Friday, 23 December 2011

Story Plot

It is amazing how just reading the daily news can give rise to plots for the next book. I was reading that the Eden Project has withdrawn from sale jewellery made with the rosary pea, sometimes called Crab's Eye peas. It turns out that the toxin contained in the peas is 75 times more toxic than the feared Ricin made from Castor Oil beans. Sometimes these peas have been found in ethnic baby rattles!

Ideal stuff for the bad/good heroine in my next book.  The peas can be purchased openly through the internet, including Ebay!

Sunday, 18 December 2011

Background to TFOH

As part of my Adam Cranford series I've created a "Draft" of a member's handbook for the Foundation of Honour. I'd be interested to receive suggestions from fans of Adam Cranford to add to the text of the handbook. You can find it on Kindle .com and .  If you don't have an actual Kindle Amazon do a free reader for PC, Apple, Android which can be found here.

Thursday, 8 December 2011

Fresh breeze

There's a pretty strong breeze in Edinburgh at the moment.  164 mph on the Cairngorm.

Wednesday, 7 December 2011

Lansley's NHS

Andrew Lansley has published his plan for privatisation of the NHS, ooops I mean health reforms. They cement my view that the concept of the NHS Walk-In Centre is thoroughly dead. There is no mention of Walk-In Centres in the Primary Care bit of the plan (item 44), the GP lobby in the Lansley advice coterie is getting its way. They are determined that the public will attend their [private partnerships] surgeries at a time convenient to the well paid  GPs rather than the needs of the public. People go to Walk-In Centres because they either can't get the service they need from their GP or the quality of service is so bad that they seek an alternative.

Meanwhile I've been contacted by a Nurse Practitioner (30+ year's experience, Masters degree in medicine) who tells me his future employment is so uncertain that he's stopped buying a season ticket for travel to work. He now only buys a weekly rail ticket.

Monday, 5 December 2011

Hospital A&E Walk-In Centres

You'll have seen my earlier comments about NHS PC Walk-In Centres. In the main these are being closed, though sometimes a Walk-In Centre will be attached and managed by Acute Trust personnel rather than senior primary care medical staff. With the PCT WICs the emphasis is on successfully treating the person who walks through the door with subsequent follow-up by that person's GP. Where the need is serious andurgent the PCT WIC nurses will refer the case to the nearest A&E dept, usually following phone discussion between the WIC and A&E medics. The objective is to divert less urgent and less serious cases to the WIC.

When the WIC is managed by an acute trust and located close to an A&E department the nature of the service changes. The focus is much more dealing with unwarranted non-urgent patients to direct them away  from A&E. The focus is reducing the queues at A&E rather than treating the patients.

There's a case reported in the Daily Mail web site where a person who should have been treated by an A&E doctors was turned away by an A&E receptionist and told to go the WIC next door. The details in the Daily Mail report are not extensive but it appears the poor chap left the WIC with just eardrops and subsequently died from blood poisoning and brain damage. Here's the BBC report. It is very sad and my heart goes out to his family.

I do wonder however what the outcome would have been had the patient initially attended a PCT WIC where the nurses are trained to work autonomously (on their own) and give a through examination. Any urgent/serious cases are then passed immediatly to A&E, if necessary using a blue light emergency ambulance. There are clearly defined medical protocols the nurses are trained to follow which provide "red flag" markers of serious conditions.

In any event, patients presenting with a medical condition should not be turned away on the word of a clerical receptionist.

Friday, 2 December 2011

Rats or Birds?

One of the signs that something is wrong in an organisation is when several senior managers leave of thier own choice in a periods of a few months. A recent article in the Guardian Newspaper highlights a case in the Barts Hospital in London UK. The guy in question has worked at the place as a skilled surgeon for many years. Suddenly he finds it an unacceptable place to work! There have been several instances of senior administrative and clinical staff (5 out of 14 orthopedic surgeons) finding employment at an alternative location more attractive. Is it rats leaving a sinking ship or is it birds flying away before an earthquake? Has someone broken the spiritual backbone of the place? It is very difficult and expensive to repair a damaged corporate psyche. Maybe there is a programme of cuts using an experienced aggressive "Turn Around" Director?

The same kind of thing has happened in the North Staff's hospital. Now the administrators had to draft in Army Medics to keep their A&E  department running. Professional medical staff such as surgeons and specialist nurses will be caution about joining to work at a hospital with a damaged reputation.

It is a pity, because BARTS does some good clinical work caring for the patient. For example they're the only hospital actually checking the safety standards of surgical instruments. See the worrying Panorama programme in July 2011. They also do good work in research in Prion infection on surgical instruments. Perhaps the problem is the way the administrators engage with the clinical staff? Is there a climate of bullying? Are we getting value for money from these highly paid administrators?

Thursday, 1 December 2011

Rescue the economy - no income tax

The United Kingdom is in financial trouble. As a country we are spending more than we earn. Our government has to borrow money to be able to provide basic services. If your monthly income is £1,500 yet you spend on average £2,000 a month you will very soon get into serious financial trouble.

The old financial tools deployed by the UK Government to deal with this situation just do not work in the current global environment. They may try to stimulate the economy by reducing the bank interest rate. The idea being that lower interest rates encourage people to borrow more money and spend that on manufactured goods, thus promoting growth. The problem is that interest rates are already at a record low level and the real interest rates charged to the public remain stubbornly high. As the banks try to recover from the losses of their previous toxic debt (casino banking) scandal and also raise their reserves they have no incentive to reduce interest rates charged to customers. The other problem with stimulating growth through low interest rates is that people use the borrowed money to buy imported goods thus worsening the country's debt position.

The lower interest rates also discourages frugal people with spare money from long term savings. The is little point in saving if the actual deposit interest rate is lower than the rate of inflation. People see their savings better protected by investing in property. This gives no net gain in the national wealth and sees money sucked away from investment in UK industry. The Catch 22 with "investment" in property is that it only works by forcing up property prices. People borrow more money to pay these increased property prices, when there is an increase in the interest rate it will suck a massive amount of spending money from the economy to pay banks. In 1989 the base bank interest rate rose to 15%.

