C-NOMIS - another IT fuck-up

This time a grandiose Ministry of Justice IT project, C-NOMIS, to create a national centralised database to track offenders in Her Majesty's penal institutions, comes under the critical eye of the National Audit Office (NAO). Full report here.

I will quote the NAO's press release:

"The project to provide an IT system to support a new way of working with offenders was to be introduced by January 2008, and had an approved lifetime cost of £234 million to 2020. By July 2007, £155 million had been spent on the project, it was two years behind schedule, and estimated lifetime project costs had risen to £690 million. The Minister of State at the Ministry of Justice called a halt to the project while options to get the budget under control were sought.

Many of the causes of the delays and cost overruns could have been avoided with better management. There was inadequate management oversight and the technical complexity of the project was significantly underestimated. Budget monitoring was absent and change control weak. In addition, the main supplier contracts were designed in such a way that sufficient pressure could not be brought to bear on suppliers to deliver to time and cost.

In January 2008, the National Offender Management Service began work on a rescoped programme with an estimated lifetime cost of £513 million and a delivery date of March 2011. They opted for the lowest cost approach, which would deliver the Service’s revised needs, although this option did not have the best benefit to cost ratio.

The full financial impact of the delays is uncertain, but it is likely to be at least £41 million; £15 million of which has been spent on aspects of the project which have now been cut from the design. £226 million has been spent on the project so far and roll-out of the system to prisons is expected to commence in April 2009."

The core software is SAP's BusinessObjects XI Release 2. "The C-NOMIS Case Management system is based on a COTS package called TAG from Syscon Justice Systems Ltd under contract with EDS". See article here. And here are links to SAP, EDS (a subsidiary of Hewlett Packard) and its summary of its work with the UK prison service and to Syscon (who interestingly are in the business of prisoner medical records as well - surely the NHS should involve them?).

The NAO is not impressed. I am sure questions will be asked in Parliament.

So Dr Crippen, Dr Rant, Dr Goldacre et al ... don't think the NHS is the only one being taken for an IT ride.

Coup d'Etats and other funny going-ons - Part V: The Dogs of War

My boss has gotten interested in the funny goings-on in this part of the world and has gone out and bought Tropical Gangsters by Robert Klitgaard, Adam Robert's' The Wonga Coup and Frederick Forsyth's The Dogs of War.

The former relates the experiences of a World Bank representative in Equatorial Guinea (EG) in the late 1980ss. I thoroughly recommend it - as it relates much about the horrors of the Macias Nguema regime and the only slightly lesser horrors of his successor and nephew Obiang.The Wonga Coup seems to have been updated since its original publication in 2006, I assume to include updates on Mark Thatcher's fate and Simon Mann's extradition from Zimbabwe to the notorious Black Beach prison in the Equatorial Guinean capital Malabo.

As I have loaned him several books over the last few years, he offered to loan them to me. As I have read the former and latter fairly recently and having only recently learned of Forsyth's admitted knowledge of or involvement in a 1973 coup attempt in EG I opted to borrow Forsyth's Dogs of War first published in 1974. I haven't read it in 20 or more years so, with my current knowledge, it will be gripping - and if he was ever to write an autobiography or permit someone to write a biography, it would make interesting reading.

Just opening the first two pages are chilling in their dedication and epigrams ...

Dedication:

"For Giorgio, and Christian and Schlee,
And Big Marc and Black Johnny,
And the others in the unmarked graves.
At least we tried.".

In the novel's introductory epigrams he reproduces two quotes:

"Cry "Havoc" and let slip the dogs of war" - Julian Caesar, William Shakespeare.

"That ... be not told of my death,
Or made to grieve on account of me,
And that I not be buried in consecrated ground,
And that no sexton be asked to toll the bell,
And that nobody is wished to see my dead body,
And that no mourners walk behind me at my funeral,
And that no flowers be planted on my grave,
And that no man remembers me,
To this I put my name."

Thomas Hardy.

Unrelated (?) regional developments: The French judicial system has frozen the substantial French bank accounts of Africa's (currently) longest-serving president, Omar Bongo, of our nearest continental neighbour, Francophone, Gabon.

Coup d'Etats and other funny going-ons - Part IV

Well, we must be grateful that our political on-goings do not approach those of another ex-Portuguese colony in Africa, Guinea-Bissau, where the military chief was assassinated with a bomb, and the army, blaming the president, has promptly assassinated him.

