Thursday, 26 May 2011

Hang your heads in shame!

Anyone who's spent more than a couple of days in a modern British hospital will recognise the symptoms: the stench of unemptied bedpans, the emergency buzzers deliberately left out of reach, the unfilled drinking water jugs and the moans of patients who have gone too long without pain relief. I make no apology for saying this. I know that not all hospitals are the same, but there's too much of a pattern of familiarity running through a report released today that says elderly patients are having to have water prescribed because staff aren't ensuring their patients are adequately hydrated. This is a scandal. There's no other word for it. And to all those doctors from the BMA complaining about the government's plans to improve the health service... you should be ashamed of yourselves. Not content with taking telephone number salaries and treating your patients like Medieval serfs, you spend your time blocking basic improvements to patient care while the people you're supposed to heal are dying of thirst. Physician heal thyself!


  1. Dementia patient's hospital treatment 'degrading'


    In essence this poor woman with dementia and a chest infection died after 16 days in hospital where she was treated with non-oral sedatives on nearly 90 occasions. No one ‘noticed’ that she had become hungry, and then agitated, at seeing the other patients being fed.

    It makes one wonder how many individual members of staff, over 50 shifts or so, preferred to keep their heads below the parapet, rather than risk their jobs by exercising a smidgin of humanity or querying the doctors’ judgements.

  2. Good to see you posting again TM. I also read this report and found it both disgusting and very distressing. I have never experienced hospital as an in-patient and hope I never do. As I get older I find that reading more and more reports about the demise of NHS "care", and especially about the atrocious treatment of the elderly in both public and private "care-homes", very depressing. I have now stopped taking my statins as I would rather my death was rapid (but not just yet!!) rather than a long, lingering fade-out in one of these vile institutions.

  3. HOW deceiving man and life can be. That's why why it's known as mastering the labyrinth.

    A man/woman can receive an education.
    Aquire a well cut suit and a few cultured mannerisms. However he can not hide the light or lack of it behind his eyes.

    I have seen more light and truth behind the eyes of uneducated petty thief and the drunken lost - than some technicians of the flesh - disguised as medicine men/women. Including some of their bureaucratic bluff masters.
    Some are not remotely in the realm of healing. And never will be in this life, however technical they get with the flesh.
    It is important to remember this has nothing to do with money - it is always a choice - at a soul level in some instances.

    Ultimately there is no hiding from or negotiating with, the truth.

    Like Colin, i choose death before i get abused by one or more of these gutless thugs disguised as medicine men/women in these institutions.
    They have no comprehension or understanding of the damage it does to a soul in their last few days.

    There are, it has to be said some wonderful souls who work in medicine and Nhs - they need to feel empowered enough without coerce via their own free will to speak out against any darkness. Rather than tapping into the many excuses on offer.

    My heart aches for those abused - and their unconscious abusers.


  4. The Daily Telegraph covered this story. In the comments section is a comment from a someone who, as a student nurse in 1991, was given a copy of a poem on their first day on the Elderly Care Unit.

    They write that Kate, the writer of the poem, was unable to speak, but was occasionally seen to write.
    After her death, her hospital locker was emptied and this poem was found.

    [A poem about humanity]
    What do you see nurses
    What do you see?
    Are you thinking
    when you are looking at me
    A crabbit old woman
    not very wise,
    Uncertain of habit
    with far-away eyes,
    Who dribbles her food
    and makes no reply,
    When you say in a loud voice
    'I do wish you'd try'
    Who seems not to notice
    the things that you do,
    And forever is losing
    a stocking or shoe,
    Who unresisting or not
    lets you do as you will
    with bathing and feeding
    the long day to fill,
    Is that what you're thinking
    is that what you see?
    Then open your eyes nurse
    You're not looking at me.
    I'll tell you who I am
    as I sit here so still,
    As I use at your bidding
    as I eat at your will.
    I'm a small child of ten
    with a father and mother,
    Brothers and sisters who
    love one another,
    A young girl of sixteen
    with wings on her feet,
    Dreaming that soon now
    a lover she'll meet:
    A bride soon at twenty,
    my heart gives a leap,
    Remembering the vows
    that I promised to keep:
    At twenty-five now
    I have young of my own
    Who need me to build
    a secure happy home.
    A young woman of thirty
    my young now grow fast,
    Bound to each other
    with ties that should last:
    At forty my young ones
    now grown will soon be gone,
    But my man stays beside me
    to see I don't mourn:
    At fifty once more
    babies play round my knee,
    Again we know children
    my loved one and me.
    Dark days are upon me,
    my husband is dead,
    I look at the future
    I shudder with dread,
    For my young are all busy
    rearing young of their own,
    And I think of the years
    and the love I have known;
    I'm an old woman now
    and nature is cruel,
    T’is her jest to make
    old age look like a fool.
    The body it crumbles,
    grace and vigour depart,
    There now is a stone
    Where once I had a heart:
    But inside this old carcase
    a young girl still dwells,
    And now and again
    my battered hearth swells,
    I remember the joys,
    I remember the pain,
    And I'm moving and living
    life over again,
    I think of the years
    all too few - gone too fast,
    And accept the stark fact
    that nothing can last.
    So open your eyes nurses,
    Open and see,
    Not a crabbit old woman,
    look closer - see ME

