Making UK Government Effective and Accountable

The UK is small consisting of a bit of Eire that we ought to give back since it is just a complication in terms of managing the country. 

This article ignores Scotland and Wales as well though it would make sense to include them if their regional status could be reversed.

In England we have (according to http://en.wikipedia.org/wiki/Local_government_in_England#Principal_authorities)

• 27 counties
• 32 London Boroughs
• 36 Metropolitan Districts
• 55 Unitary Authorities
• nine “government offices of the regions” (see http://en.wikipedia.org/wiki/Regional_assembly_%28England%29#The_regional_assemblies)
• 122 separate authorities for education (http://en.wikipedia.org/wiki/Local_education_authority#List_of_local_authorities_responsible_for_education_by_region)
• 152 health trusts (http://en.wikipedia.org/wiki/List_of_Primary_Care_Trusts_in_England)
• and 47 police authorities (47 http://www.apa.police.uk/the-apa/who-we-are)

All these bodies might have different outlooks on life and performance targets but they are essentially the web by which tax and borrowing is turned into services and every single body will have standard business systems as well as some more specialised applications designed to deliver their outcomes.

The Cabinet Office has been talking about a Government Cloud containing all UK public sector information and delivering applications via the web. I do hope some thought has been given to abolishing all the administrative and political boundaries that will get in the way.

England is far too small to justify so many administrative bodies and running them costs a fortune as all the standard functions are duplicated.

If the bodies are not abolished then perhaps they might be forced to use shared services by removing the whole IT budget of every one of them and investing it in cloud application services.

Centralisation not only has economic benefits but makes uniform security easier, simplifies authentication across the whole public sector and might help even out the standard of services across the country

A unifying idea for psychiatric self help

This Blog is an invitation to discuss the predicament facing a person who feels, insurmountable and inescapable problems, total inability to act except to curl up cry and shake, fetal position with voluntary inertia. Day and night hallucinations with or without medication are common. Some relief can be obtained, assuming communication is possible through those few who have mastered their problems and can sometimes empathize and advise from their experience.

Help is often designed to fragment the problem, chipping away at issues that the health services has no staff or equipment to attempt alleviation. For many of us lifelong medication is needed and I have no problem with that if carefully and frequently reviewed by a good psychiatrist. GPs are often forced in the UK to the desperate step of prescribing drugs to render the patient unconscious until more appropriate care can be found; due to paucity of qualified mental care facility available this may be up to 6 months. GPs are neither trained to diagnose psychiatric illness, to understand the side effects of long term usage or to recognise signs of a patient reacting negatively. Death, despair and suicide follow.

There is comprehensive coverage of the psychoactive drugs on wikipedia at antidepressant list and these are all linked into wikipedia pages on depression and insomnia very well . There are, of course many other learned books and journals that both GP and patient should FULLY absorb building up a matrix of what works well for a specific patient and set of drugs, at what dose and at what time of day.

In my own case little consistent improvement was visible which led my GP at the time to prescribe a potentially lethal cocktail by adding oxycontin in high doses to the list alongside all the other depressants and SSRIs she was dishing out liberally.

Fortunately a drug induced coma led to many of the drugs doses being simply evacuated by over worked E&A staff pushing as much water and sterile solid though me.

As an absolute accident I missed two whole sets of medication in a row and found that I remained depressed, as expected, but was able to walk unaided, talk coherently and, vitally, from that point on formally refused any further medication from the amateurs employed as GPs at our surgery

9 months on I am, of course, unemployable having been ill for over a year but I read prodigiously and get plenty of exercise.

It really does pay to do your own research, checking with online qualified psychiatrists from time to time. If I had paid to get the treatment that I have needed we would now be a house-less, penniless grown up family of four all reliant on my pension.

At least we saved our marriage (just) and a very degraded relationship with the children who are now 23 and 26 but still at home thanks to the recession.

The other observation I would make at the "talking therapies" supported by Rethink and the governmant may cut costs and waiting lists by using cheap unqualified staff and they will work for those who do not have a clinical depression due to imbalanced brain chemistry or neural activity. For those of us with clinical depression talking does no good and, for me, is harmful.

Please do share your thoughts with me and I will help if I can (via private message if requested)

A word of warning - it is easy for the psychiatrically ill to seriously damage all those around them. This is especially the case where the patient is disruptive, violent or delirious.

The growing youtube collection of videos relating to depression may help those readers who do not understand why someone who is clinically depressed cannot "snap out of it". Brain dysfunction can defeat the strongest will.

Public Sector Programme Accounting

I have written in various blogs and discussion groups, beginning with the one at http://nigeles.blogspot.com/2010/09/public-sector-audit.html , many times but thought one last plea for sanity might be worthwhile.  The debate in the UK goes back to the planning for Whole of Government Accounts and adoption on IFRS - I guess about 15 years.  Yes the wheels of change to central infrastructure do turn very slowly.


At the time I was reviewing US GAO reports based on sets of programme accounts where Congress set out resources, milestone and measurable targets.  This seemed like a huge leap forward to me as it ties  audit and accounting to time, inputs and measurable outcomes all at one go.  Just what the UK cannot do.

I made representations but they were ignored;  the team wrestling with WGA (Whole Government Accounts) felt they had enough to do without proposing a change in the entire Parliamentary accountability system.  Unfortunately they also ignored the advice that private sector accounting standards do not fit the public sector and lead clients to do nugatory and, arguably, meaningless, work trying to squeeze the public sector based on social objectives agreed by Parliament into a private sector model meant for investors and shareholders.

The most fundamental issue in the public sector is why it exists at all.  That reason, at best, is some communal need.  In the early days these needs are basic such as currency, defence and the humane treatment of those unable to fend for themselves – dead piles of babies with servant mothers and aristocrat fathers on church steps eventually do lead to calls for action.  It is also bad for business to have members of the community wandering around starving in rags.  These issue may even need reconsidering today with the current government unable to understand that the over 50s and inexperienced 20s will become destitute as will the disabled.

