I really enjoyed the Sunday night session. I have been looking forward to it for months, the idea of Robb Johnson and Roy Bailey on the same bill, magic!

Al Baker was on first, a young man just out of Manchester University, radical, angry, zealous, but also funny and not a little charming. I particularly enjoyed the song, "I wish I had a Mohican", about the indignities of a Socialist falling in love with a young Tory girl and "Till the Fences Fall". He wore a black hat which reminded me very much of Boxcar Willie if such comparisons are allowed?

Tracey Curtis astounded the whole audience, by appearing to be aged about 16 or 17 yet telling us at some length about her four daughters and about her history years ago in a punk band! She sang lilting, melodic, haunting songs, some for her daughters, (This is Rosas Happy Song particularly delighting the audience) and another song which I did not get the title of, which went along the lines of I am not proud to be British but I like the town I live in and the people who live there which made reference to the many ways we can hurt each other, including war and unfettered capitalism.

Robb Johnson was on very good form, he did say at one point that he was not very famous, but he must be wrong there, he has always been famous in my household. We are Rosas Lovely Daughters rings out on a very regular basis for instance. And whenever I have seen Roy Bailey he always does at least one Robb Johnson number. I particularly enjoyed No-one Wants to Look Like You (Jack Straw) and you could not help being moved by his song about the Liverpool football tragedy at Hillsborough. We did our best to get the butterfly/chaos theory going, in the skies over the Picket, by joining in with a song called Up the Workers, hoping to encourage our Lady of Grantham to go to a better place. He came off stage about 10.30pm to set-off back to Hove to be ready to go back to work on Monday morning that is dedication!

Roy Bailey is an old favourite of mine, and of many in the audience too. He is now 73 and getting a bit forgetful with some of the lyrics (although he had us wiping laughter tears away as he talked about forgetting the names of things and forgetting what he was going upstairs to collect and sometimes even forgetting whether he was on his way up or down the same stairs.) I particularly enjoyed his rendition of Crawford Howards parody of Willie McBride which he sang unaccompanied. This is not a skit of anti-war songs, but a skit on all the people who insist on singing it in pubs when they have had too much to drink and are maudlin and thus have turned it (according to Crawford) into the kind of song you never want to hear again. I was hoping for You cannot break the oath of a Tolpuddle Man but sadly it was not to be. He was funny, wise, warm and very well-received, a good half of the audience gave him a standing ovation and he delighted with Rolling Home for his encore.

He is having a concert in October to celebrate his 50 years in the business, more information here.

I sat next to a guy named Boris who told me he had come all the way from Switzerland to Liverpool for the weekend, just to attend the festival and had been to Friday night and Saturday nights performance. He really enjoyed it although was a bit concerned that there were only two women out of the 15 or so acts he saw. Perhaps we women politicos need to learn to sing and write songs, or else we need to politicise those who are already doing it. He was very impressed with Liverpool and had flown straight to JLA from Switzerland so perhaps there is a new route there we can exploit.

I was also pleased that Richard McLinden came along with his colleague El, I didnt see any other elected politicians, from any parties, but perhaps the politicians dont have a history in Liverpool of engaging in musical solidarity or musical protest? I guess I have been a bit spoilt because as a close friend of Cath Ingham I have been taken along to see Raise Your Banners in Sheffield, Holmfirth Folk Festival and singer song-writers like Roy and Robb for years. I have also seen Roy with Tony Benn on the Writing on the Wall tour at least three times, including once at Labour Party conference in Blackpool about 15 years ago. I bought 8 copies of their double cassette tape in 1996 and every friend had it from me for Christmas that year, excellent I can highly recommend it if you have not heard it! I expect you can get it on CD these days.

All praise to Alun Parry for organising the weekends festival and Phil Hayes for hosting it, lets hope it can become an annual event.

It was an uplifting event and gave my socialist faith a much-needed shot in the arm.

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The Chinese have a proverb: "May you live in interesting times." And we are living through interesting times indeed.
Whatever the political posturing regarding the current rescue plan, a plan needs to be passed. Credit markets are frozen and banks are going bust every day. This is not totally because of "toxic" mortgages. This has a lot to do with FASB 157, also known as "mark to market".

