Northernlands 2 - In conversation with...


Paul Connell & Marc Farr chat with Ben Goldacre, asking him about Open Prescribing and his latest piece of work on Open Safely


This transcript comes from the captions associated with the video above. It is "as spoken".

Hi everyone. Welcome to Northernlands 2

which is pioneering and online

And this is our Open Data Saves Lives session.

This is the first session and I'd like to say welcome to Ben Goldacre

and Mark Farr. In a minute they're going to talk about and tell us

who they are, but before that my name is Paul Connell, founder of

ODI Leeds. So I guess you can say, ODI Leeds is my fault.

So, over to you Mark. Tell us where you are

and what you doing here.

Hi Paul I'm the chief analytical officer for East Kent

hospitals, which is a big acute trust based across

That side of Kent from Margate right across to Ashford,

including Canterbury and various other things, and I'm also the

regional chair for Analytics for Kent and Medway. I get involved in

a whole range of other things with people like yourselves and

Ben and Health Foundation and others, but that's my day job

Ben? My name is Ben Goldacre. I trained as a doctor at Oxford

and London then trained in psychiatry at the Maudsley.

trained in epidemiology, which is kind of applied medical statistics

at London School of Hygiene.

And then I came to Oxford four years ago to set up something

called the data lab and we're quite an odd group in the sense

that we we're truly mixed team of software developers, traditional

academic researchers and clinicians, and we set out to

build live interactive data- driven tools and services as

well as traditional academic research papers. And then I guess

alongside that I also do showing off stuff. So I write a column in the

Guardian. And wrote books called Bad Science and stuff like that.

Fantastic, so odd people showing off. I feel comfortable with that

that's good. So Open Data Saves Lives that came part of ODI Leeds'

strategy last year and it is basically it's Mark's fault.

So mark came and spoke kindly at the Northland one conference.

He put that in my head about Open Data Saves Lives as

something we could use to to engage with people in the health

and social care sector and take all the stuff we've been doing

and apply it to the health sector. But we didn't know how

important it would become in

2020. It was something we started in 2019. We started work

on it. And then since the start this year with the pandemic,

we've been doing a weekly session around data, health and

what we can do to do to help and share. And we've all been

looking on with awe and admiration at the work you've

been doing at Open Safely, Ben.

So tell us about it. Tell us what it does and why it's so amazing.

Oh thanks. Alright, you have to promise me

that we can talk about Open Prescribing at some point,

'cause that is actual open data. Open Safely is interesting

because it's the absolute opposite. It is the most

closed data imaginable, and rightly so. It's individual

patients' full electronic health record. So we've built a very

highly secure and unprecedented electronic health records

analytics platform that's running across the full primary

care data. Pseudonymised. Of 40% of the population. That's

about 20 something million people

And. We wanted to like in order to achieve that we had

kind of various goals. First up, we knew we couldn't do it in the

traditional model of doing a large data extract and

researchers downloading that onto their local hard drive and

then running some state of code or some other code in the kind

of walled garden stats package. We couldn't do that because that

would be monstrously insecure. But it's also inefficient and

expensive to ship 40 billion rows of data, which is what

we're working across.

So instead we built a secure analytics platform inside the

data center of the EHR vendors TPP. So that's where the data

already resides and that brings a number of really important

positive benefits. First of all, it's very cheap and efficient.

You're not shipping 40 billion rows around the country, even

down the fattest N3 pipe or post-N3 is still at the

scale where you'd want to drive. Well, I mean, you're not really

allowed to drive around too much at the moment, but

it's a scale of data where in peacetime you stick a hard drive

on the passenger seat and drive to go and get it.

Secondly, it allows you access to near real time data which is

really important in a pandemic instead of large episodic

extracts. It also brings however enormous security benefits, so

you're already in an ISO27001 compliant environment.

You're in a place where you've got logs of

everything that happens, so you can be certain that everything

is safe and secure, and you are not exposed to the risks of

people doing reidentification attacks on data, which is what

you get with big downloaded data sets. Think everybody understands

about the risks of re-identification attacks or should I explain

them briefly. You've got 47 seconds to do it.

Alright take my wife. So if you want to find my wife in a GP research

data set, even though it's taken her name and her date of birth off,

you just look for somebody had twins in 2013, a baby in 2014

and the event codes moved from London to Oxford around about

2015 and then from publicly available information you found

my wife having then re- identified my wife in a

pseudonymous data set. You then discover everything else that's

attached to her pseudo ID.

