The Night Mail

[polybear]

2 minutes ago, Happy Hippo said:

Which would require a Dentist!

 

Nah - all you need is a Dremel + drill bits + st. steel locking wire + w/locking pliers.

Sorted

[rockershovel]

1 hour ago, polybear said:

 

Not him; I can't recall his name at present ( @PupCam ?) but it'll come back to me.....

 

 

 

Wire-locking their gobs shut should work

My good wife periodically accuses me of not paying attention... I have no idea what she is talking about....

[Happy Hippo]

1 hour ago, polybear said:

 

Nah - all you need is a Dremel + drill bits + st. steel locking wire + w/locking pliers.

Sorted

And four large Royal Marines to hold the recipient down whilst you attempt the surgery

[Winslow Boy]

3 hours ago, jamie92208 said:

Is it possible to fit such controls to wives, asking for a friend. 

 

Jamie

I believe, so I'm told, that they tried that a number of years ago, but they had to discontinued it as the mechanism they used kept getting jammed on wide open. It was very distressing because the wives just couldn't stop and eventually they wore themselves out. There's even a report that some formed a choir and we're quite successful until of course the fashion for such things changed. Nothing is known about the husbands. Perhaps you could ask your friend.

[iL Dottore]

3 hours ago, rockershovel said:

The NHS is proverbially "the nearest thing the British have to a religion" and I'd agree with that. The English, particularly are a communitarian people with a strong sense of "fair play" which bears little or no relation to the ideological obsessions of the political class. 

 

The ultimately failed revolution of 1945-8 was based upon equality of opportunity, not outcome. It was based upon the long-term accrual of social capital - a better life for the next generation - and no-one thought that wrong. 

 

It was based upon full employment, for many years. 

 

Regarding the NHS particularly, certain early flaws existed and still do. Particularly, it was believed that it would improve the general health of the nation, and tend to be self-limiting - so much for THAT! That said, it was instrumental in the great disease eradication programmes of the 1950s and 1960s, notably TB and childhood diseases like scarlet fever and diphtheria. 

 

There was no provision for elective surgery except through a GP's referral.

 

There was no provision for the mass provision of palliative and anti-depressant medication which costs so much now. 

 

It certainly wasn't generally seen as an open-access service for all comers. 

 

Over time, it has adapted as the other great avatars of that time failed to adapt. It has become a huge driver for immigration, by its chronic failure to train staff. It has been thoroughly looted by the PFI initiatives of the New Labour era, sonething which was known at the time. It has become a vehicle for institutional capture by the Liberal Left. 

 

All that, and STILL it provides things which I don't care to think how they might otherwise be provided. My good wife has had bilateral knee replacement surgery and lumbar decompression in the last 3 years, with further lumbar treatment to come. I'm glad I don't have THAT on my insurance... does the term "pre existing conditions" mean anything to you? 

A very good analysis.
 

As for your last point “pre-existing conditions”, in Switzerland this restriction only applies to supplementary insurance (the type that gets you the private room, even when NOT medically required; residential rehab and PT when outpatient treatment is perfectly adequate, 2 weeks in a “wellness spa” etc.). The basic insurance (grundversicherung) does cover existing conditions and provides for all necessary treatments as and when needed. With the basic coverage you’ll be in a semi-private room instead of a private room (the ward system is pretty much unknown here), treatment will be outpatient or day patient rather than residential where feasible. Medications, surgeries, scans and treatments will be driven by condition, not cost.

 

There are, however, a few things that are not covered by the basic health insurance that the NHS does provide; and these things are generally cosmetic procedures not necessary for a persons health and well-being. So plastic surgery for breast reconstruction after a mastectomy would  be covered by basic health insurance, a “boob job” would not be covered. Same goes for things like “tummy tucks”, “butt lifts” and “nose jobs”.

 

Because everyone has to have health insurance (with assistance from the state for the truly indigent), and because this money is solely used for healthcare, it does mean that the health system is adequately funded (no medical system in the world will ever be overfunded…)

 

One final point: there is a certain amount of co-pay required, something that horrifies most Brits. Co-pay will depend on your retention (how much you will pay yourself before insurance takes over - and this is a yearly amount). In Switzerland for chronic diseases there is a yearly co-pay cap and so the co-pay amount is affordable (and this is assisted with by the state for the truly indigent), When I had my knee protheses installed, I ended up paying a grand sum of SFr 80 for four weeks (2 weeks hospital, 2 weeks residential rehab) and this was for in-house TV and radio and some meal “upgrades”.

