Monday, 28 January 2013

Talk : Financial Incentives for Healthcare

Nottingham Café Scientifique recently hosted a talk by Prof. Ruth McDonald, Professor of Healthcare Innovation and Learning, Nottingham University Business School, entitled “Financial incentives for healthcare – are they bad for our health?”

The talk considered whether the public could trust doctors to ‘do the right thing’ for patients or whether financial incentives were required to do this.

In addition, the talk was based on experience of evaluating some of these recent ‘Pay for Performance’ initiatives in England and California. It described what happened and looks at the lessons we can learn from this.

Why Incentives?
Prof McDonald explained that there had been a number of instances of incentivised contracts being introduced to NHS staff, including GPs (2004), Pharmacies (2005) and Dentists (2006). Prior to these contacts, these groups had been paid simply on the basis of the number of patients they treated, without reference to whether they were being effective at improving patient health. The contracts aimed to align payment with government policy goals, such as reducing obesity, or the number of smokers.


Hartley Road GP surgery


GP Contract 2004
General Practitioners usually operate as self-employed partnerships of doctors and, in 2004, their contracts were radically overhauled to try and incentivise GPS to improve patient outcomes and also to make general practice a more attractive career for medical graduates (at the time there was concern that the average age of GPs was quite high and that there were not enough graduates coming through to replace them).

25% of earnings in the new contract were related to achievement of a series of “Quality and Outcomes Framework” targets, of which there were some 146! - this was in contrast to the previous contract that had tied earnings exclusively to the number of patients on the practice roll.

http://en.wikipedia.org/wiki/Quality_and_Outcomes_Framework The QOF targets covered four main areas:

• Clinical standards (chronic disease areas such as coronary heart disease (CHD), hypertension or diabetes).
• Organisation standards (patient records, information for patients etc).
• Patients' experience (number of services and how they are provided
• Additional services.

Software was used to allow GPS to monitor their performance against the targets and also to promot them to ask appropriate questions during consultations.

The new contracts were negotiated with the medical profession and agreed via a ballot, so it was certainly not something that was imposed unilaterally.

To sweeten the deal, the new contracts ended the requirements for GPs to provide out-of-hours cover (something that had been a significant disincentive to entering the profession) and also gave practices a “Minimum Income Guarantee”, which required new money to be made available.

So, what were the effects of the new contract?

It is worth noting that there was no historical baseline data against which the impact of the new contracts could be compared, but what can be said is that there was a very high level of target attainment by GPs.

Reassuringly, GP’s did not just reach the targets and then stop - they continued to put resources in to improve performance further, despite it not having any financial benefit for them. In addition, it was found that, over time, the new system resulted in better outcomes for those in lower socio-economic groups, which improved the equity of the NHS GP system.

More disappointingly, it was found that there was little or no change in the prevalence of key chronic diseases such as CHD, asthma or diabetes.

There were also a number of adverse effects of the new contracts…

The government of the day had estimated that GPs would attain some 70% of the targets and had structured the contracts accordingly - but in practice GPs attained around 90% of the targets, resulting in significantly higher incomes for GPs, and extra expenditure for the Government.

Prof McDonald had been curious as to where the “70%” target had come from and had eventually tracked down the source to Tony Snells, clinician who was working in the Health Department at the time. Dr Snells had been approached in a corridor by one of the group drafting the legislation who asked him what percentage of the targets GPs were likely to meet. Dr Snells said that he didn’t know, but the policy drafter was persistent and asked Dr Snells for an estimate, so the Doctor suggested, off the top of his head, that 70% might be a good starting point.

Unbelievably isn’t it?

Morale and co-operation also suffered in some cases. Earnings for practice nurses typically increased by around 3% (nurses had a much wider and more responsible role under the new contracts) - but GP earnings increased by around 38% ! Nurses in one practice who received a token bonus from their GPs would become discouraged when finding out that nurses at another practice had been given payments of several thousand pounds.

Related to the increased role of nurses was a concern that GPs were not getting experience of the more minor and routine ailments of their patients and that this was having a detrimental effect on their overall skill and competence.

Lastly, once the Government realised how much they were “overpaying” GPs, they changed the contract to impose extra tasks on GPs, which led to a loss of trust between the two camps.


Mary Potter Health Centre


Pharmacy Contract (2005)
The Pharmacy contracts introduced in 2005 also had the aim of encouraging improvement in patient outcomes. One example of this was the “Medical Use Reviews” or MUR’s, where pharmacists discuss the medication that a patient is using to ensure that the patient understands all the medication they are taking and review whether it all remains appropriate.

Pharmacies were paid £28 per MUR, but had to get the patient to sign a form. Inevitably, it didn’t look very good that the pharmacist was being paid for giving advice.

On the other hand, pharmacists were often under a heavy workload and found it difficult to make time for MUR’s.

Dental Contract (2006)
Like the GP’s contracts, the changes introduced with the 2006 Dentists contract were far reaching and included the curtailment of open ended funding and patient registration. Treatment had previous been according to a comprehensive schedule that defined specific payments each different type of treatment.

In the new contract, this was changed to collect treatments into one of three bands of “Units of Dental Activity” or UDA’s.

