Test Equipment Anonymous

ME pron

A few moments ago, I heard a helicopter buzzing around overhead and thought nothing of it as the Police chopper often flies over our house on its way to base or a shout, but then it got louder and looking out the lab window I was greeted by an Air Ambulance landing in the school playing field right behind my house. This operates out of my local airfield at North Weald and my son grabbed his camera and took this photo just as it lifted off again to return to base as it was not required in the end after all.

It is a charity and is entirely funded by the public, and it must cost an absolute fortune to operate as not only have they had a dedicated base and hanger built for it, but also they get a huge number of callouts where they are ultimately not required in the end. We have seen them dash out and crew up, heard them request permission from the airfield tower for clearance to lift off and go, on my air scanner radio, only for them to call for clearance to return following a stand down a minute or two later, money wasted.

Specmaster wrote: ↑Mon Nov 28, 2022 1:40 pm A few moments ago, I heard a helicopter buzzing around overhead and thought nothing of it as the Police chopper often flies over our house on its way to base or a shout, but then it got louder and looking out the lab window I was greeted by an Air Ambulance landing in the school playing field right behind my house. This operates out of my local airfield at North Weald and my son grabbed his camera and took this photo just as it lifted off again to return to base as it was not required in the end after all.

It is a charity and is entirely funded by the public, and it must cost an absolute fortune to operate as not only have they had a dedicated base and hanger built for it, but also they get a huge number of callouts where they are ultimately not required in the end. We have seen them dash out and crew up, heard them request permission from the airfield tower for clearance to lift off and go, on my air scanner radio, only for them to call for clearance to return following a stand down a minute or two later, money wasted.

As far as I know most of the medevac's in this area are privately owned. It is not unusual for a request to put a medevac on "stand by" while the personnel on scene assess the victim first. Then if it is indeed required then the chopper flies to the scene. But I'm not really sure if "stand by" means the chopper is crewed and started or just be prepared to start up and go.

vk6zgo wrote: ↑Mon Nov 28, 2022 5:10 am

MED6753 wrote: ↑Sun Nov 27, 2022 6:57 am

Cubdriver wrote: ↑Sat Nov 26, 2022 7:31 pm If anyone wants a Tek 7000-series extender, the person I got mine from has another up for sale. While they're asking $30 more for this one than I paid for mine, I doubt you'll find one this cheap any time soon. NAWTS, of course.

https://www.ebay.com/itm/314246845535?m ... name=11021

-Pat

Would love to have one but not at that price.

Ditto here, ----- even the international mail is a bit savage when you convert it to Oz Pesos!

I remember my old work had several Tek ones & a couple of copies made in the "PMG Workshops".
Easy to do, when you have Senior Techs, Techs, & Trainees on tap, &, as a large Comms & Broadcasting organisation, can buy the stuff to build the hardware cheaply.
Not so much for the normal person in a back shed!

The 7000 series extender is a tad more complex than a 500/560 series extender due to the frequencies it has to pass in order to effectively troubleshoot a plug-in. I tried looking up the price in a 1973 Tek catalog but I've been unable to find it. I have a 500MHz 7B92 Time Base plug-in that's totally dead which would require that extender. Luckily the seller refunded all my money when I informed him it wasn't working but his advert claimed it was fully functional. So it's a free bee and perhaps one day purchase another one and have this one as spare parts.

There will probably be no more projects from me until at least January due to the Humbug season. What I budget for TE will be used for that. So when are some of you characters gonna step up and post some projects? You can't rely on me all the time for your porn fix.

Specmaster wrote: ↑Mon Nov 28, 2022 1:40 pm A few moments ago, I heard a helicopter buzzing around overhead and thought nothing of it as the Police chopper often flies over our house on its way to base or a shout, but then it got louder and looking out the lab window I was greeted by an Air Ambulance landing in the school playing field right behind my house. This operates out of my local airfield at North Weald and my son grabbed his camera and took this photo just as it lifted off again to return to base as it was not required in the end after all.

