NHS To Cut 17 Routine Procedures

The NHS prepares to cut back on 17 procedures to save £200 million a year, including breast reductions, tonsil removals and snoring operations. Varicose vein surgery, haemorrhoid operations and procedures to remove harmless skin lesions could also be cut under the plans.

The policies endeavour to stop more than 100,000 unnecessary procedures taking place in the United Kingdom yearly and hundreds of millions of pounds could be saved every year by tightening guidelines for treatments where the dangers outweigh the advantages.

The announced proposals will ensure procedures, such as those for carpal tunnel and lesions on eyelids, will only take place where there’s a good motive to do so and alternative procedures such as injections, changes of diet or physiotherapy will be effective in the majority of circumstances.

Evidently, by decreasing random or dangerous procedures for some patients can get favourable results while diminishing waste and targeting resource to where it is most demanded and the first step is looking at situations where surgery is better circumvented.

It was stated that at best, inconvenience or disappointment to patients by offering treatments that are not effective and, at worst, hurting patients will no longer be done, which leads me to this enigma, if they knew that offering these procedures were not effective or harming patients, why were they being done in the first place?

NHS England’s board of directors will convene next week to examine the proposals which will then be put out to consultation.

Grommet

Other procedures on the list of 17 include grommets for glue ear and hysterectomies for heavy menstrual bleeding, with the policies drawn up in consultation with the National Institute for Health and Care Excellence (Nice) and four of them will be offered only when a patient makes a particular request, with the other 13 being allowed only when particular criteria are satisfied.

Apparently, it has become common to associate an action with treatment, but now, sometimes doing nothing, or doing less, actually is the safest method and treatments and procedures that bear a high risk or are linked with serious side effects will only be allowed when there is proof that the advantages are worthwhile.

Now they want an important and realistic talk with the public, patients and clinicians about what can be expected from the NHS within the stifled reserves it has available.

The proposals put forward by NHS England would see the commissioning of the following 17 procedures diminished or discontinued and other, less invasive, procedures will be used instead to preserve money.

Four procedures will only be given upon a demand by the patient.

These are:

Snoring surgery
Dilation and curettage for heavy menstrual bleeding
Knee arthroscopies for osteoarthritis
Injections for non-specific back pain

An additional 13 treatments will only be allowed when certain conditions are met.

These are:

Breast reduction
Removal of benign skin lesions
Grommets for glue ear
Tonsillectomy
Haemorrhoid surgery
Hysterectomy for heavy menstrual bleeding
Removal of lesions on eyelids
Removal of bone spurs for shoulder pain
Carpal tunnel syndrome release
Dupuytren’s contracture release
Excision of small, non-cancerous lumps on the wrist called ganglia
Trigger finger release
Varicose vein surgery

These so-called minor procedures are sometimes life savers for people who would profit from them and some people who have had these procedures would not have been able to work and would have spent years on the sick, so it’s hardly a saving.

A hundred billion in tax breaks for the wealthy and two hundred million more in austerity savings by the Tory government on those who are the poorest in society and that’s not fair.

Gradually the Tories are dismembering and tearing apart the NHS for privatisation but when the actuality of taxes and VAT remain the same, you will end up with a health insurance bill that will cost you three more times than your healthcare.

It’s a sad day when the Tory government has its voters thinking its all the immigrant’s fault, divide and conquer, whilst the wealthy sit back and count their profitable earnings.

Now they’re saying that patients should be charged for GP and hospital appointments and the radical move would end the system of an NHS free at the point of delivery and those backing the scheme say charges are preferable to the covert rationing of healthcare which they say has become endemic.

They said charges to see doctors would dissuade people with insignificant infirmities from jamming up GP surgeries and a number of doctors have previously asked for the introduction of a £25 charge to see GPs, but so far the BMA has not approved the policy.

But earlier this year polling of GPs saw eight in 10 were in support of charges for some services and the purpose of the proposal was to decrease stress on the NHS, by helping patients to take more responsibility.

Supposedly, there is a huge amount of demand in general practice and they’re just putting a shot across the bow saying that this is something to be analysed for improving the flood of patients going through general practice doors who might perhaps think twice about doing it.

Now they’re saying that too many patients are visiting GPs when they would have improved after a few days rest or could have seen a pharmacist but more men than women are hesitant to ask for medical help from their GP and some men it has been observed are already in the advanced stages of testicular cancer which has spread to their brain and lungs by the time they see a GP and promoting this so-called flood of patients would make this hesitation detrimental for ALL patients.

Patients will ignore warning signs if there is going to be a restraint on seeing a GP because they will just think they’re wasting time when time is what they don’t have and as it stands, a survey for the Everyman Male Cancer Campaign suggested that almost twice as many men as women had not visited their GP in the past year.

Evidence implies fewer men go to dentists or ask the pharmacist for help and information, or frequent contraception clinics, although men are more prone to end up in the hospital because they delay for so long which then puts more stress on our hospitals and less on our GPs but shouldn’t the point of contact be on our GPs first?

Even male cancer helplines are used more by women, talking on behalf of partners, fathers or sons. And the fact that more women get skin cancer than men but more men die from it, indicates how late men are going to doctors.

Historically women have always been the gatekeepers of well-being in the family and it could also be argued that women use the NHS at an earlier age because of contraception or childbirth and they’re usually more in tune with developments in their bodies and therefore visit a GP more frequently.

At the moment Cancer survival rates in the United Kingdom are amongst the lowest in Europe because both sexes are for some reason less likely to go to a doctor and then their cancer is diagnosed too late and soon they won’t go to their GP at all because they’ll think that they’re wasting time.

A GP is the person you go to see when you think something is wrong with you, it shouldn’t matter if it turns out that there is nothing wrong but a person should feel comfortable enough to go and visit one, particularly if they’ve been with that practice for a really long time, what happened to the trusted GP? Now it’s all about making a buck or two…

It’s very disturbing when people, especially young men feel they can’t go and seek medical attention until their symptoms become almost life-threatening. However, this culture is evolving and more people are going to see their GP but now they want to put a stop on it which suggests that life-threatening conditions will be disregarded because people will be too frightened to visit their GP for fear of wasting their time.

The access times and attitudes of GPs has shifted considerably and some doctors have this patronising manner and some doctors can be pretty dismissive, so it’s no wonder that men don’t take their symptoms to the doctor until it’s pretty serious.

Loads of men don’t visit the doctor because they shrug off their symptoms either as bravado or simply because it doesn’t seem important enough, which is very ironic because the stereotype is that when men get man-flu they seem to think things are more serious than they actually are.

The other reason is that they don’t want to put the doctors out and take precious time away from those seen to be sicker than they are and this is heightened by overburdened GPs want to get through their daily surgery, given the impression of rushing their patients through.

Then patients believe they’ve put out a GP by them with what they consider minor symptoms and then they don’t go back again.

Sadly, some GPs can end up being condescending and demeaning because GPs are overburdened and patients end up never going back again or request for another GP at the surgery and such behaviour can steer patients away.

But there should be strict rules about how GPs speak to their patients as this can drive patients away and affect a patients health

There must be strict rules about how GPs can speak to their patients as this can drive patients away and affect patients’ health, particularly those patients that are very ill.

Making medical self-observation a component of school education along with some fundamental medical education and the capacity to tell symptoms of certain ailments should be as essential as elementary maths or English.

It would also be advantageous to implement a yearly health checkup for every person. It doesn’t need to be high tech, just a 20-minute appointment with your GP to do some fundamental examinations and a chat but I again this would put too much pressure on the NHS (or too much money.)

It should be mandatory for men and women to have routine examinations at the doctors for cancer because too often we hear of people being diagnosed too late and we should all granted the chance to be periodically reviewed by our GP.

Perhaps we should all have extensive health examinations on an annual basis but this would mean more GPs or them having to work weekends, but what’s the price for a human life?

Should the Government consider alternative means of financing the NHS and consider co-payment from patients? And even if it was necessary to consider co-payments for NHS clinical services to re-establish sufficient provision, would the service really get any better?

Each aspect of your life you pay for whether it’s your holiday, your home, your car or whether or not your children go to private school.

But not everybody lives a privileged life especially when we’re at a time when there’s a rise in homelessness and people have to go to food banks. There are already people who can’t afford to see a dentist and soon they won’t be able to access a doctor and we’ll be back to before the NHS was founded.

Richard Branson recently sued the NHS for £2,000,000 and the way it’s going, he’s surrounding the NHS like a rotten carcass and when he descends, our healthcare will be his business.

There are people out there that would be prepared to pay money to see their doctor and if they can afford that, then that’s great, but there are those that can’t afford it and those that can afford it, then they can afford to pay for private healthcare.

The thing that people don’t understand is that if you complain it gives the government more incentive to sell off the NHS.

However, in Switzerland, everybody has health insurance. It’s mandatory.

They can determine which health insurer to go for, whereas in Britain you’re effectively forced to take out a government policy.

In Switzerland, the health insurers, in their turn, have contracts with doctors and hospitals, so there’s a choice and competition at two levels: among insurers and among healthcare providers.

So, what about the poor? Well, they’re compulsorily covered too. If they don’t have enough money to pay a premium, it’s paid for them.

Of course, this is up for debate and are we in Britain worshipping the false god of the NHS, clearly, we need better healthcare and other countries have moved on, so should we?

