When leaders don't

[JohnD]

Peter,

I know that arguing with true believers is useless, but your intervention distracts from a discussion of the real causes of the destruction of the NHS.

The daily requirement of Vit D is 400-600 International Units (about 20 MICROgrams).     This may be found in 100g of an oily fish, such as salmon or mackerel, OR by spending 15 minutes with the arms and legs exposed to summer sunshine, if you are light-skinned, much longer if dark-skinned.   The vitamin is synthesised by UV in the skin.

It's a valid argument that we evolved to live naked in a sunny climate  and have developed to wear clothes in cold places.    We have also evolved a paler skin, so that the first, or moderate supplements by tablet are adequate, in summer time.   But the VitD lobby has chosen to go the MegaDose route, advocating ten times the requirement every day, and arguing that it has a multiple role in physiology so will protect us against multiple threats and illnesses.      Why would evolution have gone that route, when dark-skinned people in our original African home would need to find a kilogram of fish, or more of other foods, to eat every day?   Such an evolution would have left us as vulnerable as the Dodo, which clearly we are not.

Sad to say, this is reminiscent of the fallacy of so much modern 'wellness' advocacy, and the work of Linus Pauling.  "If something is good for you, then more is better."    Pauling was a genius who won TWO Nobel prizes, but he became convinced that MegaDose Vit C would cure the 'common' cold.     He said that a daily GRAM or more of VitC, ten times the accepted daily requirement, a 'hammer' as you have described megadose VitD, would prevent or cure a cold, although in both cases the excess vitamin  would be excreted, unused, un-metabolised and  unchanged, in the urine that same day.

No one now accepts Pauling's theory, and I fear that the Megadose Vit D is a Dodo too.

John

[Escadrille Ecosse]

9 hours ago, thebrookster said:

Does he take private patients by any chance? I might be on the look for bone doctor in the not too distant future............

He doesn't now Phil. However... he works at the Jubilee. Not sure exactly where the Health Board cutoff is over your way but might be able to get a referral?

[PeterC]

7 hours ago, JohnD said:

Peter,

I know that arguing with true believers is useless, but your intervention distracts from a discussion of the real causes of the destruction of the NHS.

The daily requirement of Vit D is 400-600 International Units (about 20 MICROgrams).     This may be found in 100g of an oily fish, such as salmon or mackerel, OR by spending 15 minutes with the arms and legs exposed to summer sunshine, if you are light-skinned, much longer if dark-skinned.   The vitamin is synthesised by UV in the skin.

It's a valid argument that we evolved to live naked in a sunny climate  and have developed to wear clothes in cold places.    We have also evolved a paler skin, so that the first, or moderate supplements by tablet are adequate, in summer time.   But the VitD lobby has chosen to go the MegaDose route, advocating ten times the requirement every day, and arguing that it has a multiple role in physiology so will protect us against multiple threats and illnesses.      Why would evolution have gone that route, when dark-skinned people in our original African home would need to find a kilogram of fish, or more of other foods, to eat every day?   Such an evolution would have left us as vulnerable as the Dodo, which clearly we are not.

Sad to say, this is reminiscent of the fallacy of so much modern 'wellness' advocacy, and the work of Linus Pauling.  "If something is good for you, then more is better."    Pauling was a genius who won TWO Nobel prizes, but he became convinced that MegaDose Vit C would cure the 'common' cold.     He said that a daily GRAM or more of VitC, ten times the accepted daily requirement, a 'hammer' as you have described megadose VitD, would prevent or cure a cold, although in both cases the excess vitamin  would be excreted, unused, un-metabolised and  unchanged, in the urine that same day.

No one now accepts Pauling's theory, and I fear that the Megadose Vit D is a Dodo too.

John

John, I am beyond discussing the science of D3 with medical professors: it bores me. Unfortunately you are being mislead by those professors in their "expert committees". The extensive science literature gives chapter and verse as to why 400-600 IU daily is ten fold too low (except for bone health). I  am chasing more exciting science now that all my family , friends and wider aquaintances are D3-aware. My duty re D3 as a scientist is done. Time will tell who is right.  Peter

[zetecspit]

Back to today. I see the govt is sticking some funding in to move bedblockers out of hospitals. Amazing it has taken this long to see that is the way forward in easing NHS issues. Tjhere is soem more money for some sort of upgrades, it sounded like for turning areas for ambulances or such stuff. I wasn't aware that was an issue, but with queues maybe it is. 

