A reply to Fraser Nelson: the only thing astonishing is how little power local authorities have

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Catherine Staite

Fraser Nelson’s article on Birmingham City Council last Friday was a very disappointing offering from an experienced journalist and a reputable paper – more Daily Mail then Daily Telegraph. 

It was riddled with inaccuracies.

Birmingham City Council does not have ‘astonishing power’. What is astonishing is how little power local authorities have, even in big cities.  Central government has as iron grip on local government. Money – how it is raised and spent – and policy – the thinking which underpins those choices – are the two key levers of government and central government controls them both.

The average amount of local authority income derived from Council Tax is 16%.  Council Tax is a regressive tax based on 1991 property valuations and bears no relation to the real costs of providing local public services.  LAs cannot increase CT by more than 2% without a referendum, for which they must pay.

The remainder of their income is made up of rents, fees and charges (local authorities can’t make a profit) and business rates (which central government gathers and re-distributes to a national format).  The remainder comes from grants from central government. BCC’s take from Council Tax is only 7.5% because of poverty and property values, which means it is disproportionately dependent on central funding, which has been cut by 35% since 2010.

The gap between rising demand and falling resources is getting wider by the minute in Birmingham, just like it is in Chicago.  The difference is that Chicago can run a deficit of billions – and has done so for the last ten years.  BCC has to balance its books.  It is still obliged to deliver over 1700 statutory duties – from trading standards to disposal of the dead to the protection of children. Year by year it has less and less room to manouvre.

What is really astonishing is that Birmingham and other local authorities still manage to deliver very good services. A recent Ipsos Mori poll showed satisfaction remains high.  That is because authorities have protected frontline services in spite of losing 15% of their jobs since 2010.

Splitting up Birmingham City Council would make no sense at all. The comparison with Manchester is entirely spurious.  The geography and demography of the ten unitary authorities in the Greater Manchester area is very different to Birmingham but the success of that area is built on collaborative upscaling not on separatism. They have banded together to create a Combined Authority. It’s the only way to get the economies of scale and critical mass to compete, bring growth and deliver infrastructure.

The West Midlands is not made up of unitary councils – it is a mixture of unitaries and two tier areas – encompassing counties and districts.  This makes it harder for Birmingham and the wider West Midlands to emulate Greater Manchester’s collaborative progress.  In Birmingham, some services are run at a neighbourhood level, and a district structure helps support better engagement and differentiation but there is nothing to be gained by splitting the city.

Birmingham is a global city, competing with Chicago, Melbourne and Guangzhou and dividing it up would be a nonsense.  Last week senior people from Birmingham City Council were in China, drumming up business for the city.  Would Beijing be interested in talking to Kings Heath District Council? I think not.

Blaming Birmingham City Council for the architectural failings of the 1950s is like blaming David Cameron for Suez.  It’s entirely pointless. Most cities have some 1950s and 1960s monstrosities but Birmingham is being very successful in transforming the city centre. The Bull Ring works, New Street Station is being transformed and whatever Prince Charles thinks about the new library, I think it is truly amazing.  It is beautiful and original.  What is more important is that it works.  Hundreds of thousands of people have flooded through its doors and librarians have had to work hard to keep up with the huge rise in demand for books.  That is the real measure of its success.

People hark back to the happy days of Joseph Chamberlain who as Mayor in the 1870s and thereafter transformed the city and created the legacy of civic splendor, including the University of Birmingham.  The difference between then and now is that he did have ‘astonishing power’ because he had control of both the money and the policy.  In spite of the herculean efforts of Lord Heseltine, central government controls the big money for skills, growth and infrastructure.  It is to the credit of Birmingham that they have done so much with so little.

Poverty is indeed a problem in Birmingham but not one which the city council can solve. National policies drive national poverty which is then concentrated in big cities. Birmingham is super-diverse and has a high proportion of young people.  Ethnic minorities and the young have been disproportionately effected by the recession.  Central government’s cuts to benefits to vulnerable people are shunting the costs of poverty onto local government at a time when they have few resources with which to respond.

