World Poverty and How to Solve It

Rachel Carson, an American marine biologist, published a book called 'The Silent Spring'.It had been prompted by the devastation of her friend's bird reserve, by DDT pesticide spraying going on nearby. In the book she outlined the consequences of indiscriminate pesticide use and how it could affect the whole environment through the food chain. That book prompted the start of the environmental movement and the founding of the Environmental Protection Agency.

Peter Benenson,a lawyer, was on the tube in London. He opened a newspaper to read an article about two Portugese students who had been sentenced to seven years in jail for drinking a toast to liberty. He and his friend Eric Baker, got together, sent off an article called 'The Forgotten Prisoners' to the Observer. That article was reprinted in several international papers and became the mission statement of the organisation that they went on to found, Amnesty International.

During the Bosnian war, two brothers, Fergus and Magnus MacFarlane-Barrow, drove a truck full of provisions to Medjugore in Bosnia, a place that they had visited some years previously on a religious pilgrimage. From that, they started to deliver aid to Africa and on one trip, they spoke to a girl whose mother was dying of Aids. When they asked her what she wanted, she said that all she wanted was food to eat and to be able to go to school to get an education. From that came Mary's Meals, a charity that encourages children to go to school by providing meals at the school. This breaks the poverty trap in several ways; it means those parents who are ill, do not need to worry about them getting fed; it means the children get a valuable education which will enable them to get a job; and it means the children do not have to go into prostitution to earn money for their families and run the risk of catching Aids themselves.

Richard Reynolds, who lives in a tower block in London, grew depressed with his surroundings and started planting sunflowers just outside the block. More people joined him and they launched an assault on derelict land, concrete roundabouts, overgrown planters and general ugliness everywhere. It has grown into Guerrilla Gardening, a movement that tackles urban neglect with flowers and forks.

Ok, what's this to do with world poverty, (the subject of World Blogging Day) and how is it going to solve it, apart from the more obvious example of Mary's Meals? And what has a guerrilla gardener got to do with a marine biologist?

First up, these people all understand what poverty actually is. It's not just absence of money. It's absence of education, absence of justice,absence of freedom and absence of beauty. Poverty comes in many forms.

Secondly,they knew that they could not do it on their own. Rachel Carson got info from fellow scientists unofficially and they reviewed her book very carefully so that the corporate lawyers wouldn't jump on her head;Peter Benenson relied on his contacts in the media and his friend Eric Baker, to launch Amnesty; Magnus and Fergus MacFarlane-Barrow relied on their friends at Dalmally Lodge to support them in their work; Richard Reynolds gathered friends and volunteers round him for the guerrilla gardening. Conquering poverty is something we have to do together for it to work.

Thirdly, they were all content to do one thing that played to their own resources. So Rachel Carson wrote an academic book on the environment;Peter Benenson the lawyer, studied cases of prisoners of conscience and publicised them; Magnus and Fergus MacFarlane-Barrow used their physical toughness as fish farmers to actually drive trucks to Africa; Richard Reynolds used his gardening instincts to create places of beauty. They didn't try to solve everything.

Fourthly, none of them minded that people thought them a bit crazy. George Bernard Shaw once said; '
"The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.'
All of them understood that progress means being avant-garde.

Finally, all of them understood the poverty of their own society. That does not lie in lack of resources, or skill, or money, although they all play their part. The poverty that underlies them all, is poverty of vision. We look at what we can't do, rather than what we can. We look to others to do what we could do ourselves. We belittle ourselves and the resources that we have; our material wealth, our time, our gifts, our friends. When it takes a fiver to feed someone for a year in Africa, why is anyone starving there? How many lawyers and biologists graduated the same year that Rachel Carson and Peter Benenson did? How many people could wield a gardening fork like Richard Reynolds? How long does it take to mow a piece of overgrown grass? But these people took responsibility. They didn't wait to be asked or chosen. They chose themselves and got on with it.

Go on. Do something. You don't need to save the whole world. You don't need to do something you can't. Just do something that you can. And who knows where it will take you...


Note:The lovely picture at the top is from Richard Reynolds' Guerrilla Gardening; these sunflowers are actually growing in front of the Parliament, (although at a distance). Wonderful.

Computer Says No.. Connecting for Health Isn't - Well, Connecting

The cyber disaster that is the National Programme for IT continues; Times Online reports on the Royal Free Hampstead NHS Trust, who switched on their 'Millenium Care Records Service' some months ago and had to amend 12 000 patient records in the space of three weeks. Software crashes were a regular occurence and the trust had to bring in extra staff to cope with the disruption. The trust naturally wants compensation; they have had to spend a lot of money to compensate for the faults in the programme. And this is where the fun starts. The local service provider for their area is Cerner, who actually devised the system. However, the trust cannot sue them. That is because the actual contract is between BT and the Secretary of State for Health. If the trust wants compensation, it will have to appeal to the Health Minister. Will they get their money back? I wouldn't bet on it.

