Tag: NHS

Colonoscopy Day


After a week of a Low Residue Diet, a day of fasting, and a day supplemented by laxatives, the dreaded day had arrived. (See my previous Poo Sticks post)

My appointment at the hospital was scheduled for 10:00. By 10:45, I was sitting in a small office with a nurse. I gave my medical history. Then the nurse showed me to a room where I could change into my hospital gear.

It was there that I was provided with the standard hospital gown, open at the back. I was also introduced to my “dignity pants”. These are made out of some kind of paper, very loose and with a trapdoor at the rear, for easy access.

Over all this I put on my dressing gown and slippers. Obviously I was the epitome of sartorial elegance. And so, suitably attired, I was collected and led down several long corridors. Up several floors to the theatre suite.

Why are the reception/changing areas always so far away from the treatment rooms ?

Anyway, on arrival, I was fitted with a cannular and had my obs recorded.

After a short wait I was loaded onto a trolley in preparation for entering the theatre. There was a further short delay as they cleaned the room, after the previous patient had been evicted.

Showtime !

I was wheeled into a small room packed with people and equipment. Well, three nurses, me, and eventually the doctor. Very snug.

I was asked to roll on my side and a muscle relaxant, sedative and pain suppressant were administered. Being on my side allowed me to watch the whole procedure. I viewed it on the same screen that the doctor was using.

As the camera traveled along my colon, I was thinking this is like Indiana Jones riding a mining cart along a tunnel. Laid out before me were the pink walls of my colon. I was impressed with how well I had cleaned up, thanks to the Picolax. As we trundled along in my cart, me riding shotgun with the doctor, we rounded a bend only to be confronted by …… what was that ? A rock fall, a cave in …. what ?

I spoke out loud, “Oh that doesn’t look good!”. Nobody responded to me, which was perhaps quite telling.

At this point the doctor started taking photos, biopsies and leaving markers (tattoos). And then the mining cart started the return journey and the procedure was over.

There was very little discomfort in fact my imagination blew everything out of proportion. I found being able to see what the doctor was seeing very interesting. I have since heard from friends and family that have experienced a colonoscopy. They all have no knowledge / memory of the procedure as they were all knocked out. I was told that I would be sedated and my records show that I had fentanyl. But, I didn’t experience any softening of mental focus. I am guessing that I was only given a minimal dosage.

I was wheeled out to the recovery room where I was given a cup of coffee and some biscuits. That was the best coffee ever ! Being my first proper drink since around midnight, twelve hours before. Just before I went to bed.

After a repeated series of obs, I was allowed to dress. The nurses and I then headed down to the discharge waiting room. But after more that half an hour nobody came to see me. So, I went off to find someone. A very helpful young lady in scrubs dispatched a nurse to find out where my doctor had gotten to.

It transpires that he was up to his elbows in another patient. I was transferred to another waiting area, with comfy seats. Being the only one in there, I should have realised that this was the bad news room. The doctor arrived, with back up.

The doctor was supported by one of the Bowel Cancer Screening nurses and a nurse from the Colorectal unit.

The doctor then proceeded to tell me what they had found and the next steps.

Firstly, he is pretty sure I have Colon Cancer. Confirmation will come from the biopsies they too during the procedure. Apparently they took eight samples. I was watching but didn’t count.

The “rock fall” was in fact the cancer / tumour / growth and it prevented the doctor from completing the procedure. The camera could not get past the growth so not all of the colon was examined.

The doctor seemed pretty positive. Given the position of the growth, it should be operable. I might get away with keyhole surgery. And, most importantly to me, I might not have to have a bag. However he went to great pains to stress that none of that is guaranteed.

To determine what is going on further upstream, I am scheduled for a CT Scan. I already have an appointment to see a consultant the following Tuesday.

By then he will have the biopsy and scan results and should be better placed to formulate a battle plan.

So, onward and upwards. Stay tuned …..

Poo Sticks – Updated


No, not the children’s game immortalised in the Winnie The Pooh stories.

I am referring to the game played by adults of a certain age. The NHS initiates this game. As part of their Bowel Screening Programme they send a package through the post requesting a sample of your poo. You then return it to them and they analyse it.

I’ve played this game with them for several years. Presumably, I was winning because I never heard back from them. No news is good news, right!

That continued until late last year when I was invited to a telephone consultation.

