Time to crowd source performance management?

Public sector targets have been getting a bad press recently. Speaking about the Mid-Staffordshire hospital scandal, David Cameron told Parliament that the Francis Inquiry blamed

…a focus on finance and figures at the expense of patient care—he says that explicitly—underpinned by a preoccupation with a narrow set of top-down targets pursued, in the case of Mid Staffordshire, to the exclusion of patient safety[1]

And it’s not just the NHS. In November 2012 five Kent police officers were arrested for allegedly manipulating crime figures[2], a practice that research by a former police officer suggests is just one of several ways used by the police to game targets[3].

That targets can lead to gaming, distortion and unwanted results is not a new discovery. Target setting dominated Soviet Union economic planning for 60 years and plenty has been written on the way that targets were gamed there[4]. So why are they still around?

Well firstly because they appear to work. For example, despite the widespread evidence of gaming in the NHS during the New Labour era, there is also evidence that targets did play a part in bringing down waiting times[5], and they were certainly implicated in some impressive economic growth in the Soviet Union. But a more compelling reason for at least some form of performance measurement is accountability. Public bodies act on behalf of the public, spending public money to provide services that the public want or need. It is not unreasonable to expect that they should be able to demonstrate that they are doing this in an effective and efficient manner—that their performance should be measured and that they be taken to task if it is not up to par. Is there a better way to achieve this?

The operations of public bodies are complex, with multiple, potentially competing objectives sometimes covering many areas. Trying to sum up performance with a small number of measures requires a degree of aggregation[6] which hides detail. It makes by and large flawed assumptions about the ability to judge the whole by looking at a part[4], allowing the situation where an organisation both hits its targets and delivers abysmal levels of service. The use of clear, prescriptive methods for measuring lends itself to gaming and manipulation of the figures. The process of audit is wrapped in information asymmetry—the organisation being audited knows far more about its workings than the body doing the auditing. But what if public bodies were expected to work on the basis of completely open books, publishing for public scrutiny as much data about their performance and operations as could be accomplished whilst still respecting issues of data protection?

With all the data out in the public domain aggregation is reduced. It becomes possible to spot differences in performance in different areas of the organisation’s operations. There is less reliance on reporting only small parts of the story. To an extent a reverse information asymmetry is introduced—there is no prior knowledge of who will look at which area of the data when or how, making gaming extremely difficult. Organisations would be incentivised to ensure that all their figures showed good service, not just those they know they will be judged on. Eric Pickles has already said he wants an army of armchair auditors scrutinising local government accounts[7], but why stop at finance? The digital era and modern management information systems make this level of transparency possible for the first time. There are examples from around the globe of increased transparency leading to corruption being uncovered by citizens[8]; it’s time to extend that to poor performance.

Of course, I am not suggesting that all responsibility for performance management be crowd sourced. Monitoring performance, reviewing information, learning from it and improving systems as a result, is the job of managers. But introducing the possibility of scrutiny by citizens or peers can do much to overcome the weaknesses of the current approach. Such change represents not just a major shift in culture towards greater transparency, but a shift in attitude towards how data are used, from the terror of sanctions to a more learning focused culture based on intelligence gathering[9]. It allows an organisation to concentrate on learning how best to deliver its services, instead of how best to hit it targets. The two are rarely the same thing.

  1. Hansard (2013). House of Commons. Wednesday 6 Feb 2013 [Online]. Available from: http://www.publications.parliament.uk/pa/cm201213/cmhansrd/cm130206/debtext/130206-0001.htm#13020677000972 [Retrieved 24 April 2013] []
  2. Laville, S (2012). Kent police officers arrested over crime statistics ‘irregularities’. The Guardian [Online], 15 November. Available from: http://www.guardian.co.uk/uk/2012/nov/15/kent-police-arrested-statistics-irregularities [Retrieved 24 April 2013] []
  3. Patrick, R (2009). Performance management, gaming and police practice: a study of changing police behaviour in England and Wales during the era of new public management [Online]. PhD thesis, University of Birmingham. Available from: http://etheses.bham.ac.uk/534/ [Retrieved 23 April 2013] []
  4. Bevan, G and Hood, C (2006). What’s measured is what matters: targets and gaming in the English public health care system. Public Administration, 84 (3): 517–538 [] []
  5. Hood, C (2006). Gaming in targetworld: the targets approach to managing British public services. Public Administration Review, 66 (4): 515–521 []
  6. De Bruijn, H (2006). Managing Performance in the Public Sector. 2nd ed. London: Routledge []
  7. Department for Communities and Local Government (2010). Eric Pickles ‘shows us the money’ as departmental books are opened to an army of armchair auditors [Online]. Available from: https://www.gov.uk/government/news/eric-pickles-shows-us-the-money-as-departmental-books-are-opened-to-an-army-of-armchair-auditors [Retrieved 19 November 2012] []
  8. Bertot, JC, Jaeger, PT and Grimes, JM (2010). Using ICTs to create a culture of transparency: E-government and social media as openness and anti-corruption tools for societies. Government Information Quarterly, 27 (3): 264–271 []
  9. Hood, C (2007). Public service management by numbers: Why does it vary? Where has it come from? What are the gaps and the puzzles? Public Money & Management, 27 (2): 95–102 []

Does size matter?

