NHS Choose and Use - not a popular choice with GP's, another disastrous chapter in £12.7 Billion NPfit IT program

The excessively well paid CEO of the NHS David Nicholson dropped so many jaws on House of Commons Public Accounts Committee yesterday to further consider the £12.7 Billion on the £12.7bn NPfit scheme it's a wonder a radiologist with a portable X ray and an orthopaedic surgeon weren't required.

He was explaining that the "Choose and Book" system ,which was expected to attract 39Mn bookings by 2008 had in fact resulted in ..er.. nearly 6 Mn. Limply he explained (still it appears retaining his job) “Utilisation of the system is not as great as we would have imagined at this stage.”

There are bright spots “On average half of first appointments are now made through the system.” The fact that GP's were incentivised (ie paid money to use it) and that ending it would not affect usage was, he said ,"unfounded".

“One of the things we will do as part of the next stage review is to publicise patient’s rights to choice, to get pull.” Which sounds dreadfully like huge amounts of dosh spent on , more surveys, pamphlets, Posters, and late night TV advertisements - hopefully not like the NHS "Hooked" ads that received the most complaints last year by the ASA and were banned.

Health Insider website has some comments from users (ie GP's paid to use it)Chris Frith a GP in Hereford said "the design needs a complete rethink as hours and expertise are being wasted in General Practice at present to earn our LES (payment) if we are lucky. "

Reliability and system design are common problems .."If the system reliability could be sustained and not leave communities without a fully working system for a week" ...."It also only works with Internet Explorer so you have to buy Windows to make a hospital appointment. (many of us have Windows-free systems) "....." (a) combination of IT and general system failures risks driving away even committed GPs" ...."If C&B actually did do what was intended - support patient choice and make booking appointments quick and easy for patients and practices, - we'd all be using it and this thread would not be occurring. Unfortunately a combination of very clunky software and poorly designed Directories of Services (different for every Trust)" ..."We can no longer afford to create software/systems that no one is willing to use."..." "The recent spine update has meant several weeks of access problems. In addition the update to allow full choice together with the 18 week wait has created a meltdown in the directory of services." Why? As part of disaster recovery plans, should we now include spine updates as a risk?"

It is only sustained by payment to GP's for using it ..."The DES might have stopped but almost every PCT has introduced an equivalent LES. It is ONLY the funding that keeps this going, for very many GP practices." Doctors are remarkably resistant to change - eg : take a look at the digital stethoscopes available for improved diagnostic use. (see pic follow link for evident benefits) Maybe its because they cost £100 each... and they need incentivising.

Quite simply patients choice is predictable anyway....."I have yet to have a patient who has chosen anything other than the local hospital. " Apparently patients in hospitals don't want to travel and if hospitalised ,have what we doctors call visitors, who won't want to travel far.

Lord Patel's experience - asking for Manchester Eye Hospital instead of the local and well thought of Local Hospital stumped the GP and working together we finally made it....for Lord Patel to receive over ten letters cancelling the appointment, each of which I posted to the GP and each of which he told me to ignore...because, "the system isn't working properly". I did.

Turned up, excellent consultation. The consultant queried why I chose the Manchester Eye Hospital and was intrigued when I explained they saved my fathers eyesight in 1911 when a button hook he was reaching for, fell off the mantel piece and fell in his eye. Which meant he missed the opening of the Manchester Electric Light Cinema in Rusholme.

"Lorenzo" software

This project is now only 4 years overdue and early (and very, very brave) adopters Morecambe Bay Hospitals NHS Trust , Bradford Teaching Hospitals NHS Foundation Trust and South Birmingham PCT, issued a statement in early June saying that "deployment testing is identifying technical issues which are being resolved on an ongoing basis". This was just before a scheduled demonstration to MP's.

Criticism of delays with the Care Records Service have been met by Ministers giving a series of dates when the first sites will go live. These have been repeatedly deferred.

Many MPs are concerned that NHS will be pressured into going live on an a system that is not yet ready to meet promises made by ministers... or the Department of Health's financial contractual commitments to local service providers.

From 1-7th March USAF / RAF flew 309 "close-air-support" missions in Afghanistan and 315 in Iraq

Bruce Miller at Old Hickory's Weblog is always required reading, and his latest post (Sunday March 11th 2007 1.01 EST - but remember the DST !) is an essential read.

OH has been assiduously reading the Air Force Link which posts a daily combined USAF and RAF report on combat missions flown daily - Here are a few details .. you will want to read more.

A GBU-12 is a 500-lb. laser-guided warhead.
A GBU-31 is a 2,000-pound class munition guided by an $18,000 Boeing tail kit.
LP's notes in red the rest in italics is OH.

March 2:

Other F-16s were assigned reconnaissance in an area near Fallujah. A joint terminal attack controller (JTAC) member passed the location of a targeted individual who was hiding in a hole in the vicinity. The F-16s dropped GBU-12s, though the target was not struck.