The result is a realisation that the rich have to be taxed heavily in order to pay for social programmes run at a defensible level to defend from outside and inside threats all the community members. There follows a small, but necessary, diversion on taxation.

Taxation is, therefore, a necessary evil for a morally sound community.  It is important at this point to realise that those who can afford to pay it are those who make money within the community whether or not they then export it via dubious means to other communities and that that the level of tax will depend on their legitimate obligations to their families as well as the money however raised.

A fair (progressive) tax system has to be wholly based on income and the rate has to rise proportionately to avoid further impoverishing those on a lower income;  so tax bands arise.  My view is that these should go all the way up to 90% for those on incomes more than three times the median income.  This would not only raise money for the programmes voted for by the citizens but give the elected representatives some chance of delivering the desired outcomes without crippling debt.

The most unfair tax is one on consumption since the impact on the poor is much higher than that on those rich who fail to evade it.  It is therefore ironic that the UK government choose to raise VAT when those hardest hit are least able to absorb payment of more tax.

Assuming that democracy is working the citizens should be able to recognise the programmes that they voted for when Parliament allocates funds.  This is essential since the rights of the government to tax should be directly derived from the costs of the programmes they were elected to deliver.  I am, after 30 years of auditing central government, well aware that manifestos can be seen burning even on election night.  Pressure groups are the citizen's only other weapon between elections and they are now largely starved of funds perhaps as a matter of policy; it is certainly convenient to strengthen the few rich supporters, ignore their tax evasion and cut funding of groups to support those who have neither the good fortune or abilities to move from poverty to the funded elite.

At present funding is allocated in huge blocks;  there is no clear link back to the programmes the electorate wanted or to measurable indicators that will show whether the desired aims are being achieved.  Even an elected representative cannot dig down to the the meaningful information on objectives achieved and costs incurred either in the past or in the future plans.  Questions asked in the House about the odd weapon, war, crisis or flood take an enormous amount of effort to answer because the accounting is not constructed to answer questions about programme costs or benefits.

Parliament exists to deliver the outcomes it promised on election so should have been insisting on a programme accounting system linking inputs and outcomes from the outset yet few MPs to this day understand that the adoption of accounting systems designed more for private sector interests than public sector purposes has led to the increasing invisibility of the true cost of the initiatives they themselves are deeply committed to.

In a programme accounting system it is the delivery bodies that become hazy whilst the programme and its measurable outcomes is what Parliament votes for and reviews each year.  If standards are maintained and outcomes achieved the monolithic departments of state become irrelevant since it may be them or any other private or third sector body that delivers the outcome required.  Most monoliths would decompose becoming planning, resourcing, monitoring and contracting agencies tasked with one or more of the the key objectives.

More than half of the current central government audit effort is taken up in checking accounts with the result that you end up with something resembling company accounts giving scant information on programmes (especially those that span monoliths). Parliament is left with piles of numbers that cannot be interpreted in their role of programme delivery agents unless they specifically ask about costs or performance targets of programmes they have a particular interest in.  The cost of answering such a question is immense since that is not how the accounts are set up to deliver.  This must change as scarce resources need to be very carefully targeted at the programmes that parliament agree have the highest priority.

When the audit report is complete it is formally submitted to a parliamentary committee called the Public Accounts Committee.  At present they are faced with the same problem as Parliamentary Members and often ask for more detail on programmes than either the audit office or civil servants can provide.  Surely it makes sense to realign the accounting process to produce results relevant to the programme value for money questions that the Committee should really be probing both on behalf of their colleagues in Parliament and their constituents in the electorate.  The voter cares whether their local services have improved but I doubt that one has read a set of government financial accounts unless they are themselves in the monolith concerned.

This meaningless waste of resources on producing information no-one wants has to stop.  The public services report to us all on the progress made on the mandate we gave them;  they are not companies who need to worry about misleading opportunistic investors or shareholders.  That is why public accounting and auditing needs to be radically different to that found in the private sector and somebody must surely have the will to act on this.

The lack of programme accounting damages effective accountability but there is another issue namely sector boundaries.  There are arcane mechanisms by which a programme that crosses the boundaries between central and local government or between the government and third sectors is now having to be pushed hard as the government try to make third sector (charities) take on delivery responsibilities with little or no payment as an incentive to do anything.  Since the third sector is already impoverished by the failing economy dumping delivery of services to those in dire need can only lead to further deterioration.  There is, for example, almost no provision in my Borough (Bexley) for any support for those on the street, unemployable, psychiatrically disturbed or in need of further training for employment.  Social Workers used to be visible for those who needed them but the needy are now simply ignored - this is care in the community in action.  Now think back to those wonderful accounts - is any of this misery apparent.  Perhaps MPs just don't care - I get little sympathy from David Evennett in our Borough and it may be that there are none left with the will or power to restore our welfare state.  The point I wish to make is that even if they wanted to they would not find it easy to get the performance or expenditure statistics necessary to show how bad the situation is becoming.

If Parliament allocates funds to an independent agency solely responsible for delivery of a specific programme many of the awkward barriers between sectors simply disappear as they are absorbed into a single programme team with.  The means of delivering the outcomes required would have, of course, to follow ethical rules and be subject to comprehensive audit by the government audit office but the boundaries and obstacles to choosing relevant, local experts disappear at a stroke.   Of course for social welfare to improve you still need MPs to care but at least they would have ammunition to use in order to improve failing programmes if they knew the performance statistics.

My personal view is that a decision has been taken to hide as much misery as possible using the financial standards of the public sector, to destroy social services and ignore those who are impacted but since I have seen the impact at first hand and seen how it can be ignored by the centre I may be biased.  I believe we will see health, education, careers and housing for the advantaged and a Malthusian purging of everyone else.

 I'm not even sure that the UK is a democracy any more rather an an oligarchy.