Writing on the INLOGOV blog a few months back, Catherine Staite argued that it’s time to start talking about merging smaller councils, asking

How can we justify the inefficiencies and unnecessary overheads of two tier areas and tiny unitaries in the current financial climate – when cuts are having a real impact on the most vulnerable?[1]

But is the assumption that big is better necessarily true? With Britain’s largest council, Birmingham City Council, in dire financial straits[2] perhaps it’s time to question the belief that larger authorities are more efficient.

When two small district councils, Babergh and Mid Suffolk, considered whether they should merge they compiled a detailed business case which suggested that a merger would save council tax payers around £1.8m annually across a combined general fund budget requirement of around £20m[3]. What is conspicuous by its absence in that business case is any discussion of the impact that merging might have on outcomes. The implicit assumption appears to be that outcomes will remain the same, thus allowing the reduced costs to be claimed as efficiency. Let’s consider some of the reasons why this might not be the case.

Allocative efficiency

To explain what I mean by allocative efficiency, we’ll look at an almost topical example. To keep our food bill down we achieve economies of scale by buying a lot of our food in bulk from a wholefood wholesaler. A few weeks ago we were compiling our bi-monthly order and with Easter approaching we wondered whether we should buy a box of six chocolate eggs. It would have saved us a fair bit on buying eggs individually from a retailer. The problem is that the nephews like their chocolate sweet and milky, we prefer it dark and at least 70% cocoa, and the in-laws are partial to a spot of white chocolate. So buying a crate of identical eggs would have meant that most people didn’t have the chocolate experience they would have liked. We’d have pushed down our inputs, but outcomes would have suffered.

This is a very real danger with merging authorities. A bigger council may enable economies of scale, but economies of scale assume that the same service is right for everyone. Different areas have different problems, different populations and different aspirations. The ability of a council to respond to the preferences of its citizens should sit at the heart of any measure of performance[4] and smaller, more decentralised units may provide better opportunities for greater responsiveness[5][6].

Leadership and staff engagement

During my career in local government I’ve worked for both a large unitary and a small district. The contrast in the culture of the two organisations, and in my sense of engagement and ability to influence outcomes, could hardly be more marked—I was far happier in the small district. It would be foolish to generalise from this one personal observation and there may be many factors other than organisational size involved. Nevertheless, there is evidence that transformational leadership is more prevalent in smaller organisations[7] and there is evidence that transformational leadership enhances staff commitment, engagement and performance[8][9].

Staff are at the heart of public service delivery and the ability to deliver services efficiently depends on their commitment and engagement. Merging councils threatens this commitment and may actually result in reduced productivity as a result.

Size and the ‘new model’ for public services

In her blog post, Catherine discusses a new model for public services being developed by INLOGOV. Key to this new model is building capacity within communities themselves, facilitated by public bodies building stronger relationships with them[10]. But is merging authorities going to facilitate stronger relationships between communities and councils? Studies in Scandanavia suggest that larger political units have lower levels of non-electoral participation[11], lower levels of political trust and lower satisfaction[12]. Larger councils are likely to feel more distant to citizens, with elected members representing larger numbers of constituents. The job of building trust will be all the more difficult, threatening any potential improvements in outcomes that the new model might deliver.

The new model discussion paper observes

Perhaps the behaviour which really needs to change first, so other change can follow, is that of people in the public sector.[10]

It is difficult to disagree. I am not arguing that things should stay the same. There is no doubt that the public sector has to get smarter in delivering better outcomes for less. It needs radical change in the way in which it approaches service delivery. It needs to work more closely with communities both to ensure outcomes are aligned with community aspirations and to enhance the capacity of communities themselves. It needs changes in approach and culture throughout. But creating larger authorities is unlikely to facilitate this change.

