“Underground Tokyo”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Greeted in the hotel’s 16th floor lobby by our guide for the day, Miwako — call me “Meewa”; nice lady, very good English.   How did she spot us?   Maybe we were the most casually dressed —- or just taller than most around us  —– or the most obviously bewildered ?

After a brief introduction, we headed off to the underground station.   All 5′ 2″ of Meewa leading the way at a fast pace, with her two black clad minders strolling along behind her like obedient camp followers.   When we get to the subway station, our obedience becomes ever more attentive as Meewa weaves in and out of the crowds of morning commuters.   Getting lost down here is not an option.   The Japanese signs are all indecipherable and the English translations are unpronounceable.   Meewa’s suggestion to follow the green symbols would be ok if we could spot them, but in this melee there is no chance.    So we hang on to the sight of Meewa’s fast disappearing white coat.

When we get to the platform, its narrow and full; every inch of the side wall has a body pressed against it like wallpaper.   We find an alcove where there is a little room to form a queue behind our leader.   As the train arrives the doors open on an already full train.    No-one gets out, and with a big slurp the train sucks the wallpapered bodies off the tunnel walls and into the even fuller train.    We squeeze in behind.    Sardines couldn’t do any better!

Once inside, its standing room only, with handles drooping from the ceiling for people to steady themselves, although there is no chance of falling over.    The handles are just at the right height for Tom and I to bang our heads on them as we pass each one.    Maybe now we can see a reason for masks — one sneeze and hundreds of people will catch a cold !

After several stops and a change of train to a slightly fuller one.   We reach our destination and the escape from the underground burrow begins as Tom and I chase the rabbit in the white coat.

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“First Steps in the Ginza”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

The first day in Japan is still not over and at 3pm we venture out onto the streets outside our hotel in the Ginza area of Tokyo.

A bewildering mixture of people, unreadable signs,

luxury designer label glitzy shops,

restaurants with windows full of plastic plates of food, sushi everywhere, lots of noodles.

Bars with stairs leading up to the first floor or down to the cellar, but if they are on the ground floor, they have solid doors so either way you can’t see what you might be walking into.  It is similar to the hotel entrance but you’re less confident of the outcome.

A queue out of nowhere, at least a hundred yards along the pavement outside some big shops.  Must be a sale – but no, when we reach the front of the queue – NOTHING.

Walking by on the pavements are lots of small people – men average around 5′ 6″ – women more around 5′ 0″ and most women do not have high heels. Most of the men are in suits and ties.  The women are much more varied – most with coats (it’s a cold, spring day) topped with scarves or shawls/throws, nearly all with boots either knee or angle length.  Many of the ankle boots are topped with frilly lace or animal fur.  Younger girls often wear socks to the knees.  Overall there is a smartness about the place – jeans and open neck shirts don’t seem to have blessed Japan yet.  Very occasionally you see a kimono which looks very elegant.  Just once I caught a glimpse of an elderly couple both in kimonos.

There seems to be very few tourists, certainly not European or American.

The biggest surprise was to see lots of people walking towards you wearing a large white surgical style face mask.  I had already heard about it before I came, but it is still a shock to see so many people with them.  You see them outside and inside shops and offices.

Explanations given to me include:-

  • Protection against pollution
  • Protection against getting infections
  • Protection against giving infections
  • Protection from pollen
  • Providing modesty for girls

None seems very convincing for such a dramatic appearance.  Yet at least 30% of people seem to wear them.  Strange!

I did see one green mask on a man who I suppose could have been a travelling surgeon.  I also saw one girl with a very fetching leopard skin mask who must have been a model I guess.

End of a very tiring first day in Japan.  Brain scrambled and befuddled.

MAYBE I IMAGINED IT ALL ?

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Japan — Stranger First Impressions

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Our Tokyo hotel is the Mitsui Garden Hotel in the Ginza district.  You enter through an uninviting closed solid panel door at the bottom of a 24 storey office block.  It opens automatically when you approach, but no concierge is at the door to greet you , just a starkly bare and small lift lobby.  One “up” button on the outside of the lift and inside just one button with “16” on it.   A controlled and controlling entry.

