WOW Louise.... just WOW. I'm in absolute awe of you. What a meticulous piece of writing. You know what I think of you, you're all real life superheroes to me. I can only imagine the multi-faceted judgement calls that have to be made about what HUMAN gets what space. What you deal with is just unimaginable. I bow down to you, I really do.
It was a really interesting read. Having spent a lot of time at our local hospital over the last few years (4x90+year old parents/in-laws) I’ve witnessed the bed allocation issues and seen the results of the lack of investment in adult social care that leaves frail old people waiting for days for discharge until a suitable place can be arranged for them. However, the overwhelming impression is of the care and kindness of the staff who are obviously doing their very best for the patients.
Thank you Helen. In many ways I was fortunate that most of my years of practice were in the relatively protected world of children’s wards/hospitals, but my fellowship year 2022-3 was back in adult services, and it was absolutely heartbreaking to see the effects of the social care chasm. Perhaps that’s an essay for another day. There is so much change that is needed, and I want to advocate as much as possible, but it can be hard to know where to start. Thanks for getting me thinking xx
Louise, I read parts of this essay with tears in my eyes. Having your perspective on this has been so educational for me and I'm ashamed at how superficial my understanding on this deeply complex topic has been to date. Will be sharing this with friends and family. Thank you xo
Such a brilliant post. So glad you have written this Louise. I remember you from Anna Wharton’s meet up… your poem about the forceps was amazing too.
I was a mental health support worker on various inpatient wards from 2017 to 2019. It wasn’t my first time in the NHS as I had previously worked as a midwife.
One of the worst things I ever had to do was to explain to a 17 year old CAMHS female inpatient that she was going to be transferred to a mixed adult ward upon her 18th birthday.
How could that even be possible? Why are mental health patients, particularly women, not receiving parity of care and safety with their physical health peers? I could go on (and on) about this but I’m derailing a bit here.
Thanks again for starting this conversation.. I no longer work clinically as a midwife or in mental health, I’m strictly part time and non clinical…it’s a strange loss to live with isn’t it? ❤️
Thanks Rebecca, that means so much especially coming from someone with your experience. I cannot imagine what that 17 year old had to go through. It's just unthinkable, and the risks are so much higher, as we've seen from the many, many stories of abuse on mental health wards. Just heartbreaking. I get upset enough about 16 and 17 year olds falling through the gaps between paediatric and adult services (which they do, frequently). But yes, it's a big shift dealing with the fact that I can't directly do anything about any of this any more. Really really weird when I think of the thousands of operations I've done, but never will again. Anyway. Thank you so much for your kindness.
I hear you Louise. I can’t go back to the wards. I will never deliver a baby again. It’s difficult to process, but sadly it’s getting more and more common.
Part of the reason I moved from inpatient mental health work to community was because of the girl I wrote about. I just couldn’t face that again. When my daughter turned 18 a few years ago, I thought of that same girl and my heart broke thinking about her, her parents and her family and what a distressing time it was all round. I wish I could have done more.
Great to connect with you Louise, thanks for your lovely reply.
I get it, totally. I shared a poem today about the black books us NHS folk carry of the patients that changed us irrevocably. And same, so glad to connect with you ❤️
Thank you Louise, this was such a thought-provoking piece, thank you for your invaluable personal insights as well as the thoroughly researched evidence to support your points. It is fascinating to have your insider knowledge and experience on this very important topic xx
It’s very good in terms of shining a light on the terrible state in the NHS re wards and beds, safety and care. Beds were an issue over 20 years ago when I was a baby physio on a ward!! It’s only got worse of course.
I particularly liked the example of how much the hospital saved after they had those consultants in - although as I found in my former career they could have asked the staff and teams to get the same answer!! So frustrating.
I thank you for stressing that this is not about political soundbites.
Those who are vehemently opposed to trans people full stop will always hate the idea they get a side room because their real agenda is to humiliate and degrade trans people and make their lives intolerable.
Unfortunately- I already know from a friend of one young trans man who has died by suicide since the SC ruling was announced.
Yes , everyone deserves to be treated with the thought and attention you clearly showed the patients under your care and as you so carefully and throughly explained the situation is dire and requires urgent and serious attention.
The minister for Health & Social Care would do well to put as much of his effort and resources into this and other such critical matters rather than spend his time attacking trans people and removing their access to healthcare.