It is a charity and is entirely funded by the public, and it must cost an absolute fortune to operate as not only have they had a dedicated base and hanger built for it, but also they get a huge number of callouts where they are ultimately not required in the end. We have seen them dash out and crew up, heard them request permission from the airfield tower for clearance to lift off and go, on my air scanner radio, only for them to call for clearance to return following a stand down a minute or two later, money wasted.

Not money wasted; money doing what it should be used for.

The entire point of Life Flight is those cases where every second is the difference between life and death, or long hard recovery and being a vegetable. The whole point is they're on their way while the first responders are triaging the patient, so that when they are needed they're there without a second wasted.

Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

Specmaster wrote: ↑Mon Nov 28, 2022 1:40 pm A few moments ago, I heard a helicopter buzzing around overhead and thought nothing of it as the Police chopper often flies over our house on its way to base or a shout, but then it got louder and looking out the lab window I was greeted by an Air Ambulance landing in the school playing field right behind my house....

I once saw, out of my adjacent office window, the London Air Ambulance land on the slip road off the North Circular road pictured below.
Note all the (very tall) lamp posts, signs, railings and all the other clutter. Also note the slope of the road, it's steep, 1 in 4 or 1 in 5. The road is 10.86 metres wide, as can be seen in this satellite shot.
The rotor diameter of the MD Explorer helicopters that they use is 10.31 metres, so the entire width of the road surface for all intents. To say that I was impressed with the pilot sticking a landing on that slope, with lots of clutter and very little room to manoeuvre is an understatement.

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm
Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

Incorrect. Medevac's in this area are owned by Air Methods, a publicly traded company. Go look it up.

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

You're making the error of mistaking England with the greed soaked corporate culture of the US. Here medical services are free at the point of delivery, no corporations involved to bill any end users and only a remarkably light cost in National Insurance contributions (an income tax by any other name which nominally funds not only the health service but other benefits including the state pension) of around £120 a month for anyone on the median wage.

The contrast Graham is drawing is with the air ambulances being paid for by charities while all the other ambulance and paramedic services are paid for out of taxes.

Following bd139's example on a thread in the other place, a few months back, I've just received five CTI 10MHz ex cell tower OCXOs from Aliexpress. I recall they cost £12 all told. They did need desoldering from the bits of PCB they were on, which was quite fiddly.

I left one of the Racal frequency counters on overnight to stabilise properly - they take ages - and fed it with the 10MHz GPSDO. 9.9999997 MHz and it stays there. It's fiddly to adjust closer.

Then I set a 10K multiturn pot to half way for the frequency adjustment, and set up a crude test rig with jumper wires and a bench PSU and used a scope probe for the O/P. The O/P was fed to a scope as a sanity check and then to the frequency counter.

These units are powered by 5V and take up to 0.5A when they are warming up. It drops to about 0.2A after a few minutes. They all gave a reasonable square wave and with the pot at half travel they were within 20 Hz of 10MHz. It was easy to adjust them onto 9.999997MHz and they stayed there for 20 minutes (until I went onto the next one).

All good and with lots of adjustment in them. Thoroughly recommended.

The next step is to work out how to apply them to one of the Racal frequency counters which has an OCXO which is old and tired. I'm pretty sure its internal standard is 5MHz and the OCXO supply voltage may be higher.

MED6753 wrote: ↑Mon Nov 28, 2022 4:23 pm

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm
Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

Incorrect. Medevac's in this area are owned by Air Methods, a publicly traded company. Go look it up.

What the flupp does that have to do with whom they send the bill to? And most such services over here, even the regular ambulances, are billed on a cost-plus basis. Whether billed to a charity or to the patient's insurance or even to the hospital's assigned-risk insurance pool, no conventional corporation is paying the bill. And those who are paying the bill don't have a choice, and they will fight it, too.

