Endless soap

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Waiting and waiting.

On Monday, I met four friends for lunch, my first outing since Op Hunt Saboteur. It was fantastic to be out with people, eating, talking, laughing and being generally human.

One topic of conversation was the Archers slow burn storyline of coercive domestic abuse as Rob begins to undermine and control Helen, gradually increasing the pressure to the point now where he has hit her. One of my friends had been unable to continue listening.

For many years, I loved East Enders. I enjoyed the bleakness, the characters, the writing and storylines, the families and their relationships. As a writer, I learned a great deal from the ways that those plots interwove, the need for ancient soap history in order to unscramble some of the current issues, the building and releasing of narrative climax.  Soap narratives are always open-ended, there’s never a happy ever after, the end – not even for death.

Remember the return of Dirty Den, whose body had been recovered from the canal a year after his shooting? That British kitchen sink realism contrasted so perfectly with the glamour of US soaps, notably Dallas and Dynasty in the 80s, where characters were horribly burned in car crashes to return as a new, flawlessly beautiful actors after burns surgery. Den just reappeared, teeth bared as usual,  having apparently faked his own death. Then the trope of improbable plots became deliberately hilarious with Footballers’ Wives – the fake tan baby swap was the pinnacle of British soap piss taking meets pantomime.

But East Enders began to change. The Dawn Swann and mad doctor May storyline went on, and on, and on and on. I could no longer suspend disbelief, or even enjoy the disbelief as an end in itself. I stopped watching, because I simply couldn’t take any more of the dragging out. This is a recognised phenomenon, and it’s the one S was mentioning at lunch. It has several names, including ending fatigue. It prevents us from ever attaining the emotional resolution we need, because there never is one.

Waiting, endless waiting. Always waiting.

I love a good story, a good drama. Some writers have that ability to tell tales in such a way that they reveal deeper truths, surprises, twists, new perspectives. Writers like Hilary Mantel, Kate Atkinson, Joanne Harris and Stephen King know how to do that, understand the balance, the importance of characters and situations. Then there are those highly popular storytellers who lack finesse or skill, who just offload a good story in narrative chunks, tell rather than reveal;  Jeffery Archer and Barbara Taylor Bradford are two who rely on that tactic. It might be a rollocking tale, but it leaves me cold because I’m interested in the wider truths. Stephen King describes finding a story as digging up a fossil using a range of suitable tools; if you hack at it with a mallet you’re going to lose lots. (If you look down on Stephen King, read ‘On Writing’; he’s wonderful, and he’s a darned good writer).

My own reveal has been prolonged already; gradual awareness, inquiry, thought, explaining away, and then the start of the resolution for the first part of my narrative; I have a brain tumour, here it is on the MRI scan. I fossicked to find more, was met with honesty, a few suggestions, no definites. That’s the beginning of my narrative as its progressed and I’ve begun to take in what is going to happen. Meanwhile the possible outcomes have narrowed.

At each stage, I’ve met setbacks. The delayed operation, the result of a wider political culture that’s hell bent on privatising and putting finance above social care and public welfare impacting directly on my personal story. Then the cancellation for no bed as I was prepped and ready to go. The melodramatic decision to go on Spotlight. The wait for the next op date, the stress of sitting and waiting, wondering whether the bed would be there for me.

The operation went ahead, I came through remarkably well. I’ve learned that there’s no magic abcess to let me off the hook and as information has dripped in, I’ve understood that this is most likely the illness that will kill me. But I don’t know for sure; maybe I’ll get run over by a bus, or trampled by a Galloway on the moors. I know I will have radiotherapy on my brain first off, I know that I have cancer cells roaming my brain because the protective blood brain barrier has been breached.

I know the prognosis for a GBM4, the type of primary tumour this might be, is poor. I know the prognosis for metastasised cancer (most likely this will be breast cancer, but not for certain) is variable, but poor. I know I have nodules on my left lung that might be further mets. I don’t know how treatable they are, whether the disease process can be slowed in my case.

So here I am, living the endless soap of setbacks and delayed resolutions. As S said about the Archers, the stress comes with the lack of an emotional release, the resolution delayed to the point where you’d rather stop listening.