The lift opens onto a spatious lobby on the sixteenth floor, with a panoramic view of the city and Tokyo bay.   A brilliantly set up piece of design !   The reception counter is minimalist  —  a brown topped counter, with no clutter to be seen anywhere.    Three reception staff who must be related to the taxi driver — black trousers, white shirt, black jacket, black ties  — no white gloves.   Check-in only takes a few minutes, then with a smile and a bow of the head, you are presented with a plastic card and shown to a second lift.

The second lift lobby is as stark as the first, except the lift has more buttons and there are three lifts.   Only problem is none of them work 😦 not until you realise that you have to use your plastic card to summon the lift 🙂  Tommy San, who is practically Japanese by now, quickly realises this is a proximity card.   (We are both jet-lagged after 20 hours of travelling and a nine hour time change.)    Then the lift doors open  — in we get — more buttons 16 to 24.    We press 19, but the lift is broken again  😦   the button lights up but the lift does not move  😦   The lift does speak to us, but it is not helpfull as it is in Japanese  😦    Then Tommy San realises that we have to use the proximity card again  🙂    I’ll bet no-one breaks into Japanese banks.

Up on the 19th floor we arrive at our rooms.   Tommy San is into his straight away.   I take a while to understand that swiping the card doesn’t work.   Inside the room the magic card becomes a light switch.   I have seen this before, so it wasn’t a surprise.    Except that there are no other light switches  ?????    Eventually I find one for the bathroom, but once inside that’s a whole new technological adventure.    The loo has a control panel like I imagine the cockpit of the space shuttle.   Only the instructions are all in Japanese —  an inconvenient convenience.    A simple chain with a pull handle would have been good enough for me.   The control panel also has pictures, but I don’t know what they mean either  😦     I decide to press the one with a capital W.    This turns out to be a bad idea, because a fountain of water spurts out of the toilet.    Thank goodness I wasn’t sitting on it at the time !   I only manage to  stop the fountain by pressing another  W.    By now the toilet is fully illuminated and the seat is getting hot.    It is only a matter of time before we go into orbit.   I don’t figure out how to flush the loo until I accidently lean on the control panel, at which point there is a loud  WOOSH.   This must be the take off.    Several days later I am still learning how to drive the loo.

One more surprise came with another anonymous button, with a clue in English  —        ” Press this switch to enjoy the view” — curosity got the better of me.  With one touch I am standing in the bathroom as the opaque glass window becomes transparant and I have a view onto the world outside my bedroom window.   Fortunately there is no-one looking in from outside the 19th floor !   Although I do wonder if there are lots of telescopes in the distant office tower blocks ?

And this is still the first day !

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Japan — More First Impressions

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Travel from Narita Airport, 40 miles to Tokyo centre by limosine.  Except it is not a limosine, it’s a coach — no horses — just the posh bus variety.   Still it has a uniformed driver in white gloves and an assistant to load your luggage.   The journey takes about an hour, mainly on a motorway with high walls and fences on each side, so not much to see.

Observing the vehicles on the motorway, they are nearly all Japanese.  Quite a contrast with the UK, where most cars are foreign made.  The number plates seem odd, as they only have four digets — you would think they would need at least seven like the UK, given the zillions of cars made by Toyota and Nissan.

Eventually we arrive at the coach drop off point, which proves conclusively that it is no limmo, as we now have to get a taxi to our hotel.   So we drag our suitcases to the nearest taxi rank, which is inconveniently located on the opposite side of a busy dual carrigeway. There we are met by another man in a uniform and white gloves, who organises us into a queue.

When we reach the front of the queue, our taxi driver pulls up, gets out of the car to load our cases — and Number One Son starts talking to him in  Japanese !  I am already tired and jetlagged, now I am completely befuddled.  Tom has been learning to speak Japanese during the last 12 months and waited until this moment to surprise me.  BRILLIANT.

Smartly dressed taxi driver in an informal uniform — black trousers, white shirt, black waistcote,white gloves.  Not at all like the casualness of UK cabbies.  His car doors opened and closed automatically.  The interior of the cab was sparklingly clean and rather strangly draped in lace — like grannies antimacassers on the sofa.

                                                               A  strange  start.