We've had it in the news where insurance companies tried to not pay for a ambulance ride because the patient died enroute, claiming failure to provide services.

mnem

Cerebus wrote: ↑Mon Nov 28, 2022 4:31 pm

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

You're making the error of mistaking England with the greed soaked corporate culture of the US. Here medical services are free at the point of delivery, no corporations involved to bill any end users and only a remarkably light cost in National Insurance contributions (an income tax by any other name which nominally funds not only the health service but other benefits including the state pension) of around £120 a month for anyone on the median wage.

The contrast Graham is drawing is with the air ambulances being paid for by charities while all the other ambulance and paramedic services are paid for out of taxes.

Unless I'm misunderstanding your point, it seems to me that is very clearly still a matter of "they don't have a choice". And I'll wager that the reason these particular services are operated by charities is still due to corporations wanting it that way, and having the laws changed to suit them.

Even with your more civilized medical services model, there will be bean counters involved; I can see "high cost of operations for low return" being one motive, also of course several different scenarios where liability would be a driving factor in divesting/isolating that service from the rest of the healthcare services provided.

Please enlighten me to the differences in how your medical corporations operate; whether billing the government with some regulation as to profit margin or billing an insurance company purely for-profit, in your healthcare system, services are still delivered by corporate entities, right?

mnem
*pulls out a notebook and pencil*

Cerebus wrote: ↑Mon Nov 28, 2022 4:10 pm

Specmaster wrote: ↑Mon Nov 28, 2022 1:40 pm A few moments ago, I heard a helicopter buzzing around overhead and thought nothing of it as the Police chopper often flies over our house on its way to base or a shout, but then it got louder and looking out the lab window I was greeted by an Air Ambulance landing in the school playing field right behind my house....

I once saw, out of my adjacent office window, the London Air Ambulance land on the slip road off the North Circular road pictured below.

Slip road.jpg

Note all the (very tall) lamp posts, signs, railings and all the other clutter. Also note the slope of the road, it's steep, 1 in 4 or 1 in 5. The road is 10.86 metres wide, as can be seen in this satellite shot.

Slip Road satellite.jpg

The rotor diameter of the MD Explorer helicopters that they use is 10.31 metres, so the entire width of the road surface for all intents. To say that I was impressed with the pilot sticking a landing on that slope, with lots of clutter and very little room to manoeuvre is an understatement.

Arh yes, I remember that as well, just by Abbey Road junction on the slip road heading east towards Wembley. Those pilots are highly skilled and ex RAF I think.

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm Not money wasted; money doing what it should be used for.

The entire point of Life Flight is those cases where every second is the difference between life and death, or long hard recovery and being a vegetable. The whole point is they're on their way while the first responders are triaging the patient, so that when they are needed they're there without a second wasted.

Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

The point I was making about money wasted was just that, it was money wasted on a shout that didn't really warrant the helicopter. I've at the airfield when they have crewed up and taken off and then, before they have even left the airfield perimeter, have been told to stand down again. True, I don't know the precise details of who and how the decision to enlist the Helimed helicopter services is carried out, but it just strikes me as a waste of money under those circumstances when we only 2 such helicopters covering one of the largest counties in the country but have hundreds of ambulances all over the place feeding many hospitals. That particular helicopter is based at North Weald, on the western edge of Essex and the other is at Earls Colne in the north of the county, and I believe they between them cover 3 large counties of Hertfordshire, Essex and Suffolk, so I'd have expected them to be called out only really necessary, in case they were required somewhere else.

Also given that the main hospital is only 2 miles from my house, I was amazed a couple of years ago, to see flashing blue lights right side my front door late at night. Looking out there was one of the charities ground emergency support vehicles and a normal ambulance, and they were carrying out an emergency operation on a neighbour with all kinds of floodlights set up in the middle of the road and while it was raining. Once the neighbour was stable enough, they loaded them into the ambulance and took them to hospital. I'd have expected the doctors and surgeon to have come from the hospital, not the charity, who had to drive some 16 miles to attend the scene.

mnementh wrote: ↑Mon Nov 28, 2022 5:55 pm

Cerebus wrote: ↑Mon Nov 28, 2022 4:31 pm

mnementh wrote: ↑Mon Nov 28, 2022 4:08 pm Of course they're funded by charities. No corporation that had a choice would ever pay that kind of money over and over again to "maybe save a life"... such service would always be the first thing cut by the bean counters, unless of course they were billing someone else... like a charity... on a "cost plus" basis.

mnem
"Good luck, and godspeed..."