After my prolonged Easter weekend wait, the two bank holidays, the not hearing, I tried on Tuesday afternoon to discover when my appointment would be. There is one Neurologist Oncology nurse covering the SW this week, one.  I eventually got hold of a secretary in neurology, who told me that I have an appointment next Monday, but as yet no time; she will let me know. Another weekend. My soap opera storyline continues. I wonder whether I might be killed off now, and perhaps return next year as a new actor without cancer.

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Op Hunt saboteur: going under

Where’s my pyjama t shirt? Mum’s ironed one pair of spotted pyjamas she wants me to take but, I never iron pyjamas. I don’t like that horrid little girl pink of the t shirt, nor the little girl hearts on the bottoms. What’s that about? Will the t shirt go over my head after the op?

Have I got a sore throat? I feel a bit chesty too, maybe a cold. If I say nothing will it be okay? But of course I’ve been feeling like this since October, that getting a cold ache and tug as I inhale. Nothing new.

Washing my hands I think of bugs on the towel and grab a fresh one. I used the phone, that must be crawling with microscopic life. I go and wipe it.  Infection control training, a necessary annual annoyance at work, does stick. I was always careful at work of course, primarily because you’re routinely making interventions such as intravenous cannulation where you can introduce pathogens straight into the blood stream. There are also many immune compromised people, and it’s easy to start spreading their nasties to others. But it’s only in the past few weeks that this concern has built into my own life now I’m taking steroids which makes me more liable to infection. I grew up outdoors, covered in mud, drinking unpasteurised milk often straight from the cow. I take the view that we all live in balance, including with the microbiomes that live within us. But not today.

Mum keeps asking have you got your…let me get that, don’t do that I’ll do it… my inner crocodile appears. Bun aka Sausage is most upset this morning. She knows.

There in the back of my brain, is the tangible presence of my tumour, the knowledge of the op, the potentials for what Hunt will turn out to be… but whatever that is, it already is. It’s just that I don’t know who this bogeyman is, what he’s  doing to do to me later on, whether he’ll leave a lingering whiff of aftershave or a large spillage and nothing will get rid of the smell.

I want coffee, I want breakfast. At last it’s 10 o clock and we leave. Back onto Fal Ward, same bag, same label, enhanced sense of dread. Will they cancel again? Finally I get the call to change and head up to blue bay. It’s less busy today. I’m trying not to think about the B word. My anaesthetist flies up. He’s L, a pony-tailed hippy doctor, and we have a chat about the anaesthetic and he explains in detail that he will be asking me to wake up and to consciously make the effort to  breathe at the end at which point he’ll remove the tube. I like detail, and feel reassured.

Finally, I get my HCA with a folder, the final sign that it’s going ahead. He runs thought the last minute bits, name check, allergy check, date of birth, signed consent form. No danger of some imposter getting my op today, I’d probably kill.

We start our walk to the theatre waiting room. There I ask them about the cancellations. Many of the people leaving the NHS at the moment are the experienced staff, and staffing is as much a problem as the beds themselves. It’s the same in the ambulance service. Only the young and fresh can keep with the pace and the relentless pressure of under-funding and under-staffing; the whole resourcing issue that is the end result of so-called ‘efficiency savings’, known as ‘cuts’ if like me you can speak plain English.

Mr Fewings my surgeon bursts through the door and hurtles past from the previous op; he’s gowned and wearing a rather up-market embroidered St George’s cross theatre cap.

“Morning young Roper! I’ll be back in a minute to do your op!”

“If you don’t I’ll shoot you.”

“My wife’ll probably do that for you.”

The HCA and I are called and walk to the anaesthetics room for Theatre 6. Lots of kit, my HCA, a theatre sister, D, who likes to swim in the sea, and C the anaesthetics registrar who I discover has had an interesting career path including a spell as a GP. He’s wearing a gown in a particularly fine shade of blue, another good sign.