Operations are always done on the evidence of need and you have to meet guidelines to have the operations done on the NHS so not much will improve.

While small breasts may produce aesthetic distress due to an observed failure to accomplish specific beauty criteria, big breasts produce serious health problems.

Enlarged breasts in females are called macromastia and in males ginecomastia. Men normally suffer from ginecomastia because of extremely complex health maladies such as obesity, pituitary gland, a gland in the brain producing hormones regulating organism functions, tumour and hyperprolactinemia, a raised hormone absorption in blood, which in females is necessary for breastfeeding, whereas women may have bigger breasts without any systemic pathology.

Normally, women with bigger breasts complain about a backache, pain in the neck, migraine, chafing, heat rash, restricted physical exercise, yeast infections, striae, scar-like streaks and a serious emotional malady.

Several sorts of pain arise because of poor posture and persistent nerve problems because the mass of breasts degrades the spine formation and leads to nerve compression.

Consequently, different kinds of pain arise and even though the pain can be subdued with medications they don’t eliminate the central problem and damage.

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Non–steroidal anti-inflammatory medications such as Ibuprofen, Diclofenac, Ketorolac and others may be provisionally helpful but also, skin is usually damaged because rubbing, heat and sweating make the skin more exposed to injuries, therefore big breasts are much more receptive to infections, inflammation and chafing.

Furthermore, the quick growth of breasts results in striae because our skin is flexible and if growth is very fast it tears apart leaving scar like streaks and the skin is further damaged by wide trenches on the shoulders from bra strap pressure.

Even though women are normally eager to have big breasts, those who have frequently encounter emotional pain. They find it hard to get appropriate clothes and they feel uncomfortable because of the sweating, rashes and restrictions to exercise unobstructedly.

The lack of physical movement itself causes weight gain, bad physical condition and health dilemmas and teens in such circumstances are particularly exposed to being made fun of which can lead to a poor emotional condition.

Women that have a breast conversion do not do so casually and do so because the problems that they’re getting exceed the dangers of having surgery and women with an enlarged body mass index have worse postoperative outcomes and more complexities than women with a healthy mass.

And the loss of the nipples and areola, asymmetry and sensitivities are the most frequent complexity of this intervention and the operation is done under general anaesthesia and only in hospitals.

An Ipsos Mori poll of more than 1,000 adults found 71 per cent backed the idea of charges for missed GP and hospital appointments and 47 per cent supported charging patients who have conditions and ailments which are created in some way by their lifestyle.

In total, 47 per cent of those surveyed supported this but the chemical obesogen theory speculates that artificial, environmental contaminants are adding to the global pandemic of obesity.

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In fact, intentional food additives e.g., artificial sweeteners and colours, emulsifiers and unintentional compounds e.g., bisphenol A, pesticides are extensively unstudied in respect to their impacts on overall metabolic homeostasis.

Since the industrial revolution, the goals of food technology have predominately been maximizing palatability, optimizing process performance, extending shelf life, diminishing cost, and developing food safety free from deadly diseases, bacteria, and fungi and you’d have to be a fun guy to eat this stuff.

As such, over 4,000 different components have entered the food chain, some deliberately such as preservatives and some accidentally such as bisphenol A, BPA, and there are 1,500 new composites that access the food chain every year.

And while food processing methods are continually being optimized to reduce deadly composites and toxicants such as lead, melamine, and aflatoxin, other non-toxic additives are not fully examined for their continuous, additive, and/or combined impacts on the human anatomy.

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Obesity, although a chronic condition is not because we have become a society of ravenous animals it’s because the food is intended to make us eat it involuntarily and obesity and associated chronic ailments are growing at startling proportions.

But this trend continues despite heightened awareness, nutritional and behavioural investigation, the number of diet foods available, and even gym memberships.

The smell of baked goods floats towards you as the supermarket doors slide open and your belly does a drum roll and your mouth waters at the sight and scent of so much food.

Despite your best intentions, you surrender to the deals and offers that you don’t really want.

Why not get two bags of crisps for the price of one? Before you know it, your shopping trolley is loaded and that chocolate bar you grabbed at the checkout is in your mouth. That’s because we live in a food environment that doesn’t value your health and evidence is mounting that some foods, particularly those high in fat, salt and sugar, are not easy to resist.

img.jpgFood addiction actually shares common brain activity with alcohol dependence and these high-fat, high-sugar foods also tend to be inexpensive and easily accessible, and heavily associated with chronic disease.

But this toxic food culture pervades our society and our current food climate sets us up for healthy food choice failure. But when we overeat and weight gain happens, society is there to dole out blame and shame for our crime.

But isn’t this entrapment?

Blame and shame for unhealthy behaviours happen because obesity is usually constructed as an argument of personal accountability. In this narrative, we simply are guilty of what goes into our mouths and if we gain weight, it’s a consequence of greed, laziness and a lack of willpower.

Any efforts to restructure our food environments so they’re more supportive of well-being are frequently reprimanded as disallowing freedom of choice and actions such as taxes on sweet drinks, for instance, are referred to as the actions of a nanny state.

Food companies and retailers appear especially enamoured with this debate and they actively support a dogma that the global obesity dilemma emerges essentially from loss of exercise and carefully minimize the impact of over-eating processed foods and drinks.

But what if we reframe the dispute over personal preference and collective blame by thinking of our modern food environment in the same way as the legal defence of criminal entrapment?

Criminal entrapment happens when law enforcement sets people up to perform a transgression they may not otherwise engage in, i.e., eating ourselves to death, then punishes them for it.

Let’s examine what it looks like if the food industry was put into the role of law enforcement, and the defendant is you, a member of the community seeking to make healthy food choices.

The food industry massively sells harmful food products, particularly to kids, causing over-consumption (the crime), but sadly, their business model usually depends on it.

Food marketing often uses powerful tactics to entice you to eat and overeat their products. Examples include supersizing, meal deals, buy-one-get-one-free offers and priority product placement.

Now you find yourself in an environment that undermines healthy eating, and instead drives energy-dense, nutrient-poor foods. These are affordable to buy, massively promoted and, let’s face it, usually pretty appetizing.

The food industry has spent a vast abundance of money working out what pushes your buttons when it comes with flavour and taste.

Confronted with all this temptation, you duly perform the wrong of over-consumption (the trap), frequently oblivious of the environmental suggestions and manipulations to which you have been exposed but the idea of committing the crime of over-consumption came from the food industry, and NOT you.

And the food industry persuaded you to commit the sin of over-consumption using powerful tactics. You tried to make healthy food decisions because you weren’t ready and willing to commit this sin before being persuaded to do so.

Of course, not everyone is going to fall prey to this environmental entrapment. But there’s enough proof to know that while people are aware of the risks of over-consuming energy-dense, nutrient-poor foods, healthy eating is not that simple.

Our modern food environment is not reflective of current recommendations for good health, or for defending ourselves against illnesses such as cancer. Neither is it supportive of health within populations that are most at risk, like kids or those experiencing food insecurity.

Can reforming the problem around environmental entrapment help to gather public support for better food environments? If nothing else, it may start a conversation about the quality of our food stores and the tactics that the food industry uses to impair our abilities to eat in ways that decrease the weight of chronic illnesses.

Charging patients for GP appointments would go against one of the founding principles of the NHS, that care is free at the point of need. But nothing is free now and if it is, we have to ask why.

It’s really sickening because people are paying for this baloney but of course, we can’t moan about it and things are going to get worse, particularly now the uncertainty of Brexit is beginning to actually take hold now.

We all know that it was a mistake to vote into the EU but you can’t close the stable door after the horse has bolted and our country is falling to pieces. It won’t be long before Scotland leaves us and they’ll go back into Europe and we’ll be left behind in a third world country sitting on our own.

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The Longest Income Squeeze

Increasing the minimum salary to £10 an hour would help to alleviate the longest restraint on wages since the Napoleonic era for 9 million workers and Labour is now committed to a £10 minimum salary by 2020 and the newest research for the Unite union determined that the increase for workers aged 18-plus would raise public money by £5.6 billion a year.

Workers in hospitality and retail, where low pay is common, would be the biggest victors from the increase and a £10 minimum salary would increase net income by more than £1,300 a year and would benefit 5.2 million female workers and three out of four young workers aged 18 to 20.

An intermediate increase to £9 an hour for workers aged 25 and over, £8.70 for those aged 21-24 and £8 for 18-20-year-olds would benefit 6.25 million workers.

The current full National Minimum Wage rate is £7.83 per hour for workers aged 25 and over and workers’ wallets are running on empty and incomes are being milked by cuts to in-work benefits and the government’s turbulent introduction of Universal Credit.

There’s something seriously amiss with our economy when 60 per cent of people in poverty are living in working homes and over one million food parcels are given out each year and as in-work poverty grows, large business is profiting from corporate welfare which is subsidising low pay across the economy in the manner of in-work benefits.

Raising the minimum wage and national living wage to £10 per hour would be a tremendous help for young workers and promote the end of poverty pay rates that hospitality workers have to endure and it would be a virtuous circle helping to ease the pressure on wages, while improving the public finances through greater taxes and decreased spending on in-work benefits.

A £10 per hour minimum salary would mean more money in people’s pockets which would be spent in communities and on high streets across the United Kingdom and it would help breathe life into a flagging market and make work pay.