Meanwhile, I learn that the novelist Frederick Forsyth, who wrote the famous novel The Day of the Jackal and then the The Dogs of War, the latter fictionally based on a planned coup d'etat in a mineral-rich African country, was actually involved, in a coup attempt. In an interview last year he admitted to his involvement in a planned 1973 coup in Equatorial Guinea. I don't actually condemn him for this as he was a BBC correspondent during the Biafran War in the Niger Delta area of Nigeria, whose Igbo people suffered much and emigrated to Equatorial Guinea only to suffer more under Equatorial Guinea's first president Macias Nguema,

In a media interview last year he gave his professional opinion that Simon Mann's attempt to execute a coup d'etat by air was dumb. He has a website and comes across as a right-wing git but it would be hard to be more extreme than Macias Nguema.

In related news ... I've just read that famous French mercenary Bob Denard who is most reputed for his involvement in the Comoros islands on the other side of the continent, but was involved in much more over the years, died last year - not in violence but of old age.

Coup d'Etats and other funny going-ons - Part III

This is a bit of a miscellaneous post to add a few minor miscellaneous details and anecdotes from the previous two posts on the same theme.

You might wonder what "Wonga" means? According to Adam Roberts book I previously referenced, Wonga is an old Romany word which originally meant coal but latterly then attained the meaning money.

Two white South African acquaintances, long term residents here, were questioned by local security forces after the alleged coup attempt here - the first I phoned denied knowing anything about it (which I believe), wouln't talk about it and didn't mention he had been questioned. The other I phoned on Monday but is doing a job on our sister island returning on Thursday, admitted he'd been contacted by the security services and agreed to talk to me about it this coming weekend.

The aforementioned acquaintances once worked here for another interesting South African Cristoph Hellinger, who once owned luxurious hotels on both islands and still runs a large (in terms of a small island state) construction company here. He is the owner of a vineyard and estate in Stellenbosch near Cape Town. Hellinger was not a great friend of the apartheid regime and got rich running diamond mine logistics operations for the MPLA in Angola during the civil war with Savimbi's UNITA and, given our first president's support from/for the MPLA, used Sao Tome as a staging post.

I have heard anecdotes of Filipino workers recruited by Hellinger hiding in the roof-spaces of their accomodation of MPLA-controlled diamond mines under attack from Savimbi's UNITA.

Anyway, Hellinger earned plenty from the Angolan MPLA in diamonds or diamond-money and paid our first president plenty for long-term leases on two prime pieces of land on our two islands, where on our sister island he built a luxury hotel. His admin complex and local construction company HQ remained on our island and he established the first national airline. He also got a contract to manage the state-owned luxury hotel constructed in the late '70s/early'80s by Yugoslavia (before it fell apart). However, the first democratic government here annulled this contract, awarded it to a Portuguese company which let it fall apart and it was then handed over to a member of Germany's aristocracy who sold it to a multinational Portuguese company a couple of years ago. In the meantime, Hellinger built another luxry hotel here.



In South Africa Hellinger had employed S. African B. and Filipino R. as an accountant in his hotel business there - they were both marvellous - and supported us 200% during the beginning of Kezia's leukaemia.

B. once told me how Hellinger would hide his staff in a top Cape Town hotel he owned. Black and Coloured people were not permitted to serve whites in public places under the ica, apartheid regime. Classified as "Coloured" (as her maternal grandmother was black although she looks as white as "Whites" come) under the apartheid regime and thus not allowed to serve white people. she would have to run as well.

Moving on ...

A work colleague tells me the security services didn't actually find an AK47 in the hands of ex-Buffao, leader of insignificant political party FRNSTP, Adelecio Costa, but just a magazine and 300 bullets.

Our president has threatened to resign stating he is fed up with political instability + I don't blame him but has since addressed the nation in a rather strict and paternalistic tone urging the population and political class to be more disciplined ...

EDM 754 - Response from the Secretary of State for Health

I wrote to the Secretary of State for Health requesting him to sign EDM 754 regarding uptake of the MMR vaccine and media coverage. Although parliamentary guidelines advise that cabinet members do not normally sign EDMs, the guidelines do not forbid them from doing so. Here is Alan Johnson's response ...

DE00000390297

Dear Mr Gascoigne,

Thank you for your email of 13 February to Alan Johnson about the Early Day Motion (EDM) 754 on the MMR vaccine. As I am sure you will appreciate, Mr Johnson receives a large volume of correspondence and it is not always possible for him to respond personally. Your email has been forwarded to me for reply.

The EDM supports the Government’s position that all children should be vaccinated with two doses of MMR vaccine to protect against measles, mumps and rubella. You ask why Alan Johnson, Ed Balls and Gordon Brown have not signed the EDM. It may be helpful if I explain that Ministers and whips do not normally sign EDMs. Further information on who can and cannot sign EDMs is available on the UK Parliament website at www.parliament.uk (type ‘EDM’ in the search bar and follow the links).