And the nurses pay. Seems some progress is happening. But I am a tad confused about the pay award for this year. Is that the pay starting in April 2023 or whenever the annual rise happens? Or are the nurses expecting a backdated pay rise? I guess if backdated, that has an affect on the next pay rise in terms of %. But none of it is clear in my muddled little brain. 

I just hope it all gets sorted out. And I expect it will be less a case that everybody will be happy, more that everybody is equally disappointed but knows it is the best either side can achieve. 

Edited January 9, 2023 by zetecspit

[JohnD]

Zetec,

The Gov promises 'new' money to speed the discharge of people who need less than hospital care from ward beds ("Bedblockers" is a horrible term, but is fewer words) .      But Care England, the care homes association, is demanding £1500 a week to do so, twice the average local authority charge, and the rate offered via hospitals is £400.   

We're doooooooomed.

    

[Nick Jones]

£400/week for nursing home level care is a piss-take.  It was £800+ locally in 2012 when we had to find one for my grandmother.  Had a good discussion with the owner/operator of the place we eventually chose and he even showed me some of his numbers. I was convinced.

[Nick Jones]

2 hours ago, zetecspit said:

I see the govt is sticking some funding in to move bedblockers out of hospitals. Amazing it has taken this long to see that is the way forward in easing NHS issues.

They’ve claimed they were doing it for weeks (if not months) now, but only a fraction of the cash actually materialising.

It is is amazing it’s taken this long. It’s been almost the number one problem for years.

I say again. All politicians and their families should be banned from private health care. That would focus them!

[zetecspit]

12 minutes ago, Nick Jones said:

£400/week for nursing home level care is a piss-take.  It was £800+ locally in 2012 when we had to find one for my grandmother.  Had a good discussion with the owner/operator of the place we eventually chose and he even showed me some of his numbers. I was convinced.

My parents both had very short stays in a care home before leaving us. Mum just a single night. Back in 2020. Anyway, it was £1000 a week then. A relative of my wife is in a Salvation Army home, a lovely place. Gill administers all her finances (and gets charged an annual fee for the priviledge!) and that place is just over £1000 a week, but I suspect subsidided by the SA. 

So £400 a week is daft. That is about the cost of a premier inn (just under £60/night) with no meals etc. 

But that does ring a bell, unless I am losing the plot. Was there a recentish scheme for people to take in hospital leavers into their homes? Obviously not those requiring any real level of care apart from being looked after. 

I guess those being discharged will largely be in that category? But no care type places can afford to take in people at such a low rate. Maybe they should do something similar to the approach for asylum seekers, and hire whole hotels. Maybe even mix them up a bit. Could be symbiotic to some degree.

[Nick Jones]

3 hours ago, zetecspit said:

Was there a recentish scheme for people to take in hospital leavers into their homes?

 Really?? I hope not, though sounds sketchy enough to have been suggest by some bright young public school wonk in the cabinet office. Huge cans of worms there for both sides…… Abuse/neglect for money vs. You touched ‘em last, your problem….

Obviously could work beautifully in some cases but…..

Bit like adopting a Ukrainian family. Some goes better than others. Our neighbours who tried it won’t be repeating.

[PeterC]

Cant be long before the NHS offers subsidised  trips to Dignitas.

 

[Nick Jones]

That would imply that “society” had accepted the need and legislation had caught up… in which case no need to travel abroad….

Few decades yet I fear. 

[JohnD]

Knicked from a friend's Fb post

Edited January 10, 2023 by JohnD

[Nick Jones]

 

Just need to wring a few avian necks then, and all would be fine…. Especially the goose, though more of a seagull in reality!

[JohnD]

And another.

Grant Shapps', Secretary of State for Business, said in the House today, of the objective of the  The Strikes (Minimum Service Levels) Bill, the latest bit of brightideary from the Tories, was that it would "protect the lives and the livelihoods of the British people”.

Honestly, satirists and political comedians must be crying into their beer.   Their jobs, arae along with with saggar maker's bottom knockers and quill pen makers, lost and forgotten when the Tories do it for them so well.

John

[Nick Jones]

Presumably that’s the nurse to the worthless oxygen thief?

Just suppose something were to happen to him while stood at the hospital gates, maybe a glancing blow from a falling piano, or getting trampled in a stampede for a newly opened food bank…. Something causing painful and incapacitating injury. Obviously he’d have to wait his turn for the ambulance, then wait for the hospital handover. Then spend at least 12 hours on a trolley in a corridor…. That would give some overdue life experience and might even bring a new appreciation for the real-world problems faced by many as a result of trolley government choices.

Or more likely he’d be scraped up by his security team and rush off to a private facility - which ought to be a career-ending move…..