Band 1 (1 UDA) - covers diagnosois, planning and maintenance
Band 2 (3 UDAs) - covers fillings, root canal treatment, extractions etc
Band 3 (12UDAs) - covers complex treatment that includes a lab element, e.g. bridges
Given that root canal treatment can take a lot longer than an extraction - but is paid the same - it is perhaps no surprise that the years following the introduction saw a dramatic increase in extractions, and, possibly, also a decrease in root fillings :






Thankfully, there is much work currently underway to try and devise dentistry contracts that do not contain such perverse incentives.

Other Initiatives
Dr McDonald also commented on a number of other initiatives that has been trialled in recent year such as CQUIN and “Best Practice Tariffs”. However these schemes suffer from the fact that they encourage health providers to adopt a “low risk” approach to target setting as ambitious targets may result in loss of some of the funding. One can imaging the health providers thinking something along the lines of :

“If we try really hard, we might be able to get a 15% improvement in [an outcome], but if we fail we will lose some of the money, so we are better off aiming for 5% so that we get all the available funding”

In contrast, Dr McDonald mentioned the “Advancing Quality” initiative as an initiative that had worked well, with the project having been estimated to have saved some over 900 lives, which was an outcome to unusually positive that it was reported in the prestigious New England Journal of Medicine.

The NEJM compared the initiative to similar project “the HQID program” in the US and commented that,although the UK initiative was a “tournament” in which the bonus’s were paid only to the best performing institutions, “Face-to-face communication, pan-regional participation, and the smaller size of the program in England may have made interaction at these events more productive than interaction at the similar shared-learning events that were run as “webinars” in the HQID.”

The article commented that the greater probability of the UK institutions performing well enough to get a bonus’s was also higher than in the US scheme.


MEMS


Other comments
Dr McDonald also made a number of interesting comments during the talk or in the Q&A session afterwards…
•As the US healthcare system is largely based on private insurance, it focuses its IT resources on billing, rather than patient care, or the kind of software that prompts doctors to ask questions aimed at early intervention to reduce key chronic conditions. One notable exception to this is the Veterans Administration, who have a large, country-wide IT systems which they offered to make available to other healthcare providers.

•One questioner asked why GP’s were not just simply made salaried civil servants, to which Prof McDonald commented that she had shared this view until she had met some very committed GPs in Liverpool who had made the switch from being an independent practice to being salaried NHS GPs’ - and had found that they then faced the leaden hand of NHS bureaucracy. For example, they could no longer advertise for a receptionist in the local cake shop but now had to go through the NHS regional recruitment process. And neither could that offer tea and coffee to their patients as this was against NHS rules. Collectively, these rules and regulations had caused a number of the partners to quit or consider leaving the GP profession.

•When talking about healthcare spend, it is worth remembering that the US spends some 16% of GPD whilst the UK spends only 8%.

•Patient choice is a topic of much discussion and Prof McDonald felt that that the offering of choice did not deliver benefits in terms of outcomes. For another perspective on this you can read this report by the Kings Fund.

Related Posts
Prof Ian Shaw on the NHS reforms
Challenging the BBC on their coverage of the NHS reforms

The NHS


Image Sources: All BFTF's own.

Saturday, 26 January 2013

David Ward and Robert Kilroy Silk

Bradford East MP David Ward recently commented in a discussion about Israel on his blog that:
"saddened that the Jews, who suffered unbelievable levels of persecution during the Holocaust, could within a few years of liberation from the death camps be inflicting atrocities on Palestinians in the new State of Israel and continue to do so on a daily basis in the West Bank and Gaza"

This has landed him in very deep water with the Holocaust Educational Trust and the Board of Deputies of British Jews.

On the other hand, some organisations have supported his comments.

BFTF recalls that, on 4th Jan 2004, the TV presenter Robert Kilroy Silk wrote in a Sunday Express article:
"...the Arab countries are not exactly shining examples of civilisation, are they? Few of them make much contribution to the welfare of the rest of the world. Indeed, apart from oil - which was discovered, is produced and is paid forby the West - what do they contribute? Can you think of anything? Anything really useful? Anything really valuable? Something we really need, could not do without? No, nor can I....

What do they think we feel about them? That we adore them for the way they murdered more than 3,000 civilians on September 11 and then danced in the hot, dusty streets to celebrate the murders? That we admire them for the cold-blooded killings in Mombasa, Yemen and elsewhere? That we admire them for being suicide bombers, limb-amputators, women repressors? I don't think the Arab states should start a debate about what is really loathsome."

This got him into a lot of hot water, not least from Muslim organisations, and Mr Silk had to quit his TV presenting job.

So, just to get this straight :

Kilroy Silk demonises an entire group with the word "Arab" and some in the Muslim community demands that he be fired.

David Ward demonises an entire group with the word "Jews" and some in the Muslim community demands that he keep his job.

Sounds like double standards to me.

Just as the British population (or the largely Labour voting British Muslim population) can't be held responsible for the wars that Tony Blair took the country into, so "Jews" can't be held responsible for the actions of the Israeli government.

If David Ward meant the Israeli Government (which is what he appears to have done in his later clarifying comments), then that is what he should have said initially.

Related Posts
"Double Tap" Airstrikes - A War Crime?
Families Forum : Part 1 - An Israeli Story (2006)
Families Forum : Part 2 - A Palestinian Story (2006)

Tuesday, 15 January 2013

Hey Jamie! Where's the sustainable packaging?