You're making the error of mistaking England with the greed soaked corporate culture of the US. Here medical services are free at the point of delivery, no corporations involved to bill any end users and only a remarkably light cost in National Insurance contributions (an income tax by any other name which nominally funds not only the health service but other benefits including the state pension) of around £120 a month for anyone on the median wage.

The contrast Graham is drawing is with the air ambulances being paid for by charities while all the other ambulance and paramedic services are paid for out of taxes.

Unless I'm misunderstanding your point, it seems to me that is very clearly still a matter of "they don't have a choice". And I'll wager that the reason these particular services are operated by charities is still due to corporations wanting it that way, and having the laws changed to suit them.

Even with your more civilized medical services model, there will be bean counters involved; I can see "high cost of operations for low return" being one motive, also of course several different scenarios where liability would be a driving factor in divesting/isolating that service from the rest of the healthcare services provided.

Please enlighten me to the differences in how your medical corporations operate; whether billing the government with some regulation as to profit margin or billing an insurance company purely for-profit, in your healthcare system, services are still delivered by corporate entities, right?

mnem
*pulls out a notebook and pencil*

Normal health services in the UK don't involve medical corporations. Unless you decide to go private the service is provided by the National Health Service (NHS), run by the government. Yes some services may be subcontracted but that is not part of the basic provision.
Everone has the same level of state care available, the main advantage of going private is reduced waiting times for routine treatments.

mnementh wrote: ↑Mon Nov 28, 2022 5:55 pm Unless I'm misunderstanding your point, it seems to me that is very clearly still a matter of "they don't have a choice". And I'll wager that the reason these particular services are operated by charities is still due to corporations wanting it that way, and having the laws changed to suit them.

Even with your more civilized medical services model, there will be bean counters involved; I can see "high cost of operations for low return" being one motive, also of course several different scenarios where liability would be a driving factor in divesting/isolating that service from the rest of the healthcare services provided.

Please enlighten me to the differences in how your medical corporations operate; whether billing the government with some regulation as to profit margin or billing an insurance company purely for-profit, in your healthcare system, services are still delivered by corporate entities, right?

mnem
*pulls out a notebook and pencil*

No, medical services are not, in the general case, delivered by corporate entities.

We have a National Health Service (the National as in "nationalised"), publicly owned and operated. If you walk into a hospital you walk into a state owned hospital. There are private hospitals and private doctors, for the wealthy who want to pay directly for them and for purely elective things such as cosmetic surgery, but 99% of the population go to state run hospitals and see state employed doctors.

There is no flow of money to the private sector for medical services in general, but obviously the NHS buys drugs and supplies from the private sector (at prices that are in some cases regulated [e.g. the Drug Tariff] and in other cases negotiated by someone with the power to say "We, and by we I mean an entire country, won't buy it at that price."). The NHS may sometimes contract out some services to the private sector, but under terms the NHS dictates; the private sector suppliers don't get to pick and choose how they deliver those services and are subject to regulation by the Care Quality Commission.

The guiding rule is that people get treatment according to need, not cost of individual treatment or ability to pay. The whole fact that there are not a succession of people pocketing a profit from it, or choosing to nickel and dime the service they provide, is what makes it possible and there are no opportunities for price gouging - e.g. Insulin in the UK costs a patient nothing, the NHS will pay a retail pharmacist £14.08 for a 10ml 100u/ml vial plus £1.27 for each prescription dispensed. I mention insulin specifically because we all know about the price gouging that has gone on the US in recent years. The very same drug companies that were price gouging $300 a vial in the US were accepting the NHS Drug Tariff £14.08 here (or actually, their share after the retail pharmacist had taken whatever cut of that £14.08 they could negotiate with the drug companies).

