Belfast Working Group: Basket Weaving & Soft Toys.

After decades of near-paralysis in the care of ME patients in Ulster, the DHSSPS has moved with lightning speed to set up a new Northern Ireland Working Group for ME. This left patient groups scrambling to nominate representatives in a short space of time. It was not easy to secure nominees, particularly from the counties. Even travelling to Belfast, never mind surviving a long meeting, is an impossible challenge for most patients. The resultant spread of patient representation is therefore not perfect, and inevitably there will be complaints. Counties Armagh and Fermanagh for example, are not represented. But patient groups did the best they could in the time available, and they have managed to field a robust team on the Working Group.

NI MEA have secured representation from counties Derry, Tyrone, Antrim and Down. So that no single county representative is overloaded, attendance at meetings will be rotated. Jo Calder from NI MEA is purring with satisfaction that the Working Group is up and running at last. After years of patient lobbying at Stormont, she has finally got the politicians to listen. In concert with all other patient representatives present, she delivered an uncompromising message to the Working Group - No GET. No CBT. No psychiatric management.

Derek Peters from the NI Campaign for ME/CFS Healthcare has close links with MERUK, the research group run by Neil Abbot and Vance Spence in Dundee. Derek gave a substantial presentation to the Working Group, emphasising that ME patients wanted effective treatments to address what is a physical disease, and that adequate investment in research would be the only way to find a cure. Derek was accompanied by Joan Robinson, who read some compelling patient histories. The NHS was not making adequate provision, she said, and one result was that too many ME patients were being fleeced by charlatans in the complementary sector. Antoinette Christie and her sister Jeanette Marley (familyfights4me) are very experienced advocates, and well qualified to speak on behalf of the severely affected, children, adolescents, and their families.

The final part of the Working Group meeting on 28th October focused on the future of the CFS Clinic at Belfast City Hospital. NI MEA received mixed reports about this clinic before it was effectively closed in July 2009. There had been consistent complaints. But there were no gripes about the Senior Occupational Therapist who did most of the clinic's work. On the contrary, she was well-liked by her ME patients. On 12th October the Minister told the Assembly that the Belfast Clinic had only accepted 16 patients during 2009. He said that Jayne Perkes the Senior OT was continuing to treat the existing intake. He conceded that the figure of 16 clients was not a fair reflection of demand as identified by patient groups. There is a range of possible explanations for this low number. It represented the intake for 6 months or less; only Belfast patients were eligible for referral; not all referrals were accepted or judged suitable for management; and many patients refused to be referred to a service headed by a psychiatrist, located in a psychiatric unit.

At the Working Group Horace Reid insisted that the future of the Senior Occupational Therapist in post be determined there and then. When this Group goes looking for staff to man the new ME clinics, you will discover that there aren't any. If you delay for six months, you will find that Jayne Perkes the Senior OT will have been diverted into another speciality, and all the skills she has built up over the years will have gone to waste. If you allow that situation to develop, you will be starting from zero level with the new clinics. Jayne is the obvious foundation stone upon which a new service will be built.

While Dr. Scott was the gatekeeper for the Belfast CFS clinic, it was the Senior OT who was responsible for most of the patient management. She is still in post, she is still funded, and there are plenty of patients who need to see her. No new patients have been referred since July 09, and a backlog is building up. Surely some mechanism can be devised for her to receive GP referrals. After all according to NICE, GPs are supposed to be capable of diagnosing ME. (Antoinette interjected here, expressing well-founded doubts that they could).

Line managers from the Belfast Trust were present at the Working Group meeting. They readily gave assurances that the Senior OT would remain in post, and her skills would be preserved. Reintroducing referrals from GPs would need to be done carefully when patients from all over Northern Ireland became eligible, there would be a danger that Jayne would be overwhelmed. I'd be quite pleased if she were overwhelmed, said Horace. That might prompt you to employ more staff.

There was then a short debate on the merits of occupational therapy versus physiotherapy. Derek Peters is no fan of OTs: Basket weaving and soft toys, he snorted dismissively. Jo Calder was adamant that any new ME clinic should not be headed by a physiotherapist; inevitably that would provide a route to introduce Graded Exercise Therapy by the back door.

