Government’s Response to Francis Inquiry Report (Department of Health)

Summary

The Government has published a full response to Robert Francis QC’s report into poor standards of care at Mid Staffordshire NHS Foundation Trust.

“These documents build on the government’s initial response: Patients First and Foremost, which was published in March 2013″.

Read more: Mid Staffordshire NHS FT public inquiry: government response.

Reference

Mid Staffordshire NHS FT public inquiry: government response. London: Department of Health, November 19th 2013.

The main report comprises 2 volumes:

Full Text Link

Reference

Department of Health (2013). Hard Truths: the Journey to Putting Patients First. Volume One of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry. Presented to Parliament by the Secretary of State for Health by Command of Her Majesty: Cm 8754-I. London: Stationery Office, November 19th 2013.

Volume 2 outlines the responses to each of the 290 recommendations made by the public inquiry.

Full Text Link

Reference

Department of Health (2013). Hard Truths: the Journey to Putting Patients First. Volume Two of the Government Response to the Mid Staffordshire NHS Foundation Trust Public Inquiry: Response to the Inquiry’s Recommendations. Presented to Parliament by the Secretary of State for Health by Command of Her Majesty: Cm 8754-II. London: Stationery Office, November 19th 2013.

The Government has also responded to the House of Commons Health Committee’s Third Report of Session 2013-14: After Francis: making a difference:

Full Text Link

Reference

Department of Health (2013). The Government Response to the House of Commons Health Committee Third Report of Session 2013–14: After Francis: making a difference. Presented to Parliament by the Secretary of State for Health by Command of Her Majesty: Cm 8755. London: Stationery Office, November 19th 2013.

Alternative Online Interactive Format

There is also an online version of the Government’s full response to the Francis inquiry into the Mid Staffordshire NHS Foundation Trust:

Full Text Link

Reference

Mid Staffordshire NHS Foundation Trust public inquiry: government response. London: Department of Health [Online], November 19th 2013.

Main Themes Grouped Into Five Areas

Recommendations are grouped into five main areas:

Compassion and Care.

Sub-categories include:

  1. A common culture.
  2. Caring for older people.
  3. Commissioning for standards.
  4. Department of Health leadership.
  5. Implementing the recommendations.
  6. Nursing.
  7. Putting patients first.
  8. Role of supportive agencies.

Values and Standards.

Sub-categories include:

  1. A common culture.
  2. Caring for older people.
  3. Commissioning for standards.
  4. Coroners and inquests.
  5. Fundamental standards of behaviour.
  6. Healthcare standards.
  7. Implementing the recommendations.
  8. Leadership.
  9. Local scrutiny.
  10. Medical training and education.
  11. Nursing.
  12. Openness, transparency and candour.
  13. Putting patients first.
  14. Performance management and strategic oversight.
  15. Professional regulation.
  16. Regulating healthcare systems: Health and Safety Executive.
  17. Regulating healthcare systems: Monitor.
  18. Role of supportive agencies.

Openness and Transparency.

Sub-categories include:

  1. A common culture.
  2. Coroners and inquests.
  3. Department of Health leadership.
  4. Effective complaints handling.
  5. Fundamental standards of behaviour.
  6. Healthcare standards.
  7. Implementing the recommendations.
  8. Information.
  9. Leadership.
  10. Local scrutiny.
  11. Medical training and education.
  12. Openness, transparency and candour.
  13. Patient, public and local scrutiny.
  14. Putting patients first.
  15. Professional regulation.
  16. Regulating healthcare systems: Health and Safety Executive.
  17. Regulating healthcare systems: Monitor.
  18. Role of supportive agencies.

Leadership.

Sub-categories include:

  1. A common culture.
  2. Department of Health leadership.
  3. Healthcare standards.
  4. Implementing the recommendations.
  5. Leadership.
  6. Medical training and education.
  7. Nursing.
  8. Patient, public and local scrutiny.
  9. Regulating healthcare systems: Monitor.

Information.