The scientific community has been convinced for a considerable time that there is no link between MMR and autism. Just recently, three US judges who are experts in vaccine claim hearings concluded that there is no association between vaccines and autism. The overwhelming weight of evidence shows that MMR is the safest way to protect against measles, mumps and rubella, and the number of studies demonstrating this is growing. A list of the key studies examining MMR can be found on the NHS immunisation information website www.immunisation.nhs.uk, by selecting ‘The Vaccines’, followed by ‘MMR’ and ‘Research timeline’.

The Department of Health’s most immediate concern is that cases of measles are on the rise due to poor vaccine uptake over the past decade. The Department has an MMR catch-up programme now in progress and have provided extra funding to Primary Care Trusts, as well as additional supplies of the vaccine.

The message that the Department is promoting is that MMR is the safest way to protect children against measles, and that it will also protect them against mumps and rubella. Furthermore, it will also help protect those children who cannot have vaccinations for medical reasons.

I hope this reply is helpful.

Your sincerely,

Deepa Shah

Customer Service Centre

Department of Health

EDM 754 - MMR vaccine and the Media update

Early Day Motion 754 how has 100 signatures.

Proud Father

Just received this from Jaime's school ...

Dear Mr Gascoigne

Miss Rowcroft has asked me to contact you with regards to the Rochdale Childer Award. Every school in Rochdale has a Rochdale Childer Award which consists of a spectacular trophy, which remains on permanent display in school, as well as a medal and certificate to be kept by each year's recipient. There is also a special award's evening held at the Town Hall in Rochdale, which all school's attend in attention to the individual presentation within a school assembly.

The idea behind this annual award scheme is that a pupil from (name of school omitted) should be recognised for the contribution they have made to our community. This can be an act of charity work, caring for the elderly or a disabled friend or relative or even over coming some form of adversity and yet still being an inspiration to others.

With this in mind we would very much like to award this year's trophy to Jaime. Considering all he has been through in the last few years, with Kezia's illness and of course the move from Sao Tome to Rochdale and having to adjust to a completely different way of life, his dad still remaining in Africa, a new language to learn and having to make new friends.

Seeing it written down in black and white really makes us realise what an incredible 'journey' he's been on this last couple of years and through all of that he has never complained. He is the most delightful boy whom all his teachers consider a 'dream pupil'. His command of English is now amazing considering his starting point in Year 3.

We're sure you will agree with us that this award is an excellent way to recognise Jaime's achievements. If you are in agreement please let me know by return e mail. We will then formulate a 60 word statement explaining the reasons for Jaime's award which will be published in the award winners' booklet alongside the statements from other schools' award winners and to arrange a date and time for the award to be presented in school. We hope Jaime's mum will be able to attend this along with any other guests you may wish to invite. We also usually invite the Rochdale Observer to take a photograph, again if this is ok with you. The date of the award evening at Rochdale Town Hall is Thursday 18th June, again guests are invited to attend.

I hope to hear from you soon. If there are any further questions you have please feel free to ask. We do need to let the Rochdale Childer committee know the name of our award winner by Friday 20th March at the latest.

Kind regards

Mrs Jane Higgins

Giv - the most expensive soap in the world

Well, not exactly ... but it does promise me Refreshing Beauty with Pearl Extract

Pearl Extract?

Yup, you heard right - it's even in the list of ingredients!

And it claims on the side of the benefits of Pearl Extract - Natural sea minerals that cleanse your skin gently along with a Refreshing Perfume for dynamic personality as well as what you might expect in a bar of soap - Sodium Soap, Water, Glycerin, Titanium Dioxide, Teta Sodium EDTA and CI 42051.

Made in Indonesia, I imagine impoverished pearl divers selling their pearls, and rather than embellishing the necks of rich western women, earning a pittance from the soap manufacturer.

Is there a glut in the pearl market?

Observing the rather charming young lady on the packaging, she must be using Pearl Extract toothpaste as well. I hope she can tell this man (and myself for that matter) what brand of toothpaste she uses.


If any of my readers, especially Ben Goldacre and Dr Crippen (please promote it to your patients, write to NICE so it can be prescribed in two years or so as a treatment for teenage acne), would like to sample the benefits of Pearl Extract, send me 20 Euros or an equivanlent hard currency to to allieve your consciences about impoverished Indonesian pearl divers, and the father of a daughter with leukaemia (come on there - I'm going to take a 5% cut for the trouble!).

Home from Home

Just received this message ... watch out for Jaime!