An OT Manager was present, and defended her speciality: Actually we undertake quite challenging projects, such as Condition Management Programmes for the DWP said she, brightly. (Most ME patients are now being refused the higher rate of ESA by the DWP. Not sure it is helpful for OTs to associate themselves with this draconian new regime). Antoinette said she had negative experiences with OTs in the Community. Horace confirmed that a number of mothers had made similar complaints to NI MEA. (One Senior OT had refused to recommend a stair lift for one severely affected teen. The girl was then reduced to crawling upstairs on hands and knees).

Horace referred to official guidance such as paragraph 1.4.4.1 in the NICE CFS/ME guidelines, (p.42). For people with moderate or severe CFS/ME, providing or recommending equipment and adaptations (such as a wheelchair, blue badge or stairlift) should be considered as part of an overall management plan, taking into account the risks and benefits for the individual patient. This may help them to maintain their independence and improve their quality of life. Horace asked: There are regular complaints that OTs in the Community are not providing these aids. Could it be that individual OTs regard ME patients as malingerers? Could it be that personal prejudice is blinding them to official guidance??

The Chairman David Galloway asked whether NI MEA's endorsement of Jayne Perkes implied an endorsement of Occupational Therapy? Horace said it was an endorsement of an individual who was trusted by her patients; it didn't imply approval of any particular NHS speciality. Mr. Galloway repeated that he envisaged Jayne playing a lead role in the proposed new service; for instance she would certainly be involved in the training of new members of NHS staff. There are an estimated 6700 ME patients in Northern Ireland, and much of the responsibility for them will now devolve on one single part-time NHS employee. Jayne Perkes has been carrying that kind of load for some years, and luckily has survived so far. Let us hope she can continue to.

H.
More when I get the energy.

NB. These e-mail bulletins should not to be regarded as official minutes. They are edited highlights, recorded from memory by Horace. These and future blogs are posted at:

http://nimea-ni.blogspot.com

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Belfast Working Group: A Shoestring Affair.

“The Minister and his civil servants are resorting to the art of illusion, and are desperately trying to conjure imaginary ME services out of thin air.”

First Meeting of the Northern Ireland Working Group on ME, 28th October 2009.

The Northern Ireland ME Working Group is going to be a shoestring affair. It will not be the Belfast equivalent of the English CMO’s Working Group in 2002, and it will not be comparable to ongoing efforts in Scotland to produce a Statement of Best Practice.

The Working Group Chairman (David Galloway, Director of Secondary Services DHSSPSNI) opened proceedings by announcing that the primary intention was to set up pathways to guide ME patients to existing services in Northern Ireland. This drew a tart response from Horace Reid, who said that currently there were NO specialist services for ME patients in Ulster, and than any new pathways will simply lead to blind alleys. The Chairman seemed to accept this point.

