Some time ago I wrote a blog called Horses Arse.

I was reminded of that today.MattHancock had sent me a letter telling me not only am I still extremely vulnerable. But after lockdown . Tier 1 = Pints +Chips +Sleepovers, Tier 2 = pints + chips and Tier 3 = 0 pints 0 chips, begins after lockdown. Matt further explained that after Thursday I can go to work or not, or see other people or not, or go to shops or not but hurrah I get to get Vitamin D sent to me. Seriously? Maybe he could send me to a sunny beach or slope. Or not ?

Tiers seem to line up with NHS grades 1 Emergency 2 Cancer and 3 the rest. There was I wondering how to communicate with the hospital to ask for change of suprapubic, to ask for clinic letter from Mr Kidney so that GP will believe me, let alone bloody new implant as if. I’ve had texts and letters and Eric the computer keeps telling me I have new messages. What they all mean I have no effingnidea. In a search for knowledge I’ve watched tv. ….

A documentary series chronicling the Royal Free over the last few months. Whilst the desperate situation Covid patients and those who treat them, is well described elsewhere, the plight of everyone else is less well understood.

Two points, of many, seem pertinent today. Firstly whilst private hospitals were used for non NHS urgent care during the pandemic peak, government support was withdrawn at short notice. This brought non Covid back to NHS main sites which were experiencing vastly reduced capacity.

The second vignette concerned a colorectal surgeon. He had been called to see a cancer patient-with- a- stoma who had had a fall. She was admitted as a Tier sorry grade 1 emergency for the fall. But her stoma reversal operation was not an emergency. That is a grade 3. Because…her cancer has been treated, well for the time being at least..and the stoma is part of that. But it is leaking and distressing. Being a Grade 3/4 . She stayed in hospital 3 weeks waiting. Finally to poor lady and Mr Colorectal’s relief the whole hospital IT infrastructure failed. This meant all emergency operations were stopped because…. wait for it…there was no paperwork. For Mrs Stoma- Reversal her papers were all in order and as Mr Colorectal was able to sprint round the hospital clutching pieces of paper, her operation could go ahead. He was last seen sweating, exhausted and scrubbing up….and all before 8 am he announced.

A distinct lack of staff space and logic are making the already stretched NHS elastic band start to snap.

>> In the midst of the migraine muddle of this morning Jerome rang.
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>> It is worth explaining he seemed to be sprinting across London and helping me to sort the suprapubic change. He said it was quicker to phone rather than text as he ran between a leak and another part of the hospital dodging traffic.
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>> Once I had established it was not a leaking bladder but a leaking hospital ceiling, I could begin to picture the scene. Patients who had been anxiously awaiting surgery lined up in corridors only to find it had all been cancelled. Bet Jerome managed to explain and offer sympathy and solutions before he sprinted away.
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>> What then for the patients?. What will happen? Where is the capacity?Where what how who?
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>> The thing is Jerome explained. There are simply not enough doctors nurses porters etc etc. It was bad enough before covid struck but now we are impossibly stretched exhausted frustrated . And that’s just the patients! .
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>> He used this analogy: It is as if the patients are Grand National horses. The doctors the jockeys. The jockeys coax those patients round the course jumping every hoop and hospital hurdle. Inevitably the horse trips falls breaks a leg or worse. jockey tumbles too trying to save the horse before him/her self. But then the Clerk of the Course turns up. Of course the Clerk has little or no experience having never actually ridden a race horse. The pony trek ride he or she boasts about on LinkedIn , does not actually count.

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Clerk gets the whip out, berates the jockey. Sets new targets. The jockey coaxes the horse up and off they go again over Berchers Brook round the course once twice and just when the finish is in sight the Clerk screams ‘ go round again’ do not pass out. Loose horse? Ignore it.
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>> Off they go again. Implants die and linger. The pacemakers lose pace. The bladders leak. Or do not empty, like mine ! The stomas fester.

Loose horses never get seen again and the list of entrants gets longer and longer.
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