Each day lenders must mark their assets to the marketplace. It's like you having to appraise your home everyday and if your neighbor was under duress because they got very ill, divorced, lost their job and was forced to sell their home quickly they may have sold it super cheap. Now, does that mean your house is worth that super cheap price? Clearly not. Why? Because you are not under duress. You have the time to sell your home and get a more normal price, which more accurately reflects true market conditions. But "mark to market" does not allow for this, which creates a vicious cycle.

Why is this so bad? Because as lenders mark down their assets, the amount that they have loaned previously becomes much riskier in relation to their assets. For example, say a bank has $1 million in assets and say they have $15 million in loans outstanding. Their ratio is an acceptable 15 to 1. But should they take a paper write down of $500 thousand due to "mark to market" requirements, their ratio suddenly changes to 30 to 1. This is because their assets are now only $500 thousand after taking the paper loss, while their loans outstanding are $15 million. And at 30 to 1 this bank is viewed as a risky investment. So the stock price starts to get hit, it becomes harder to borrow, and most importantly harder to make money. The bank is then forced to sell some of its loans to reduce its ratio...at cheap prices. And this makes the vicious cycle continue.

And a quick look at the holdings of these loans show that 95% are problem free. Additionally, the Credit Default Swaps (CDS) that are used with the pools of mortgages are relatively safe. But this requires a bit of understanding. You see, when a pool of mortgage loans is put together, it isn't just A paper or B paper etc....it's everything. It's got some A paper, B paper, C paper...and even what looks like toilet paper. An "A" investor buys the whole pool but because they are an "A" investor their safety is greater because they can avoid the first 20% (an example) of defaults. So they own the whole pool but are sheltered from the first batch of defaults, and for this they get the lowest rate of return. As you can figure from here the more risk investors want to take, the higher the return. So the investments are relatively safe, but the accounting rules currently place undue pressure on the banking institutions.

Now add to all this, the opportunistic "shorting" done on the financial stocks, much of it illegal because those shorts did not legitimately borrow shares (called naked shorting), and you exacerbate this whole problem. Thank goodness for the recent temporary ban on shorting in the financial sector. As for the plan the government is the only one who can step in to do this. And they have to do this. And they will do this. The nauseating political posturing from both sides is just part of the process.

This is not easy to understand for the general public. In fact most politicians don't get this either. That's why it is a difficult yet critical bill for them to vote on.

Once this is done it will take some time but the markets will stabilize. As for the real estate and mortgage industries, it will take a bit of time but we will make it through this. Rates will remain attractive and the influx of credit availability will help the housing market gradually improve. This ultimately will be the medicine needed to improve the situation overall.

As always - please keep in touch, especially during these volatile times. I am here to help you in any way that I can.

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www.aacr.org. Commentary on clinical trials:The American Association for Cancer Research aims to educate the public
about what a clinical trial can offer and ensure people know all of
their treatment options, including clinical trials, at the time of their
diagnosis. Through this process patients can make an educated decision
when choosing their course of therapy with their doctor. - Raymond N.
DuBois, M.D., Ph.D. President, AACR and Provost and Executive Vice
President of Academic Affairs, M. D. Anderson Cancer CenterThe challenge is to make patients and healthcare providers more aware
of clinical trials. While more funds for research are needed, progress
also requires more participation in clinical trials. - Gwen Darien,
Director of Survivor and Patient Advocacy, AACRCancer patients need to ask their doctors about clinical trials. Its
important to be proactive and find out about treatment options and
decide which is right for you. - Connie Mielich, cancer survivor and
clinical trial participantThe care I received while participating in a clinical trial was the
best Ive ever had. The healthcare providers were very attentive to my
needs. Some patients may have reservations about enrolling but I advise
people to ask their doctor about clinical trials and discuss it with
their loved ones. - Connie Mielich, cancer survivor and clinical trial
participantAbout the AACRFounded in 1907, the AACR is the worlds oldest and largest professional
organization dedicated to advancing cancer research and the prevention
and cure of cancer. The membership includes more than 28,000 basic,
translational, and clinical researchers, healthcare professionals
cancer survivors and advocates in the United States and 80 other
countries. AACR marshals the full spectrum of expertise from the cancer
community to accelerate progress in the prevention, diagnosis and
treatment of cancer through high-quality scientific and educational
programs.i Harris Interactive survey - data on file
ii CISCRPs 101 Facts About Clinical Research: Treatment Cures of
Disease. The Center for Information Study on Clinical Research
Participation. July 2007.