C is going to start by inserting an intravenous cannula. I don’t even feel it, and then notice it’s a grey, wide bore, into my hand. Any paramedic would be impressed by that. Next, however, comes an arterial line for instant monitoring of my blood pressure during the surgery. This goes into the radial artery in my left wrist. A stab of fear. I don’t mind needles usually. My left hand still isn’t entirely sure where it is, and there’s a period of struggle where I’m failing to hold my arm or hand in the right place before I remember that thanks to Hunt, while I might think it’s in one place, it’s most likely not. So I end up with a board to put my arm on.

The arterial line presents some problems because I have a small and oddly-angled radial artery. C uses more local anaesthetic each time, but I’m fretting about it, feeling afraid of the next stab although it’s perfectly bearable. More displacement fears, something to latch onto in a physical sense. After a chat with L, C tries again using ultrasound. I begin to get that faint feeling, the sicky ugh. I can hear them discussing it, it looks to be in but isn’t. I ask for a couple of minutes to get over it, which they give me. D talks more about the sea to distract me. At this point I discover that L likes to swim under the full moon at Crazywell Pool, one of my favorite wild swimming spots on the moor. I’ve got the right gang in here; but I’m still really fretful. I hate it.

L takes over the arterial line as he explains to C about the planes of the artery. I think back to all those intravenous cannulations (into the vein which is far less complicated than this) where you miss, and start to lose confidence. I had one period as a new paramedic where I felt I’d never get one in again. Then whop, in goes a difficult one, and your confidence returns. You start to feel them in three dimensions. Noddy stuff by comparison of course.

We’ve now been almost half an hour; it’s 1 o clock. I’ve enjoyed chatting with the team as they distracted and tried to relax me. It’s a new experience for me to feel so anxious about things like needles, the minor transient ache-pains that I know I have to go through. It’s just today I don’t want to. I don’t want to be here, but I know I must.

And then the atmosphere turns as L switches into professional mode to get me anaesthetised. The padded mask, quite claustrophobic and I can’t feel the oxygen coming through. that horrid curry-sauce scent that reminds me of Scottish vomit (x pints o’ Heavy, chips and curry sauce being the most usual stomach contents encountered in the pool hall I used to work in as a student). Why do masks smell like that? I take deep breaths, in and out, in and out, oxygenating ready for inubation.

The hiss of gas, the curry still, D’s face, L looking at me, his green cap has a dangly back for the ponytail and bobs wobbles as he talks; the motion is like the dippers bowing and bobbing underwater in the Tavy. The plastic insert in the ceiling pulls me, concentric circles in white. There you go Lynne…

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Severe operational stress

IMG_2771I feel shredded. I was fuelled by anger on Friday, an anger I could not fully express to the equally upset staff at the hospital who are powerless to do anything about the situation we are all in.

I’d become dehydrated and felt dreadful as I’d had nil by mouth since 10pm on the previous evening, and my op was finally cancelled at 1215. I ran straight into the Spotlight interview fuelled by a pint of water and cheese and biscuits that I could barely swallow.

After the interview came a kind of emotional entropy that led to the sucking presence of a black hole. Chaos in my head as I wondered what to do, how I’d get through another weekend. Had I known the op was off before I’d got there, had I not met my new friend and been hit by her dreadful predicament, I’d perhaps have been able to prepare for it, plan some treats. I couldn’t cry even. And still no dreams, a kind of blank.

I’d half watched Lucy Hawking talking about her children’s book on breakfast TV in the bay at Fal; a boy asks Stephen Hawking: What will happen to me if I fall into a black hole? You’ll be turned into spaghetti! Stephen replies. That thought continues to echo over the weekend. I feel like spaghetti.

Yesterday (Saturday) I woke as usual at 3am, and read through Facebook. I couldn’t access my writing brain at all. I could barely stand in the morning; a weird internal tremble, a fine quavering drizzled from the point on my neck which marks the base of Hunt’s physiological and psychological presence. I laid down and managed to doze for a while after breakfast. I’m playing music, and have latched on to Adele’s new album, and an old Anthony and the Johnsons’, both of which connect emotionally and seem to calm me, but without blasting through my feigned equilibrium.