In his statement to the Northern Ireland Assembly on Monday 12 October 2009, the Health Minister tossed a number of mutually incompatible proposals into the air, and we are now waiting to see where they land. Among the phrases he used were: “We are guided by the NICE guidelines.” “We are looking at best practice in other areas.” “In common with NICE guidelines, a neurology-based service rather than a psychology-based service.” “We will take account of the neurology review, which is coming forward, and the physical and sensory disability strategy, the consultation on which will be put out shortly.” “No doubt we can tease out whether to have one ME centre in Northern Ireland or use the services that are available throughout the health and social care framework to create a system in Northern Ireland that is signposted by GPs.”
Take out of that what you may.
The NICE CFS/ME guidelines of 2007 became operative in Ulster in February 2008. The NI CMO instructed the health trusts to implement them, and invited their proposals. A deafening silence ensued, and absolutely nothing has happened since. Except that in July 2009 the Belfast Trust closed the only existing specialist ME facility that we had in Northern Ireland.
The Health Minister is embarrassed that 7000 ME patients are being largely neglected by his Department, and tells fibs in the Assembly to disguise this failure: “Mr McCarthy says that ME patients have nowhere to go. That is not true. Patients have the whole health and social care system to address their needs, and it does so.” ME patients here know this is pure fiction.
With recession, severe budget cuts are now affecting the NHS in Ulster. In September for instance, 150 acute beds in the two main Belfast teaching hospitals came under threat. It would initially cost £0.7m if the DHSSPS thought of implementing the NICE CFS/ME guidelines in Ulster, and that kind of money will be hard to find. So the Minister and his civil servants are resorting to the art of illusion, and are desperately trying to conjure imaginary ME services out of thin air.
At the Working Group’s first meeting Horace got to the point pretty quickly: “The needs of ME patients have been identified long ago by committees in Canada, Australia, England and Scotland. There is no need to re-invent the ME wheel in Belfast, with prolonged deliberations. The proceedings of this NI Working Group should be time-limited. The important thing is implementation. The only thing that will impress our patients will be results on the ground. We have a very large number of patients who are being neglected, we have no budget, and I could count on the fingers of one hand the number of NHS staff in Ulster who know anything about the management of ME. These are the unpalatable realities, and the challenges for this Working Group”.
A wide range of clinical disciplines were represented at the meeting by senior NHS personnel, and Antoinette Christie and her sister Jeanette left them in no doubt of the consequences of government failure to invest in the diagnosis and management of ME. She and Jeanette are seasoned advocates, and they are a formidable double act. Antoinette has two teens with ME, one of them very severely affected. As a mother she is carrying a load which would destroy most families, but she remains amazingly full of fight.
NIMEA knows of many other mothers in the same situation, who dread ham-fisted intervention by the NHS and Social Services, and who have leaned it is safer to keep your head down and not attract attention. But not Antoinette. She knows the NHS is failing her, and she actively carries the war to the enemy. She and Jeanette outlined at length how it had taken fully 11 years to get a diagnosis for one of her boys. This was very powerful original testimony, coming from an ME mother right in the firing line. On Wednesday last it was a vital part of the new Working Group’s proceedings. What she had to say wasn’t news to the patients present, but it probably came as a shock to the civil servants and senior medics. I hope it did them some good.
Sooner or later Antoinette was going to become a target for the Child Protection squad, and eventually that happened when she asked for home tuition.
Horace to Antoinette: “You asked for help, and instead of helping they made trouble for you.” Antoinette: “Yes.”
Horace to Chairman: “NIMEA can tell you of other instances where ME mothers have been subjected to the same kind of ‘Blame the Victim’ tactics by DHSSPS employees.”
Towards the end of the meeting only one senior doctor contributed to the discussion with the patients. Speaking very briefly, he said that the NICE guidelines were a tool to bring about improvements for ME patients in Northern Ireland.
Seizing on this, Horace quoted from page 305 of the guidelines:
Key principles of care for people with severe CFS/ME.
“Management of severe CFS/ME is difficult and complex, and healthcare professionals should recognise that specialist expertise is needed when planning
and providing care. Diagnosis, investigations, management and follow-up care for people with severe CFS/ME should be supervised or supported by a specialist in CFS/ME. People with severe CFS/ME may need to use community services at times. These services may include nursing, occupational therapy, dietetics, respite care, psychology and physiotherapy. The input of different professionals should be coordinated by a named professional.”

This was the level of service Antoinette and other ME mothers should be receiving, but instead they are left abandoned and forced to cope on their own. If the NHS in Northern Ireland intends to implement in full the NICE recommendations for severely-affected patients, then it has a mountain to climb, said Horace.

The next meeting of the Working Group will be in the New Year. By that time the different Health Trusts are expected to come up with proposals to establish new services for ME patients in Ulster.

More soon.