In the meantime, an examination of approved figures by the GMB union has determined that more than 500,000 young people in the United Kingdom experience wage differentiation as they’re paid less simply because of their age.

Minimum-wage

The union is supporting a Private Members Bill calling for age banding in the National Minimum Wage to be discarded, which was set to be debated by MPs in the House of Commons Friday (6 July) but under prevailing minimum pay banding employers are able to pay £7.38 per hour to workers who are aged between 21 and 24, and only £5.90 per hour for those who are aged 18 or over but not yet aged 21.

It’s difficult to relate how infuriating it is being paid fewer wages than someone doing the identical work as you simply because of your age and it doesn’t matter how laboriously you work or how much energy you put in, you are just not worth as much and it makes people feel belittled.

It’s not asking for much, just to be given the same salary as your co-workers for doing the equivalent work. It’s not like people get reduced bills or rent, so why should they be employed at a reduced rate of pay.

But when minimum wage does go up, hours are cut but low skilled workers meaning Human Beings still have to live like qualified workers do, they still have to eat, pay bills, et cetera and they can’t do that on a low wage.

£10 an hour would seemingly disable a lot of humble businesses, it would either shut them down or the worker would get laid off as the businesses couldn’t afford them and that’s why companies use immigrant workers because they’ll work for more hours and fewer wages because they’re the bourgeoisie of our society and how does it go? It’s better to employ them plebs than those who were born in the United Kingdom.

A minimum salary of £10 an hour is reasonable in the 21st century. It would help the working poor, many of who have to claim benefits as well as working and when the minimum wage was first introduced, the Tories and the bosses insisted it would create mass lay-off, it didn’t and neither would this.

A person should be given a sufficient salary for the work that he/she does, irrelevant of age. Why should somebody of 45 years old be getting more than a person of 25 years old when they’re doing precisely the same job? Well, they shouldn’t, if it’s the same work they should be getting precisely the same salary and because they’re not, that’s called slave labour.

And if you factor in the discriminatory income differences emerging from this extended period when the wealthy get richer at the expense of the poor who unavoidably, therefore, get poorer and poorer and have the exploiters of neoliberal economics no morals at all even when they see the destitute people they have plundered and reduced to living on the streets as beggars.

 

Aristocrats Bidding For A Lifelong Seat

Parliament is about to hold an election with 11 candidates. Each candidate is a man, every candidate has inherited a title and only 47 Tory aristocrats in the House of Lords can vote.

The victor will be able to make your laws for life. So, welcome to the strange world of a hereditary peer by-election and the successful victor will get to talk in the House of Lords, claim a £300-a-day allowance, and have the power to shape and vote on the laws of the land.

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The policy is a grotesque hangover from Tony Blair ’s efforts to refurbish the House of Lords but when the ex-Labour PM essentially abolished obtained peerages in 1999, he consented to let 92 of them stay in the House of Lords as a trade-off.

Nearly two decades on, the situation has still not been settled. That means when one of the hereditary peers dies or retires, the peers that got booted out in 1999 get the first refusal on his or very rarely her seat.

The departure of Lord Glentoran at the age of 83 has opened up an opening and because he was a Tory, only Tory hereditary peers in the Lords of which there are 47 can vote.

But should we get rid of the antiquated dumping ground for has-beens and the vested? And at £300 a day for doing nothing and subsidised food and alcohol what’s not to like?

As it’s established now, the House of Lords is an unnecessary, outworn establishment. It should be dumped quickly and 101 names drawn out of a hat of all those listed on local voting lists in the United Kingdom. Those people work for a twelvemonth in a new House of Representatives following which a new draw takes place.

Britain is quickly becoming broken and when parliament is presented on TV, half of them are fast asleep and maybe it’s time to eliminate the House of Lords because it’s just a means to ensure that aristocracy always has a powerful influence on society, in promoting their own interests at the expense of the general populace.

It’s a system of Lords who like to have a drink at the bar but these are Lords who are accountable for our country, yet these intoxicated fools are assembled in the House of Lords. How many people do you know that are permitted to booze on the job?

The House of Lords must be eliminated or at least improved because this privileged gravy train should stop now and of course the government will use all imaginable methods and deceptions to reach their goals.

As an artist would simply settle and criticise the market for not being able to sell their work, the government find it easy to simply condemn society.

However, the Queen’s nephew, a 24-year-old ambitious banker and a formal naval commander have all joined Britain’s strangest election race for a life-long seat in the Lords. The men are all amongst the candidates for the next hereditary peer by-election, in which only the descendants of those with qualified rights can stand and the only other, an elite group of 31 surviving peers can vote.

A husting for the chosen post will be held in the House of Lords before the victor is chosen in a covert vote on July 3 and there are 19 candidates in the running to be a new crossbench peer replacing the retiring Earl Baldwin of Bewdley.

As well as the Queen’s nephew the Earl of Snowdon who is 19th in line to the throne, Cody Tennant, 24-year-old Lord Glenconner, wants the seat and each candidate is permitted to issue a 75-word statement to peers to say why they should be elected to the red benches.

Lord Glenconner has promoted his Master’s degree from the University of Aberdeen stating that he takes a great interest in politics and legislation.

This cracks me up! I take a great interest in politics, although I don’t have a Master’s degree and we all know that having a Master’s degree does not give you the savvy to make decisions on our country and with people’s lives and these privileged toffs have no idea what goes on in the real world.

We want real people governing this country, not Joe Nineties…

Don’t Grope Your Women

Tube bosses could wage an ad campaign telling passengers not to grope women travellers and it’s thought advertisements on the transport system could serve to restrain sexual harassment experienced in the rush-hour.

Some passengers see their rail trips as an excuse to feel up women and sadly it is a place where people appear to believe it’s an excuse to act disgustingly and it’s thought an advertising approach could be very powerful.

Having a campaign on the Tube carriages: ‘Please don’t think this gives you the right to grab someone’, that could be really useful because you are all standing up, crushed together, staring at the advert which can’t be avoided.

But is this actually a way to campaign and will it actually work? Is it the right way to use taxpayers money?

Whether we put ads on the tube or not, there will invariably be somebody out there that believes it’s okay to perv and grope somebody on the tube during rush hour and advertisements are not the way to go when trying to stop sexual harassment of women and girls.

Admittedly we live in different times where music videos are plastered across our TV screens of women dancing with their cleavage hanging out and butts on display but that does not consent for a man on the tube to push his face into woman’s cleavage in front of startled passengers.

Pornography online has exploded exponentially in the last decade and it’s presenting us with really disturbing challenges on how women are viewed in relationships and what boys expect of them and what girls expect of themselves.

However, groping on the tube is not a recent thing, it’s been going on for a long time and if we hop back to the 1980’s it was going on then if not before then.

There are over 12 thousand CCTV cameras on the London Underground system, watching the actions of millions of travellers every single day but some passengers are also doing their own electronic reconnaissance.

There is an increasing number of websites and photo spectators devoted to critiquing the look, attire and habits of individual passengers.

Travelling on the Northern line in South London on a Sunday morning, a picture was covertly taken by someone using a mobile phone but it wasn’t until three days later that the man whose picture had been taken realised that his photo was part of an online trend.

His image arrived on the website Tubecrush.net and a connected Twitter account, and his appearance and style sense was being ranked online but he had no idea whatsoever. He was simply sitting on the tube minding his own business on a Sunday morning after being out the night before.

Several days later his friends were phoning him up and emailing him and laughing about his picture being online.

Tubecrush.net encourages passengers to post images of strangers they find attractive or eye-catching and subjects must be guys commuting on the London underground and the men having their picture taken are usually oblivious to their image being online.

Tubecrush.net was established by four young professionals residing in South London.

Seven months ago Steve Motion, Gemma Dean, Andy Kaufman and Michael Sparrow were watching a dating quiz show on television when they came up with the concept for the site.

They were watching women judging male participants on the TV, and imagined it’d be hilarious if you could do that in real life and they imagined that taking photographs of men on the tube in London would be best because the underground has a particular kind of ambience.

People frequently sit in silence and gaze around at everyone they’re travelling with so it seemed an entertaining concept so they chose to start taking photos of themselves and then invited strangers to send theirs in too.

The site now gets images from as far afield as Brazil and Japan, as well as other UK cities, including Glasgow and Manchester but many are refused and if the pictures weren’t taken on the Tube then they don’t tweet them, as they want to keep the main website centred on the Underground itself.

Hundreds of pictures posted are then classified into categories, including which portion of the tube system the image was taken on and the Northern Line and the District Line appear to be most prevalent for images.

A number of related social networking accounts and online galleries have sprung up. Some like @peopleonthetube focus on strange attire and unusual events, while the now-defunct @tube_chicks rated photos of female travellers.

But @tubecrush chose not to request pictures of women as they felt like men taking photographs of women on the tube felt strange, it’s not the same as gay men or women taking photographs of other men.

The site first brought in gay men who wanted to send in pictures, but now 60 per cent of images taken are from women and Tubecrush.net is now so successful it has prompted a sibling twitter account to be set up in New York – @subwaycrush.

It has also started to market branded commodities and is looking at establishing websites in other cities.

There are also the legal complications of viewing this sort of pornography and how it might affect their loved ones, their girlfriends, wives or even their children and is this a violation under the Public Order Act?

However, electronic reconnaissance could be a thing of the future, a little like our neighbourhood watch because it could hinder those pervs and those groping women on the tube but honestly, we need real policing on our underground system.