    I think this poem should be taught to ALL medical staff, they should be examined on their understanding of its relevance to their work and they should not be allowed contact with patients until they really understand the import of this poem.

    Well we can always hope - if we never reach for the sky how will we ever know what we could achieve.


  5. Sarah - London27 May 2011 at 12:19

    Afternoon. The poem is heatbreaking and I think that it applies to all older people, not just those in hospital - generations who slowly become invisible and ignored. I will print out and keep to remember when I am next irritated by someone slow in front of me etc - thank you.

    ETM - hope all is well and that you are keeping busy!

    Happy Friday to all, Cats' Mother

  6. maybe the hospital system there should be given a copy of the geneva convention , the patients should be at least treated as well as prisoners of war .

  7. Dear TM,

    I have enjoyed your blog since just after you started. I am also disappointed by the imperfections of the system, but I see it from the inside, not as a patient, but as a hard working staff member.

    Patient care is the most important part of any health professional's job, no matter what role they play. We all work together for the same overall aim. Almost all of us work extremely hard (for painfully little pay) but I cannot deny that there are some lazy incompetent bastards out there.

    Budgets are limited; that is the unpleasant reality of every facet of any organisation. Cost cutting measures are a necessary evil, however, care cutting is not.

    Basic measures are vitally important to patient care and comfort. I agree with your critique. BUT, I think you have gone too far. Your diatribe is unbalanced and unfair. There are cases of inadequate care, but the overall picture is not the one you paint.

    I would like to see 'traction man' return to hospital to see how it is to work there. Try working as a nursing auxiliary for a week - then lets see what you have to say.

    Then I would like to see you deal with a budget, and be forced to see what corners you are forced to cut, and how people criticise you.


  8. Dear John

    I can't disagree with you. My piece is emotional and one sided but I'm very angry about this. I'm so angry I can't tell you. No one in this country (or anywhere) should die of thirst through neglect. It's unacceptable. I don't care what pay rates are or budgets have been cut... giving someone water to drink costs nothing and is a basic duty of care we all owe each other in a civilised world.


  9. WHY is it that it is 'he' who speaks out about an atrocity that has 'gone too far' and not the so called "lazy incompetent bastards" as described? ---Which of those is it - that has 'gone too far'?

    John Surgeon, it is you yourself who doesn't 'see' because as you said yourself...."I see....not as the patient"
    Your words are very telling. How can you have perspective if you don't decipher your discernment from your judgement?
    That's why money is everyone's favorite excuse.
    It excuses them from discerning.


  10. I hadn't finished my post above, i had to go out urgently!
    I'm going to 'finish' it now...

    I think John what your really saying is; 'I'm over worked, under paid and without due gratitude for my good work and efforts. There are a great many who feel like that! BUT you see, that's not the issue here because if a person is truly confident in their worth and ability - they wouldn't be offended by those who speak out about atrocious standards.
    You see you really do have a choice (unlike the vulnerable patient) and here are just some of them.
    1. You can call it a day and just leave - find another way to pay your bills.
    2. You can put your head above the parapet, as described by the first posting on this article. And speak out against the injustices that occur right under your nose, including those "lazy incompetent bastards out there." Bearing in mind that takes real balls and character - because of course you risk losing your income. No doubt that's why it's such an unpopular option!
    Or, 3. Do as you have done, and get defensive about your owm efforts - hiding behind the bureaucratic system of unaccountability. And say.... It's not me governor...."it's all those lazy incompetent bastards out there."!!!