Including all of chlamydia episodes after we got married.

Or nocturnal enuresis bed wetting aged 14 or any of these

other things which do not apply to my wife. To be absolutely clear.

But I'm just giving you examples of first of all how

easy it is to identify somebody and also the catastrophe of what

you can discover about them. But we also wanted to go beyond just

having an even a generic trusted research environment.

Because we thought we could do

we could do better, so the most disclosive data, the riskiest

data, is the event level data, where it's like one row and it

says this pseudonym ID on this date at this time had a blood

pressure test and it was 140 systolic over 100 over 70

diastolic. Those kinds of single events. Now when you're doing

epidemiology research. You don't necessarily need all of that

very granular detail. For example, you might want to build

a data set that's one row per patient. Rather than one row per

event. And for each patient you might want to, say, create a

variable that's one if they've had a high blood pressure

reading in the last six months, and zero if they've not.

We didn't want to create a world in which researchers had the full

power of a versatile query language against the most

disclosive data, so instead we built a platform where

researchers never have to do that, never, never should be

able to do that. Never, never do that. So instead you describe

your study population, and that's essentially just a very

stripped down representation of the SQL query that you want to

do. And that runs against the real data to extract your true

data set and then you can run your state of code or your R code

or whatever. And there's lots of really clever fancy bits

in between there. So for example, we wanted to push

forward from a world in which people do electronic health

records research in silos for the most part, never sharing

their code lists, which is what they used to identify outcome

variables or drug exposures or disease exposures, never sharing

code. We wanted to push people towards open ways of working,

but not in a kind of

shaking fists kind of way, but just make it easy for people to

do the right thing. So we built Open Safely in that image.

And so.

Anytime you want to run code against the platform would

define a cohort. You have to do that by writing it in a GitHub

repo. You can clone a template right now, and if anybody wants

to at home you can go to Open Safely's GitHub repos and you

can clone that template and build your own study definition.

Then we're also trying to bring sort of computational data

science techniques into being the norm for EHR research.

For example. You write your study definition and you don't just

say I want this outcome variable to be: "Have you got high blood

pressure or not?" You also say "I want this outcome variable to be

high blood pressure." Using the following code lists in the

following date range to say one or zero and I'm expecting the

prevalence of that to be 15% of

the population. We then automatically generate a

simulated data set so it's not synthetic data that respects the

co-segregation of exposure and outcome variables. It's just a

simulated data set, randomly generated, so then you can

develop your stator or R code and it will check on GitHub that it

passes tests. Then you push it to run on the real data and then

you get your summary results out and then somebody manually... well

two people manually look at them to make sure they're not

disclosive, and then they get released out so that the rest of

the team can take a look.

And it's all built

in a glorious giant collaboration, and I cannot tell

you how much fun it's been. It's bordering on a love affair

between our teams, actually, and it feels to me like

a massively missed opportunity to get EHR

software developers working closely with EHR researchers.

It's sort of real no brainer, and actually I feel like it's

as with a lot of things during covid and I hope we can talk

about this in more detail later, it's been great to see

the pace picking up and some unhelpful barriers cautiously

and thoughtfully worked around during the period of covid.

So Mark, you run data at a massive hospital. What's it been like in

a massive hospital dealing with data and covid?

I mean, I thought, like you, it was sort of be beholden on me to

do kind of first line research. So I went to a place in Austria

where everybody caught Covid and then. But the weird, the weird

thing for us is that because a lot of people say to us, well

how do you cope with situations like this? Well hospitals they

sort of do that a lot you know

we're ready for planes to fly into bridges and natural

disasters and oil spills and chemical issues and all this.

So we're quite good at putting up operational Control Center,

producing gold command and Silver Commander, Bronze Command

and all those sorts of things, but it's like nothing else we've

ever seen. And a lot of the issues for me, and I agree

with a lot of what Ben said and I'll give you some examples in a

minute of things that I think are really positive and have

kind of accelerated, but we had

to receive national modelling advice and then work out really

quickly that it didn't really work for us, so then had to

stand up local modeling resources to build models that

were more akin to us. That didn't take sort national

averages and just apply them crudely down into Kent. So we had

a whole stream of modelling work that started really quickly. Now

are we going to put up a military hospital? A kind of

Nightingale for Kent, as it were, and how many ventilators

would we need and where would we get in from? And it all felt

really difficult and we thought we were going to have hundreds

and hundreds of ICU beds and

as of today, I think we've got less than 40 people in an ITU

bed on a ventilator, so we you know we converted theaters

into ITUs which were now converting back the other way,

and it's not, it's not out of any mistakes that people made,

it's just it's been so new that we had to kind of work in

such an agile way with the data particularly on the modelling.

