United Kingdom: News from Forward-ME Group

If by provenance you mean where is it from, I assume it is genuinely from Bateman Horne. If you mean quality assurance then, having just looked through, I think it is terrible. It is a sort of BACME Guide to Therapy for biobabblers. It rambles on about politically correct concepts and then plunges in to make believe pathology and treatments.

I did mean "quality assurance".

IF "provenance" can have both meanings, then I suppose thats not obvious enough. I recognise "quality control" as a function within a municipal organisation. And the NHS monitors for some quality control. So does Sainsburies. Quality control is woefully lacking in many organisations, charitable and clinical.

I am not familiar with the usage of "quality assurance". I could use a handier word than control & assurance. A handy word for the unspecified quality marks being assumed - whenever preliminary, contrived or low-grade indications are dressed up. As if proven by the "evidence-based" label.

Such endorsements; supposed to have evaluated the evidence in question. Supposedly vetted as an authentic conclusion. Given pause for thought, I replaced "provenance" with "quality", since my sense of "provenance" was obscure. The closest I can find for its other usage is:

================
Data lineage > Data provenance:

In information systems, data provenance is information about the entities, activities, and agents involved in producing a piece of data;

- it records how data was derived and can be used to assess quality, reliability, and trustworthiness.

Provenance > Date provenance:

Scientific research is generally held to be of good provenance when it is documented in detail sufficient to allow reproducibility.

Scientific workflow systems assist scientists and programmers with tracking their data through all transformations, analyses, and interpretations.

Data sets are reliable when the processes used to create them are reproducible and analyzable for defects.

Security researchers are interested in data provenance because it can analyze suspicious data and make large opaque systems transparent.
 
I see that Forward-ME has a website and lists its member organisations.

One of the members is the Patient Advisory Group for the ME Research Collaborative.
PAG support patient-centred biomedical research into ME, using its diverse voices of patients and carers to advise associated bodies and platforms. PAG were Co-Chairs of the Research Working Group for the Department of Health and Social Care’s ME/CFS Delivery Plan.
It sounds as though this group has been influential in making policy affecting people with ME/CFS.

The link for the organisation goes through to an AfME page - here
There is no information about who is a member of the group or who represents them on Forward-ME. There is no information there about the selection process for getting onto the PAG. I have seen something suggesting that the MEA has run the selection process in the past, but they are not now an organisation I would trust to select good quality members.


Forward-ME says one of its values is

Integrity and Transparency

We act honestly, ethically and in the best interests of people with ME, communicating clearly and maintaining transparency wherever possible.
I think part of that transparency and accountability is making public who the representatives taking part in Forward-ME are.
 
MERC was formerly the CMRC. I think there are at least a couple of people on here who have indicated that are or were on the PAG. Maybe @InitialConditions or @Andy? Sorry, I’m just guessing and I may be completely wrong but they may know more.
No, not me. I am not, or have ever been, a member of the MERC PAG.

I think part of that transparency and accountability is making public who the representatives taking part in Forward-ME are.
But is it ethical or in the best interests of those particular people with ME/CFS? If their identities were made public, how would you hold them accountable for their opinions? And why should you be able to hold them accountable for their opinions?
 
But is it ethical or in the best interests of those particular people with ME/CFS?
I think that is something that they have to decide for themselves. There are plenty of way for them to voice their opinions or to inform other advocates if they don't think it is safe for them to make their identity known. But, if they are making significant decisions for or on behalf of people with ME/CFS, then I think they should be willing to say who they are.

It's not a matter of holding people accountable for their privately held opinions. It's about holding advocates accountable for their actions and for what they are saying about people with ME/CFS, what they are saying people with ME/CFS want and need.

how would you hold them accountable for their opinions?
There are lots of ways to hold advocates accountable. A lot of them flow naturally from the advocate making themselves available to communicate with the people they are representing. People can decide if they want to support a charity that the person has a role in. People can write to them to explain why what they are saying isn't accurate or to give them more information.