They had discovered some traces of “non visible blood.” The net of that hour long conversation was their decision to offer me a colonoscopy. I say offer because it was left open for me to decline the procedure.

What sort of cretin would I have to be to decline ?

You are 73 years old. Your body is wearing out. When the professionals are concerned enough to contact you, it’s only polite to accept.

And so an appointment was made for a colonoscopy and a package duly arrived in the post. Said package contained several pages of information about the procedure. It also included a blow by blow script for the preceding seven days and three sachets of Picolax.

It seems, understandably, that before a colonoscopy the medics like you to clear your tubes. So, for seven days I had to follow a “low residue/low fibre diet”. That is to say I had to cut out all foods containing fibres which are hard to digest. This helps reduce the amount of undigested food passing into my large bowel.

Adhering to this diet presents extra challenges when preparing meals. Those bad boy fibres are really sneaky, popping up when you least expect them. Also many of them are contained in favourite five a day fruits and vegetables.

For example you can eat potatoes but not the skins. You can eat pretty much any root vegetable, like carrot, swede, and turnip. Just make sure they are peeled and well cooked. They should be soft enough to mash. No peas, beans, citrus fruit or berries etc. and no seeds or grains. Even onions are a no-no. The list is endless.

Over the last few days I have become a nervous food prepper/eater. I was preparing some bell peppers for dinner only to find that they are not allowed. Similarly, on Sunday I was holding a glass of red wine when I decided to consult Dr. Google. Nope, red wine is not allowed, in fact turns out I should be avoiding alcohol in general.

Yes, you can make tasty meals acceptable for a low residue diet. However, they lack texture. They are also missing key ingredients to take the flavour to the max.

And so, here I am, having completed the low residue diet. Looking forward to my colonoscopy tomorrow. To be honest I am actually looking forward to eating real food tomorrow night. Just one more hurdle to cross, well two actually.

Hurdle number one is that today, 24 hours before my procedure, I am not allowed to eat anything. I can only consume clear liquids. These include water, squash, coke, lemonade, black tea/coffee, clear soup, marmite/bovril/oxo mixed into weak drinks with hot water. By this time tomorrow I will so hungry you may find me gnawing on a table leg

Hurdle number two, you may remember that earlier I mentioned Picolax. Picolax is a laxative and I have to consume three doses. The first was at 08:30 this morning. The next dose is scheduled for 12:30 and the last to be taken at 18:30.

Having read the instructions the only thing at the forefront of my mind is “Make sure you are close to a toilet”

Oh well, I suppose it’s all for the best.

Stay tuned.

Today, January 15th, was colonoscopy day.

Unforseen


None of us can see into our futures. It wouldn’t be much fun if we could.

However, Jon, my son in law probably wishes he had been touched with a small spoonful of prescience.

Yesterday, he was swapping out the battery in his car. It is a task that he has carried out many times over the years. What made this time a little different was his treading on uneven ground.

Before he knew it, his left foot tucked under as he put his weight on it. He heard a sharp crack, followed by his eyesight being impaired by blue spots and, as he parked his bum on the kerbside, an overwhelming feeling of nausea.

The net result was a trip down to the Urgent Treatment Centre (UTC) at St Mary’s hospital in Portsmouth, with yours truly acting as a taxi driver.

Generally speaking, nobody wants to go to the UTC. Primarily because the wait times can be horrendous and the waiting room would not be high on anyone’s list of must see places. At the time of writing the current wait time is indicated to be 3 hours.

So, at around 11:45 I dropped Jon at the UTC and went to find a parking space.

At 11:50 Jon was booked in and awaiting triage. By 12:15 he had been seen and was waiting for an x-ray having been told there was, potentially, a two hour wait.

At just after 13:00 immersed in Swedish detective thriller I was startled back to reality by my phone ringing.

Jon had been dealt with and was ready to head home.

The diagnosis, he had broken the very end of his fibula.

So no cast, no boot just a pair of crutches to help him keep the weight off and advised to take paracetamol to deal with any pain.

We obviously caught the UTC just at the right time. Jon had been dealt with in around 75 minutes.

So thank you and well done the NHS.

Grumpy Old Man


What do you complain about the most?

Everything and anything.

Aren’t you supposed to get wiser as you grow older ? I don’t recall anyone saying that with increased wisdom comes a marked decline in tolerance levels. I am 72 now, but I think I noted my intolerance building when I hit 60.