Benzodiazepines and ADHD drugs for depression

I am writing to dispel some of the myths about the benzodiazepine and amphetamine families. They became a popular alternative to barbiturates and conventional amphetamines in the mid 1950s and have more recently been much criticised as addictive drugs likely to increase psychosis in the long run. This has not been my experience. I recently had a very prolonged bout of psychosis and depression due to a real life situation I found neither tolerable or soluble. I was initially treated with strong anti psychotic drugs and sedatives of the old fashioned kind (e.g. trazadone) pre-dating benzodiazepines. After many months I got temazepam back as a treatment for my acute daytime panic attacks but sleep remained disturbed and often led to sleep walks, falls and inappropriate behaviour. Because the UK health service has few psychiatrists the appointments were months apart so trials lasting months were carried out of many anti-psychotics such as amitriptyline, fluoxetine, mirtazepine, sertraline, trazadone and venlafaxine. During these months little was prescribed to ensure a solid period of night time sleep which led to my family having to deal with an individual in a state of anxiety and subject to bizarre behaviour. During my treatment every class of anti-psychotic was tried until a cocktail so strong was prescribed that I had a serious fall breaking my left acetabulum, pubic bone and lower sacrum. This led to not fracture clinic treatment but the prescription of oxycodone as a pain killer along with continued high dose sertraline as an anti-depressant combined with indomethacin. The combination rendered me delirious and so constipated that I had to go back to A&E once every few days to have catheter and enema treatment. It is a very effective formula for chemical castration. One night I missed my tablets and decided to stop the lot when offered the morning doses. Within three days I was walking again and alert during the day. True walking was difficult after the fractures but simple tramadol plus cocodamol helped a lot. I was aware of the need for long term pain killers and hence the need for something benign which I chose myself. As I recovered I found that a single fanatical doctor had brainwashed my entire family to see all benzodiazepines as the spawn of Satan. This led me to do a lot of research during which I found that there were many diazepines suited to different tasks and many patients who should not take them. It is fairly easy to identify someone who should not be given benzodiazepines; prescribe a week of short term acting bezodiazepines like temazepam and then tell the patient to take a break for a week. If they cannot go cold turkey then they are likely to ramp up doses and become addicted if treatment is resumed. Wikipedia has an almost exhaustive list of bezodiazepines listing the half life of each so the doctor needs to match drug to problem. I had insomnia so something with a long half life like diazepam is good as it helps at night and reduces my panic attacks in the day. For severe and acute panic temazepam is better and oral administration may be too slow. In my own case my depression took the form of not wanting to do anything at all and none of the medications helped with that. Once I did finally see psychiatrists both physically and online our conclusion was that the daytime symptoms should be treated like ADHD with drugs like adderrall and ritalin as daytime treatments. Unfortunately, although I still think this is correct, there is only one UK institute that is able to prescribe these drugs (Maudsley) and my place on the waiting list is likely to have a longer life than me. What I am trying to say is that few drugs are all bad. Even older drugs like phenobarbitone and chloral hydrate (prescribed as welldorm or chloral betaine now) have their uses. I understand the reluctance to dole out benzodiazepines like sweets but please do not throw out the baby with the bathwater. In my case careful and minimal use has been a vital part of my recovery. I am much more worried about the ability of a GP to dish out such high doses of oxycontin that I could not even get up for weeks. It would be good to hear from psychiatrists and patients about their experience

IT governance review objectives

When planning to review or manage a computer system there are some rule of thumb objectives that are worth bearing in mind. For financial auditors the control objectives are set out in the IAS (International Auditing Standards). For IT governance reviewers a better guide is the ISACA (Information System Audit and Control Association) COBIT (Control Objectives for IT). Security audit objectives are covered in COBIT but enhanced in the guidance set out in the CISSP (Certified Information System Security Professional) guidance. For reviewing the management of IT services the generic standards are best enhanced with the guidance set out in the ITIL (IT Infrastructure Library).
Governance is really the key and Senior Management should have identified all the critical infrastructure they need to deliver the services that they are responsible for then planned contingencies to cover events that could reasonably be expected to cause a breach in the delivery or integrity of the services. The result should be documented and compliance enforced and tested.
Governance should cover consideration of
Effectiveness
Efficiency
Economy
Confidentiality
Integrity
Availability
Accountability
Regularity
Senior Management should be able to demonstrate an alarm and alert system that would bring a breach of any of the control objectives to their attention and guidance on contingency plans to deal with the threat.
There ought to be a catalogue of threats to services which includes assessment of likelihood, impact and recovery.
Recovery plans are useless unless tested so there ought to be evidence of testing for recovery from simulated threat outcomes and probing of vulnerabilities through penetration testing.
Effective governance requires that the whole board agrees the key services of the organisation, prioritisation of services, assessment of threats, responsibility for carrying out contingency plans and testing organisational resilience.
Much of the testing and some of the control objectives rely on the existence and integrity of transaction level information for a long time. I would suggest that 7 years is not unreasonable. Such evidence is clearly of little use if its integrity and completeness cannot be demonstrated so review of the effectiveness of these aspects of control is a prerequisite for a reviewer.
The reviewer can begin by checking that all the objectives, documentation, testing, alerts and alarms set out above are in place and considering the independence and qualifications of those who documented testing. After that the reviewer should probe weaknesses and help Senior Management identify key areas for improvement.
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Taxation

Poverty is now a fact in UK households consisting of the disabled, retired and unemployable.

A radical change to tax could help by abolishing basic rate tax and ramping up the tax on those earning twice the average income to rates ranging from 40% to 90%. This was done by Sweden without a sudden flight of the professionals from the country and instead encouraged those in the 90% band to opt for a shorter working week thereby making room for more professionals to take up jobs for the days freed up.

Corporation Tax

The tax paid by companies is something that has fallen out of the limelight. A quick review of the amazing ability of our top 100 companies to evade corporation tax might enable HMRC to increase the basic rate tax threshold thereby benefitting those on low incomes.

Making the most of the EU

Getting the economy going again is something the current government is unwilling to fund by taxing the rich who invest/spend outside the UK, paying a living allowance to the poor and disabled or commissioning useful public works.

I wonder if the government have considered the vast numbers of historic monuments that might be eligible for restoration under EU grants. This could inject income, provide employment, enhance the skill base of UK workers and improve the state of our tourist traps whilst recovering some of our EU contribution.