Another Government tactic is to print extra money. This is not money that has been earned or borrowed, it is merely a devaluation of the national currency. In effect it is debasement of the coinage or clipping silver from the coins. It is a technique usage for centuries when the rulers do not have enough income to meet expenditure. The current fashionable name for this is Quantitative Easing. The problem is that this reduces the value of the money held, in our Sterling currency, by overseas banks and investors. It is in effect a back door devaluation against other currencies. The problem is that devaluation increases the price of goods imported into this country. As we spend more on imports than we earn by exporting the effect is that we further increase the indebtedness of the UK by printing money. If anyone doubts the impact of a currency collapse look at the example of Argentina. Currency devaluation tends to increase interest rates as oversea depositors look to maintain the return on their loans to this country.

Over the past couple of decades businesses based in the UK have tried to reduce their operating costs by moving their production processes overseas. While this may reduce the monetary cost of the product it increases the amount of goods that we import. Moving production overseas also removes paid employment from UK employees. It means those ex-employees (and the companies on their behalf) no longer contribute to UK employment and national insurance taxation. Unless that employee can find another job he/she becomes a burden on the UK Government in terms of social benefit payments and reduced tax contribution. It also means that the individual surviving on social benefits is less likely to contribute to the UK economy by purchasing UK manufactured goods. The last Labour Government expanded the size of national and local government to create jobs, but this increases the national borrowing requirement to pay for the additional Government direct employees and outsourced employees.

At the end of the twentieth century the UK economy was bolstered by additional income from North Sea oil and gas, but that additional income source is rapidly diminishing. The United Kingdom needs to take some serious steps to rebalance its economy. We need to start earning a lot more than we spend. We have some massive debts to pay off. We cannot use the old tactic of inflation and devaluation, that would just increase the repayments on our existing massive debt.

We need to make imported goods less attractive to the UK population while at the same time make UK manufactured goods much more attractive. This would help to rebuild the UK manufacturing base as businesses are encouraged to produce locally. This can be achieved by applying a minimum 30% tax on any imported goods, food stuff, fuel, service, raw materials to this country. An import tax on food would also encourage farmers in this country to produce more food from their land, thus improving our food security. At present our food supply chain breaks down very quickly if imports are disrupted for any reason. With the prospects of global food prices increasing we need to encourage our farmers to produce more homegrown food.

To compensate for the increased price of goods in the shops we should at the same time alter the income tax bands so that the ordinary 95% of the population pay no income tax. There could still be taxation of the wealthy. Suitable balancing of the tax rates would mean there is effectively the same same life quality for the UK population, but just that there is a greater incentive to buy locally produced goods and less incentive to use imported goods. That would boost the incentive for businesses to manufacture in the UK thus improving the employment of people within the UK. As the employment situation improves the reducing demand on social benefits will follow, reducing the demands on the public purse.

No doubt many of the current politicians and economists will argue that using import taxes is a bad thing. However, those people have had their chance and failed. Their theories, maxims and economic models no longer work. It is time for a new direction. We should shrug off the colonial guilt of trying to stimulate the economies of overseas countries. They've had their start-up, we now need to look after ourselves and prevent an economic hangover for our children.

Monday, 28 November 2011

NatWest Bank Branch problem

I've just had 25 minutes of my life stolen from me by the NatWest Bank.

I used to have my main accounts and savings with them, but those were removed to another bank long ago following poor service and dubious interest rate practices. My wife and I have a joint account with the NatWest ever since we married over 30 years ago, but I cannot access it because the bank lost its record of my date of birth. However that's another story.

My company currently banks with the NatWest, but needless to say that customer relationship is hanging by a thread. It is only the work required to notify our clients and suppliers which protects the NatWest. We no longer leave any substantial sums of money in that bank. It goes elsewhere to where we know our custom is valued.

I've taken a day out from my business and was tidying some paperwork in my home office when I came across a bunch of shares dividend and royalty cheques I'd overlooked. Mostly I use direct payment of dividend/royalties into my other bank, but there are a few I still handle manually via the NatWest. I duly totted up the total value of the cheques and filled in the paying-in book prior to visiting the local NatWest Bank branch. As I'm in London at the moment it just happened to be the Lewisham branch. When I arrived at 2:25pm I found a long queue snaking around inside the branch. I checked my watch suspecting a long wait would follow. Only two counter positions were open.

I was not disappointed. It took 25 minutes for me to reach the front of the queue. During the wait I'd seen fourteen people turn away from the branch when they saw the length of the queue. By that time an additional counter position had opened. The manager tried to make the claim that refurbishment works would be completed within a couple of weeks and the queuing would not happen. What total nonsense! The queue was there because there were not enough counter positions open. In fact their refurbishment work is reducing the physical number of counter positions.

Perhaps the NatWest bank regards 25 minutes as an acceptable waiting time for their customers? I most certainly don't. The rot started when the retail banks decided it was a clever idea to remove Branch Managers. You know the type, they'd recognise you in the street and would have an idea of how much money you owe/deposit in the bank. When things went wrong with their service you'd know who to complain to. Instead now the NatWest wastes its money on television advertising spouting propaganda that the NatWest is a caring bank or something similar.

Saturday, 26 November 2011

Another senior nurse goes from UK NHS

Yesterday a highly skilled senior Cardiac nursing sister left the UK NHS. She'd worked at a central London hospital for many years. During the period she self-funded BSc and MA degree qualifications in medicine. She was managing a ward of critically ill cardiac patients. Tired of the clinical nurse staffing cuts under Lansley, the excessive unpaid overtime (12 hour days) and professional bullying abuse from some doctors/managers she decided to leave. She could no longer tolerate the disrespect from her Acute Hospital Trust employers.
She's looked around and has found a senior post in a middle east hospital. She's instantly doubled her salary, has paid for accommodation and it is all tax free.

It is fascinating yet unsurprising that the Acute Trust Board discuss a survey on staff concerns and conclude that people are happy. In reality the medical staff are angry and frustrated. It is time for the board members to get away from the board room and go actually meet the workers. Such bullying can have severe financial consequences.