  1. Staite, C (2012). Making ends meet: what aren’t we talking about? [Online]. Available from: http://inlogov.wordpress.com/2012/12/03/making-ends-mee/ [Retrieved 1 April 2013] []
  2. Butler, P (2012). Birmingham City Council faces £757m bill to settle equal pay claims. The Guardian [Online], 12 November. Available from: http://www.guardian.co.uk/uk/2012/nov/12/birmingham-council-equal-pay [Retrieved 3 April 2013] []
  3. Babergh District Council and Mid Suffolk District Council (2011). Detailed business case for staff and service integration, and for the creation of a new council [Online]. Babergh and Mid Suffolk District Councils. Available from: http://apps.csduk.com/CMISWebPublic/Binary.ashx?Document=9600 [Retrieved 3 April 2013] []
  4. Boyne, G (1995). Population Size and Economies of Scale in Local Government. Policy & Politics, 23 (3): 213–222 []
  5. Wallis, JJ and Oates, WE (1988). “Decentralization in the public sector: an empirical study of state and local government.” In: Fiscal federalism: Quantitative studies [Online]. University of Chicago Press. pp 5–32. Available from: http://www.nber.org/chapters/c7882.pdf [Retrieved 4 April 2013] []
  6. Kahkonen, S and Lanyi, A (2001). Decentralization and governance: does decentralization improve public service delivery? PREM Notes 55 [Online]. The World Bank. Available from: https://openknowledge.worldbank.org/handle/10986/11382 [Retrieved 3 April 2013] []
  7. Alimo-Metcalfe, B and Alban-Metcalfe, J (2006). More (good) leaders for the public sector. International Journal of Public Sector Management, 19 (4): 293–315 []
  8. Bass, BM (1999). Two decades of research and development in transformational leadership. European Journal of Work and Organizational Psychology, 8 (1): 9–32 []
  9. Herold, DM, Fedor, DB, Caldwell, S and Liu, Y (2008). The effects of transformational and change leadership on employees’ commitment to a change: a multilevel study. Journal of Applied Psychology, 93 (2): 346–357 []
  10. Staite, C (2012). A new model for public services? [Online]. Birmingham: INLOGOV, University of Birmingham. Available from: http://www.birmingham.ac.uk/Documents/college-social-sciences/government-society/inlogov/discussion-papers/new-model-discussion-paper-1012-2.pdf [Retrieved 25 February 2013] [] []
  11. Rose, LE (2002). Municipal size and local nonelectoral participation: findings from Denmark, the Netherlands, and Norway. Environment and Planning C: Government and Policy, 20 (6): 829–851 []
  12. Denters, B (2002). Size and political trust: evidence from Denmark, the Netherlands, Norway, and the United Kingdom. Environment and Planning C: Government and Policy, 20 (6): 793–812 []

Valuing outcomes in urban forestry

Eric Pickles says that local government must become more efficient[1]. It’s nothing new. Sir Peter Gershon was saying the same thing back in 2004[2] and increasing efficiency was an important driver of the public sector reforms of the Thatcher era[3]. We all need to work hard to increase productivity, but how do we know if we’ve succeeded?

Productivity goes up if the ratio of outcomes to inputs increases. Outcomes are not what is actually produced, but the satisfaction that a customer gains from these[4]. So in a bed factory the inputs are labour, materials etc, the outputs are beds and the outcomes are a good night’s sleep. Directly measuring the value of a good night’s sleep is quite hard, but the market gives us a pretty good idea by showing what a customer is prepared to pay for a bed. Consequently it’s common in the private sector to use outputs as a proxy for outcomes when assessing productivity.

The outputs and outcomes of local government are not generally traded in the market, so assessing their value is rather more difficult. Let’s consider how we might go about assessing the value of outcomes from one particular local government service, that of managing public trees.

There are some particular problems with this area. Firstly, trees grow slowly. The effects of changes in the way they are managed can take many years to become apparent. The effects of planting a new tree at a particular place will not be fully apparent for several decades, in much the same way as the effect of education on a person’s job prospects and salary lags well behind the actions of a school teacher. Secondly, the outcomes of managing public trees are many and disparate, and often difficult to disentangle from other causes. They can range from a sense of well being[5] to cleaner air[6][7], reduced crime[8], reduced CO2 emissions[9], flood mitigation[10], increased economic activity[11] and more[12]. Thirdly, whilst value in the private sector is usually viewed from the perspective of a consumer, many of these values are wider and can be characterised as being social or environmental[13].

One potentially straightforward way to assess efficiency gains in the public sector is to assume that output is equal to input and to establish an indicator of service quality. A given increase in quality over the base line can then be quantified by reference to the baseline input[4]. However, given the complex nature of the outcomes of tree management, establishing an indicator that reflects overall performance would be difficult. Furthermore, the delayed impact suggests a need to be able to account for anticipated future benefits.

The concept of Social Return on Investment (SROI) has gained some support recently[14]. SROI uses financial proxies to monetise the outcomes of activities that have social benefits and can be used either evaluatively or to forecast future value[15]. If suitable proxies can be found it could offer a way forward.

The i-Tree system may help provide those proxies. Developed by the USDA Forest Service, i-Tree is a software modelling package that can be used to estimate the value of a range of benefits, including energy and CO2 saved, stormwater runoff, air quality and increases in house values[16].  Its use so far in the UK has been limited and the two publicised studies, in Torbay and Edinburgh, restricted themselves to estimating the value of carbon storage and air quality[17][18]. Benefits are context sensitive—the savings on air conditioning costs deriving from shade trees are likely to be rather more in San Fransisco than in Sheffield for example—and much of the work on monetising benefits has been done in the US. Further work is needed to adapt i-Tree to the UK context, but it shows some promise as a means of monetising the outcomes of urban forestry.

