The Night Mail

[cctransuk]

43 minutes ago, Oldddudders said:

The NHS is arrogant. ... Stop the NHS sycophancy!

 

Funnily enough, the only adverse medical experience we had in Cornwall was a planned procedure at a private (expensive) hospital.

 

The procedure was cancelled because they hadn't arranged for an anaesthetist!

 

Give me the free NHS any day! (Yeah, I know all about NI contributions)!

 

CJI.

[Dave Hunt]

5 hours ago, jamie92208 said:

I hope that Jill is OK Dave. 

She's fine thanks Jamie. A bit sore but no adverse signs.

 

2 hours ago, Oldddudders said:

At age 2, Sherry required surgery for a hernia, probably caused at birth due to her umbilical being wrapped around her. She was in hospital for a fortnight, and her parents were not allowed to visit. Good to see the poxy NHS hasn't moved on. That has nothing to do with resources or costs. You pay their wages. Create merry hell with the NHS Trust.

 

The place where Jill had her operation is actually a private clinic to which NHS patients are referred to ease waiting lists so I don't think the NHS can be blamed.

 

59 minutes ago, polybear said:

 

All are available on request; if the NHS were to routinely send copies of everything to every Patient (much of which they probably wouldn't understand anyway) the cost would be astronomical.

 

The bumph I have received concerning my MRI scan next Monday states that the results are not sent to patients but will be sent to the doctor who referred me and should I want a copy I should ask him/her. 

 

Dave

[Dave Hunt]

8 hours ago, Dave Hunt said:

I’m passing the estimated two hours drinking a large cappuccino, listening to the Eagles and reading s book about the West Highland Railway. It’s a full, rich life.

 

3 hours ago, Compound2632 said:

The John Thomas classic, I hope.

 

Just so. I bought it back in about 1975 and it kindled an interest in the West Highland Railway exceeded only by that in the Midland. I recently decided that it was time I reread it and it is proving just as interesting and enjoyable as all those years ago.

 

2 hours ago, BoD said:

… a man of impeccable taste.

 

I'm flattered that you noticed ☺️

 

Dave

[AndyID]

3 hours ago, Compound2632 said:

 

The John Thomas classic, I hope.

 

Is this part of Flavio's anatomy quiz?

 

😁

[Compound2632]

6 minutes ago, Dave Hunt said:

I bought it back in about 1975 and it kindled an interest in the West Highland Railway exceeded only by that in the Midland. I recently decided that it was time I reread it and it is proving just as interesting and enjoyable as all those years ago.

 

I was given a copy about the same time, or maybe a year or two earlier. It is said that I spent an entire trip from Glasgow to Fort William with my nose in the book rather than pressed to the carriage window.

[DaveF]

When I had my colonoscopy in January this year I was sent a copy of the photos and a letter to explain what had been found.

 

I also received a copy of the letter sent to my GP confirming that the polyps removed were benign and no follow up was needed.

 

David

[Dave Hunt]

8 minutes ago, Compound2632 said:

I was given a copy about the same time, or maybe a year or two earlier. It is said that I spent an entire trip from Glasgow to Fort William with my nose in the book rather than pressed to the carriage window.

 

I became quite fascinated with the whole history of railways in the West Highlands, especially the proposed Glasgow North Western and the potential of extending the Invergarry & Fort Augustus to Inverness. On a family holiday to Scotland in 1981 I spent a whole day exploring the route of the I&FA, finding such things as the piers of a viaduct, remains of bridges and parts of the trackbed while Jill entertained the kids. That cost me more than a few brownie points!

 

Dave  

[Happy Hippo]

3 hours ago, BoD said:

… a man of impeccable taste.

I thought this when I first read the post and misread it that that he was reading about the Welsh Highland Railway.

 

Still, I will openly admit to having occasional cravings of blue Class 27 and short trains of Mk 1 stock.  Plus the freight service that was about 20 years behind the rest of the rail network of the time.

[Compound2632]

Mine is the paperback edition; I was entranced by the painting on the cover:

 

 

It's in two volumes - and has been for forty years or more, having split on spine the from over-reading - like my copy of Nock's Speed Records on Britain's Railways, of the same vintage. 