Thursday, 24 November 2011

Death by attrition - Walk-In Centre

I'm watching the death by attrition of an NHS Walk-In Centre:-
  • Buildings closing (scheduled to be demolished quickly after);
  • Alternatively buildings given to a GP practice; even though they are a private concern;
  • Primary patients directed away without treatment ("Go to your GP or another clinic such as sexual health");
  • Any vacant position arbitrarily removed, regardless of the reason for the vacancy.
  • Senior nurses bullied and excluded from management meetings to encourage them to leave;
  • Senior nurses made redundant;
  • Junior nurses told their jobs are being regraded (downwards) with no real consultation;
  • Overnight working in A&E (not primary care) imposed regardless of contract;
  • Nurses diverted to streaming duties in A&E;
  • Nurses joining a union for the first time ever;
  • Specialist computer systems for patient consultation records abandoned and no further maintenance paid.
  • Services like Emergency Contraception cancelled - "go to another clinic" even though it is closed and the patient would need an appointment. 
  • Senior administrators making arbitrary clinical decisions
  • Budgets diverted away to other purposes.
All of this happens without consultation with the public and little warning to patients. All that is left is a deskilled shell nominally called a Walk-In Centre where a couple of nurses share a room somewhere in a larger department.  The PCT or Acute Trust claim the Walk-In centre hasn't "closed".

I've now seen this happen in four different locations over the past couple of years. It is a sickening waste of the public money invested in the creating WIC infrastructure and in the cost of building and training a skilled team of nurses. The public are left with no improvement of services as a result and the workload (queues) in the local A&E increase as a consequence.

One point never successfully handled under if retaining the patient records. They are supposed to be maintained safely and accessible for at least 25 years. This is an enormous cost risk, with the nurses dispersed there is no one able to dispute a legal medical claim. It is another consequence of the Lansley blind bull in a china shop leadership.

This happening in many places in the UK..

Edit: 17th April 2012

I recently had a chest infection which needed treatment with antibiotics to help it clear up. I've not troubled my GP for the past 15 years but I was not surprised to find I could not get an appointment until the following Monday (I was phoning on a Wednesday).  The receptionist's advice was to go to A&E dept or to the local Walk-In Centre. The local walk-in centre is one of those which has closed to be replaced by a ghost service located in another GP Surgery. I wasn't working so I drove to the WIC and was seen by a Nurse Practitioner within half an hour during the normal working day.  However I note that the opening hours have been cut down considerably and there is a map on the wall showing the "Catchment Area" street by street, within a radius of one mile. Proper Walk-In Centres do not have catchment areas! They deal with whoever comes through the door

The next closest Walk-in Centre by time of travel was open in December 2012, but it is now closed and the site is a car park.

Tuesday, 22 November 2011

More about NHS WICs

My blog piece on NHS Walk-In Centres has generated some interesting, if uninformed, comment so I’ll extend the article somewhat.
The idea of the Walk-In service is that patients can walk in from the street if they want medical advice, after treatment the patient walks out. The Walk-In Centre does not deal with A&E cases, though it is not unknown for ambulance crews to deliver patients to a Walk-In Centre where the condition is minor. The general rule is that if the patient has broken bones, needs a stretcher or has chest pains they get directed to A&E.
The WIC consultation is designed to be a one shot process. To assess and treat if appropriate; the WIC procedures are not designed for follow up sessions. If follow up is necessary the patient will be referred back to their own GP or to acute medical practitioners in an appropriate local hospital. The WIC may offer associated services such as a phlebotomy clinic (taking bloods), but not as part of their routine assessment process.
Mostly the cases for assessment and treatment are where the patient presents with headache, high temperature, colds and flu.  They are cases that would otherwise clog the waiting areas of the local GP or A&E Department. The WIC normally has a qualified medical prescriber present during their open hours, the usual route for patients to obtain medicines is to visit a local pharmacy, but the WIC will also hold a stock of common medicines for on-site dispensing.  When the WIC practitioner recognises a serious underlying condition the person will be referred back to their GP or in urgent cases on to the local A&E department. These referrals routinely represent a very small proportion of the cases handled.
The Walk-In Centre is normally led by a senior primary care nurse practitioner (Matron).  The lead nurse will usually manage both nurses and administration staff. Where appropriate the lead nurse /Matron will also employ a part time salaried GP to handle cases that need the skills of a GP but patient cannot for some reason attend their own GP. Most primary care nurse practitioners (PCNP) are qualified to MA degree level in an appropriate medical discipline with additional training specifically to work as a Nurse Practitioner. They will usually have at least 10 years experience of actual practice in the primary care area. They are decidedly not “Practice Nurses.”
The nurses in the walk-in centre are trained in medical assessment. They are expected to take comprehensive notes recording how they reached a diagnosis in each case. Those records are personally signed as a legal record by the nurse. The WIC matron regularly audits the patient records for quality for the nurses and the salaried GPs. Nurses are provided with detailed written rules as to how to perform their work. They are not permitted to perform such work unsupervised until they’ve been given a written sign off of their competency. They are also encouraged to routinely consult with their seniors when they have any uncertainty. A recent study in the litigious USA showed that less than 2% of Nurse Practitioners were mentioned in medical claims. In the UK the training and supervision is more intensive.
The concept of the UK NHS Walk-In Centre was created in the late 1990s by the Labour Government. It was a time when the public in some locations found it notoriously difficult to obtain a consultation at their GP’s surgery. GP surgery hours were limited and normal working people would have to take time off work for a 3 minute consultation with their local doctor when they finally achieved the minor miracle of getting through to the GP receptionist phone. Most GPs are not directly employed by the NHS, they act as sole practitioners or partnerships that have few actual constraints on how they deal with patients or which actual hours they are available to patients. GPs will contract with a local primary care trust to provide services, but it remains the fact that GPs are their own bosses.  The design of the Walk-In Centre service was to counteract that lack of service. WICs were specified to be open daily (364 days a year) from 0700 through to 2200 and thus not just constrained to working hours.
In the past few years WICs close to acute hospitals have been performing an additional function in reducing the waiting queues at the A&E departments. A skilled nurse(s) from the WIC would be stationed in the local A&E department adjacent to the waiting area to perform first line triage of attending patients. Those with minor conditions are advised (not mandatory) to visit the near-by Walk-In Centre to receive quicker appropriate treatment