The only thing people have to pay for is drugs, and only nominally at that, and small partial contributions for dental treatment (which are capped for each course of treatment). If you have to pay retail prescription charges, and many people do not, (e.g. over 60s go free, so do pregnant mothers, people with certain specific medical conditions like cancer or diabetes, unemployed and so on) they are a nominal £9.35 for each line item on the prescription irrespective of the actual cost of the drugs whether that's a 30p pack of paracetamol or an exotic £1000 drug. You don't pay anything for drugs supplied in hospital, only drugs for out patient treatment.

That's fucking amazing; government actually charged with and providing public services to... the public.

Keep that as long as you can; hold onto it like grim death. Cuz that's what it is over here, and what you'll have the instant you let them privatize any portion of how it is administered or services provided.

Healthcare over here has been turned into a sausage machine; one whose real primary purpose has been to take property ownership from the general public and concentrate it into the holdings of fewer and fewer ultra-wealthy families every generation.

The American Dream of a owning a modest home and enough left over to feed oneself and family and maybe retire without being destitute is a pipe dream for more and more of the population at the same breakneck pace.

Cheers,

mnem
*sigh*

Yeah, not to sure how long we can keep the NHS as it is though, our current penny-pinching gubermint are keeping the service short of cash, understaffed and under paid, and they have been in talks with what was the Trump administration about adopting your system. Currently there is talk of charging people £50 for a doctor's appointment and if anyone tries to shortcut the system and present themselves at a hospital for treatment, without a doctor's referral, there would be a £100 charge. We need a fresh gubermint quick to prevent the existing one from doing any more damage.

Specmaster wrote: ↑Mon Nov 28, 2022 7:10 pm The point I was making about money wasted was just that, it was money wasted on a shout that didn't really warrant the helicopter. I've at the airfield when they have crewed up and taken off and then, before they have even left the airfield perimeter, have been told to stand down again. True, I don't know the precise details of who and how the decision to enlist the Helimed helicopter services is carried out, but it just strikes me as a waste of money...

I do know. You're looking at it with the benefit of 20/20 vision; knowing after the fact that the air evac wasn't need. You're not seeing how it is supposed to work. It is supposed to be that the helicopter is dispatched because it is likely to be needed, and until someone with proper medical knowledge can make the decision to abort, they proceed every time as if they were needed and not a moment to spare.

Think about it like a code blue in a hospital; everybody mobilizes as if the patient were crashing, even with the times when the patient knocks his wires off.

More often than not, a first-responder is not proper medical personnel; they are just emergency rescue with first eyes on the scene, and they relay what they see to dispatch or their CO who makes the decision whether the scene is likely desperate enough to need air evac. We are all trained to observe and report as accurately as possible; but that ultimate decision to launch has to be made by those further up the chain.

It is at that point that the heli is dispatched, and they continue as if they were needed until someone with sufficient medical knowledge arrives onsite to triage and make the medical decision of whether a vic can be stabilized without the services of air evac. On the other end, rescue people may actually be directed to scout and clear a LZ; whether or not it is needed, we have to have a place for them to land and a plan to get the vic(s) to the LZ in a safe and orderly fashion. I've had to work that detail a number of times, though only been on a call where air evac actually lit onsite like 3 times.

So no, it is not money wasted... it is one of those rare cases where money is being used for what it should be used for: Taking no chances where a life is on the line.

mnem
*salutes*

If you need more than a couple of prescriptions a month and don't qualify for free , you can pre-pay £108.10 a for 12 months coverage no matter how many drugs you need.
A couple of years ago SWMBO was on a "biological" drug, one dose a week at over £1000 each cost to NHS (apparently about 3 times that in the USA) all covered by £108.10. Last year I my employyer started covering me, and at my level, SWMBO foe BUPA private medical coverage as a "perk". I ust pay tax on the premium. This year SWMBO had an issue that put her off work and needed a minor surgery. Downside of NHS is 6 month waiting list for that surgery. 3 weeks wait on BUPA. Saved SWMBO's employer two months wages and let somone else get NHS surgery early. Yes SWMBO (and I) get full pay when on sick leave. Not uncommon here, unlike the USA.