    JOHN YOU HAVE A CHOICE - and that's before you've handed the elderly patient a glass of water...


  11. I think that John "the surgeon"s comments are what might be expected from someone who is within the system but also, at the same time, well distanced form the "nitty gritty" of post-operative aftercare.

    I just wonder that after performing a triple heart by-pass, liver transplant or even a hernia operation, how much contact he has with the patients? Very little, I suspect.

  12. I think everyone employed by the NHS, should have a taste of the standard of care the ordinary person recieves, to experience what the ordinary patient experiences.

    No doubt all staff of any hospital when ill, are treated privateley or are insured .

    They possibly never witness the true horrors that NHS patients have to endure.

    The surgeons have seen it all and done it all, there is nothing they have not experienced , one body is the same as the other, no supprises, no mysteries just mundane operations time and again, and they get well paid for what they do.

    What they could do is go in as a mystery patient, just to see how the other half live, the true reality, the real stories of other patients experiences, the quality of care and attention.... and food..!!

    Perhaps they could take notes on the staff, ask where they were trained, how long for etc.

    A simple note book and pen or digi camera, could aid in good investigations on the true state of the NHS, done by an NHS member of staff or someone from the government to find out the truth, perhaps a year long study, three days a week as a patient in every hospital in the UK, after all, scientists are granted for any study, from why nails rust to what is in a grain of sand.

    XTM....... How is the leg doing, not heard a thing in months, better I hope ?


  13. I AGREE, whether it's brain surgery or wiping backsides. The humanity - the human connection is EXACTLY the same. We are pieces of meat and case numbers without that humanity toward each other.
    The salary may be very different, but it is just so much easier for too many, to just look the other way or excuse it rather than risk any unpopularity.
    John -'Surgeon' just doesn't get it - can't see for looking. Institutionalized to the last.

    Having a system that absolves all accountability, can only serve one thing - and that's itself. And not the most important thing, the patient.


  14. Dear TM,

    I completely agree with you. Basic care is so important. Vitally important. We can provide the best medical / surgical care in the world, but the patient will die if the basic needs are not cared for properly.
    Comfort / Freedom from pain
    Compassion and understanding

    Most patients don't want an expensive anti cancer drug, invasive heart surgery, or complicated treatments. They want to be looked after, cared for and live in comfort and dignity, despite their medical problems. Unfortunately for our politicians, that is not a vote winner, but cancer drugs are. For example Herceptin.

    I agree that money is used as an excuse. But this basic care is not free. Ask the hard-working nursing auxiliaries. They are a vital but under-recognised group who do so much for our patients. However, their budgets are being slashed repeatedly. Therefore standards of care have also fallen. For some in management, it is considered acceptable for a ward to be understaffed. It is considered a cost saving measure to have fewer auxiliaries than advised. This situation will get worse before it gets better.

    There is a limited budget for any health service, and our politicians and hospital management have to decide how to spend that money. Unfortunately it is spent on vote winners such as Herceptin and not on basic care.
    [Just for the record, Herceptin is an excellent drug, which can work very well, in specific situations, but it is incredibly expensive at up to £50,000 for a year’s treatment. I am not saying that it shouldn’t be used, but we can’t cut basic care to pay for it.]

    I used to work in the NHS, but moved abroad to work in a trauma centre in the Alps. And I am delighted at the better standard of care that we can provide here.
    I really should send you the list of hospital food possible here. It would astound you. This is a public hospital where care is a priority (including food). There are, of course, still lapses and imperfections to the system, but it does seem to work so much better than anything I have previously experienced.
    The food is of a high standard, always cooked fresh on-site and never the reheated rubbish served in the UK. The meals on offer always change so that you are unlikely to get the same thing twice in the same month. Compare that to the UK.
    You also have the option of a glass of wine with your meal.

    I will send you the menu when I can.

  15. Dear LdV
    I hate the way that I am tarred with the same brush as my colleagues. I do not appreciate that. I do not know who you are, your background or what you do, so I don't intend to criticise you. I wonder how you would have reacted to my comments had I not written that I was a surgeon. You don’t know me, or anything about me. And I don’t work in management.
    I have been a patient, and have seen the other side. I admit that I was lucky though, and only had good experiences. I attempt to provide that for my patients.
    I am not in any way offended by anybody speaking out to improve standards. I do too, just from inside the system.
    Too reply to your points.
    1. I love my job and will not be going anywhere.
    2. I have never tried to be popular. I agree with you, but we do work together to improve patient care in my department.
    3. I am very much aware how much more needs to be done. No need to be defensive, but you have to honest about the reasons behind the current problems. The bureaucratic system is an unfortunate mess, but does at least attempt to provide the best care to the greatest number of people. It doesn’t always succeed.