If a group is advising a government about what should be in a government policy or plan for ME/CFS or if they are voting in Forward-ME, don't you think that, at the very least, the leader of that group should be named so that people can contact them?
 
But is it ethical or in the best interests of those particular people with ME/CFS? If their identities were made public, how would you hold them accountable for their opinions? And why should you be able to hold them accountable for their opinions?

All of us, to some degree or other, have competing interests. If a group is representing a quarter of a million sick people those sick people are entitled to be in a position to judge what those competing interests might be. Competing interests are also likely to reflect the competing interests of those selecting the representatives. That process has in the past also been opaque.

Normally a group of people representing a large population in negotiations about services for that population would interact with that population and make themselves known. It may work well, but I think if transparency is to mean anything then it makes sense for individuals to make themselves known. Having got involved in the process I have to admit that it does seem a very unusual situation.
 
There are plenty of way for them to voice their opinions or to inform other advocates if they don't think it is safe for them to make their identity known.

But, if they are making significant decisions for or on behalf of people with ME/CFS, then I think they should be willing to say who they are.

It's not a matter of holding people accountable for their privately held opinions. It's about holding advocates accountable for their actions and for what they are saying about people with ME/CFS, what they are saying people with ME/CFS want and need.

If a group is advising a government about what should be in a government policy or plan for ME/CFS or if they are voting in Forward-ME, don't you think that, at the very least, the leader of that group should be named so that people can contact them?
Well, there are two things there.

Do I, as someone who is a highly visible and transparent patient advocate, personally think that the leader or representative of the PAG be named - if ForwardME asked me for my advice then I would say yes, it would be preferable to do so.

However, they are not and not being named isn't the same as not being potentially contactable - if you have issues with how ForwardME works then I would suggest contacting ForwardME with your concerns.

Do you think it is acceptable for a group to be represented on Forward-ME when it has no named members?
In short yes, as I can understand why some patient advocates would only be willing to volunteer their energy and time under the basis of anonymity, or pseudonymously such as a forum username.

All of us, to some degree or other, have competing interests. If a group is representing a quarter of a million sick people those sick people are entitled to be in a position to judge what those competing interests might be. Competing interests are also likely to reflect the competing interests of those selecting the representatives. That process has in the past also been opaque.

Normally a group of people representing a large population in negotiations about services for that population would interact with that population and make themselves known. It may work well, but I think if transparency is to mean anything then it makes sense for individuals to make themselves known. Having got involved in the process I have to admit that it does seem a very unusual situation.
They interact with the population by being members of the population themselves. They have collectively made themselves known as the MERC PAG.
 
However, they are not and not being named isn't the same as not being potentially contactable - if you have issues with how ForwardME works then I would suggest contacting ForwardME with your concerns.
I doubt my views will hold much sway with ForwardME. But, I hope that the people who are involved with it might consider whether, in a community where so much is opaque, where so much is 'about us without us', it is reasonable for an organisation with no named members and, as far as I can see, no public information about how the members are chosen, to be part of ForwardME's decision-making.
 
I think in the perilous situation pwME are in, and with the past history of the CMRC including BPS promoters, it is reasonable for its PAG to have a way of informing pwME of their stance on ME/CFS science and medical and care. How otherwise are we to trust them to represent us fairly and accurately? Whether that means naming them, or providing statements from each of them I have no idea.

Given that the current members of the PAG were presumably promised anonymity, we clearly should not out them.

But if individual pwME or carers are representing pwME in decision making bodies such as Government delivery plans or funding decisions, then I think those individuals should be prepared to be named and contactable via the organisations they represent.

There are ME/CFS related organisations with patient reps who are working against us - eg Colin Barton's Sussex group, and Paul Garner on Coffi. There are likely also to be a lot of patient reps who are well meaning but have little knowledge or experience beyond their own illness, and may therefore, with the best of intentions, give very poor advice. Take Sarah Tyson, Russell Fleming and the recently ousted head trustee of the MEA, for example.
 