[JohnD]

Nick, 

Which "private facility" provides emergency care?   There is a online list of "Private Urgent Care Centres", just in London: https://www.facebook.com/page/1673693016241746/search/?q=wingwalking.     Elsewhere, I haven't looked.

And read the  small print.   "By providing patients with rapid access to specialist medical care, from a HCA UK emergency doctor, we are able to treat a wide range of minor illness and injuries" [my emphasis]     The blurb goes on to say that "Our Urgent Care Centres do not treat life-threatening illnesses."

In the UK, emergency health care is exclusively provided  by the NHS.   And, I'm sorry to say, routinely abused by members of the public who can't be bothered to wait to see their GP or feel that they deserve treatment more quickly than is justified.   That's why this poster is seen outside most NHS A&E departments:

The poster's not exaggerating!  People do come to A&E with cuts, colds and other things that just need good sense and bit of mothering.

John

Edited January 11, 2023 by JohnD

[thebrookster]

32 minutes ago, JohnD said:

And, I'm sorry to say, routinely abused by members of the public who can't be bothered to wait to see their GP

Careful John, that's a very one-sided viewpoint there.

I'm afraid to say a lot of folks avoid their GP because you cannot get an appointment to see them. I certainly have not been able to get an appointment to see mine for several years now. Even "emergency" cases you have to phone in first thing in the morning and hope to get lucky in the GP lottery.

Surgery hours are 2 or 3 hours in the morning, again afternoon and a couple of hours in the evening, and chances are they will simply refer you on to someone else anyway.

I'm afraid I long lost faith in the GP system, I remember my local docs from childhood who were always accessible, now I am forced into using whichever surgery my local health board dictates, and the service is abysmal.

So I cannot see my way to blaming folks who feel they have no choice. I agree some are playing the system, but I suspect they don't make up the entire picture.

[Nick Jones]

An illustration of why people might (not unreasonably) end up in A & E from personal experience today.  My stomach is giving me gyp. Gastritis. Not my first rodeo by any means, but pretty severe at this point and in combination with a hiatus hernia, my oesophagus is in tatters. Gaviscon not enough. I’ve previously had various PPIs. I don’t like them (unpleasant side effects), but they are effective. I need some more, which means I need a prescription. No GP appointments (even phone) available for the foreseeable and the surgery has turned off “Ask my GP” due to “excessive demand” (truth is zero GPS). I don’t actually need to see a GP, hell, my wife could write me a prescription. She won’t though, not without due process. There is no way to access due process though…..

Turning off “Ask my GP”, a system supposedly designed to screen/triage/prioritise patient requests and direct them to the right practitioner (physio, nurse, pharmacist, GP) suggests they have just given up.

[Nick Jones]

3 minutes ago, thebrookster said:

So I cannot see my way to blaming folks who feel they have no choice. I agree some are playing the system

Don’t think many are playing the system. Why would you offer yourself to the bedlam (in its original meaning) that is your average UK A&E department without strong reason?!

In this neck of the woods, we have things called “minor injuries units”. Actually former cottage hospitals downgraded that offer basic patching services even up to the level of setting simple breaks (providing the x-ray machine isn’t broken, there is a doctor in the house etc, etc). However, their existence appears to be semi-secret - good news if you do know about them, but not helping reduce traffic at general A & E. Maybe a few more of these and a raised awareness?

[thebrookster]

9 minutes ago, Nick Jones said:

However, their existence appears to be semi-secret - good news if you do know about them, but not helping reduce traffic at general A & E. Maybe a few more of these and a raised awareness?

This, and a return to 24/7 GP services. There's something to be said for calling an out-of-hours GP for some inconsequential malady, and getting a good old fashioned rollicking for doing so. This helps teach people how to use services effectively and when you have a local doc you can trust, it works. No point in shouting at people abusing A&E if they feel they don't have any other choice!

[Nick Jones]

Don’t get me started on out of hours GP “services”.

Now only accessible I think via the very mixed blessing that is 111 and staffed on the ground by random locums scraped up from anywhere.  Some of them may be ok but our encounters with them in the days of sick kids were deeply unsatisfactory. The last had us driving directly from them to A & E just up the road, in spite of being told to take the child home and give (more) paracetamol.

The result was immediate admission and emergency surgery for a ruptured appendix. I believe the A&E consultant made a formal complaint about that one. 