Sub-categories include:

  1. A common culture.
  2. Caring for older people.
  3. Coroners and inquests.
  4. Effective complaints handling.
  5. Fundamental standards of behaviour.
  6. Healthcare standards.
  7. Implementing the recommendations.
  8. Information.
  9. Medical training and education.
  10. Patient, public and local scrutiny.
  11. Putting patients first.
  12. Performance management and strategic oversight.
  13. Professional regulation.
  14. Regulating healthcare systems: Health and Safety Executive.
  15. Regulating healthcare systems: Monitor.
  16. Role of supportive agencies.

The Government’s Response(s) to Francis’ Individual Recommendations

Alternatively, it is possible to browse responses to each of the 290 individual recommendations in the public inquiry report. Most of Francis’ individual recommendations have been accepted.

  1. Recommendation 1: Accountability for implementation of responses.
  2. Recommendation 2: Adopting and demonstrating a shared culture.
  3. Recommendation 3: The NHS Constitution.
  4. Recommendation 4: Prioritising patients in the NHS Constitution.
  5. Recommendation 5: Expectations in the NHS Constitution.
  6. Recommendation 6: Values in the NHS Constitution handbook.
  7. Recommendation 7: Staff commitment to the NHS values and Constitution.
  8. Recommendation 8: Subcontractors abiding to NHS values.
  9. Recommendation 9: Professional and managerial codes in the NHS Constitution.
  10. Recommendation 10: Staff compliance with guidance.
  11. Recommendation 11: Compliance with standard procedures.
  12. Recommendation 12: Reporting of incidents.
  13. Recommendation 13: A range of safety and quality standards.
  14. Recommendation 14: Governance of compliance with standards.
  15. Recommendation 15: Comprehensive governance standard.
  16. Recommendation 16: Provision of fundamental standards.
  17. Recommendation 17: Enhanced quality standards.
  18. Recommendation 18: Involving professional bodies in designing compliance measures.
  19. Recommendation 19: Merger of system regulatory functions.
  20. Recommendation 20: Policing fundamental standards.
  21. Recommendation 21: Monitoring information accuracy.
  22. Recommendation 22: Standard procedures and practice for compliance.
  23. Recommendation 23: Formulation of standard procedures and practice.
  24. Recommendation 24: Clarity over compliance with fundamental standards.
  25. Recommendation 25: Developing measures of outcome.
  26. Recommendation 26: Direct action over policies.
  27. Recommendation 27: Promoting effective enforcement.
  28. Recommendation 28: Zero tolerance of fundamental standards.
  29. Recommendation 29: Offence for death or serious injury to patient.
  30. Recommendation 30: Immediate steps if suspected breach of standards.
  31. Recommendation 31: Routine monitoring and inspection to lead to coordinated intervention when necessary.
  32. Recommendation 32: Immediate steps if suspected risk to patient safety.
  33. Recommendation 33: Interim powers for health regulators.
  34. Recommendation 34: External performance management whilst under regulatory investigation.
  35. Recommendation 35: Regulators sharing information.
  36. Recommendation 36: Co-ordinated collection and sharing of performance information.
  37. Recommendation 37: Trust compliance with standards in quality accounts.
  38. Recommendation 38: CQC access to complaints information.
  39. Recommendation 39: Mandated complaints return from providers.
  40. Recommendation 40: Focusing on complaint narrative.
  41. Recommendation 41: Reviewing non-compliance with patient safety alerts.
  42. Recommendation 42: Sharing serious untoward incidents with CQC.
  43. Recommendation 43: Monitoring media reports.
  44. Recommendation 44: Addressing serious incidents or avoidable harm.
  45. Recommendation 45: Care Quality Commission notified of upcoming healthcare-related inquests.
  46. Recommendation 46: Quality and Risk Profile.
  47. Recommendation 47: Overview and scrutiny committees and foundation trust governors.
  48. Recommendation 48: Care Quality Commission letters to foundation trust governors.
  49. Recommendation 49: Routine and risk related monitoring.
  50. Recommendation 50: Inspection as central method of monitoring.
  51. Recommendation 51: A specialist cadre of hospital inspectors.
  52. Recommendation 52: Collaboration in inspecting.
  53. Recommendation 53: Changes to Care Quality Commission by evolution.
  54. Recommendation 54: Records of regulatory issues.
  55. Recommendation 55: Reviewing the Care Quality Commission’s capability.
