Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, March 12, 2015

Call For Abstracts - Activity Based Funding Conference, May 2015.

This release appeared today.
Media alert, March 2015

Activity Based Funding Conference 2015

Key industry leaders, health experts and practitioners from around the country and abroad will come together for the Activity Based Funding Conference in Adelaide from 27 to 29 May this year.
The Activity Based Funding Conference 2015 will focus on the broader aspects of Activity Based Funding (ABF) to promote discussion around driving transparency and efficiency in Australian hospitals.
Abstract presenters are encouraged to provide case studies that demonstrate how they are using ABF for more than funding and attendees will be encouraged to think about the wider implications of ABF data use in Australian hospitals.
A mix of local and international presenters will provide a range of different approaches to ABF application. Confirmed international speakers include Professor Keith Willett, Director for Acute Episodes of Care at the National Health Service (NHS) in the United Kingdom Dr. Sue Calikoglu, Deputy Director of Research and Methodology at the Maryland Health Services Cost Review Commission (HSCRC).
The conference will feature a panel session with Commonwealth, state and territory government representatives to provide an update on progress across Australia in addition to an overview of the work completed by IHPA over the past year by IHPA’s Chair, Shane Solomon.
Workshops will be offered to delegates on Wednesday 27 May prior to the two-day conference. Sessions will cover an introduction to ABF, advanced management using ABF, developments in classifications, mental health care classification development and an explanation of the National Efficient Price.
For the full program and to register for the conference, visit www.abfconference.com.au.
To join the conversation, please follow @IHPAnews and #ABF15 on Twitter.
Activity Based Funding Conference 2015
Workshop dates
Wednesday 27 May 2015
Conference dates
Thursday 28 to Friday 29 May 2015
Location
Adelaide Convention Centre, Adelaide, Australia
Website
About the Independent Hospital Pricing Authority (IHPA)
IHPA is an independent Commonwealth agency established under Commonwealth legislation as part of the National Health Reform Agreement (NHRA) reached by the Council of Australian Governments in August 2011.The NHRA sets out the intention of the Australian Government and state and territory governments to work in partnership to improve health outcomes for all Australians.
IHPA is charged with determining the National Efficient Price and the National Efficient Cost for public hospital services, allowing for the national introduction of Activity Based Funding. The implementation of ABF will improve transparency, and strengthen incentives for efficiency in the delivery of public hospital services.
– ENDS –
Contact
Alison Wares, Communication Manager, Independent Hospital Pricing Authority
T: 02 8215 1176 E: alison.wares@ihpa.gov.au       M: 0434 629 469
Abstracts - due by 20 March are requested on the following topics:
Topics for abstract submissions are included below.

  •  Activity Based Funding management
  • Using Activity Based Funding to drive efficiency
  • Costing issues at the hospital level
  • Embedding Activity Based Funding locally
  • Developments in classifications
  • Coding and documentation improvement projects
  • Other Activity Based Funding related topics.
Here is the link for abstract information:

http://abfconference.com.au/abstracts/
-----
Specialist stuff but some may be interested in either submitting or attending.
David.

Wednesday, March 11, 2015

Can Someone Explain Just What This Document Is For And How Is It To Be Actioned?

This appeared last week from NEHTA.

eMedications Management Functional Framework v1.0 March 2015 Release

Created on Monday, 02 March 2015
The eMedications Management (eMM) Functional Framework outlines the key capabilities within medications management business systems.
It can be used to identify opportunities and gaps in medications management process automation, system integration, information quality and terminology standardisation.
This is the first official release following its conception as part of the Jurisdictional eMedications Management (eMM) Collaborations initiative.
We are pleased to announce that the eMedications Management Functional Framework v1.0 is now available for download from the following location on the NEHTA website:
The scope of the eMedications Management Functional Framework covers a range of capabilities from medications reconciliation to dispensing, including supporting functions such as supply chain, and dependent functions such as reporting and monitoring.
Important Information
Significant refinements since the last eMM workshop updates have been documented within the release note for the benefits of those participants. Other stakeholders will also gain an understanding of its evolution and ongoing maintenance by reviewing the latest updates. Download the release note as follows:
Feedback
We value your feedback and encourage questions, comments or suggestions about the eMedications Management Functional Framework. Please email the NEHTA Help Centre or call us on 1300 901 001.
Thank you for your continued support.
Regards,
NEHTA (Strategy, Architecture and Informatics Group)
Here is the link.
The core appears to be this diagram:
As far as I can tell all we have here are a list of functions (and some definitions in an Excel Sheet). The desired functions have been largely unchanged for the last 15 years. Just exactly what is added here and just why are we paying for this and similar documents?