Friday, 18 November 2011

The death of the NHS Walk-In Centre

One of the better changes introduced to the UK National Health Service (NHS) was the concept of Primary Care Walk-In Centres. They were located primarily in urban or city locations and were available to the public from 7am to 10pm for 364 days a year. In other words they were available at a time convenient to the public rather than a time convenient to local General Practitioners (GP).
The Walk-In centres were staffed by teams of highly skilled primary care nurses and led by autonomous Primary Care Nurse practitioners. The procedures and skills of the nurses, who were qualified to prescribe a full range of drugs and medicines, mean that they could deal with 98% of the cases without the need for a medical GP. For those few where the nurses could not handle a GP would be be employed on a part time basis by the lead Nurse Practitioner.
No appointment was necessary, people could literally walk in off the street and receive a medical consultation. Those with long term medical conditions would be given any necessary urgent treatment and referred back to their GPs for long term primary care.
The concept was extremely successful:
  • The costs were low. A WIC patient consulation was about £25 cost to the NHS. If that patient had gone a GP it would have cost at least the NHS at least £35. If the patient couldn't get to see a GP and decided to go to the local Accident and Emergency the minimum cost to the NHS would be £105.
  • Waiting times were good. Patients were seen within an average of 20 minutes or less in a fully staffed WIC.
  • The GP practices in the UK are run by independent contractors. They could turn patients away or close for the day at the whim of the GP Partners. The WIC teams were obliged to stay open, requiring permission from the local Primary Care Trust (PCT) and the Dept of Health before they could close.
  • The WICs helped to reduce queues in the local Accident and Emergency departments when patients with minor ailments were "streamed" away from the Hospital to the Walk-In Centre.
  • The WICs had a very low medical error/claim rate.
Sadly now most of the Primary Care Walk-In Centres have now been closed and their skilled teams of nurses dispersed. There are other reports on the Internet. In some cases the closures are hidden by the retention of a couple of junior staff and assigning them to a local GP or an A&E department. With the GP led Walk-In Centres you will see the daily open hours change from 0700-2200 to something like 0800-1900. In some cases the nurses are transferred to Acute Trust (Hospital) where the nurses role is subtly changed from being trained autonomous medical practitioners who diagnose and prescribe. Now they have to double check any decision with expensive doctors.

Originally the funding of the WIC team came centrally from the Dept of Health, it was ringfenced and could not be diverted to other purposes. Subsequently the ringfenced funding was merged into the general funding of the Primary Care Trusts. Opponents of WICs soon diverted the funding away from the WICs and the closures started. Remember the WICs often dealt with the failures of the GPs. They were seen as a threat to their profits. When the Conservative/Liberal coalition government came to power the scourge of the NHS in the shape of Andrew Lansley was released. He decided to wipe out the Primary Care Trusts and to hand the financial reins to the local GPs.  GPs see WICs as financial competition. It signalled the end of the PCT funded Walk-In Centres. Some have been absorbed by the budget hungry Acute Trusts (hospitals) to act as a streaming front end to A&E purely intended to prevent breaches of the waiting time targets. The Acute Trust, typically struggling under the financial burden of a PFI project, gains the funding from the Walk-In Centre, but the public lose the benefits.

These facilities are closed without public consultation, possibly leaving a ghost service to protect against public follow-up. The health administrators hate having their closure plans examined in public. Hundred's of thousands of pounds will have been spent in creating each of these Centres. It is often wasted. In one case the building was handed over to a local GP (private) in another the buildings will be demolished to provide parking spaces.

The consequence of these widespread WIC closures in London will be felt with greater queues in A&E, particularly at the time of the Olypmics 2012. Some of these walk-in centres were due to provide support to visitors. Here's a BBC report of a typical example in Surrey. They used to have a local WIC but it closed. You'll see a similar pattern in Croydon, New Cross, Whitechapel (E1), Homerton, Canary Wharf, Liverpool Street, Victoria and many other locations such as Stapleford, Ashfield, Leeds, Derby, Bradford, Salford, Harrow, Nottingham, Kirby, Trafford, Bromley, Manchester, Southampton , Barnsley, Warrington York Haverhill (Suffolk) Loughborough

An attempt to close Peterborough WIC.

Update: Late Nov 2011  One of the Walk-In Centres scheduled for closure soon,  as usual had a busy day as people attended for treatment yesterday. Many of those people would have gone to the local A&E Dept. Needless to say, the nearby A&E Dept managers are wetting themselves at the prospect of a 40% uplift in visits when the Walk In Centre closes. The A&E waiting time targets are going to be shattered, they already fail to meet waiting targets frequently enough as it is on present levels of patients.

Update Feb 2013: To make matters worse the local A&E Departments, which were protected by the Walk-In-Centres taking part of the load, are getting closed down as part of the service cuts. The (private) GP led Walk-in-centres open just 13 hours a day 8 - 7pm compared with Nurse led (NHS) 16 hours and the GP WICs have significantly reduced staff levels.

Friday, 28 October 2011

iStockphoto Photo's

We've occasionally used to provide photo's for presentations and advertising work. We've just received notice from them that they are "expiring" our credit because we've not used the account for a while. We regard that as theft. We don't care what their terms and conditions say, it is plain simple corporate theft. No doubt they'd take a dim view of anyone misusing the copyright material, but they have no problem with their own theft tactics.
If they do not want to continue to do business with us, they should just refund the outstanding credit.

They've now been added to our email blacklist and will no longer be recommended.

Tuesday, 27 September 2011


I wonder why the South African Government is delaying the via of the Dali Lama? The Dali Lama is planning to visit Desmond Tutu in South Africa.  Some pressure from the DRC?

Monday, 9 May 2011

UK NHS reform GP cynicism

The Royal College of General Practitioners are complaining the proposed government reforms may unravel the National Health Service. The general "idea" is to give control of primary care funding to local consortia of GP's whole then commission services. At the same time the government are proposing to introduce competition for the provision of health services.

We must not lose sight of the fact that most General Practitioners are independent contractors/partners. The GPs do not have a contract of employment with the NHS. The GPs are allowed to keep the profits they make from the fees they charge government for the provision of health services. To allow the GPs to commission their own services represents a gross conflict of interest. Their primary motive is profit. The GPs already receive a massive annual income, as a private contractors, plus many hidden state subsidies. Giving them control of the purse strings is utter lunacy.

The Royal Collage of GPs complain that competition will wipe out the NHS [reduce the GP profit], yet at the same time GP commissioning groups actively campaign to halve the staffing levels of the existing NHS Walk-In Centres. These places are nurse led, using highly skilled medical practitioners, and provide a service 365 days a year from 7am through to 10pm. They handle 90% of the cases GP's handle and in many cases treat the overflow of patients who are unable to get an appointment at their own GP. Most GP practices are open to the public for about 8 hours a day for 250 days a year. The cost per clinical consultation is at the highly available Walk-In Centres is about 75% of an equivalent reduced availability GP consultation. The GPs hate the exposure that properly qualified Nurse Practitioners can provide a good clinical service without the need for expensive GP's.