Plum and her daughter and I walked slowly on the moors to Wistman’s Wood in the spring sunshine in the afternoon, before retiring to the Two Bridges for a cream tea. It was lovely to see them, and to be outdoors, to chat with a ten-year old. I had a couple of wobbles but stayed upright, all through the slightly blurred vision that lends a kind of 1980s US soap flashback atmosphere where Bobby Ewing emerges from the shower having been apparently dead for the last two series…

Today (Sunday) Bun and I went to Plymouth’s Barbican and the Hoe with a couple of paramedic friends and had a lovely lunch and a big catch up. Of course the topic turned to the bed situation at Derriford.

Our district hospitals, in common with their cancelled surgical patients, are all under severe operational stress. It’s a constant, especially over winter where illness is more prevalent both in the community, and in the staff.

One point became clear today as we discussed it. When a crisis hits, the hospital trust implements a system of alerts that trigger certain actions to alleviate the immediate problem. But that’s not what’s happening, because the problem cannot be alleviated by the measures available. Bottom line – high alert states are not sustainable as a matter of routine, because once implemented there is simply nothing more you can do to further relieve the pressure.

This state of affairs has been continuing for weeks and months at a time, on an annual basis. The trusts are almost all in financial deficit and missing targets  and it’s worsening rapidly. So they are losing money with hundreds of operations cancelled, and with no way of addressing the fundamental causes of the crisis which, while varied and complex, come down in the end to not enough money in the NHS and not enough beds, and swingeing cuts to social care which compounds the situation.

(When the government says social care is down to councils to fund, they fund the councils and have cut their budgets by 35% since 2010.  When they talk of billions in bail outs for councils, they are talking Tory councils only. In any case bail outs are too little, too late).

This document from the Royal Devon and Exeter Hosptial (RDE) shows exactly what kinds of pressures are placed onto the services – and the staff – and explains in detail exactly how the pressures arise and how little can be done to sustain this level of crisis management – because that’s what this is – crisis management, resulting in the failure of the core functions of the hospital and its inability to meet such vital patient services as cancer waiting times, another of Jeremy Hunt’s alleged concerns. And the money they do have for surgery and so on is going down the drain.

It’s worth noting here that RDE is smaller than Derriford which is also the major trauma centre. If anyone can point me to Derriford’s equivalent document I’d be most grateful.

One common excuse for such crises are high numbers of elderly living longer. So where, in an area where people come to retire into the vast new housing developments, the Macarthy and Stone type buildings, are the commensurate extra resources? Without some joined up thinking and long term planning, we are sunk. Our hospitals have been struggling for years with this race to build while we allow the whole system to lurch from crisis to crisis. When I worked in Torbay just a few years ago, it was routine to find five or six ambulance trolleys with patients queueing up in the ED corridor, waiting for cubicles to become free. That hospital was already overwhelmingly too small for the burgeoning population 15 years ago.  At that time 65% of the Torbay population was over the age of 65. Many of those have no support network because they’ve left it behind for a dream. I met one woman, in her late 60s, whose husband had become ill shortly after their long-planned move to the seaside. I’d been sent on the car to assess, and as we waited for an ambulance to take him to hospital she told me their story. He was dying, and had been for the year the’d lived in their lovely home. She’d been stuck, unable to join the clubs she’d meant to join; she missed her friends from home and her family desperately, but hadn’t expected this to happen. She told me she’d decided to knock on her neighbour’s door, try to find a friend close by where she could pop in for a cuppa now and again. The neighbour opened the door: ” We don’t socialise” she said, and slammed it in her face.

And if it’s not the role of government to plan for this, to have a long-term strategy, then what is their role? Blaming the crisis on the elderly?

The NHS needs money, now. It needs beds and staff. Instead it has a Secretary of State in Jeremy Hunt who has busied himself with the white elephant of a completely uncosted, routine 24/7 NHS  while he attacks and alientates the front line staff. Meanwhile the NHS truly 24/7 system, the one that picked me up, diagnosed and planned my urgent treatment so efficiently and compassionately, is unable to carry out its plan for me. It has the resources, for which it is paying; the expert staff and the theatres. Yet these cannot be used for the want of beds. The entire system, based on clinical priorities, has collapsed in a catastrophic haemorrhage of money and lives. My tumour continues to grow.