David.

Tuesday, March 10, 2015

The AMA President Makes The AMAs View On The PCEHR Very Clear. Hardly Positive.

This appeared a few days ago:

Health Policy Stagnation

Published: 02 Mar 2015
Brian Owler
As Health Minister Sussan Ley engages in consultation with health and consumer groups about the Government’s GP co-payment and other Medicare changes, work on other areas of the health system is in stagnation. There is a vacuum as far as health policy is concerned.
The co-payment has sucked the life out of health policy development, discussion, and debate. This has not only been detrimental to the Government, it is also harmful for the practice of medicine and for our patients.
…..
The Personally Controlled Electronic Health Record (PCEHR) was not that long ago touted as the most important initiative in health. Today, all we hear about is the massive waste of taxpayer money in its development. The Abbott Government commissioned a review but, 14 months later, is yet to respond to the review’s recommendations. The PCEHR remains in limbo, a very large white elephant.
More here:
This is a very interesting article that reviews an amazing list of issues where we are suffering from what has to be described as ‘policy paralysis’. At least some of this is due to the policy vacuum we had with Mr Dutton for so long - up until December and the reshuffle that give is Minister Ley.
With the list of policy problems including:
- Hospital Funding.
- Primary Health Network Start-up
- Health Budget Control and Activity Based Costing
- Indigenous Health and Closing The Gap.
- Agency Abolition for Prevention etc.
- Mental Health and more recently the issues emerging with
- Sixth Community Pharmacy Agreement. (see below)
There is a fair bit to sort out as well as the PCHER!

Scathing audit threatens multi-billion dollar pharmacy deal

Joanna Heath
Health Minister Sussan Ley has threatened to blow open negotiations for a fresh five-year multi-billion dollar deal with pharmacy owners for distributing subsidised drugs, which could substantially weaken the influence of one of the most powerful lobby groups in Canberra.
On Thursday the Auditor-General published a scathing report into the administration of the Fifth Community Pharmacy Agreement struck in 2010, finding it failed to deliver forecast $1 billion savings to the government and was beset with administrative errors.
The Pharmacy Guild, which represents pharmacy owners, is well-known in Canberra for its hardball lobbying tactics and grassroots electoral campaigns against parliamentary critics. Negotiations for the sixth agreement to come into force in July this year have only just begun.
Ms Ley said she was deeply concerned by the findings of the report and threatened an inquiry if a full explanation of the shortcomings was not given.
More bad news for the Pharmacy Guild here:
Of course while the Co-Payment issue is still not resolved - as we are told here - and the rest of the list above the chance of the PCEHR getting focus and decisions seems to be pretty unlikely.

Coalition working on fifth incarnation of Medicare policy after co-payment killed

Prime minister tells question time the latest attempt to introduce a co-payment is ‘dead buried and cremated’ and a new ‘value signal’ would be developed
The Abbott government is now working on a fifth version of its Medicare policy after the prime minister declared its latest attempt to introduce a co-payment “dead buried and cremated” but the health minister said she had not finalised an alternative to achieve the same policy aims.
The government is retaining a freeze on the Medicare rebate that would force doctors to abandon bulk billing over time unless they finally agree to alternative budget savings – and it says its policy goal to restrict bulk billing to the “vulnerable” remains.
The health minister, Sussan Ley, said she was still negotiating with doctors about alternative Medicare savings as she abandoned the fallback policy of a $5 rebate cut announced by the prime minister last December and “put on hold” in January.
More here:
It really feels like no one is on top of all this just yet.
I guess we will wait a little longer!
David.

