TJ – money might have been an excuse 5-6 years ago – but as a proportion of GDP, the NHS is now not much cheaper than many successful European systems.

For me the challenge is how you introduce financial and clinical accountability to the system, with some sensible competition to spur people and services on, and penalise failing teams rather than reward them, without dismantling the ethos and structure of the current service.

What do you think of the issues about how nursing has changed which are raised above and in radio/newspaper commentary?

I can’t see many people who do think that…

The issue is why our system isn’t better.

If someone cannot feed themself – they need help being fed. Now lots of dementia patients will not eat that much as they detiorate. But I have heard enough from intelligent professional, and sometimes ex-nurse patients who have witnessed food being left out of reach of patients etc etc… to believe this story…

and the key issue is why some wards and hospitals succeed and others do not…

She was awful. Really pitchy and mediocre.

Little Roy was great

Elfin – ok

Fewer Bigger A&E units (make capacity issues dealable with) Less NIMBY “don’t close my unit” crap.

Triage by experienced Drs or Nurses freed from protocols – and I’ve seen this rubbish from a parent’s side too.

Don’t get rid of the 4 hour A&E target ( a Tory decision) as the evidence is that the death rate is higher in units (irrespective of turnover) with a >4 hour wait.

Stop making all Nurses do degrees as part of their training. It’s not necessary, and I really think it does make them miss some of the unique qualities that Nurses can bring as carers, clinicians and advocates.

Senior A&E staff present at night. In fact there is very little place for any Dr with less than 5 years under their belt in a Hospital at night.

Imaging needs to be running full on 24/7. A major cause for delays – but not in sensible countries.

Less management is not an issue – the NHS is under-managed compared with other Health Services and Private Sector industry. Crap unaccountable management is.

And hang any MP who bases his reelection policy on keeping his local St Shipman’s open.

Northwind Having done 6 months Paediatric Casualty in a first world country (not this one or the US) I’d beg to disagree…

Actually – for a child it is very poor.

Elfin – I’d love to kick the tories – but this has been going on way longer than that. A lot of the stuff which wasn’t being done isn’t really in the remit of nurses any more. And that may be part of the problem.

🙁

I’m going to get flamed here… but… a Dr’s view

Two Issues

1) Rapid patient turnover on many wards and increasingly technical treatments combined with shorter stays makes old-fashioned personal nursing difficult. But this does not explain malnutrition on wards full of elderly patients

2) The “Professionalisation” of all qualified nurses (no ENs, all students doing degrees, the “nursing process”, project 2000 etc etc) has enhanced the clinical and bureaucratic skills of nurses whilst not empathising traditional caring and “vocation” enough. And this has left a huge gap where underpaid, untrained auxiliary staff are left to do personal care roles which would have been supervised or performed by trained nurses.

I think highly trained autonomous specialist nurses are brilliant and I ask them for help and advice a lot. But equally many of the nurses who are now 25-40 seem to have difficulty seeing past the protocol to the patient, in a way that those aged 50 and above don’t. Ironically the training which was meant to make them autonomous has constrained their view by being too reductive.

I believe that just as not every 18 year old or even 50% of them needs to go to university, Nursing might have done better avoiding the degree model for all, and then encouraging the higher fliers/more technically minded/future independent clinicians to move on through a degree path later.

actually the first bar alone of the Stranglers “no more heroes” would be a really good one. Short, but there is nothing else like it

If it doesn’t cause disinhibition… then I’ve wasted a lot of money on drinks for women when I was younger… 🙁

But yes – the issue is that being drunk is not an excuse to behave badly.

Some older ones

Walk on the wild side (Herbie Flowers on Bass)
Hit Me with your Rhythm Stick – Ian Dury(the still awesome Norman W-R)
The Intro of “Birdland” by Weather Report if you want to test them a bit (Jaco – still the best ever)
Come Back and stay – Paul Young (Pino)
Is She really going out with him? by Joe Jackson
And Steady as she goes – first few bars – by the Raconteurs (and a bit similar to the previous suggestion)

On an iPad, and I think on iPhone/iPod touch, TunedIn radio does just that, at least the cheap and brilliant full version does. Not sure about the free version.

SR I don’t think that one post, in 24hrs, by someone whose views are well known counts as “a lot”. Do you?

You kind of make my point actually… 🙂

Yes… or maybe no… In different people they dissolve at different speeds… And in most people the inside of the mouth heals really quickly.

I know what you mean – I had some plastic surgery to the inside of my lip (after using my face as an alternative way to land a jump) 2-3 weeks ago. After 4 or 5 days it was driving me potty so I removed the stitches one by one over the next few days… and then some of the deeper sutures started to come out through a small hole in the inside of my mouth by themselves…

Interestingly I found a pair of nail scissors hugely better than the stitch-remover blades we use on patients at work…

I am NOT recommending this strategy by the way!