Human embryology

There has been a lot of debate in the press about the proposed rise in compensation for those wishing to donate eggs for women who cannot use their own.

I do believe that sperm donation should be compensation-free since it is fairly trivial and non-invasive but donating eggs is time comsuming, invasive and potentially hazardous to the donor so £750 seems like too little to me rather than too much.
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government puts mental health money into chat therapy

I'm sure the comparative cheapness of talking therapies appealed to the government in making their decision to place emphasis in funding in them rather than clinically experienced psychiatrists which the nation is chronically short of. There is no shortage of less qualified and less experienced "talkers" who, in my experience, do more harm than good.

The problem is that people who do not have mental health issues but think they have go to "talkers" and are then "cured"

Real mental illness has a biochemical root that is not a matter of talking but one that requires surgical or medication-based treatment.

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Directory of care organisations

counselAndCare http://www.counselandcare.org.uk/
directGov http://www.direct.gov.uk/en/DisabledPeople/index.htm
disabilityuk http://tinyurl.com/2eey2pd
disabledLiving Foundation http://www.dlf.org.uk/
focus on disability http://www.focusondisability.org.uk/
mencap http://www.mencap.org.uk/
mind http://www.mind.org.uk/
rethink http://www.rethink.org/
RNIB http://www.rnib.org.uk/Pages/Home.aspx
scope http://www.scope.org.uk/
shelter http://www.shelter.org.uk/

Disabled to be even further attacked

Disabled to be hit by cuts to Independent Living Fund
http://tinyurl.com/25b83xu
This completes the attempt to starve, render homeless, reduce mobility and render helpless the disabled whether by sight impairment, physical impairment or mental incapacity.

DWP consultation on DLA reform

DWP have published a discussion paper on the proposed changes to benefits affecting the disabled.


Readers of my recent blogs and tweets will know that I have argued against making the economic cuts hit those most in need.  I would rather see corporate tax laws enforced and loopholes closed.  This would raise far more revenue than the disability living allowance cuts.


The comments below have been submitted to DWP, my MP, rethink and those who follow me on social networks.  Please reuse anything you like and do add your own comments


Response to public comment document Disability Living Allowance Reform  

Question 1 What are the problems or barriers that prevent disabled people participating in society and leading independent, full and active lives?  
Mental and or physical incapacity such that no paid work is possible   
Mental or physical symptoms that render it dangerous to the individual or others for them to be in a normal working environment or indeed unaccompanied anywhere.
 
Question 2 Is there anything else about DLA that should stay the same? Recipients of higher rate DLA and MobA need assisted living so their combined allowance would have to cover the median private sector rate for that provision since few state run communities still exist.  In my area (DA1) the cost of private care is between £500 and £1000 per person per week so if care is to be outsourced that is the accommodation and food component of need; transport remains as is now.
 
Question 3  What are the main extra costs that disabled people face?
Inability to earn money for food and accommodation
The cost of a shared able bodied carer
Cost of a car with driver or taxis to get to voluntary work, therapy and discussion groups
 
Question 4  The new benefit will have two rates for each component:
Will having two rates per component make the benefit easier to understand and  administer, while ensuring appropriate levels of support?
What, if any, disadvantages or problems could having two rates per component cause?
Flexibility is reduced for cases at the margins.
Existing payment matrix is only 12 cells each with a rate – hardly complex
 
Question 5  Should some health conditions or impairments mean an automatic entitlement to the benefit, or should all claims be based on the needs and circumstances of the individual applying?
Some mental and physical disabilities can neither be treated nor cured.  In such cases this could be established at initial assessment.
I would also point out that mental incapacity must be decided by at least one qualified psychiatrist and not a specialist assessor with little medical knowledge and, at best, a degree in some occupational related subject  
Right to appeal to a panel of qualified mental or physical specialists must be built in.
The named social worker of the individual being assessed must sign off the final assessment and ensure that the result is the ability of the individual to live safely and comfortably in suitable accommodation.
If the individual is in a private care facility because there is no state facility then financial liability will continue even if the individual is hospitalised – the state must cover this cost as the price paid for outsourcing care to the private sector
 

Question 6  How do we prioritise support to those people least able to live full and active lives? Which activities are most essential for everyday life? 

Assessment should start with need – how much does appropriate accommodation, care, travel and food cost and then take into account the ability of the individual to earn anything

Question 7 How can we best ensure that the new assessment appropriately takes account of variable and fluctuating conditions?
Monitor RPI, get GP to sign notes indicating change or no change, liaise job centre to find out if individual is in work or could be in work if work was availabke.  In the latter case benefit will obviously have to be continued.
 
Question 8 Should the assessment of a disabled person’s ability take into account any aids and adaptations they use?
• What aids and adaptations should be included?
• Should the assessment only take into account aids and adaptations where the person already has them or should we consider those that the person might be eligible for and can easily obtain?
Stage one is for health and welfare to provide adaptations that will benefit the individual
Stage two is assessment of the ability of individual with aids that have been provided
 

Questions 9, 10 and 11 have essentially the same answer

Question 9:  How could we improve the process of applying for the benefit for individuals and make it a more positive experience? 

For example:
• How could we make the claim form easier to fill in?
• How can we improve information about the new benefit so that people are clear about what it is for and who is likely to qualify?
 
Question 10  What supporting evidence will help provide a clear assessment of ability and who is best placed to provide this?
 
Question 11 An important part of the new process is likely to be a face-to-face discussion with a healthcare professional.
• What benefits or difficulties might this bring?
• Are there any circumstances in which it may be inappropriate to require a face-to-face meeting with a healthcare professional – either in an individual’s own home or another location?
Claimant need fill out nothing if he/she has a carer.  Carer or claimant to submit evidence of living expenses.  Medical assessment from GP and appropriate specialist.  Any occupational
therapy reports to be reviewed by an appropriate qualified consultant physician.
 