Defence Has A Few Cost Overruns On Its Electronic Health Record System - About 300%

An Aust. National Audit Office Audit of the Defence E-Health System (DeHS) was released today.
The best way to read the report is via the detailed summary. Here is the link:
The financial bottom line comes here:
“Over time, the approved total DeHS project cost rose to $133.3 million, some $110.0 million higher than the original budget. At each approval stage, the project has been funded internally using Defence’s departmental budget, and Defence did not request supplementary funding from government. Nevertheless, there is an opportunity cost associated with Defence allocating significant additional funds to the project.”
Here are the key recommendations:

Lessons learned and recommendations

“25. As discussed, Defence’s management of the DeHS project was beset, in its early phases, by a range of avoidable shortcomings. A key lesson of this audit is the importance of properly scoping and planning complex ICT projects, as a basis for providing sound advice to Defence senior leadership and government, and establishing the pre-conditions for successful implementation. There are more restricted options for Defence senior leadership and government once a project that is considered beneficial is well underway and clearly requiring funds beyond its original budget. This underlines the critical importance of applying a rigorous approach at the outset of a project to develop the project scope and budget. Project proposals and cost estimates should be based on a full understanding of project parameters and risks, and subject to thorough review.
26. A further lesson of the audit is the importance of adequate coordination of internal resources and expertise—to mitigate project risks and inform effective delivery—and the adoption of sound project management methodologies and practices. Government has endorsed project management methodologies so that entities follow a structured approach in developing, overseeing and delivering intended capability, and these methodologies should be consistently followed.15 Further, Ministerial approvals, and processes such as Gateway reviews, are specified by government to oversight the effective use of public resources so as to achieve value for money in project delivery, and Defence is expected to apply these requirements.
27. The ANAO has made two recommendations aimed at providing Defence with reasonable assurance that project proposals and cost estimates are reliable; and achieving benefits realisation for DeHS by standardising use of the system and implementing agreed functionality.”
It would be fascinating to know what this team makes of the PCEHR!
David.

Monday, March 09, 2015

Now Here Is An Idea That Amuses I Read The Other Day - Non E-Health But Actually Serious

A source I have since forgotten recently suggested we pay Anonymous using Bitcoin to silence the IS Internet Propaganda!

Sure makes sense to me! They might actually be able to do it. I am sure Senator Brandis will struggle!

Back to e-Health!

David.

Weekly Australian Health IT Links – 9th March, 2015.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A really quiet week with very little I noticed of any real consequence to the longer term future of e-Health.
We still need to hear from Minister Ley on what is happening with the PCEHR.
-----

Good Samaritan app puts doctors at legal risk

6 March, 2015 Paul Smith
Doctors signed up to a good Samaritan app that crowdsources life-saving CPR aid by tracking their nearest medical emergency could face legal action if they ignore alerts from the device.
It has been claimed about 1000 doctors have registered with GoodSAM app, which is used at the scene of emergencies to send out alerts that immediately pop up on smartphones of nearby doctors, nurses or paramedics.
If doctors choose to reject an alert, the GoodSAM app automatically alerts the next nearest responder within a 500m radius.
But medical defence organisation Avant has issued its own warnings, saying doctors working in NSW or the NT should turn off the app when they are unable or unwilling to respond to an alert.
-----

New app could expose doctors to legal risks

5th Mar 2015
DOCTORS have been warned that a new app that allows the reporting of medical emergencies could land them in medico-legal strife.
The GoodSAM (Smartphone Activated Medics) app allows doctors and other medicos to register and be alerted when a member of the public uses it to report an emergency they have witnessed close by.
Medical indemnity group Avant warned today that in NSW and the Northern Territory, doctors who have the app turned on could be exposed to legal risk if they fail to respond to a request for assistance.
They could limit their exposure by turning off the app when they are not willing to respond to an alert, said Avant’s special counsel for medico-legal advice and health law, Kate Gillman.
-----

Beating the odds

An artificial heart that would last a lifetime? They said it would never happen - until now.
By Trent Dalton
HE whispered in a Scottish drawl: “You wanna see somethin’ cool?”
Professor John Fraser has been an intensive care specialist for two decades. He established the Critical Care Research Group at Brisbane’s Prince Charles Hospital in 2004. He’s seen cool things before: heart transplants; machines that can rebuild a blackened human lung before your eyes; bodies of children wrenched from the cold and still grip of beyond.
It was three years ago when he whispered the invitation, at a backyard barbecue at his house in Brisbane’s northern suburbs. We were eating sausages, talking about outdoor music systems controlled by one’s mobile phone. The things we humans can accomplish. Our wives went to school together. I’d known him for 13 years, long enough to know that when he asks if you would like to see something cool he’s not about to show you a Harley-Davidson motorcycle.
-----