Thank you for writing this and sharing your expertise. I only hope any of my trans friends is fortunate enough to meet a clinician with your ethical and moral approach to care should they ever need to go to hospital in the future. 🙏🏻
Very interesting - and very well researched. I really think you should send it across to the HSJ or Kings Fund so more eyes in NHS see this too.
Suspect the conflict between the NHS guidance and Supreme Court ruling may lead to guidance being amended. But the wheels turn slowly so maybe a test case will come to court on this first. Will be interesting to see what happens.
This bit was especially interesting to me:
‘The majority of instances of mixing of sexes is quite simply down to delays waiting for a bed in an appropriate ward or bay.’
Also that the stats seemed to reveal more sexual assault incidents in psychiatric wards. Do you think there should there be stricter rules re wait times here ? (And space provided to them first)?
I’d be interested to tot up the amount of money spent on considering the issue of SS spaces generally v the money spent actually generating more space. If that’s even possible !
It’s something I think about more broadly - whenever there’s any debate about this issue. Is the airtime given - or argued about it by either side - proportionate. Not saying it shouldn’t be. It should. But are there bigger issues getting ignored. And does emphasising it too much sometimes play into the hands of RW extremists. Is it a political distraction ?
The biggest issue as you say is that we need more space. An advertising campaign from a pressure group with people like you writing the ads could do a lot to help refocus people on the big things we need to be thinking about. I can almost picture them in my head now and you co-ordinating the writing work :)
Keep us posted on the changes in policies etc- I’m sure many will be interested. X
I take your comment about where the money is being spent migjt be better invested to actually improve things.
I’d also point out that all this discussion about the segregation of trans people, and particularly trans women, is going to alter nothing as these attacks are bot perpetrated by them. As far as I am aware no woman has ever made a complaint about a trans woman on a ward.
The right wing discourse which has infected our politics - even this current government- is staggering. And terrifying. And does nothing to improve the situation for sick people in hospitals or the safety of women and girls.
Where is the rest of the article please? It seems to finish mid sentence.
There are people out there who do others harm - men, women, trans people, black, brown, gay, straight - the crime of a small number of people within any group does not necessitate the whole group be excluded - otherwise men wouldn’t be allowed to do anything or go anywhere given most crimes are committed by men. And no one thinks that is a sensible idea.
Removing trans people from whichever part of society or another does not tackle violence again women and girls.
I just googled it, Jacqui, as I wanted to check your claim that there hadn’t been any attacks. There were quite a few headlines so you will be able to find it easily. The problem that the trans community will not address is the fact that there are some people who are using the ‘safety’ of the trans umbrella to gain access to female services. Until we can have a conversation on both sides on what to do about those interlopers, then we will be stuck. They are giving the trans community a bad name and so I would have thought they would want to address it too instead of denying those people (like the men jailed for rape as women, or the men who self-describe as women to gain access to children in women’s refuges or supermarket toilets) exist.
People who want to harm others will always do so - excluding trans people from a space means these people will find another way while innocent people suffer.
Back to my comment about curfews on men. Wouldn’t many women say they’d feel safer walking home after a night out if all the men had a 9pm curfew? It’s a ridiculous suggestion because the majority of men have no intention of harming women but some do.
The issues highlighted in Louise’s essay show all the very many things that make patients feel unsafe in hospitals. It is a huge issue and trans people are not the problem here except in a tiny number of isolated cases.
The figures for staff assaulting patients are terrible. And the long waits to get beds - I remember this when I worked in a hospital years ago and it is much worse now.
I’m afraid that the “people who want to harm others will always do so” argument is not one that I can endorse. By that same logic trans women should be able to continue to use male spaces because most men won’t hurt them but that tiny majority who might would hurt them wherever they are. It’s very difficult and I can see both sides but the real issue is male violence and for me that is an issue biological men — however they identify need to resolve. Trans men will also never be safe in men’s spaces and I believe they should continue to have access to the spaces of their biological sex, in the same way that they embrace the biology of their female body if they choose to use it to have a baby, which I think more and more trans men choose to do now. Too much focus is on what trans women want, trans men never get a look in.
Really interesting and surprising that amongst the data collected there’s no segmentation between psychiatric wards and other facilities ( maybe I’ve missed that, however ). I strongly suspect that many of the patient-patient sexual assaults would occur in these facilities- and also patient-staff. As you say, privacy, dignity and safety should be paramount for all. Most patients who need to be in hospital are just grateful to be in a bed and the last thing they care about is who is in the ward with them, unless they are disturbing others with unpleasant behaviour or noise.