A significant problem remains, however. The UK valuation figures are based largely on avoided costs—societal costs of poor air quality, notional costs of “non-traded carbon”[18]. As such they do not represent the value that citizens attach to urban trees. One aspect of the US model, house prices, can be said to represent citizen based value in that it represents a revealed preference, but beyond that the views of citizens are largely absent from the system. Given that so much of the value of urban trees can be seen as social and environmental it may be appropriate that valuation is not based solely on citizens’ views, but is it right that those views are excluded altogether?

  1. Pickles, E (2011). Delivering better for less locally [Online]. Available from: https://www.gov.uk/government/speeches/delivering-better-for-less-locally [Retrieved 29 March 2013] []
  2. Gershon, P (2004). Releasing resources to the front line: independent review of public sector efficiency [Online]. London: HM Treasury. Available from: http://www.hm-treasury.gov.uk/d/efficiency_review120704.pdf [Retrieved 29 March 2013] []
  3. Hughes, OE (2012). Public management and administration: an introduction. 4th ed. Basingstoke: Palgrave Macmillan []
  4. Watt, P (2006). Measuring efficiency gains in local government that derive from improved service quality. Birmingham: INLOGOV, University of Birmingham [] []
  5. O’Brien, EA (2005). Publics and woodlands in England: well-being, local identity, social learning, conflict and management. Forestry, 78 (4): 321–336 []
  6. Donovan, RG, Stewart, HE, Owen, SM, MacKenzie, AR and Hewitt, CN (2005). Development and application of an urban tree air quality score for photochemical pollution episodes using the Birmingham, United Kingdom, area as a case study. Environmental Science & Technology, 39 (17): 6730–6738 []
  7. Nowak, DJ, Hirabayashi, S, Bodine, A and Hoehn, R (2013). Modeled PM2.5 removal by trees in ten U.S. cities and associated health effects. Environmental Pollution [Online], 178: 395–402. Available from: http://www.nrs.fs.fed.us/pubs/43676 [Retrieved 25 June 2013] []
  8. Kuo, FE and Sullivan, WC (2001). Environment and crime in the inner city: does vegetation reduce crime? Environment and Behavior, 33 (3): 343–367 []
  9. McPherson, EG and Simpson, JR (1999). Carbon dioxide reduction through urban forestry. General Technical Report PSW-GTR-171 [Online]. Berkeley, CA: USDA Forest Service, Pacific Southwest Research Station. Available from: http://www.fs.fed.us/psw/publications/documents/psw_gtr171/psw_gtr171.pdf [Retrieved 2 April 2013] []
  10. Xiao, Q and McPherson, EG (2002). Rainfall interception by Santa Monica’s municipal urban forest. Urban Ecosystems, 6 (4): 291–302 []
  11. Wolf, KL (2003). Public reponse to the urban forest in inner-city business districts. Journal of Arboriculture, 29 (3): 117–126 []
  12. Coder, KD (1996). Identified benefits of community trees and forests. University of Georgia Cooperative Service Forest Resources Publication FOR96-39 [Online]. Available from: http://warnell.forestry.uga.edu/warnell/service/library/for96-039/for96-039.pdf [Retrieved 2 April 2013] []
  13. Bovaird, T and Watt, P (2010). “Understanding value for money in local authority led public services: scoping a research programme.” In Sixth Transatlantic Dialogue: Rethinking Financial Management in the Public Sector. Siena, Italy. 24 June 2010 [Online]. Available from: http://www.academia.edu/1316427/Understanding_Value_for_Money_in_Local_Authority_Led_Public_Services_Scoping_a_Research_Programme [Retrieved 29 March 2013] []
  14. Millar, R and Hall, K (2012). Social return on investment (SROI) and performance measurement. Public Management Review [Online]. Available from: http://www.tandfonline.com/doi/abs/10.1080/14719037.2012.698857 [Retrieved 1 April 2013] []
  15. Nicholls, J, Lawlor, E, Neitzert, E and Goodspeed, T (2009). A guide to social return on investment [Online]. London: Cabinet Office. Available from: http://www.neweconomics.org/sites/neweconomics.org/files/A_guide_to_Social_Return_on_Investment_1.pdf [Retrieved 1 April 2013] []
  16. Sarajevs, V (2011). Street tree valuation systems. Research Note FCRN008 [Online]. Edinburgh: Forestry Commission. Available from: http://www.forestry.gov.uk/pdf/FCRN008.pdf/$FILE/FCRN008.pdf [Retrieved 29 March 2013] []
  17. Rogers, K, Jarratt, T and Hansford, D (2011). Torbay’s urban forest: assessing urban forest effects and values. A report on the findings form the UK i-Tree Eco pilot scheme [Online]. Exeter: Treeconomics. Available from: http://www.itreetools.org/resources/reports/Torbay_UF_Report.pdf [Retrieved 25 March 2013] []
  18. Hutchings, T, Lawrence, V and Brunt, A (2012). Estimating the ecosystem services value of Edinburgh’s trees [Online]. Edinburgh: Forestry Commission. Available from: http://www.forestry.gov.uk/pdf/Edinburghi-treereport.pdf/$FILE/Edinburghi-treereport.pdf [Retrieved 3 April 2013] [] []