mnementh wrote: ↑Mon Nov 28, 2022 9:27 pm

Specmaster wrote: ↑Mon Nov 28, 2022 7:10 pm The point I was making about money wasted was just that, it was money wasted on a shout that didn't really warrant the helicopter. I've at the airfield when they have crewed up and taken off and then, before they have even left the airfield perimeter, have been told to stand down again. True, I don't know the precise details of who and how the decision to enlist the Helimed helicopter services is carried out, but it just strikes me as a waste of money...

I do know. You're looking at it with the benefit of 20/20 vision; knowing after the fact that the air evac wasn't need. You're not seeing how it is supposed to work. It is supposed to be that the helicopter is dispatched because it is likely to be needed, and until someone with proper medical knowledge can make the decision to abort, they proceed every time as if they were needed and not a moment to spare.

Think about it like a code blue in a hospital; everybody mobilizes as if the patient were crashing, even with the times when the patient knocks his wires off.

More often than not, a first-responder is not proper medical personnel; they are just emergency rescue with first eyes on the scene, and they relay what they see to dispatch or their CO who makes the decision whether the scene is likely desperate enough to need air evac. We are all trained to observe and report as accurately as possible; but that ultimate decision to launch has to be made by those further up the chain.

It is at that point that the heli is dispatched, and they continue as if they were needed until someone with sufficient medical knowledge arrives onsite to triage and make the medical decision of whether a vic can be stabilized without the services of air evac. On the other end, rescue people may actually be directed to scout and clear a LZ; whether or not it is needed, we have to have a place for them to land and a plan to get the vic(s) to the LZ in a safe and orderly fashion. I've had to work that detail a number of times, though only been on a call where air evac actually lit onsite like 3 times.

So no, it is not money wasted... it is one of those rare cases where money is being used for what it should be used for: Taking no chances where a life is on the line.

mnem
*salutes*

No, I do understand the logic in what you are saying about code blue etc, but the point I'm making is that it as far as a charity is concerned a waste of money, they don't have a bottomless pit of money to dip into to finance everything. With just 2 choppers covering 3 counties, there is always the real risk that the chopper will be out on a shout that ends up as they are not required, while a real emergency call where their presence could make a massive difference to the final outcome, fails to get their support because they are already committed to another call.

I suppose the real solution is to ensure that all first responders are sufficiently trained to be able to make that decision earlier rather than later. I live just a mile away from the major ambulance station and I can hear the two-tone sirens wailing all day long as they are constantly in demand, and it is impossible to scramble a helicopter to them all in case they are required.

Specmaster wrote: ↑Mon Nov 28, 2022 9:23 pm Yeah, not to sure how long we can keep the NHS as it is though, our current penny-pinching gubermint are keeping the service short of cash, understaffed and under paid, and they have been in talks with what was the Trump administration about adopting your system. Currently there is talk of charging people £50 for a doctor's appointment and if anyone tries to shortcut the system and present themselves at a hospital for treatment, without a doctor's referral, there would be a £100 charge. We need a fresh gubermint quick to prevent the existing one from doing any more damage.

The "talk" is only from the loony fringe of the right. Any British political party knows that to adopt anything like that as policy would be a way of saying "We want to lose the next election". The British are rightly proud of the NHS and, although we moan about waiting times and the like, most Brits would fight like hell to keep it. The only genuine threats to it are if things are done under the radar and, again, the minute that comes out in public the party involved would be signing its electoral death warrant.

Cerebus wrote: ↑Mon Nov 28, 2022 7:43 pm No, medical services are not, in the general case, delivered by corporate entities.

Regrettably that is changing fast, and not for the better.

Cherry-picking by companies is rampant, for things like cataract operations, or outpatient medical care for the elderly such as foot clinics and other things that might need to be dealt with in the home. Jeremy Hunt pushed for that when he was the Health Minister.