A telling statistic is the consultation duration in a Walk-In Centre is an average of 12 minutes per person. These Nurse Practitioners are very thorough. Compare that with your own visit to a GP. most of their consultations last 2-3 minutes. The error rates at Walk-In Centres are very low, which is good considering the staff have to deal with unknown patients who walk through the doors.
One of those GPs looking for closure of the WICs is a close advisor of the Health Minister Andrew Lansley. Indeed Mr Lansley has introduced him at public speaking events as a GP expert. That same person is actively involved in the management of a local new GP consortia who will commission health services including the GP practices where the advisor has an ownership/profit interest. Their recommendation is to break up the WIC in his area (about 100,000 consultations a year). The WIC has already had substantial staff cuts imposed.

Not good. These ill consider government proposals have already caused a lot of damage and unnecessary expenditure. Prime Minister Cameron promised to protect the NHS yet he seems to have put it under the control of unreformed self-interest groups.

Thursday, 5 May 2011

Why we stopped using Google Adwords

We used to use Google Adwords to advertise our business on the responses to Google searches by the public. We stopped using them. 
Why did we stop?

  • It was not the cost;
  • It was not the hit rate;

We stopped because we could not get to talk/online chat with a real person in Google about the problem we encountered. We had the wording of an advertisement rejected without explanation by Google. The advert wording was not offensive, nor so far as we could see did it breach any published Google rules. We were in fact trying to correct an entry generated by Google about our business. We keep getting calls from Joe Soap consumers asking us to fix problems with their home PC's. We don't do that. We build trading floors and data centres and we charge high fees for that specialist skill.

The only "assistance" from Google was an automatic  Catch-22 type of response referring us to the Google rules. We'd already checked those and needed to speak to a human being, but that appears to be impossible for Google. A typical response from a money rich global corporation who can afford to lose a percentage of customers through poor communication.

What triggered this blog posting? Google have emailed us an offer of £100 to start advertising with them again. The sender of the email -!! Once again automated with no contact with a human being! What a waste.


ps. I've just been told Google have sent a new email  to our director increasing their offer to £150. To think they could have avoided this if they'd decided to make it possible for us to actually chat to a human being.

Wednesday, 4 May 2011

PC Maintenance Department

I've just had one of those unsolicited calls from a bunch of crooks trying to convince me there is a virus infection on my PC. They were calling from an Indian sub-continent call centre over a very poor quality VOIP line. Their scam is to induce you to visit a webpage to check out your PC using their software. Typically your PC will become "Hijacked" until you pay some form on ransom to them to cure the problem they loaded on to your PC such as file encryption of all of your data & programs. Effectively your machine becomes unusable until you pay them. Even then there is no guarantee that your PC is left in a clean state.
Their pattern of operation is obvious:

  1. A junior member of their team calls by phone and describes themselves as the PC maintenance group. They then feed you the line that your PC has reported faults and virus's to them. They'll suggest your machine is running slowly and erratically.
  2. Next step is to get you to run a standard Microsoft tool already on the PC so you'll see routine status messages which occur (normally hidden) on every PC displayed on your screen.
  3. The next step is to persuade you to visit their website to have it scan your PC to fix the "problem". If you do that you will cause a trojan program to load on to your PC and to commence it's evil work of corruption.
  4. Then they'll tell you that you have to pay a "fee" to repair your PC.

I must tell you I hate these criminal parasites. I take every action possible to keep them talking on the phone (at their cost and time) while they try to persuade me to follow their instructions. I play the dumb user who makes loads of mistakes when entering their instructions. I don't tell them that I'm pretending my PC is running the old MSDOS 5 operating system which pre-dates Microsoft Windows. The result is that none of the PC commands they they tell me to use will ever work.  This time I had them talking for 45 minutes, with a chain of six of their "experts" before they gave up. 

Unfortunately they didn't call on a phone where I can record the conversation, but here's a typical extract from the conversation (remember I think I have a back and white character based display of MSDOS 5 whereas they think I have a standard Microsoft windows screen say - Vista.):

  • criminals: "...Do you see the start button on your PC desk top?"
  • Alaric: "No, I don't have a button on my desktop. It is just a standard office desk. There's the phone in one corner, a cup of tea in the other corner and my PC keyboard in front of me."
  • criminals: "Just click the Start Button and type..."
  • Alaric:"but I just told you I have no buttons on my desk top, it is just a desk. Ok I've pressed the button on the front of my PC and it turned itself off. Is that what you wanted me to do...?"

This went on for 45 minutes with them getting increasingly angry because I couldn't follow simple instructions. Eventually they gave up saying they'd call me back in a few minutes. Hopefully the time I spent on the phone reduced their ability to pester other people and cause real damage to those unsuspecting souls. Sadly with the British Telecom phone system it is nigh impossible to trace these criminals calling from overseas.

Sunday, 24 April 2011

Don't trust your smartphone!

I was reading up on a demonstration by Samy Kamkar on his web site where he accesses a database created by Google to map the MAC addresses (electronic hardware serial number) of wireless routers. Part of the data may have been collected by the infamous camera cars used to create Google's street view. Samy's contention is that every Android phone harvests the GPS position and the MAC address of every wireless router they pass by in the street. That information is then transmitted back to Google where it is used to update the database. On Samy's web site you can enter the MAC address of your own wireless router and get a response which shows the location of your building. It was accurate to within 50 metres for my building.
No doubt similar data will be gathered for the iphone population as well. Soon (now) advertisers and security forces will have access to a database where they know the physical location of every wireless router in the country. Snooperville is definitely here! As you walk or drive past a "known" wireless router your journey will be accurately tracked. That information can be tied into CCTV cameras which film your face or vehicle.
I'm currently working on a storyline for my next book where the bad guys use the MAC address of the victim's smartphone to track the good guys. This would be highly accurate and leave no trace on official records. I'm envisaging a business where couriers/messengers are paid to carry the smartphones of rich people to leave a false trail of tracking information.