Tubecrush.net does set out on its website what to do if someone sees their own photo in a gallery and wants it removed and it has a photo removal request option and so far, in seven months, only three people have asked for their picture to be taken down.

However, the underground is deemed a public area, making photographing legal, but there are the moral concerns when the photographs of strangers are uploaded online.

Most are totally oblivious their picture has been uploaded and is being scored by strangers and should the site be taken in the spirit it was intended? And isn’t this invasion of privacy?

An invasion of privacy happens when there is an interference upon your reasonable expectation to be left alone and incorporates the four principal kinds of invasion of privacy claims, an intentional tort primarily controlled by state laws.

Encroaching upon another’s solitude or private affairs is subject to liability if the invasion is deemed extremely objectionable to a reasonable person. This tort is frequently associated with peeping Toms, someone illegally intercepting private telephone calls, or snooping through someone’s private records.

Taking pictures of someone in public wouldn’t count, but, using a long-range camera to take photos of someone inside their home would qualify and making a few undesirable phone calls may not constitute a privacy invasion, but calling frequently after being ordered to stop would.

I guess taking photographs of people on the underground would depend on a person’s opinion and how they feel about it and I wonder out of 100 people on here, how many would agree it was acceptable and how many would say it wasn’t.

I know that when I’m out and about taking photographs of my family that I’m really mindful that there are no people other than my family in the background. But, if I was in a place like Trafalgar Square where there are numerous people, people don’t seem that bothered but if I was in a public place like the tube and couldn’t help but get other people in my shot I would attempt to ask if it was okay to do so, it’s just a matter of respect.

On principle. A person has a right to protest having his/her face plastered over newspapers or shown around to all and sundry. So, get permission if you need or cannot avoid the person’s presence in the photo if you plan to show it around or distribute it.

In almost every country, the act of taking photos, despite the subject is allowed when you’re in a public place. You can shoot people, buildings and public art. No one needs to give you permission.

Bottom line, be courteous, respectful and kind and it may not be illegal but no one in a public place has a reasonable expectation of privacy, but what you do with that photo is a different story and if you intend to distribute it, then you should do so with their consent.

Doing it without consent is allowed, but it’s also other things as well, like offensive.

British reticence on the rail network is making it difficult for women to speak up about being sexually violated and figures gathered by BBC Radio 5 Live Investigates reveal that the amount of recorded sexual offences on trains has increased in five years from 650 in 2012/13 to 1,448 in 2016/17.

The data, which was released by the British Transport Police following a freedom of information request, reveal that the majority were sexual attacks on females aged above 13.

The figures, which include England, Scotland and Wales and cover the London Underground, revealed that women were more comfortable reporting incidents to the police, but also that passengers must do more to look out for each other.

As many times as you hear a genuine story about someone intervening to help, you learn another one about nothing happening.

People don’t socialise on the tube and we should put our mobile phones away or Ipads and socialise a little better and take some responsibility for each other and we require a different kind of transport system because, after all to most people who travel on them every day to work, it’s partially their home for the best part of the morning and evening.

It’s somewhere that people want to feel safe and not have to look over their shoulder all the time in case somebody decides they want to feel up your arse or put their head in our cleavage, but most occurrences take place in the rush hour when carriages are busy.

And I can remember the days when I went to work and had to stand on a very packed tube, my face up against the glass, like a sardine in a tin can whilst some stranger behind me groped my arse and I couldn’t move because there just wasn’t enough room to turn round.

And what gives men the freedom to believe that they can do that to a woman, do men not have any self-control over their penis, or do they think that they have the god given right to do so because they’re men?

It’s an opportunistic offence in many ways, and when the tube is really full these perpetrators act on that and busy carriages make it even more challenging for others to intervene, so it’s especially difficult for a stranger to see what’s happening.

The probability of a victim saying something is really low, so we should all be looking out for each other a bit more and many of the reported crimes involve men pushing up against or touching up a victim, usually in a busy carriage.

We could have women-only carriages which would decrease these assaults but then there would be people out there that would say that’s sexist and perhaps it is, but the point that’s missing is that men should be able to keep their sexual urges under raps, and the odds are that many of those men have probably got wives or girlfriends at home waiting for them.

 

The Lessons Learned

Of all the startling findings from the inquiry into Gosport War Memorial Hospital, and the fact that workers raised concerns as early as 1991 but were disregarded will make for especially disturbing reading for the families affected.

Hospital administrators joined ranks and fired the nurses who made complaints as a small group of night staff making waves and it emphasizes the unfortunate reality that whistleblowers find themselves in a remote position.

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There have been some recent instances of how whistleblowers have been handled by their employers. Unfortunately, these incidents cast light on the way that whistleblowers continue to be subdued rather than supported, both in the NHS and the private sector.

And the use of gagging clauses when whistleblowing doctors get financial settlements on agreeing to leave their job is still endemic in the NHS. Even if confidentiality terms are expressed so as not to restrict a doctor making a protected confession under whistleblowing laws the perception must be that if paid to leave, the mouth should remain securely closed about whatever worries he or she had cultivated.

This is hardly consistent with the new spirit of openness and transparency in our health services.

 

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With the Care Quality Commission that said that two-thirds of NHS hospitals are giving unreliable care, and that budget constraint and cost-cutting will simply lead to more shortcomings, it is increasingly difficult to see why whistleblowers are not listened to and protected, supported, or even honoured as champions of the public interest.

Whistleblowing is not only about public disclosure of disrepute, early, internal admission of shortcomings and dangers gives administrators a chance to take early preventative measures, to learn from mistakes and possibly bypass the spiral of harm and risk that defines the embarrassments that continue to surface.

In severe situations, dangerous surgeons can be weeded out and their practices discussed.

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Concerns over Ian Paterson’s surgery had circulated since at least 2003 and his performance was examined in 2004, and in 2007 an in-house investigation ended in Solihull NHS hospital ordering him to stop performing his disreputable cleavage-sparing mastectomies.

But, he proceeded to carry out these and other dangerous and futile procedures until about 2010. The General Medical Council (GMC) forced restrictions on his practice in 2011 and a study of Paterson’s NHS practice was conducted by Professor Sir Ian Kennedy in 2013.

Ian Paterson served at two private hospitals run by Spire who ordered their own Verita independent review with results also published in 2013 but recent press news of his criminal case have not incorporated aspects of obvious whistleblowing activity but the Kennedy investigation into Paterson’s NHS ventures included references to the fact that whistleblowers were in fact repeatedly disregarded.

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Whistleblowers don’t fare well in the NHS. This is one of the main findings of management in the NHS that it is inwards-looking, over-defensive, and likely to destroy, by a diversity of means, those who suggest that the Emperor has no clothes.

This is not unprecedented to this Review. It is a scourge on the NHS and is one of the main areas where lessons must be learned and the Paterson situation confirmed a breakdown at all levels of oversight and rule in the NHS and the private sector.

Early exposure of his activities would have stopped injustice, injury and perhaps the mortality of the victims and evaded notable sums to meet several hundred compensation claims which are now practically incontestible.

It appears curious that nobody had felt able to speak out. Did doctors turn a blind eye and keep their heads down? Clearly, there must have been honest associates at Paterson’s NHS hospital and at the Spire hospitals who knew of the abuse he forced on subjects but may have been scared to raise concerns in the knowledge that they would be extinguished and victimised?

Were there doctors who attempted to take measures to protect patients from Paterson but were barred from doing so? Equally, were there doctors or administrators who for many reasons, none defensible, who did not want the truth to surface?

It has now been reported that up to ten doctors who served with Ian Paterson are under investigation by the GMC, probably for neglecting to act on concerns.

Trust managers risk punishment for neglecting to protect patients from harm, so neglecting to act on a whistleblower’s anxieties can be a dangerous approach and Bristol Medical Director Dr John Roylance was struck off for professional wrongdoing by the GMC in 1997 after he decided to ignore warnings from children’s heart surgery whistleblower Steve Bolsin.

The GMC ruled that Dr Roylance had failed in his duty to intervene to ensure the protection of patients, and the GMC had control because he was a registered medical practitioner (a radiologist).

More recently former Royal Cornwall Hospital, Truro Medical Director Dr Robert Pitcher was struck off by the Medical Practitioners Tribunal Service at a misconduct hearing in October 2016 for neglecting to protect patients from the risk of harm at the hands of disgraced gynaecologist Rob Jones.

Robert Pitcher had declined to act between 2007 and 2008 on shortcomings reported by Jones’ associates and confirmed by four investigators, three of whom were independent consultants, who had identified significant concerns that require resolution.

One of the reports had identified 46 dangerous failings in Jones’ practice but Pitcher chose to disregard its findings and some of Jones’ co-workers especially junior consultants and senior trainees who gave testimony at the Medical Practitioners Tribunal Service (MPTS) hearing stated they believed it had been hugely hard to raise concerns about a senior co-worker, they were afraid of the consequences on their own careers, being perceived as agitators.

They also expressed their disappointment that nothing productive was done in response. It was not until concerns were heightened directly by the Trust’s Chief Executive in 2012, skirting the clinical and medical administrators, that sufficient response was finally taken.

rcog-logo.jpgThe Royal College of Obstetricians and Gynaecologists (RCOG) investigators then described the team as divided and dysfunctional and that social and personal concerns had led to bungled opportunities to investigate impartially.