Hunt is cutting nursing bursaries when we have too few nurses. He is discouraging the mature nursing students with life experience and most likely preventing many of them from entering the profession because they won’t be able to afford it. Doctors are leaving in droves as he tries to force unsafe practices on them while the hospitals collapse.

Hospital trusts have to say this too. Look at the apologies and excuses. It’s not their fault. But for goodness’ sake tell it like it is for once, stop covering for this government which is letting us all down.

I am under severe operational stress. I’m on Black Alert.  I woke at 2am, and I’m still here writing at 0622. What if I don’t hear today? What if it’s another week like the last two? I was warned.

BBC Spotlight

BBC Spotlight 11 March 2016

I had already spoken to a BBC Devon reporter about the cancellation of 90% of theatre slots at Derriford at the weekend, and was going to speak to a Spotlight crew, and also on BBC Radio Devon, earlier this week. I wanted to make a point about cuts and their expensive results in both human and financial terms, but was quite unsure about how that might work out. I was wary too of making this about my personal situation, my cancelled op, to the detriment of all those others in a similar position. Radio is far more controllable in that I’d have been speaking live to the presenter. For the tv news, I’d lose that in the edit. In the end, my op stopped the piece and I didn’t feel able on Thursday to speak about it.

Yesterday I knew with absolute certainty that I’d do this. The final impetus came from the woman I’d met in blue bay and our long conversation as we waited. So I called the reporter as soon as I got news that ops were being cancelled, then again when my cancellation was confirmed. Within an hour of arriving home, the reporter and cameraman were there and ready to film.

John was very receptive to my point of view, and having been told earlier by another reporter that he didn’t want political points, I was pretty concerned that this would become a story about the hospital, about their failures rather than the bigger picture.

Once we’d talked in depth, John was happy to discuss my opinion particularly because of my professional NHS experience and because I had some statistical evidence to back the social care crisis, although not for the information I’d been given at the hospital which hadn’t been volunteered in the context of a news report. There’s a whole debate to be had here about politics and the BBC, and the notion of political bias; but opinion is valid, and it isn’t about perceived political bias, it’s about airing the range of viewpoints and sparking debate. Closing it down would appear to be the political and media default at the moment, through rubbishing entire viewpoints and political stances, through personal attacks and sneering.

As John left, he told me he’d already picked up on two points I made that he was going to use to make the story. I didn’t know what those were, however.

I’m very pleased that my points were made, and that the edit allowed me to have a valid and informed opinion. But it could have gone horribly wrong.

I’d like to add Plum’s comments here too, because as ever she’s hit some crucial nails home. (And my happy op top is by ebay, Plum).

I have massively mixed feelings about this.

On the one hand I am incredibly proud of Lynne for having the presence of mind, dignity and perspective to make the very last minute cancellation of her time-critical brain tumour surgery the headline story on her local TV news. She speaks with clarity and without histrionics. I couldn’t manage that in her situation… I can barely talk to her about it without becoming ranty and shouty and sweary and thoroughly undignified… I certainly wouldn’t be fit for TV before the watershed.

But on the other hand I am sad, and livid and disappointed that her surgery has been cancelled in this way. And I am even sadder that the medical director at Derriford, in his statement, didn’t get the obvious point across… That critical care beds are in short supply because this government does not adequately resource the healthcare service that we have all already paid for, that we continue to pay for, and that they promised they would not interfere with before they were elected into coalition. While we have people, in positions of power in NHS Trusts, who do not challenge the government on the elephant in the room that is lack of funding we will never see any improvement. And while we have an electorate that can’t be bothered to look beyond the end of their own noses, and the spin and lies this government feeds them, there is no prospect of change.

And I am absolutely apoplectic at the Tory MPs who, today, talked for 4.5hrs on a two clause bill about foreign nationals that has already been once debated and rejected. They spun that out purposely to thwart debate of a private member’s NHS Reinstatement Bill.

So today sums up perfectly the dichotomy between those who need urgent critical care, and those who will not tolerate any challenge to the government having divested themselves of the responsibility to provide that care free of charge at the point of use.

I’m ashamed of our ‘democracy’. It is a sham.