Thursday, 14 April 2011

USA Companies canot spell

I know, I spelt "cannot" wrongly! However it shows how basic spelling mistakes can distract the reader. Here's one from a web advertisement (love the UK english version) from the major USA power equipment company Emerson. It was captured today.

It makes me wonder if they are seriously in the business of reducing emissions.


Tuesday, 29 March 2011

Boiler Room Scams

If the profit sounds too good to be true and someone unknown to you phones you out of the blue then it is most likely a scam. You should be particularly cautious when the "company" making such an offer is not regulated by any government body.

A friend of mine who has a great deal of experience in investing and also investigating "Boiler Room" scams showed me me an example of a case (here and here) that matches those criteria. It is a UK Company registered  in July 2010 called Nemesis Commodities Ltd who called him at home with an unsolicited call. In that call and several subsequent calls they made unsupported claims about a wonderful trading opportunities with natural colour diamonds.

The general idea is Nemesis buy certificated natural colour diamonds from investors, sell them to you based on the value of the certificate. Then Nemesis enter the diamonds as parts of batches into auctions at Sotheby's where other rich  investors buy them at a high price and so you make a profit. They told my friend Sotheby's generously give a reduced them a reduced commission fee. Oh dear oh dear me.

They even sent him literature describing diamonds as being weighed in "carrots".

My friend's view was that anyone how gave Nemesis Commodities money would learn they'd chosen their company name well!

Tuesday, 22 March 2011

US Presidential conversations tapped?

I was reading an article in the BBC news website when I came across the following statement: 
"Nothing in a SCIF is allowed to operate on a remote control because that's a frequency that can be tapped," he says. "Much of what is distributed is done on fibre, not copper as fibre as yet can't be hacked into."

The SCIF is a secure tent used by the President of the United States to take confidential phone calls/conferences  when he on tour somewhere. They are designed to prevent eavesdropping of the confidential information. However the follow up statement that Fibre cannot be hacked into is total rot. It is in fact very easy. strip back the insulation covering the fibre, bend it in a radius of about 2 cm and attach a laser sensor. Bob's your uncle, you can read the data traffic as if you are plugged in to the fibre. I've see this done live at a security demonstration.

Hopefully any such communication to the SCIF via copper or fibre will be end-to-end encrypted  to defeat any such line tapping.


Sunday, 20 March 2011

The great US$ pricing rip off

One of the great features of the Internet is it's truly global nature. A business can offer services without having to worry about geographic constraints. The electronic delivery cost are the same if you are Texas USA or Almaty in Kazakhstan. Coupled with credit card payment your company can have a global presence for no additional cost. For electronically delivered products you no longer have to worry about overseas shipping or warehouse costs.

It is regretful to see some  companies attempt to take advantage of this Internet opportunity by giving differential pricing depending on your location. One example of this is a company called who provide hosting of online webinars and web presentations. They target the business world around the globe. However if you are located in the UK they attempt to charge you 149 British Pounds a month for their basic subscription. If you are based in the USA, their fee is 149 US Dollars per month. On today's rate of exchange they are charging UK customers 162% of the USA price. There is no excuse for this type of price gouging.

Brighttalk use a technique called IP Address Geolocation to identify where you are based. If you are based in the USA your web browser will be show a price in USD; if you are located in the UK your web browser will show a price in GBP.  The geolocation technique detects the Internet IP address assigned by your Internet Service Provider (ISP) to your business. There are central lists of the location of the IP addresses assigned to ISPs. Those lists are used to translate  into an approximate geographic location for your business. Unfortunately for them there are techniques which allow people to change the "geographic location" of the client PC; so we can see the differential pricing. They also embed location details in "cookies" stored on your PC by them when you access their website.

Of course Brighttalk are not alone, there are USA based software companies like Adobe conduct similar inexcusable price gouging on software downloads.

The company I provide consultancy services to has a programme of video webcasts for its marketing and educational services delivered by the Internet. Needless to say we will not be using Brighttalk. That company has been blacklisted by us for its I-gouging practices. We are not the only people upset by Brighttalk.


Thursday, 17 March 2011

Councils attack Scouts

Under the the need to save public money Local Authorities in the UK have cut libraries. In some areas they've halved the number of branch libraries. These "savings" are disproportionate and politically motivated cuts aimed to punish the Coalition Government for reining in the excessive expenditure of  the Local Authorities. 

The reason for the national government cuts are because the the previous Labour Government was massively overspending while at the same time failed to regulate UK banks. They have left the country with massive debts and equally massive additional interest payments on the debt.

Now the local authorities are attacking voluntary organisations such as the Scouts Association by massively increasing the rents paid by scout groups for the "rental" of public rooms and halls. The Local Authorities know such fees will attract wide public concern. I do not need to provide any explanation of the useful social function provided by the volunteer charity organisation called the Scout Association. It is again a politically motivated decision.

At the same time we hear of over 2000 local authority employees paid more than £100,000 a year. Before increasing the fees to charities local authorities should be looking closer to home and cutting the excessive salaries of their own bloated bureaucrats. There were massive increases in Council Taxes over the past 10 years, way above the rate of inflation. What have they done with all of that money other than been profligate?


Thinking of a USA holiday?

If you go to the USA for a holiday think twice about using an ATM to get cash US dollars. The banks out there are looking to charge $5 a withdrawal. That is on top of any charge by your domestic bank for a foreign currency transaction. Now that is what I call price gouging by overpaid Banking executives.

The banks introduced ATM as a cost saving. It meant they could reduce the level of tellers at the bank counter. It now looks like they are now pushing the service as a revenue stream.

I like visiting the USA, but this type of price gouging coupled with the "reception" at immigration where you are fingerprinted like a common criminal does rather push the country down the level of attractiveness.


Thursday, 10 March 2011

Yodel with delight

I have had an unexpected additional day/night in Geneva. I knew that would happen as soon as I approached their telecomms room. The dead table on the floor indicates the great care they bestow on their room. The ancient dusty ceiling tiles are another hint. This is just an initial glance of the greater horrors I saw later.

Their comms room
It contrasts a lot with the hotel room they booked me into for my stay. I hate to say it but if they spent the same money on their technology rooms I wouldn't have to be paying them a visit.

Hotel room

I'm surprised the normally so efficient Swiss workers allow this to happen, but life is full of surprises. Most of the stuff is fairly cosmetic and can be tidied with a few day's work. Their CEO was astonished when I took him through the obvious security errors in their set up.