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“Tokyo – First Impressions”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Tired after an 11-hour flight, and a sleepless-night journey over the North Pole.

Quick and easy passage through customs – 5 minutes for finger printing and a photograph – no fuss, no suspicion, a polite smile from the Customs Officer.  (what a contrast with America ever since 9/11 – where now you are made to feel guilty and unwelcome before you enter the country – that dispicable act of terrorism has put a nation on the defensive in a way that is not at all American).

Instant baggage reclaim, followed by a cursory baggage check.   Just questions, no search (although Number-one Son had prior instructions from me to take off his Rayban dark glasses and Michael Jackson fingerless gloves!)   Then on to meet and greet a smartly dressed Mr …?….  (missed the name – I was not paying courteous 100% attention).

First step is to rent a phone – my old Nokia doesn’t work in Japan.   Two very helpful assistants speak good enough English to explain how the phone works  (which English people back home fail to do – is it my fault that I wasn’t born with a mobile phone stuck in my ear?)   When I take a deep intake of breath at the £5 a minute charge to phone home, both  shop assistants and Mr …?….  politely suggest I go and check out one of the other half dozen phone shops.   Not having intended to complain in the first place I do a quick 180° turn and sign on the dotted line.    I’ll bet ET didn’t have these problems.  🙂

Next step is the Japan rail card.   We must convert our pre-paid voucher into  JR Cards (Japan Railways) and get tickets and seat allocations for all our planned journeys.

The first thing that was different was that Mr ….?….  left our bags on the trolley outside the JR office – unattended – what implicit faith in the honesty of the Japanese.   I had been told stories before about the lack of crime in Japan, but both Tom and I kept looking over our shoulders to see if the bags were still there – they were !

Now back to the rail tickets and Mr JR office man  –  no stetson hat included.  Mr …?…. explained to Mr JR our full 5-day rail pass itinerary minute by minute, day by day, station by station.    Mr JR handwrote it all down with two pens taped together – one black and one red.    The black one for his notes of Mr ….?…..’s instructions, the red one later for a flourish of ticks to show that everything was checked.   Poka-Yoke  — mistake proofing on daily display.   ( Tom thought I was kidding when I used this term,whichI learned from Sid Joynson, but it was evident everywhere we went.)    Then each journey’s batch of notes were stapled together with another sweeping gesture.

Now comes the automated bit, surprisingly late in the process for this most high-tec of countries !   Mr. JR goes over to the ticket machine that must control the whole of Japanese Railways.   After a few minutes of data entry and printer wurrrrrring, he returns with a fist full of tickets.

His next step is to complete the JR RAIL PASS  –  the golden key to free transport the length and bredth of Japanese Railways.  All done by hand and checked with us again. Then journey by journey, ticket by ticket,  Mr.JR rehearses all our steps —- train by train,   coach by coach,   seat by seat,   station by station,   minute by minute.   Mr. …?…. interjected to say that trains are all on time ” one minute late – NO TRAIN “.  I sense they think that we might not be all that punctual.  We are on holiday after all.

The tickets were then placed in separate envelopes for each journey and handed to us with both hands and a bow.  The final sign-off flourish was done with an old- fashioned rubber date stamp and an ink pad.   A throw back to bygone years, in this land of advanced technology.    STAMP,  STAMP, STAMP, STAMP,  like a 21 gun salute to signal the issue of another JR RAIL PASS.

  As we leave MR. JR tells us —  at the station to present our JR pass to a real man in a ticket boothe and not to use the automatic machines. “Men are much better than machines – machines are not as good as men”  he says with a smile.

Anywhere else this twenty minute meticulous and repetitative approach would have come across as mindless beaurocracy.  In Narita Airport, it left you with an impression of incredible customer care !

                                         Thank  you Mr. JR   and Mr. Yoshida.

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“Japan Odyssey”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

An Introduction

My interest in Japan began 17 years ago in 1995, when I first came across a book called “Sid’s Heroes”.   At the time I was hungrily devouring management books, searching for better ways to lead The ExtraCare Charitable Trust.   I read the book from cover to cover in one weekend  –  I could not put it down!   Within weeks I booked to go on a 5 day training course run by Yorkshireman Sid Joynson on Japanese management techniques.   It began a  friendship with Sid that lasts to this day.