 

Of course, Switzerland being a high pay medium tax country does mean much more in life is affordable to the average Swiss than it is to the average Brit.

[iL Dottore]

12 hours ago, AndyID said:

 

Here's a sad example of "reluctance to pay". My childhood friend, best man and ski pal lived in Edinburgh. He made a lot of money and had all the toys. Lovely house, expensive cars and a beautiful yacht. He had not been feeling well for about a year and was being treated by a NHS doctor.

 

He was 56 when died of a heart attack. No heart condition was diagnosed prior to his death.

 

Had he shelled out for a better private doctor I'm pretty sure his heart condition would have been diagnosed. Of course, even if it had, he might still have succumbed.

A sad story indeed.

 

A private consultation may or may not have revealed the underlying problem, But I reckon that it would have done - as exploratory assessments (such as a stress test and/or a multigated acquisition [MUGA] scan) would have been done pretty quickly after visiting the private GP if paid for privately.

 

Unfortunately, for many reasons, in the NHS the time between tentative diagnosis and confirmatory assessment(s) is frequently far too long.

[Oldddudders]

17 hours ago, Dave Hunt said:

I have a railway modelling friend who retired from his dental practice a few years ago. Throughout his career he treated only NHS patients and says that a dentist who does as he did can make a very good living without resorting to private practice, although taking on some private patients is understandable. In his opinion, dentists who do only private work are simply greedy.

I feel that one of the big changes among both docs and dentists in my lifetime is the expectation of how hard they need to work. In my yoof I feel they were always at work, and well-rewarded by average salary standards. Not for nothing did Sherry and my GP drive a Jaguar (JRP47). As the years have gone by, in common with many others, they have increasingly sought a better work/life balance, and so docs' on-call at all hours now tend to be covered, probably by agency locums. The objective is to spend more time elsewhere, e.g. on the golf course, enjoying the fruits of your years of study and hard work. Private medicine/dentistry makes that easier to achieve with fewer days at the coalface. 

 

Like the rest of us, these guys and gals only get one kick at life's ball. Are they really being greedy or selfish?

[Compound2632]

2 minutes ago, Oldddudders said:

Like the rest of us, these guys and gals only get one kick at life's ball. Are they really being greedy or selfish?

 

Like many vocational jobs, the satisfaction gained by doing it has been screwed out of the system by management and process.

[TheQ]

21 minutes ago, Winslow Boy said:

I believe, so I'm told, that they tried that a number of years ago, but they had to discontinued it as the mechanism they used kept getting jammed on wide open. It was very distressing because the wives just couldn't stop and eventually they wore themselves out. There's even a report that some formed a choir and we're quite successful until of course the fashion for such things changed. Nothing is known about the husbands. Perhaps you could ask your friend.

I believe there is a documentary about it called Stepford Wives

[petethemole]

On the subject of young working class women having a full extraction and a set of dentures, this was often done as a wedding present.  The bride's father would pay for it, so the happy couple wouldn't be burdened by such costs later.

[Winslow Boy]

39 minutes ago, TheQ said:

I believe there is a documentary about it called Stepford Wives

I only saw the second film Stepford wives sing. It was quite good actually. The only bit where credulity was stretched was where they made the husbands teas using fresh ingredients. I thought they were havin' larf not using upf's.

[Hroth]

1 hour ago, Happy Hippo said:

And four large Royal Marines to hold the recipient down whilst you attempt the surgery

 

Ear defenders too, the noise will be truly horrific until surgery has been completed...

 

[rockershovel]

1 hour ago, iL Dottore said:

A very good analysis.
 

As for your last point “pre-existing conditions”, in Switzerland this restriction only applies to supplementary insurance (the type that gets you the private room, even when NOT medically required; residential rehab and PT when outpatient treatment is perfectly adequate, 2 weeks in a “wellness spa” etc.). The basic insurance (grundversicherung) does cover existing conditions and provides for all necessary treatments as and when needed. With the basic coverage you’ll be in a semi-private room instead of a private room (the ward system is pretty much unknown here), treatment will be outpatient or day patient rather than residential where feasible. Medications, surgeries, scans and treatments will be driven by condition, not cost.