Child protection is a stark example of this phenomenon.  Most child abuse has its roots in poverty, drug and alcohol addiction, domestic violence and mental illness.  Local government cannot solve all those ills alone.  Every serious case review and every inquest highlights a very simple lesson.  Children can only be protected when all the key agencies work together – schools, GPs, mental health services, the police, the hospitals – as well as children’s social care.  Cuts in public sector funding have a knock on effect on child protection.  West Midlands police cannot attend all the case conferences they should.  It is in those circumstances that children fall through the net.

Somehow it is always the Council that gets the blame.  They do hold the ring in a complex network of agencies, professionals and responsibilities – but they cannot always be expected to hold the blame.

Catherine Staite

Catherine Staite is the Director of INLOGOV. She provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.

The paradoxical nature of being successful

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Ian Briggs

The world of social science can be an odd place at times. Much is quite rightly being made of the impact of severe reductions in public spending, but when social scientists look at the levels of satisfaction with public services, many see the general quality of services remaining high.

This seeming anomaly can seem even more confusing when we start to look at the tactical moves made by public institutions and bodies to place themselves within a market-based approach to service provision. For those in the private sector demand stimulation is a core activity. Seeking growth, market penetration and improving competitiveness are very much at the heart of sound management and leadership. But for the public sector the issue of demand brings with it issues of access criteria, rationing and strategies o deflect demand away from the most pressurised services.

The rise of strategic commissioning has been for many the key mechanism to deal with market-based approaches to service provision – this brings with it tactics that seek to make public services more attractive to market-based provision, stimulating provision rather than stimulating demand. Indeed, there are growing numbers of examples where through taking a market-based approach to provision, citizens are readily accepting that services are commissioned by public bodies but actually provided by private and third sector organisations.

Consequently, if satisfaction and contentment remain high (though it has to be accepted that is not in any way universal), why should we worry?

Having happy and content consumers for a commercial organisation is indeed something to be very highly valued and the same should be true for our public services. However, there is a sting in the tail. There are an increasing number of examples of what we can refer to as ‘needs acceleration’ – if you satisfy a demand for a good or a service then over time it brings with it an appetite for yet more. This is a phenomena that is well understood in many consumer markets; once you have provided a good product the time will come when it needs replacing and the consumer expectation is that it will bring with it an advancement in quality and increased utility.

For local councillors, the expenditure of monies on local improvements can bring with it both satisfaction and a feeling that if an improvement is made in one area then another must be close behind. This is ‘needs acceleration’ – if you can make one thing better then why can you not deal with another perceived problem? For many in local communities the history of planning gain through section 106 agreements often leads to a paradox – this is now being keenly felt with severe budget reductions.

An example of this is where developers have brought improved local facilities such as play areas with housing developments, over time the asset investment cost is overtaken by revenue costs to keep the facilities in good order. Over ten years a play area that cost £60k to build and install can bring with it equal levels of cost to ensure that it is maintained and operated to an acceptable standard. This impact of ongoing revenue costs over capital costs is an issue that is at times challenging to get across to communities who seek improvements in civic amenities but remain unaware of the longer term implications of meeting revenue expenditure obligations.

The same can be said for where we have schools that are judged to be of high calibre. This brings with it the perceived advantage of higher property values and greater pressure for development. A local school with strong OFSTEAD reports is attractive for a developer seeking to build new properties on adjacent land. For the developer the housing mix is determined by national regulation though it is clearly in the interests of the developer to build houses that are saleable and attractive to potential customers who seek to have a place in a good school for their children. Given that any new development brings with it obligations under section 106 or the CIL, the local community has the right to expect that local facilities and infrastructure improvements will follow – though, again, the actual benefit may be relatively short term. Although the open spaces and free public access facilities that come with new housing development are to be welcome and indeed seen as a necessity, over time the costs of maintaining such improvements will have to be met from somewhere. This cost can and does often fall on the local community, increasing pressure on expenditure in future years, at a level that can be difficult to calculate.

This, however, cannot be an argument for mediocrity. We need development; any community that does not seek to improve is failing in its civic duty – though we may be facing too many problems in years to come by taking a short term view of civic performance. For many councillors, the pressure to create physical improvements to a place is huge; though if we concentrate too much on the immediate future at the expense of the longer term we can see that some of our public services will fall into neglect, especially as the cost of maintaining those services and facilities increases over time.