Dear children, parents, schools, embassies, refugee groups, and anyone else who helped make this project possible,

Last year, or before, you helped photographer Caroline Irby in her search for a child from every country in the world now living in the UK. As you know, this work was published in the Guardian magazine and on their website a few months ago.

Caroline is currently away on a new photographic expedition in Africa but has asked us here at Eleven Film to inform you that she has made a new series of four short films, using the photographs and interviews she collected. The series, titled 'Home from Home' will air on Channel 4 at 7.55pm on Monday 16th, Tuesday 17th, Wednesday 18th and Thursday 19th March 2009.

Whereas in the Guardian magazine only some of the children/nationalities could be shown, a child from every country will appear in this TV series.

Thank you again for your help and participation. We hope you enjoy the films.

Very best

Joe Murray
pp Caroline Irby

Joe Murray
Eleven Film
3-4 Portland Mews
Off d'Arblay Street
London

Coup d'Etats and other funny going-ons - Part II: The Wonga Coup

Beware, beware the Bight of Benin
For few come out though many go in.

Less than a year later, March 2004, saw a coup attempt in Equatorial Guinea (EG). Richer pickings this time as EG is the third largest oil producer (after Nigeria and Angola) in Africa.

After independence from Spain in 1967 it was led by Macias Nguema whose brutality can be compared with that of Uganda's Idi Amin and the Central African Republic's Bokassa (shall we make a league table of the most brutal dictatorships that exist/have existed in Africa/the world? Perhaps by those killed or tortured per 1000 heads of population?) Anyway. his nephew Obiang, the current president, overthrew him in a coup in 1979 and promptly had him executed by a Moroccan firing squad. His own human rights record is only just slightly better than his uncle's.

In 2003 Simon Mann, a Brit who had run a mercenary business Executive Outcomes which gained fame in Sierra Leone and for whom several ex-Buffaloes worked, got together with some of his chums and decided to launch a coup in EG. They started off by setting up a "front" company led by a certain Nick du Toit supposedly to invest in fishing industry and recruited several other South African ex-special forces colleagues. He also befriended Obiang's younger brother, Armengol Nguema, the head of EG's security services and with a ruthless reputation. One of Nick's colleagues Sergio Cardoso travelled to Sao Tome on more than one occasion to seek advice from Arlecio Costa, the ex-Buffalo who led the attempted coup here and other Santomense ex-Buffaloes.

Prior to their arrival in Bioko another ex-Buffalo, Johannes Smith, had set himself up as an independent security advisor to the EG government.

Mann remained in South Africa doing the logistics - procuring arms, recruiting ex-special service "foot soldiers" and arranging transport. The cover story was protection of a mine in the southern Democratic Republic of Congo. Recruitment was not a problem - there were promises of rich pickings but arms and transport proved to be. Time was getting short as they hoped to install exiled EG politician Severo Moto as president before (obviously to be rigged) elections in March 2004. Transport proved problematic - he persuaded ex-UK prime minister's son Mark to finance the purchase of a helicopter (Mark Thatcher later claimed before a S. African court he had been misled into believing it was to be used in a new air ambulance company - oh yeah!). An airliner big enough to transport the troops and collect the arms cargoes was more problematic - eventually he bought one from a US family-owned company Dodson Aviation with an office in S. Africa and it was personally flown to S. Africa by a member of the Dodson family. Arms were an even greater problem and he eventually approached the state-owned Zimbabwe arms supply company (he should have contacted Viktor Bout!) and placed an order to be collected on the Dodson plane on its wat to Malabo with the foot-soldiers.

Loose talk!

Our previously mentioned Johannes Smith got wind of it and informed the EG government which contacted the cash-strapped Zimbabwe government and in an oil-for-action swap, Zimbabwe agreed to the arrest of everyone on the Dodson plane.

Nick du Toit made a final pre-coup visit to South Africa. He was returning to Bioko on a privately chartered jet which stopped off in Sao Tome to refuel and dropped off a South African businessman assisting and investing in a company helping the Santomense ex-Buffaloes to develop a luxury tourism complex on the north coast of Sao Tome.

As Nick and colleagues disembarked in Malabo, they were arrested. As Simon Mann and the "foot-soldiers" landed in Zimbabwe to collect the arms, they were arrested. South Africa negotiate for most of the "foot-soldiers" to be released after c. 1 ome year. Nick du Toit and colleagues langiush in the infamous Black Beach Prison as does Simon Mann who was extradited from Zimbabwe to EG.

Reference: The Wonga Coup by Adam Roberts

EDM 754 - MMR vaccine and the Media

I am pleased to see the parliamentary webpage for EDM 754 MMR Vaccine and the Media has now been updated and that 65 MPs have now signed the motion including my own. For an EDM this is quite a respectable number.

