Friday, January 30, 2009

Off-Treatment - Consultation #2

Much confusion about who was to arrange transport - our local health authority or the hospital. Apparently, post-treatment it should be the former. Anyway amidst much last-minute confusion the former couldn't, so after conversations between Carol, our health worker and Teresa, our hospital social worker, the latter managed to arrange transport.

Anyway, all is well Kezia having a neutrophil count of a whopping 4.71!

Thursday, January 29, 2009

NHS Connecting for Health - Parliamentary Review

After the recent slamming of Lord Darzi's Next Stage Review by the UK Parliament's Health Committee, its Public Accounts Committee has just published its report The National Programme for IT in the NHS: Progress since 2006.

It is equally damning. I haven't finished it yet but reflecting my Freedom of Information Act denied request regarding how much the NHS pays Microsoft, the Department of Health also refused to reveal to the committee how much it is paying CSC for the development and (non-) deployment of the Lorenzo patient care record system.

To quote "Confidentiality agreements that the Department made with CSC in respect of two reviews of the delivery arrangemets for Lorenzo are unacceptable because they obstruct parliamentary scrutiny of the Department's expenditure ".

Tuesday, January 27, 2009

Internet Banking Security

Over the years my bank's Internet banking security has gradually got more and more secure.

First I had to enter a four digit numerical code, different to the one used to get money from an ATM, and reply to one of four questions to which only I knew the answers (inconveniently one of the answers I specified is 19 characters long and seems to be the one that comes up most often. Does their security software have a built-in algorithm for the longest possible answer?). Then last year they introduced a new system whereby it asked you randomly for just two digits of the numerical code in addition to the security question.

They are now introducing a new security measure - giving a Visa Debit/Credit card reader to every customer to attach to the customer's computer (I assume by USB?) to verify his/her identity when conducting fund transfers or establishing new standing orders.

According to their website it will work with Windows and Mac OS but fails completely to mention Linux.

At least it is meant to work with Firefox. Though the instructions for setting up your browser seem to be rather complex for your average user.

But what is behind this?

It cannot be cheap to distribute for free a card reader to every cardholder using their Internet banking services. Everytime I log on to their Internet banking service I get a lengthy warning about phishing attempts. Are other banks implementing these card readers? Is Visa (but not Mastercard or American Express) the only card company implementing this?

Is the government trying to trace our money transfers?

I cannot transfer outside of the UK via the Internet. The website will not accept a Swift or NIB code. What is this all about? Do other banks accept Swift/NIB codes on their Internet banking sites?

Monday, January 26, 2009

Al Jazeera and Ushahidi

News channel Al Jazeera have started to use Ushahidi to map the conflict in Gaza.

Wednesday, January 21, 2009

Turning Doctors into Managers

Please refer to the NHS Glossary for explanation of abbreviations and acronyms mentioned in this post.

The UK parliamentary Health Committee's review of Lord Darzi's NHS Next Stage Review (NSR) raises many issues and concerns - too many for me to discuss here.

But one section of the committee's report, "Measures to improve he leadership and workforce of the NHS", is worthy of comment.

Firstly, the Health Committee notes the MTAS clinician training fiasco of 2007 about which it has already commented in a previous report.

Now let me quote from the Health Committee's current report into the NSR:

Turning doctors into managers

167. The NSR recognises that "in parts of the NHS, competing interests between clinicians and managers has, on occasion, been against the best interests of the patient". At the heart of Lord Darzi's proposals for improving leadership is his aspiration to bridge the gap between the two groups and to encourage doctors to become managers. Mr David Nicholson claimed that:

We are quite unusual as a health system in this country of having relatively few clinicians in the most senior posts and I think it shows in terms of the focus of our work.[209]

According to the NSR, the new Leadership Council will identify and train talented and suitable doctors who will become senior SHA managers of the future. According to Mr Nicholson this could be achieved fairly speedily:

Our aspirations are that within three years on every shortlist for a chief executive job in the country there will be at least one appointable clinician who will be available for appointment.[210]

Doctors who become managers will be required to keep their clinical skills if they wish to re-enter medical practice. Although some may abandon medical practice, others will wish to remain clinicians first and managers second. This will mean both time and funding will have to be made available so that clinicians can maintain their skills.