A question that often arises in our teaching and research on the issue of strategic commissioning is what it is exactly that make strategic commissioning strategic. The answer may lie in the balancing of meeting immediate need with longer term vision – too often commissioners are faced with commissioning for the here and now and fail to see that we have to make all provision sustainable; poor short term commissioning may meet immediate needs but fail to take into account where service need will be in years to come. Most councils are willing to admit that they struggle with the very idea of having a commissioning strategic – they can see the need for it but commissioning for future needs is something that can be driven out as today’s agenda is about meeting known needs today.

Commercial organisations have at their fingertips different strategies that are perhaps unavailable to us – they can offer differentiated products and services where premium products and services can be delivered alongside standard ones. The premium charges cover the cost of research and development and the cost of the premium in the first place.

What remains is that whilst there may be growing evidence that some people are generally satisfied with what is provided in a period of austerity and service diminution, the actual demand for services does not actually decrease. We offer an increasing number of potential substitutes and alternatives, but where we make improvements or update facilities and services within the mind of the public it can and does bring an expectation of more.

briggs

Ian Briggs is a Senior Fellow at the Institute of Local Government Studies. He has research interests in the development and assessment of leadership, performance coaching, organisational development and change, and the establishment of shared service provision.

Delivery of public services and economies of scale: Cooperation as an alternative for small municipalities

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Germà Bel

The economic crisis has strongly affected many developed countries, and has caused serious tensions in government finances. These constraints are particularly important at the local level, because local governments have limited taxing bases, and fiscal competition is stronger. Policy discussion on local government reform and local cost reductions, as well as increasing efficiency in local service delivery, is widespread.

Besides the measures of suppression or reduction of intermediate local government in some countries, the most relevant feature of local government organizational reform is the search for a better scale, to be able to provide local services in a more efficient manner. A policy frequently proposed to reduce costs is merger of municipalities. In practice, most experiences worldwide have had compulsory character, given the usual reluctance of municipalities to merge. However, it is by no means clear that municipal amalgamation results in cost reduction.

An alternative reform of local service delivery increasingly which is increasingly used has been intermunicipal cooperation, which focuses on functional consolidation of services instead of focusing on amalgamation or consolidation of governments. Little is yet known about why municipalities engage in cooperation to deliver local public services.

Shedding further light on this question is the aim of our recent article ‘Why do municipalities cooperate to provide local public services? An empirical analysis’. We use a database of the Spanish region of Aragon, characterized as having many small municipalities. Our empirical analysis confirms that small municipalities need to cooperate with other municipalities so as to reduce the costs of providing services. The need to exploit scale economies, which is not possible for small municipalities individually, may be one of the main factors driving the decision to cooperate.

Of course, municipalities could also contract to a private vendor to benefit from scale economies. However, higher transaction costs with privatization seem to be particularly influential in the decision of local governments to privatise or cooperate in the delivery of solid waste collection. Our analysis shows that small municipalities prefer to cooperate so as to reduce costs, while larger municipalities prefer to privatise the delivery of the service.

The clear policy implication of our work is that intermunicipal cooperation, as opposed to privatisation, may well be an optimal solution for the delivery of services by local governments in small municipalities. Municipalities of this type have to face the problems of a lack of competition and high transaction costs, while facing the need to exploit scale economies. By cooperating, scale economies can be achieved with lower transaction costs and fewer concerns for competition than is the case for private production.

A full account of this research is available in my recent article with Xavier Fageda and Melania

Full details of this research are available in my article with Xavier Fageda and Melania Mur: Why do municipalities cooperate to provide local public services? An empirical analysis.  Local Government Studies, 39(3), 435-454.

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Germà Bel is professor of Economics at Universitat de Barcelona and Visiting Professor at Princeton University (Woodrow Wilson School). His research focuses on public sector reform, with a special emphasis on privatization and regulation, and he is particularly active in the study of transportation infrastructure and local public services.

Building public trust in policing? The contribution of Police and Crime Commissioners, one year on

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John Raine

The ‘Plebgate’ saga, which has now drawn apologies to Andrew Mitchell from three chief constables, has once again raised questions about police integrity and dented public trust and confidence in policing more generally. Building such trust was, of course, one of the Coalition Government’s arguments for introducing Police and Crime Commissioners (PCCs) – and, as the first anniversary of those elections is now close upon us; it seems timely to consider what difference PCCs have so far made.