I agree with Ben that we've got some stuff done that's really

positive. For almost two years I've been trying to get the NHS

to agree to share data with the police.

To analyze intimate partner violence.

I felt really strongly about this and there

was a lot of reporting through April in the Sunday papers about

domestic abuse, and you know, calls to sports centers and so on

And we managed to make the case that it's reasonable to

link these two datasets together. Done securely done appropriately

along similar lines to... similar, but different

to what Ben's done. And we got that agreement. We've got that

agreement for three out of four hospitals in Kent within a week,

and I'm going to try and knock the

last one over soon. And we had some initial results back from

the police, just a kind of a, you know, a kind of linking 2

files together level before we even start trying to do any sort

of predictive modeling. And it looks like it's really, really

powerful. The data. So getting stuff done and getting it done

quickly, and sensitively, I completely agree with Ben.

That's been that's been really key for us.

I mean, we've been talking, you know, one of the concepts is how

do we now get that? And how do we write up so you're doing it

in Kent. How does that happen in Carlisle as it just

happens without all of us getting involved and it links to your

point, Ben, it's forcing people to be open in how they access

the data, how they access your

work. And that's fundamentally what Open Data Saves Lives is

about, so I guess we're talking about getting people to use the

web. So when you write a blog post about that mark and we put

the governance framework around it and you write a little story

blog, and a technical blog and you put the code on GitHub, how do

we get that deployed in Carlisle next year without having to

spend a lot of money on consultants which you know

that's the dream, really?

Yeah, I mean we've put a lot of stuff out publicly, so all of

the joint data control agreements that we've had been

through 25 lawyers. Everything that we run through

the committee I chair is all publicly available, so we set

up, new local data sets for Covid, not b'cause the regulators

asked us to, but because it seemed like sensible thing to do.

We shared through your good selves data

dictionaries for all of that we've got through the webinars.

We've got people. Kind of adopting that, and,

you know, giving us advice on where is the latest decent list

of where care homes are because that was something we had to

look at really urgently, really quickly and just getting UPRN

data for care homes would have just been turgid and taken

months and months. And we kind of got that done quite quickly,

Which you think is the best, by the way, Mark. Did you get CQC

care homes list matched to UPRN. Yes, I think that was

and again that was through just contacts of Paul we got to that

list much quicker than we would have done historically, so

that's quite useful. That published data that the CQC do.

We went through geography at Open Data Saves Lives

in the session and it was

how the UK has managed to shoot itself in the foot about

geography and how the... No. I agree, I think there's a

there's some really interesting cultural stuff in there as well.

Like for example, there's often a lot of anxiety and lack of

clarity around licensing for things like geodata, and

that's almost worse than just a hard yes or a hard no to a given

data set, in particular because it let's people who are being

miserly off the hook 'cause they can live in the shadows.

But also it creates anxiety where

you might have one individual in an organization,

he says, look, I've looked at the licence. It's fine.

We can reuse this. It's OK. Don't worry about it and their boss,

who's a generalist and legitimately across 14 different

areas just goes 'Oh God! I don't know you better go and you

better go and get that reviewed by legal' and then reviewed by legal

means it's in a huge queue and reviewed by legal is expensive and

slow and all that. Yes, it's so much easier to say no

We could just rolled over on the IG on the police thing

and the thing I always say, it would be famous last words, but

if you kind of go up into the legality of it and the ICO, it's

about if you're doing a good thing or not. If you boil it down.

The language as you become... actually becomes more loose.

So are you doing something that you would

defend in court and would help you sleep easy in your bed?