Accountability, or lack of it, has been a recurring theme in this saga. In April 2006,an open letter was sent to the Health Committee by leading IT experts, asking about the feasibility of the programme and complaining that there was a lack of information and transparency regarding the project.

The costs have gone up and up. Connecting for Health was originally pitched at £2.3 billion, went up to £12.4 billion, and estimates are now £20-30 billion. An unofficial estimate, said to be in a minute to the Treasury, puts the possible final cost at £50 billion.

Perhaps the most infamous episode in this escapade, was when Accenture, one of the companies involved in the implementation, withdrew its services in September 2006. It should have been fined £1 billion for breach of contract. It was actually fined £63 million by Richard Granger, the Director General of the programme. In a previous life, Richard Granger worked for Andersen Consulting. That company later re-named itself Accenture. You join the dots.

Now, I know what you're going to say. It's a big project, they always overrun, it's the NHS, it'll be alright in a few years, once they've sorted out the software. But it's not alright. We're talking about not millions,but billions of pounds. We're talking about a bail out on the kind of pegging level of the credit crunch. And at the end of it, we don't have a system that works. We cannot afford this as a country. The health minister Alan Johnston needs to get his seriously tackety boots on and tackle this. If that means taking BT to court, then so be it. 'Computer says no,' just isn't an option anymore..

Note: this post replaces an earlier post that I did on this subject that was somewhat rushed and lacking in accuracy as a result. After a nights sleep, some comment from Sean Brennan and a nice cup of tea, this resulted. Hope this is more to your taste, Sean.

Watch the Lady - the Art of Misdirecting a Controversy

A few months ago, Mike Gray, a bowel cancer patient, gave the Scottish Parliament one of its more uncomfortable moments, as he asked for the right to be given Cetuximab, a new cancer drug, on the NHS. He had already spent £26 000 buying his treatment privately, and had been penalised for this by the NHS, who do not allow private and public treatment to run together. Yesterday, Nicola Sturgeon announced that there would be a review of whether co-payments would be allowed. This has ignited the debate about whether this would result in the thin-edge-of-the-wedge means tested payments for treatment; others chose to castigate NICE (The National Institute of Clinical Excellence) for not allowing Cetuximab to be on prescription. But the one question that hasn't been asked is; why are this new class of cancer drugs so expensive in the first place?

That's the question that Slate, the American online magazine asked in this artice. And it was a real eye opener. Here in Britain, the cost of Cetuximab,Zevalin and Avastin are £35 000,£12 000 and £20 000 per annum. But for the US, the costs are $16 000, $17 000 and $24 000 per month! You do the math, but it's pretty obvious that these drug companies are thinking of a number and then multiplying it by how much they think they can get away with.

I never thought I would agree with NICE on anything, especially when they restricted the prescription of dementia medicines, but I am with them on this. The drugs companies are the real villains here, but the media have completely missed the target and are blaming NICE instead. It's a vile thing to hold sick people to ransom and that is what the pharmaceutical giants are doing. I can understand a high charge for a medicine like Zevalin, which is used for non-Hodgkins, a relatively rare secondary cancer of the lymph glands. But Avastin and Cetuximab are both for colorectal cancer, a very common cancer. How can they justify these prices?

As far as co-payments go, the jury is out. I have mixed feelings about where such legislation should go. But I think the media should turn a very large spotlight on the pharmaceutical companies and ask them why they are charging the prices they are and what their profit margin is. This is the nub of a controversy which is becoming increasingly misdirected. Don't watch the lady. Watch the prestidigitation of the pharmaceuticals...

Pushing them Down the Stairs - the Dark Side of Caring

Our friend Bill introduced me to his new girlfriend. She turned out to be a part-time carer in a care home, so I immediately started to pick her brains. She was cheerful,open, voluble and, it seemed to me, compassionate. You could see straight off that she was a good carer.

'Don't they just drive you mad?' she asked happily. 'The only reason I don't push them down the stairs is that I'd be found out'.

Like so many really important bits of information it was imported in the guise of a joke, and in time-honoured fashion I laughed back. It wouldn't have been in the spirit of the conversation to have pressed her on the subject. I rather wish I had. I'd have liked to have asked;

-How close to the truth that remark had been;
-Whether she had done such a thing;
-Or almost done it;
-Whether any of her colleages had;
-How she reconciled such thoughts with her caring philosophy.