  56. Recommendation 56: Communicating the Care Quality Commission’s strategic direction.
  57. Recommendation 57: Care Quality Commission evaluation of detecting and responding to warning signs.
  58. Recommendation 58: Integrating patients into the Care Quality Commission’s structure.
  59. Recommendation 59: Representatives of professions on the Care Quality Commission Board.
  60. Recommendation 60: Regulation of governance.
  61. Recommendation 61: Merger of system regulatory functions.
  62. Recommendation 62: Patient and public involvement in Monitor.
  63. Recommendation 63: Publication of Monitor side letters and ratings.
  64. Recommendation 64: Merger of system regulatory functions.
  65. Recommendation 65: Quality of care as a pre-condition of foundation trust authorisation.
  66. Recommendation 66: Stakeholder consultation as a pre-condition of foundation trust authorisation.
  67. Recommendation 67: Quality and sustainability as a pre-condition of foundation trust authorisation.
  68. Recommendation 68: Quality and sustainability as a pre-condition of foundation trust authorisation.
  69. Recommendation 69: Quality and sustainability as a pre-condition of foundation trust authorisation.
  70. Recommendation 70: Duty of utmost good faith.
  71. Recommendation 71: Quality and sustainability as a pre-condition of foundation trust authorisation.
  72. Recommendation 72: Full inspection as a pre-condition of foundation trust authorisation.
  73. Recommendation 73: Performance reviews of Monitor and the Care Quality Commission.
  74. Recommendation 74: Guidance for foundation trust governors.
  75. Recommendation 75: Enhancing the ability of the Council of Governors.
  76. Recommendation 76: Foundation trust governors accountability.
  77. Recommendation 77: Training and development of foundation trust governors.
  78. Recommendation 78: Advisory facility for governors.
  79. Recommendation 79: Fit and proper person’s test.
  80. Recommendation 80: Disqualification of directors.
  81. Recommendation 81: Experience and training as fitness criteria.
  82. Recommendation 82: Removal of directors.
  83. Recommendation 83: Monitor guidance on principles of exercising power.
  84. Recommendation 84: Reporting of executive and non-executive contract termination.
  85. Recommendation 85: Executive or non-executive director guilty of serious failure.
  86. Recommendation 86: Training and continued development of directors.
  87. Recommendation 87: Care Quality Commission powers of prosecution.
  88. Recommendation 88: Access to Health and Safety Executive incident information.
  89. Recommendation 89: Serious untoward incidents shared with Health and Safety Executive.
  90. Recommendation 90: Health and Safety Executive should obtain expert evidence.
  91. Recommendation 91: Comply with NHS Litigation Authority risk management standards or an equivalent.
  92. Recommendation 92: Financial incentives to achieve risk management standards.
  93. Recommendation 93: NHS Litigation Authority having regard to staffing levels.
  94. Recommendation 94: Development of NHS Litigation Authority database.
  95. Recommendation 95: Care Quality Commission access to NHS Litigation Authority reports.
  96. Recommendation 96: Limitation of NHS Litigation Authority standards and assessments.
  97. Recommendation 97: Transfer of the National Patient Safety Agency to a system regulator.
  98. Recommendation 98: Mandatory reporting of significant adverse incidents.
  99. Recommendation 99: National and Reporting and Learning System information.
  100. Recommendation 100: Unreported serious incidents should be shared with a regulator.
  101. Recommendation 101: Peer review inspections for patient safety.
  102. Recommendation 102: Patient safety data should be open for analysis.
  103. Recommendation 103: Patient safety information shared with Monitor.
  104. Recommendation 104: Care Quality Commission use of National Patient Safety Agency data.
  105. Recommendation 105: Incident reports and standardised mortality ratio.
  106. Recommendation 106: Healthcare associated infections surveillance.
  107. Recommendation 107: Public Health England sharing information.
  108. Recommendation 108: Support to local agencies: infection control.
  109. Recommendation 109: Multiple gateways for registering complaints.
  110. Recommendation 110: Litigation should not prevent investigation of a complaint.
  111. Recommendation 111: Promoting desire to receive and learn from complaints.
  112. Recommendation 112: Feedback as important as complaints.