Currently it feels like we are rapidly moving to a National Health Insurance Service, which is still free at the point of delivery

We have a National Health Service (the National as in "nationalised"), publicly owned and operated. If you walk into a hospital you walk into a state owned hospital. There are private hospitals and private doctors, for the wealthy who want to pay directly for them and for purely elective things such as cosmetic surgery, but 99% of the population go to state run hospitals and see state employed doctors.

One very interesting practice is the ability to "dip in and out" of private and NHS care. Thus in the past I have

• been referred to specialists by the NHS General Practicioner at the end of my road, or buggered myself and ended up in the NHS A&E
• been diagnosed or initially treated by the NHS
• in complex non-urgent cases, wanted a second opinion from the local expert, and I've seen that expert privately and paid for it myself or via a company insurance policy
• when surgery was required, had it done by that same local expert (for free) in the NHS hospital rather than privately on the grounds that if something goes wrong in a private hospital they get an ambulance to take you to the better equipped local NHS hospital

In one case the NHS covered a very serious spinal operation (8hrs, 2 surgeons) and it was also covered by company health insurance. I pushed to have the insurance company billed, and that came as an unwelcome admin burden for the surgeons. In the end the insurance company coughed up £24k

There is no flow of money to the private sector for medical services in general, but obviously the NHS buys drugs and supplies from the private sector (at prices that are in some cases regulated [e.g. the Drug Tariff] and in other cases negotiated by someone with the power to say "We, and by we I mean an entire country, won't buy it at that price."). The NHS may sometimes contract out some services to the private sector, but under terms the NHS dictates; the private sector suppliers don't get to pick and choose how they deliver those services and are subject to regulation by the Care Quality Commission.

The guiding rule is that people get treatment according to need, not cost of individual treatment or ability to pay.

The CQC is a mixed bag. Assessments are primarily a self-assessed box-ticking process, and that has come unstuck in homes for the elderly amongst other places.

What is unquestionably a remarkably good organisation is NICE (National Institute for Clinical Excellence). They continually reassess good clinical practice to see what works, what doesn't work, and what is value for money. The latter is based around the concept QALY (Quality Adjusted Life Year). QALY assesses how much decent life would be gained by a treatment or drug. That implies three valuable things:

• terminally ill patients aren't overtreated; better to have 6 months of palliative care than 2 years of hellish treatment
• the younger you are, the more expensive treatment can be - provided it leads to a good quality of life
• no treatment just to increase money coming into an institution or someone's pocket

The NICE recommended assessments and treatments are published, and I would recommend them to anybody anywhere as a sanity check of what is proposed for themselves or others. In paricular, look for the NGxxx Guidance documents for the overview.
https://www.nice.org.uk/guidance/condit ... d-diseases

The whole fact that there are not a succession of people pocketing a profit from it, or choosing to nickel and dime the service they provide, is what makes it possible and there are no opportunities for price gouging - e.g. Insulin in the UK costs a patient nothing, the NHS will pay a retail pharmacist £14.08 for a 10ml 100u/ml vial plus £1.27 for each prescription dispensed. I mention insulin specifically because we all know about the price gouging that has gone on the US in recent years. The very same drug companies that were price gouging $300 a vial in the US were accepting the NHS Drug Tariff £14.08 here (or actually, their share after the retail pharmacist had taken whatever cut of that £14.08 they could negotiate with the drug companies).

The NICE assessment is regularly used to bludgeon drug companies into reducing the price of drugs to something non-stupid. That occasionally means a delay of a few years, but that has the benefit of allowing widescale effectiveness to be assessed.

The only thing people have to pay for is drugs, and only nominally at that, and small partial contributions for dental treatment (which are capped for each course of treatment). If you have to pay retail prescription charges, and many people do not, (e.g. over 60s go free, so do pregnant mothers, people with certain specific medical conditions like cancer or diabetes, unemployed and so on) they are a nominal £9.35 for each line item on the prescription irrespective of the actual cost of the drugs whether that's a 30p pack of paracetamol or an exotic £1000 drug. You don't pay anything for drugs supplied in hospital, only drugs for out patient treatment.