Robert Pitcher was punished for putting the interests of his associates above patient safety and an entirety of 204 compensation claims in the interest of Jones’ victims for their avoidable injuries was managed by associates at Enable Law (Foot Anstey).

Nearly half of those claims related to injuries sustained following treatment by Jones following 2008, so may have been circumvented altogether if Pitcher had taken suitable action.

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Cardiologist Kevin Beatt’s situation has further been in the headlines. Dr Beatt had voiced concerns for 3 years over staffing and supplies deficits and workplace oppression and intimidation of junior workers at Croydon’s Mayday hospital and this came to a climax following the death of a cardiac patient during a routine angioplasty procedure in 2011.

Kevin Beatt was fired in September 2012. The Trust said he had made vexatious unsubstantiated and unproven allegations of an unsafe service but a tribunal ruled two years later that he had been unjustly fired in a calculated attempt to damage his reputation and subjected to the unlawful detriment for making protected disclosures.

Dr Beatt has now subsequently been victorious in the Court of Appeal following a 5-year battle and the Court of Appeal accepted the initial 2014 employment tribunal ruling.

The Trust viewed Dr Beatt as a rabble-rouser and it’s too easy for an employer to endorse its view of a whistleblower as being a challenging co-worker or an awkward person, as whistleblowers usually are and it blankets reason.

Parliament had quite deliberately, and for understandable policy reasons, conferred a high level of protection on whistleblowers and if there’s a moral from this rather disturbing story, which has turned out so terribly for the Trust as well as for Dr Beatt, it is that employers should proceed to the removal of whistleblowers only where they are as positive as they honestly can be that the admissions in question are not protected.

In Whistleblowing cases, the three relevant questions for an employment tribunal are whether the worker has made a protected disclosure, whether he or she has been handled detrimentally and whether the reason why the worker has been handled detrimentally was that he or she had made the protected disclosure.

The third point is relevant. Why has the worker been treated detrimentally as he or she maintains?

Whistleblowing is expected to have implications for a patient’s consent before he or she undergoes treatment and the hospital’s duty of candour following the procedure has taken place that is expected to become apparent as more evidence comes before the courts.

We are now in an era of self-determination and the well-informed victim. The Supreme Court ruling in Montgomery in 2015 announced that it’s a doctor’s duty to take just consideration to guarantee that a patient is conscious of physical dangers implicit in treatment, and of logical choices.

In order sufficiently advise, the doctor must engage in a discussion with the patient and must disclose the possibility of intermediary circumstances and complexities that might happen. Placing the responsibility on a patient to ask questions when the patient may not know what questions he should be asking is no longer enough.

The test of materiality is whether, in the circumstances of the particular situation, a rational person in the patient’s condition would be expected to append importance to the risk, or if the doctor is or should really be conscious that the particular case would be required to attach importance to it.

The relevant circumstances involve the amount of responsibility owed by the doctor and the information of the risks and benefits of each decision before the patient undergoes treatment and for the patient to make a very informed choice, shouldn’t he be informed of the associated benefits of undergoing surgery at a separate hospital unit with excellent experience and knowledge, better equipment or whose surgical and medical workers have a more solid safety record in that procedure?

If a surgeon lacks skill in the particular procedure to be achieved, patients should be informed of this.

The whistleblowers whose cases have been recorded have intensified concerns over shortcomings at their own hospitals. The difficulty for the hospital is that if patients are informed that a senior doctor in that unit has mounted concerns over inadequate resourcing, lack of adequate staff, or extraordinary death rates or maybe an unfortunate happening in a particular procedure those patients will definitely choose surgery at another centre.

If parents had been informed of the true position at the Bristol children’s heart unit in the 90s they would have chosen other hospitals which may eventually have ended in the loss of supra-regional status and associated supplementary NHS funding.

The availability of readily accessible, comprehensible, up-to-date, risk-adjusted facts allowing patients and families to examine units and realise the hazards they and their children risk undergoing surgery at a particular hospital is clearly a fundamental element of consent yet it seems to be a long way off in spite of this being a primary recommendation of the 2001 Kennedy Report.

Infinite patients may not want to probe into the cosmos of facts but some will want to examine the circumstances and will want to be able to match the record of other units in that particular procedure.

What is the Trust’s obligation to inform a patient if their treatment has gone wrong? The duty of candour begun in 2014 for the NHS and in 2015 for all healthcare providers forced a duty to give notification of a patient safety incident, a notifiable event which has or which could in the future give rise to particular, defined kinds of harm.

This burden befalls the NHS or private sector provider rather than the specific doctor. Failure to abide by this is a crime punishable by a penalty of up to £2500 and may result in the Care Quality Commission (CQC) excluding the provider’s certification.

The duty of candour has not caught up with the law on consent and the impression from the guidance that has been issued inside the NHS and private sector is that this is a box-ticking process, with the use of template letters giving usually formulaic solutions.

They apologise but don’t admit liability or acknowledge fault, a mantra on which much of the guidance appears to be founded may comply with the wording but only shows the essence of the responsibility.

There appears to be a moral nonconcurrence between honesty before treatment and reticence following that treatment and there are implications of the relationship between a doctor and his management and his contradictory commitments to both patient and employer, normally an NHS Trust in this context, which represents additional possible impediments to the execution of the duty of candour.

This proposes a difficult moral problem for doctors involved in a patient’s treatment, their commitment to do no harm and has a doctor fulfilled his obligation to the patient if he neglects to inform him before proceeding or to tell him after treatment has taken place that matters have been expressed by senior co-workers?

There are many perplexities and struggles that can arise for doctors serving in the NHS when it comes to complying with the duty of candour. These can be difficult problems for NHS workers which were not completely thought through when the duty of candour bill was introduced.

Violations of the duty of candour may be viewed by management as obvious wrongdoing on the role of the employee even if the underlying treatment failure if ascribed to the doctor’s own shortcomings, would not have led to his removal.

In addition, the worker could be opened to the risk of fitness to practice proceedings by the GMC both for the latent failure and the failure to comply with the duty of candour. Even though doctors may wish to comply with their moral responsibility to the patient, given how whistleblowers have been handled by administrators in the NHS in a long list of notorious cases.

Would you be happy with your employment status as a doctor if you were to give a full explanation to a patient who had experienced an unfavourable outcome?

What if you knew of broader systematic failings, lack of resources, bad habits, or the ineptitude of associates which may have acted as a part in the outcome?

The insurance factor may also be a hindrance to an effective and genuine duty of candour and a concern is whether private insurers, or in the case of the NHS their indemnifiers, the NHS Litigation Authority (NHSLA)/Clinical Negligence Scheme for Trusts (CNST) scheme, will really allow their insured or their workers to satisfy the obligations of the statutory duty of candour in agreement with what is the intended spirit of the legislation.

Whilst being open and impartial will be second nature to the large preponderance of doctors, there are pressures which may have the unintended consequence of making doctors unwilling to acknowledge that transgressions have taken place.

Taking the Bristol children’s heart surgery embarrassment of the 90s as an illustration, families were not given detailed explanations after their children died or sustained brain damage and other notable harm. In this position, if a duty of candour is to have any significance clearly a patient must be notified of the part the known ineptitude of a surgeon or lack of necessary resources or inept amounts of suitably qualified personnel has or may have participated in the disadvantageous outcome?

On the other hand, there may be a danger that the Trust loses its indemnity if it is determined that there has been a failure to comply with the duty of candour.

Children’s heart surgery, in many ways little has improved since the 1990s when concerns were heightened by whistleblower Steve Bolsin and parents of a child with an extremely complicated congenital cardiac defect such as Hypoplastic Left Heart Syndrome may be unaware but should be told that Birmingham is currently the best national centre for corrective surgery on this lesion.

Inevitably units with a higher level of skill in hugely complex procedures such as surgery to correct HLHS or the Fontan are going to deliver better results in terms of lower fatality rates and a lower percentage of and capacity to deal with surgical complexities.

So what can a parent anticipate from the duty of candour if their child has undergone surgery at a unit that lacked expertise in this procedure? They may be given a frank account of why their child died or suffered complications but in the same way that they should have been notified of the broader facts before surgery, and they should have been notified that there may have been a very different outcome if their child had been operated on at one of the leading centres.

These are questions of life or death and the failure to disclose this sort of information after a child has died or survived with brain damage is unlikely to satisfy a family’s understanding of the level of candour they can expect.

What if Steve Bolsin and Raj Mattu had raised their concerns today?

This story of an individual suffocated by an NHS trust reluctant to accept its shortcomings has been replicated at many other hospitals since Bristol. Some of the systemic, cultural failures at Bristol in the 90s are being repeated now, a generation later, failures that the law protecting whistleblowers or duty of candour as currently framed are able to address. News reports of scandals in the NHS raise the inevitable question ‘Have the lessons of Bristol been learned?’

Missed chances to act on internal matters have been a recurring topic of the large-scale inquiries into NHS shortcomings of the last 20 years. In 2001, the Kennedy Inquiry into children’s heart surgery at Bristol discovered severe, structural failures at a unit that had shrouded itself in a club culture of deliberate blindness to safety concerns.

As early as the late 1980s, the recently-arrived consultant anaesthetist Stephen Bolsin had made his concerns over disturbing surgical death rates explicit to his superiors at the Trust, fellow clinicians and administrators, occupying all levels of authority right up to the summit of the NHS and the Royal Colleges, declined to heed his warnings.