Some years ago a patient rep/PAG member on a particular ME project blocked me on social media as they strongly disagreed with my views on a subject that had absolutely nothing to do with ME (views that I had never expressed on any ME page, or directly to the patient rep). It was very clear to them that I was a pwME.
So I could no longer express my views and significant knowledge re the ME project to them, the person had excluded me from giving them information relevant to the ME project, and it made me feel utterly powerless.

I must say in general, that when I read the term 'patient rep' or PAG - my heart sinks. Patient reps/PAGs are not elected, and we rarely (though sometimes) have any say in how they represent us. I do know that some PAGs are very responsible and do consult with the wider patient population. Some just represent themselves, or are over compliant to orgs we don't agree with or trust.

.
 
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Without wanting to make this about any individual patient representatives there are major accountability problems across many ME organisations that supposedly represent us & work on our behalves.

Forward ME until very recently did not have a working website. The last minutes of a FME meeting that I have seen are from 2020. And CMRC - now apparently called MERC - rivals FME in its opacity, with the only written account of its patient-led representation being the 2021 self-published book by Opal Webster-Philp. (Having had a copy shared with me I was very surprised to learn that the CMRC PAG had its origins in Esther Crawley's MEGA project.) And the last CMRC minutes that I can find - in my own collection, having been removed from AfME's website - are from 2019.

If these organisations can't even do the basics - operate a functioning website, publish minutes of their meetings, engage with patients on social media - what confidence can we realistically have in them?

S4ME is a small Internet forum, yet its volunteers are remarkably open and accessible; it even has elections. I do not think it is too much to ask that those engaged with DHSC, the NHS, etc - supposedly representing us all - exhibit at least the same, if not higher, levels of transparency and accountability.

I said this back in 2024:
perhaps the thing that annoys me most is that so much relating to pwME is done in secret: everything about us without us, or with the involvement of a few "patient representatives" who push themselves to the fore & often do not know what it is they are talking about at all. The whole DHSC process has been highly opaque and looks like it will be a complete muddle. There needs to be proper, broader, engagement.
Nothing has changed.
 
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everything about us without us, or with the involvement of a few "patient representatives" who push themselves to the fore & often do not know what it is they are talking about at all.

I also wonder if some representatives are chosen by bodies like DHSC for their convenient views. Or clubbability, or expectational 'realism'.

If you're trying to push through something dressed up as meaningful provision with as little effort and expense as possible, the last thing you want is awkward sods asking inconvenient questions.
 
Yes.

And sure, perhaps the representatives on the MERC-PAG were promised anonymity by whoever selected them, perhaps to protect them from difficult people with ME/CFS, perhaps somewhat validly to protect their families from the consequences of prejudice against people with ME/CFS. That should be respected while they do whatever the MERC-PAG was expected to do. The anonymity should not extend to the aims of the organisation, and the process and criteria for selection of its members.

I'm not too sure what the tasks of the MERC-PAG are these days, but I thought it was supposed to be focussed on research decisions. Anonymity can perhaps be justified in research funding decisions, to avoid decision-makers being lobbied. I'm not sure what research funding decision-making the MERC-PAG has done. If they just serve as an advisory panel, I don't think there is much justification for them being anonymous even in that limited scope.

But, if anonymous members of the PAG now find themselves in a ForwardME working group working with the UK government on a plan for service delivery, isn't that scope creep? How can we know that people chosen for their ability to contribute to decisions about research (by who?) are the right people to make decisions about service delivery? How can they engage with the community to gather and refine ideas? How can we know if we should have concerns about their views?
 
To be fair, even if it risks 'breaching confidentiality' my impression is that the people who might well be MERC-PAG members on the ForardME working group are intelligent well-meaning patients and carers who openly acknowledge, and increasingly so, that they know rather little of the practicalities and politics of medical service delivery. They were keen on the idea of drawing up a format for service delivery, having seen the DHSC draft, independent of any activity here.