On the advice of a friend, BFTF recently bought some MSC certified Jamie Oliver Fish Fingers.

When served as Fish Finger sandwiches, the consensus of the BFTF household was that, compared to the awesomely good value Sainsburys Basics MSC certified fillet fish fingers, Jamies offering had slightly nicer breadcrumbs but the actual fish tasted pretty much the same.

But what caught BFTF's eye was that whilst Jamies Fish Fingers made a big play of their sustainability (which is a GOOD THING, but also achieved by Sainsburys MSC certified Basics Fillet Fish Fingers) the actual card packaging shows no evidence of being made from recycled or FSC certified stock, suggesting that there is every chance that it is instead card from rainforest wood that has been unsustainably or illegally.

In case you are wondering, dear reader, that is NOT A GOOD THING.

So BFTF send feedback to Jamie and Youngs (who Jamie has partnered with) to ask them whether the card in the packaging was sustainably sourced and, if not, when it would be...

Update:04 Feb 2013
Youngs recently responded saying that they "do not use recycled board for products that have direct contact with food for food safety reasons" and that "The packs are however manufactured from fresh forest fibres sourced only from sustainably managed forests."

In BFTF's experience, companies who are really using sustainably sourced paper or card will immediately state what standard they are buying to (e.g FSC), so it was a little disturbing to receive this rather bland statement from Youngs, so BFTF sent back an email thanking Youngs for getting back to me and saying:

"The term "sustainably managed" is often used by companies to cover up the fact that their paper/card isn't really sustainably sourced at all. I'm sure that isn't the case with Youngs and hope you can advise what standard the card supplier is working to. For example, is it : FSC ? (which would be a good thing); PEFC ? (which is a significantly less strong standard); ISO14001 ?(which does not mandate any percentage of sustainability) or Something else?


Update:06 Feb 2013
Received a futher response from Youngs, wich said :

"I have been further informed by our packaging department that all our paper materials come from responsibly sourced forests. The forests we source from hold ISO14001, PEFC and FSC chain of custody however as a business we currently choose not to identify this on our printed packaging."

ISO14001 and PEFC are (to BFTF's understanding) much weaker standards that FSC and it is a little disturbing that Youngs were not aware of this. Maybe they have been the victims of Greenwash, or perhaps they are practicing it? Either way, perhaps Jamie should have a word with them...So BFTF chased him up again via the feedback form on his site :

"Card used for these products appears to be made to ISO14001 and PEFC standards, both of which allow a large amount of unsustainable (e.g. illegally logged rainforest) wood to be used. Youngs don't appear to understand that ISO14001 does not guarantee sustainability."

Chased up via website on 12th April and 04th May

On 8th May received the following from jamieoliver.com, which doesn't actually answer the question I asked :
"...Our Packaging Department have advised that we do not use recycled board for products that have direct contact with food for food safety reasons. The packs are manufactured from fresh forest fibres sourced only from sustainably managed forests..."

So bounced back a response pointing out that PEFC and ISO14001 were very weak standards and did not offer any real protection against the use of illegally or unsustainably logged wood, and that since Tesco were able to use FSC paper even for their till receipts, I couldn't see why Jamie Oliver couldn't use FSC card for his fish finger packaging.


Jamie Oliver's Fish Fingers - Sustainable Fish... but what about the packaging?


Related Posts
Challenging Halfords on labour practices in the developing world
Sustainable paper at Orion Books
FSC at Random House
A message to WHSmith
Challenging FireAngel on sustainability

Sunday, 6 January 2013

David Aaronovitch, Star Wars and FSC

BFTF was in the book-buying mood yesterday and seemed to have hit the jackpot when the Dorling Kindersley Hardpack epic "Star Wars Year by Year - A visual chronicle" came into view. It was a great looking book that described, in words and pictures, the develoment of the Star Wars films, including premininary sketches of the spacecraft, character deveopment (Luke Skywalker was originally called Luke Starkiller for example) and information on the cultural references that George Lucas was drawing on.

BFTF wanted to buy two! One for BFTF and one for a Star Wars loving friend.

But, on closer inspection, there was a deal-breaker.

The book wasn't printed on sustainably sourced paper (such as FSC)

So, with a tearful eye, BFTF put the book back on the shelf and walked out of the store and, later, send this message to DK via their feedback form:
"Saw [the book] in a shop today. Looked awesome! Would love to buy two (one for me, one for a Star Wars fan friend).

But I shan't, because it does not appear to be have been printed on sustainably sourced paper (e.g. FSC certified) and I don't want to buy books that may have been printed on paper made from illegally or unsustainably cut trees.

Can you please advise when DK expect that all of its print output will be printed on sustainably sourced paper?"

Moving on to a bit a later in the day, and a different bookshop, BFTF noticed a book by David Aaronovitch entitled "Voodoo Histories - How Conspiracy Theory has shaped the Modern World". A brief click through revealed suggested that it had some very interesting background on the development of a number of the 20th century's most enduring conspriacy theories (such as the Protocols of the Elders of Zion, the death of Diana and the Obama "birther" theories). Importantly, the book also seemed to take a look at the world-view of people who believed in such theories.