    Dear Colin,
    Unfortunately not as much time as I would like. The time I get with my patients is for the most part, my unpaid overtime. Not through choice, but through the fact I am supposed to be in three places at once. I take my time after normal working hours to properly look after my patients – my phone doesn’t constantly ring. That way I get to know them and their families and provide better care.
    Thankfully my girlfriend understands.
    I am a junior trauma surgeon, and am very much involved in the ‘nitty gritty’. It isn’t easy, but it is rewarding.

    Dear Rhonda,
    As traction man posted in 2009, Prison food is better than hospital food.
    Frightening, but not surprising considering the budget spent on it. They know the prisoners will riot, but the patients in the hospital will not. What a pity.

  16. A few years ago my mother suffered a double tragedy, her husband died and then her mother, she was traumatised and did this official document that she did not want to be recucitated.

    Ever since then , she was ignored when doctors did their rounds when she was admitted, her local doctors in her surgery did not have time for her.

    I told her to write a letter to recind the request, this she did , and now the surgery treats her like any other patient.

    My mum is 77 this year and is in bad health, but due to her decision years ago to sign a legal form of " no recusitation" she was treated like a leper.

    Her pleas to hospital staff that she is allergic to penisilin were ignored, she was put on a drip of penicillin and she was comatosed.

    Do surgions know exactly what is going on in the wards, do they exist in our reality ?

    My mum couldn`t fault the food as it was home cooking .

  17. yo john ,maybe you should read tm;'s entire blog , then you would know quite a bit , hell right off the bat he states he is a photo journalist , so researching his subject is something he is schooled to do before he pipes off .and his injury put him very much in deep contact with all sort types of malnutrition and abuses by the hospital system there first hand .if he was the politacl sort i would encourage him to run for a council seat there .

  18. REGISTRAR JOHN, I appreciate that it is difficult sometimes to gauge the tone in the written word in a blog or text. Sometimes the point or gist is lost.
    I would like to add my 'background' or social grading - classification is of no relevance and neither is yours.
    I was responding to your comment and summary of TM's article posting. As "unbalanced and unfair diatribe - and not the overall picture." What i should have said is that i disagree with you Dr.John. Reason being is that these obscenities do in fact occur in the Nhs (and other 'care institutions) across the board, and often enough to reach people's awareness, including national news coverage. It is every bit a part of the overall picture.

    I think that you have taken personally the critique of a 'system' that is not working. By highlighting that most of the time this does not occur as opposed to the occasions it does.
    Whether you are aware of it or not that is standard institutional response to any 'complaint' -The concept of; Not looking at the individual abuse but looking at the machine... Not seeing a person, but seeing a 'condition' At that point degrees of humanity are always lost. And any resolution and/or healing can only occur on a technical level. The integrity of the 'whole' is lost.
    This is the epitome of what is occuring in the Nhs and other institutions.
    Denial and resistance always negotiates with truth to a lesser or greater degree denying or undermining it. Again, eventually people are no longer 'seen' because they have become case numbers. This Dr John breaks my heart, what we do to others we do to ourselves.

    Also, i disagree with you about the bureaucratic system.
    The Nhs is now so vast so huge it has become unhinged. Many of it's bureaucratic solutions are causing it to consume itself in error - like a cancer.
    Vast sums are wasted day to day on inefficiencies and the sytem itself perpetuates this. With an excess of management to manage the management who manage the managers. With six figure salaries. And front line staff are taking the blow as always for cost cutting.
    It is a bureaucratic carousel phantom and therefore can only serve itself, not the patient.