It was, we all remember, an inauspicious start; with an embarrassingly low electoral turn-out (averaging less than 12 per cent) because of poor advance publicity on the new PCC role; failure to provide most voters with candidate election leaflets, and choice of a November polling date when no other local or national elections were taking place. Moreover, matters seemed to get worse in subsequent months with critical media headlines concerning the appointment of deputy commissioners and youth commissioners; reports of disagreements and discord with chief constables, and discontent over policy priorities and budget decisions.

But one year on, with PCCs becoming established in their roles, the picture has begun to look rather more settled. It is, for sure, too soon to assess the impacts – beneficial and otherwise – of the new police governance framework. But a recent round of ‘stock-take’ interviews with a small sample of PCCs (including Conservative, Labour and Independent office holders), has highlighted at least two key respects in which the directly-elected model of governance already seems distinctly different from the previous regime of Police Authorities.

First: the new PCCs are giving much more priority to public engagement – they are out and about on a near daily basis, presenting themselves and taking feedback at council meetings, in open public meetings, and indeed, in shopping precincts and market squares around their (very large) patches. They are also all actively exploiting the potential of Facebook, Twitter and other social media in reaching-out and communicating and handling considerably more direct correspondence (email and post) and telephone calls from citizens. Their public profile is already much higher than that of Police Authorities.

Second: there is a stronger sense of ‘local leadership’ to their work. The Home Office has admirably resisted the temptation to try to drive the new system and impose its own perspectives and priorities on PCCs. Although cuts in all police budgets have been driven by reductions in Home Office grants, Westminster and Whitehall have generally allowed PCCs to get on with the job locally as each considers best. As a result, there is more diversity between the PCCs with regard to their approach and priorities in the role than was previously apparent with Police Authorities.

Relationships and accountabilities with chief constables and with other criminal justice and local governance agencies are intriguingly variable, as each PCC brings their own personality and preferred style to the role. Indeed, it is clear that the different career backgrounds and experiences of each PCC are colouring and shaping their approach to the role and their priorities.

By the time of the next PCC elections – scheduled for May 2016 – it will be interesting to gauge the significance and durability of these early signs of change towards stronger democratic engagement and local accountability, and to see what, if any, are the implications for public trust and confidence in policing. At least a more lively public debate and much higher turn-out are surely to be expected next time.

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John Raine is Professor of Management in Criminal Justice at INLOGOV. He has been involved in criminal justice research, consultancy and teaching at Birmingham for some twenty-five years and has a strong track record of commissions for the Home Office, Lord Chancellor’s Department/Department for Constitutional Affairs/Ministry of Justice on aspects of policy and practice within the criminal (and civil) justice sectors.

Want a 50% turnout in a local election? Try Neighbourhood Planning

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Chris Game

Yes, there were other news stories last weekend – Grangemouth, St Jude, Plodgate, Merkel’s mobile, Lady Gaga’s new album. Still, a more than 50% turnout in something local governmenty surely merited some kind of headline.

Last autumn, remember, the national turnout in the police commissioner elections was under 15%. Yet on Thursday, in the Cheshire village of Tattenhall, they voted in droves – not for a mayor, councillor, or commissioner, but to express overwhelming backing for their neighbourhood development plan.

From the damp squib of elected mayors to the micro-meddling of Communities Secretary Eric Pickles, the Coalition’s localism agenda has hardly been an unqualified triumph. With neighbourhood planning, though, it does seem to have hit on something capable of imbuing in at least some of us “a zeal for participation”, as Nancy Holman put it in her recent, more conceptual, discussion of the topic.

Introduced in the 2011 Localism Act, neighbourhood planning is about giving people more influence over planning decisions affecting their daily lives: choosing where new homes, shops and offices should be built (or not built), what these buildings should look like, and what infrastructure is needed.

The Act allows parish and town councils or other representative community groups (as in the Upper Eden and Exeter cases described below) to formulate Neighbourhood Development Plans (NDPs), that will shape development in their area – provided they ‘have regard to’ national policies and conform with local planning strategy.

Proposed NDPs must pass an independent standards check, usually by a planning inspector, and are then put to a referendum, organised and paid for by the local planning authority. If the Plan receives majority approval, the planning authority must adopt it, and it becomes part of the legal framework with which future planning decisions must comply.