What I think has been a real failure is that some of the organised charities have either decided to take a low profile or have provided mixed messages or encouraged compromise when it was clear that what was needed was something very different from the deconditioning rehab model still in place.

And I also trace a lot back to poor chairmanship of the original delivery plan working groups (and I am not referring to members here, who did there best to steer things to a useful outcome). There was a total lack of urgency or focus for over a year.

The current situation is not perfect but I am optimistic that almost everyone wants to pull in much the same direction. The task may well be impossible but at least people may be able to learn things from each other in this exercise that can be invested in future negotiations.
 
I don't follow the first sentence!

Nor the second really.
I will agree that it is an assumption that a pwme will interact with other pwme. There are many reasons people don't interact with other pwme at all levels. Including situational by who they are surrounded by and what those might think, but also what they either think or have been taught to think of other pwme.

Depending on which it is that might mean they are less likely to join, or will join a PAG thinking quite like laypersons that other pwme could 'learn from them' but not the other way around. Vice versa I guess a group that is needed to be covered is below and is not going to join lest it blow their cover, and they have less intrinsic lack of will to meet other pwme or thoughts on them just can't situationally.

Particularly earlier on and/or milder if you are still outside the house and trying to work often you keep your label quiet. And that will relate to the issue of anonymity and us having to understand it (but find a workaround) because lots are in this situation so it needs to be included, but those people will often extend that to not joining groups that would if a colleague was to see it 'out them'.

The famous people thread has reminded me of this phenomena of the label making you more vulnerable than not having it and just 'being rubbish' is more forgiven or 'being demanding' if needing adjustments is less to worry about.

I found that in a workplace where even if you finish yourself off keeping a smile on your face and collapse at home but not at work and are very good compared to well collagues at what you do then the label itself makes you a sitting duck not just to observation but to being the scape goat for a team that needs an excuse (as you have teh disability/illness flag next to your name) even when you are the one that stopped the productivity from actually being worse. Or clients might assume the sick person is the reason etc.

I observed this happening to others with significant not hidden disabilities too as mine being invisible meant others (friends, neighbours, colleagues and so on) didn't know and it was intriguing what people say and do regarding this without noticing they were letting anything slip because it was just like talking truth passing time stuff, so anyone then getting ill will be aware of this and might have been part of similar conversations themself - and I certainly know the label can change what people see instead of what the truth is in front of their eyes etc. Assumptions could be made about whether you wanted a career/were ambitious/could deal with stress that weren't really about your interests all of which you wonder where they come from but still are there in others
 
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I think in the perilous situation pwME are in, and with the past history of the CMRC including BPS promoters, it is reasonable for its PAG to have a way of informing pwME of their stance on ME/CFS science and medical and care. How otherwise are we to trust them to represent us fairly and accurately? Whether that means naming them, or providing statements from each of them I have no idea.

Given that the current members of the PAG were presumably promised anonymity, we clearly should not out them.

But if individual pwME or carers are representing pwME in decision making bodies such as Government delivery plans or funding decisions, then I think those individuals should be prepared to be named and contactable via the organisations they represent.

There are ME/CFS related organisations with patient reps who are working against us - eg Colin Barton's Sussex group, and Paul Garner on Coffi. There are likely also to be a lot of patient reps who are well meaning but have little knowledge or experience beyond their own illness, and may therefore, with the best of intentions, give very poor advice. Take Sarah Tyson, Russell Fleming and the recently ousted head trustee of the MEA, for example.
I'm thinking that for the purposes of external validity - and to use the market research term 'qualified to answer the question' (ie you can't talk about what the buying experience was like for the store if you never bought anything). And then that really becomes complex when you imagine struggling at work for 6months vs been there done that for a decade in different roles and ended up disabled and how wide the question is.

there needs to be something around confirming composition and views but that isn't along the lines of the tosh of pretending there is balance needed for climate change panels on news programmes handing over 50% to people with a certain ideology when that isn't representative of any range or any population or indeed experience needed, just giving 50% to those who will sponsor a certain outcome. That is just a trick to back-door in something based on politics rather than truth/getting job done interpretation of the term 'representation'.

plus you can't have people who haven't experienced x fully answering the same questions on x and given the same weight if that is the topic. What those who are yet to work in y area think they need is important, but not to be mixed in with the information from those who already do or have worked in y area saying turn out to be the real problem areas, or what actually led eventually to them getting iller etc.