  113. Recommendation 113: Patients Association’s peer review into complaints.
  114. Recommendation 114: Complaints of serious incidents trigger investigation.
  115. Recommendation 115: Arm’s length independent investigation of a complaint.
  116. Recommendation 116: Advocates available to all complainants.
  117. Recommendation 117: Access to advice for Complaints Advocacy Services.
  118. Recommendation 118: Publication of complaint summaries on Trust websites.
  119. Recommendation 119: Local Healthwatch access to complaints.
  120. Recommendation 120: Commissioners access to complaints information.
  121. Recommendation 121: Care Quality Commission access to serious complaints information.
  122. Recommendation 122: Large scale failure of clinical services.
  123. Recommendation 123: General Practitioners undertaking a monitoring role.
  124. Recommendation 124: Commissioners applying fundamental safety and quality standard.
  125. Recommendation 125: Compliance with enhanced standards.
  126. Recommendation 126: Code of practice for managing organisational transitions.
  127. Recommendation 127: Commissioners scrutinising providers.
  128. Recommendation 128: Commissioner access to experience and resources.
  129. Recommendation 129: Commissioning focus on standards.
  130. Recommendation 130: Commissioners requirements of providers.
  131. Recommendation 131: Alternative sources of provision.
  132. Recommendation 132: Commissioners monitoring contract performance.
  133. Recommendation 133: Commissioners intervening in management of complaint.
  134. Recommendation 134: Commissioning patients’ advocates and support services.
  135. Recommendation 135: Commissioner accountability to public.
  136. Recommendation 136: Commissioners acting for their public.
  137. Recommendation 137: Commissioners powers of intervention.
  138. Recommendation 138: Commissioners’ contingency plans.
  139. Recommendation 139: Ensuring patient safety and quality standards are met.
  140. Recommendation 140: Sharing information when concerns are raised.
  141. Recommendation 141: Individual responsibility of regulators and performance managers as well as co-ordination between them.
  142. Recommendation 142: Unambiguous referral and information.
  143. Recommendation 143: Metrics relevant to quality of care and patient safety.
  144. Recommendation 144: Metrics for commissioners on quality.
  145. Recommendation 145: Local Healthwatch structure.
  146. Recommendation 146: Local Healthwatch Funding.
  147. Recommendation 147: Coordination between local Healthwatch and other scrutiny organisations.
  148. Recommendation 148: Local Healthwatch leadership.
  149. Recommendation 149: Support for scrutiny committees.
  150. Recommendation 150: Power of inspection for scrutiny committees.
  151. Recommendation 151: Complaints to Members of Parliament.
  152. Recommendation 152: Training standards concerns.
  153. Recommendation 153: Duty to cooperate with professional regulators.
  154. Recommendation 154: Coordination of healthcare organisations providing regulated training.
  155. Recommendation 155: Routine visits to local education providers.
  156. Recommendation 156: Approving training placement providers.
  157. Recommendation 157: Deaneries reporting to General Medical Council.
  158. Recommendation 158: Student and tutor feedback on safety and quality.
  159. Recommendation 159: Surveying medical students and trainees for feedback.
  160. Recommendation 160: Encouraging openness in trainees.
  161. Recommendation 161: Training visits to contribute patient safety.
  162. Recommendation 162: Patient safety as the priority of all education.
  163. Recommendation 163: Ratios of trainers to trainees.
  164. Recommendation 164: Adequate resource to meet training standards.
  165. Recommendation 165: Approved practice settings to prioritise protecting patients.
  166. Recommendation 166: Assuring compliance with approved practice settings criteria.
  167. Recommendation 167: Inspection of approved practice settings.
  168. Recommendation 168: Incorporating approved practice settings scheme for post-graduate training: DH and GMC.
  169. Recommendation 169: Incorporating approved practice settings scheme for post-graduate training.
  170. Recommendation 170: Composition of Health Education England board.
  171. Recommendation 171: Local Education and Training Boards structure.
  172. Recommendation 172: Medical practitioners proficiency in the English language.
  173. Recommendation 173: Organisations and staff must be honest, open and truthful.
  174. Recommendation 174: Candour in the event of death or serious harm.