This is a good example of why more independent reporting is needed on the air wars. The GBU-12 is a 500-lb. laser-guided warhead. They fired it (although the plural is used in the report) to get one guy hiding in a hole - and missed him. This was "near" Fallujah. Was this a hole out in a field somewhere? Or was it in the middle of a populated urban area? And I've got to wonder how many F-16s are being used to drop 500-lb. warheads to get one guy. Let's take it for granted that the F-16 crew had accurate information that this
guy was an enemy guerrilla... or maybe some poor guy got caught short and was having a crap ?

March 4:

In Afghanistan yesterday [Mar. 4], an Air Force B-1B Lancer dropped guided bomb unit-31s on a building near Sangin containing anti-coalitioninsurgents. A JTAC confirmed a direct hit. The B-1B also provided two shows of force, releasing multiple flares and bundles of chaff in the same area with successful results reported by the JTAC. (Bundles of chaff, do the Taliban have SAM's and nobody is telling us .. or are they just adding to the festive atmosphere ?)

In this case, at least two of the "2,000-pound class munition guided by an $18,000 Boeing tail kit" were dropped "near" Sangin.

March 6:

[In Afghanistan] Other Navy F/A-18s dropped GBU-12s and GBU-38s on two separate anti-coalition insurgent buildings near Sangin. All weapons hit the desired target as confirmed by a JTAC. Other F/A-18s also dropped GBU-12s and GBU-38s on enemy forces in a wooded area and another enemy building near Sangin.

The USAF reports 309 "close-air-support" missions flown in Afghanistan and 315 in Iraq (American USAF and British RAF combined) in the first 7 days of March.

On March 8, U.S. Air Force, Royal Air Force and French air force tankers flew 37 sorties and off-loaded more than 2.7 million pounds of fuel -- the equivalent of more than 65 full Air Force logistics readiness fuel trucks.

Picture - TOP Leaflet airdrop delivers message to Taliban

AF 60th Anniversary Flag Dedication Ceremony

Flooded Bolivia gets humanitarian relief

Airman 1st Class Josh Huffman drops warning leaflets over the mountains of Afghanistan March 6. Leaflets were dropped to warn Taliban extremists not to interfere with coalition activities. The mission was launched to help improve security and the quality of life for Afghan people. Judging by the height of release this would appear to be an exercise in futility.

Of course the other pic is of the WWE guys and gals in a RAW tribute at Bagram Air Base, December 19th 2005 (They haven't been back since) "The Divas also helped the troops get in the Holiday spirit, as Trish Stratus & Ashley took on Candice Michelle & Maria. " If you are seling Jeffersonian participatory democracy and schooling for girls, you gotta show'em what it's all about.

Makes you proud to be a soldier.

Commander in Chief gets ready for Martial Law

When Kellog Brown Root, (KBR), the engineering and construction subsidiary of Halliburton Co. (HAL : NYSE) announced the award of a 5 year $385 million contract (an Indefinite Delivery/Indefinite Quantity (IDIQ) ) from the US Department of Homeland Security to supports its Immigration and Customs Enforcement (ICE) facilities in the "event of an emergency" a lot of heads got scratched.

This unique and novel contract placed on 24th January 2006 with immediate effect , is to provide temporary detention and processing capabilities in the event of an "emergency influx of immigrants into the U.S"... or as KBR mysteriously said .." to support the rapid development of new programs" (?).

Now Signs of the Times has a facsinating piece "Bush Moves Toward Martial Law" by
Frank Morales which may have identified another piece in crazy jigsaw of Dubya's assualt on the Constitution.

According to to Senator Patrick Leahy (D-Vermont), the President has signed off legislation which will actually encourage the President to declare federal martial law .

Historically The Insurrection Act (10 U.S.C.331 -335) with the Posse Comitatus Act (18 U.S.C.1385), has placed strict prohibitions on federal military involvement in domestic law enforcement.

Now in a private signing ceremony in the Oval Office on October 17th, 2006 the President wiped his ass on the Constitution one more time and stuck his John Hancock on Public Law 109-364, or the "John Warner Defense Authorization Act of 2007" (H.R.5122) (2), which allows the President to declare a "public emergency" and station troops anywhere in America and take control of state-based National Guard units without the consent of the governor or local authorities, in order to "suppress public disorder."

On the same day ,but more publicly he signed off the Military Commissions Act of 2006 which allows , amongst many other crimes, the ability of the US to hold people anywhere in the world, and torture them.

Senator Leahy first struck out on September 19th, about this Constitution wrecking and bricklaying the wall around the supporters of freedom and democracy, noting that 2007's Defense Authorization Act contained a "widely opposed provision to allow the President more control over the National Guard [adopting] changes to the Insurrection Act, which will make it easier for this or any future President to use the military to restore domestic order WITHOUT the consent of the nation's governors."