 

There are, however, a few things that are not covered by the basic health insurance that the NHS does provide; and these things are generally cosmetic procedures not necessary for a persons health and well-being. So plastic surgery for breast reconstruction after a mastectomy would  be covered by basic health insurance, a “boob job” would not be covered. Same goes for things like “tummy tucks”, “butt lifts” and “nose jobs”.

 

Because everyone has to have health insurance (with assistance from the state for the truly indigent), and because this money is solely used for healthcare, it does mean that the health system is adequately funded (no medical system in the world will ever be overfunded…)

 

One final point: there is a certain amount of co-pay required, something that horrifies most Brits. Co-pay will depend on your retention (how much you will pay yourself before insurance takes over - and this is a yearly amount). In Switzerland for chronic diseases there is a yearly co-pay cap and so the co-pay amount is affordable (and this is assisted with by the state for the truly indigent), When I had my knee protheses installed, I ended up paying a grand sum of SFr 80 for four weeks (2 weeks hospital, 2 weeks residential rehab) and this was for in-house TV and radio and some meal “upgrades”.

 

Of course, Switzerland being a high pay medium tax country does mean much more in life is affordable to the average Swiss than it is to the average Brit.

Co-pay is... oh, I don't know. Most people pay varying sums, often quite substantial for dental treatment and it doesn't appear to cause a revolution. Spectacles are not free. 

 

I suspect that the real problem with free-at-point-of-delivery vs co-pay for GP services, was and is that much of GPs time is taken up prescribing palliative and anti-depressant medication to patients with nothing effectively treatable, wrong with them. 

 

Any GP will tell you, in the unlikely event that you manage to find one (and these days, you have more chance of finding a police officer) that they could delete 50% ofcany given days' list with no real harm done. 

 

Add in that our present GP "service" is something which no-one would willingly pay for, and I can't see that we will be paying any time soon. 

 

I'm intrigued by the idea of meal "upgrades". English hospital food is quite inexcusable, having replaced  railway catering as a source of national embarrassment. I spent a few days in hospital a few years ago and after the first day, went and ate in the staff canteen. It was apparent from the various dressing-gowns that I wasn't the only one. 

Edited April 7 by rockershovel

[skipepsi]

Like a lot of things NHS food is variable by location.

[Winslow Boy]

4 minutes ago, rockershovel said:

Co-pay is... oh, I don't know. Most people pay varying sums, often quite substantial for dental treatment and it doesn't appear to cause a revolution. Spectacles are not free. 

 

I suspect that the real problem with free-at-point-of-delivery vs co-pay for GP services, was and is that much of GPs time is taken up prescribing palliative and anti-depressant medication to patients with nothing effectively treatable, wrong with them. 

 

Any GP will tell you, in the unlikely event that you manage to find one (and these days, you have more chance of finding a police officer) that they could delete 50% ofcany given days' list with no real harm done. 

 

Add in that our present GP "service" is something which no-one would willingly pay for, and I can't see that we will be paying any time soon. 

 

I'm intrigued by the idea of meal "upgrades". English hospital food is quite inexcusable, having replaced  railway catering as a source of national embarrassment. I spent a few days in hospital a few years ago and after the first day, went and ate in the staff canteen. It was apparent from the various dressing-gowns that I wasn't the only one. 

I seem to recall reading a few years back of an analysis of how much hospitals spent on providing food to patients and it was found that on average they were spending less than the Prison Service was.

Wasn't there an experiment done by the Prison Service at one of there Youth Offending facilities, Aylesbury I think, where they altered the diet of the inmates and found that they were less violent. Can't remember whether it was vitamins that were added.

[iL Dottore]

1 hour ago, Oldddudders said:

The objective is to spend more time elsewhere, e.g. on the golf course, enjoying the fruits of your years of study and hard work. Private medicine/dentistry makes that easier to achieve with fewer days at the coalface. 

When people tut-tut about “private medicines” low hours, they are ignoring the non-patient facing work GPs and other clinicians have to do (true for all GP practices - no matter where you are in the world).
 

My GP friend (now retired) had surgery hours 07:30 - 11:30 and 14:00 - 18:00 M, T, W, F. Thursday was 07:30 - 11:30. However, lunchtimes were spent reviewing patient test results (they usually came in the morning post) and Thursday afternoons he did house calls (mostly to care homes and the like). As a member of the local GP association he was on call one night in every 14.

 

The problem nowadays with GPs (almost a universal problem) is that more and more women have become GPs. The problem with that is not their expertise or ability, but rather the fact that as women they have to juggle marriage, career, motherhood and family in a way men don’t have to. So if a women GP can work part time, she generally will.