It’s back to the old joke…

“- Granny… please make a noise like a frog…

– No Darling, I don’t want to,

– But Granny… PLEEEEASE….

– No Darling… that would be undignified…

– But Granny… PLLLLEEEEASE make a noise like a frog!

– Oh – all right – but why do you want me to do that?

– Well dad says that when you croak we are going to Disneyland!”

Yep… some scrote had the new heavy 10 foot wide (each) wooden gates of the entrance to Bedge a few weeks back… someone at the FC underestimated the strength of your average scally. Now if they had spent the money on trail repairs no one could have nicked it.

My local place. There are some good bits not on the marked trails including bits we are working on. Is it worth 1.5 hrs and £8.50 parking? I’m not sure… But there is a layby on the A21 😉 or you can join our club. Probably worth that journey if you do two laps. Basically we do need a bigger hill. It’s fun at night though…

If you are around at 1000 on a Saturday am we usually have a club pootle. Perhaps not this weekend though I think.

No anti-Christian sentiment here so far. Strange how some people almost seek to be persecuted…

I think BigJohn has it spot on

One question here which interests me is how people would answer the question if it were read out to them verbally. Is BODMAS (I don’t think we had parentheses in my youth) a strictly written convention?

And there we go… yes we all remember BODMAS from school… but in the real world the operations are performed sequentially unless the brackets are explicit…

I’d be interested in the professions/jobs of anyone who does not think this is 0.

My 9 year old strolled past – saw this thread and laughed – saying “anything multiplied by zero is zero… isn’t it…”

Any arguments about this will be about the way it is written and what it “means”

Had mine for three years – they get left for 6 months over summer – never any problems

😯 😯 😯

Been there a fair amount in the past

The one thing I wouldn’t miss is the Fra Angelico frescos at San Marco.

Also try eating in some of the restaurants south of the arno, a bit more off the beaten track.

On the plus side… you will have more time to spend here…

😆 It would be a slight commute…

Rough… I’d hate that

This is the job where you inadvertently tore the head of HR a new one when she carved you up?

We use this in a dampish shower room with a serious (up to 25L per minute) power shower

http://www.tlc-direct.co.uk/Main_Index/Ventilation_Index/Shower_Fan_Light/index.html but with an over-run timer

with something like this http://www.tlc-direct.co.uk/Products/ADAV100.html

And you would need the transformer for the light.

Working well for 10 years, needed to replace the fan once.

And cables and brake hoses looking bit bland 😉

Elfin… Fair points… But I’m not an employee. No one provides me with transport. And those inconvenient patients kept being ill.

Now if you were talking about the wimpy attitudes of teachers and schools to closing at the drop of a hat…

The road darling. And living at the top of a steep hill with a crap r/w drive car on summer tyres… But actually I wasn’t stuck. Nicked my wife’s 4×4. So she was stuck instead. 🙂

In fact the dealer of the car I had then said that none of their staff got in for a week with their company cars… Guess the marque.

The point is with proper preparation it isn’t an issue.

Minging. Sorry. Blue rotors and red hubs?

Elfin old chap. Last two years it has happened actually. Before that about 5 years ago. I quite like it. The crispness of snow, quiet streets, kids playing etc… But some of us actually have to be mobile for our jobs.. Sorry and all that.

But the kebab shop did stay open. Result.

Elfin old chap. Once you escape from the bits of Sussex you feel comfortable with… We have hills and narrow roads and few snowploughs and not enough whingy metrosexuals to get our roads clean. Year before last I couldn’t get my car more than 100m from the house for nearly 2 weeks. Last year (4×4 time) it was only a day, but the sprogs had 8 days off school, my colleagues couldn’t get to the surgery for a few days leaving just me etc etc. And those inconsiderate elderly people dying of cancer wanted to be visited. What softies…

One day you people in London will learn there is more to Sussex than Brighton…

I’m not saying life is hard. I like the seasons, but only an idiot isn’t ready for them.

Looks like my old fuel ex 9 😕

Elfin. I have lived in Canada and spent three weeks once at -30 max… I’ve driven 10000km on ice and gravel roads. I live in a 500 year old house made of tiles, woodworm and ox-dung. We will be cold this winter but that’s fine.

As people have pointed out to you winter tyres work better below about 7 degrees. Twice in the last 2 years everything has ground to a complete halt for over a week around here and yet the ill people I look after expect to be seen.

I admire your style usually but your smug metropolitan condescension is out of place here.

Mud tyres never came off the SS

Winter tyres going on the car next week. And we do get snowed in down here in Sussex.

Central Heating on yesterday, but off again today.

3 1/2 weeks skiing booked.

I love Winter

The Bugle
AIOTM sadly finished
Collings & Herrin (but currently on a break – but 160 hours of poorly produced puerility available… 😉 )
And Desert Island Discs (500 of them available)
Pappys Fun Club

My eldest son likes Procter and Gamble, and Answer me this

More or Less if you like numbers/science/economics