Yes, I was horrified that it was really difficult to find any accurate data on assaults, all that I found was reports from separate investigations carried out by submission of freedom of information requests. Yet hospitals spend enormous amounts of time gathering, explaining and submitting data every time a patient stays in a mixed bay on intensive care for 4 hours waiting for a ward bed… that’s when you realise this isn’t about patients, or safety, it’s so a politician can say “look what I’ve achieved”
It really, really is. It’s that old saying (I think I actually paraphrased it in the essay) - what’s measurable isn’t necessarily what’s most important…
I read all your essay and know nothing about the NHS as I live in Switzerland but I think what you say about it being what is not measurable being the most important is the absolute truth. My uncle was in hospital in london with covid in 2020. He is a journalist and a writer, and he wrote a radio play about his experience - or what he learned from his wife about his six months in intensive care, as for many of those months he was in a coma. The play was produced by the BBC. It’s called Devoted, and it’s amazing. He has nothing but praise for the NHS staff. It must be terrible to have to shuffle beds like rubik cube puzzles without this whole trans issue coming into it. People are people. Interesting piece; although I admit I would have to read it a few times to fully comprehend (I hope!). Oh, my uncle is called Ray Connolly. The play is Devoted. Have a listen . I think you will like it 🙏 Sorry for this long badly written comment but I didn’t sleep last night so my neurons are wonky!
Thank you Louise, for this insightful essay- gosh, how complicated things are! It's heartbreaking to read and I hope your words reach the people who need to listen.
Beautifully written and researched. I'm continually astounded by the complexity of the system, and at the same time eternally grateful for it, as it's saved my life and that of both of my children.
In all that you've said, what stays with me the strongest are how frequent are the instances of sexual harassment, abuse and assault. Its heartbreaking and infuriating.
I tend to be more of a glass half full person and see the potential for improvement, for positive growth all around me. But when faced with statistics that show that il these atrocities are a relative norm in society, it makes it challenging to see the way forward. Where and how do we begin to address healing a societal or cultural belief that sexual assault is in any way acceptable?
Heartbreaking and infuriating is about as spot on as you can get. I genuinely hope that improvement is possible, because the alternative is unthinkable. Speaking up feels really uncomfortable, but wasn't something I could put off any longer, because the people making the decisions just have no idea what the reality is. Thanks for your thoughtful comments lovely.
Thank you for writing such a considered and well researched piece on this. Really interesting and truly highlights where the real issues are underneath all the politicising and distraction.
Great piece of well researched writing on a complex and difficult subject. The added authenticity of your considerable professionl experience brings the situation into sharp focus. Usually in a 'business' context, there's a phrase, 'What gets measured gets done.' This was clearly demonstrated in your example when the ED waiting times were significantly reduced once there was a focused effort to minimise fines. As you say though, the reporting of breaches to the single sex accomodation rules seems to be measuring, recording and reporting the wrong thing. Or at the very least is being interpreted as something that it is not. It's surely a symptom of the shortages in resources (staff and space) and an issue of capacity and flow through the system, with bottlenecks both into and out of hospital care. If privacy dignity and safety are truly the aim for all patients, regardless of gender or sex, fundamental and systemic change must be the priority.
So well-written it didn’t feel as long as you prepared us for Louise - as I’m sure you know, there is an important niche for you here with the topics that you are qualified and passionate enough to write about
thank you for the time taken to provide a detailed and fact based assessment. The febrile atmosphere and "debate" that has sadly become normalised creates losers on all "sides" -
I am not surprised it was difficult- the consequences can be dire - but facts and intelligent assessment of the situation by someone like you who knows how the NHS works is so important
The vast majority of people who have any awareness of this situation beyond the “headlines” actually want the right thing as far as possible for both “sides” there will be compromise, but rather than an either or mentality we should focus on “and”
WOW Louise.... just WOW. I'm in absolute awe of you. What a meticulous piece of writing. You know what I think of you, you're all real life superheroes to me. I can only imagine the multi-faceted judgement calls that have to be made about what HUMAN gets what space. What you deal with is just unimaginable. I bow down to you, I really do.