168. Witnesses agreed that it was desirable that more doctors should become managers in the NHS. However some had concerns about certain obstacles in the way of achieving the proposal. Dr Hamish Meldrum, of the BMA, argued that:

Unfortunately, and I think it probably happened because of successive changes and reorganisations and everything else, there is a feeling that in some areas the quality of management is not very good and that clinicians who get involved in that—I hear expressions like they have gone over to the dark side or they have sold out or they could not hack the day job.[211]

Dr Meldrum also claimed that the debate sometimes overlooked the point that "The main reason we went into medicine [was] to be doctors and clinicians, not to be managers".[212]

169. The reluctance of doctors to take on managerial roles might help explain why previous attempts to increase the number of clinician-managers had been unsuccessful. The King's Fund for example told us that:

The last three attempts to secure a national approach to developing the most senior leaders has been marked by less than impressive outcomes.[213]

We were informed that there was little reason to be optimistic that the NSR would succeed where other initiatives had failed:

This policy is ironic as during the Blair years it was proposed to create a NHS University to meet these problems. This was abandoned expensively. Will these proposals thrive where the NHS University failed? The need is obvious but the policy drive has failed in the past![214]

Furthermore, the NSR states the DoH "will identify and support the top 250 leaders in the NHS", and establish a new NHS institution for both managers and clinicians to develop training schemes for all NHS employees.

I am concerned.

Doctors are good managers. They are good at managing my healthcare. They are good at diagnosing my condition, prescibing my medication. Kezia's consultant, John Grainger, has been bloody marvellous. He is a trained paediatric haematologist. I assume he does not have an MBA.

Here the Minister of Health in successive governments (we've had several) has been a clinician with no training in management. Dr Lima, the only orthopaedic specialist in the country, who sees every broken/fractured bone in a population of 160,000, and is well-received and respected. Two or so governments ago he was made Minister of Health but he insisted on continuing his orthopaedic work at the country's only general hospital.

If John Grainger, our trained paediatric haematologist, is invited by the government to become one of the 250 and will need to be trained as a manager, and will need to keep up his clinical skills if he ever wants to continue treating kids such as Kezia, which was surely his primary motivation to enter the medical profession, then ... how will he be compensated and how will kids such as Kezia be treated

A good General Practitioner practice in the UK has a non-clinician practice manager.

I think Lord Darzi's recommendation that clinicians are trained to be managers sucks. My own experience in a completely different field of work is that a technician (which a doctor is) does not (always or necessrily) make a good manager or supervisor.

The NHS managers, if they were good, would be working in the private sector or would be working in he NHS through theire public service conscience.


Clare, just to prove to you and your patch contributors, that your initiative is appreciated, here is Kezia's quilt on a December 2008 washing-line and there is the bunk-bed we bought in April so I don't have to sleep on the sofa!

Tuesday, January 20, 2009


Over the centuries there must have been many shipwrecks around the shores of these islands.

In legend one of our ethnic groups, the Angolars, is derived from the survivors of a slave transport shipwreck who managed to eke an independent living from the forest and fishing in the south of Sao Tome until they were "conquered" by the Portuguese in the 1870s.

So below you will see three contemporary shipwrecks.

Our first is in a small cove in the northwest of the island. I have no idea when it occurred as it was already there when I arrived in 1989. Over the years it has gradually evolved into this lump of rust. It looked like it was a trawler but who knows ...

The next two occurred in the last two years. The capital city and port of Sao Tome are built around a relatively sheltered bay in the northeast but occasionally a storm will descend from the north. This local cargo transport, owned by a Lebanese businessman also running a middle-range hotel on the island, ended up on the beach of the city bay. Stripped of anything valuable and despite pathetic efforts to move it and threats from the local authorities, it remains a sight-seeing eyesore in the centre of the city.

Our third is a similar cargo transport that got carried out of its mooring and some two kilometres down the east coast. Ending up on the rocks, a local businessman imaginatively established a bar/restaurant on the beach directly opposite the wreck named "The Pirate".

To round off this nautical post, UK Admiralty charts for the Gulf of Guinea show an unexploded Depth Charge in the capital city's bay.

Thursday, January 15, 2009

Fly Fly

Fly Fly
What can you see?
A bird.

Fly Fly
What can you see?
A cake.

Fly Fly
What can you see?
Santa Claus kissing my mum.

By Jaime

Blog to Book

I cannot say I've been picked up by an agent or publisher to convert this blog into a book. I've not even been picked up by printed compilations of blog posts! My only claim to literary fame was being mentioned as a favourite in a forum at last year's Cheltenham Literary Festival by Tom Reynold's of the blog Random Acts of Reality and author of Blood, Sweat and Tea (sure my hits soared for a couple of weeks but descended again - and even you haven't linked to me Tom, you git! Don't you like me any more?)

I am now reading Waiter Rant - Behind the Scenes of Eating Out by A. Waiter, a New York waiter who started blogging his job experiences and was picked up to put the blog into paper form. As said, I have previously read and written about Tom Reynold's Blood, Sweat and Tea derived from his blog recounting his work in the London Ambulance Service (both the blog and the book are marvellous!). There are several other books out there derived from blogs.

