueView 2009\acctrl.dll”

[delreg]
HKCR,”CLSID\{6C7DC044-FB1E-4140-9223-052E5ABE7D24}\Implemented Categories\{40FC6ED4-2438-11CF-A3DB-080036F12502}”
HKCR,”CLSID\{6C7DC044-FB1E-4140-9223-052E5ABE7D24}\Implemented Categories\{7DD95802-9882-11CF-9FA9-00AA006C42C4}” ; remove “safe for scripting” marker

[nuke]
HKCR,”CLSID\{6C7DC044-FB1E-4140-9223-052E5ABE7D24}”

[Strings]

Then select the hyperlink to your dwg file and IE will ask you whether to open or save it. Select Open. TrueView will then ask you for a Template file - click Cancel and TrueView will open with your drawing perfect!

Thanks to Slinger and Swami.

Link to OpenCad.

MtF Doctor

Dr Z is not the only transexual doctor out there - today I read about GP Dr Michelle Drage, this time MtF.

"GPs demand right to treat refugees"

I have written before upon the rights of non-UK citizens residents to medical treatment under the free UK National Health Service. The GPs (primary care) do not want to police immigration status.

Although a full UK Citizen, you are not entitled to free NHS treatment, whether primary or secondary, unless you have been "ordinarily resident" in the UK for six months. Exception - Accident and Emergency. If A&E pass you (non-UK "ordinarily resident") on to secondary care, the local Primary Care Trust where you were admitted can charge you for secondary care treatment.

Kezia's first visit to the UK was to A&E from which five hours later she passed to secondary care.

So, as I have stated before, we are lucky that the bean-counter at our local PCT did not understand the complex regulations or is extremely sympathetic.

In 2004 the Department of Health (DoH) began a review and consultation of free NHS treatment of "failed" asylum seekers. One may be a "failed" asylum seeker but remain in the UK for several reasons ...

- you are appealing.

- the situation in your country of origin has radically changed (vis Zimbabwe or last week's coups in Mauritania and Guinea-Bissau)

etc etc ...

... you will not be immediately put on a plane.

"In April 2004, ‘Statutory Instrument 614’ was enacted by the Department of Health1. This meant that those classed as ‘not lawfully resident' in the UK, including vulnerable migrant groups such as victims of trafficking and other undocumented migrants, were no longer, with a number of important exemptions, eligible for free NHS hospital care. Until April 2008, asylum seekers whose claims had been refused were also being denied hospital care.

However, a judicial review by Mr Justice Mitting found this group to be ordinarily resident and thus eligible for free NHS care. The Government has appealed this decision, with the hearing scheduled for mid-November. However, for now, failed asylum seekers should be able to access these services.

The 2004 changes in access to secondary care were soon followed by a consultation examining proposals to extend the new rules to limit access to primary care. The stated intention of the proposed regulations was to reduce ‘health tourism’ - overseas visitors arriving in the UK with the sole purpose of exploiting NHS services. The results of this consultation were never released.

In March 2007, a Home Office paper ‘Enforcing the Rules’ was released. It examined access to public services by ‘overseas visitors’. The document stated 'Illegal migrants are unlikely to place a great strain on the NHS as most are thought to be young and therefore relatively healthy' (page 13). However, it suggested the denial of services could be used to deter undocumented migrants from entering the country and to encourage refused asylum seekers to leave.

The issue of charging foreign nationals for care is currently being revisited by the Government. A review of their findings is expected soon. It is expected that this will lead to changes in the regulations governing entitlement to NHS primary healthcare services."

The Global Health Advocacy Project and Medsin are leading the campaign against the government's November judicial appeal.

The Global Health Advocacy Project and Medsin requested through the provisions of the Freedom of Information Act access to the responses of the 2004 consultation. They were not granted access to the responses, but were given a list of those who responded.

The Global Health Advocacy Project and Medsin have since approached those who responded to the original consultation to allow them to see their responses. I am disappointed to see that notable cancer and leukaeimia organisations were not included in the original consultation exercise: Leukaemia Research Foundation, CLIC Sergeant, ACLT, Antony Nolan Trust, Macmillan etc etc.

However, amongst those who responded to the Global Health Advocacy Project, notable concerns raised were as follows:

1. Seventy five percent of submissions from healthcare providers expressed concern that denying care would place them in breach of professional codes of conduct. Many were concerned that questioning patients about their immigration status could damage the doctor patient relationship.

2. Sixty eight percent of submissions expressed concerns regarding the public health impact of the proposals, particularly the risk that the delayed detection and treatment of infectious diseases would constitute a risk to public health.

3. It was stressed that certain groups were particularly vulnerable and concerns were raised about the potential impact of the proposals on children and pregnant women. The majority of respondents felt refused asylum seekers, settled in the UK, were not 'overseas visitors', rather they were a vulnerable group who should not fall within the scope of the proposals.