Out of touch Tory

A few days ago the media reported that MPs had called for a 32% pay rise for themselves. The figure actually came from a survey of MPs conducted by the Independent Parliamentary Standards Authority, the body responsible for setting MPs’ salaries. BBC Radio 4’s PM programme dutifully rang round and found an MP prepared to give an interview on the matter—Andrew Bridgen, Conservative MP for North West Leicestershire. If you’re quick you can hear Mr Bridgen’s musings (about 33min 25 seconds in, or listen on AudioBoo), but for those of you that missed it here’s a brief transcript of a part I’d like concentrate on:

A man or a woman who’s very capable, doing well in their profession, whatever that may be, with a family, are they going to be willing to take that pay cut and look their children in the eye when it’s Christmas and you can’t have what you normally have because mummy or daddy wants to be an MP. Umm, there’s a whole load of people who will not be able to be MPs. You either have to have people who think that £65,000 is a lot of money, or people for whom £65,000 is insignificant, and the vast majority of the public are in the middle and they would struggle to be a member of parliament I think.

Setting aside the bizarre and emotive comments about children at Christmas let’s look at the idea that the “vast majority” of the public are “in the middle”, by which Mr Bridgen presumably means they neither consider £65,000 to be insignificant, nor do they consider it to be a lot of money.

If Mr Bridgen is talking about the national debt then I would be inclined to the view that £65,000 is insignificant, but it seems pretty clear from the context—a discussion about MPs’ salaries—that he is not. He is talking about salaries. On the first point, then, instinctively I agree with him. I have no evidence to back this up, but a hunch that if I were to do the research I would indeed find that the vast majority of the public do not consider £65,000 to be an insignificant salary.

On the second point, however, I think he just may be a little out of touch. Do the “vast majority” of the public really not consider £65,000 to be a “lot of money” in the context of salaries? Of course, I can’t go out and ask the whole of the public, but with a properly designed survey drawing on a large enough representative sample I could find out. And as luck would have, just such a survey exists.

Since 1983 the British Social Attitude survey has been conducted annually, involving in depth interviews with 3,000 respondents selected using random probability sampling to ensure that the results are representative of the British population. In 2009 the survey asked the question “What is a large income (per year)?”. And when the results have been appropriately weighted to allow them to be generalised to the whole population they are pretty clear.

82.7% of the British population consider £65,000 per year to be “a large income”.

Of course, “vast majority” is a somewhat subjective term, although objectively it must be greater than 50%. But I’d being willing to wager that if you asked the British public the vast majority would consider 82.7% to be a vast majority. And “a lot of money”, in the context of salary, is not exactly the same as “a large income”, but it’s as near as damn it.

This is just one MP and his views on one subject. It’s impossible to generalise from this, but it is pretty clear that on this issue Andrew Bridgen is completely out of touch with the British public.

He goes on to argue that

There’s no doubt that over the past 20 years MPs’ pay has not kept pace with the Civil Servants they were pegged at 20 years ago.

This statement too is somewhat dubious. It is actually not quite 20 years—MPs’ pay was pegged to that of senior Civil Servants following a full review of pay and expenses in 1996. In each year between 1996 and 2007 it increased by the same amount as the midpoint on the senior Civil Servants pay scale. Except for 2001 and 2002. In these years MPs’ got an additional £2,000 in their pay rise[1]. Since 2008 MPs’ pay has been linked to a basket of 15 groups of public service workers. It has risen by 1.5% since April 2009, a period over which there has been a public sector pay freeze. This blog suggests that over the past 20 years MPs’ pay has increased relative to the mean salary in the country. And data collated on the Guardian’s data blog suggests that between 1989 and 2008 MPs’ salaries as a proportion of the national mean rose by 9% (from 193% to 211% of the mean).

There may be good reasons to pay MPs more, but Andrew Bridgen certainly hasn’t found them, and frankly nobody with such a fragile grasp of facts should be paid as much as he’s being paid now.

  1. Kelly, R, 2009. Members’ pay and allowances—a brief history [Online]. Standard Note SN/PC/05075. London: House of Commons Library. Available from: http://www.parliament.uk/documents/commons/lib/research/briefings/snpc-05075.pdf []

Blood over breakfast

Browsing Facebook this morning as I munched my marmite I found myself faced with a photograph of the blood splattered bodies of Palestinian children lying dead on a pavement. It’s not the first time in recent weeks that friends have felt it necessary to remind me of what is going on in the world in such a graphic way.