  175. Recommendation 175: Patients questions answered fully and honestly.
  176. Recommendation 176: Statutory duty to disclose information.
  177. Recommendation 177: Public statements must be full and honest.
  178. Recommendation 178: Duty of candour to be included in the NHS Constitution, employment contracts, policies and guidance.
  179. Recommendation 179: Gagging clauses to be prohibited.
  180. Recommendation 180: Guidance and policy on openness.
  181. Recommendation 181: Statutory duty of candour for patients injury.
  182. Recommendation 182: Duty on individuals to provide truthful information.
  183. Recommendation 183: Criminal offence to obstruct statutory duties.
  184. Recommendation 184: Duty of candour to be policed by Care Quality Commission.
  185. Recommendation 185: Nurse training to include practical requirements of compassionate care giving.
  186. Recommendation 186: Consistency of practical nursing training.
  187. Recommendation 187: Pre-degree care experience.
  188. Recommendation 188: Values-based aptitude test for aspirant nurses.
  189. Recommendation 189: Common nursing and midwifery qualifications.
  190. Recommendation 190: National training standards for qualification as a registered nurse.
  191. Recommendation 191: Values-based recruitment for nurses.
  192. Recommendation 192: Responsible Officer for nursing.
  193. Recommendation 193: Common minimum standards for Responsible Officers.
  194. Recommendation 194: Nurses annual learning portfolios.
  195. Recommendation 195: Ward nurse managers responsibilities.
  196. Recommendation 196: Knowledge and skills framework for nursing.
  197. Recommendation 197: Leadership training for nurses.
  198. Recommendation 198: Measuring culture on the front line.
  199. Recommendation 199: Named nurses for patients.
  200. Recommendation 200: Registered older person’s nurse.
  201. Recommendation 201: Dividing the functions of the Royal College of Nursing.
  202. Recommendation 202: The importance of nursing representation at provider level.
  203. Recommendation 203: Coordinating nurse leaders.
  204. Recommendation 204: Providers required to have registered nurse executive director.
  205. Recommendation 205: Recording advice from nursing directors on any major changes to nursing arrangements.
  206. Recommendation 206: The role of the Chief Nursing Officer.
  207. Recommendation 207: Uniform description of healthcare support workers.
  208. Recommendation 208: Distinguishing between nurses and healthcare support workers.
  209. Recommendation 209: Registration for healthcare support workers.
  210. Recommendation 210: Code of conduct for healthcare support workers.
  211. Recommendation 211: Training standards for healthcare support workers.
  212. Recommendation 212: Developing standards for healthcare support workers.
  213. Recommendation 213: Dismissing unsatisfactory staff following breach of code of conduct.
  214. Recommendation 214: Training for managers and leaders.
  215. Recommendation 215: Standards for senior managers and leaders.
  216. Recommendation 216: Patient safety in the leadership framework.
  217. Recommendation 217: Competencies for leaders.
  218. Recommendation 218: Non-compliance with standards for leaders.
  219. Recommendation 219: Applying leadership standards to a wider range of managers.
  220. Recommendation 220: Training facility for leaders.
  221. Recommendation 221: Oversight of NHS trust boards.
  222. Recommendation 222: General Medical Council involvement in complaints and concerns.
  223. Recommendation 223: The General Medical Councils interactions with other regulators.
  224. Recommendation 224: Systemising the sharing of information between professional regulators.
  225. Recommendation 225: Peer reviews following individual concerns.
  226. Recommendation 226: The Nursing and Midwifery Council’s power to intervene prior to disaster.
  227. Recommendation 227: The Nursing and Midwifery Council’s power to investigate.
  228. Recommendation 228: The administration of the Nursing and Midwifery Council.
  229. Recommendation 229: Revalidation system for nurses and midwives.
  230. Recommendation 230: Promotion of the Nursing and Midwifery Council.
  231. Recommendation 231: Nursing and Midwifery Council procedures and trust disciplinary procedures.
  232. Recommendation 232: Nursing and Midwifery Council providing support to directors of nursing.
  233. Recommendation 233: Public understanding of the General Medical Council and Nursing and Midwifery Council.