4. Eighty seven percent raised concerns about the workability of the proposals. These included the challenge of requiring front-line healthcare workers or NHS administrators to determine immigration status.

5. Fifty five percent of respondents were concerned about the cost effectiveness of the proposals. Many felt that administrative costs incurred, as well as the costs associated with an inevitable increase in the uptake of expensive emergency services, would exceed any savings made in primary care. Some highlighted the Government's failure to undertake a cost-benefit analysis of the proposals.

6. A number of respondents thought the implementation of these proposals would lead to discrimination, social marginalisation and damage to the public perception of migrant communities. Some called for a full race impact assessment prior to any implementation of the proposals.

7. Twenty nine percent of submissions expressed concerns that the proposals would violate several international human rights agreements and therefore be open to legal challenge.

8. Whilst five submissions were broadly supportive of the proposals, seeing the current situation as lacking clarity, these submissions all contained concerns. One of these respondents contacted us to inform us that their organisation no longer held the views expressed in their submission; another submission called for vulnerable migrant groups to be excluded from the proposals. Others were concerned about the practicality of the proposals.

Whilst we acknowledge our sample may be biased, the concerns raised are valid and important. It is vital that the Department of Health address these points before moving ahead with further policy change. We call upon them to release the remaining two hundred and thirty six submissions in order that these valuable expert opinions are available to inform public debate and policy.

Our full conclusions and recommendations can be found towards the end of the document. Our recommendations include:

1. We suggest denial of healthcare should not be used as a means of enforcing immigration policy.

2. We recommend the Government reconsider leaving any community unable to access primary care as this could undermine efforts to tackle infectious diseases.

3. We recommend refused asylum seekers fall outside the remit of these proposals.

4. Front line healthcare workers and administrative staff have insufficient knowledge of the asylum process to implement these proposals.

5. Government must recognise that administering a charging regime would place a significant burden on front line NHS services.

6. We recommend the Government undertake a full cost benefit analysis of both proposed and existing NHS charging regulations.

The Department of Health has been under increasing pressure from the Home Office (responsible for the state budget and immigration) to cut - and want to leave some of the most vulnerable members of UK society without basic healthcare. The DoH has never published the findings of this consultation.

I would not oblige our readers to go though the whole 60+ pages of the Global Health Advocacy Project and Medsin report but please read this article from last Sunday's Observer (sibling edition of The Guardian). I cannot put the medical profession's opinion more succinctly than this article, but If you cannot be bothered to go read either the whole report or even the Observer article, there are two major objections from the medical profession. And please sign the petition here.

1. It is unethical. It goes against the General Medical Council's (state medical regulatory body for doctors) Code of Ethics and ip so the "Hippocratic Oath".

2. If GPs are not allowed to treat, vaccinate etc, then non-deported rejected asylum seekers will spread the risk of preventable disease to the entire population.

The only exception under government and NHS rules are if the patient turns up at A & E ... I am happy we took Kezia to A & E ...

There are few countries in the world (excepting the EU) for which a visa to enter the UK is not required. Is it not too much to ask that with each visa application to enter the UK, the local UK Embassy requests a health certificate from an embassy-approved physician ?

‘Our members believe that denying proper medical care will seriously impede some clients from exercising their rights to enjoy a reasonable family or private life. Denial of treatment to one family member, for example the husband of a British-born wife and father of British children, who is applying for leave to remain with his family, will impact on others. They also doubt whether a court would find it proportionate to deny treatment which for instance would enable a child to walk with assistance in order to attend school and be part of thec ommunity when he or she had been born in this country and had played no part in his or her parent’s illegal entry to the UK.’

Immigration Law Practitioners Association

Is Kezia a Health Tourist?

"Freedom of Information...can be inconvenient, at times frustrating and indeed embarrassing for governments. But Freedom of Information is the right course because government belongs to the people, not the politicians [...] Public information does not belong to Government, it belongs to the public on whose behalf government is conducted.

Wherever possible that should be the guiding principle behind the implementation of our Freedom of Information Act."

Gordon Brown, 27 October 2007

Countries I'm still lookin for ...

I explained yesterday about Caroline and Emily's project for the UK newspaper The Guardian and TV station Channel 4 to interview and photograph children from every country in the world resident in the UK. They're still short of a few countries so if any of our readers know families from the following countries, please let us know (contact addresses at the end of this post).

Bahrain, Barbados, Brunei, Central African Republic, Comoros, Republic of the Congo (i.e. Brazzaville not the DRC Kinshasa), Djibouti, Gabon, Grenada, Guinea-Bissau, North Korea, Madagascar, Marshall Islands, Micronesia, Montenegro, Nauru, Nicaragua, North Korea, Oman, Palau, Qatar, San Marino, Tunisia, Vatican.

Some countries in this list surprise me, especially the Arab states and the ex-British colonies ... but I'd be interested in learning your opinion of the odds of finding a UK resident child from North Korea and the Vatican!