Question 12  How should the reviews be carried out? For example:
• What evidence and/or criteria should be used to set the frequency of reviews?
• Should there be different types of review depending on the needs of the individual and their impairment/condition?
Unless GP notes indicate a change there is little point repeating
 
Question 13 The system for Personal Independence Payment will be easier for individuals to understand, so we expect people to be able to identify and report changes in their needs. However, we know that some people do not currently keep the Department informed. How can we encourage people to report changes in circumstances?
Department asks for regular GP “sick” notes and possibly a rough breakdown of living costs. 
If the individual is in a care home run by private sector then that could be paid directly.
 
Question 14  What types of advice and information are people applying for Personal Independence Payment likely to need and would it be helpful to provide this as part of the benefit claiming process? 

Clear definitions of each criterion that will have an effect on the outcome
 
Question 15 Could some form of requirement to access advice and support, where appropriate, help encourage the minority of claimants who might otherwise not take action? If so, what would be the key features of such a system, and what would need to be avoided?
Those eligible to claim should have a carer and the carer should act as advocate.
 
Question 16  How do disabled people currently fund their aids and adaptations? Should there be an option to use Personal Independence Payment to meet a one-off cost?
Cost of approved aids and adaptations should be met in addition to PIP by the state;  at present the wealthy buy the best available whilst others rely on appeals and third sector assistance. As I understand it PIP is to be set at minimum to cover living costs so aids would have to be funded in aaddition to regular PIP
 
Question 17 What are the key differences that we should take into account when assessing children?
Children unlikely to be working or eligible to work.
Children will often have a parent as main carer
Children currently expected to live in parents’ home forever as no provision for assisted living.  When older than 18 young people should be found assisted living accommodation in a community where the disabled person can interact with peers ( http://tinyurl.com/38wg6jn ) .
 

can the internet be tamed?

In the US we have seen a concerted effort to control information passing over the internet by targeting individuals, sites and ISPs but so long as there is an independent ISP or satellite uplink or even a land line to another jurisdiction's ISP the traffic can still flow.

The internet model was designed by the Rand Corp at the request of US military at height of cold war.  It heals itself and does not suffer from the amputation of networks from its core.  Its purpose was to be able to communicate at all costs and that is what it does.

Confidentiality of internet traffic came late to the party as early exploitation was by free thinking academics rather than the military.  PGP was at the forefront of bringing internet privacy to the masses.  It raised awareness that data sent across the internet ended up all over the place very quickly.  Site to site security was provided by weak SSL (at the insistence of various governments) and personal privacy by a variety of freeware encryption solutions.

At this point we have a network in which all the data between the user and the intended destination can be encrypted so it would be impossible to filter the good from bad traffic.  In fact from the generators of bad traffic's point of view the more people who encrypt the better since it reduces the profile of their encrypted traffic.  Government threats to subpoena ISP data and to run keyword filters makes people like me who did not encrypt anything other than financial information wonder if I should simply encrypt everything to protect myself from those who might steal my personal data.

I am not of the view that all traffic on the internet is benign and agree that it would be good to find some way to stop criminals communicating freely from one internet cafe to another but I am just saying it is already very hard and will get harder.  The best you can do is try to shut down hubs where illegal material is stored.  Of course bouncing an internet connection around the world makes it hard to know where the "hub" is and with the birth of cloud computing it might not be anywhere physically and even if it is found the data will almost certainly be encrypted.

So long as encryption is used on the internet the option of filtering by content is ruled out so that leaves banning Non Government Organisations from using encryption so the filters generate a hit if the traffic contains the keywords or cannot be interpreted into the language of the country using the filter.  This approach is used to stop outgoing and incoming encrypted material across corporate firewalls but these are tiny islands in a vast sea of interconnections.  Adopting the banning of SSL and content encryption across a whole country would render the internet unusable commercially.

We have a dilemma.  The same internet technology can be used for good or bad so stopping the bad stops the good too.  The introduction of cheap disposable mobile phones had a similar impact on the analysis of voice traffic.  When necessary all mobile voice traffic is jammed until the situation is under control but you can only do that if you know where the problem is so internet control is all or nothing.  Switch off all the trunk routes for voice, internet and satellite communications into and out of the country. Then what?

The main lesson to be learned from wikigate is that classified information should not be aggregated on machines connected to a wide area network and that the data should all be encrypted in any case.  The difficulty of containing unwanted data flow once it has escaped is not feasible without damaging legitimate use of the internet.  There are also lessons to be learned about vetting personnel who might abuse their privileges.  This is not news but it is a wake-up call that systems handling classified data need better technical controls and much better physical and personnel controls.  In a war zone that's hard so the response should be to make only essential information accessible from access points in hostile environments.

The other kind of poisonous traffic is that relating to the planning of major criminal activities.  This will have to be handled the old fashioned way by investigation and analysis of behaviour of suspects and then gathering evidence by observing activity rather than electronic surveillance.

My conclusion is that the internet can be killed at an enormous cost to society but not manipulated to serve only one master so no it cannot be tamed.

data protection in the cloud

We are told that the future of internet computing is "the cloud".  What this means is that organisations and individuals will just share applications and data without the need to run their own web servers to run the applications or store the data.

We are also told that it would be a good idea to centralise all data about each individual inside the cloud that is the internet so that individuals could conveniently alter things like address or mobile number without having to log on to dozens of web sites.  From the public and private sector point of view it is also convenient as it provides a one stop shop for data on an individual they are doing business with.

The thing is that I might be happy to share some information with one organisation but not with others.  I might also like my data excluded from searches without my authorisation.  How can I get this assurance?  I know that I have to log on to change my data but how do I know what controls operate over search engine access or access to my data by organisations I have not entered into an agreement with.

The first problem is the cloud itself.  It is virtual and hence in no one place or country particularly when you take into account the backup and mirroring arrangements of the organisation managing the pool of personal data.  It is common practice to backup data remotely and in the case of the cloud it might make sense for this to be in the timezone opposite to mine.  It is most unlikely that the legal constraints on access will be universally enforceable worldwide.