[JohnD]

I'm sorry that people's dissatisfaction with NHS services gets directed at the people who try to give it.   But ask yourselves, why  is the service so awful?   It's difficult to get seen by your GP - twenty years ago there was a great expansion in GP numbers, and in the normal way of time they are now retiring.    Trained doctors, let alone GPs are too few overall.    The result? GP practices with too few doctors to deal with demand.    This argues against my previous case, that people come to A&E with 'trivial' problems, problems that they should see their GP about, or their pharmacist, or their mother.

So let  me pass on to the reason why there are too few trained doctors.  See the Medical Schools Council Report 2021: the-expansion-of-medical-student-numbers-in-the-united-kingdom-msc-position-paper-october-2021.pdf (medschools.ac.uk)  Just two charts from that study:

In Fig. 1, "PMQ" is Primary Medical Qualification" and "IMG" is International Medical Qualification.  In those middle years of the 2010s,up to 40% more  new doctors from outside Europe  came to the UK, while UK graduates stayed static.     Fig.2 shows that despite all these new doctors, the numbers who qualified and joined the Medical Register rose by less than 20%.   Not enough doctors.   Worse, the UK one of the richest countries in the world, is robbing some of the poorer of their medical talent.

What did the study conclude?   "to achieve a sustainable medical workforce, significant expansion of medical schools will be required."     Note this is after the previous expansion in medical schools and medical student numbers, which has been "unplanned and competitive"    The report concluded that 5000 new medical graduates a year were required, which would need all the medical schools to expand, and for THIRTEEN more to be founded,  And funded, of course, which to date, the Tory Government has done nothing about, despite this report being two years old.

 THAT is just one reason why you get lousy service from the NHS.    The remarks by Grant Shapps and other Tories about the ambulance workers and nurses "Endangering the people" had me shouting at the radio, that THEY have  been endangering the people, for that last thirteen years!

John

Edited January 11, 2023 by JohnD

[PeterC]

There are on-line prescribing services supposedly run by GMC-accredited doctors. Not cheap. eg Dokteronline. 

 

[Escadrille Ecosse]

59 minutes ago, JohnD said:

I'm sorry that people's dissatisfaction with NHS services gets directed at the people who try to give it.   But ask yourselves, why  is the service so awful?   It's difficult to get seen by your GP - twenty years ago there was a great expansion in GP numbers, and in the normal way of time they are now retiring.    Trained doctors, let alone GPs are too few overall.    The result? GP practices with too few doctors to deal with demand.    This argues against my previous case, that people come to A&E with 'trivial' problems, problems that they should see their GP about, or their pharmacist, or their mother.

So let  me pass on to the reason why there are too few trained doctors.  See the Medical Schools Council Report 2021: the-expansion-of-medical-student-numbers-in-the-united-kingdom-msc-position-paper-october-2021.pdf (medschools.ac.uk)  Just two charts from that study:

In Fig. 1, "PMQ" is Primary Medical Qualification" and "IMG" is International Medical Qualification.  In those middle years of the 2010s,up to 40% more  new doctors from outside Europe  came to the UK, while UK graduates stayed static.     Fig.2 shows that despite all these new doctors, the numbers who qualified and joined the Medical Register rose by less than 20%.   Not enough doctors.   Worse, the UK one of the richest countries in the world, is robbing some of the poorer of their medical talent.

What did the study conclude?   "to achieve a sustainable medical workforce, significant expansion of medical schools will be required."     Note this is after the previous expansion in medical schools and medical student numbers, which has been "unplanned and competitive"    The report concluded that 5000 new medical graduates a year were required, which would need all the medical schools to expand, and for THIRTEEN more to be founded,  And funded, of course, which to date, the Tory Government has done nothing about, despite this report being two years old.

 THAT is just one reason why you get lousy service from the NHS.    The remarks by Grant Shapps and other Tories about the ambulance workers and nurses "Endangering the people" had me shouting at the radio, that THEY have  been endangering the people, for that last thirteen years!

John

You are perfectly correct John.

And living in Glesga' you are also right about the nonsense that goes on in A&E. I have unfortunately witnessed it myself. I am frankly amazed at what the staff put up with sometimes, truly above and beyond.

[RedRooster]

Not just in the UK, my Dr retired last year, he was great no bullshit he told it like it was, phone him in the morning see him in the afternoon. No layers of receptionist vetting you and everything on paper not a PC to be seen. 

Now I have to wait days to see someone young in the new clinic and all they want is to send you for a blood test, everytime. 

Our local A&E will be closing at night soon as not enough staff. Apparently none of the newly qualified Dr's want to work rural. Macron is putting a law in place that for their first 2 years they have too. 

Don't start me off about dentists either, from loads to one and a 5 month wait. 

RR