I’m also quite jealous of Lynne’s green stripy top.

 

 

 

 

Bed blockers?

I wanted to say more about bed blocking because it is the tabloid headline phrase, the shorthand used to conjure images of elderly people waiting for places in nursing homes.  But it’s a lazy stereotype, and it’s one of the means whereby the concept of value in public services can be so easily reduced to one of finance and ‘efficiency’, and the so-called ‘difficult choices’ in cutting funding to the point where they collapse.

There are many reasons why someone might be in a bed which is needed for someone else. By definition it is almost always the case that such a person is also not having their needs met in an acute setting, because so many of those needs are pastoral rather than treatment-based. Their best interests might be to take them home with support; to take them to residential or nursing care; to begin specialist rehabilitation; to access specialist care and treatment centre for those with a particular acquired condition; or perhaps a hospice or other end of life care. None of those decisions will be straightforward, all will involve a multi-disciplinary team of professionals to assess and coordinate what’s in the best interests of the individual.

These are not decisions to be rushed. Where it’s clear cut, there should be the provision in the social care system to action the decision of course, and that’s largely missing. The halfway houses (community hospital wards being one vital resource that’s been decimated) are at best overstretched. In the meantime, a purgatory exists between the two systems of acute medical services with the potential for a level of recovery, and the decision to move to palliative care.

Imagine the complexity, the medical ethics, the emotions, the fading hope. I want to say that today, because I fear I’m guilty of a lack of sensitivity towards the many human beings, families and friends in that position. I’ve chosen freely to publicise my own thoughts and worries and to highlight the wider political implications, to have a mission. But how easy it is to casually trample yet another diverse and vulnerable group of individuals into the mud of a tabloid headline. These individuals are equally deserving of proper, well-resourced and funded care, and very often they are not getting it. They are also deserving of the time they need to negotiate the inherent web of emotion and conflict.

Action

On 11 March there will be an attempt led by Caroline Lucas MP, with support from a cross-party group of MPs to introduce the NHS Reinstatement Bill.

I’ve given the link to 38Degrees‘ page which has a further link for your MP’s contact details. There is also a link explaining what the bill aims to do.

If you’d like to do something proactive, might I ask you to contact your MP and ask her or him to support the bill?

You might also ask questions about cancelled operations in your area, and about cuts to social care and community and general hospital beds.

My MP has yet to respond to my points, perhaps because he is too busy earning his £460,000 annual salary as a barrister. But maybe yours will.

Thank you.

 

 

 

Still no beds

I’ve still not heard about my op, and so I call Tony my neuro oncology nurse. He says it’s impossible to say when the surgery will be, as Derriford hospital has had to cancel 90% of its neurosurgery ops this week. I will hear as soon as there’s news, he promises, but it might well be next week now.

Bed-blocking is a key issue, and this is bound with 6 years’ of cuts to social care budgets and the concomitant increased pressures on district general hospitals who have to take up the slack. If there is no care there, and the community hospital beds have been cut repeatedly, managing frail elderly people becomes increasingly a case of shoving them into ‘spare’ beds which exist for acute conditions, surgery and so on. To have 90% of the neurosurgery in a top district center cancelled in a week is pretty devastating.

For my type of diagnosis, NICE guidelines state that I should be referred within two weeks of the diagnosis; this was easily exceeded and I saw my first neurosurgeon within 3 days, specifically because he did not want to leave me hanging around over the weekend without having discussed the plan. He (Mr Titus Berei) then called me personally on the Tuesday morning to tell me he’d spoken to Mr Fewings who is now my consultant. Mr Fewings saw me three days after that. So, nothing but excellence and compassion there. Ditto for the referral from my GP, which was done at 5pm on the evening of my request for an urgent appointment, and the full neurological assessment had been undertaken including all the scans and bloods by 5.30 the following afternoon in the AMU at Derriford.

Now, the guidelines state they have 31 days in which to start treatment, the first part of which is excision of my tumour. Until such time as this can take place, I have no histology, no certainty about what I’m dealing with, and no treatment plan. Imagine hanging there, swinging on gibbet hill, waiting for your neck to snap. Derriford hospital neurosurgery department was ready to smash that target too, were it not for circumstances outside their control, circumstances caused entirely by austerity, government mismanagement of the NHS over the past 6 years and swingeing cuts to social care.