Sid’s teaching greatly influenced the way I went on to manage ExtraCare.   In our formative years at ExtraCare, Sid ran many training courses for ExtraCare to pass onto hundreds of staff the quality improvement techniques of Kaizen and Taozen.   They see the frontline staff and residents themselves as the “experts” and give them tools to improve every aspect of  service delivery.   Goal setting and performance measurement became essential management processes in the Trust.

That chance finding of a book on a shelf is what ultimately enabled The ExtraCare Charitable Trust to lead a transformation in the way housing and care for elderly people is built and managed in the UK.

A THOUSAND THANKS SID

On my retirement in 2010, I was delighted to be  given the present of a trip to Japan.   Over the following  weeks I will publish a thread of blogs describing my experiences during a 10-day trip with my son Tom made in March 2012.  They will be illustrated with photos I took and with some of Tom’s sketches.

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Tommy Graham’s Blogtoons on Packaging

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Since the GrumbleSmiles blog was started, we have been illustrating some of the posts with cartoons.  This is the third post in building a gallery of all the blogtoons.

I’ve written a series of posts on my struggles with packaging which seemed to have inspired some of Tom’s best cartoons.  You can find the blogs in the TAG CLOUD by clicking on Packaging.

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“Princethorpe Court 5”

For earlier stories on this subject, click on   “PRINCETHORPE COURT STORY”   in the TAG CLOUD.

Now we come to the final and most important chapter of the story.   All the effort, time and money would count for nothing if we had not achieved  “Better Lives for Older People”.

Anne Miller bought into the concept of promoting residents’ independence and choice completely.   In no time at all she involved them in all decisions about how Princethorpe Court was managed.

The Residents

Princethorpe Court was designed with activity in mind, so the communal areas were a platform for enhancing your lifestyle.

The restaurant was not a fast food outlet, it was a place you could come each day and socialise.   Everyone had a kitchen in their flat where they or the staff could prepare breakfast or tea, but lunchtime was a popular ‘communal event’ with the majority of residents.  Couples tended to be more self-sufficient, but the majority of residents lived on their own, so lunch was an opportunity for a natter.

There was a hairdressing room which was another popular place for a chat and a sure way of looking your best and lifting your spirits.  The communal laundry was another good place for catching up on all the latest gossip.

Dotted around the scheme, one in each street, were four small sitting rooms.   With Anne Miller’s encouragement, these were taken over by the residents and gradually established their own individual identity.   One as a library full of donated books and jigsaws, one was a spiritual room for quiet contemplation.  Others were used for knitting,   card making,   darts,   quizzes,   poetry reading,   costume making,   exercise  — the list became endless.   Many of these activities were organised and run by the residents themselves.

Anne saw every resident as a potential volunteer.   It was her way of ensuring everyone’s talents and abilities were recognised and utilised for the communal benefit.   After our initial concern about the size of the scheme, we often continued to discuss whether the scheme was too big – there were 48 flats but around 60 residents altogether.  The Social Service view was that anything over 35 flats would become institutional.   Anne’s perspective was that as long as each resident had a ‘role’, they would not get ‘lost’ in the size of the scheme.   Her idea of a ‘role’ was beyond any formal definition of a volunteer — Nora was a very quiet lady who liked to stay in her flat most of the time and just look out of her lounge window, which overlooked the car park — she always knew who had visited the scheme each day and became the scheme’s self-appointed security guard.

The residents at Princethorpe Court would not mind me saying they were “unremarkable”, they were no different to the residents in any of our later extracare schemes.   They had the usual range of frailties that you would expect in an age group that ranged from 60 to 100.  Their average age was late 70’s.   Most were women (80%), mostly widowed before they moved in, almost all came from the local area.   About a quarter had mobility issues and used a wheelchair.

At the same time, the staff ensured that all the residents were treated as individuals, and as their life stories and accomplishments became known, they were made to feel unique.   In that sense they were all “remarkable”.