 

1 hour ago, Oldddudders said:

Like the rest of us, these guys and gals only get one kick at life's ball. Are they really being greedy or selfish?

Rather strangely, those who rail against doctors and dentist earning well (after completing years of gruelling training and gaining expertise and experience in a high stress and high pressure environment [specialist training]), seem to be very quiet about the huge amounts of money footballers and other “sports personalities” earn.

Inverse snobbery at work, perhaps?

1 hour ago, Compound2632 said:

 

Like many vocational jobs, the satisfaction gained by doing it has been screwed out of the system by management and process.

Something my ex-NHS colleagues can attest to.

According to a number of them, one of the advantages of private practice was the near total absence of the bureaucratic cr*p they had to deal with in the NHS - allowing them to concentrate on patient care. On the NHS what should be a simple case note (“syringed out ears, examination found nothing of note”) becomes a multi-line, if not multipage, exercise of pointless expansion of the “bleeding obvious”.

Edited April 7 by iL Dottore

[polybear]

1 hour ago, Happy Hippo said:

And four large Royal Marines to hold the recipient down whilst you attempt the surgery

 

Bear once worked with a guy (late 1980's to mid 90's) who would buy a cheapo car (no more than a couple of hundred quid) and use it for business use; the mileage rate meant it very soon paid for itself.

One particular 2CV had the front wings sewn on with st. steel locking wire.

 

1 hour ago, iL Dottore said:

..... indigent......

 

Huh?  😕

Alexa.....

Oh, gotcha.....skint....

 

1 hour ago, iL Dottore said:

.... and some meal “upgrades”.

 

Of course, Switzerland being a high pay medium tax country does mean much more in life is affordable to the average Swiss than it is to the average Brit.

 

13 minutes ago, rockershovel said:

Co-pay is... oh, I don't know. Most people pay varying sums, often quite substantial for dental treatment and it doesn't appear to cause a revolution. 

 

 

A Certain Bear's cheque book (remember those?) is still bleeding after a dental implant 😬

No regrets though.

 

13 minutes ago, rockershovel said:

I'm intrigued by the idea of meal "upgrades". 

 

That's where you get a relative to bring in a Pizza from the local takeaway.

[polybear]

16 minutes ago, Winslow Boy said:

Wasn't there an experiment done by the Prison Service at one of there Youth Offending facilities, Aylesbury I think, where they altered the diet of the inmates and found that they were less violent. Can't remember whether it was vitamins that were added.

 

Probably a strong sedative.....

[iL Dottore]

2 minutes ago, polybear said:

 

That's where you get a relative to bring in a Pizza from the local takeaway.

Possibly true for the NHS.

In Switzerland it probably means changing the planned Zürigeschnetzeltes* mit Rösti! for a grilled steak, pommes frites and a mixed salad.

 

* as far as I am concerned Zürcher Geschnetzeltes is the Swiss equivalent of “mystery meat in a light brown sauce”. Not my favourite. (https://www.myswitzerland.com/en-ch/experiences/food-wine/recipe/zurich-geschnetzeltes/)

[jamie92208]

5 hours ago, Happy Hippo said:

Which would require a Dentist!

 

3 hours ago, Winslow Boy said:

I believe, so I'm told, that they tried that a number of years ago, but they had to discontinued it as the mechanism they used kept getting jammed on wide open. It was very distressing because the wives just couldn't stop and eventually they wore themselves out. There's even a report that some formed a choir and we're quite successful until of course the fashion for such things changed. Nothing is known about the husbands. Perhaps you could ask your friend.

 

Someone read through the old minute books of our Baptist Church which was founded in 1707.  At some point in the later 18th century,two lady members were expelled for having railing tongues. 

 

2 hours ago, Winslow Boy said:

I seem to recall reading a few years back of an analysis of how much hospitals spent on providing food to patients and it was found that on average they were spending less than the Prison Service was.

Wasn't there an experiment done by the Prison Service at one of there Youth Offending facilities, Aylesbury I think, where they altered the diet of the inmates and found that they were less violent. Can't remember whether it was vitamins that were added.

I have a vague memory of having read that the food in Alcatraz was very good for that reason. 