I find people, in general, to be rude and impatient. Just the other day, I was waiting 2nd in line to order food in a pub. I opened my mouth to order when a woman stepped past me and started her own order. Once upon a time, I would have said that it was the young that were rude, but these days, I think the older generation doesn’t set very good examples. This person was at least my age, if not older.

When I was young, we were taught to be polite and courteous. I still try to meet those standards, but boy, do I get bent out of shape if I don’t receive the same treatment

Our roads seem to have become more dangerous due to other drivers having forgotten the highway code. Happily tailgating, pushing me because I won’t exceed the speed limit. Not bothering with their indicators, presumably relying on my ability to read their minds and cutting into the safe distance I have left, causing me to have to brake excessively hard.

The driving issue seems to have worsened since the covid lockdowns. Maybe this is just my perception as I was in Australia when it all kicked off, and I spent seven months driving down there in WA. A different style of driving. When I got back to the UK, there were a couple of lockdown periods, and then everyone was back out on the roads. From there on in it seems to me that the UK driving standards have deteriorated.

I think the biggest thing I complain about is the lack of access to doctors. If you want an appointment you have to ring up at 08:00 if it’s urgent, 10:00 for a routine appointment. Woe betide you if you miss that time by a second.

Invariably when you dial you get the engaged tone, you may be lucky and be told you are “number n” in the queue. Then, if you get to speak to a real person you will be told that all appointments for the day are gone.

The online consult system is a joke, and if you happen to have two conditions to discuss with the doctor, you have to go through the whole process twice.

As I said, I spent seven months in WA. I had to sign up for Medicare. Brilliant. I could go on line, see my doctors available appointments, choose one that suited me and then see the doctor.

Six days a week !!! Why can’t we do that here in the UK?

I could go on, but I am sure you all have better things to do than read my rants.

Actually, come to think of it, that’s why you are here.

It’s Obvious Really


https://app.portsmouth.co.uk/full_page_image/page-8-1958/content.html

Read this article yesterday. I am always amazed that, so often, it requires a study to discover the obvious.

Only a few days ago, I posted that I felt my wife’s stenosis diagnosis was delayed by up to twelve months due to the lack of face to face time with a doctor.

Much of a doctors diagnosis has to do with “observation.”

You can not “observe” via a telephone consult.

We have been forced into using e-consultation tools. My experience is that they do not allow sufficient space to describe symptoms fully. On several occasions, when I have used the e-consult tool, I have found the questions leading you down a path to either diagnosis of a brain tumour or diabetes when you are suffering from a broken toe. Invariably, the tool tries to abort, telling you that you need to see a doctor, which is where we came in.

You can not “observe” via an e-consult.

Last year, we were told by a nurse practitioner that nothing had changed, that we were getting the same level of service from our GPs as we always had.

What total and utter nonsense.

Another issue with the current level of service is that there is no continuity. In the “good old days,” not only could you get a face to face appointment with a doctor, but it was the same doctor each and every time.

Continuity would allow the doctor to “observe” physical changes in the patient between appointments.

So, back to the article, anyone with more than a single brain cell could have seen that patients are not getting safe and accurate diagnosis under the current level of NHS care.

My Prostate And Me – Part 12


Well here we are again. After another long hiatus, I thought it was time to update you all. The lack of posts on this subject is purely down to, in part, happenstance and in part, inertia on my part. So, for that, I apologise.

So, my last post was back in 2020, following a five year hiatus. Only 28 months this time, I must be improving.

My previous post ended with me waiting for various scans, which were duly carried out, as follows:

  • 1st August 202 – CT Scan
  • 3rd August 2020 – MRI Scan
  • 11th August 2020 – Bone Scan
  • 25th August 2020 – PET CT Scan

Much as I like playing with all the NHS toys, I could do without the palaver of driving to the hospital, searching for a parking space, then waiting for my turn in the scanning department. Don’t get me wrong, I am very grateful for the attention that I am getting. Anyway, the net result of all these scans was, overall, a positive one. The scans indicating that there was no sign of the cancer around the prostate itself, and, apparently, no sign of metastasis. Prostate cancer apparently tends to migrate to the bones, or so I believed. So also getting the all clear from the bone scan was a positive thing.