I should have asked all these questions The trouble was that I didn't dare. Because I knew exactly how she felt.

Thus opens one of the darkest and bravest chapters in the Hugh Marriott's classic, 'The Selfish Pig's Guide to Caring'. I have been thinking about it for the past week, because of the case of Joanne Hill, who was sentenced to fifteen years for drowning her four year old daughter Naomi in the bath (the daughter had cerebral palsy).

My first reaction to the headline was; 'good.' I have grown sick of the rash of murders of children by their parents, the case of David Foster being only one in a growing list of these incidents. But as I read the various BBC articles accompanying the leader article, I grew more and more disturbed. This was not something that happened out of the blue. This was a gradual process over a number of years of severe depression, guilt over her child's condition and fear for her future,alcoholism and erratic taking of the medicines she had been prescribed. All the things in fact, which carers are extremely prone to and which they only avoid by those closest to them, watching out for them.

Being a carer is a different country. The gulf between the theory of caring and the practice, is enormous. It simply isn't possible to fully explain to a lay person, what it's like, and there is also a certain amount of badly concealed disdain for those who care. The phrase in the report that triggered this post was 'mild cerebral palsy.'

It's mild. What's the problem? Get on with it. Callipers are easy to manage after a while, and you'll get used to the staring. Don't worry about how your child's going to do at school,if she's going to get bullied, if she'll get a job, if she'll ever marry, what'll happen if you die before she does. And by the way, don't expect us, the taxpayer, to fund her care. Cerebral palsy isn't sexy enough for us; it makes you look funny. You should have had an abortion and saved us a lot of bother and money..

Mild.Mild. How patronising can you get?

But let's return to the subject. What did those around Joanne Hill observe about her behaviour?

- Her husband observed how she was depressed and would come home to find her drunk on the sofa and her daughter asleep.
- Her GP referred her to the local Mental Health Team after she suffered a severe relapse of her depression in Christmas 2006. In June 2007, they decided there was no need for further involvement, and batted her back to the GP.
- Her parents looked after her in Christmas 2006, when she left her own home for a while;
-Her childminders observed that she had a severe drink problem and on several occasions turned up drunk to collect Naomi.

Why could none of them see where this was going? For the same reason carers don't talk about pushing their loved ones downstairs; they didn't want to see it. They didn't want to admit that that abyss was there, looming and that Joanne Hill was getting closer and closer to it. To stop it would have involved tremendous upheaval and her removal from the house for her own sake. And it would have involved bringing up the difficult subject that Joanne Hill might at some point, harm someone she was caring for. Just mentioning it, is taboo. But to avoid the abyss, you've got to talk about it. You've got to name it and stare into it, to know where you could end up without support.

You might have noticed that this news story is over a week old. That is how long it took me to write on this subject; I never have before, it is so difficult. But I felt obliged to. The victim in this was a little girl of four, and I feel she died because no one could talk about the possibility that her carer might harm her. All carers know of this possibility. We all know that darkness. And if we could find the courage to talk about it, maybe Naomi would be alive today.

Close Encounters of the Third Kind- the Growing Dilemma of the Voluntary Sector

It's not a good time to be in the voluntary sector in health. Maybe it never is, but two stories have been rumbling on over the past few weeks, which illustrate the perils of being in this sector just now. One is the story of Kinloch Rannoch community, whose GP opted out and then retired in 2006. Tayside Health Board's solution to this, has been to attempt to bring in First Response, a volunteer service that specialises in on-the-spot defibrillation treatment, to replace the GP. Not surprisingly, this has met with a right royal raspberry from the local community. The second story is St Margaret's Hospice in Glasgow, which was asked by Greater Glasgow Health Board to admit a wider range of continuing care patients; not simply people that are at the end of their life, but those with complex mental health problems, and also nursing care patients.St Margarets has refused to do this, and is now looking down the wrong end of a £1.2million shortfall, as GGHB threatens to withdraw its funding.

What is interesting about these cases, is how each organisation has dealt with the NHS. There are three rules for a voluntary organisation that accepts public funding;
1. Know your remit.
2. Know the government's remit.
3. Do not let the two remits coincide, even if it means loss of funding.

First Response has a problem with its identity. It was set up by an RAF pilot, Scott Bateman,after the death of his father from a heart attack. The original idea of it, was to provide on-the spot emergency treatment from a trained volunteer to a patient, while waiting for an ambulance to arrive. They have a strong bias towards difibrillation treatment, and they tend to be centred round RAF posts, which are rural and the volunteers originally came from the RAF. However, things have changed as they have evolved.
First Response now recruit not just military personnel, but civilian personnel called 'community responders'.