So trying to address the risk of domestic abuse

during lockdown feels like a good thing to do. I'm not

building a mailing list for a drug company. I feel really

confident that that's a good thing to do, but it's really

easy in law to say it's all bit difficult actually, and we need

to come up with a way of consenting every single patient

before we do it. You know, we're trying to get the British Red Cross

at the moment to

look after some of the patients that come into our Emergency

Department who've got quite chaotic lives and they're definitely

coming from a good place to try and do it, but I've had to push

and push and push for us to do that, and we now doing it

because in law you kind of drift into 'did we consent them?

did we? Were they able to consent well enough for us to

record that they consented enough?' and I think that's part

of what Open Data Saves Lives is to give a kind of robust defense

against this kind of lazy.

privacy concern angle. Yeah, I think you do need to be,

you know, good people can do bad things for the right reasons and

I think I think there has actually been a lot of

sloppiness around IG over the years. I mean, the thing that I

actually find really dispiriting is that there are a lot of

projects out there which are to my mind

monstrously insecure by design, but which have

ring-binders filled to overflowing with signed-off paperwork saying

that they are all fully legal under IG. And actually,

it's interesting. It cuts both ways.

You can have bad IG that blocks good things. You can have

bad IG that permits very bad things. And I do think

think again there's a really interesting cultural point here

Which is first of all

During this period of turbulence, and it's not, it's

not anarchy, its flexibility. There's a lot of really good

stuff being done on the hoof by people going "OK. I'm going to

pick up the phone. I'm going to talk to the person in the local

authority or the hospital who normally I'd have to go through

15 different layers to get to. I'm just going to go alright.

Hi is that Barbara? I've got an idea. Can we do a thing? And

what I'm really hoping is that

I think there's a lot of enthusiasm in the air for

retaining the best of the new norms that have arisen during

covid in the post covid era and I think it would be really

powerful if that happens. I think the other thing that I'm

really hoping to see is... this really speaks to the issues

around public goods, around incentivising innovation

especially with open data and open source tools.

I'm really hoping to see.

Successful delivery. Not just rewarded in terms of praise or

some kind of monstrously complicated like, "Oh, you're a

Pathfinder. And now we're going to work out how to deploy it

with, with an innovation deployment opportunity grant

that costs more in person. Time to ask for it." Right?

What I'm hoping we will see is

people going OK here's a group of people who delivered

something that's useful. And

we're gonna take the approach of GDS and the best of digital

innovation in the private sector and go you resource teams, not

single pieces of work. And you go: Here's a bunch of people who did

something really useful.

Let's resource them because fundamentally, the big

challenge that I think government and the health

service face is...

You're trying to get a whole bunch of new behaviours

around technical skills happening out in

government in the health service. It's really difficult to do that.

You're struggling uphill against people having

line managers who are generalists who don't understand

the technical work that their immediate reports are engaged in

and all of that.

One of the best things you can do is well is trying to create

the perfect job descriptions and the perfect formal job ladder.

And you could also say right. We found people who are doing

something useful out in the

system. They're definitely delivering 'cause they've got a

proven track record of shipping outputs that worked. Now let's

resource them so that they can be number one taken off any jobs

that don't use the technical skills they have that we want to

see exploding across the system.

Resource them so that other people can go and sit next to

them and watch how they work and learn from them so they can spread

And let's resource them to either produce

essentially propaganda or educational materials, either

themselves or with somebody else. And actually, frankly, I

think the thing we're also really overdue for is a bit of

proper knowledge management. There are professions who were

unfortunately don't have a good name, it they've got names like

librarians or information scientists, but they're not

putting books back on shelves. There are people have given a

great deal of thought into how to curate complex technical

knowledge in a commons of knowledge to help people find

the information they need at the right time to help stop good ideas

getting lost and all of that. When I was when I was allowed

to go to the pub, I used to get drunken rant about

that sort of stuff. All I'm asking for is a coherent

information architecture? Well, do you know what there's

a thing called the web?

And if you put things on the web people can

find it, you know. Imagine if that health architecture, you

know we just said every project should have three things, which

is a story blog which describes what is. A technical blog which

says how we did it and then a repo with the data and code and

you link it all.

And then you said, well, actually I can then find it on the web

and then I can look it up. Well it links to

a point that Paul and I were talking about where one of

the things we found under Covid is that we've been asked to give

loads and loads of people loads of data all the time, but we

never get any of it back.

And Ben, if you and I run neighboring trusts

I don't get to see your data. Which would be really helpful.