Or, maybe the prostate cancer was hiding ?

Although there was no sign of the cancer around the prostate or in my bones, they did discover something in my lung !!! I became aware, very recently, that Prostate Cancer can metastasise to the lungs. So my case became the subject of one of the hospitals multi-disciplinary meetings.

Apparently there was much chin and arse scratching, bone tossing and probably some discussion about how Pompey were doing in the football league. The net is that my urologist talked to the chest doctors. They, the chest doctors, suggested that, whatever it was, was in a difficult to reach place. They further suggested that “we” should wait for 6 months and then have another scan. Then decide what steps to take.

My man, the urologist, didn’t think that was such a good idea. He felt, if this was the prostate cancer, it would be better to be proactive and treat it accordingly. Consequently he decided to start me on a course of Prostap injections.

And so it was that, on the 14th October, 2020, I started my course of Prostap. One injection every 4 weeks. This continued until November of 2021.

During this time, continuing blood tests and a scan showed the “thing” in my chest had shrunk and my PSA levels were dropping. In the words of my urologist, the “thing” had self diagnosed itself to be Prostate cancer. So we continued on with the Prostap jabs until, following a conflab with my urologist, we decided that I should take a break.

Apparently Prostap, along with most medications, comes with its own baggage. One potential side effect is the impact to ones bones, increasing the possibility of osteoporosis. With everything else that’s going on I certainly didn’t need that in my life.

I continued having blood tests to monitor my PSA and each of those was followed up with a telephone consult with my urologist. Always a very pleasant few minutes chatting followed by wishing each other well until the next call.

Latterly the calls included a concern about the fact that my PSA levels were bouncing around up to a new high of 3.2. Thats up from the zero point something I was at once the initial Prostap course was well underway.

At the end of August 2022, during a telephone consult with my urologist, it was decided that I should restart the Prostap injections. I had the first of the new course at the end of September. This time round the jabs are on a 3 month cycle and my next one is scheduled for March.

Following the last blood test, the Prostap, after only 3 months, appears to be working its magic. My current PSA level is 0.4 Great news by any measure..

From initial diagnosis, Brachytherapy in 2015 and thru to Prostap it has been an interesting experience. If, in the future, I have anything significant to report I’ll post again.

Before I go, I would like to thank all of the NHS staff who have handled my various visits to and stays in the Queen Alexandra Hospital, Portsmouth. You have, thus far, been amazing.

The journey, certainly isn’t over, but for now that is it.

Taking The Edge Off


Merry Christmas to you all. And I truly mean that. I hope you have managed to have a great time, and that you have managed to stay healthy, despite Covids best efforts and those of the other seasonal diseases that tend to crop up at this time of the year.

Over past years Gerry and / or I have managed to contract one of the various bugs doing the rounds during the Christmas period. Being sick really does take the edge off things especially when it means not seeing the grandkids opening their presents.

However, an unexpected benefit of the precautions taken, during the Covid pandemic ,seemed to be a reduction in the number of these seasonal infections. Sadly, now that many of the precautions have been relaxed there are many bugs doing the rounds. And, of course, Gerry has gone down with the dreaded lurgy, yet again. I say yet again, as this must be the third bug she has contracted this year.

Usually we are scanning around for the culprit, hunting down patient zero, searching for the one that passed on their germs. However, this year there are several candidates.

On the Friday before Christmas we were visited by a friend who said her husband was suffering with something. On the Saturday, Christmas Eve and our 45th Wedding Anniversary, we were visited by our daughter Angie and her husband Jon. He was suffering with a sore throat, croaking well.

That brings us to Christmas Day itself. Our granddaughter Keeley was hosting us this year, and of course nobody wanted to call it off, but, Keeley and her eldest, were both suffering with their own lurgy variant. And we didn’t see her youngest as he was in bed all day doing battle with his own lurgy. Although we had a good time and the food was yummy, the day was a little subdued. The edge had definitely been taken off.

Obviously, the odds were not in our favour and Gerry started with a tickly, then sore, throat late on Monday, Boxing Day. And there we have it, multiple folks at which to point the finger of blame.

Our concern is, as always, that anytime Gerry contracts one of these coughy cold/flu things, it invariably travels down onto her chest and evolves into a chest infection. Earlier this year she had two such episodes resulting in three prescriptions of antibiotics.