Belfast Working Group: Them and Us.
“Our patients have never been given what they need and want. We have always been fobbed off with whatever it has profited the psychiatrists to force upon us.”
First Meeting of the Northern Ireland Working Group on ME, 28/10/09.
When NIMEA met the Health Minister on 28th September we were surprised and pleased by his plans. There was to be an ME Working Group, patients would be invited to sit on it, and a new clinic was contemplated, in a neurological context.
In England NICE has operated a successful strategy of divide-and-rule with the ME charities. One patient group had a very cosy relationship with the GDG, to the exclusion of others, and an even cosier relationship with the NICE legal team during the Judicial Review proceedings. The same tactics of favouritism are obviously in operation within the CCRNC also.
But thankfully there is no sign of the DHSSPS resorting to the same kind of Machiavellian strategies in Ulster. All patient groups in Belfast and the counties who wanted to be represented on the NI Working Group, found themselves knocking on an open door. All shades of opinion have been given a welcome. What should happen, has happened.
At the first meeting the patients were given their full say. As a matter of fact, during the 90 minutes allocated it was difficult for anyone else to get a word in. There were ten civil servants and senior NHS personnel present, and they were exposed to the full blast of decades of pent-up patient frustration.
The Chairman was David Galloway, DHSSPS Director of Secondary Services, and he was obviously following his Minister’s instructions to properly consult with patient Stakeholders. Mind you, such was the volume of patient input that he had to abandon half the meeting’s planned agenda.
Among the medics the Neurologists were represented, as promised. The designations of others present are still causing come puzzlement: “Assistant Director Physical & Sensory Directorate”, “Programme Planner for the elderly and physically disabled”, “Older People's Services”, for example. But there wasn’t a psychiatrist in sight – hooray!
At a late stage we discovered that the medics had held a “pre-meeting” before our arrival. Didn’t want to talk in front of the children, d’you see? That was a bit disconcerting. Considering none of them had any specialist clinical expertise in ME, what could they usefully discuss in our absence?
And at our meeting there was very little interaction between NHS personnel and we patients. A few responded only very briefly, when prodded by the Chair. They were hearing NHS horror stories from patients on every side of the room, but this produced little apparent reaction.
In any other medical specialty, I imagine that in such a meeting there would be unanimity of purpose and brisk engagement between clinicians and clients. But in the UK it has not been like that as regards ME. Our patients have never been given what they need and want. We have always been fobbed off with whatever it has profited the psychiatrists to force upon us.
In Belfast it was not possible to divine what the medics were thinking. That was a pity. This was a rare opportunity for some much-needed doctor-patient rapprochement, and it hasn’t yet materialised.
Medical care shouldn’t be like this. It shouldn’t be a case of “Them and Us.” I hope we can do better. I hope we can persuade them to see it our way.
More later.
H.

The Corridors of Power.
First Meeting of the Northern Ireland Working Group on ME, 28/10/09.
Having been admitted to the corridors of power - for once - ME patients in Ulster did not miss the opportunity to have their say.
NIMEA was determined that patients distant from Belfast should be represented. As a NIMEA Group Contact, Shelly Gilfillan made a 180-mile round trip from the farthest reaches of Co. Tyrone (4 hours driving in total), to speak for ME patients west of the Bann.
She had quite an impact on proceedings:
Horace: You drove yourself from Tyrone this morning?
Shelley: Yes.
H: How long will it take you to recover, after today?
S: A week.
H: And the same would apply to all ME patients in Co. Tyrone if they had to travel to Belfast to access specialist ME care?
S: Yes.
H: You and your son both have ME?
S: Yes. My son is severely affected and bedbound.
H: How will you manage to look after him this week?
S: Fortunately my husband has a day off work tomorrow.
By this time the Chairman of the Working Group had got the message, and was hastily assuring Shelley that the proposed new Belfast ME Clinic would have an outreach centre in Co. Tyrone.
Shelley: When will we have the outreach clinic?
Chairman: It’s under active consideration.
S: Who are you going to send?
C; (Stammering a bit). Staff from Belfast.
S: But you said you hadn’t got any staff yet.
C. (Flustered now) Well, we will have to train them.
Having got properly into her stride, Shelley then began a demolition job on the Examining Medical Practitioner who came to assess her son for DLA …

For the record, the Corridors of Power are a collection of Portacabins which have seen better days, with a well-fed resident white tabby. The civil servants were a friendly bunch. The DHSSPS Director of Secondary Services, who chairs the Group, handed out tea and biscuits in person. AND he collected the empty cups from the tables afterwards. The same couldn’t be said for most of the NHS professionals present, who were rather stand-offish. Or maybe they were just paralysed with guilt.
More when I emerge from boom-and-bust.
H.

NI ME working Group

The Northern Ireland ME Association finally secured a long sought-after meeting with the Health Minister, Mr Michael McGimpsey, in September this year. The outcome of this meeting was the establishment of a Working Group on ME, and this initial meeting took place at Castle Buildings, Stormont in October.

The Group is made up of DHSS&PS, Health Board & Health Trust Officials; the NI MEA delegates were Ken Hull (Chair, NI MEA) Mrs Jo Calder (NI Administrator), Mrs Shelley Gilfillan (Network Support) and Horace Reid. There were also a few other ME representatives who attended this initial meeting.