Reading Waiter Rant got me thinking about what makes a blog into a good book.

There must be many factors but one of the major ones must be to not follow the maxim "We reserve the right to go off subject and write about what the fuck we want."

I enjoy NHS Blog Doctor and Dr Rant, the Whites in NZ, Lucia and others but I don't think we'll ever make it to paper. I am too diverse ... writing about Linux, BBC iPlayer hacks at the same time as Kezia's blood-counts and the state of the UK National Health Service does not make a book. Drs Crippen and Rant are so focussed on the politics of the UK NHS their paper versions would probably not sell outside of the UK medical professsion. The Whites in NZ recount personal daily life with a daughter with leukaemia and rarely venture further afield - of little interest unless you are a personal friend or going through the same shit.

Obviously, the life of a sex-worker, a Delta Airlines stewardess sacked for posting mildly provocative photos of herself in Delta uniform, and Shawn Atwood's experiences in Joe Arpaio's Arkansas prisons (he's stilll working on the book but has got an agent) make interesting reading ...

... but a mixture of leukaemia, IT hacking and random observations just ain't going to make it.

We were outted (with agreement) for a good cause by photo-journalist Caroline Irby as to our geographical locations last year. A good (git) of a friend gave my boss the url of this blog so, although I still feel I cannot talk about work and my employer, I can at least talk about where we live.

Cited links on right.

P.S. As a complete aside, some two years ago Xena of turned me onto DJ Carlitos' weekly world music radio show on WRIR. Each 2 hr+ show is a free downloadable in no DRM mp3 format.

Wednesday, January 14, 2009

NHS Cancer Commissioning Toolkit

I tried to register on the NHS Cancer Commissioning Toolkit website yesterday.

Today I received this email:

Hi Angus

I’ve been sent your details by the Cancer Commissioning Toolkit team to ‘activate’ your registration. However, I need to know who your employing organisation is (this was blank on the user details) as users have to be employees of NHS organisations that have signed Data Access Agreements. Sorry if this sounds pedantic/bureaucratic, but there are currently some restrictions on access – but if you can confirm that you’re employed by an NHS organisation, then that’s not a problem!

Many thanks

Best wishes


Pauline Quennell

Network Audit Project Manager


My response:

Hi Pauline

As the Sector field in the registration form includes "NHS User", as I and my family are registered with a GP practice, as my daughter is undergoing treatment for leukaemia under the NHS and as only certain fields are asterisked, giving the impression these are the only ones that are obligatory, I assumed I would be eligible to sign-up for the Cancer Commissioning Toolkit.

However, I am not an employee of the NHS and therefore, as you explain, not eligible. Perhaps the CCT website designers could make this clearer.

Best wishes


The DoH document on Cancer Commissioning Guidance is here.

Tuesday, January 13, 2009

NHS Next Stage Review - Parliament's response

It seems the UK Parliament's Health Committee is not very impressed with Lord Darzi's Next Stage Review. Their full report published today can be found here.

Monday, January 12, 2009

Wednesday, January 7, 2009

The NHS writes to me

Today I have received a personal letter from Ben Bradshaw, Minister of State for Health, asking me most politely to complete the attached GP Patient Survey.

He has commisioned Ipsos MORI to select me randomly from the NHS list of patients registered with a GP. The reference number on Ben's letter is 8339412879. The reference no. on the attached Ipsos MORI questionnaire is 8003357137. My online password is JZVPS. I am assured that "Once the survey is finished, your contact details will be destroyed". Ipsos MORI "will keep your contact details confidential". Ben Bradshaw's letter has two barcodes and a couple of other mysterious numbers, the Ipsos MORI survey has another two barcodes. I can't read barcodes. So my response is secure aaand I am confident they won't be passed on to the immigration authorities, the police, social services, the PCT or even my GP.

Ben doesn't tell me when or where the results will be published.

So I will dutifully fill it out and send it off in the prepaid envelope ... and if you want to hack my responses, please try! I certainly will next week!

Monday, January 5, 2009

Nativity 2008

Kezia had been alloted a minor role as a Star in the school nativity play but Mary got stage-fright and Kezia understudied. Her headteacher tells me she was amazing!

Thursday, January 1, 2009

All About Princess



true love.beast

personality.sweet,kind and patient

sleeping beaty

true love. prince phillp

personality.sleepingbeat is a

beautiful girl with lovely voice

and natrull grace.


true love.prince charming

personality.intelligent and hardworking.


true love.prince eric,independent

and impulsive.



true love. Aladdin

personality.fiery,courageous and intellingent.

Snow white

true love.prince sweeps

personality.gentle and lovenature.

By Kezia Lima Gascoigne