Last Thursday, in the fourth of these referendums, nearly 52% of residents turned out and 96% of them supported the Tattenhall and District NDP – which means it now has legal status? Well, not quite yet.

game table

The NDP is a professionally prepared 30-page document replete with a vision, objectives, a strategy, implementation plan, maps, appendices, and six clear policies on various aspects of community life. But not all policies are equal, and here Policy 1 on Housing Growth is clearly more equal than the others that flow from it.

There are currently 1,090 homes in Tattenhall parish and the Plan proposes allowing up to 30 new homes in the built-up village in the period to 2030, plus some smaller scale development elsewhere in the parish. Three national housebuilders, however – Wainhomes, Barratt Homes, and Taylor Wimpey – have applied to build a total of 305 homes in what the Plan regards and rejects as “large-scale inappropriate development along existing village boundaries”.

The builders contest some aspects of the Plan and also the independent examiner’s impartiality, and the first two firms have lodged a judicial review challenge, which, until the High Court has deliberated, will prevent the Plan being formally adopted and joining what Planning Minister Nick Boles has called the quiet planning revolution.

He used the phrase back in March to describe the similarly positive outcome of the first referendum in, appropriately enough, Eden – though not the Garden thereof, but Eden Valley to the east of the Cumbrian Lake District.

The Upper Eden NDP is quite different from Tattenhall’s, not least because the area is extremely sparsely populated and about 17 times Tattenhall’s size. Again, the main focus is housing, but the proposed development rate here is 40 homes a year, and 545 over the plan period to 2025 – a higher total than the 479 in the district council plan, with all 66 extra homes allocated to rural areas that the parish councils involved in preparing the NDP felt had previously been overlooked.

Other policies include increasing affordable rural housing by permitting more conversions, incentivising developers to provide more housing for older people, and improving broadband provision. This being the first NDP referendum, there was a lot riding on it, not least for Ministers, and Upper Eden delivered. In a 34% turnout – nearly double that for Cumbria’s police commissioner vote – 90% backed the Plan.

The St James area of Exeter, site of the next plan that went to referendum, is completely different again: 6,000 residents sandwiched between the city centre and university campus in a community that has been losing its traditional and diverse character through the intrusion of traffic and car parks, neglect of green space, but particularly the conversion of family homes into houses in multiple occupation (HMOs) – student occupation.

The NDP was prepared by the Exeter St James Forum, a group of local people, including students, brought together initially by residents’ associations. Key policies included restricting the spread of HMOs and bringing more social balance to the area, encouraging small businesses, a tree planting campaign, and identifying certain residential streets for ‘home zone’ treatment with reduced and slowed traffic.

In a May 2nd vote in a student-dominated ward, turnout was an unsurprisingly disappointing 21%, but the endorsement of the Plan a positively Putinesque 94%.

The last of the four NDP referendums to have taken place so far was held on the same day, in the South Oxfordshire town of Thame, and we have another quite different scenario.  For Thame’s NDP was a direct response to the core strategy in South Oxfordshire’s local plan, which proposed to allocate 600 homes on one large site on the outskirts of the town, rather than, as many residents seemingly preferred, on developable sites within the town itself.

The district council, to its credit, backed Thame Town Council’s bid for government funding to produce its own NDP, on the understanding that it could cover only non-strategic issues and not, for instance, the numbers of proposed homes. Advised by professional urban designers, the town council consulted with residents, identified more than enough potential sites, and eventually agreed on a ‘Walkable Thame’ option, the condition of which is that new homes should be within walking distance of Thame town centre.

In the May referendum it was approved by a more than 3 to 1 majority on a nearly 40% turnout. As the local media justifiably boasted, Thame residents had become the first in England to pick their own housing sites through a neighbourhood plan.

Three more referendums are currently lined up, but this is a trickle with the potential to become a flood. There are now well over 600 recognised Neighbourhood Planning Areas, and Ministers claim that over half of English local authorities are working with groups on community planning, many of whom are receiving government grant funding to help them prepare draft plans.