[Happy Hippo]

1 hour ago, Northmoor said:

It's strange how few people don't treat a medical consultation like a work meeting, where at the end you recap to ensure a common understanding of what's been agreed.  However, the better GP/specialist will check you understand what you've been told by asking you to tell them.

Except when you are referred for an investigation into a specific condition and the specialist team assume you have been sent for something else.  It is galling to say the least, when you turn up to the follow up appointment, having discussed and agreed the issue in some detail at the previous appointment, to have to go through the same rigmarole again because they are not listening,  and are still under the impression that you are still attending for the  condition they want you to be suffering from, as opposed to what is actually causing the problem.

 

Some parts of the NHS are brilliant as evidenced by my dealings with some departments.  Others, I will politely say are less so.

[Dave Hunt]

38 minutes ago, Compound2632 said:

Mine is the paperback edition; I was entranced by the painting on the cover:

 

 

It's in two volumes - and has been for forty years or more, having split on spine the from over-reading - like my copy of Nock's Speed Records on Britain's Railways, of the same vintage. 

 

That's the one. Mine also started to fall to bits but I treasured it to the extent that I had it rebound with hard covers, although the original front a back covers are now part of the whole.

 

Dave

[Hroth]

I've three of the Pan "David and Charles" series, all were priced at 35p, which I got for Christmas in probably 1971 or 1972. They were The Somerset & Dorset Railway (Atthill), The West Highland Railway (Thomas) and The Highland Railway (Vallance).  The S&D and the WHR copies are well read, the Highland turned out to be a bit dull, rather like the cover illustration...

 

Hey ho, look at the time! Bye for now...

Edited July 14, 2023 by Hroth

[J. S. Bach]

Night Owl from a suddenly thundering and wet Piedmont.

[Darlington_Shed]

Regarding the NHS discussion, it reinforces my view (held for some time) that we no longer have a National Health Service - we have a variety of regional health trusts that range in quality from very good to absolutely absymal and, even within the good ones, the individual care is extremely variable.

 

Mrs Shed had to rush to Newcastle on Wednesday because her Dad had been taken into hospital. Last month he had a consultation about heart surgery - he has a leaky valve. Surgery was scheduled, meetings and consultations were had, and 24 hours before said surgery, the surgeon said there would be no problems because there was no history of heart issues. FIL pointed out that he had had open-heart surgery - in that very hospital - 35 years earlier. Oh, said the surgeon paging through his file, there's no mention of that here. Result: surgery cancelled. On Wednesday, he suffered a collapse because of radically low blood pressure caused - apparently - by the meds the hospital had prescribed for his untreatable condition.

 

It is, in my opinion, a lottery where the losers die. @Oldddudders is right - the hagiography needs to stop and a grown-up discussion needs to happen.

[AndyID]

I wondered if, rather than air or water, a heat sink/shunt might be enough to prevent burning holes through the thin steel I'm using to weld our deck railings. I clamped a small piece of 3/8" thick aluminum inside the tube and that seems to do the trick. The only snag is how to clamp it when it's five feet along the tube?

 

I have concocted this thingy. Here are the parts:

 

 

And here it is partially inserted into the square tube.

 

 

Hopefully the spring will apply enough pressure to ensure good contact between the aluminum and the steel tube. It feels like it is doing that as it takes a fair amount of force to slide it along inside the tube. The thingy (heat shunt skate?) will be attached to a calibrated rod so I can position it beneath each paling as it is being welded to the rail tube. The palings are all on a 4.5 inch pitch.

 

EDIT: While typing this it occurred to me that if there is insufficient pressure between the aluminum and the steel it would be possible clamp it in position with a hydraulic piston instead of just a spring but that would be a lot more complicated.

 

It could also be done mechanically by rotating the positioning rod. The rod could rotate a cam that elevated the aluminum to force it against the steel tube. A bit like a scissors jack with a very long handle 🙂

 

 

 

 

 

Edited July 15, 2023 by AndyID
moinfo

[polybear]

1 hour ago, AndyID said:

The thingy (heat shunt skate?) will be attached to a calibrated rod so I can position it beneath each paling as it is being welded to the rail tube. 

 

So that'll be a broom handle with pencil marks on it then.....

[AndyID]

10 minutes ago, polybear said:

 

So that'll be a broom handle with pencil marks on it then.....