 

Jamie

Edited April 7 by jamie92208

[Dave Hunt]

At the hospital I have just been in the patients’ food is prepared in the same kitchens that supply the staff and visitors’ canteens, albeit with a slightly more limited menu, and whilst not haute cuisine or in over-generous quantities is good quality.

 

Dave

[Northmoor]

1 hour ago, Winslow Boy said:

I seem to recall reading a few years back of an analysis of how much hospitals spent on providing food to patients and it was found that on average they were spending less than the Prison Service was.

Wasn't there an experiment done by the Prison Service at one of there Youth Offending facilities, Aylesbury I think, where they altered the diet of the inmates and found that they were less violent. Can't remember whether it was vitamins that were added.

I remember something similar that showed a huge proportion of violent prisoners (or those imprisoned for violent offences) had a significant zinc or magnesium deficiency.

[Northmoor]

1 hour ago, iL Dottore said:

Rather strangely, those who rail against doctors and dentist earning well (after completing years of gruelling training and gaining expertise and experience in a high stress and high pressure environment [specialist training]), seem to be very quiet about the huge amounts of money footballers and other “sports personalities” earn.

Inverse snobbery at work, perhaps?

I overheard several comments yesterday about the ASLEF strike, to the effect that "they're all paid too much anyway".  I find most people only complain about the pay of others when it's more than their own*.  Personally I don't complain about what sportsmen earn (many do); if someone is prepared to pay them that, good luck.  In such roles - in fact in any role paid significantly more than average - you are paid for the value you add, not the work you do.  The problem is that as society, we don't put sufficient value on some roles like nursing.  Of course the Law of Unintended Consequences may apply: if you were to make nursing relatively well-paid, would the wrong sort of people be attracted to it?

 

*My own nomination for overpaid profession is the Project Manager.  Good ones are worth the money, but I have met far too many who have no understanding of what they are managing, spend most of their hours moving numbers between spreadsheets and have to defer to someone else to make any decisions based on that data.  So they're actually data administrators, but that doesn't sound nearly as important, does it?

[Oldddudders]

Projects, and the roles of the PM, take many forms. Some have a known outcome - for example when I was appointed at short notice to manage the closure of Tunbridge Wells - Eridge, where it was a case of finding alternative berthing sidings and scheduling formal Consultation with staff, mainly traincrew, which enabled the project team to identify a feasible date. 

 

Then there was the Touche Ross initiative in 1990, for which as Project Director, my task was senior hearts and minds within Sectors and Regions, about budgets, project manager skills and generally enabling BR to spend its capital forecast. The 1992 General Election, with the mandate for Rail Privatisation, rendered the whole thing irrelevant.

 

In late 1992 I was asked to take on Tribute, a large IT project hopelessly out of control, with the internal supplier failing to impress his sponsors, InterCity and European Passenger Services. Since the new system was required to sell tickets for the forthcoming Eurostar service, as well as providing InterCity with a better system that included reservations and ticketing in one terminal, there was a lot of pressure. I instigated the first - and almost certainly the last! - real User Acceptance Test team on BR, and they drove a coach and horses through each release of software. They cost a bomb, but when summoned by the Board's Director of Business Review (the late Andrew Jukes, later pilloried in the press as a "Fat Cat" for his purchase and sale of a ROSCO to good effect, not to mention founding Exactoscale) he endorsed my approach unreservedly. The unexpected overnight transfer of EPS to being a GOCO withdrew part of my sponsorship and my role lapsed forthwith. 

 

My next role, as Project Controller, BRIS Privatisation, was a bit different, with Timeline Gantt charts being my responsibility on a monthly basis, as well as minuting, and occasionally chairing, meetings with every BRIS Unit. 

 

At no time, on any of those projects, did I run a spreadsheet, and had little idea how to do so!

[Dave Hunt]

3 hours ago, polybear said:

Bear once worked with a guy (late 1980's to mid 90's) who would buy a cheapo car (no more than a couple of hundred quid) and use it for business use; the mileage rate meant it very soon paid for itself.

 

It must have been catching. In the same period I worked with a chap who used to buy cheap bangers at car auctions, at which his brother who was an AA patrolman would accompany him to give them the once over so that he didn't buy anything dangerous or liable to die in short order, then run them until they became uneconomical, scrap them and repeat the process. Generally they could find cars with valid MOTs at knock down prices and when the time came to dump them it was surprising how much he got for scrap. He used to keep a record of everything and he claimed that the sums came out quite favourably compared with buying more expensive cars and keeping them for longer. 

 

Dave