It was a really interesting read. Having spent a lot of time at our local hospital over the last few years (4x90+year old parents/in-laws) I’ve witnessed the bed allocation issues and seen the results of the lack of investment in adult social care that leaves frail old people waiting for days for discharge until a suitable place can be arranged for them. However, the overwhelming impression is of the care and kindness of the staff who are obviously doing their very best for the patients.
Thank you Helen. In many ways I was fortunate that most of my years of practice were in the relatively protected world of children’s wards/hospitals, but my fellowship year 2022-3 was back in adult services, and it was absolutely heartbreaking to see the effects of the social care chasm. Perhaps that’s an essay for another day. There is so much change that is needed, and I want to advocate as much as possible, but it can be hard to know where to start. Thanks for getting me thinking xx
Louise, I read parts of this essay with tears in my eyes. Having your perspective on this has been so educational for me and I'm ashamed at how superficial my understanding on this deeply complex topic has been to date. Will be sharing this with friends and family. Thank you xo
Such a brilliant post. So glad you have written this Louise. I remember you from Anna Wharton’s meet up… your poem about the forceps was amazing too.
I was a mental health support worker on various inpatient wards from 2017 to 2019. It wasn’t my first time in the NHS as I had previously worked as a midwife.
One of the worst things I ever had to do was to explain to a 17 year old CAMHS female inpatient that she was going to be transferred to a mixed adult ward upon her 18th birthday.
How could that even be possible? Why are mental health patients, particularly women, not receiving parity of care and safety with their physical health peers? I could go on (and on) about this but I’m derailing a bit here.
Thanks again for starting this conversation.. I no longer work clinically as a midwife or in mental health, I’m strictly part time and non clinical…it’s a strange loss to live with isn’t it? ❤️
Thanks Rebecca, that means so much especially coming from someone with your experience. I cannot imagine what that 17 year old had to go through. It's just unthinkable, and the risks are so much higher, as we've seen from the many, many stories of abuse on mental health wards. Just heartbreaking. I get upset enough about 16 and 17 year olds falling through the gaps between paediatric and adult services (which they do, frequently). But yes, it's a big shift dealing with the fact that I can't directly do anything about any of this any more. Really really weird when I think of the thousands of operations I've done, but never will again. Anyway. Thank you so much for your kindness.
I hear you Louise. I can’t go back to the wards. I will never deliver a baby again. It’s difficult to process, but sadly it’s getting more and more common.
Part of the reason I moved from inpatient mental health work to community was because of the girl I wrote about. I just couldn’t face that again. When my daughter turned 18 a few years ago, I thought of that same girl and my heart broke thinking about her, her parents and her family and what a distressing time it was all round. I wish I could have done more.
Great to connect with you Louise, thanks for your lovely reply.
I get it, totally. I shared a poem today about the black books us NHS folk carry of the patients that changed us irrevocably. And same, so glad to connect with you ❤️
I’ll definitely check that poem out. Thanks Louise ❤️
Super welcome - it’s just a short one on notes - here if you’re looking for it xx
https://substack.com/@lulamorris/note/c-113267613
Thank you Louise, this was such a thought-provoking piece, thank you for your invaluable personal insights as well as the thoroughly researched evidence to support your points. It is fascinating to have your insider knowledge and experience on this very important topic xx
Thank you Lyndsay, I appreciate your kind words xx
I’ve listened to and read your essay.
It’s very good in terms of shining a light on the terrible state in the NHS re wards and beds, safety and care. Beds were an issue over 20 years ago when I was a baby physio on a ward!! It’s only got worse of course.
I particularly liked the example of how much the hospital saved after they had those consultants in - although as I found in my former career they could have asked the staff and teams to get the same answer!! So frustrating.
I thank you for stressing that this is not about political soundbites.
Those who are vehemently opposed to trans people full stop will always hate the idea they get a side room because their real agenda is to humiliate and degrade trans people and make their lives intolerable.
Unfortunately- I already know from a friend of one young trans man who has died by suicide since the SC ruling was announced.
Yes , everyone deserves to be treated with the thought and attention you clearly showed the patients under your care and as you so carefully and throughly explained the situation is dire and requires urgent and serious attention.
The minister for Health & Social Care would do well to put as much of his effort and resources into this and other such critical matters rather than spend his time attacking trans people and removing their access to healthcare.