The discussion lasted almost 2 hours, and the patient representatives covered such a wide remit that part of the set Agenda has to be abandoned! Areas covered included the desperate need for a Specialist Facility, a Paediatric Specialist Facility, satellite clinics throughout the Province, Medical Students to receive training in ME, GPs to be more aware of the illness, better understanding with Benefits and Welfare Agencies,, schools & colleges and employers. It was emphasised that CBT or GET were NOT accepable forms of treatment for ME, and that any future Clinic/Facility must not be sited within Psychiatry. The NI MEA stated that it felt any such Clinic should be headed by a Physician.

The next meeting is due to take place in the New Year. The full Report of the October meeting will be put on the NI MEA website, and NI MEA members will also have details in the NI MEA Newsletter. Any further information will also be posted on the website as and when they take place. Watch this space!!!

Horace Reid is writing a series of blogs, which are also going to be included here. They are not, of course, formal minutes or notes, but personal observations by Horace.

The Northern Ireland ME Association - THE FACTS

The following are the TRUE facts about the Northern Ireland ME Association, its work, the services it offers, and its ethos.

• The NI MEA runs an Administration Office in Belfast, and is staffed on a full time basis by the NI Administrator. She is the only employee.

• The NI Administrator has had ME, and understands the symptoms, the problems experienced by patients, the illness, the misconceptions that still exist, and the controversy surrounding the illness


• The NI MEA has a Management Committee, the vast majority of whom are, or have been, ME patients themselves; they are unpaid volunteers who give freely of their time to help others with ME - sometimes to the detriment of their own health.


• The Association has been in existence for 20 years, and therefore is not a new organisation, and is fully cognizant of the lack of facilities, care, treatment and management that still exists within the NHS. It is also fully aware of the degrees of severity that can happen with ME, and has seen at first hand the plight of severely ill patients.


• The NI MEA has always maintained that ME is a debilitating, physical illness - this is clearly to be found in our Mission Statement on the Homepage of our website:- www.nimea.org and elsewhere on this blogspot.


• The NI MEA has consistently made it clear that is does not advocate either Cognitive Behavioural Therapy (CBT) or Graded Exercise Therapy (GET), again stated on the website and on this blog.


• The NI MEA accepts the only form of "treatment management" that it would advocate is PACING - that applies now, has in the past, and will do in the future until a cure can be found.


• The NI MEA calls itself the Northern Ireland ME Association - not the NI ME/CFS Association, or the NI CFS/ME Association. The simple reason for this is that it did not, and will not adopt the term CFS, because it feels that by doing this it lends credibility to the "watered down" name for this awful illness. Neither does the NI MEA see itself as an "umbrella" organisation - we deal with ME only. We are, of course, also fully aware that many within the Medical profession still use the term CFS when diagnosing this illness - however the NI MEA does not feel it has to go along with this; Chronic Fatigue is only one of the myriad of symptoms, and therefore does not fully impact the true misery involved with this illness.


• The NI MEA does not give false hope of a cure - respected researchers, specialists and clinicians have already stated that, as yet, there is NO KNOWN PROVEN CURE for ME. This does NOT mean, of course that there is not help, certain treatments and management for the illness.


• The NI MEA does not advocate any form of particular treatment - either mainstream or alternative. We have found that some of these "treatments" can be counter-productive, disappointing for the patient, and in a very few instances nothing short of a scam. The Association feels that patients are intelligent enough to recognise these.


• The NI MEA has had contact with the CFS Service at Belfast City Hospital - surely it is better to have dialogue, make our views and concerns known in an adult and mature way, rather than agitate and antagonise - we feel it is better to act in a responsible manner, with some sort of credibility; The CFS Service is also fully aware of the NI MEA views on CBT and GET, and that the only treatment that the NI MEA supports is PACING.


• The NI MEA supports and, where finances permit, contributes to the on-going biomedical research taking place in the UK. It also has regular contact with MERUK - formally MERGE.


• The NI MEA has made it patently clear that it feels funding should be channelled into biomedical research and not psychological. This view is made clear on our website and elsewhere on this blog.


• The NI MEA has spent many years campaigning for even 1 Full Specialist Facility for ME patients. This Campaign continues despite rejections and disappointments during those years.

• The NI MEA is also campaigning for a proper Adolescent Facility in addition to an Adult Facility.

• The NI MEA is fully aware of just how much still has to be achieved regarding this illness, the total lack of provision, the scepticism still prevalent in some circles, the total lack of NHS funding and the need for immediate action. To this end the NI MEA has met recently with the Health Committee at Stormont, the Chief Medical Officer for Northern Ireland, and has been trying, without success to date, in getting a meeting with ANY of the Health Ministers throughout the years. However, the NI MEA continues to actively pursue all concerned.