Contacts:

Emily: ebutselaar at googlemail.com

Caroline: caro at carolineirby.com

Me: agascoigne at eits.st

K

Something I owe to the soil that grew -
More to the life that fed -
But most to Allah Who gave me two
Seperate sides to my head.

I would go without shirts or shoes,
Friends, tobacco or bread
Sooner than for an instant lose
Either side of my head.

Kim, Rudyard Kipling.

Diversity

Caroline Irby: "I am currently...

...travelling throughout the UK in search of a child from every country in the world to interview and photograph. If you know any non-British children living here, born in the country of their nationality please let me know!"

There are children from every UN-recognised country resident in the UK. Sorry Somaliland and Kosovo - you probably don't count, even though I am sure you have residents in the UK.

Caroline and Emily are freelance journalists/photographers who have been commissioned by the national UK newspaper the Guardian and the national UK TV Channel 4 to interview and photograph the ethnic diversity of children living in the UK. They have been scouring the country for child-representatives of every UN-recognised country. Their project will also appear on the web. The aim, obviously, is to show how ethnically diverse the UK is.

So far they have found children of 154 of the 193 but small countries like our own remain difficult. Caroline tells me that Tuvalu was a particularly difficult one and Emily tells me Namibia was also difficult.

Yesterday, after the recommendation of a mutual journalist friend and relative (on Nanda's side), Jaime and Kezia were interviewed and photographed.

I skyped whilst Caroline was there, and filled her in a little bit. It was apparently going well and she promised to send me some photos - looking at her "portfolio" I think they will be truly great.

Good to give some payback!

Emily Butselaar:

"Thank you for your time earlier, I'm so pleased Nanda is interested in the project. As discussed the Guardian has commissioned a project to photograph and interview - by August this year- a child from every country in the world living in the UK. There are 193 countries (according to the UN) so hopefully we will be photographing close to 193 children. The finished work will be published in the Guardian magazine and Channel 4 will be showing the pictures and extracts from the interviews in a series of mini documentaries.

So far we have interviewed 154 children. We have been travelling right across the UK to find children. The material collected will create a historical snapshot of the UK today; its tone will be upbeat, a celebration of diversity. The criteria are that the children are aged between 0 and 16 (inclusive) and, ideally, that they were born in their native country, to both parents of that nationality ie to qualify as 'Cypriot', for example, they should have been born in Cyprus to a Cypriot mother and father.

If the children are very young, we just photograph them and record them telling me their name and the country they are from, no more. If they are older and speak English, we ask about them about their first impressions of Britain, what we could learn from their native country and what their hopes are for the future. It takes around forty minutes to an hour of their time.

The photographer Caroline Irby is travelling to meet the children at their homes, schools or activity clubs, then taking very informal pictures showing the children doing something normal for them: it could be eating, playing, riding the bus home, celebrating a festival or just a simple portrait. Please see attached the attached samples for an idea of how the project will look. If you'd like to see some more examples of her work, please visit www.carolineirby.com.

Only their first names will be used in the magazine / on Channel 4 and the name of the school they attend will not be disclosed.

The story should hopefully increase understanding of the 'experience' people from abroad have in the UK and present migrants in more positive light than it is sometimes the case.

What we are hoping is that we could set up a time and date to photograph and interview Nanda's daughter. She suggested it would be easier to liaise with you to arrange this.

Thank you in advance for your help."

The Open Rights Group

Instead of repetition I will point you to Tom Reynold's post on the protection of our freedoms in a digital age. And given this is a sometimes medical blog the Open Rights Group's page on the NHS.

Patientline Revisited

The principle hospital bed-side telecommunications services company in the NHS has gone bust!

I wrote about Patientline several times last year when there was much criticism of their telephone and television charges. In April 2007 they raised their bed-side telephone outgoing charges from 0.10 pounds a minute to 0.26 pounds. Incoming calls were charged at 0.49 pounds a minute. And as I previously pointed out a regular telephone call is 0.03 pounds a minute. The state regulatory authority for telecommunications obliged them to reduce the bed-side outgoing call to 0.10 pounds a minute, but incoming could calls remained at 0.49 pounds a minute.

Patientline TV-viewing services were 3.50 pounds a day.

In spite of their exorbitant charges, the company has run up a debt of £90 million so on Friday last it put itself into"administration" (i.e. bankruptcy).

Good riddance to bad rubbish I say ... but there is a catch.

The creditors (three banks) have moved in, forgiven Patientline £35 million of debt and formed a new company, Hospedia, taking over the Patientline services.

However, it also aims to take over Patientline's only (but smaller) competitor Premier Telesolutions (which also provides bed-side telecommunications solutions),

The Patientline bank consortium, Hospedia, and the backers of Premier Solutions are awaiting the Office of Fair Trading (our trading regulatory organisation) for a decision whether they can cosy up in October.

So a two company market becomes a one company monopoly?