Now what exactly happens when I log on?  

The system looks up my logon identifier in a database and then checks that the password matches the one given.  Assuming that the data store is accessed via https rather than just http then the password will have safely passed from the individual to the store as clear text but in the case of https the whole interchange is rendered private with encryption so it would take a determined attacker who captured the entire interaction to find out the password.  You may have noticed the increased use of captcha fields where you are shown letters and numbers jumbled up with other shapes.  These are designed to be readable by a human but not a PC thereby reducing the chance of someone setting up a robot to try a whole list of passwords for a given logon identifier.

Let's assume the password is secure.  The next step is getting data to and from me which raises the question of how the data is stored.  The whole point is that the data is shared with those whom I authorise so the data cannot be encrypted using the encrypted version of my password.  If the data storage operator encrypts all data using a key only they know then that would enable the operator (assuming only they know the key) to send, receive and store the personal information. But....

Why should I trust the data storage operator?  

This is a very good question which  raises a second use of encryption.  There is a sort of encryption whereby I keep one private key and share the other.  When I encrypt some data with the private key it can only be decrypted with the shared key.  The data operator would associate my shared key with my identifier and then share the data I authorise with the organisations I authorise by decrypting the data with my shared key and the encrypting it with the shared key of the recipient so the recipient can only get back the data with their private key.

This raises the question of where the keys come from.  I should not trust anyone else to generate the pair of keys because then they will know both and the whole system of protection is compromised.  Pretty Good Privacy had a way round this involving running a program to generate the keys on a stand alone PC disconnected from the internet.  The mechanism involved typing garbage into a window on screen until there was enough random data to use as the basis for generating a key pair.  Given the the process involves recording the timing between key presses as well as the garbage typed it would be hard for the same individual to generate the same key pair twice let alone someone pretending to be that person.  Once the key pair is generated you then secure the private key as you wish and send the shared key to the data store operator.

Encryption is one tool to help secure personal data in the cloud but it is only part of the security policy the data operator should be expected to follow.  The operator should implement physical access controls over their system,  they should vet their employees, they should use the controls in the operating system and applications that they use to secure the data store.  The whole system should then be audited by independent experts every 6 months and then certified secure.

What has been described is a solution to central storage as envisaged in Mydex

I might prefer a very different model which is to store my personal data onto my own USB stick and share by allowing an application on the USB stick to fill in forms for me.  This is the solution used by Roboform.  It is up to me to back up and to secure my USB stick but if I keep it unplugged when I do not want to share anything the data is simply not there to be hijacked.

Of course I have to make sure all the systems I fill in forms for are secured by https before I submit the data and I would need to establish a trust in the recipient organisation to secure the data I submit.

In both the central storage and USB stick examples there is a final and difficult problem.  When I give an organisation access to personal data I am trusting them to secure it whether it came from me directly or via a central store.  That trust ought to be based on the results of regular independent security audits like those required for the central store.

Search engines would see only what is stored unencrypted but I need to be able to trust authorised users of my data to encrypt it and hence the security audits.

The organisations that provide your internet connection (ISPs) can gather all the traffic on any account they choose but if the communications involving transfer of secure data are protected by SSL they will not be able to look inside the private packets of data unless assisted by organisations with massive computing power who would be able to do the decryption in time.

So ..... there are lots of issues to resolve before entering into data sharing in "the cloud"

Communities for those with special needs

RNIB Redhill  had students with a wide range of disability all of whom were able to live as a community with a little help fron the house staff and a lot of help from each other. The mixed disability residential programme was ended in 2007 due to withdrawal of education funding on the basis that teaching life skills was not academic enough.

Although RNIB Redhill College was set up as a day centre for the sight-impaired the college became a centre of excellence for teaching a wide range of disabled students life skills through their mixed disability residential programme that ended in 2007 following the loss of government funding. 

I believe that the Redhill community is a viable model for mixed disability, assisted living, long term accommodation which could be self funding from the benefits and earnings of the residents forming a safe haven for those who would be at risk due to mental or physical disability if on their own in a general purpose flat or house.

Surely it would be possible to fund  similar residential centres within towns around the country where mixed ability people could live and learn from each other but also interact with the wider community.

I have created a list of organisations that might help realise this dream in the blog at: http://nigeles.blogspot.com/2010/12/directory-of-care-organisations.html
If you can think of others please let me know

It would be great if readers lobbied their MPs about the need to provide for assisted living for those with special needs

There is also a facebook group on disability care in the UK at https://www.facebook.com/home.php?sk=group_183851574958756&ap=1

Conservatives attack disabled

It looks like the lifelong disabled are a key target of the current
government since carers, Disabled Living Allowance and mobility allowance
(http://tinyurl.com/36dmrfd)are all to be cut . In my view it is grossly
unfair to target those least able to help themselves. In the case of
cerebral palsied children who become cerebral palsied adults the dependence
on the state is absolute yet the care and support is subject to a maze of
organisations, some of the most complex regulations affecting access to
services and now further financial pressure. If one individual satisfying
the current stringent criteria that my daughter met was hit by all of the
cuts they would be left to die on the streets. Is this the face of the new
conservatives?

national data bank

At present every individual's data is held in hundreds of databases that are almost certain to be inconsistent and many will also be insecure. Both the public and private sectors hold both information that should be publicly available and also data that should only be released with the permission of the data subject.

Lots of sources mean lots of effort to update them when personal data changes and multiple requests for the same data. Another implication is that the value of one database alone cannot justify the investment in security necessary to protect the data that should not be public.

It would make a lot of sense for there to be a national repository of open and private data managed under the authority of a body independent of both government and private sector.

In this scenario all users would have RSA key pairs and a chipped key card funded from the savings generated by removing the duplicate existing databases. The key pair would be generated locally on a stand alone machine, stored on the card chip and then the public keys transmitted from the card to the national database directory via an online terminal.

Personal data would be accessible only to holders of an encrypted token generated from a large random number and the subject's private key held only by them.