Conspiracy theories are something that worry BFTF quite a bit. Over the last few months, BFTF has had a number of conversations with people who genuinely think that the Moon-landings may have been faked. BFTF has pointed out to them a few of the reasons why the evidence for the faking of the moon-landings is very poor.

And asked them rheotorically that, if the US actually HAD managed to convince (or otherwise silence) thousands of programme workers, amateur radio enthusiasts around the world and the entire Russian intelligence community - would they then go and try to pull the same trick again with Apollo 12, 13(yes, BFTF knows that one didn't land on the Moon), 14, 15, 16,and 17?

In one case, BFTF explained that BFTF had actually interviewed Prof Farouk El-Baz, head of Apollo astronaut training about a number of aspects of the programme - and then asked the "denier" whether they thought that the Prof was lying to BFTF or whether they thought that the Prof had had the wool pulled very comprehensively over his eyes?

Anyway, back to the issue at hand.

Would Voodoo Histories pass the sustainability test?

Happily, the answer to that is a resounding Yes, as Vintage Books is a company within the Random House Group. And according to the blurb inside the book:
"The Random House Group Limited supports The Forest Stewardship Council (FSC), the leading international forest certifi cation organisation. All our titles that are printed on Greenpeace approved FSC certifi ed paper carry the FSC logo. Our paper procurement policy can be found at www.rbooks.co.uk/environment."
Result! The book was bought and BFTF looks forward to reading it in due course.

BFTF also sent a message to Vintage via their feedback form thanking them for using FSC certifed paped and mentioning that BFTF would not have bought the book had this not been the case.


Voodoo Histories


Related Posts
Heirarchy of Disagreement
Sustainable paper at Orion Books
FSC at Random House
A message to WHSmith
Challenging FireAngel on sustainability

Thursday, 3 January 2013

Report - A study of the EDL

Faith Matters have recently published a report entitled "A Study of the English Defence League" which investigates what draws people of faith to right wing organisations and the effect that the EDL has on community cohesion and interfaith relations.
The report really is worth reading, and the links it reveals between the EDL and extremist faith groups are frightening.

The fact that the EDL fundraised in the US has echoes of the notorious NORAID campaigns that funded the IRA in the 70s and 80s.

The report makes a series of key points:

There is a need to maintain resilience as the EDL's message is tailored to play on historical angsts Between faith groups and their campaigning with faith groups is thought out.

Christian institutions on a national level, bar a few locally, have not been robust in condemning the actions of the EDL which disrupt communities and who attempt to divide Christian and Muslim communities.

Religious institutions need to recognise the fact that a small number of radicals within their communities might be drawn to right--‐wing organisations…

The EDL has European and international links which allows it to fundraise at an international level. British authorities need to look at their international money flows, especially when extremist groups are involved…the ability to raise funds from the US need to be highlighted, since US residents promoting street based social unrest in the UK by donating to the EDL needs to be curtailed.

Religious communities should emphasise that the actions of small groups of extremists should not be allowed to represent their whole faith. Each group should publicly denounce their actions robustly at local and national levels
.




Update:08Jan2013
Seeing some rather nasty comments come up for moderation, so thought it worth pointing out that comments basically saying "xx are scum" will be deleted and not published.

Wednesday, 2 January 2013

Proof that activism really can work

BFTF often hears people saying that there is no point challenging governments or companies because :

"they will do what they want to do anyway"

"what can I as a single person do"

"they won't listen to me"

All of the above fundamentally attitudes fail to understand a number of basic truths about collective action.

Firstly, that if the Afro-American community in the 1960s, or disenfranchised British women at the turn of the century, or Black South Africans in the 1980s - had taken the approach suggested by the quotes above then none of these groups would have won the basic human rights that they did. Such is the power of sustained, organised, collective action.

Secondly, whilst we cannot all do everything, we can all do something. And that whilst results are not within out gift, our efforts are. Many guests on the BFTF radio show have commented that it only takes a few, independently written, letters on a particular subject to land in the mailbox of a large company before the company starts to take action to change its policies.

All the same, BFTF would like to offer people some concrete examples of how activism has really made a concrete difference to the policies of a company or government....

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April 2014 : Activism pressure forces Tesco and Oriental&Pacific to switch to sustainable Tuna
A month long campaign by Greenpeace, in combination with pressure from television chef Hugh Fearnley-Whittingstall has forced tuna supplier Oriental and Pacific to switch from its current practice of using nets and "Fish Aggregating Devices" (a combnination which kills large numbers of other marine creatures as "bycatch") to a more benign longline fishing method.

As UnderCurrentNews comments :
" 'Greenpeace today welcomed the move, which puts Oriental & Pacific on a par with other major UK tuna brands. But Tesco still comes in for stinging criticism. The supermarket had previously committed to making its own-brand tuna sustainable, but as soon as it fulfilled that promise it then introduced unsustainable Oriental & Pacific tuna, in a stroke undermining its public commitment to protecting the oceans,” the activist organization explained."