First Response are acquiring their own set of vehicles; cars with markings almost indistinguishable from a paramedic's car. They are also setting up a scheme called 'Life Bikes' for operating in connurbations and rush hour traffic. This is a move away from their rural setting.

First Response have been granted the title of 'NHS Partner' and they display the NHS logo on their website.

I do not think that First Response is deliberately setting out to undermine the regular ambulance serices. But I think that the health boards have led them step by step into a situation where they will find themselves doing that, and it has happened because of their inexperience and because they were not clear enough on what their remit was.

By contrast, St Margarets Hospice in Clydebank has never allowed themselves to be mistaken for the health board. They know their remit; to provide specialist palliative care to the dying and judging by these minutes, they are not afraid to say so.

Palliative care comes under the quicksand banner of continuing care for the elderly. This can mean a dozen different things from a long term condition like Alzheimers, to cancer sufferers, to elderly with complex mental health needs. Their life span can be anything from a few weeks to a couple of years. What many hospices do to avoid confusion, is that they simply deal with cancer sufferers and neurological conditions such as Motor Neurone disease. St Margarets is different, because it will take people with other conditions as well, the proviso being that they are in the last stages of their illness.

Glasgow Health Board like other boards, has a problem with continuing care beds, and judging by the number of beds currently being discussed for the new Southern General, is going to have even more of a problem with these type of beds in the future. Hence their efforts to get the hospice to change its remit to what would amount to a nursing home. St Margarets has stuck to its guns, even although GGHB has threatened to remove funding. They have not allowed the health board to dump its responsibilities on them, and have not allowed themselves to become subsumed into a diluted version of professional services.

Perhaps the main difference between St Margarets and First Response, is age. St Margaret's has been going for 70 years; First Response has only been going for ten years. But it needs to heed the wake up call from Kinloch Rannoch if it is going to survive another ten. As for St Margaret's? Well, it's run by nuns. As Fr Jack probably didn't say; be afraid, Tom Divers. Be very afraid.

Big Brother is Watching You

First the good news. Richard Branson the bearded one, has decided to abandon his efforts to enter healthcare for the time being, Pulse reports. He says the reason is the current economic downturn and that this is the wrong time to be heading out on a new venture.

Now the bad news. The government is considering giving access to the computer records containing the postcodes, addresses and medical conditions of every man, woman and child in England. They have made the rather quixotic concession that a medic will have to have permission from the patient, but those outside the NHS will have access.

The most prized commodity in commerce is information. And this is the kind of information that companies like Virgin will need, to run private health concerns. This is already done to a certain extent through loyalty cards in supermarkets; these record what you buy and compare it to your 'customer profile'. This information is used by the supermarkets themselves and is also sold on to medical companies, insurance, holiday operaters and all manner of businesses. But at least there is a certain amount of agreement involved. You don't have to enter into the loyalty card scheme if you don't want to. And the supermarket only has access to those who already shop in their store, so it has limits.

This idea, however,is in a completely different league and completely outrageous. Perhaps the most disturbing thing about this report, is that it is short and low profile. I sincerely hope that the media give this idea the kind of bad publicity it deserves and doesn't wimp out on challenging the government on this. The information age and big brother is truly upon us..

Scotlands Drink Problem in Pictures

Do you want to know why Scotland has a drink problem? You need look no further than you r local supermarket. This is the scene that greeted me at Tesco yesterday;















Yep, right at the entrance. Three big bins that you can't miss; make it wine, because more women shop in here than men. Put it on the right hand side; most folk are right handed and it'll make it even easier.

Ok. I want to buy a wide screen telly. Oh, there's some wine that I can buy instead. What was it I wanted?
















I promised wee Jamie that I'd get him a pair of roller skates. Oh, there's some wine next to them; really convenient, that'll go well with the skates..




















Right, some bacon for breakfast and a morning snifter to wash it down..

















Nothing like a cheap lasagne full of hydrogenated fats to go with some Chasse du Pape.



















Right, I'll get some ice cubes for the Coke and lemonade that I'm buying. Oooh, wonder what ice cubes are like in wine?
















Why do we have a drink problem? Why is the number of women with a drink problem increasing? Send to Johnny Tesco Walker,The Ministry of the Bleedin' Obvious, Chardonnay Aisle, St Budweiser's-in-the-Square, Glasgow PST ASA NEWT. And the prize is a bottle of wine..