Thank you for writing this and sharing your expertise. I only hope any of my trans friends is fortunate enough to meet a clinician with your ethical and moral approach to care should they ever need to go to hospital in the future. 🙏🏻
Very interesting - and very well researched. I really think you should send it across to the HSJ or Kings Fund so more eyes in NHS see this too.
Suspect the conflict between the NHS guidance and Supreme Court ruling may lead to guidance being amended. But the wheels turn slowly so maybe a test case will come to court on this first. Will be interesting to see what happens.
This bit was especially interesting to me:
‘The majority of instances of mixing of sexes is quite simply down to delays waiting for a bed in an appropriate ward or bay.’
Also that the stats seemed to reveal more sexual assault incidents in psychiatric wards. Do you think there should there be stricter rules re wait times here ? (And space provided to them first)?
I’d be interested to tot up the amount of money spent on considering the issue of SS spaces generally v the money spent actually generating more space. If that’s even possible !
It’s something I think about more broadly - whenever there’s any debate about this issue. Is the airtime given - or argued about it by either side - proportionate. Not saying it shouldn’t be. It should. But are there bigger issues getting ignored. And does emphasising it too much sometimes play into the hands of RW extremists. Is it a political distraction ?
The biggest issue as you say is that we need more space. An advertising campaign from a pressure group with people like you writing the ads could do a lot to help refocus people on the big things we need to be thinking about. I can almost picture them in my head now and you co-ordinating the writing work :)
Keep us posted on the changes in policies etc- I’m sure many will be interested. X
Yes the guidance is apparently being reviewed at present
I take your comment about where the money is being spent migjt be better invested to actually improve things.
I’d also point out that all this discussion about the segregation of trans people, and particularly trans women, is going to alter nothing as these attacks are bot perpetrated by them. As far as I am aware no woman has ever made a complaint about a trans woman on a ward.
The right wing discourse which has infected our politics - even this current government- is staggering. And terrifying. And does nothing to improve the situation for sick people in hospitals or the safety of women and girls.
https://mailonline.pressreader.com/article/282308208590834
Where is the rest of the article please? It seems to finish mid sentence.
There are people out there who do others harm - men, women, trans people, black, brown, gay, straight - the crime of a small number of people within any group does not necessitate the whole group be excluded - otherwise men wouldn’t be allowed to do anything or go anywhere given most crimes are committed by men. And no one thinks that is a sensible idea.
Removing trans people from whichever part of society or another does not tackle violence again women and girls.
I just googled it, Jacqui, as I wanted to check your claim that there hadn’t been any attacks. There were quite a few headlines so you will be able to find it easily. The problem that the trans community will not address is the fact that there are some people who are using the ‘safety’ of the trans umbrella to gain access to female services. Until we can have a conversation on both sides on what to do about those interlopers, then we will be stuck. They are giving the trans community a bad name and so I would have thought they would want to address it too instead of denying those people (like the men jailed for rape as women, or the men who self-describe as women to gain access to children in women’s refuges or supermarket toilets) exist.
People who want to harm others will always do so - excluding trans people from a space means these people will find another way while innocent people suffer.
Back to my comment about curfews on men. Wouldn’t many women say they’d feel safer walking home after a night out if all the men had a 9pm curfew? It’s a ridiculous suggestion because the majority of men have no intention of harming women but some do.
The issues highlighted in Louise’s essay show all the very many things that make patients feel unsafe in hospitals. It is a huge issue and trans people are not the problem here except in a tiny number of isolated cases.
The figures for staff assaulting patients are terrible. And the long waits to get beds - I remember this when I worked in a hospital years ago and it is much worse now.
I’m afraid that the “people who want to harm others will always do so” argument is not one that I can endorse. By that same logic trans women should be able to continue to use male spaces because most men won’t hurt them but that tiny majority who might would hurt them wherever they are. It’s very difficult and I can see both sides but the real issue is male violence and for me that is an issue biological men — however they identify need to resolve. Trans men will also never be safe in men’s spaces and I believe they should continue to have access to the spaces of their biological sex, in the same way that they embrace the biology of their female body if they choose to use it to have a baby, which I think more and more trans men choose to do now. Too much focus is on what trans women want, trans men never get a look in.
Really interesting and surprising that amongst the data collected there’s no segmentation between psychiatric wards and other facilities ( maybe I’ve missed that, however ). I strongly suspect that many of the patient-patient sexual assaults would occur in these facilities- and also patient-staff. As you say, privacy, dignity and safety should be paramount for all. Most patients who need to be in hospital are just grateful to be in a bed and the last thing they care about is who is in the ward with them, unless they are disturbing others with unpleasant behaviour or noise.