 

That would work quite well too although it might have a tendency to go up in flames 😄   It might also be a bit too rigid. The tube bends appreciably as you weld the palings. The welds tend to reduce the length on that side of the tube. That distortion gets cancelled out when you weld on the other rail.

 

I'll use 1/4" diameter steel rod instead. The marks will be made with a file and a white paint pen.

[iL Dottore]

6 hours ago, Darlington_Shed said:

. @Oldddudders is right - the hagiography needs to stop and a grown-up discussion needs to happen.

The UK definitely needs to have a grown-up discussion about the NHS (and funding is just the tip of the iceberg)

 

The NHS came about because during the WWII the coalition government was appalled by how many people were unfit for either military service or war work due to avoidable medical/health issues. The NHS was their solution to avoid that situation recurring. So the first question to be addressed is “what is the purpose of the NHS in the 2020s?”. If it is to provide the best possible health to the most people possible, then hard decisions will need to be made: such as “should the NHS provide X (where X is something like IVF or certain cosmetic surgeries) to otherwise healthy individuals?”

 

The next thorny issue to address is funding. According to the Government’s own website (and also the Kings Fund) the NHS is funded mainly from general taxation supplemented by National Insurance contributions (NICs). Which means funding will always be at the mercy (and largesse) of the politicians. If it is decided that “free at the point of use” remains the way to go, a shift away from how it is currently funded towards a ring fenced “NHS tax” (to be only used for healthcare) would be a sensible solution. Alternatively, either the  French or the Bismarck models of heathcare provision could be a solution.

 

The NHS (like any healthcare system) cannot provide limitless medical care to an ever increasing and aging population. So how much responsibility for one’s health should the healthcare system push back onto the populace? Currently, avoidable disease (obesity, alcohol, tobacco and sedentary lifestyle caused conditions) are taking a huge chunk out of the NHS budget (around 40% according to some NHS sources). Again difficult decisions will need to be made, such as should the health service provide an alcoholic who refuses to stop drinking a second liver transplant after destroying the first transplant through drinking? A focus on prevention rather than cure would be also advantageous (along the lines of do “X” now at a cost of £, rather than wait and do “Y” later at a cost of £££££)

 

Finally, how should a modern health service be structured? Some critics of the current NHS have observed that the NHS is the last of the 1948 Nationalised State Behemoths where “Whitehall knows best” and in many places within this behemoth staff treat patients as an inconvenience and believe that “patients should be jolly thankful for what we deign to give them”. A harsh criticism certainly, but one that that is not unfounded.
 

When the NHS was being proposed, amongst the critics of the proposal were local authorities – such as the London County Council - and local charities, who objected to have everything run from Whitehall (not to the concept of having the government fund healthcare). And I firmly believe that the LCC and the charities were right. The only role that the government should play in such a health service is to provide the funds (by whatever means decided upon) and set the standards for clinical care (not access times or whether or not a local health service does X or Y), allowing local authorities to set the priorities for healthcare to meet the needs of their population in their area. Again, this is an topic which will require honest and open discussion and difficult decisions.

 

I fear, however, that the politicians (and others) who do have the Power to initiate such a difficult discussion with such far-reaching consequences, have neither the intellect, the gumption or the political courage to do so.

[Happy Hippo]

If what iD suggests ever came to pass, then I fear that the 1.5 tonnes of cake I'm currently prescribed every week, would have to be paid for.

 

However, those that do receive prescribed medicine will note that the cost of a prescription is now £9+ per item.

 

Yet, sometimes the prescribed item is available over the counter at far less cost. So should the doctor only be prescribing expensive drugs and telling patients to buy x,y, or z at the pharmacy as it will actually save the patient money?  Or would that be somewhat counterproductive when you can make someone pay £9+ for something, that they could get off the shelf for, let's say, £3.60?

 

 

[Hroth]

6 minutes ago, Happy Hippo said:

However, those that do receive prescribed medicine will note that the cost of a prescription is now £9+ per item.

 

Those under 18 or over 60 and other defined illness groups don't pay prescription charges. And taking out a "prescription season ticket" soon pays for itself for paying patients with a large number of items per prescription.

 

I'll be the first to agree that the season ticket is practically unaffordable for those on low incomes and benefits, and that something should be done to address that inequality.

 

[Happy Hippo]

1 minute ago, Hroth said:

 

Those under 18 or over 60 and other defined illness groups don't pay prescription charges. And taking out a "prescription season ticket" soon pays for itself for paying patients with a large number of items per prescription.