Ten days later , Senator Leahy entered into the Congressional Record that he had "grave reservations about certain provisions of the fiscal Year 2007 Defense Authorization Bill Conference Report," the language of which, he said, "subverts solid, longstanding posse comitatus statutes that limit the military's involvement in law enforcement, thereby making it easier for the President to declare martial law." This had been "slipped in," Leahy said, "as a rider with little study," while "other congressional committees with jurisdiction over these matters had no chance to comment, let alone hold hearings on, these proposals."

In a telling bit of understatement, the Senator from Vermont noted that "the implications of changing the (Posse Comitatus) Act are enormous". "There is good reason," he said, "for the constructive friction in existing law when it comes to martial law declarations. Using the military for law enforcement goes against one of the founding tenets of our democracy. We fail our Constitution, neglecting the rights of the States, when we make it easier for the President to declare martial law and trample on local and state sovereignty."

..But it's been done. The elected Guardians of democracy have been sleepwalkin'.

Offshoring warrantless surveillance - more bollocks from the conspiracy freaks

Dag Wilhelmsen is General Manager of the NATO Consultation, Command and Control Agency and is on a 4 day visit to Bulgaria to meet the Minister of Defence Vesselin Bliznakov and the State Commission on Information Security. Dag says of the NC3A "we provide, as a host nation as it's called, the capability to acquire a lot of NATO equipment and systems such as satellite communications, automated information systems, communication networks and deployable capabilities for NATO's operations."

In the light of the entry of Bulgaria to the EU in January announced last week it is important there is clarity of understanding between all NATO members.

His visit coincides with a curious e-mail Lord Patel has received regarding previous posts on US warrantless surveillance of domestic telephony / IP traffic in the US. The unkown but knowledgeable informant claims that the US outsource surveillance just as they do, imprisonment, torture and interrogation.

Data split off AT & T and other networks is ( the writer claims) squirted anywhere in the world for further analysis and this is undertaken by friendly folks who accept US military establishments, suitably equipped who take on staff on short term, highly deniable contracts who can be found strolling the streets on 4 week breaks on an island to the Eastern end of the Mediterranean well known for it's highly visible and well known mountain top communications gear.

They then disappear for 6 week stints - it is claimed - to the home of Ovid and a little further south and north of Greece .. where they might this week bump into Dag Wilhelmsen.

The writer was impelled to write (they say) after reading a post about CACI (suppliers of torturers to Abu Graigh and beyond) and their software skills in providing EU telcos to meet the forthcoming Data Directive.

So. get this crazy idea, data is split off domestic US telcos (well we know that), squirted to (say) Bulgaria and Romania, (i.e outside US legal jurisdiction) to be worked over by staff familiar with analytical software (but anonymised) used to handling massive data volumes (with security clearances of the highest order) , supplied by firms such as CACI (and many others ?) which might be tied in with NATO Command and Control agencies ? Preposterous nonsense, curiously this lunatic didn't involve a pitch for Viagra. Who on Earth would believe such crap ?

That's the trouble with the Internet, this sort of bollocks can circulate without the slightest shred of evidence. That Dag Wilhelmsen, the General Manager of the NATO Consultation, Command and Control Agency was evidently wasting his precious time in Bulgaria meeting the Minister of Defence Vesselin Bliznako. Let's trust he didn't waste any time (and NATO taxpayers money) going to the US installation at the Ravnets base outside the port / airport of Burgas on the Black Sea.

Look and Learn on the Web -

In January 2004 with angel finance by CEO Dr. Tim Tuttle and CTO Dr. Adam Beguelin launched Truveo its video search engine technology in September 2005 which utilizes a proprietary web crawling technology they call "Visual Crawling".

"The next few years will see a dramatic increase in the amount of video available on the web," Dr. Tim Tuttle said last December when taken over by AOL. - to be added to Seattle based Singingfish acquired in in November 2003 to form the basis of the AOL Video Search - which is brilliant.

Nothing is more certain as traditional printing presses have been hit by the web , perhaps the TV studios are going to be hit as the amateur film maker, newscaster, newshound stakes their place.

Since then Google’s (Market Cap US£130Bn) has acquired for US$1.65 billion worth of shares video playing Web site YouTube.... which let's face, it is small potatoes to them, and will undoubtedly swell their ad base.

Now we hear that Yahoo are deep in talks with Facebook a private company located in Palo Alto, CA. It is a networking site built around college students — Facebook launched in February 2004, and the website claims over 10 million registered users across over 40,000 regional, work, college and high school networks. According to comScore, Facebook is the seventh-most trafficked site on the web and is the number one photo-sharing site.

Facebook has the most unfriendly face of any such site (clean, minimal so cool it's freezing) and says of itself in PR Newspeak ,which was probably constructed by software that correctly understands syntax but not people.

"Facebook is a social utility that helps people better understand the world around them. Facebook develops technologies that facilitate the spread of information through social networks allowing people to share information online the same way they do in the real world. "

Those guys at Yahoo would be well advised to look at ITV's acquisition of Friends re-United for US$200 Mn....The CEO who did that is now spending more time with his roses.