See NHS Blog Doctor and Ben Goldacre's Bad Science for the background to this story.

Coup d'Etats and other funny going-ons - Part I

Some funny things have been going on in the region in the last few days ...

First, last week security forces arrested a group of c. 40 people here claiming they were planning a coup d'etat. Then in the early hours of Tuesday morning a group of men turned up in two boats in Malabo, the capital of Equatorial Guinea on the island of Bioko and attempted to storm the presidential palace. There ensued a three hour gun battle until the invaders were repulsed. The Equatorial Guinea government claims they were members of the Nigerian Movement for the Emancipation of the Niger Delta (MEND - a direct descendant of the Biafran war in 1967-70) who have denied their involvement. Yesterday the Nigerian governnmet did not deny MEND involvement but denied its own involvement,

So first a history lesson ...

Equatorial Guinea gained its independence from Spain in 1967 and Sao Tome e Principe (STP) from Portugal in 1975. Most Portuguese left in 1974-75 but a handful stayed on and when in 1977, the government claimed they had discovered plans for a coup d'etat as part of a larger international plot to topple tht MPLA government in Angola, they were rounded up and briefly imprisoned. On their release some stayed, some returned to Portugal. I was given names last weekend but obviously will not repeat them here

Over the coming years there were largely unsubstantiated rumours of planned coups but in 1978 a body of Angolan armed forces arrived on Sao Tome to assist STP in its defense.

No further "serious" attempts occurred until 1986 when a Santomense, Manauel Afonso Rosario dos Santos, resident in Gabon, had formed a political grouping the "renovated FRNSTP " which joined forces with another exile group to form the UDISTP. Improved relations between the STP and Gabonese presidents led to him being expelled from Gabon and he ended up in Cameroun. His supporters in Gabon were increasingly pressurised by the Gabonese government and, having been refused entry to Cameroun, ended up in Namibia where the apartheid regime offered them the choice of prison or military service in South Africa's crack and clandestine military unit the 32 Battalion (widely known as the "Buffaloes") who were fighting the Nambian independence movement SWAPO in northern Namibia/southern Angola).

In 1988 a group of c. 45 men arrived in small trawlers in ST, led by Rosario dos Santos, and attempted a coup but were quickly rounded up. Rosario dos Santos (now deceased) , who personally led the expedition, was soon released and in the light of democratic reforms founded a (pretty unsuccessful - no seats in the National Assembly) political party - Frente Democratico Cristao (FDC - translation the Christian Democratic Front).

The 32 Battalion was mainly composed of black South Africans, Angolan and Mozambican exiles with this small group of Santomenses. Apparently ruthless.

With the end of apartheid the 32 Battalion was disbanded and gradually, the Santomense elements drifted back here.

In July 2003 the Santomense ex-Buffaloes, along with some discontented members of the local armed forces led an attempted coup.

At that time we lived just behind the Prime Minister's house - I heard shots at 4 am, turned over and went back to sleep. At 0630 am a Santomense friend phoned me and told me of the coup - the president was out of the country at the time, they rounded up all the members of government and incarcerated them in the capital's military HQ.

The US Ambassdor to STP with entourage, based in Gabon, were in STP at the time to give a reception celebrating the two countries' independence days given the two holidays fall within a week of each other. Their hotel was just around the corner from our residence so I spoke to my boss and asked if I should check up on them on my way to work. He replied "Yes".

I stopped at the junction of our backstreet with the PM's street, looked right towards her house, saw soldiers outside so took a left. Arrived at the hotel to find the US Ambassador having a breakfast crisis meeting with his team. His first, obvious, concern was the safety of the few other US citizens on the island but he wouldn't let his own US citizen diplomatic staff out of the hotel. So, I volunteered to go and find them and report back on their "safety". I was fortunately accompanied in this mission by another UK citizen working for the US embassy in Gabon (obviously the US ambassador wasn't too concerned with UK citizens). So Joan and I became firm friends and, after avoiding a few road blocks, were able to report that all his citizens were fine. I then ran errands, interpreted, translated etc for the US ambassador for the following few days ... a welcome distraction from my normal job!

At first the only diplomats from "major" countries were from the US and Portugal and they initiated negotiations with the Buffaloes. Then delegations from the Economic Community of Central African States, Angola and South Africa turned up and tried to turf the Americans out ... only after protests by Portugal and S. Africa (if I remember rightly) was the US Ambassador permitted to rejoin the negotiations.

Upshot of the negotiations:

1. More US support for the Santomense military (yes it has happened).
2. More Portuguese support for the Santomense military (?)
3. More South African support for the Santomense ex-Buffaloes

Part II next week.