See also this report

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Feb 2014 : Orcas no longer to be displayed at Winter Olympics
A campaign by Sumofus.org (and others) to stop the display of two Orcas that had been caught from the sea specifically for display at the Winter Olympics has achieved success. The Orcas will not longer be displayed there - but they remain at risk of being sold to other dolphinariums. Sumofus wants "White Sphere", the company responsible, booted out of the International Association of Amusement Parks and Attractions (IIAPA), the world’s largest trade association for amusement parks and aquariums (see here)

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Jan 2014 : Burberry commit to eliminating dangerous chemicals from their production processes
A campaign by Greenpeace had resulted in Burberry implementing a pretty comprehensive programme (pdf) to eliminate certain chemicals from their manufacturing process.

BFTF is a bit disturbed by the focus on the presence of very low levels of chemicals in the actual clothing - just because you can detect something does not mean it is at a dangerous level. Indeed, Greenpeace itself admits that "as far as toxicologists know, these concentrations don't present an acute risk for children".

In contrast, it is hard to find any information on the dischages to local water systems that occur during the manufacturing process, which is where, BFTF suspects, the real damage is being done.

But if one digs hard enough, items like this, very interesting, this article can be found, in which a Mr Li Changlin, who lives downstream from a major textile works in Dongguan, China is quoted as saying "We used to eat fish and crayfish out of this river...We swam in it. There were green plants on the banks and the water was clear. After 1989, the factories came and the water turned black.". The article also points out discount clothing stores have put a lot of pressure on the textile industry in China, with one industry executive pointing out that "The first thing they say when they sit down in a meeting is, 'How much discount do I get from last year?'".

Another article also describes some of the bad practice in the textile industry in China, and its effects on the river environments.

Also relevant is this Greenpeace Report

Actions
Sent Tweet to Burberry saying well done in commiting to eliminate dangerous chemicals from its production processes.

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Dec2013 : Giant palm oil trader commits to ending deforestation
http://www.greenpeace.org.uk/blog/forests/victory-giant-palm-oil-trader-end-deforestation-20131223 Making palm oil shouldn’t mean destroying Indonesia’s rainforests. But dangerous and greedy companies are trashing them to grow oil palms. It’s pushing orangutans and tigers ever closer to extinction.

Greenpeace has spent months investigating the palm oil industry. Everywhere they went they came across the same name : Wilmar International, a commodities trader through wose hands pass 45% of the world’s palm oil. The evidence linked Wilmar and its customers to the destruction of tiger and orangutan habitat, human rights abuses and conflict with forest communities.

And throughout the autumn, Greenpeace exposed how Wilmar was laundering this dirty palm oil and selling it to major brands, like Gillette, Ferrero, Cadbury, L’Oreal and Clearasil. Our campaigners in Indonesia protested at Wilmar’s offices and rolled out massive banners in freshly-cleared forest, showing Wilmar’s customers just what they were buying.

Then something interesting happened.

First Ferrero announced a detailed, ambitious plan to only buy forest-friendly palm oil. Then Mondelez (which makes Cadbury) and L’Oreal made an initial commitment to no deforestation (although they’re still working out the details).

And when its customers started moving, Wilmar had no choice but to follow suit.

On 5 December, Wilmar announced that it would stop clearing forests and stop buying oil from companies that it knew were engaged forest destruction. “We know from our customers and other stakeholders that there is a strong and rapidly growing demand for traceable, deforestation-free palm oil,” said Wilmar’s CEO, Kuok Khoon Hong as he launched their new ‘no deforestation’ policy, “and we intend to meet it.”

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Jun2013 : Challenging Nestle to stop buying from companies that destroy rainforests
People around the world took part in a Greenpeace campaign to stop Nestle working with companies who were destroying the rainforests. The campaign included 1.5m views of a short Youtuve video, over 200,000 emails sent, hundreds of phone calls and countless Facebook comments.

The end result was that Nestle "developed a plan which will identify and remove any companies in their supply chain with links to deforestation so their products will have "no deforestation footprint".

And that plan is already bearing fruit with Nestle cancelling their contract with the Sinar Mas group ( Sinar Mas is company that is "destroying Indonesia’s rainforests and carbon-rich peatlands.")

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Jun2013 : Government considering limiting number of appointments with GPs
Articles such as this one suggests the the Conservative party had, as part of a survey, asked party members whether they agreed or disagreed that "There should be no annual limit to the number of appointments patients can book to see their GP".

38 Degrees swung into action and, within 2 days, had got an epetition of over 180,000 people challenging Jeremy Hunt to :
Please reject proposals to limit how many times we can visit our GP. Being able to visit a doctor, whenever we need to, is at the heart of our NHS. Please confirm that you will never limit access to GPs, and that our NHS will remain free and universal, without any restrictions.

Which resulted in Jeremy Hunt sending a Tweet saying:
"In case being mislead by 'neutral' 38Degrees e-petition, it IS NOT and WAS NEVER going to be Conservative policy to limit GP appointments"

Whilst BFTF is a supporter of 38Degrees, feelings about this particular action are conflicted, for the following reasons:
i) Parties should be able to ask whatever questions they wish of their members without fear of censure, there is nothing wrong with being oontroversial in order to generate a debate.

ii) But BFTF worries that, had the response from the Conservative grass roots been positive, GP visits might have ended up being limited, and this might be done by the back door (the NHS and Social Care Bill, for example was not in the Conservative Manifesto for the last election).

iii) A "Tweet" does not strike BFTF as being strong evidence of Government policy - it's hardly the kind of thing one would like to rely on a in court of law, for example.