This morning, wanting to get a jump on things, I started the marathon task of trying to get an appointment to see / speak to a doctor. To stand a chance of getting an appointment, you have to start calling Crookhorn Surgery at 08:00. I started calling on the dot, with the following results ……

75 Calls = Number of attempted calls when the line was engaged.
This is only possible when using a modern phone, hitting redial immediately the system drops the call. I can’t imagine what folks do that are still reliant on landline phones and those that aren’t au fait with modern technology.

7 Calls = Number of calls picked up by the automated system, where I had to listen, excitedly, to a message which informed me that they were busy and to call back later. At which point the call is cut leading to huge disappointment.

At 08:13, after some 82 redials, I managed to break through to join a queue where I was informed, regularly, that my wait time was one minute. After some time I actually spoke to a human. The net result, after just under 10 minutes, was that we had been triaged and informed that we would receive a call from a doctor by 13:00.

This is better than last time where we attempted to get through, and, after 40 minutes were informed that there were no more appointments that day and that we would have to call back the following morning.

The good news from this, is that we had received the call from the GP, who duly prescribed the antibiotics. At 10:21 I received a text from the pharmacy to say that the script was ready for collection. By 11:30 Gerry had taken her initial dose.

Obviously, this is an improvement over our previous experience. But it does not reflect well on the NHS. Covid regularly gets the blame for whatever ails the NHS. All I can say is that prior to 2019 we were able to get appointments fairly easily, that we actually got to see a doctor on almost every occasion. Since 2019, trying to phone for an appointment is a chore, which rarely results in a face to face appointment.

Today my wife was called by a doctor who prescribed antibiotics over the phone. He didn’t see my wife, didn’t take her temperature, didn’t listen to her chest / lungs. This is not the NHS service that we are used to. But it seems that we are going to have to accept this as the new norm.

Well Said ….


I have copied this, as is, from a post on the “One Police” Facebook page.

It was triggered by the Sarah Everard tragedy but is relevant to so much more that is going on in the UK. This post touches on the nasty attitudes which have been visible for several years now. Permeating our society and throughout BREXIT, the pandemic, BLM, and so much more.

There are people in this country, and around the world, who are hell bent on division and antagonism. People who will happily hijack what was meant to be a peaceful event, albeit one that te authorities had said should not go ahead.

As ever the police are stuck between a rock and a hard place.

I debated for hours whether to post this or not…….

I’ve read lots of tweets and posts over the last week, and especially in the last 24 hours which have made me angry, sad, furious, shocked, mortified, confused, and just plain pissed off.

Don’t enforce the law = massively criticised / hammered in the media.
Do enforce the law = massively criticised / hammered in the media.

Ask yourself what are they supposed to do? Coronavirus legislation is what it is, we are still in the middle of a global pandemic, and 10’s of thousands of people have died as a result, directly or indirectly depending on which view you take of Covid.
But the fact is the rules are laid out, as per the wishes of the government. And they are there ultimately to attempt to keep us safe. The task of enforcing these laws (as always) falls to the police, along with everything else they’ve got to do.
So again, what are they supposed to do? Enforce the law, or don’t enforce the law. They will be hammered either way. Can’t win.

What happened to Sarah Everard was utterly horrific. And it goes without saying i completely understand the strength of feeling towards the case and the issues raised. The sad reality is what we all saw last night was the blatant hijack of a vigil (which had been rightly told not to go ahead and backed by the courts) by activists, anti-police agitators, opportunists with ulterior motives and those hell bent on causing a disturbance. All under the ever present camera lenses of those with other agendas.
Spraying “All Coppers Are Bastards” on a police van is not supporting Sarah’s family.
Shouting “No justice, no peace” is not supporting Sarah’s family.
Holding up “Defund the Police” banners is not supporting Sarah’s family.
Unfortunately a reaction was sought by some, a reaction was had (through the clear disregard of the law, public safety, call it what you will), and the aftermath perfectly timed and captured for the media to lap up and farm out.

I know who WAS supporting Sarah’s family though. The police family liason officer’s, sticking by them throughout the most awful time of their entire life.
The investigation team which has worked and IS working tirelessly to put the person responsible for this horrific act behind bars.

And let it be said right now, if it even needed saying: NOBODY HATES BAD COPS AS MUCH AS GOOD COPS.
They go against every oath we hold dear. They ARE NOT us.