Here are four people just to illustrate the point:-

TOM was a quiet man, a keen gardener.   He took over the extensive greenhouse and grew salad crops for the restaurant.   His tomatoes were his pride and joy.   Over the years he won medals and certificates galore.   A glass cabinet in the entrance hall of the scheme houses a big silver cup which was awarded to Princethorpe Court at ExtraCare’s first “Garden in Bloom” competition.   In the years to follow we realised that rewarding outstanding talent with small prizes was a way of reinforcing the message that residents had great skill and could still achieve a lot in later life.

JACK AND MABEL looked life in the face and overcame any difficulties they had with a smile.   At well over 70, they regularly flew to Canada to visit their children and grandchildren.   They were the life and soul of any party, in fact I first met Jack when he was bashing himself over the head with a tin tray and singing an old music hall song.   Playing the spoons was another favourite of his.

Jack fell in the empty bath overnight when he had got out of bed to go to the toilet.  He couldn’t get back out and Mabel could not hear him shouting for help, so he spent the rest of the night sleeping in the bath.  Then he got a lecture from Mabel in the morning for being so clumsy.  By the way, Jack had a tin leg, which he wasn’t wearing at the time.

In fact it was his tin leg that brought them together.   In Coventry during the war, they were both running to get into an air raid shelter.   Jack was slow because of his tin leg and when he got to the top of the stairs down into the shelter, he tripped and tumbled down the steps and landed on Mabel.   That’s how they first met – they were married for over fifty years – so Jack said he must have fallen for Mabel in a big way !

JOY KING moved into Princethorpe Court when it opened and still lives there today – over 20 years later.   I first met Joy when we played in a Christmas pantomime together.   She was the Fairy Queen — I think I was the bad guy.   I later found that Joy had come from a theatrical background.   Her father ran a travelling repertory theatre and Joy had to look after her baby sister while her mother and father were performing twice a day in plays.   They lived an itinerant life moving from one theatrical digs to another.   It was a hard life and Joy had a poor education because they never were in one school for more than a few weeks.

Joy joined in all the activities at Princethorpe and one of her proudest days was when she was awarded a degree from the University of ExtraCare for having completed a computer course.

There are hundreds of stories like these which just goes to show that  “Everyone has a Story to Tell”.   This was the title of a book we published to celebrate the lives of our residents after the first five years of ExtraCare.

The hard evidence to show that this model works is only becoming clear nearly 30 years after Princethorpe Court was conceived :-

  • Residents who move into residential care on average only live four more years – in ExtraCare housing the average length of stay is 14 years.
  • The average age of ExtraCare residents is between 75 and 80.  When asked how old they feel, most residents say they feel between 10 and 20 years younger than they actually are.
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Tommy Graham’s Blogtoons on Pills

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Since the GrumbleSmiles blog was started, we have been illustrating some of the posts with cartoons.  This is the fourth post in building a gallery of all the blogtoons.

Elderly people and their pills seem to go hand in hand.  So not surprisingly I’ve written a series of blogs on this subject.  Click on Pills in the TAG CLOUD to see the posts.  All the pills blogtoons have a super heroine – Pilly Gallore and her superhero GP Astroglax.

 

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“Dignity Be Damned ” 4

This blog really started two years ago and was revived by the report from the “Commission on Improving Dignity in Care of Older People”.  (Click on “Dignity be Damned” in the TAG CLOUD).

The report was co-authorised by the Local Government Association, the NHS Confederation and AGE UK.  It is well argued and makes a lot of common sense recommendations.

Few would argue with their aspiration to provide better care for the elderly.  However, I am not sure they have fulfilled their stated ambition to “identify the underlying causes of these persistent failings”.  I have commented on what I think should be a more strategic response on my previous blog on this subject.

Meanwhile, here are my comments on their 48 recommendations:-  (Click on the following link www.nhsconfed.org/Documents/Delivering%20Dignity.pdf  if you want to read the full report).