Website offers repeat referrals and sick notes

4 March, 2015 Kate Aubusson  
An internet start-up is offering patients repeat referrals and sick notes after a five-minute Skype call with a GP. 
But the new website has attracted the ire of the RACGP, which has warned doctors against taking part in the service. 
The Medical Certificate website, which launched last month, is selling the one-off consultations for $29, through which patients can secure repeat referrals for ongoing specialist treatment or medical certificates for employers.
The online platform makes no attempt to follow-up with patients after their specialist consult and has no mechanism for feeding information back to their regular GP. 
-----

Doctor rating site ‘scraping’ rego details

1 March, 2015 Paul Smith
A doctor rating website has been lifting information regarding doctors’ registration status that is currently stored on the AHPRA website.
The DoctorInspector website invites patients to rate health practitioners and includes some registration details next to the doctor’s name, such as their registration number and qualifications.
AHPRA is stressing the information used by DoctorInspector is already available to the public via its website and that DoctorInspector is not using confidential information AHPRA holds about individual doctors. 
“The website operators appear to have used technology known as ‘screen scraping’ to automatically pull information from the [AHPRA] public online register,” AHPRA’s CEO Martin Fletcher said.
-----

Govt report pins Australia's future on technology, but ignores NBN

Summary:Technology and innovation will be at the centre of Australia's continued productivity over the next 40 years, according to the Treasury Department's latest Intergenerational Report.
By Leon Spencer | March 5, 2015 -- 06:21 GMT (17:21 AEDT)
The Australian government's latest five-year Intergenerational Report, published on Thursday, places technology and innovation at the centre of the country's continued productivity over the next 40 years.
The quinquennial report (PDF) is intended to assess the long-term sustainability of current government policies and how changes to Australia's population size and age profile may impact economic growth, workforce, and public finances over the following 40 years -- in this case, to 2055.
The new report highlights the impacts that technology has already had on Australia's industry and society, and suggests that by supporting innovation, adopting new technologies, facilitating foreign trade and investment, and fostering competition, the government can boost future productivity growth and living standards.
-----

Technological advances to push costs down in healthcare sector

Sid Maher

AUSTRALIA is set to defy the health costs of an ageing population for another decade but federal spending on healthcare will double in 40 years.
Federal government spending on health is expected to fall as a proportion of GDP over the next decade but it will pay more in real terms for Medicare services and drugs.
The Intergenerational Report said that under laws passed by parliament Australian government health spending will rise from $2800 in today’s dollars and reach $6600 in 2054-55 or 5.7 per cent of GDP.
But under the government’s proposed policies, which included the GP co-payment and a crackdown on short doctor visits, that figure would have been reduced to 5.5 per cent of GDP.
-----

Clinical judgement trumps guidelines: expert

5th Mar 2015
CLINICAL judgement must remain central to the patient consultation irrespective of the use of guidelines, a UK guidelines proponent says.
Speaking at a Grand Rounds meeting this week at Dunedin Hospital in New Zealand, Professor David Haslam, chair of  the UK National Institute for Health and Care Excellence (NICE), emphasised the importance of clinical judgement.
“When I meet the presidents of the royal colleges in the UK, they frequently tell me that junior doctors, especially, treat guidelines as if they are mandatory,” Professor Haslam said.
“It’s absolutely clear to me that sometimes it’s inappropriate to follow the guidelines.”
-----

eMedications Management Functional Framework v1.0 March 2015 Release

Created on Monday, 02 March 2015
The eMedications Management (eMM) Functional Framework outlines the key capabilities within medications management business systems.
It can be used to identify opportunities and gaps in medications management process automation, system integration, information quality and terminology standardisation.
This is the first official release following its conception as part of the Jurisdictional eMedications Management (eMM) Collaborations initiative.
We are pleased to announce that the eMedications Management Functional Framework v1.0 is now available for download from the following location on the NEHTA website:
-----