Last night could have been and should have been a huge outpouring of support for Sarah, with doorstep candlelit vigils across the country in scenes like we saw with “clap for our NHS heroes” albeit an unbelievably sad reason on this occasion.
But in all the noise and smoke, the real message and the real show of support has been lost, as we woke up to celebrities, government officials and the *media lambasting the police.

*The utterly poisonous mainstream media quite literally, day in day out, wake up with the seemingly sole intention of dividing people, and causing hate.
In any way they can, they sow the seeds of hate between us, whether it be race, religion, gender, anything. Because it generates clicks, and in turn money.

We’re at a point now where the police are always seen as the villain. My inbox has been pinging away with calls of “murderers” and “scum”. We’re so quick to forget names like Wayne Marques, Ian Dibell, David Whyte, Keith Palmer, Nicola Hughes, Fiona Bone, Stephen Oake, Sharon Beshenivsky and many others. Who risked everything and in some cases gave everything to try and keep us safe.

I don’t know where this all ends up. I don’t even know why i wrote this. Maybe i’m just sick and tired of hearing the one sided narrative, and want to try and give a voice to the “silent” majority.

Don’t get me wrong, we are NOT perfect, never claimed to be. We’re only human and can / will make mistakes, it would be hugely naive to think otherwise. But we’re not the enemy.

I guess i’ll sign off by saying this is only my opinion. I’m not speaking on behalf of the police, although in amongst the handful of likes and comments it will inevitably get, i just hope the message gets through.

I, for one, hope the message gets through too. Something needs to change in the attitudes of the vocal minority. And certainly the media wants to do some serious soul searching, to look at themselves and where their allegiances lie.

The silent majority also need to find their voice.

News Article Should Carry A Warning


I have just read the attached article regarding Colchicine, a drug that could, potentially, be used to treat patients with Covid-19.

https://app.portsmouth.co.uk/2021/02/05/a-drug-used-to-treat-gout-could-reduce-covid-hospital-stays-according-to-new-research/content.html

Whilst I am supportive, of any additional tools made available, in this worldwide fight with Covid-19, I believe the author of this article has been delinquent, in not warning of the risks associated with the use of Colchicine.

I don’t mean risks associated with the proper administration under medical supervision.

What I am more concerned about, is the potential for Joe Public to self medicate, should they, like me, have this medicine in their cupboards.

Colchicine is a drug, used to treat patients suffering from Gout. The article says that use of Colchicine could reduce Covid hospital stays. And whilst that may be true, what the article does not say is that Colchicine is not safe for long term use.

As a Gout sufferer I have been prescribed Colchicine. It was prescribed to suppress my first flare up of Gout, taken over a few days. Subsequently, it was used to ensure that a second flare up did not occur, as I started my daily regime of Allopurinol.

At that time, it was made very clear, by my GP, that Colchicine was to be treated with respect.

Since then, I  have held a small supply of Colchicine in reserve, should the Gout return. Thankfully, I have not had to resort to the emergency tablets, the Allopurinol is doing its job.

My sister, also a Gout sufferer, can attest to the diarrhoea side effect, caused by the higher dosages.

My point is that at the time of the initial prescription I was warned of the toxicity of Colchicine.

From the NHS Web site ….

What if I take too much?

Taking too many Colchicine tablets can be very dangerous. It could be fatal.

Symptoms of taking too much Colchicine can include:

● feeling or being sick (nausea or vomiting)

● stomach ache

● bloody diarrhoea

●signs of low blood pressure (such as feeling dizzy or lightheaded)

Come on “The News” do due diligence and balance optimism with a required caution. There are folks out there who may just try self medicating if they start to exhibit Covid symptoms.

Idiocy – Party Goers Waving Two Fingers At Authorities


More than £11,000 in fines issued for baby’s birthday party in Nottingham

https://www-bbc-co-uk.cdn.ampproject.org/c/s/www.bbc.co.uk/news/amp/uk-england-nottinghamshire-55963093?utm_source=upday&utm_medium=referral

A one year old baby doesn’t understand or care about parties. This gathering was all about the adults. Adults that decided to gather, regardless of the rules or the law.

Basically they have all waved two fingers at the government, shown total disrespect to our emergency services and the NHS.

There is no excuse. These people deserve everything they get.