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May 2013 : Primark and other retailers sign the Bangladesh Safety Accord
Great news from War on Want :

"Global retailers, including Primark, H&M, Tesco, Zara and C&A, have bowed to pressure and signed the Bangladesh Safety Accord. Tens of thousands of you called on Primark to sign the agreement, and hundreds of thousands more around the world joined us in demanding change, following the wholly preventable building collapse which killed over 1,000 people. This is a momentous deal and you helped make it happen.

Together with the Bangladesh National Garment Workers Federation (NGWF) we launched a petition targeting the brands, we organised protests outside UK stores of Primark, we did interviews on TV news channels, we went on national and local radio, we sent thousands of emails, and we bombarded the retailers on their social media pages. And the pressure is paying off."

(NB: The heart of the Accord is the commitment by companies to pay for the renovations and repairs necessary to make factory building in Bangladesh safe. The agreement is legally binding. It will save lives.)

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2013 : Telegraph invokes terrorism in article on racial segregation in Israel
A campaign by the The Council for Arab-British Understanding in described in an article by the organisation. The artilcle stated that, on 3 March, the Telegraph published a news article online regarding the introduction of racially segregated bus services by Israel and illustrated it with a picture of a July 2012 suicide bombing in Burgas, Bulgaria that was carried out by a group unconnected to Israel.

Caabu comment that it cannot be right to illustrate a story on wholesale racial segregation by Israel, with a terrorist attack on Israelis. This implies there can be a security justification for comprehensive discrimination against an entire people. In short, the Telegraph have used an image of a terrorist attack, which happened outside of Israel and was not carried out by Palestinians to justify the comprehensive discrimination against Palestinians within Israel.

Following Caabu's highlighting of the issue, The Telegraph have removed the image of the bombed bus and replaced it with an image of a bus in Israel with people queing by it.

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2013 : 38Degrees and the Government sell off of the nations Forests
When it was revealed that the Government intended to exempt private healthcare companies from Corporation Tax, the government body Monitor stated that “...Monitor will not be recommending that private sector providers should be exempt from paying corporation tax."

But within a day of 38Degrees members lobbying Monitor they had backed down and hat was a swift turnaround from the beginning of the day, when Monitor had refused to rule out this tax break:

“We have had responses and held detailed conversations with providers from all sectors and we are taking time to analyse the evidence before drawing our final conclusions.”

Accoring to 38 Degrees, Monitor had commented that they were taken aback by the number of 38 Degrees members contacting them - and they were keen to know what they had to do to get us to stop 38Degrees putting them under pressure!

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2013 : 38Degrees and the Government sell off of the nations Forests
In late 2010, the government announced a plan to introduce a new law to allow all publicly owned woodlands to be sold off in the future. The government might have expected a few predictable protests, but there was nothing predictable about what happened next.

538,107 people signed the 38 Degrees petition and over 100,000 contacted their local MPs. Some 30 local campaigning groups sprung into action around the country and over 220,000 spread the word on social media.

When the government finally did admit they got it wrong, they promised to set up an independent forestry panel to advise them on what should be done next. Again, 38 Degrees members sprang into action:

34,000 wrote to the panel to tell them what we wanted for our woodlands’ future - more that 80% of all the responses they received

And the Independent Panel on Forestry was critical. They found the government had "greatly undervalued" the benefits woodlands provide for people, nature and the economy. They then called for forest policy to be held in public trust for the entire nation, shielded from political interference – with one member saying, “the tree cycle is wholly different to the electoral cycle.”

And now, after two years, the the government has at last, quietly issued an official announcement confirming that they won't try selling off England's forests again.

BFTF is proud to have been a small part of that effort.

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Waitrose, Shell and Greenpeace
Late in 2012, Waitrose announced that they were planning to open a number of shops on the forecourts of Shell petrol stations.

Greenpeace, who were campaigning against Shell's drilling in the arctic, were outraged and wrote to Waitrose three times to ask them to meet with Greenpeace - to no avail.

So then Greenpeace called on the ordinary people of the UK to send an email to Waitrose demanding that they abandon their Shell shops plan. In addition, Greenpeace acivists went to Waitrose stores to talk to managers and customers there.

Very soon, the Waitrose boss wanted to meet with Greenpeace

And soon after, they had put their forecourt shops plan on hold and agreed with Greenpeace that the Arctic should be a protected sanctuary, a move that would make the polar region off limits to oil drillers like Shell.

NHS Privatisation and SERCO

BFTF has been hearing rumblings for some time about poor performance by private health company SERCO - but has not got round to finding out any details - until now.

252 Instances of Falsified Data
A report in the Guardian describes how SERCO, who had won the contract for the out-of-hours GP service in Cornwall presnted false data to the NHS on 252 separate occasions.

A number of whistleblowers had already alleged that the company manipulated data when if was failing to meet its targets.

The former Tory health secretary and chair of the health select committee, Stephen Dorrell, said that:
"To falsify returns once is once too many – to falsify 252 times represents a pattern of behaviour which should lead to a full review"

A review found patient satisfaction to be high, but a separate survey of local GP's revealed concerns about staffing and inappropriate patient assessment.