Operations at Bristol continued, in the hands of surgeons whose shortcomings were later laid exposed in the GMC disciplinary inquiry. By this time, scores of children had died or sustained harsh injuries. The information was sketchy but it was determined by extrapolation from the insufficient data available that 171 children who could have survived if they had been operated on in other hospitals had died at Bristol over the period 1982–1994 reported by the Public Inquiry.

There was no data for the incidence of non-fatal unfavourable outcomes so no ghoulish examples could be made.

Even though cardiac surgery has led the area in the publication of outcomes data, to this day the only data accessible to evaluate the performance of a surgeon or unit is a 30-day mortality. This absence of data and the poor quality of the data that is accessible can make it hard for a doctor to confirm his anxieties over the performance of his or her colleagues are justified.

Professor Bolsin, as he became after leaving Bristol, earned the most fame as a whistleblower, and paid the ultimate price, emigrating with his family to Australia in the light of extensive bias in the medical field. Bolsin became in his own words the most hated anaesthetist in Europe.

Fortuitously, he’s since received a number of prestigious awards and accolades in honour of his actions. The idea of a clinical rule that took root in the United Kingdom and internationally rose straight out of Bolsin’s efforts.

As with all other whistleblowers whose stories are now commonplace to us, all he had done was to attempt and heighten concerns over the safety of his unit. He had served in accordance with his morals and took a course of action that he knew to be honest and morally right.

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In his address to the latest Turn Up the Volume conference, he warned us of the single fact that we must never lose sight of the patient.

Hiding data about risky practices leaves hospitals exposed to negligence allegations relating to failures of consent. It is self-evident that, in medical procedures, a patient or his family, must give properly informed permission to treatment, recognising the dangers and ramifications of what they’re about to encounter.

At Bristol, parents were given surgical outcome predictions, figures for survival rates and surgical danger, which may have reflected national standards but which the Trust apparently knew to be incorrect for their own unit at Bristol.

Where patients or families consent to surgery at a unit or hospital that is known to have a poor record or unsatisfactory safety record, maybe even dangerous staffing levels, their consent could be tainted. The NHS may well face allegations affirming a failure to warn, that it will find hard to defend.

Raj Mattu, the former cardiologist at Walsgrave Hospital in Coventry, revealed a crisis of overcrowding and patient safety at his unit in 2001. The Trust had imposed a 5 in 4 policy of squeezing an additional bed into cardiac wards meant for four patients, a policy that left essential services such as oxygen, mains electricity and suction less available to some patients.

Raj Mattu and his co-workers believed this presented a risk to patients and would take lives, they begged for the practice to end but the administration refused to listen.

Raj Mattu witnessed the death of a 35-year-old patient who had suffered a cardiac arrest. He and his co-workers had been unable to provide the patient with the expected standard of cardiopulmonary resuscitation because they could not reach the patient or deploy the equipment due to his position as a fifth patient in a four bedded bay.

Raj Mattu and two senior nurses recorded a serious clinical incident report and recorded aspects of these obstacles in the patient’s case notes. His co-workers nominated him to put forward their concerns and in a letter to the Trust’s Chief Executive David Loughton, Mattu complained that the concerns he had expressed had not been acknowledged or replied to by the Trust management.

Raj Mattu’s reward was a suspension and a decade-long fight before he was finally exonerated. This was despite the CQC issuing a report following 2001 reporting it as the worst ever patient safety report they had produced for any Trust, verifying an excess death rate of 60 per cent compared with the following excess death rate of 29 per cent at what became the notorious Mid Staffs.

The excitement over Raj Mattu’s treatment by his management is one of several case studies in the opprobrium suffered by those who break ranks and voice concerns and whose careers are ruined.

Some 200 grievances about Raj Mattu were made by the Trust to the GMC, health regulators, the former Strategic Health Authority and even the police, every single one of which was found to be without justification. In the meantime, the NHS, and the public lost the services of an experienced and honest doctor.

The question of how much it takes to dispense with the fallout of a fumbled whistleblowing process, let alone the human deaths of patients who have experienced avoidable harm, is becoming glaringly obvious. This, astonishingly, is a factor that appears to have eluded the notice of Jeremy Hunt in his drive to decrease NHS expenditure.

The failure to foster a culture in which hospital staff are urged to come forward with their patient safety concerns is a missed chance to save public funds.

Significant legal costs are incurred by the NHS challenging allegations made by whistleblowers and challenging them through continuous disciplinary procedures, tribunals and the courts. The economic expense of snubbing whistleblowers’ warnings can be enormously costly for the NHS.

Where a Trust knows of a serious problem but declines to act or takes measures to cover it up, negligence cases grow and heeding Steve Bolsin’s anxieties and grasping the problem may have saved the NHS in excess of £100 million when one factor in the costs of the GMC Inquiry, Public Inquiry and the cost to the NHS fighting some 200 cases for mortal injuries and 50 claims for significant damages where children survived but sustained severe injury.

This calculation does not include the immense suffering and harm done to lives, which makes for even more unpleasant calculation.

Raj Mattu’s incident is also an object lesson in the cost to the NHS of pursuing whistleblowers. Incorporating the price of all the disciplinary processes and legal proceedings, his Trust built up a detailed bill of up to £10 million.

Figures of a comparable amount have been insinuated in the media representing the compensation given to Raj Mattu for his broken career, out of which he has had to pay his own large legal expenses to accomplish that outcome.

Press releases imply that the Trust’s legal expenses for their failed five-year fight upon the now fully vindicated Kevin Beatt now stands at £440,000.

Compensation claims on the NHS for Ian Paterson’s NHS operations are reported to have cost the taxpayer upwards at least £10 million. Many of these claims could have been bypassed if his Trust had put into practice methods to help, receive and act on the concerns of whistleblowers.

The legal expenses incurred by the NHS in fighting the Ian Paterson cases are not yet known. Spire and their insurers are fighting allegations brought by Paterson’s private patients, a stance that may well harm the reputation of private health providers and potentially reduce their chances of securing sourced out NHS contracts.

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Junior doctor Chris Day was victorious in the Court of Appeal in May 2017. Dr Day had raised concerns over staff deficits and informed administrators at London’s Queen Elizabeth Hospital that he was the only doctor covering an 18-bed intensive care unit.

He maintains that his career has been slaughtered after malicious accusations were then made against him, making it difficult for him to proceed with his training. Chris Day was prevented from pursuing an employment claim because Health Education England maintained that junior doctors were excluded from the protection of whistleblower laws.

Following a 2-year appeal process, the Court of Appeal decreed that the case must be sent back to the employment tribunal for them to determine whether the Health Education England (HEE) had broken Day’s terms of employment.

Support for Day has been so great that he was able to raise £140,000 for his legal expenses through crowdfunding. In the meantime, the costs to the taxpayer will surely be in six if not seven figures by the time the case has reached a conclusion.

This does raise a question mark over the seemingly narrow view of whistleblower cases taken by the NHS and perhaps their lawyers. And seemingly, so far there hasn’t been a case where there has been a successful challenge, invariably whistleblowers have been vindicated but at a great personal cost to the whistleblower and the taxpayer. In the meantime, patient safety has been endangered.

A great deal has changed for whistleblowers, a fear of whistleblowing still penetrates the NHS and a number of whistleblowers reported their stories at the recent Turn Up the Volume conference. Sadly the warning to would-be whistleblowers was simple and severe, only do what is right if you are very strong.

Be prepared to be beaten, individually, professionally and legislatively. Only proceed if you have insurance to meet the legal costs and the time to spend with your lawyer going through the facts in great detail.

Expect little or no assistance from the regulators, your MP or anyone else. Be aware that your career may be permanently damaged; former colleagues will shun you and you will lose friends.

So how would a Steve Bolsin or a Raj Mattu be dealt with today? Sadly I can’t help thinking the answer would be little different and they would find many obstacles placed in their way.

Giving enhanced rights to pursue a claim in an employment tribunal after alleged discrimination has taken place is only a partial solution. Suspending whistleblowers and treating them as potential litigants rather than fellow medical professionals working towards a common goal cannot be the answer.

If managers continue to take steps to crush whistleblowers such as Kevin Beatt when they raise concerns over dangerous practices or conditions presenting a possible safety risk, are they really going to allow a doctor to be candid when explaining an adverse outcome to a patient? If hospitals conceal wider problems and systemic failures from patients this would suggest we haven’t come far.

If a breach of the duty of candour carries criminal sanctions it is difficult to see why suppressing a whistleblower, and ignoring safety concerns, is not handled with equal seriousness. It should be a mandatory requirement for hospital management to listen to what a whistleblower has to say, investigate and act on those concerns and only dismiss them after a full investigation has found them to be groundless.

More than 450 patients died after being given strong painkillers inappropriately at Gosport War Memorial Hospital and taking into account the missing records, an additional 200 patients may have experienced a similar outcome.

Clearly, there has been a disregard for human life of a huge amount of patients from 1989 to 2000 and there was an institutionalised regime of prescribing and giving dangerous amounts of a medication not clinically supported at the Hampshire hospital.

And a hospital opiate scandal that killed up to 650 patients could happen again because the NHS is still ignoring whistleblowers.