• The NI MEA does not blame others for the NHS refusal to fund ME Services, and the current Health Minister for not giving serious attention to ME.


• The NI MEA now receives some Core Funding from the Department of Health, Social Services & Public Safety to run the Administration Office. This came about after many years hard work and ceaseless attempts to obtain this funding. Because of this, we can now pass on the benefits of funding to our members - see below.*


• There are no "strings attached" to the funding - it is given on merit for the work being undertaken by the NI MEA.


• Because of the Core Funding from the DHSS&PS the NI MEA can now offer FREE membership for life *


• The NI MEA offers all its services FREE *

FREE Services include :-

• Full access to the NI MEA Medical Advisor (Consultant Physician who ran an ME Clinic in one of London's leading Hospitals for many years)
• Full access to the NI MEA Benefits Advisor (a local expert in all of the Benefits systems)
• Full access to the NI MEA Paediatric Advisor (a local Consultant Paediatrician)
• Full access to the NI MEA Education Advisor (an expert in Special Educational Needs, and Statementing, and is a Tutor for the OU in Teacher Training)
• Benefits Application Packs
• Benefits Appeals Packs
• Specialist Medical Packs for GPs, Consultants etc
• Specialist Education Packs for Schools and colleges
• Support Networks throughout NI
• Children & Teens Support Network throughout NI
• Young Adults Support Network throughout NI
• Parents Support Network throughout NI
• Quarterly Newsletter
• Extensive Range Information Leaflets and Brochures
• Booklets for Children and Teens

These services cost the ME patient nothing - all they need to do is contact the NI MEA by:-
Information Line (24 hours) Tel: (028) 90 439831 (Leave your name and address)
email: jo@nimea.org
website: www.nimea.org and fill in the on-line Enquiry application.

These are the real facts about the NI MEA. We are here to help where we can, when we can and in whatever way we can.

The Northern Ireland ME Association - HERE FOR ME AND YOU

FULL Blog reply from NI MEA to Ian McIlroy on UTV Life blog

The following is the FULL reply which the NI MEA submitted to the UTV LIfe blog on Tuesday 15th April in answer to the post made by Ian McIlroy. Somehow, this full version, which had been posted by the NI Administrator, did not appear on the blog as it had been orginally submitted.

In his long post, Ian McIlroy forgot to mention that he is a member of a rival ME charity, with an axe to grind, and something to gain from knocking NI MEA.

He is aggrieved that NI MEA receives DOH funding, and his organization does not. Funding is available to those who lobby for it. NI MEA lobbied at Government Buildings once in October and twice in November, including briefings to the CMO and the Assembly Health Committee. When was your organization last at Stormont, Ian?

Ian is angry and frustrated that NI MEA would not advertise on behalf of Dr. Derek Enlander. Dr. Enlander is a distinguished Ulsterman based at a famous New York Hospital. As a research lecturer, he is most welcome. However while he is in Belfast for a short period, Dr. Enlander
proposes to see patients. Some questions arise: does he intend to actually treat patients; if so how will he supervise their continuing care from 3000 miles away; and will his own regime conflict with a patient’s current NHS treatment? With such uncertainties, there can be no immediate endorsement from NI MEA for any visiting doctor.

Ian is upset that we invited a psychiatrist to a doctors’ conference at Lagan Valley Island last year. Now let’s get real here. He’s the consultant in charge of the Belfast ME clinic. Do you think the doctors in the audience wouldn’t have missed him if he had been excluded? Fine start to a conference that would have been. Our speakers included Drs. Willie Weir and Jonathan Kerr, both from London, and both leading opponents of the psychiatric model of ME.

But whoops! - Ian forgot to mention those details also.

NIMEA committee members are all patients, all volunteers, and are all ill. Our work is always achieved at the cost of their own health.

When there is anything to be done, there is always a shortage of volunteers to assist. Despite that, our committee members do much good work. After all the work is done, those who were previously “too tired” to help, often receive a burst of energy, and direct venomous criticism at those colleagues who did make the effort. Ian has been rather inactive on the ME front, until yesterday. But now he’s in line for a black belt - as an armchair critic.

Jo Calder.

Administrator,

NIMEA.