  19. I too was given the above poem whilst training to be nurse in the 1980's. I am still working as a nurse in critical care in a disrict general hospiotal in Scotland and feel sickened when reading about the care experienced by some elderly people. Problems with elderly care go back many years and whilst training I witnessed poor care in this area. What really upsets me is that all nurses are now being tarred with the same brush. Myself and my colleagues work very hard to provide a very high standard of care to our patients, often forgoing breaks whilst working 12 hour shifts and staying late to finish paperwork. The difference working in critical care is the staffing levels with a maximum of 2 patients to 1 nurse and a 1 to 1 ratio for ventilated patients. This staffing ratio makes all the difference, even after a very busy shift I have the comfort of knowing that I have provided the very best of care for my patients and supported their relatives. hospital care has changed dramatically in the 22 years I have been nursing. The burden of paprework means that I spend over an hour a day writing care plans and filling in assesments, much of the paperwork is duplicated and no one ever looks at it, the exception being if something goes wrong. I believe part of the problem to be a lack of qualified nurses in the wards. Research shows that patients outcomes are better when the staff delivering care are educated to a high level. Critical care units pride themselves on the quality of care offered, with trained nurses delivering all the care from bedbaths, oral hygeine and pressure area care, as well as managing the life support aspect of their jobs. Medical care has improved and people are living longer with multiple co morbities, as a society we have to decide whether we are going to fund this care fully. My area attracts large amounts of resources as it is seen as cutting edge, we look after a large amount of elderly patients, nursing them through their critical illness only to hear they never got out of hospital because there was no money to spend on their rehab or on decent ward care. I have been following the debate re provision of healthcare in England closely and am glad that Scotland are not following this example.

  20. I am 69 and had cancer surgery 9 months ago. I have no criticism of the hospital or my treatment, by some miracle even the food was edible! but this was a surgical ward and well staffed. I am fine at the moment but I, and I suspect many others, have no intention of living when I can no longer take care of myself with perhaps some help if needed. I most certainly will never go into a nursing home, my mother did and, if she had been aware, I know how much she would have hated it. Barring dementia I fully intend to go out in my own time and way leaving my hard worked for house to my family. I have made sure they are all aware of my wishes and intentions. I never thought I would see the day I was afraid to go into hospital, despite my own excellent experience, but I am now.

  21. We still spend much less on heatlhcare in the UK than in equivalent countries. The consequences are:

    Australia: One RN (an RN is a person who has attended Nursing school) to 4 patients on a general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

    USA: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

    Singapore: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need. This is what singamore nurses tell me anyway. I've never been there.

    England One RN to 12, 15 or 30 patients on a 30-ish bed medical ward. She might have several untrained carers that assist with basic care only. Pharmacy, clerks, and housekeeping are 9-5 and dump on the RN. If the RN doesn't do their bidding, the patient doesn't get what he needs and the Nurse gets the blame. The RCN is oblivious.

    With thanks to Nurse Anne.

  22. several years ago i was admitted to hospital with anorexia.Every day,breakfast,lunch,dinner and supper I was watched like a hawk until I had cleared my plate.Can you even imagine what a task that was for a normal healthy person,let alone those who were required to gain weight before they could leave?A challenge that only those who have experienced the joys of cook/chill food can picture.

  23. KAT, that must have been truly horrid for you, while coping with the crucifying challenge of anorexia. I hope that by whatever means you are now in full recovery. And an awesome triumph.



  25. I work at one of those hospitals that has been critisised by the CQC, allow me to tell you a few facts. The elderly care wards have 28-32 patients, with 4 members of staff to look after them. 2 qualified nurses (thats 16 patients each)and 2 care assistants. On an average day there are approximately 20 patients that need feeding, and probably 25 that need washing and dressing. DO THE MATHS. The trained nurses are LEGALLY responsible for complex and time consuming drug rounds at the same time that patients need feeding, washing and dressing. They are also LEGALLY responsible for A RIDICULOUS AMOUNT OF PAPERWORK, lengthy admissions, transfers and discharges, doctors rounds and patients assessments. That leaves 2 pairs of unqualified hands for feeding, washing and dressing. AGAIN, PLEASE DO THE MATHS. Why of why oh why do the public (yourselves) continue to critise care staff who (in my hospital, i can't speak for others)are trying so damn hard to do an impossible task. Our managemnt (like Stafford) continue to ignore the Incident Forms and complaints from staff regarding not enough staff do the job properly, and in the press 'admit' to failings on behalf of the nurses. It makes me sick, and I can only live in hope that one day the public get behind the real reasons for poor care in the UK as appose to constant uncalled for blame upon the nurses. I am not denying that there are poor quality nurses out there, but there is much more intentional short staffing of the wards than there are unkind and uncaring nurses. I certainly WILL NOT hang me head in shame!