'Truly awful': Centrelink, Medicare apps slammed

Date March 4, 2015 - 1:00AM

Noel Towell

Reporter for The Canberra Times

The federal government's range of Medicare and Centrelink online apps are so bad they are getting claimants kicked off benefits, users have complained.
The Department of Human Services now has 12 applications for smartphones that are supposed to allow clients to conduct their Medicare, child and income support transactions online without having to visit a government office.
But the apps, which are linked to the MyGov portal, have been panned by users with the Express Plus Medicare and Express Plus Job Seekers coming in for the worst of the online ire.
But Human Services defended its apps on Tuesday, saying 3.7 million versions had been downloaded and they had been used to process 36 million Centrelink and Medicare transactions.
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Investors see future in cornea-based biometric technology

Date March 3, 2015 - 9:44AM

Beverley Head

Sydney optometrist Stephen Mason should know soon if his cornea-based biometric technology can be successfully commercialised.
In January Mason secured a $450,000 loan from Nemex Resources to allow his start-up to complete prototyping. That follows a 2014 deal that saw the Perth based mining company take a 30 per cent stake in Mason's company, Wavefront Biometric Technologies, with the option to grow that to 51 per cent.
Key to the initiative is Mason's patent for a biometric identity system based on the first Purkinje image which is the reflection from the outer surface of the eye's cornea.
According to Mason; "There are tiny little differences in your eyes from day to day but a vast difference between mine and yours," adding that, "The cornea is a natural one time PIN."
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Mental health: Poor and remote areas don't have equal access to services, Monash University study finds

By medical reporter Sophie Scott and Alison Branley
March 2, 2015, 6:46 am
The largest ever study into mental health services in Australia has found government programs are failing to give people in poor and remote areas equal access to help.
The Monash University study looked at Medicare data relating to 25 million mental health items billed between 2007 and 2011.
It found people who lived in disadvantaged parts of metropolitan areas, rural and remote areas accessed the least number of services despite needing them the most.
In some cases, the top fifth of Australian society had about three times better access to some psychological services than the bottom fifth.
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Choosing Wisely launches soon

Nicole MacKee
Monday, 2 March, 2015
AN Australian program to engage the medical community in identifying and reducing the use of health care services of little or no benefit to patients has been widely welcomed by experts ahead of its launch next month.
The Choosing Wisely Australia initiative, modelled on similar international programs, will be facilitated by NPS MedicineWise, and will involve medical colleges, each recommending five services that providers and consumers should question. (1)
The first lists will be made public when the program launches next month, with additional lists added later in the year.
Dr Lynn Weekes, CEO of NPS MedicineWise, said the program would challenge the notion that more was necessarily better.
-----

Primary Health Networks: key questions and challenges

| Mar 02, 2015 11:06AM
While the media has been focussed on the Government’s proposed GP co-payment, there have been potentially bigger changes to primary health care progressing behind the scenes.
The transition from Medicare Locals to Primary Health Networks (PHNs) may not appear significant, as the functions and objectives of both organisations are very similar. However, there are some key changes in relation to ownership and structure of the new PHNs which have the potential to fundamentally change our primary health care sector.
The possible introduction of private companies, such as private health insurance funds, into the primary health care space, raises a slew of complex policy, transparency and governance issues which will need to be resolved to ensure the changes result in positive changes for consumers.
These include dealing with potential transparency and accountability issues around the tender process, given that some tenderers from the private sector, such as Aspen Medical, contribute to political fundraising activities.
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Enjoy!
David.

Sunday, March 08, 2015

Looks Like Some Extreme Dodgyness Occurred With The 5CPA E-Prescription Initiative. A Very Interesting Audit.