Nurses raised the alarm about the use of the powerful painkillers at Gosport War Memorial Hospital, Hampshire, in 1991, but administrators rejected their concerns but then an independent panel determined that 456 patients died at the hospital between 1989 and 2000 because of an institutionalised practice of the shortening of lives through administering opioids without medical justification.

One of the main lessons from the inquiry is the need for a constant practice of openness and honesty in the NHS. The health and care system needs to move away from past closed and defensive responses to mistakes. It must understand the importance of being open about blunders so that mistakes can be discussed and lessons learnt.

All organisations have fields of excellence as well as weakness. It’s important, to be impartial, and open to those flaws, inside organisations and with the people and all healthcare professionals must be open and impartial with patients when something that goes wrong with their treatment or care causes or has the potential to create, harm or distress.

Communications between patients and medical practitioners can sometimes be testing. We have all had consultations where the communication was not the best, both as medical practitioners or as a patient ourselves.

Neither usually wants to create a complicated situation but general mistakes, by both groups, frequently occur in such an event and communication and paying attention are necessary for each consultation but in particular, for situations where communication may become difficult.

However, two-thirds of hospitals are offering poor care and further warns that pressure to decrease costs could lead to a further substandard health service in future years.

The NHS is failing on safety due to lack of finance and bad administration. The finger of blame points at you, David Cameron and the NHS get billions and the CQC are accountable for the levels of care and safety so they are sinking hugely.

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Everyone knows the traditional perception of Florence Nightingale. This worthy, self-sacrificing woman would be rolling in her grave now if she could see what was going on with our health service.

This gentle maiden of high degree cast aside the pleasures of life to relieve the pain of the afflicted as the Lady with the Lamp floated through the aversions of the hospital at Scutari and anointed with radiance her morality to dying soldiers.

The National Health Service today, staff spirit is at its deepest decline. Staff shortages appear to be endemic at nearly every level. The Health Service is practically extinct, destroyed by the government.

All the evidence points to the reality that there’s a grave deficiency of doctors everywhere in the Health Service, in the hospital setting and in general practice, and this deficit is increasing, and it’s become perilous.

It is not a shortage, like the others, due to pay. It’s a deficit which arises essentially out of a failure of planning not perhaps so much by the Minister of Health as by his forerunners, but a failure of planning which began out of statistical misinformation.

The best estimation is that we need at this time, no less than 250 more doctors a year coming into the Service that we’re now getting and it’s pretty obvious that an increase like this can’t be compressed into the current medical schools.

One necessary action that the Government needs to take and take now is to ensure the immediate establishment of two, probably three, new medical schools and even if they take that decision now, it will be eight or ten years before those new schools can make any real enrichment to the medical staffing of the Health Service.

If there seems to be any problem in getting enough medical students, the medical students might in future be induced from a slightly broader social status that has been used in the past and much publicity has been made in recent months about the migration of doctors, and suggestions have been made that this has been the principal reason for the lack of medical staff in our Health Service.

It has been implied that about one-third of the doctors who qualify in each year discover themselves, inside a really short time, migrating either to Commonwealth nations or to the United States of America.

Put to one side for a moment the most consistent river of negative NHS stories, of cuts and shortages and waiting lists, and examine how victorious the NHS has been and still can be, supplied the proper funding.

The NHS is one of the few entirely publicly-funded healthcare services in the world and since 1948 has treated and saved the lives of millions of people. Each one of those patients was treated on a basis of their need rather than their capacity to pay.

Each one of those patients was able to obtain advanced medical technologies and up-to-date medicines as a consequence of the NHS.

The world has evolved a lot in the sixty or so years since the start of the NHS and the NHS is facing multiple difficulties as society ages and the expense of innovative medicine and medical technologies progresses but, these difficulties are not uncommon to the NHS, all developing countries are facing significant constraints on healthcare due to an ageing society and the growing expense of innovative medicine and medical technologies.

Despite the unprecedented pressure in funding, the NHS has survived one of the best and most effective healthcare systems in the world. The reason the NHS has this position is rooted in the reality that it’s an entirely publicly-funded system that is countrywide in England.

Through a broad chain of organisations, the NHS gives value for money, provides adequate and fair access to care, and is flexible to a developing world. The NHS has precisely what is required to afford world-class healthcare for the future, if only it were financed well enough.

There are always critics that maintain that a social insurance based-system is more effective but these results from the Commonwealth Fund report confirm that this is not the case and in the United Kingdom is not unparalleled in facing rapidly increasing healthcare expenses.

Yet, in developed countries where healthcare is financed by a method of mandatory social insurance, then insurance contributions have to increase to support healthcare standards. These contributions are by people and employers and in many respects, social insurance works as another kind of tax on the person and employers. Transferring to a social insurance paradigm would be substituting one kind of tax with another kind of tax.

At the core of the NHS is the belief that access to healthcare should be equal for all and not dependent on anyone’s economic standing. In the Commonwealth Fund report, the United Kingdom was the leader in access to care, which included measures of patients going without health care due to payment problems or problems obtaining the right kind of medical care.

Without a doubt, the NHS is one of the best healthcare systems in the world as by sharing the costs through taxation, high-quality healthcare can be applied to everyone according to their requirement and since 1948 the NHS has proved that it can adjust to variations in the medical profession.

New medicines and medical technologies are extremely costly. In other healthcare systems access to these would be subject on your insurance protection, which would, in turn, be subject on how much you and your employer are prepared to pay, or conditional on how much you can afford to give in medical expenses.

In contrast, under the NHS it’s possible for everyone to have access to the latest technologies despite financial status and because everything has evolved over the years people are prepared to give a little more in tax to embrace that.

The NHS has always succeeded to include new technologies into its service, making them accessible to the entire population. Organ transplants started in 1960, computed tomography in 1972, and keyhole surgery and magnetic resonance imaging in 1980 and since 1948 the NHS has prescribed innovative medicines shortly following their launch for hundreds of medical conditions, including heart disease, cancer and diabetes.

But Care patients are being punished with huge bills because of a postcode lottery for NHS funding and people can be 25 times more likely to get their costs covered depending on where they live.

South Reading Clinical Commissioning Group (CCG) funded social care costs for 8.78 patients per 50,000 people while Salford financed 220.38.

Reading has a really low ageing community, 12 per cent against the national average of 17.7 per cent and the NHS funding data for October to December 2017 found vulnerable people in England with the most costly medical needs were not handled in the same way despite where they live.

The model doesn’t work because it is not financed correctly. Here’s some data the United Kingdom uses, approximately 9.5 per cent of GDP on healthcare. Most other developed countries spend more than us by 1-2 per cent.

That’s a lot of extra cash we could use, other countries do, why are UK taxpayers not worthy of that investment in their well-being?

Because Nurse Nightingales lamp is too dim. Blame the government.

 

Isis Does Not Exist

A Labour councillor who was forced to quit as a school governor after insisting that ISIS did not exist has now been elected to a council committee dealing with radicalisation.

Safia Akhtar Noor was suspended by Yew Tree Community School in Birmingham following numerous Facebook posts in which she disputed whether ISIS was to blame for terror attacks.

Even though the school suspended her and she later quit, she was allowed to stand for Labour in May’s local elections and gained a place in the Small Heath ward with more than 3,000 votes.

Birmingham council has now appointed a questionable Muslim Labour member who has previously declared that the Islamic State does not exist and has rejected Islamist attacks to a committee tasked with protecting children from radicalisation and terrorism.

On the day of the attack in March last year, she wrote: “Can people stop fighting on Facebook? Sadly people died in Westminster today but people die every day in Syria, Palestine, Africa, Rohingya, Kashmir. Need I carry on?!! Grow up and stop pointing fingers!”

Five days later she claimed in another message: “So someone got stabbed after the attack last week as a result of media and government claiming that SO CALLED ISIS HAD CLAIMED RESPONSIBILITY.”

She continued: “There is no ISIS and there is no proof.”

ISIS strives to forge an Islamic state called a caliphate across Iraq, Syria and beyond. The group executes Sharia Law, rooted in eighth century Islam, to build a culture that reflects the region’s ancient history.

ISIS is recognised for murdering dozens of people at a time and carrying out public killings, executions and other acts and ISIS use advanced devices like social media to support reactionary politics and religious basis. Fighters are devastating holy sites and valuable artefacts even as their leaders deliver a return to the ancient days of Islam.

In 2014, ISIS dominated more than 34,000 square miles in Syria and Iraq, from the Mediterranean coast to south of Baghdad. At the end of 2016, ISIS territory had shrivelled to about 23,320 square miles, according to IHS Jane’s.

In 2015, ISIS was thought to be keeping 3,500 people as captives. Most of the imprisoned were women and children from the Yazidi population, but some were from other racial and holy minority communities but ISIS’s income comes from oil stock and stealing, taxes, payoffs from abductions, selling stolen artefacts, extortion and regulating crops.

The Islamic State of Iraq and Syria, better known as ISIS, claimed liability for the November 13 terrorist assaults in Paris but according to Safia Akhtar Noor ISIS doesn’t exist, well, I guess she could be right, which would suggest that the British government are misleading the people.

And now Safia Akhtar Noor has been selected for the council committee dealing with radicalisation.

Even with lack of proof, you can still make people think that it was there or it did happen and even if we don’t know it exists, it doesn’t mean it doesn’t. It just implies we don’t know one way or the other and we really haven’t been made aware of it yet, so it’s not part of our consciousness except if it’s in the media, but that still doesn’t mean it’s a reliable source.