Since the national database would replace the myriad existing ones there would be massive savings offset by charges to those extracting information. The resulting surplus would be used to buy state of the art security for the national database along with a dedicated team of security professionals to continuously monitor threats, countermeasures and traffic hitting the server.

It would be possible to clone the national database to backup sites accessed over different physical and logical routes and on different IP ranges so that a denial of service attack would result in no perceptible service level degradation by users.

Of course there would be cries of Big Brother if such a database was established and these would have to be met by third party attestation that neither private nor public sector could abuse the data held. The power to unlock private data would always rest with the subject or those designated by that subject.

Access to the technology would also be cited as an obstacle but terminals could be in post offices, libraries, hospitals, job centres, council offices and so on. This would still leave a few remote subjects far away from a terminal and it would be cheaper to simply supply them with a home version of the terminal rather than to set up a less secure phone based service. There would remain some subjects unable to use a terminal due to disability; in such cases an advocate would need to be available to carry out their transactions with the full permission of the data subject.

Given the level of identity theft it may even be acceptable to subjects, in time, for sputum based DNA to be used as an identifier to supplement voice, eye, card and fingerprint authentication.

All access to private data would be logged and sent to the subject at regular intervals so that they could ensure that only access they authorised had taken place.

On top of all this the national database would be subject to annual security audits the findings of which would be published in full in a language that data subjects could understand.

Regulation fit for the target

In 2005 the National Audit Office published a report on the complexity of the benefits system http://www.nao.org.uk/idoc.ashx?docId=CEB51B1D-07A8-45B7-8F85-C472333F34D0&version=-1

What is apparent is that the complexity is inversely proportionate to the ability of the potential recipient to unravel it.

This applies to every aspect of "special needs" provision. As social services are cut back there is very little chance of a special needs person encountering a state provided advocate and even less chance that they will be able to obtain what care remains in the system on their own.

Special needs of all kinds stand out as an area where opaque regulations minimise state liability to care. The situation is made worse by a typical case involving contact with more than 30 organisations each with their own waiting list, budgets and forms.

One way to deal with this is to establish a public advocacy service as a single point of contact for the special needs client whether they are seeking eduction, employment, housing or just social interaction. That way the advocates could learn the existing mass of regulations and connections between responsible bodies. This is rather like relying on a trained human to answer call centre queries using a plethora of unconnected information systems rather than trying to design a new system that replaces the trained human.

The other way is to wish publicly that it was easier but plan to gently deposit the problem on a remote back burner.

It would be nice to see anything positive to promote stable special needs communities in which groups of individuals could live with, perhaps, one advocate and a collection of special needs people who could work together to compensate for each other's disabilities.

I encountered only one such community in the course of a search lasting more than 20 years and that was the Redhill College run by the RNIB with a funding contribution from the government education budget. Sadly that is now gone as a result of the education contribution being withdrawn on the basis that funding ought to be awarded only to institutions that teach mainstream qualifications rather than skills for life. http://www.facebook.com/#!/group.php?gid=117965814884402

Loonies on bikes

There is a school of thought that mental illness is fictitious just because it is in and of the mind. As a victim of depression and psychosis I have not always known who "I" is or what that "I" is doing and certainly could not guarantee consistent socially acceptable behaviour or pronouncements.

Mine is a mild inability to relate to myself and others properly. Others have tiny glimpses of the reality others believe in rather than short glimpses of otherness like me.

When residential and psychiatric care is cut back the mentally ill cannot just get on their bikes and suddenly become normal enough to earn a living and care for themselves so they end up isolated and untreated in the poorest housing on the market until they either demonstrate that they are a danger to others or simply die.

It is easy to cut where recipients are least able to complain so all flavours of central and local government do this. In Hitler's case this was taken to the extreme by transporting the disabled to the death camps. Is neglect so very different?

I believe there is a tacit agreement to care for each other at the heart of the notional social contract that forms the basis of a democracy and would hope that this survives even in hard times

government cuts

Government exists to
* provide a stable social structure
* protect citizens from each other, misfortune and ill-health
* collect tax to fund services
* deliver uniform, effective services thoughout the nation

Government has no justifiable mandate to intervene unless citizens rights are threatened.

Government has a duty to ensure effectiveness and uniformity of essential services such as police, health, education and social services. Consistent standards are not helped by local government.

Government has no right or duty to promote minority interests such as sport with funds raised from the entire population.

So what can usefully be cut:
* local government can be abolished including local education authorities, police
authorities, health trusts with exisitng staff simply becoming service delivery
agents for centrally administered services
* minority interest departments such as DCMS and DCLG can be abolished

Getting rid of local politics has the added advantage of ensuring end to end accountability for effective service delivery.

humanity

Ever thought about the real value of homo sapiens

We have raped every corner of our planet without producing anything which is of any benefit to any other species except in response to guilt about the destruction we have wrought.

You might think of the aesthetic, technological and intellectual achievements but these all benefit only ourselves often at incredible cost to the rest of the planet.

We cannot even live at peace with each other.

Part 2 at http://nigeles.blogspot.co.uk/2013/11/humanity-revisited.html

depression

I hope this blog will enable those who are depressed to recognise someone who shares their feelings and those who study psychiatry as a test case.

My depression is about inability to change or tolerate a mind set. It sometimes leads to tears or rage. Every victim either dies or finds a release mechanism; in my case medicines were required to break the loop and remains the only way to break the shell

It sometimes involves weeks of horrible night and daymares formed from all the terrible things I've seen humans do to other humans.

In retrospect I can see that the seeds of the problems were visible from childhood manifesting as nightmares and inability to relate normally and hence almost always ending out the odd one out.

Perpetual isolation results from the perception that I understand no-one and vice versa which means that there is a persistent tendency to shut the world out lest misread emotions lead to enmity rather than friendship. It would be good to talk but bad to do anything that might upset my own emotional balance or that of others.

Nothing is worth doing because nothing is interesting because nothing helps.