The West Cornwall MP and health select committee member, Andrew George commented that:
"[the 252 instances of falsificaton were]altered in a period when Serco knew that it was already under heavy scrutiny and was no doubt trying to clean up its act...It was the period before this when I fear such data manipulation would have been worse. This also raises wider concerns about opening up even more of the NHS to private companies who, it seems, will go to any lengths to win and retain contracts."

Other Links
Interview with Prof Ian Shaw (Health Policy Prof at UoN)
Challenging the BBC on their coverage of the NHS Bill
Post on the NHS Bill

Contrary to common thought...

This post is intended to be a home for various articles in which Muslim scholars comment on issues where the Muslim community has, basically, lost the plot.

02Jan13 : The Islam women were promised
An article by Musa Furber comments, with sadness, on how some Muslim majority societies betray the human rights of assualted women by pressuring them to marry their rapists. He states:

"When I read of these cases I am always left baffled at how Muslims can support allowing a rapist to obtain a pardon by marrying his victim, often by pressuring their victims and their families to cooperate. As a specialist in Islamic law, I know that these cases are egregious violations of what Islam teaches on the rights of victims, the definition of justice and the meaning of marriage"...

"Compelling a rape victim to marry her rapist (alleged or convicted)...forces her to live in a relationship that is based upon hatred, alienation, violation and abuse, and it rewards her attacker for his violence..."

"There is something deeply wrong when a Muslim society views the shame of a single rape to outweigh facilitating the spread of corruption and the wrongful taking of life. . These tragically frequent stories of women violated over and over again can only be described as the perversion of Islam, unfortunately, by Muslims themselves."

Tuesday, 1 January 2013

The Snow Art of Simon Beck

Simon Beck, 54 hails from the south of England but spends his winters in the French ski resort of Les Arcs creating beautiful gemetric desings in the snowfields around the resort.


An example of Simon Beck's Snow Art


An alumni of Oxford University, Simon works as an orienteering mapmaker (converting maps to a form suitable for orienteering) and, even as a young person, had an interest in geometric designs, commenting that “I used to draw a lot of geometric designs, used spirograph a lot, and made polyhedral.”

His internet home is on Facebook where you can find pictures of his work as well as an interesting set of interviews, a few points from which form this blog post.

Simon made his first snow design in 2004 and his designs typically take about 10 hours to create from start to finish - making it a challenge to complete a design and still have daylight to photograph it, indeed Simon comments that “ and are often based on classic mathematical constructions such as the Mandelbrot set, Koch curve or Sierpinski triangle, Simon suggests that a good beginners design are “Sierpinski triangle, flower of life, stars formed by surveying the corners of a polygon and joining them up”


A design based on the Kock curve


Of course, a common question to Simon is to ask how he plots out the design and actually makes it in the snow...


A snow art design


Simon initially draws the design on paper using a pencil, ruler and protractor - and then transfers then to the actual snow using a handheld orienteering compass, with distance being estimated using pace counting or measuring tape - with the lines being kept straight by walking towards an aim point in the distance. Simon uses snowshoes, which do a good job of marking out the lines and filling in areas.

Curves can be judged or made using a clothes line attached to a centre point. This latter method is more accurate, but means that Simon needs to physically walk to the centre of the circle, which may not be ideal for some designs.


How the snow art looks up close


As it takes so long to complete a design, they are often completed in the dark and Simon has to wait until the next day to take a photograph. Indeed, Simon estimates that “at least 25 percent have to be done again because of failure to get the photo”.

Another hazard is making an error, as Simon explains “The hardest past is avoiding a 'stupid' mistake, and the most frequent cause of those is a wrong aiming point (straight lines are made by aiming at a point in the distance but one can easily accidentally aim at the wrong point)”


Another beautiful Kock based design


The designs generally last until the next heavy snowfall (which can sometimes be the same night they are completed) - but may survive as a “ghost” below fresh snow, or even other designs, for several months.


A design based on the circle of life


Perhaps the most touching, and thought provoking, of Simons comments relates to what he hopes people will get from seeing the designs:

“I hope to spread the message the mountains and snow are beautiful and worth preserving, and there are better things in life than spending so much time doing things you don't want to so that you can spend money you haven't got (yet) to buy things you don't need to impress people you don't like”


And finally, one for those who remember the 80's


Sources
All images used by kind permission of Simon Beck.

Challenging Halfords on wages in Cambodia

BFTF recently bit the bullet and bought a new bicycle with the aim of using it for excercise and, occasionally, actually as a means of transport.

After some research, the one BFTF went for was a Voodoo Marasa from Halfords. It is a great bike, and riding it is an immense joy.

Whilst reading off the serial number it case it ever get stolen, BFTF noticed that it was made in Cambodia.

Nothing wrong with that, and it fact it's great to see the developing world get their share of the global industrial pie. But that share needs to be fair. The workers need to be paid a living wage. The company needs to pay its taxes.