Letter from Parliament

A staff member in my MP's office has written to tell me he will be signing EDM 754 regarding the MMR vaccine and the media.

Meanwhile on his website he writes:

"A couple of weeks ago I went to the open day organised by Care UK of the mobile CATS (Clinical Assessment and Treatment Services) units at the top of Yorkshire Street. These are five brand new shiny units costing several million pounds which will visit Rochdale four days every month to provide consultations and treatment not by the NHS but by private companies.

At about the same time I was being given information that hospital services at the Infirmary were under severe pressure. For example the Ambulance Service’s target of eight minutes for blue light emergencies was only being met in 60% of cases.

Staff at the Accident and Emergency during the same period were dealing with record numbers of patients – the highest of the four hospitals in Pennine Acute yet the government insist that Rochdale be downgraded to an Urgent Care Unit by 2012.

Similarly our maternity unit is due to close in 2012 yet in 2007 had a record number of births. Across Greater Manchester the Healthy Futures and Making it Better proposals are unravelling even before they are fully implemented.

Would the millions spent on giving private health companies lucrative contacts be better spent on improving our local hospital? In a reply to a letter I sent to the Health Minister Ann Keen dismissed those concerns saying “the performance of Rochdale A&E of 96.8% remains high but does need to improve”. Try saying that to those staff giving 110% in A&E? - how pompous and out of touch!

The operation of the Choose and Book system is another issue which was taken up in debate by my colleague Andrew Stunell MP for Hazel Grove. This is a system which is supposed to enable patients to choose their Consultant and hospital for an outpatient clinic. However despite assurances given during the Healthy Futures Consultation it is virtually impossible to get an appointment at Rochdale Infirmary because the consultants are refusing to hold clinics there. Andrew quoted the experience of one Rochdale resident. "

Couldn't agree more.

MMR Vaccine and Leukaemia

In the light of my previous two posts on take-up of the MMR vaccine and Ben Goldacre's Bad Science's spat with Jeni Barnett and the LBC radio station, I have keenly been following the on-going story. I really feel Adrian Sudbury, Josie Grove, Davo, Christian and the many others who have died of immuno-suppresive diseases would be turning in their graves - I truly hope they come back to haunt Jeni Barnett and LBC management. The degree of support Ben is receiving from both the medical and non-medical blogosphere is impressive and again I implore all my UK readers to write to their Members of Parliament to support the EDM 754 in the UK Parliament encouraging up-take of the MMR vaccine. I have already written to mine (and, as an aside, was surprised to read of his vociferous opposition in parliament to the recent Israeli activities in Gaza. but then again, being the cynical sod I am, I have to remember that many of his constituents are infidel sooties). In the light of their support for the late Adrian Sudbury's but on-going campaign to encourage education about Bone Marrow Transplantation in the last years of secondary schools,I am surprised to see that our Prime Minister, Secretary of State for Health Alan Johnson (johnsona@parliament.uk) and Secretary of State for Children, Schools and Families Ed Balls (http://www.edballs.co.uk) (after all they are all MPs - do parliamentary rules not permit cabinet members to sign EDMs?) have not signed the EDM, especially given the Department of Health's memorandum reproduced below. Many thanks to HolfordWatch in a comment on one of Ben's posts on this for bringing this official DoH memo to my attention.

Subject: Public Health Link: MEASLES - PROTECTION OF HEALTH PROFESSIONALS [NONURGENT (cascade within 48 hours)]
Importance: High

To: NHS Trusts - Medical Directors (England)
NHST/FT/007 - NHS FOUNDATION TRUSTS (ENGLAND) - MEDICAL DIRECTOR
Primary Care Trusts - Medical Directors

Cc: NHS Trust Chief Executives
NHST/FT/001 - NHS FOUNDATION TRUSTS (ENGLAND) - CHIEF EXECUTIVE
PCT Chief Executives
Public Health Link
Regional Directors of Public Health
SHA Chief Executives

From: Professor David M Salisbury CB - Immunisation Policy -
Monitoring and Surveillance - Department of Health
Date: 19 May 2008
Reference: CEM/CMO/2008/07

Category: NON URGENT (cascade within 48 hours)

Title: MEASLES - PROTECTION OF HEALTH PROFESSIONALS
-------------------------------------------------------------------------------------------

To: Medical Directors

Cc(for information only): Chief Executives of PCTs, Foundation Trusts, SHA Chief Executives, RDPHs and Public Health Link

Dear Colleague

MEASLES

I am writing to you to let you know about my concerns about protection of health staff and the risks to patients at a time when there are increasing number of cases of measles. I have recently learned of a junior doctor who whilst working on an oncology ward developed measles. The doctor had not been vaccinated.