That, bearing in mind my mental state, resulted in a surge of anger. Anger that the real story is not out there. Rage that this government continues to lie and spin and hide evidence and divert the blame onto Trusts for financial mismanagement, stopping bursaries for nurse training, attacking junior doctors over some ridiculous meaningless mandate for a ‘truly 24/7 NHS’ that was predicated on the willful misrepresentation of a report claiming 16% more deaths for those admitted at weekends which even the report’s author countered.

Meanwhile, notice how Jeremy Hunt and Cameron et al take no responsibility, ever, for their briefs. They are paid public servants, yet they are not accountable for their mismanagement of the NHS and other public services, it’s always Labour, or Trusts, or feckless poor people, or doctors, or nurses, or people expecting to be paid fairly for what they do. The (un-mandated read my lips no top down reorganisation of the NHS) Health and Social Care Act 2012 actually removed the responsibility of the Secretary of State for Health to provide free health care for the population. Are you angry? You should be.

Having spoken to Plum this morning, I had posited the idea of contacting my (Tory) MP, and she encouraged that idea strongly. So I dialled Mr Geoffrey Cox QC MP’s surgery in Tavistock and launched into a frighteningly coherent rant through lips which are today especially rubbery, and which I feared would simply degenerate into the tears I have yet to shed (because if I start to cry, I suspect I might not be able to stop).

I have asked several key questions, and made some very specific points about accountability, transparency of government, ideological actions and ignorance of, misrepresentation of or burying of evidence.

I have asked what is going be done to fund social care so that this type of nightmare no longer occurs. And I won’t take the £600k bail outs currently being handed out to Tory-run councils only as an answer to that.

I have asked why we have among the lowest beds per head in Europe.

I have asked how exactly government policy is aiming to deal with the current crisis and who in government is going to take responsibility for it.

I have asked for absolutely no spin or bullshit, nor devolving of blame; I have asked my elected parliamentary representative for straight, open answers on the situation as he sees it and the actions that his government is going to take to address them.

I have pointed out the stupidity of the 24/7 NHS in situations such as this. I didn’t mention the shambolic and pathetic attempts by the Dept of Health advisor the other day to explain in corporate business speak to a committee of MPs exactly how they had failed to cost any of the 24/7 NHS, nor to account for whether or not the £10 billion so-called bail out of the NHS included this money.

I did point out that junior doctors have my support, 100% (the strike next week might potentially affect my surgery too, but I’ll take that), and that this is not about money, it’s about saving the NHS from destruction prior to privatisation.

I warned Mr Cox to be straight, since as a paramedic I know what goes on, I know first-hand the effects of coalition and Tory cuts so he can’t fool me.

I pointed out that anyone can suddenly find themselves in my position – and that’s when you need the NHS.

I mentioned that had we been under an insurance-based system as in the US that I would most likely be sunk now (the least efficient, most expensive, and least equitable system in the world really only seems like a great model with which to replace our incredible, equitable, cost-effective NHS when you’re a politician with personal interests in giant private healthcare and insurance corporations, as numbers of our representatives of all parties are, doesn’t it?)

The NHS, still surviving after years of big investment by Labour, was still a great value system in 2014, but note the plummet to  28th in the world by this year. Now the spiral of crises in funding and beds is hitting terminal velocity; yet it’s not the government’s fault. Regardless of that, if I lived in the US, and if I had managed to get insurance, it would have been massively expensive and studded with exemptions to enable them to avoid paying my bills because of my past medical history.

The advisor I spoke to took the rant with good grace (and rather too many casual ‘okie dokies’ if he is, unlike politicians, subject to a performance review target culture) and is passing the information urgently to Mr Cox, who will be looking at the situation in Derriford, and then I hope addressing some of my policy points and – crucially – the social care crisis.

I’m still feeling rather calm, but it would seem I’m going to really need that shrivelling prayer.

Oh, and I’ve just posted off my DVLA form B1 and driving licence to voluntarily surrender it on medical grounds.