 

I'll be the first to agree that the season ticket is practically unaffordable for those on low incomes and benefits, and that something should be done to address that inequality.

 

That is why I was a sickly child and then remained illness free until I passed my 60th birthday🤣.

[bbishop]

On 13/07/2023 at 06:26, iL Dottore said:

I think “Dr Google“ is part of the problem. Somebody has a few symptoms, looks it up on Google and suddenly is banging on the door of the local GP practice convinced they have developed a life changing or terminal condition.

 

What “Dr Googlel“ doesn’t do is differential diagnosis! Take for example “nausea and vomiting“, were I to list all those conditions that have nausea and vomiting amongst the symptomatology, the list would run into several pages. Making a diagnosis, usually involves a combination of observing/examining the patient, listening to the patient describe their problem and – frequently – some confirmatory/exploratory tests (and many years of experience*) - something most patients have neither the experience nor the training to do (and it’s not advisable to diagnose yourself even if you do do it professionally for a living, for the simple reason it’s very hard to be completely objective about yourself)

 

It’s all very well to say “listen to your body“, but not infrequently your body is doing the equivalent of sitting in a corner muttering incoherently to itself. A further complication is that quite a few minor conditions are self limiting (mild diarrhoea, for example) and can be more than adequately addressed using an OTC drug and self-care (for mild diarrhoea, sublingual Imodium and adequate hydration usually does the trick).

 

How to get the general public to walk that fine line between turning up at the GP for completely trivial reasons and not going to the GP when something really does need medical attention Is something that has puzzled better minds than mine. However, a bit of basic, practical, scientific and medical coursework** in schools would certainly be a good start.

Sorry, a bit late to this discussion as I use my Handy for brief conversations.  

 

I very much agree with Flavio.  AS a CFR, I do not diagnose my patient.  I merely use my skills and tools to determine whether my patient is "big sick", advise control, then keep the patient alive until the cavalry turns up.

 

Ok, there can be a bit more than that at times, but always worth keeping to the "KISS" principle.  And I might be panicking inside, but externally it is just "could I give you some oxygen, please?"

 

[Northmoor]

2 hours ago, iL Dottore said:

So the first question to be addressed is “what is the purpose of the NHS in the 2020s?”.

An excellent analysis @iL Dottore.

 

This should be the first question in any analysis of any government department: what are you trying to achieve?  In my field this is called Requirements Engineering; work out what you want to achieve first and only then, how you should best achieve it.  Otherwise you will always get a slightly better version of what you already have (e.g. building fleets of BR Standard Steam locos instead of widespread electrification), when there may be options that are vastly more cost-effective.  The problem we have in the UK is that for too many politicians, the answer is, the NHS in the form it was created in 1948 and it's all the fault of the other lot for not spending as much as we would etc.

[jamie92208]

12 hours ago, Dave Hunt said:

 

I became quite fascinated with the whole history of railways in the West Highlands, especially the proposed Glasgow North Western and the potential of extending the Invergarry & Fort Augustus to Inverness. On a family holiday to Scotland in 1981 I spent a whole day exploring the route of the I&FA, finding such things as the piers of a viaduct, remains of bridges and parts of the trackbed while Jill entertained the kids. That cost me more than a few brownie points!

 

Dave  

There is an excellent short story set on the Glasgow and North Western about the attempted robbery of a TPO.  I'in an anthology called 'Sixteen On".

 

I am also a fan of the Railways of the Highlands and had a good time cycling rou d places that they go to in 1973. Many 26's and 27's were seen and I was made welcome by many signalman.  I think that have got most of the histories in either paperback or hardback. 

 

Jamie

[polybear]

3 hours ago, Happy Hippo said:

However, those that do receive prescribed medicine will note that the cost of a prescription is now £9+ per item.

 

Yet, sometimes the prescribed item is available over the counter at far less cost. So should the doctor only be prescribing expensive drugs and telling patients to buy x,y, or z at the pharmacy as it will actually save the patient money?  Or would that be somewhat counterproductive when you can make someone pay £9+ for something, that they could get off the shelf for, let's say, £3.60?

 

 

 

Bear would hope that any half reasonable Chemist would be doing that job already - if not then you're using the wrong one.