Wednesday, 9 March 2011

Your wireless microphone will be banned

Amazing what odd snippets of information you come across while travelling. Apparently in the UK many of the wireless microphones will be banned in 2012. The radio frequency they use is being/has been sold off by Ofcom.
Searching on Google soon finds references to the issue. Here's one.

Channel 69 will be permitted in London in 2012  during the Olympic Games.


Credit card Government - we are now seeing the bill

The previous UK government made great use of a form of credit card spending called Private Finance Initiatives (PFI) to build hospitals and schools. The loved this method because it "hides" the actual committed expenditure from the normal measures of government debt/expenditure.  The idea is to get private investment in return for agreeing to lease back the building/facility for a long time from the private company. These deals can last forty or fifty years. A good idea except that the actual long term costs are enormous. 

Now the National Health Service is  reaping the wind as a consequence. A BBC report gives just one example of this in a Hampshire hospital. The hospital was rebuilt using PFI. Now the local Health Trust cannot afford the charges from the PFI private company and wards are being closed. This happening throughout the country. Front-line clinical staff, nurses and doctors are losing their jobs as a consequence.

When the PFI contracts are set up the private companies borrow the money to finance the project (it doesn't appear on the government books). The cost of the loan is then charged back to the local Health Trust, plus any administration costs involved in providing the service. Unfortunately the contracts normally give the PFI company exclusive rights to provide the accommodation services for the long duration of the PFI contract. There are literally no limits to the charges levied.  It gives rise to light bulbs that cost £85 when replaced by the PFI contractor. The private companies (and Banks) make an absolute killing on this racket. 

One other trick is the PFI companies refinance the original loan at a lower interest rate than the original loan. They then pocket the difference in interest rate payments with no sharing with the NHS or tax payers.

We have burdened the next generation with enormous costs because the previous government was not honest about its true expenditure requirement. It would have been far cheaper if the government had borrowed the money themselves. The politicians who allowed this to happen despite warnings will retire on fat pensions funded by the tax payer. Their will be no penalty for their financial negligence. 


Tuesday, 8 March 2011

The joys of travel and lack of Acrobat

Off to Zurich today then Geneva tomorrow. It's really annoying that just about all flights go via London Heathrow. It really adds to the journey time. It's amazing how you can get to hate airports. Still it is the essential part of our business in the financial centres around the world. I'd thought I'd got away from all of the travelling, but if the client says meet me for lunch tomorrow near Hauptbahnhof you just pack your bags and go. At least the weather forecast is good, normally it rains whenever I visit Zurich.

I mentioned I'd complete the story on Adobe software on my PC following the upgrade to 64 bit Windows 7. I might as well use the time while I wait for the flight call. A nice thing about Google Blogspot is you can update it from anywhere.

The "PC Mover" software did a great job of moving my application software, but the Adobe licensing schemes seem to be particularly devious and resisted the upgrade process. I guess I should have un-installed their products before attempting the upgrade. Part of that process allows you to move the product to another machine and then re-licence the product. 

Anyway I didn't migrate the licence. When I came to use Adobe Acrobat it refused to work with some message about Acrobat could not load the core DLL. The acrobat "printer" didn't work either. My heart sank. I didn't realise just how much I use the Adobe Acrobat product. Things were just as bad with Adobe InDesign. That wouldn't work either.  Those products are just about essential for my author activities.

I tried un-installing and re-installing both products but had no success in getting them to run. The problem would not go away.  I contacted Adobe. They wanted a prince's ransom for a support contract before they'd talk to me. It was time for some intensive Google work to see if other people had the same problem. Eventually I discovered for InDesign the Adobe licence file had become corrupted. There seems to be a hidden central licensing system installed on your PC whenever you install their purchased/licensed products. I managed to find a utility program buried in the Adobe support pages. After downloading the program and running it I seem to have fixed the InDesign problem.

The Adobe Acrobat problem was more intractable. After un-installing Adobe Acrobat again, I used CCleaner to tidy up the Windows registry file. Then, following some hints from the Google searches, I manually deleted all of the files relating to the previous Adobe Acrobat installs. Many of those were in hidden directories. One more run of CCleaner and then a new install of Adobe Acrobat 9. It finally burst back into life. It was frustratingly complex. It is annoying when software vendors do not pay attention to tidying up the PC when you un-install a product.

That seems to be the end of that story, at least I can get back to normal computing now, though I'm having great fun playing with the video effects on PowerDirector. It is amazing how much disk space these video files consume. My loyal laptop would stand no chance of supporting the editing.

Back to reality in the airport. I have a feeling that I'm going to be pleased I bought a good thick book with me to read while I'm waiting.


Sunday, 6 March 2011

The author in 64 bit video editing land

The continued story of migrating to 64 bit computing for video editing...
In earlier posts I described the decision to use PowerDirector video editing software to help make promotional material for my book series. I'm now just starting to cautiously tip toe into that arena as the Microsoft Windows 7 (64 Bit) install disk whirs into life in the DVD drive of my PC. If things go wrong I might lose a whole computer load of programs and data. The process is amazingly simple. Just one question about whether I want to reformat the disk? No way! I want to keep years worth of data thank you.

The Win 7 Professional install went smoothly, but few of the original application showed on the screen. Remember I'd chosen a fresh install (but no reformat) so the process would not look for and activate existing applications. Time to get the Laplink PC Mover into motion.  I found the PC Mover install file and installed it. Within a few moments it was hard at work rebuilding the application software links from the earlier created "Moving Van" file. When the Microsoft Win 7 install was in progress it had found the earlier windows installation and moved the relevant files to a folder called windows.old. PC Mover was digging into the old windows folder to find the applications. I did not need to intervene except to de-install the Kaspersky anti-virus software to prevent it interfering with the software rebuild (I re-installed it later).

Within a couple of hours my PC was back and working. I deleted the trial version of Cyberlink's PowerDirector 9 that I'd installed under Vista 32 bit then re-installed it from the original install file. The install software recognised it was in working in a 64 bit operating environment and installed a 64 bit version of PowerDirector 9 which was fully capable of addressing as many gigabytes of main memory as I could cram into my PC motherboard. Increasing the available amount of memory greatly improves the video rendering time.