Would be really helpful for me to know in Maidstone if your

numbers are going up and mine are going down. So we had to

create all that ourselves. There's also something

really important, I think, Mark

around. Reciprocality. So if you hand over a load of data

you should expect to see the thing that is used for coming

back to you.

Not lock down on NHS England Tableau dashboard

I mean joking aside

if you had a principle where every time you sent some data

a sit rap or whatever you got, everybody else's back. There's

nothing identifiable on any of that and we''ll put some

governance around it, but it'd be really, really powerful if I

knew exactly how many people in every school in Ashford had been

tested and what our rates were as we drifted into Maidstone.

Really simple to do so. We ended up

We did some really good stuff locally without being told or

asked to just link a load of our data together and to create new

datasets that we're all sharing in the open using some of Paul's

tools hopefully, but it's frustrating that you're involved

in this machine of pushing data into a center and nothing useful

comes back. And even if it just went to people like you that

would be a start, but if it kind of came promptly back to us,

as we sent it, that'd be really

really helpful. Open Prescribing which we built in my

group in Oxford is another very good example of that.

[Open] Prescribing's our service that let's any interested person

go and see exactly what each individual GP practice is

prescribing down to the level of individual prescriptions, month

by month, individual practice

level. And Open Prescribing now has 135,000 unique users a year

15-or-so 1000 unique users a month It's got thousands of people

subscribing to alert service that's driven off fancy

statistical process control techniques under the bonnet,

but which is nice and friendly and easy to use

when you subscribe. And

we did that very deliberately because we, you know, I've

worked with EHR data in the past. Rich, disclosive, but

pseudonymised very detailed event level data. I wanted to start

building live interactive tools and services like Open Safely,

but we start with Open Prescribing, without being

shackled and slowed by the phenomenal cost and permissions

which is legitimately around closed data. So that was

the only way that we could possibly have got our group

up and running and using kind of agile collaborative approaches

and freely sharing code on GitHub where we've now got

45,000 lines of code in total. Well, I think more relevantly

1000 issues open and closed

So working with that open data first, it's

probably the richest health data set that's ever been shared as

open data. And we have published

studies showing that in places where Open Prescribing is used

that prescribing improves.

We've got huge numbers of examples of really important

signals that we've detected on

risk, quality and cost effectiveness that simply would

never have been discovered anyway. They were certainly

never detected by the people employed by NHS business

services or authority or NHS England to analyze this data

And why should they be? That's not a criticism of those

organizations, but people working behind closed doors,

but also in limited numbers obviously will never have all of

the perfect answers for every possible user group. For every

possible analytic idea on every

possible aspect. Of every possible dataset. It's just ludicrous

to ever imagine that that's how creative analytics could

possibly work. There's also, I think something really

interesting and political here, which is around where data is and

isn't disclosed. So Mark, you working in an NHS Trust

Hospitals are quite large and powerful

organizations, and there's a really interesting historical

anomaly, which is that...

The GP level data for practice level data. It's basically all

published and shared as open datasets. Compare that with

hospitals. No hospital prescribing data. Medicines

usage data 'cause GP prescribing hasn't really have... no hospital

medicines' usage data is shared as open data. I'm happy

to talk about the reasons behind that. We've got paper hopefully

coming on that in the BMJ soon

All of the model Hospital data and this is the flagship

variation in care national analytics program. Not a single

one of the things that it measures about each hospital,

is shared. Now that would be much, much less disclosive, and

I think it's really, really interesting to think why is

GP data always shared as open data which then creates this

really fertile ecosystem of people doing collaborative

analytics to help? And also done in a really positive spirit like

we just, we almost never see anyone misusing Open Prescribing

in a childish way. We never see people going. Is this the worst

GP in Kent? In fact, we've never seen that, but it's really

interesting. GP data shared hospital data, not. I wonder

if that's a function of their political weight and their size.

We're rabbiting on... God, God, I've got to go yes. But let's finish on

something positive. So we - myself and Mark - we're launching Open

Data Saves Lives as a bit more of a thing this year and that

exactly that point is to help people and give them

permission to share more, do more and also kill reports. So

rather than writing reports and presentations, powerpoints,

build stuff that fixes stuff. So that's what ODI Leeds is doing.

In Kent Mark? What are you doing this so positive and out of all this?

I'm still reveling in my success with the police, but

I've also got everyone to... I've got joint data control, which

is a GDPR function signed up across the whole region, so we

got 2 million people.