Yup.

Cerebus wrote: ↑Mon Nov 28, 2022 10:39 pm

Specmaster wrote: ↑Mon Nov 28, 2022 9:23 pm Yeah, not to sure how long we can keep the NHS as it is though, our current penny-pinching gubermint are keeping the service short of cash, understaffed and under paid, and they have been in talks with what was the Trump administration about adopting your system. Currently there is talk of charging people £50 for a doctor's appointment and if anyone tries to shortcut the system and present themselves at a hospital for treatment, without a doctor's referral, there would be a £100 charge. We need a fresh gubermint quick to prevent the existing one from doing any more damage.

The "talk" is only from the loony fringe of the right. Any British political party knows that to adopt anything like that as policy would be a way of saying "We want to lose the next election". The British are rightly proud of the NHS and, although we moan about waiting times and the like, most Brits would fight like hell to keep it. The only genuine threats to it are if things are done under the radar and, again, the minute that comes out in public the party involved would be signing its electoral death warrant.

Precisely.

The NHS is the closest the British public have to a religion. That was clearly demonstrated during the opening ceremony of the 2012 Olympics. I've occasionally wondered whether foreigners had the slightest clue why hospital and medical sequences were included.

Specmaster wrote: ↑Mon Nov 28, 2022 10:21 pm No, I do understand the logic in what you are saying about code blue etc, but the point I'm making is that it as far as a charity is concerned a waste of money, they don't have a bottomless pit of money to dip into to finance everything. With just 2 choppers covering 3 counties, there is always the real risk that the chopper will be out on a shout that ends up as they are not required, while a real emergency call where their presence could make a massive difference to the final outcome, fails to get their support because they are already committed to another call.

I suppose the real solution is to ensure that all first responders are sufficiently trained to be able to make that decision earlier rather than later. I live just a mile away from the major ambulance station and I can hear the two-tone sirens wailing all day long as they are constantly in demand, and it is impossible to scramble a helicopter to them all in case they are required.

That level of medical know-how is pretty expensive... it's not like every Fire dept can train every member to be fully-qualified EMS as well; it is literally a kind of medical degree in its own right.

I know from personal experience that the kind of crazy that runs into a burning building when all the sane people are running out... who runs towards the car that's sparking at one end and pissing gasoline on the ground the other, but sees only the vic... they are very often not suited to the intensive medical training needed to make that decision.

For the same reason, we have many soldiers and dire few combat medics.

I'd say it would be much more sensible to support those charities genrously so there is money for more air evac choppers and crew. Oh, and similarly, money to train as many EMS as we can hoodwink beg, plead or cajole into service in that meat-grinder as well.

I think you're looking at the charity aspect the wrong way; from here it seems they set up the charity that way deliberately to take on the onerous and frightfully expensive task of providing this service because it is needed.

mnem
*not suitable*

Specmaster wrote: ↑Mon Nov 28, 2022 10:21 pm

I suppose the real solution is to ensure that all first responders are sufficiently trained to be able to make that decision earlier rather than later. I live just a mile away from the major ambulance station and I can hear the two-tone sirens wailing all day long as they are constantly in demand, and it is impossible to scramble a helicopter to them all in case they are required.

They are, here at least. The EMT's on scene make the call. They notify 911 dispatch to either put the chopper on stand by until determined if actually required or dispatch immediately. 911 dispatch notifies medevac and they respond with an example of "10 minutes plus lift" (if required) or that time if immediate dispatch. Then 911 dispatch puts out additional calls for other personnel, usually fire, to set up an LZ as close as possible. But it isn't a given. Sometimes the chopper can't fly due to weather. Snow, fog, etc. It's unfortunate but it happens.

Ambulance services in my area are a combination of all volunteer, paid, or private ambulance service depending upon which town you reside in. But regardless they all have the same training and certifications as required by state law.