Wars appall me. And the situation in Gaza is no exception. I do not need these photographs to remind how inhuman this violence is. I’m told that the pictures are being circulated because if this were on a street in the West we would all know, because the media is ignoring what is happening in Palestine and Israel. Are either of these claims really true?

If children where murdered on a street in Brighton, would we see their blood covered bodies on our TV screens? Would they be on the front page of the Daily Mirror? No, they wouldn’t. And they wouldn’t because to do so would be pointless. What happens to people when they see such images? They turn off, they turn away. Is that what you really want—to have people turn away from the plight of Palestinians?

Stop a moment and think about the most powerful war photograph you have ever seen. Got it? I’m guessing the vast majority of you are thinking of Nick Ut’s image of a naked girl running away from a nepalmed village in Vietnam. Why? What is it about this image that moves everyone who sees it? That sticks in their minds for years to come? There is no blood. No gore. The horrific injuries, that still scar the girl in the picture today, are not in shot. The power is in the emotion that is captured and the story that is told. Good photography draws us in. Makes us want to look again. Moves us in powerful ways, touches our humanity. Snapshots of dead bodies just make us turn away. Who wants to look at blood over breakfast?

Is the media really ignoring what is happening in Gaza? I think not. A few days ago I heard the BBC report that the number of Palestinian deaths had now reached 100. This statistic was poignantly followed with another clear, factual, unambiguous statement. Three Israelis had died during the conflict. A powerful message delivered without gore. Yesterday the BBC’s More or Less tore into some of the Israeli Defence Force’s casualty statistics (starts about 12:40 into the programme), and Owen Jones’ appearance on Question Time was hardly brushing the issue under the table.

There are powerful images too. Images that tell a story of human suffering without showing us blood and gore. Who could not be moved by the pictures of BBC worker Jihad Misharwi crying with grief at the death of his 11 month old son?

This is a conflict that is getting more coverage in the UK media than any other that doesn’t involve UK troops. It is not being ignored. Powerful messages that engage people are being made. But bloody images of dead children threaten to undo all that good and turn people off. Think before you share this horror.

Kicked when I’m down

Work is bit crap at the moment. My post has been ‘deleted’ and I’m ‘at risk’. In the initial round of redeployment two of us were competing for one post on my current grade, and I found out yesterday that I didn’t get it. I’ve been offered a rather less inspiring post at a lower grade instead.

Although I was expecting this outcome, and have even made plans for what I would do if it happened, it’s really hit me hard. Harder than I  expected. I feel quite numbed by the experience. The last couple of days have been a daze. But one thing has been interesting.

Several people have said things along the lines of “well this must seem like nothing compared to what you’ve been through”. This assumption has surprised me. If you’re beaten up badly one week, does that make being beaten up slightly less badly the following week any easier to bear? No, of course not. Particularly if the bruises from the first beating haven’t healed. In this case, it makes the second beating considerably more painful than it would have been.

And that’s the thing isn’t it? People assume the bruises have healed. And nothing could be further from the truth. It surprised me, though I’m told that actually it’s common, but the emotional bruises didn’t really appear until I found out that treatment had been successful. In the thick of the fear and uncertainty I coped by focusing on the next milestone, the next point I had to get to. But when I reached the finish line there were no milestones left to take my attention. That’s when the full force of the horror of the last year really hit me. That’s when the grief at what I’d lost surfaced, the anger at the unfairness of it all, the shock of the terror.

I may be cured of cancer, but that is no where near the end of the story, and those that haven’t been there really struggle to get that. It’s assumed that a successful end to treatment is a moment of joy. But it isn’t. It’s the moment at which you have the space to start to feel. It’s the place where you can stop focusing on staying alive and have to turn and face the reality of what has been taken from your life. And it’s a time when you really really want the pain to stop and for life to just get back to normal. Being denied that is hard to take.

The state and gay marriage

The British press is full of the debate about gay marriage at the moment. The religious right is horrified at the prospect that it could be made legal, whilst David Cameron has become an unexpected champion of the cause. I come at the question from a slightly different angle.

For years when people asked me when I would marry my stock answer was to quote Emma Goldman, the early 20th century anarchist and revolutionary

Love, the strongest and deepest element in all life, the harbinger of hope, of joy, of ecstasy; love, the defier of all laws, of all conventions; love, the freest, the most powerful moulder of human destiny; how can such an all-compelling force be synonymous with that poor little State and Church-begotten weed, marriage?

Marriage I saw as an institution of State and Church. If there is love I argued, what need is there for marriage?

Then one day I changed my mind. I realised that I wanted to get married. I’d found the woman I wanted to stay with and I wanted her to know that. But that desire had nothing to do with seeking the approval of Church or State for my love. What it had to do with was my partner and I.