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, chief of staff for Force Health Protection and Readiness, weighs in with lessons learned from the military's response to these storms.
Hurricanes Ike and Gustav:
Real-Life Application of the Joint Force Health Protection CONOPS
The winds of hurricanes Gustav and Ike have died down but work in the aftermath goes on. Part of that work is assessing what assistance was provided by the Military Health System (MHS), what went right and wrong with that assistance, and how we can do better in the future. One thing is for sure, in addition to all the other missions of the MHS, hurricanes will keep coming and we will keep being requested to assist.
 
What does hurricane response have to do with the Joint Force Health Protection concept of operations (JFHP CONOPS)? Plenty! Although I’ve only recently studied the JFHP CONOPS, I’ll bet very few of you have—largely due to the fact that it was only recently drafted and published. As a very brief primer, JFHP is organized into six functional focus areas:
 
1. Human performance enhancement
2. Health surveillance, intelligence, and preventive medicine
3. Command and control
4. Patient movement
5. Casualty management
6. Medical logistics and infrastructure support
 
Simply put, the JFHP CONOPS examines the future warfighting context and characteristics of the future joint force in order to characterize future required medical capabilities. As I read through the CONOPS document, having recently returned from an on-site visit to the hurricane response area, I saw how effectively the document is organized and how it lays out a process for continual improvement for all types of missions, from the War on Terror to responding to disasters in CONUS.
 
Alright, enough of the CONOPS lead-in—back to the hurricane situation. Here is a summary of what we did, how well we did it, and how we can do better in the future:
 
What the MHS provided
· Leadership advice and guidance. Through the NORTHCOM Surgeon’s office, we have a nationwide array of 14 Joint Regional Medical Plans officers (JRMPOs). All available JRMPOs were mobilized to coordinate and synchronize state and Federal ESF-8 capabilities.
· Patient movement. Both within and without the National Disaster Medical System (NDMS), aeromedical evacuation units from Active Duty and Air National Guard units moved approximately 473 non-ambulatory patients out of harm’s way.
· Medical support to general evacuation effort. The Air Force’s San Antonio-based 59th Medical Wing provided medical screening and emergent care to the thousands of people evacuated from the landfall areas. 
· Medical logistics. Through the ARNORTH emergency operations center in San Antonio, the right military medical materiel was provided to the right place at the right time.
 
What went right
· The JRMPOs provided the unique “glue” that bound the interagency effort. During my trip to Texas between the hurricanes, every single agency representative I met requested more of these valuable officers.
· The Texas Military Forces, ably led in the medical context by Joint Surgeon Colonel (Dr.) Connie McNabb, proved capable of augmenting—and in many cases, replacing—Federal response assets.
· Personal initiative at all levels effectively erased policy shortfalls and ensured that patients were moved safely and quickly.
· Operational communication between military medical response experts at all levels (e.g., OSD, NORTHCOM, ARNORTH, and Texas Military Forces) provided effective situational awareness.
 
What went wrong
· The NDMS does seem adequately user-friendly to state and local medical officials.  Additionally, it does not apply to non-ambulatory patients in facilities other than hospitals (e.g., nursing homes and hospice care). Therefore, I believe we dodged a bullet so far in this hurricane season; our success is as much due to the relatively small numbers of patients requiring evacuation rather than to the effectiveness of the system.
· Medical response policies of certain interagency partners (e.g., DoD/TRANSCOM, HHS/NDMS, and DHS/FEMA) are not sufficiently interoperable to ensure seamless operations.
 