20 odd NHS organizations all signed up.

No politics. Really good network. Really good relationships.

Everything we're doing is published openly, so that's

really positive and it looks like we've got some big research

bids that we can announce soon to carry on building a linked

data set at a lower level of depth than has been done. Only

akin to some of the stuff that Ben's doing. Most people are just

linking sus data. It's not that interesting, so it's really

exciting. We've got medical

school opening. We go open a data lab with the University and

the medical school, so I'm really excited about that.

How 'bout you Ben? What's next?

We're expanding Open Safely and were expanding it in various

interesting directions. I'm really, really interested in

seeing a better Commons of knowledge around operational

research, and this is something that me and Mark have talked about

a lot. In fact, we've got a paper coming out in Journal of the

Royal Society of Medicine, I think very, very soon, which is around

how to kind of build

Make cooperational research great

again. The Lancet used to publish audits in the 80s.

I mean it was a normal thing and now it's all done behind closed

doors and there are pockets of greatness and pockets of

drudgery and manual labor in Excel. We need to

make it a thing which has a Commons of knowledge.

A shelf full of textbooks and courses rather than just going

to sit next to Mark Farr for a while and you'll pick it up.

My aim is that that's something that people who are 20

want to do when they come out of

a university with a good maths degree. That's literally what

I'm trying to do. I'm going around universities saying 'This is cool'

You can meet people like Ben and Paul

Jesus you gonna have to do better than that.

On that bombshell I'd like to say thanks very much. It's been amazing.

Goodbye from Northernlands 2. Thank you Ben. Thank you Mark

Thanks Paul

See you soon

  • Ben Goldacre

    Author, campaigner, broadcaster, doctor

    Ben Goldacre
    © Ben Goldacre

    Ben Goldacre is a doctor, best-selling author, academic and campaigner. His work focuses on uses and misuses of science and statistics by journalists, politicians, drug companies and quacks. His book Bad Science reached #1 in the UK non-fiction charts and has sold over half a million copies worldwide. He has published extensively in all major newspapers and various academic journals, and appears regularly on radio and TV from Newsnight to QI. He has written government papers and reports on evidence based policy, founded a successful global campaign for research transparency, and currently works as an academic in the University of Oxford, where he runs the EBMdataLab building live data tools to make science and medicine better, like OpenPrescribing and OpenTrials. His blog is at and he is @bengoldacre on twitter.

  • Marc Farr

    Founder, Beautiful Information

    Marc Farr
    © Marc Farr 2019

    On leaving the management consultancy Experian Marc joined UCL’s Centre for Advanced Spatial Analysis as a senior research fellow. It was there that he made initial contact with Dr Foster, analysing the relationship between geodemography and health outcomes. They were looking at the use of postcode level statistics to standardise hospital mortality rates alongside variables such as age, sex and diagnosis to enable hospitals to be compared with one another.

    In 2004 Marc joined Dr Foster as Director of Product Development where he oversaw the company’s development of tools across clinical benchmarking, financial management and health needs mapping. In 2007 Marc was made Honorary Professor at UCL in the field of Geomatic and Civil Engineering. In 2010 he joined East Kent University Hospitals NHS Foundation Trust where he is Director of Information responsible for informatics, coding and clinical systems. Marc is a graduate of the King’s Fund future leaders course and was named in the HSJ Top 50 Innovators in Health 2013.

  • Paul Connell

    Founder, ODI Leeds

    Paul Connell
    © ODI Leeds 2019

    Paul is an entrepreneur and specialist in innovation, his experience and knowledge means that he has developed a unique skill-set in the field Open Innovation, Data & Smart & Future Cities.

    He founded ODI Leeds in November 2013 and DataCity in 2016.

    ODI Leeds is a pioneer node of the Open Data Institute. It was created to explore and deliver the potential of open innovation with data at city scale. It works to improve lives, help people and create value.

    DataCity is a Data as a Service (DaaS) company that is using Big Data and AI to understand the economy in real time.


Nothernlands 2 is a collaboration between ODI Leeds and The Kingdom of the Netherlands, the start of activity to create, support, and amplify the cultural links between The Netherlands and the North of England. It is with their generous and vigourous support, and the support of other energetic organisations, that Northernlands can be delivered.

  • Kingdom of the Netherlands