  1. Deliver care at home in the community
    • Absolutely, but you will have to get GPs out and about first, and build shop window style health centres
  2. Make independence at admission and discharge a key measure
    • Good idea – why not pay a bonus for health improvement
  3. Ban patronising language
    • Yes but it’s hardly a top priority so let’s not get all P.C. about it
  4. Comprehensive geriatric assessment
    • It is wishful thinking in these express service NHS days
  5. Nutritional needs
    • A critical failing that will only be solved with more staff, volunteers and relatives
  6. Families, friends and carers
    • Agreed and see above
  7. ‘This is me record’
    • Nice idea so long as it is not turned into a blizzard of paper
  8. Feedback
    • Needs to be monitored by a panel of independent elderly people with a direct reporting line to health boards
  9. Staff take personal responsibility
    • A platitude
  10. Practiced based development
    • Should lead to a new NVQ/Nurse for the elderly qualification
  11. Recruit compassionate staff
    • Another platitude.  Most staff are compassionate, it is the system that needs changing
  12. Dementia training
    • This is essential, there should be dementia nurses at ward sister level on all elderly wards
  13. Devolved leadership
    • This will never happen inside the NHS.  It is a command and control model and probably should stay that way for short-term acute care
  14. Board leadership
    • It is called “walking the floor” but right now they could well get lynched if they ventured onto elderly wards
  15. Ward leadership
    • Will only happen if you reduce paperwork, give them enough staff and empower them to discipline poor performance
  16. Patient/family feedback
    • Who can disagree
  17. Staff reflection time
    • Ditto
  18. Professional duty of care
    • Motherhood and apple pie
  19. Protection of vulnerable adults
    • A toothless, ineffective process that has nothing to do with leadership
  20. Discharge from hospital
    • Should be controlled by community based staff, otherwise the rush to empty beds takes priority
  21. Care home values
    • Not at all clear what this is about
  22. Care Quality Forum
    • If the Nursing Quality Forum has not worked for older people, why would another forum for care work?
  23. A rating scheme for care homes
    • CQC has only just abandoned one
  24. My home life
    • A good process that should be used more widely
  25. Care plans
    • This is already mandatory but too often its use is limited to basic care tasks by pressure of time
  26. Buildings fit for purpose
    • There needs to be massive capital investment to build new accommodation and thereby eliminate old out-of-date residential care homes
  27. Family and friends, carers as partners
    • Of course
  28. Volunteers in care homes
    • Residents themselves are the most valuable and reliable volunteers
  29. More use of technology
    • Yes in principle, but it all needs to be more “elder-friendly”.  SKYPE could open a window way beyond contact with relatives, so could web cams and CCTV
  30. 360° staff appraisal
    • If it is done constructively
  31. Personal responsibility
    • Motherhood and apple pie again
  32. Access to medical care
    • Of course but it only works if doctors will come out of their surgeries
  33. End of life care
    • Agreed
  34. Board role
    • See answer 14
  35. Non Executive Directors
    • Agreed.  It should be routine and regular, not just ceremonial
  36. Invest in training
    • 5% of staff time should be spent on training
  37. Residents’ charter
    • Rarely worth the paper it is printed on
  38. Feedback
    • See answer 8 and also consider suggestion schemes, resident forums and comprehensive annual surveys of residents, relatives, volunteers and staff.  The results and improvement plans should be published.
  39. NHS Commissioning
    • Cost drives their decisions.  I have little confidence they can put a price on dignity
  40. Ditto
  41. NICE
    • All hot air
  42. More fine words
  43. Local advocacy groups
    • A good idea in principle but toothless in practice
  44. Health Watch
    • Community health councils did not work so what will change this time
  45. Universities and professional bodies
    • They already have this responsibility but are ineffective at guaranteeing good performance or compassion
  46. Regulation
    • This has singularly failed to deliver better care and I have long argued that the DoH should refocus CQC’s remit to focus on best practice and training for improvement rather than ineffective policing.
  47. Healthcare Assistant
    • I think there should be a new qualification of second level, mainly practice base ‘nurse for the elderly’, as already operated in Holland.
  48. Care Quality Commission
    • See point 45.  They should also conduct regular customer satisfaction surveys with residents and their relatives

As I said at the beginning, there is nothing much to disagree with here.  It is mainly good practice that is already implemented in the best care homes and hospitals.  The key question is why is it not done everywhere and that will not be answered by greater exhortation.

Who was it who said “two priorities are no priority at all”?  48 recommendations may be a direction of travel but they are a long way from a road map.

The second stage of the Commission’s work needs to start further back at the root causes of the problem.

Posted in HEALTH, N.H.S. | Tagged | 4 Comments