How can we improve?
· First, and perhaps most important, we need to ensure that our DoD response policies are coordinated with all agencies, both internal and external to DoD.
· We also need to lean forward to proactively work with our interagency partners on improving Federal policies. A salient example is patient movement. Whether by air, rail or bus, and whether by NDMS or non-NDMS assets, we need to do a better job of preparing to respond.
 
As of this writing, we are already taking steps to move out on plans improvement. Dr. Casscells and Ms. Embrey have empowered us to host several meetings to lead this process of policy integration. The first will be an After-Action Review of senior action officers of the MHS to identify issues and workable solutions, whether in the domains of doctrine, policy, operational guidance, or training. The second meeting will include our intergovernmental partners to review, revise, and integrate Federal policies and guidances to operationalize those improvements before the next hurricane season.
 
To conclude, I must briefly return to the JFHP CONOPS document. Its central theme is Protect the Force, Enhance the Mission. That’s a deceptively simple statement—one that elegantly sums up the strategic objective of all military medical forces. If I’ve been successful in anything during this blog entry, it’s that 1) the MHS provides a unique and vital service to our country—as was demonstrated during our response to the hurricanes, 2) no matter how good we are at providing that service, we can always do better, and 3) the Joint Force Health Protection CONOPS document is an excellent reference in understanding your role in the MHS and how you can contribute to its improvement. I’m attaching the document for those who are (or should be) interested.

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www.deloitte.com/us/humancapital/ )
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Over the past few weeks, I have discussed the challenges governments face in balancing the needs and expectations of the individual being served, the collective needs of society, the concerns of taxpayers, and political agenda of government.  To provide context for these challenges, I have shared insight from our recent Global Cities Forums (GCF) which focuses on what citizens are actually saying about what they want and expect from their government and how it should improve the quality of their lives.  We have just completed a Canadian GCF program in Toronto and over the coming weeks I will talk more about what we have learnt from this process and how governments can better respond to citizen needs and improve interaction through a renewed focus on public service human capital.
 
I believe there are two essential components of public value: outcomes and human capital.  As I recently discussed on this site, in measuring outcomes we shift the focus away from measuring outputs such as exam results, arrest rates or hospital wait times to measuring improved learning, public safety or health for improved public service value that meets citizen needs.  However, our research shows that to truly create public value, government organizations must align human resources with desired outcomes.  For example, we found that high performing governments work hard to engage their workforce through realignment and more targeted performance measures linked to outcomes.  In doing so, these governments ultimately succeed in improving social outcomes for citizens.   
 
Firstly, our research shows that high performing government organizations continuously review their ways of working, reviewing the structure and skill sets of their workforces to ensure that they are operating at an optimum level to deliver benefits to citizens and communities. As a result, high performing governments will challenge and change the configuration of their workforce to continually improve public value.
 
Secondly, we found that a robust performance management system is key for public service value creation.  To ensure that performance management is effective, our research shows that it must be bound to an organization’s mission and outcomes, including responding to citizen needs, and to be intimately linked to its strategy.  In doing so, managers, executives and staff can work together to develop performance related metrics which result in improved outcomes and a better experience for the citizen.
 
Finally, we concluded that even with a well aligned workforce and performance frameworks linked to outcomes, successful public service value creation rests largely on an organization’s performance culture.  It is one thing to have outcomes, strategies and operational plans in place, it is quite another to have the behaviors, beliefs and attitudes that will realize these with a sense of purpose, ambition and enthusiasm.   
 
To put this into context, we can see how the Ontario government has changed its approach to improved citizen services.  Service Ontario recently introduced “money back guarantees” on birth certificates if not delivered within 15 days.  To meet this objective, the government had to realign its workforce and internal performance mechanisms to make this priority a focus area for staff and enable them to reach a new goal. By using ‘pizza delivery’ philosophy, the organization was able to work through processes, become culturally challenged and stay focused on outcomes.
 
I will continue to expand on these research findings and go into more detail on the potential to improve citizen outcomes through a government focus on human capital.  As I prepare for these discussions, I am interested in understanding from you how you think governments can more effectively align and engage their workforces for improved citizen outcomes, or how the culture of government organizations can impact citizen results.

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