I cannot emphasise enough the risk that measles presents to immunosuppressed individuals, particularly children. Between 1974 and 1984, of 51 children who died when in the first remission from acute lymphatic leukaemia, 15 of the deaths were due to measles or its complications. While the incidence of measles has declined since then and the coverage of measles-containing vaccine has increased, there have been about 1000 confirmed cases reported in England and Wales in the last 12 months. There are ongoing outbreaks in other European countries.

MMR vaccine cannot be given to immunosuppressed individuals, so their protection is dependent on avoiding exposure to the virus. Protection of healthcare workers, particularly those in contact with immunosuppressed patients, is an essential part of infection control in hospital and other healthcare settings. Under the Health Act 2006, specific duties are required of NHS bodies in England to control respiratory viruses including an alert system for suspect cases, isolation criteria and infection control measures. Occupational Health Services should include relevant immunisations (see http://www.dh.gov.uk/en/Publicationsand ... /DH_081927).

In light of the above incident, I am writing to advise you of the importance of ensuring that staff working with immunosuppressed individuals are protected against measles – for the benefit of their patients and themselves. Advice is available in the chapter on measles in the book “Immunisation against Infectious Disease” (see: http://www.dh.gov.uk/en/Publichealth/He ... DH_4097254).

Unless the relevant staff can provide written evidence of having received two doses of MMR or laboratory evidence of immunity to measles, I strongly recommend you ensure all staff in contact with of immunosuppressed patients or paediatric patients are given MMR vaccine. If a staff member is unable to have the vaccine for any reason, you will need to consider the potential risk to patients.

Yours sincerely

Professor DAVID SALISBURY CB, FRCP, FRCPH, FFPH Director of Immunisation This document has been authorised by the Department of Health: Gateway reference no: 9949

P.S.  ... I forgot to curse another person as well. Dr Andrew Wakefield. 

What Does It Matter?

What does it matter to you and me
Whether it's halfast eight or three?
The nursey clock has just gone one;
And hark, the clock in the hall's begun!
But it must be wrong, for it's striking seven;
And there goes another one, on to eleven!
And I think it's four,
But it might be more -
Oh, what does it matter to you and me?
Let's have dinner and call it tea!
And we'll all go to bed and wake at three,
For the Sun will be right in the morning.

E. V. Rieu

MMR Vaccine

Following on from our last post, if you a UK citizen please contact your Member of Parliament and ask them to sign Early Day Motion #754 supporting uptake of the MMR vaccine.

MMR and Bad Science

Much is being discussed in the blogosphere about Ben Goldacre's criticism on his Bad Science blog of the LBC radio station journalist Jeni Barnett's casting doubts on the MMR vaccine.

I curse her - if you are the parent of a child at my daughter's school who has chosen not to give your child the vaccine because of the likes of Jeni, you put my immuno-depressed daughter at great risk of catching M or M or R and possibly dying - then I curse you.

Polyclinics, Lorenzo and other Madness

I am generally sympathetic with the UK GP blogging community's (or at least those that I read) criticisms of NuLabour's policies on reform and the advancement of quality in the National Health Service and Lord Darzi's Next Stage Review where he and the party promote the creation of large geographically distant "polyclinics" to replace local GP services, where local hospital A & E services are to be replaced by Emergency Care Units with only the more urgent cases to be transported to a more distant hospital within the ambulance service's government's target times, in both of which you will probably first be seen by a "nurse specialist" rather than a doctor (how is Tom Reynold's to evaluate where to take me? Is Tom Reynold's or his control centre going to decide - methinks Tom you ain't seen nuffink yet - when NuLabor really turns its eye on ambulance services).

A brief explanation to any international readers - our primary care medical system is based on private general physicians contracted by the NHS to provide primary care services to the NHS.

When we had to evacuate Kezia to the UK for her leukaemia, she was seen in the local hospital A & E and then paediatric department on a Sunday by a "sooty" SHO (i.e. still in training and if my future head of state can call my daughter Sooty then I am permitted to call him and my daughter, stepson and wife Sooty and Sweep , chimney sweeps - just as the Royal Estate of Sandringham has been selling golliwogs) who provisionally diagnosed correctly leukaemia. Dr. Khalil - you're a wog. Rochdale Infirmary's A & E and paediatric departments are to be closed, the former to be staffed I assume by "nurse practitioners".

But I do have a little tiny bit of sympathy with the "polyclinic" idea.