Yes, I was horrified that it was really difficult to find any accurate data on assaults, all that I found was reports from separate investigations carried out by submission of freedom of information requests. Yet hospitals spend enormous amounts of time gathering, explaining and submitting data every time a patient stays in a mixed bay on intensive care for 4 hours waiting for a ward bed… that’s when you realise this isn’t about patients, or safety, it’s so a politician can say “look what I’ve achieved”
It’s so depressing after the amount of effort that’s put in by staff in using data for improvement, the top down approach is still firmly embedded.
It really, really is. It’s that old saying (I think I actually paraphrased it in the essay) - what’s measurable isn’t necessarily what’s most important…
I read all your essay and know nothing about the NHS as I live in Switzerland but I think what you say about it being what is not measurable being the most important is the absolute truth. My uncle was in hospital in london with covid in 2020. He is a journalist and a writer, and he wrote a radio play about his experience - or what he learned from his wife about his six months in intensive care, as for many of those months he was in a coma. The play was produced by the BBC. It’s called Devoted, and it’s amazing. He has nothing but praise for the NHS staff. It must be terrible to have to shuffle beds like rubik cube puzzles without this whole trans issue coming into it. People are people. Interesting piece; although I admit I would have to read it a few times to fully comprehend (I hope!). Oh, my uncle is called Ray Connolly. The play is Devoted. Have a listen . I think you will like it 🙏 Sorry for this long badly written comment but I didn’t sleep last night so my neurons are wonky!
Thank you, I will look out for it! Not badly written comment at all! Hope you manage to get some rest though and feel better 💜
Thank you Louise, for this insightful essay- gosh, how complicated things are! It's heartbreaking to read and I hope your words reach the people who need to listen.
Beautifully written and researched. I'm continually astounded by the complexity of the system, and at the same time eternally grateful for it, as it's saved my life and that of both of my children.
In all that you've said, what stays with me the strongest are how frequent are the instances of sexual harassment, abuse and assault. Its heartbreaking and infuriating.
I tend to be more of a glass half full person and see the potential for improvement, for positive growth all around me. But when faced with statistics that show that il these atrocities are a relative norm in society, it makes it challenging to see the way forward. Where and how do we begin to address healing a societal or cultural belief that sexual assault is in any way acceptable?
Heartbreaking and infuriating is about as spot on as you can get. I genuinely hope that improvement is possible, because the alternative is unthinkable. Speaking up feels really uncomfortable, but wasn't something I could put off any longer, because the people making the decisions just have no idea what the reality is. Thanks for your thoughtful comments lovely.
Really interesting read thank you so much for sharing
Thank you for writing such a considered and well researched piece on this. Really interesting and truly highlights where the real issues are underneath all the politicising and distraction.
Great piece of well researched writing on a complex and difficult subject. The added authenticity of your considerable professionl experience brings the situation into sharp focus. Usually in a 'business' context, there's a phrase, 'What gets measured gets done.' This was clearly demonstrated in your example when the ED waiting times were significantly reduced once there was a focused effort to minimise fines. As you say though, the reporting of breaches to the single sex accomodation rules seems to be measuring, recording and reporting the wrong thing. Or at the very least is being interpreted as something that it is not. It's surely a symptom of the shortages in resources (staff and space) and an issue of capacity and flow through the system, with bottlenecks both into and out of hospital care. If privacy dignity and safety are truly the aim for all patients, regardless of gender or sex, fundamental and systemic change must be the priority.
So well-written it didn’t feel as long as you prepared us for Louise - as I’m sure you know, there is an important niche for you here with the topics that you are qualified and passionate enough to write about
Terrific piece, great combination of analysis and experience, thanks for shining some light on this hot topic
thank you for the time taken to provide a detailed and fact based assessment. The febrile atmosphere and "debate" that has sadly become normalised creates losers on all "sides" -
Thank you, it is indeed very sad, it's been a difficult write, this one.
I am not surprised it was difficult- the consequences can be dire - but facts and intelligent assessment of the situation by someone like you who knows how the NHS works is so important
The vast majority of people who have any awareness of this situation beyond the “headlines” actually want the right thing as far as possible for both “sides” there will be compromise, but rather than an either or mentality we should focus on “and”