An article on wages in Cambodia gives the example of Heath Kimhuor, a garment worker, whose base salary of US$66 a month is nowhere near enough to support herself and her family. "If I get sick, I don't have any money for treatment," she says. Peoples Tribunal on a Living Wage ,which concluded with a call for a living wage for Cambodian garment workers of at least US$185-200/month - enough to feed a family and provide for their children's basic health and educational needs. This is not a lot when you consider that Puma, which sources apparel from the Huey Chuen factory in Cambodia, reported US$304.3 million in net profits. Puma alone could have paid Huey Chuen's 3,400 workers an additional US$100 a month last year and still made US$300 million in profits.

Another report by the Clean Clothes Campaign supports "the Cambodian trade union's goal of a USD 131/month minimum wage goal as a first step towards a proper living wage, and to produce an action plan to ensure suppliers pay their workers accordingly. At present, the minimum wage for a garment worker in Cambodia is USD 61/month.

An this article suggests that wages have not risen for several years, are well below those of China and can often be as low as 2 dollars a day. In additions, bike manufacturing is often in a Special Economic Zone (SEZ) which, according to a USAID report, offers pro-business perks such as low taxes and low wages.

So BFTF sent off a message to Halfords (via their feedback page)with two very specific questions:

i) Do the workers manufacturing / assembling Voodoo bikes get paid a LIVING wage (which I understand to be in the region of USD185/per month) and, if not, what is their typical base wage?

ii) Does the manufacturing company pay a fair level of taxes in Cambodia. Specifically, can you confirm that the manufacturing company is not evading taxes by locating itself in a tax free zone or similar.

Halfords Reponse Updates
15Jan13 : No response from Halfords so sent another email to nudge them.
11Feb13 : No response from Halfords so sent another email to nudge them.
03Mar13 : No response from Halfords so sent another email to nudge them.
04Mar13 : Received a response from the Customer Services Team saying that they could not help and that BFTF should call the switchboard who would direct the call appropriately. Called the switchboard and was put through to.... wait for it... customer services. They refused point blank to provide any information and passed BFTF back to the switchboard. The switchboard, bemused at the fact that customer services couldn't provide any customer service, eventually put BFTF through to someone in another department who was prepared to talk to BFTF and who gave their email address for BFTF to send questions to.
4th April : No response so chased up via email
5th May : No response so chased up via email.
13th May : Received an email response from the Halfords saying that the "PR Team" was looking at this issue and would a response to my questions would "hopefully take no more than a couple of days".
4th July : Received the following response from "Automotive PR Manager" :

Suppliers Code of Conduct
Halfords insists that our suppliers adhere to a strict Code of Conduct that governs standards of production and the conditions of employment for their colleagues. This includes ensuring that suppliers’ colleagues receive at least the minimum wage as defined by local legislation – though in the case of skilled workers this is often significantly more.
Halfords conducts regular independent audits of all factories to validate compliance with our Code of Conduct and works pro-actively with suppliers to ensure that they comply with the appropriate local employment laws.
Colleagues in Cambodia are also represented by trade organisations who act in their interests.

to which BFTF bounced back saying thanks, but that BFTF would continue to look for a bike that had been put together by workers paid a living wage:

Separately, BFTF also challenged some cycling publications:

Cycling Weekly Updates
3rd March : Asked whether they could challenge Halfords (and perhaps other bike manufacturers) on this issue.
4th April : They printed the letter but did not commit to actually challenging the manufacturers.
5th May : Chased up via email.

CyclingPlus
3rd March : Asked whether they could challenge Halfords (and perhaps other bike manufacturers) on this issue.
4th April : Chased up via email.
5th May : Chased up via email.

Notts Green Party
Apr 2013 : Notts Green Party kindly offered to challenge Halfords on this issue (and ask their members to as well! Thanks Notts Greens!


Related Content
Interview with Julia Hawkins on the Ethical Trading Initiative

Related Linkst
"Green" but perhaps a little elitist bikes at Rosa Bikes (check out the comments)

BFTF's bike - it is a thing of beauty


Challenging Fire Angel on paper sustainability

BFTF recently had cause to buy a carbon monoxide detector which happened to be made by a company called FireAngel, and BFTF fully expects it to be high quality product that gives years of reliable service.

FireAngel packaging


Having said that, and with a "sustainability" hat on, BFTF could not help but notice that, on the back of the packaging the following statement:
"Green Product Initiative. The planet has been considered at every juncture of this alarms development."


Green Product Initiative Statement



and that there seemed to be no indication that the card packaging was made from made using sustainably sourced cardstock (e.g. recycled or FSC certified), nor did a search of the FireAngel website find any mention of the "Green Product Initiative".

FireAngel packaging



So BFTF sent the following email to the company via their No cigar, as it were, on the website:
I recently bought two of your Carbon Monoxide detectors and note that FireAngel has a "Green Product Initiative". However, I am struggling to see any evidence on the card packaging that it has been made using sustainably sourced card (e.g. recycled or FSC certified)

Using sustainably sourced card is one of the easiest ways to reduce the environmental impact of packaging material - and is so easy to do that even supermarket till receipts use FSC certified paper!

I am sure that your already have this covered and hope that you can confirm that your card packaging is indeed made from sustainably sourced card (e.g. recycled or FSC certified).


Update 03Jan13: Received a prompt and rather encouraging email response from FireAngel. Somewhat surprisingly, they have found this blog and left the same response in the comments section below. If BFTF remembers (and the liklihood is that it will), this issue is perhaps worth chasing up in a few months time.