Over the Xmas period Nanda, Kezia and I all came down with a nasty cold which pretty much knocked us out for a couple of days. In the case of Nanda and myself there was really no point in wasting our GP's time with a viral infection for which you can just drop paracetamol to alleviate the symptoms whilst you sit it out. But in Kezia's case I thought it wise to telephone the hospital, which advised us that in the first place we should go and see the GP practice with whom we are registered and got an apointment for Kezia to be seen within the hour - impressive indeed!

No problems at all - a 10 minute bus/taxi ride and we were seen within 5 minutes of arrival. The doctor we saw was efficient, if somewhat impersonal (another "Sooty" by the way - but Rochdale is full of "Sooties" so we need a few culturally sensitive "Sooty" doctors). Kezia is prescribed paediatric paracetamol, and, as a prophylaxis, an antibiotic. Excellent!

In the physically-connected building next door is another GP practice. My brother and sister-in-law are registered there. On our arrival in the UK my brother recommmended we register with their GP practice. We duly went and were told there were no "spaces" - "Try next door".

It seems that two senior partners had a row and divided the practice and the building.

So we have two GP practices, serving the same community, receiving funds from the same Primary Care Trust, next door to each other. My brother Pete reommended the one to which he and Paula are registered so I went to register us all only to be to told "our books are full - try next door". Next door welcomed us with "open arms".

(A question to Drs Crippen and Rant - under your practice NHS contracts are you allowed to turn us away?).

So with presciption in hand we cross the road from the two neighbouring GP practices to two pharmacies accepting (in the case of a child under-five, free) NHS presciptions with four doors separating them.

Meanwhile our GP practice has been trialling for the Heywood, Middleton and Rochdale Primary Care Trust (PCT) the new NHS Connecting for Health system for electronically communicating test results from the nearest hospital lab (x miles away in Oldham) to their practice. They have concluded it is brilliant. So it is going to be deployed it in every GP practice in the PCT. So at least one function of our Connecting for Health IT programme functions in the north-west where the Lorenzo Patient Summary Care Record has been a complete fiasco/disaster.

More lunacy follows ...

My employer and its employees have decided to recvise the local medical compensation plan (part of the larger local compensation plan). One of the revised clauses states that the cost of "over-the-counter" medications, even if prescribed by a licensed physician, would not be reimbursed. In Africa any drug available in a pharmacy, from aspirin though diazepam to morphine is available "over-the-counter". So any medication that work doc does not have in work supplies but presribes will now have to come out of our own pockets.

By the way, the new head of state of the most powerful state in the world is not called Barack Obama, but Sooty.

Sooty

A prize (please suggest what - a piece of singed stage cork?) to the first reader who can suggest an appropriate royal epithet for the Prince who will insult a coffee-coloured UK citizen who happens to be a health tourist within the royal countries of the Commonwealth (and empire) over which our head of state presides?

I hope Kezia never lives in a country where the head of state or her off-springs refer to my daughter or any of her/his subjects as Sooties (black coal-covered Dickens chimney sweeps).

Paki, Nigger, Black, Gypsy, Jew, Arab, ... name it. Fuck-off - my daughter is beautiful and if you ever ever take that away from me and her I will never forgive you.

Aphorisms VIII

"Day & Night, Black & White, Wrong & Right, Spin & Spin, Stupid Heart Cupid Heart".

Before all of this (a child with leukaemia), I was not overly concerned and perhaps am still not

When Kezia was still real small she and Jaime (and me) would dance to Don Van Vliet/Captain Beeefheart's Bat Chain Puller. A song and an album - it talks so much of our new aphorism above, which, to confess, I don't understand. An amalgam of rhymes from the aforesaid album.

Kezia would dance and dance and dance to it ...

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!

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 ".

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?

Al Jazeera and Ushahidi

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

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.

Quilts4Leukaemia

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!

Shipwrecks

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.

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 boingboing.net 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.

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

PQ

Pauline Quennell

Network Audit Project Manager

GMCCN

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

Angus

The DoH document on Cancer Commissioning Guidance is here.

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.

School in the Snow

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!

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!

All About Princess

Belle

coular.yellow

true love.beast

personality.sweet,kind and patient

sleeping beaty

coular.pink

true love. prince phillp

personality.sleepingbeat is a

beautiful girl with lovely voice

and natrull grace.

cinderella

courlar.blue

true love.prince charming

personality.intelligent and hardworking.

Ariel

couerlar.green

true love.prince eric

personality.fun,independent

and impulsive.

Jasmine

courlar.purple

true love. Aladdin

personality.fiery,courageous and intellingent.

Snow white

courlar.red

true love.prince sweeps

personality.gentle and lovenature.

By Kezia Lima Gascoigne