  26. hallo UKnurse, If you get the chance please read some of the other blogs and postings. I believe many people realize it's the institution(s) that are unhinged, like all monopolies. And there is of course good and bad in every profession. The numbers are a diabolical injustice when you've got teams of management often on good salaries. Ticking boxes and tweaking self interest.

    I see it like this; if i was not given the tools or resources to do a job and i was persistantly ignored by management. Very quickly i would take my services and self respect elsewhere. So you have to ask yourself what keeps you in that loop of negativity. Is it the love of the job, commitment to the patient, the salary, fear of change...
    I could not go home at night with any kind of peace of mind knowing i'd left vulnerable folk hungry, thirsty, maybe lying in their own mess or with inadequate pain relief. (Even though i may have done my absolute best.) With management looking the other way in self interest, not listening.
    It's not 'Love' or 'Service' that keeps a person (or society) attached to that toxic loop, that compromises everyones self respect - it's fear of something. We don't live in a war zone or dickensian times, struggling with nothing. We actually have all the resources we need, but we (all of us) allow ourselves to be dominated and manipulated by bent institutions and their management. And if enough people would act in the first instance on their own behalf, then collective change would happen rapidly.
    Thank you for being one of those commited nurses.
    LdV, Essex

  27. Thanks for your reply LdV, it was interesting and thought-provoking reading. And in response i have just asked myself, as i often do, what is it that keeps me in this job, and certainly this loop of negativity?

    After a bit of soul searching, i can say that it is the love of what the job should be, and sometimes is. It is the love of looking after unwell people in their hour of need. I have worked in nursing since I was 16 (21 years) and it is all that I know. It is the feeling of immence satisfaction that comes with looking after someone really well, when they really need it, it is the feeling of allaying someone's fears when they are ill and scared, it is the feeling of providing a good standard of care, despite the massive (institutional) odds being stacked against everything I try to do. Especially when the patient remains blissfully unaware of how much I have had to juggle, both mentally and physically, and often emotionally, in order to meet their needs. When this happens, I feel pride, and go home with massive peace of mind, and I am proud to be a nurse. Unfortunately, this is not happening as much as I would like anymore, as the financial cuts (staffing) are clearly taking it's toll, as the CQC seemed to show (although let it be said, that there were many inaccuracies in their findings, which were certainly blown out of proportion by the press, not unusually).

    Most nurses I know, including myself, hang out for the good days, the good moments when a patient looks into your eyes with thanks and relief for recieving good care. I suppose we live in hope that one day things will get better. I sometimes make firm plans to walk away, and then a little old lady will give me a hug I stay.

    I just ask the public to look into nurse/patient ratio's in the UK, compared to the safe, evidence-based recommendations. Parts of the USA, Canada and Australia are making nurse/patient ratio's law, because they are realising that it is the only way to enable good care. The recommended ratio's are 1 RN to 6 patients. One unstable patient changes the requirement to 1:4. Typical UK is 1:10. Often 1:16 in my hospital.

    Maybe I should, along with my colleagues, take my services elsewhere, and one day I'm sure i will, but until then I suppose I will just continue doing the best I can, living in hope, and beating myself up over a glass of wine at the end of a stressful shift. I do thank you for your interesting perspective, I may one day soon find a different environment to work in, for my own sake. Somebody else will take my place though, and the rotten system will continue to stay the same. The only one to benefit from that will be me.

    All the best, UKnurse x

  28. To LdV and UKnurse,

    Thank goodness for people like you.

    All the best,


  29. Bless you for that UKnurse and Colin.
    Thank you for sharing those nurse/patient ratio. They are definitely key and need a lot more public attention.
    And enjoy your glass of wine without beating yourself up!

    Best Wishes LdV

  30. T.M,

    Not heard from you in a while here , have you forgotten all your supporters ?

  31. Yes... I'm really sorry. I've been working on a few other projects and trying to get back to work. A few health issues have kept me occupied but I'll be posting again soon.

  32. Really hope to see you posting again soon - we have all missed you!

  33. Hear hear! Tell us how things are with you XTM! We miss hearing from you

  34. To all those who really do care - GET SIGNING!!

    Nurse/patient ratio petition for government -

  35. I may one day anon acquisition a altered ambiance to plan in, for my own sake