I don't have the quick answer to this without some thinking but there are ways of doing it better. And it is worth further discussion.

And particularly for ME/CFS then no you can't just have these PPI things being a black box even if we supposedly trust the organisation doing it has the right intention.

But we will be excluding some of the input for areas that are affected should anonymity be not possible - current workplace stuff in particular but also those who have unsupportive situations outside of this wouldn't want their name googleable.

And there is risk regarding level of honesty if people are being linked back to what they say that it will curtail what they feel safe actually saying. But as it is I don't know what the circumstances are anyway as to who internally finds out or sits in the room that could impact that too.

But yes anyone can claim on a form x when they actually believe the opposite and so even if it was any good to go with ideology you'd have to check it was followed through with (because I bet it only goes one way that people would do this and they don't want the other way happenning just to compensate either). And even references are fallible there because we are all exhausted and other pwme might think someone trustworthy based on a long time of experience but how much do you need to know of someone etc?

But even then you need safeguards that mean those who tend to be iller aren't being attritioned by the ability to speak louder for longer of those who think they were cured by brain training being allowed in or providing more extreme answers if it is a survey were averages are used.

And people not being that bothered about that line being included from someone else because it won't affect them in their circumstance/they can say no (as are supported well), and they assume 'others' or even they themselves 'might like a bit of supportive CBT' and don't need to think of how that could be used, can be just as much of an issue in propping up things. A lot of people can't see the unintended consequences/slippery slope of something they just 'don't need themselves' but haven't yet experienced the harm in or don't know that is contributing to harm other pwme they know experience, nevermind if they are exhausted or filling it in under time pressure or a difficult meeting etc.

And very few genuine pwme live in a situation where they could meet short timeframes to deliver properly and well-thought-through amount of work vs those who aren't trying to service committments above their threshold whatever their severity. So there is the worry there that ways of working can inadvertently be used to prioritise certain input.
 
@bobbler You've raised some of my concerns which have been only increasing as my health has been deteriorating.

At one point on that downward trajectory, I have become painfully aware of the biases, beliefs and blame within the patient community.

This is an overly simple breakdown of some major observations that concern me based on my time in online communities and seeing what milder patients think and appreciate. Not all patients are like this. I think some problems you talk about stem from what I've written in the rest of this post but you've definitely touched upon wider problems than me here.

First, there's a common trap of attributting improvements to whatever they're doing (lifestyle, off-label prescriptions, supplements, mindset), overconfidence about their understanding of science, subscribing to simplistic pseudoscientific explanations and little ability to identify even the very obviously rubbish papers as crap.

Another one is just celebrating whatever becomes available to us in terms of services and healthcare options, seeing everything as a positive step forward. Furthermore, one might be called out for being negative and difficult at any hint of criticism.

Some patients who still have some quality of life speak highly of the OT who thought them how to colour code their activity diary, physio who's helping them strengthen their body, nurse who made them feel heard and validated when she told them their symptoms were real and not in their head but proceeded with treating them as if it was all in their head. Those patients highly value and call for multidisciplinary holistic care. In addition, some patients who weren't happy with the multidisciplinary holistic care they received are calling for better multidisciplinary holistic care based on the current model.

Finally, some patients show obvious disbelief that things can get really bad through no fault of the patient. The patient must be doing something wrong if they're getting worse or if they've deteriorated to severe/very severe. Some patients refuse to see the lack of care once you cannot leave your home. Common advice from a privileged position is to have private online appointments which also fails to recognise the limits of tele-healthcare.

I'd like to think that someone with any of the aforementioned views wouldn't engage in advocacy but I see it happening.
 
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