If that meant the mind was at rest that would be something but instead it is perpetually engaged in the analysis of its own dysfunction stuck in loop of the insoluble dilemmas

From 14 until 18 I self medicated on amphetamine and nembutal with a group of friends who I will aways remember fondly as kindred spirits. This worked surprisingly well on all fronts. I was able to make new friends, concentrate on my studies and felt quite happy. But I guess I always knew it had to end.

When I went to University I decided that prescription drugs should replace self-medication. This consisted of nitrazepam to help me sleep and later amytrityline for depression then I left and moved to London.

I found London both at work and home very stressful. The only change to medication on moving to London was that nitrazepam became temazepam and Welldorm plus 30 mg amitryptyline

This remained much the same except I started using temazepam as a social lubricant and to control panic so took a lot more ot it when, at age 44, I had to spend a week with two psychotherapists on a routine week long residential management course. This led to a severe reaction both physically and mentally. I had to be helped home by a colleague. It took weeks to recover. Two course members were affected in this way but the other seemed to recover more quickly.

After 6 months new drugs were put in place (40 mg amitriptyline, 150mg, 2800mg Welldorm and 150mg sertraline

I could cope again until 53 at which point feelings of isolation, exhaustion, emotional overload, anxiety and futility reached breaking point over a year. Lots of pain but no gain to anyone. Just total isolation and then psychosis.

In December 2009 came psychosis which was terrifying in that the chamber of horrors continues but mind and body become dissociated so if you try to move you have to first find a connection with a body. Furthermore the hallucinations continue day and night.

This acute phase lasted two weeks controlled by a mixture of quetiapine, chlorpromazine, venlaxine, welldorm, trazadone, mirtazepine

I was weaned off the basket of acute control drugs and onto just venlafaxine and trazadone with my usual welldorm for sleeping. This did not help with the personality problems, anxiety, rage / frustration.

Each of the members of the initial cocktail was then tried with three month gaps in turn each with negative results.

I was left with chronic depression and despair finding it hard to get up let alone do anything. No medication was found in any of the classes of antidepressants UK psychiatrists use despite trying the whole range from major sedatives through the many tranquilizers, antipsychotics and antidepressants over 9 months.

I discovered that the z drugs zopiclone etc made me very much worse so they are on my allergy list.

Last week Lyrica was abandoned and an increased dose of diazepam prescribed and sertraline at 200mg which is what I had before the psychotic episode in December. I've found so far that I do feel calmer and can compensate for lack of energy with liberal doses of yohimbine and caffeine. Nightmareless recipe ended up as 100mg doxylamine, 2800mg Welldorm, 10mg diazepam, 300mg trazadone. I do realise that I won't know if the new cocktail is working for many months but I do have hopes for it.

I've taken an interest in my own condition and a pressure group for promotion of mixed disability assisted living which is something outward looking and the end of the my own hallucinations is a huge plus

I have now seen the psychiatrist 6 times (twice privately). Diagnosis is never very clear but we seem to have ended up with a conclusion that there is an element of autism spectrum disorder and one month supply of adderrall helped so that seems to be the case but since each prescription costs me £300 there will be no more. Instead I am on a long waiting list to the Maudsley Centre but their priority is children. So awkwardness and anxiety in public will remain since I'm advised that the wait will probably exceed my life expectancy.

One morning I just refused all daytime medication and suffered for this oer the next week but then I found I could cope if I was careful during the day. At night sedation is my only solution.

The hallucinations are gone, I can drive again, I can use my PC for hours rather than minutes so all is not lost and there is always the hope of the drug that will fix my serotonin balance, regulate my sleep, control my panic (when allowed enough diazepam) and even enable me to interact with people in a normal ways sometimes though this can rapidly turn into panic.

If you are reading this and seeking help I fear that you will find that the UK NHS will be unable to provide proper care and treatment. If you do raise the money for private care I would warn caution since many private practitioners have hobby horses and also an interest in a continuous income stream.

public sector audit

UK Public Sector Audit

Audit has traditionally focused on government agencies whether the
primary focus has been on accounts, effectiveness or security.  There is another
way of looking at society as a dynamic collection of entities and services that
are intended to deliver policy objectives safely and effectively.  Audit can be
carried out with policy objectives as the primary focus yet still reveal the
need to re-engineer components and services to improve effectiveness,
accountability or security.

Public sector accounts are prepared for Parliament and
should reflect their interests by setting out the costs and benefits of
programmes managed by clients.  The move in recent years towards commercial
style accounts is misguided and leads to meaningless activities such as valuing
heritage assets whilst making it very hard to assess the costs and benefits of a
programme that involves many organisations each with their own accounts. 
International Accounting Standards are intended to enable investors to assess
profitability which is very different from the needs of Parliament where the
interest lies in the effectiveness of funded programmes.

To deliver best value public sector auditors need to be
reorganised to follow policies from the cradle to the grave.  Auditors can
advise on formulating policy in a way that will deliver measurable outcomes. 
Auditors can follow the process of turning policy into lower level policy
instruments that deliver components and services able to deliver the outcomes
that the policy requires. 

In following policy implementation the auditor will be able
to draw on experience of services and organisations involved in the successful
delivery of policy outcomes and provide advice at all levels using the
principles of sound governance based on established and shared standards such as
COBIT, ITIL, PRINCE and the ISO 27000 family.

The family of governance standards has a following
worldwide and across sector boundaries.  This is in sharp contrast to the way
that audit is currently carried out with the auditor focused on a client
responsible for only a part of the policy formulation or delivery.  The new kind
of public sector auditor would be a part of an integrated team with knowledge of
the governance principles, experience of best practice and knowledge of all the
bodies and services necessary to deliver the policy outcome.

Reports could be handled exactly as they currently are with
Parliament as the primary customer but accountability would extend beyond the
commissioning central government body to everyone involved in the delivery chain
being subject to questioning by the Public Accounts Committee.

Shifting the focus from the delivery machinery to the
objectives to be achieved would enable Parliament to vote resources against
measurable outcomes with time cost and quality constraints.  Eventually this
would evolve into a system of programme accounting with resources being voted to
an Agency charged with delivery of that programme and accountable for delivery
back to Parliament.