Exchanging ringsMarriage to me meant making a clear commitment to my partner. It meant saying to her I love you, and I know sometimes it will be hard, but I know you’re worth it and I promise to work through things when they get tough. It meant telling the world about our love; making that commitment witnessed by those who are important in our lives. At our wedding we gathered together all of our friends and family to help us celebrate. But we didn’t invite the State. What’s it got to do with them?

Of course, like it or not, the State has a lot of power over our lives. Having your marriage recognised by the state has its benefits—inheritance, tax, pensions, perhaps residency. Pragmatically we did the minimum we could get away with to get those benefits, and popped down to the registry office with a couple of witnesses a few days before our real wedding. Dressed in our normal scruffy clothes, with no ring and turning down the offer of a reading, I don’t think the registrar thought we were taking it very seriously. Which was about right. We weren’t. We sought the State’s approval of our marriage grudgingly. We were there for little other reason than to clarify who gets what when one of us dies. Having to make the extra effort to do that was an irritation. It was a practical business deal, and if the option of civil partnership had been available to us then we would probably have preferred that.

What really mattered came later. In a very personal ceremony in an orchard in Herefordshire we declared our love to each other, made our commitments and celebrated with those who matter—our family and our friends. That was our wedding. The nurturing, loving relationship which has held each of us through the ensuing decade and through some difficult times is our marriage. And neither Church nor State has any part in that.

Irrespective of the sexuality of the partners, there is no place for the State in marriage. Marriage is between those who marry. The State should concern itself only with the practicalities, which it should do even handedly without any regard for sexuality. Whether gay or straight, the state should abandon any pretence at having a role in marriage and leave marriage to those who are in love.

What’s that on your lip?

It’s a moustache. I’ve decided to take part in Movember, an annual campaign to raise awareness of, and cash for, men’s cancers by growing a ‘tache.

Regular readers of this blog will know that in May I was diagnosed with prostate cancer. Actually I suspect regular readers of this blog would have known that even if I hadn’t mentioned it here, since pretty much all regular readers are my mum. In September I had a radical prostatectomy—my prostate was removed—and last Thursday the consultant told me that the histology looked very good. All the signs are that the cancer has been removed from my body. There are more tests to come before I can be certain, but for now, let’s assume that I’m cured.

My mo

7th Movember

It’s been a rocky road getting here. To start with, there was the coming to terms with the idea that I have cancer. And then some difficult decisions.

Option A is reputed to have the highest chance of no recurrence, but only by a tiny margin. Besides, the problem with studies into recurrence rates at 15 years is that they necessarily study treatment techniques in use at least 15 years ago, so the reality is that you’re going in blind in terms of long term success rates. Option A also causes urinary incontinence—usually short term—and carries a high risk of permanent loss of erections.

Option B has a slightly lower risk of not getting it up again, but a significantly higher risk of bowel damage resulting in faecal incontinence.[1]

Tough choices. And not just for men, but for their partners too. Consider it women, what would you prefer? A total change to your sex life, or never accepting another dinner party invitation for fear your bloke will poo his pants half way through the evening?

So, that’s my motivation then? I’m growing a mo so that men in future will never be faced with these horrible choices because they were vaccinated in their teens and prostate cancer has been eradicated?

No. Get real. That’s not going to happen any time soon.

OK, so that men will not be faced with these choices because the Urologist will just hand them a prescription and say “take one of these three times a day for a fortnight and you’ll be right as rain. I’m afraid there’s a risk that your erections will be an inch or two bigger, but we can probably treat that if it’s a problem to you”?

Nice fantasy, but no, not that one either.

I’m decorating my face and spending a month looking a complete pillock so that men will be faced with these difficult choices in the future. Because around 10,000 men each year in the UK don’t have a choice of treatment[2]. They discover they have prostate cancer too late. It kills them.

It feels a very strange thing to say after being diagnosed with prostate cancer at 47, having had my fitness, my self esteem and my love life shattered by the treatment, but I was lucky. I caught it early and I’ve probably been cured. And it’s the catching it early that’s the key. Caught early it can be cured. But let it spread and things look a lot worse. Prostate cancer has a strong preference for spreading into the bones, and once it’s there, it kills.

So I’m growing a mo this month to give me a chance to say “Guys, don’t ignore this”. Problems with your boy bits are scary, and it’s all too tempting to bury your head in the sand and pretend nothing’s happening. Don’t. Find out about the symptoms. Talk to your GP about check ups. Never ignore strange changes—it may be nothing, but get it checked out.

The choices I’ve faced were shitty, but a shed load better than dying.

Of course, a little bit of extra money for research into better treatments wouldn’t go amiss either, so do visit my Movember page and sponsor me.