  234. Recommendation 234: General Medical Council and Nursing and Midwifery Council joint working with the Care Quality Commission.
  235. Recommendation 235: Common Independent Tribunal.
  236. Recommendation 236: Senior named clinician.
  237. Recommendation 237: Effective teamwork to care for elderly patients.
  238. Recommendation 238: Communication with patients.
  239. Recommendation 239: Hospital discharge procedures.
  240. Recommendation 240: Hygiene requirements.
  241. Recommendation 241: Providing food and drink to elderly patients.
  242. Recommendation 242: Administering medication.
  243. Recommendation 243: Routine recording of observations.
  244. Recommendation 244: Electronic patient records systems.
  245. Recommendation 245: Board level responsibility for information.
  246. Recommendation 246: Consistent format of quality accounts.
  247. Recommendation 247: Sharing quality accounts.
  248. Recommendation 248: Auditing of quality accounts.
  249. Recommendation 249: Quality accounts certified by trust directors.
  250. Recommendation 250: Incorrect information in quality accounts.
  251. Recommendation 251: Regulators to review quality accounts.
  252. Recommendation 252: Anonymised data for managerial and regulatory purposes.
  253. Recommendation 253: Quality and risk profile information made public.
  254. Recommendation 254: National consistency of access to patient and public comments.
  255. Recommendation 255: Real time results of patient feedback.
  256. Recommendation 256: Seeking patient feedback following discharge.
  257. Recommendation 257: Oversight of healthcare information.
  258. Recommendation 258: Information methodologies.
  259. Recommendation 259: Information Centre to publish complaints information.
  260. Recommendation 260: Information standards for Serious untoward incidents.
  261. Recommendation 261: Statistical analysis by the Health and Social Care Information Centre.
  262. Recommendation 262: Local information systems.
  263. Recommendation 263: Healthcare professionals should collaborate in the provision of information.
  264. Recommendation 264: Information by speciality.
  265. Recommendation 265: Comparative statistics by speciality.
  266. Recommendation 266: Comparative statistics by specialty designed with the public.
  267. Recommendation 267: Comparative statistics by specialty available online.
  268. Recommendation 268: Resource for comparative statistics.
  269. Recommendation 269: Local auditing of data.
  270. Recommendation 270: Review of patient outcome statistics.
  271. Recommendation 271: Status of mortality indicators.
  272. Recommendation 272: Accreditation scheme for healthcare statistical methodologies.
  273. Recommendation 273: Healthcare organisations provision of information to coroners.
  274. Recommendation 274: Openness in the disclosure of information to coroners.
  275. Recommendation 275: Independence of medical examiners.
  276. Recommendation 276: Number of independent medical examiners.
  277. Recommendation 277: Standard methodology for certifying cause of death.
  278. Recommendation 278: Considering previous incidents relating to the deceased.
  279. Recommendation 279: Responsibility for certifying the cause of death.
  280. Recommendation 280: Raising concerns around deaths.
  281. Recommendation 281: Training in dealing with sensitivity issues around death.
  282. Recommendation 282: Prevention of future death reports.
  283. Recommendation 283: Information gathering for an inquest.
  284. Recommendation 284: Appointment of assistant deputy coroners.
  285. Recommendation 285: Avoiding bias in assistant deputy coroners.
  286. Recommendation 286: Public debate regarding major structural change in the healthcare system.
  287. Recommendation 287: Leading the development and implementation of standards.
  288. Recommendation 288: Clinical involvement in policy decisions.
  289. Recommendation 289: Department of Health officials connecting to the NHS.
  290. Recommendation 290: Department of Health culture.

A BBC News commentary:

Full Text Link

Reference

Triggle, N. (2013). Government publishes ‘blueprint for trustworthy’ NHS. London: BBC Health News, November 19th 2013.

Advertisements

About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in Acute Hospitals, Age UK, BBC News, Commissioning, CQC: Care Quality Commission, Department of Health, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Local Interest, Management of Condition, National, NHS, NHS Digital (Previously NHS Choices), NHS England, Quick Insights, Standards, UK, Universal Interest and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.