This Aust. National Audit Office Audit appeared a few days ago:
Here is the link:
Here is the background on the part I was interested in: (page 111 on)

Implementation of the Electronic Prescription Fee (EPF)

3.37 Electronic prescriptions are prescriptions that are generated electronically by prescribers and uploaded to a Prescription Exchange Service (PES). If a pharmacy subscribes to a PES, the pharmacy can download the details of a patient’s prescription from the PES instead of manually entering prescription details into the pharmacy’s database.
There are two PES providers: eRx (a wholly owned subsidiary of FRED IT, which is part owned by the Pharmacy Guild ) and MediSecure Limited (supported by the Royal Australian College of General Practitioners).
3.38  In December 2009, Health advised Ministers that a key feature of the Pharmacy Guild’s platform in negotiations for the 5CPA was the introduction of government funding for:
· a per prescription payment to pharmacies to cover the cost of processing each electronic prescription dispensed ($75.5 million); and
· software vendors to integrate a range of agreement related elements into existing dispensing software for pharmacies ($13 million).
3.39 While Ministers did not approve funding for software vendors to integrate agreement related elements into existing dispensing software, Ministers did approve $75.5 million in Government funding for a 15 cent per prescription payment to pharmacies (known as the Electronic Prescription Fee) for each PBS/RPBS prescription downloaded from a PES.
----- End Extract:
Over the next 3 years $9.12 million of EPF payments were made - however only $1.8M made it to pharmacies to cover the 15cent claims. What happened to the other $7.3M the Auditors asked?
Well a few things happened.
The Auditors noted:
“Health advised Ministers that the Pharmacy Guild had agreed that the EPF would only be paid in the  following circumstances: for e-prescriptions processed and claimed for by approved suppliers, which were generated electronically by prescribers in accordance with the specifications of the National e-Health Transition Authority (NEHTA); and if NEHTA specifications changed or a Commonwealth  approved individual electronic health record became available, the criteria may be reviewed.”
On the underspend we read
“The underspend was used for two purposes: to fund a communication strategy for prescribers and dispensers and thereby improve take up of the initiative, and to continue manual processing of claims by DHS Medicare at the request of the Guild, whose dispensing software was not ready for full online claiming by the anticipated 30 June 2011... Market forces are a disincentive to PES [Prescription Exchange Service] interoperability with one of the two PES operators eRx, part owned by the Guild and supported by the majority of pharmacies due to its links with the Guild and FRED IT. On the other hand, Medisecure is supported by the RACGP [Royal Australian College of General Practitioners] and has a greater take up with GPs but lesser with pharmacies. Consequently there are a large number of scripts (around 80 per cent of those uploaded according to NEHTA) [National eHealth Transition Authority], that are not being downloaded due to the PES preferences of the different clinical areas, and the failure of the two PES providers to interact and share information ... Advice from NEHTA is that, eRx has previously rejected MediSecure approaches to establish interoperability between the two providers.”
So in summary - the report says:
3.51 In summary, while the Australian Government had originally approved $75.5 million in funding for a 15 cent EPF incentive payment to pharmacies, in the first three years of the 5CPA, 80 per cent of EPF payments were not paid to pharmacies but were instead used to pay:
·         the two PES providers to make their proprietary software compatible with each other (to enable the transfer of electronic prescriptions between the two systems);
·         software vendors to align their proprietary software with PES providers(to enable pharmacists to download eligible electronic prescriptions);
·         the Pharmacy Guild to undertake promotional activities to support improved uptake of the EPF; and
·         Human Services to manually process EPF claims, at the request of the Pharmacy Guild.
……
(and a final zinger)
Further, Health did not advise the Health Minister on a range of issues, including: its decision to temporarily increase the incentive payment to pharmacies from 15 cents to $1.00, and to use the 85 cent difference to provide financial assistance to IT service providers; and that a study it had commissioned indicated that both PES providers were, at that time, working through a range of financial issues.
End Extracts:
So basically this EPF has been fiasco where the Ministers have not been told by the Department what is going on! Looks like mismanagement central with a bit of a cover up to boot!
I wonder what the ANAO would find with NEHTA and the PCEHR if they were asked?
David.

AusHealthIT Poll Number 260 – Results – 8th March, 2015.

Here are the results of the poll.

Is It About Time Minister Ley Announced What She Plans To Do With The PCEHR?

Yes 92% (71)

No 6% (5)

I Have No Idea 1% (1)

Total votes: 77

Well that was amazingly clear - Minister Ley needs to get on with deciding what to do!

Good to see a decent number of responses!

Again, many, many thanks to all those that voted!

David.