  1. Of course, these options are a gross simplification. If you’re faced with these choices, don’t rely on anything on this page—talk to your specialist []
  2. Source: http://www.cancerscreening.nhs.uk/prostate/statistics.html []

Pants and prostatectomies

They tell you a lot of stuff around a prostatectomy—before, during and after. Well not actually during, hopefully you’re fast asleep during, but definitely before and after. They talk about incontinence and impotence and pain management and deep vein thrombosis and catheter care and all sorts of other stuff. But nobody mentions pants[1].

Which is bad. Because there’s a lot you need to know about pants if you’re having a prostatectomy. Here’s what I’ve learnt,  in the hope that it might save some of you the pain of having to work it out for yourself.

Forget boxers. Boxers are bad. By which I mean the loose type. And that’s the big thing to know. Somewhere you’re maybe thinking “after all that surgery, I want loose, comfortable clothing”. No you don’t.

You’ll leave hospital with a catheter in. And probably with instructions to try to move, to go for a walk each day. You might think loose pants are good because they won’t trap the tube. That’s the least of your problems.

The thing is, when you go for a walk in loose, comfortable pants your willy swings about. And the tube that’s stuck in it swings about. And with each little swing it rubs a little. And before long the inside of your willy is getting mighty annoyed about this and decides to let you know the only way it knows how—by really hurting. Wear tight, close fitting pants. It’ll save you a lot of pain.

I didn’t work this out until the day before my catheter was removed, not until after a long walk around a local park. Fortunately, when my wife had collected me from hospital someone had left have a tube of lidocaine containing gel on the table by my bed, and she had the forethought to figure it might come in useful…

Once the catheter is out you’re going to pee yourself. Hopefully not much and not for long, but it’s going to happen, and nothing anyone says to you beforehand will prepare for just how humiliating this feels when it does. So you’re going to need pads. And pads are no damn use in loose pants. Once again you’re going to need something close fitting.

Close fitting pants come in a variety of designs. Which is best? All of them. No, that’s not any of them. It’s all of them. Make sure you have lots of different pants. Why? The pant wearing is relentless. There is no respite (OK, the bath, but how long can you spend in the bath?). You’ll be wearing pants all night as well as all day. And the pressure of the waist band on the wound really starts to irritate. So stock up on pants. Each time you buy pants in the run up to surgery, ask yourself these things:

  • Are they close fitting?
  • Is the waist band in a different place to all the other pants I own?

If you can answer yes to both questions, these are good pants. Even if they have a fuzzy, pink ‘My Little Pony’ design on them. Forget the look. Go for comfort.

  1. American readers please note: I’m British. ‘Pants’ to me are smaller and worn closer to the skin than your pants. This article is about underwear, underpants []

Call popups with Asterisk and Thunderbird

There are several applications around for Windows users that offer popup notification of incoming calls to an Asterisk server, looking up the caller’s name in various Personal Information Managers (PIMs). Since I don’t use Windows, they’re not much use to me, so I wondered if there was anything available for Linux.

A Google a while back threw up this script by Olivier H. Beauchesne which looked promising. It does part of what I wanted—it generates a popup notification of incoming calls, but it makes no attempt to look up the name of the caller.

I considered writing something as a Thunderbird extension, but there seemed to be a couple of downsides to this approach:

  • From recent experience of working with Thunderbird’s address book for a click2dial extension I knew that it doesn’t lend itself well to look ups keyed on phone numbers
  • I wanted something that would always be running, irrespective of whether or not I’d fired up Thunderbird

I decided to have a go at hacking Olivier’s script, quite ambitious considering I’d never written anything in Python before.

It didn’t actually take much to get it to look up incoming numbers in a SQLite database. I then wrote a dirty Perl script to pull all the phone numbers out of my Thunderbird address book and populate the database. The Perl script was way to ugly to share and I always intended to tidy it up, but just never found the time. Until now.

callPopPy in action

callPopPy in action

A prolonged period off work sick has driven me to looking for things to keep my mind occupied, and so I’ve returned to this project. The Perl script has been scrapped. In it’s place I’ve written a Thunderbird extension named Squalit, a much neater solution. Squalit can export a single contact or an entire address book to the database, and can be configured to update the database periodically, ensuring that call popups and Thunderbird are always in sync.

I then turned my attention to the popup script itself. The original relied on libnotify and its Pyhon binding, pynotify. These are only available on Gnome based Linux distributions such as Ubuntu. I thought it would be useful to make everything more portable, so rewrote it to use a library I stumbled across by Daniel Woodhouse, gtkPopupNotify. After a fair few other changes I was left with a distant descendant of Olivier’s original script, which I’ve called callPopPy. callPopPy is portable enough that I’ve had it running on a Windows XP machine, and is doing just what I wanted on Ubuntu. The advantage of the two stage approach is that other utilities could be written to integrate callPopPy with other PIMs.

The combination of TBDialOut for click2dial with Squalit and callPopPy for call popup notification provides me with great integration between Thunderbird and my Asterisk server—I guess this is what is meant by CTI.

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