I shut down the PC and opened its casing to install the new video card I'd purchased. I'd purchased a cheap (£40) Asus ENGT220 card. It comes with a gigabyte of its own memory and also 48 processors using CUDA technology. It was possible to buy a much more powerful card, but that would cost in the region of £200 and put a greater load on the power supply of my PC. I chose to avoid the expense. The key thing is that the PowerDirector 9 software can make use of the CUDA technology and offload some of the graphics processing work from the main processor on the motherboard to the 48 processors embedded in the video card. Hence even faster video processing.

When I restarted the PC Windows 7 recognised the new video card and started without major problems though the screen image quality could be better. Using the software driver install program supplied on the CD accompanying the new video card soon fixed that problem. Now any heavy graphics applications like internet TV are noticeably faster on my PC.

The PowerDirector software works fine on the upgraded PC and recognises the new video board. Editing videos is noticeably faster over the trial version running under Vista 32 bit with limited memory in the PC. One small snag arose in that my microphone had stopped working in PowerDirector. It was a basic microphone plugged in to the pink socket at the back of the PC. Some investigation (really geeky) led me to realise Windows 7 had installed some generic 32 bit driver software for the sound processing chips installed on the motherboard. A search on the manufacturer Foxconn's website revealed some 64 bit driver software for the sound processing chip. It was easily installed and the problem went away.

So there it is all complete; a powerful video editing configuration on an upgraded PC for a couple of hundred pounds sterling.  I did have some problems with my Adobe products as a result of the upgrade, but more about that later.


Saturday, 5 March 2011

A step into the unknown

After deciding to upgrade to Windows 7 64bit my first action was to order an extra 4GB of memory for my PC. With memory priced by the dollar it is quite cheap at the moment. A quick visit to and £50 from the credit card soon had memory on its way to me. When that arrived it was a matter of a two minutes work to open my PC box and plug in the extra memory.

Next was the task I'd been fearing. I wanted to go from Microsoft Vista Home premium (32 bit) to Microsoft Windows 7 Professional (64 bit). This is not on Microsoft's automatic upgrade paths. It needs a clean install of the operating system with the joys of reinstalling all of the applications from their original DVD, CD's or downloads. Do you always keep those DVD's and their product key numbers?

Fortunately I remembered a company called Laplink produce a software tool called PC Mover Windows 7 Upgrade Assistant. For £20 this tool takes a lot of the pain out of moving from an old version of Windows to Windows 7. You install the software on the "original" PC and set it running. Its first action is to examine your software and to create a "Moving Van" file. It stores almost all of your software settings in the moving van. Then you install the new version of Windows 7 on the PC but not allowing it to reformat the hard drive. Once the operating system installation has taken place reinstall the Moving Assistant. It will then use the "Moving Van" file to reconstruct the settings of your original application software and you are back in business.

But wait; I'm getting ahead of myself. On a major upgrade like this it is essential to take a complete backup of your PC and create a recovery DVD before proceeding with the changes. Then if things go wrong you have a chance to rebuild your PC without a loss of data. I have some disk backup software called Paragon so I chose to use that. It told me the backup would take 17 DVD's to backup the entire machine. I settled in for a long slow process of swapping and labelling DVD's. This where the problems started. After a few Gigabytes of data the backup would fail with an I/O error. The DVD's were effectively destroyed. I needed another solution.

It was time to spend some more money. I quickly located a suitable 320 GB external hard drive with a USB connection for about £50 from A moment's work with a credit card then I just had to sit back an wait for the post to deliver it a couple of days later. Once that was done the total backup of my PC using Paragon was complete in less than 3 hours. Another couple of hours to run PC Mover.

Now, finally, I was ready to install Windows 7 64 Bit. I slid the DVD into the drive door pushed it shut and took that step into the unknown... to be continued.

Tuesday, 1 March 2011

Reverting from author to geek

In the last blog entry I described how I had the Digital Video camera communicating with my PC. My first trial of video clip editing started with Microsoft's free Windows Movie Maker software. This was already present on my PC, so I presume it had been supplied free by Microsoft. Using that tool I fairly quickly produced a complete video. I was able to remove video sections I didn't want and also play around with the sound. Unfortunately I could only get output in the form of a .wvm file which is a native Microsoft video file format or too a DVD. I was able to load the file onto Youtube without too much effort, but for longer term plans I need a wider range of output formats. It is a pity really because Movie Maker is really easy to use, but sadly has been discontinued by Microsoft. Its replacement "Windows Live Movie Maker" has far fewer features and was only worth a cursory look.

I decided I'd need something with better video/sound editing capabilities. plus a better range of output formats:

Adobe Premiere - fully featured product, with a steep learning curve and an even steeper price of £810 (equiv. to US$1320). You also need a powerful PC running 64 bit Windows 7; with a small range of recommended powerful "multi-core"graphics cards (£150 +). I've used an earlier edition of the software.

Adobe Premiere Elements 9 - a cut down version of its big brother Adobe Premiere, reasonable editing features but a more limited range of outputs. It can run on a reasonably powerful PC and costs £79 (equivalent to US$129). It runs on Vista, probably XP, Windows 7 (32 bit and 64 bit), but unlike its big brother it does not take advantage of the 64 bit processor's ability to a massive amount of computer memory.

Cyberlink PowerDirector 9 Deluxe - a well featured editor with a reasonable range of outputs. It has a better range of functions and formats when compared with Adobe Premiere Elements 9 and will run on similar PC hardware. The PowerDirector 9 can take advantage of the processors in multi-core gaming graphics cards and shifts a lot of the processing load from the main CPU (central processing unit). The limitation is that it uses 32 bit memory addressing - max of 4 gigabytes. Editing and rendering large video files would take a long time. It is priced at £60 (equivalent to US$98).

Cyberlink PowerDirector 9 Ultra64 is like the Deluxe version but makes use 64 bit architecture so it can use as many gigabytes of processor memory as you can cram onto your motherboard. This coupled with the ability to use multi-core graphics cards give much faster (video render) processing.

I also looked at Corel's VideoStudio Pro X4 and also Xara's Magix Movie Edit Pro 17 but was not attracted to them. Eventually after trying each product on their trial period (not Adobe Premiere - far too expensive) I decided to go for PowerDirector 9 Ultra64. I've ordered a packaged version of the software.

This will mean I have to upgrade the memory and operating system on my PC to Windows 7 64 bit. This is when my trials and tribulations start ... to be continued!