It’s far too early to draw any serious conclusions – as to whether neighbourhood planning will constitute a quiet revolution or anything else. But one almost instant criticism of NDPs, raised also by Nancy Holman in her references to NIMBYism, was that they would appeal most to parish and town councils in relatively less deprived rural areas in the already over-heated south-east.

It may well prove to be true, but the four very disparate Plans to have come almost arbitrarily to referendum so far offer little support.

game

Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

Innovation in social care: it’s the how as much as the what

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Catherine Needham

People with personal budgets need to have something to buy. For some people the money will be spent on a personal assistant. But there will be lots of people who don’t have a big enough budget to employ someone, or don’t want to take on employer responsibilities. For them a more attractive option may be to buy some support from within the community. What budget-holders probably don’t have in mind is buying care slots from a big domiciliary care agency employing a high turnover workforce on zero hour contracts, replicating the local authority offer. The transformational stories that have spread about personal budgets have been based on people thinking much more creatively about the kinds of choices that budget-holders might want to make. Of course some people might want short visits from agency carers; plenty of self-funders already opt for that. But local commissioners of care services, particularly as they become market-shapers, need to ensure that 15 minute services aren’t simply chosen because there is nothing else to buy or nothing else that can be afforded.

One way to get more cost-effective and innovative services could be for commissioners to stimulate the growth of micro-providers: very small local care providers who keep costs low through minimal bureaucracy but who can find innovative ways to offer support. The Putting People First consortium has endorsed these micro-enterprises (employing 5 people or fewer) as a key element of the move to personalisation: ‘Micro social care and support enterprises established and managed by local people are in a good position to deliver individualised services and are vital elements of a diverse market’.

But is it true that very small organisations are more innovative and cost-effective than larger ones? The University of Birmingham is leading a project to evaluate the contribution that these micro enterprises make, testing if they outperform larger care providers in delivering services to users that are valued; innovative; personalised and cost-effective. We will be speaking to people who use services, and to carers, in micro, small, medium and large care providers, as well as to the providers themselves and the local authorities in which they are based.

The existing literature on scale and innovation is ambiguous: small organisations can be more versatile and lean, intimately knowing their customer-base and innovating quickly. On the other hand, large organisations have the inhouse expertise and the financial security to be experimental, utilising economies of scale. However existing studies have rarely looked at micro-providers (with 5 or fewer staff), as opposed to small organisations (classed as having 6-25 staff). Micro organisations may magnify the benefits of smallness, providing very personalised support to just a few people, and drawing on the ‘natural networks’ of the community to keep costs low. However micros may be more fragile than small providers, heavily dependent on one or two staff, and unable to participate in local tendering processes that are more accessible for small organisations.

A central issue for the research team is the extent to which micro-enterprises can become a new core offering for social care, or whether they offer creativity at the margins, for people who have the resources or imagination to step outside the domiciliary or residential mainstream. This links to the question of what kind of innovation is on offer from micro-providers: is it a what innovation, i.e. a new kind of support. Or is a how innovation: delivering ostensibly traditional services such as residential and domiciliary care in more personalised ways, being better attuned to what kind of support is being asked for, and developing more relational forms of support which utilise the assets of those being supported.

Some of the micro-enterprises supported by the national body Community Catalysts are very much offering what innovations. There is no obvious ‘old world’ equivalent of an animal-human therapy service or a bike-powered smoothie business, just two of the diverse services which Community Catalysts helped to get started. What innovations hit the headlines and help to generate excitement about how personalisation can break the mould of social care service-land. However it is the scope for process-based how innovations that constitute the most radical challenge to the mainstream of social care. People will continue to need help getting out of bed, getting washed and dressed; for some people residential care will continue to be the best place to get this support. If micro-enterprises are an affordable way to get the personalised, responsive, dignified,  domiciliary and residential support that we would all wish for our families, that will be a radical finding from the project.

For more details about the project please see the website or contact Catherine directly.

Catherine Needham is Reader in Public Policy and Public Management at the Health Services Management Centre, University of Birmingham, and is developing research around public service reform and policy innovation. Her recent work has focused on co-production and personalization, examining how those approaches are interpreted and applied in frontline practice. Her most recent book, published by the Policy Press in 2011, is entitled, Personalising Public Services: Understanding the Personalisation Narrative. Follow Catherine on Twitter: @DrCNeedham.