Arguments are from ignorance and it states that a statement is true because it has not yet been proven false or a statement is false because it has not yet been proven true and this depicts a kind of fake dichotomy in that it omits a third choice, which is that there may have been an insufficient investigation, and hence there is inadequate knowledge to prove the hypothesis be both true or false.

Arguments that appeal to ignorance rely merely on the fact that the veracity of the proposition is not disproved to arrive at a definite conclusion. These arguments fail to appreciate that the limits of one’s understanding or certainty do not change what is true.

They do not inform upon truth. That is, whatever the truth is, it does not wait upon human thought or investigation to be formed. Reality exists at all times, and it exists freely of what is in the mind of anyone.

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Despite this, the law student was able to stand as a Labour candidate in Theresa May’s local elections in the Small Heath ward which has a majority Muslim community and won with more than 3,000 votes and now, she’s been appointed to the Children’s Social Care Overview and Scrutiny Committee of the Labour-controlled council.

The body looks over initiatives to stop radicalisation and extremism and has given guidance on the Prevent strategy, designed to prevent people being enticed into terrorism and it’s shocking to think that the Labour administration would select Councillor Akhtar, of all the ones free, to this scrutiny committee.

Even though she’s atoned for stating her social media postings should have been scripted more thoughtfully, but they still represent her beliefs. Well done to Councillor Akhtar for demonstrating those beliefs, but if she wants to parade her opinions that much, maybe she should give up her day job and become an activist, that might be more instrumental for her.

And considering that the school at which she was a governor suspended her, stating her remarks violated its code of conduct, it beggars belief that Labour believes it fitting for her to manage the safeguarding of children, including protecting them from the threat of radicalisation.

henry-jackson-society.jpgAccording to a study by The Henry Jackson Society from March last year, one in ten UK Islamic revolutionaries have been sentenced and have come from the Sparkbrook area of Birmingham, which is ten minutes from Small Heath and the Labour-run Birmingham City council Europe’s largest local authority has been continually cited of turning a blind eye to extremism, including throughout the Trojan Horse scandal, when extremist Muslims imposed their agenda on state schools.

There’s not even the slightest bit of pretence anymore and the government see’s the UK’s native children as meat on the hoof, fit to generate taxes. Taxes which are to be given for logs on the UK’s funeral pyres and to pay the bills of the new overlords.

What is to become of our average law-abiding taxpayer?

It appears that our average law-abiding taxpayer doesn’t have the freedom to say no anymore except if they want to be dragged into an alley and attacked and the government appears to only understand one thing and one idea and that idea is to protect its narratives through the control of force.

Evidently, it appears that some people of faith lie to those who don’t believe and countless politicians appear to cast in the same mould but where there is a preponderance of Muslim people they will choose a Muslim because they’re in there to blend in and to penetrate and establish themselves.

Imagine a 100,000 native Christian Brits moving to an enclave of Pakistan, and voting in their own kind, there would be carnage, yet, we are told that we’re the bigoted ones.

But we English are a strange lot, in that, we are very lazy in expressing concern and fear. When we detect smoke, it’s not until the drawing room curtains are burning away and the fire brigade is tearing down the front door, that we scream, fire!

They’re educating some of our children to become followers of Islam, they’re ruining your children, and they’re taking your houses and it’s time for somebody to scream fire!

But we can be prosecuted and sentenced for saying offensive words about Muslims, it’s described as Hate Crime yet they have violated white underage English girls, while the government have snubbed it, and not one of their cases that have eventually gone to court has been classified as a Hate Crime.

But our politicians know that if they say anything, their own families, children, wives et cetera will instantly become the victims. The Muslims here dictate by numbers, intimidation and fear of their family members being hunted, abused and butchered.

Saying that there are countless Muslims that are respectable law abiding citizens and would give you the shirt off their backs and we shouldn’t tar every Muslim with the same brush and they work long hours giving back to the community, unfortunately, our government has insisted that all Muslims are the same.

Muslim is a term and as soon as we hear that term we instantly think terrorist because our government have introduced that term in our minds as terrorists. There are extremists that happen to be Muslim but not all Muslims are extremists, there’s a huge difference.

But when Safia Akhtar Noor states there’s no ISIS, people instantly think terrorist again and Muslim. They may as well put that in the Oxford dictionary “Terrorist” and then underneath “Muslim.” Which brings me to something else pretty disturbing, has Safia Akhtar Noor been elected to a council committee dealing with radicalisation so that people think terrorist and Muslim again, it’s a mindblowing twist.

All hate crimes should be punishable, we have zero tolerance for bullying and we should have the same for hate crimes. We demand that Muslims and other cultures that come to our country follow the law and that’s acceptable, what is not acceptable is when a British person thinks that it’s acceptable to launch a slice of bacon at a Muslim.

Just before the turn of the century, we had the sizeable immigration of Jewish people in England and even though we didn’t have Jewish extremists (the government at that time weren’t clever enough to foil that idea) in England, they were persecuted like Muslims are being victimised now.

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Then we had World War II and masses of Jews got wiped out, hey, World War III is on its way! Only this time it will be called a Satanic bloodbath…

The only thing we fear is fear itself. The government put fear into us and it paralyses us and this is just the country of stupid stunts and there are many other nationalities that work in England but they’re not oppressed as much as Muslims are, the difference is this, Muslims are of a different colour, whereas a Polish person in England is white which means we don’t really discriminate on faith at all, we discriminate on colour and us Brits don’t like change or anything out of the norm.

timthumb.jpgIn fact, Allah is the terrorist, not the Muslims themselves. The Qur’an says that they should cast terror into the hearts of those who become infidels and that’s all fine and dandy in their country of origin, where they can do what they like, they can cut off their heads and fingers, there’s no problem with that.

But here in England the laws are different and we’ve been pretty easy going with them, we have permitted them to erect mosques so that they can pray. We allow them to wear their own attire but what we didn’t invite into our country was extremist groups that believe they can lord over our country.

Unfortunately, we’ve put the wolves in charge of the henhouse.

Are most victims of terrorism Muslim?

It’s tempting for countless people who try and turn this question into a scorecard, attempting to figure out which religious groups are more extreme than others and it boils down to this grossly distorted keeping score, like it’s a football match.

The United Kingdom has become a bizarre world and it’s now shifted into a Looney Tunes Land.

 

 

Russia Is Preparing For War

Russia is planning for battle.

Tory Mark Lancaster declared the Kremlin is getting set for battle after learning lessons from current conflicts it has fought and the new head of the Army advised of an existential threat to Britain as he outlined the power of Vladimir Putin’s army.

Armed Forces Minister Mr Lancaster became the latest senior Conservative to voice concerns over increasing Kremlin hostility.

All you have to do is rotate the globe and look at the world from Russia’s viewpoint and examine how they might view threats, and whilst we don’t know whether they view conflict as unavoidable, they’re planning for it and Moscow’s use of cyber operations and proxies points to the fact that they don’t intend to get their hands dirty.

Although there’s another argument that Russia has decided that they’re not ready for major combat operations, that they’ve learned the lessons from Georgia and the relevant breakdown of their occupation of Crimea, and are now investing hard in the future of their current forces.

On this evidence, it’s a myth to believe that Russia won’t use hard power at some point in the future and they’re fuelled concerns about the threat from the Kremlin.

Russia now isn’t a status quo power, it’s in reconsideration mode and its purpose is presently equalled by a growing stockpile of long-range precision abilities.

The rules-based method is underpinned by power predominantly hard power and Putin doesn’t value countries with weak Armed Forces.

Looking to Russia’s current military operations, and the nerve agent attack on a former KGB agent in Wiltshire which was blamed on the Kremlin and their lack of regard for vulnerability, particularly military weakness, hasn’t altered one bit, as we’ve become more sceptical about the need or advantage of intervention, Georgia, Ukraine, Syria, Montenegro, Libya, and Salisbury.

And while increasing cyber forces was essential, regular forces were also necessary.

The misplaced understanding that there’s no immediate or existential threat to the United Kingdom and that even if there was it could only occur at long notice is wrong, along with a blemished idea that current hardware and size are irrelevant in countering Russian defeat, and that the answer rests somehow in disruptive technology, and that the faster we can field those technologies, the less useful the conventional means to combat power become as pointers of national control.

Of course, Putin is a pretty alarming character and apparently quite trigger happy and unpredictable but in a rather smart way. Although I’m not sure why the United Kingdom would be a threat to them and his military, although America might have something to do with that.

Donald Trump is making plans for a summit with Vladimir Putin throughout the US President’s excursion to Europe next month, it has been declared as the head of the British Army warns the Russian leader is preparing his troops for battle.

US officials are hoping the meeting will take place either before the NATO summit in Brussels on July 11 or after Donald Trump’s visit to Britain, which follows shortly after and the news has boosted concerns over Trump’s commitment to NATO and his visit to the United Kingdom.

It comes as Chief of the General Staff General Mark Carleton-Smith, as well as a top Defence Minister, warned that Putin is ramping up his troops for battle.

I would think that all countries equip their troops for the unfortunate, that’s why it’s called an Army but what if Putin is getting ready for war, what is the EU doing to prepare for that possible conflict with Russia? Apart from blocking Brexit and calling Donald Trump names.