1.          President's Charity - Geoff Summers
2.          The Enigma Machine - Dick Herbert
3.          Fairy Tales, A Follow up Note - Noor Ahmed
4.          Malvern Hills Meander - Jan Meggy
5.          A Tale of Two Patients - Barrie Davies

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I have thought quite long and hard about the charity for my presidential year, weighing up my speciality interests and local interests. I feel that the most appropriate charity is Kemp Hospice, especially as they have an appeal about to be launched for the extension which will allow inpatient beds for palliative care for the first time in the Wyre Forest locality.

Kemp has provided wonderful support and day case care for patients with advanced cancer and other diseases over the years and has focussed on community based care which has allowed patients to stay at home and avoid hospital admissions. It has long been recognised that some inpatient beds would compliment this approach and it is wonderful that a new centre is now planned.

Across Worcestershire as a whole there has been collaborative planning in palliative care, and in the foreseeable future there should be some inpatient beds in all localities, perhaps with more high dependency beds in one of the locations. This approach should ensure high quality palliative care throughout the county and I am sure that the new facility at Kemp will be of great value to the Wyre Forest .


Geoff Summers

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The Enigma Machine


Dr Mark Baldwin gave a very entertaining and informative talk on the workings of the Enigma machine, and how it evolved from a machine manufactured by the Poles. He spent some time telling us how the machine worked and discussed the endless different combinations used to cipher messages. These machines were used in many wartime situations by the Germans from the battlefront to the officers planning attacks from behind the lines.

The codes were analysed and broken at Bletchley Park by countless men and women working round the clock. Gordon Welchman was one man who worked at Bletchley for the entire war and persuaded Churchill to increase resources to allow the full benefit of the code-breaker's skills to be reaped. He developed a more sophisticated improvement to the 'Bombe' which increased their capability to break codes.

He went on to talk and illustrate the layout of Bletchley Park with particular reference to HUT 6 where the most important work was carried out. After a coffee break, he demonstrated an Enigma machine which he had brought with him and a colleague set up a stand with exhibits and books about the Enigma machine which could he purchased.


Dick Herbert

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Fairy Tale s
- A Follow up Note


We all lament the current state of the NHS referred to by our editor in his leading article, and poignantly illustrated in his report "Fairly Tales" in the January issue. Having served the NHS for twenty years I can share in the sadness that people like my friend Barrie Davies might feel after having given their entire professional lives to it. However I must confess that this inexorable deterioration comes as no surprise.

The NHS is a huge, monnolithic. slow moving, and unresponsive monopoly, with no real accountability. It has total control over the purchase as well the provision of healthcare in the UK . No matter how much the politicians or bureaucrats try to kick more activity out of it, no matter how much the consumers who pay for it. or the staff who work for it bemoan its state, it is not going to change by virtue of its all encompassing power over healthcare

A friend in corporate management, currently working for Sainsbury's raised an interesting metaphor. Imagine that all the people in your county had to shop at Sainsbury's. You would pay a weekly amount and queue up and get what was available, full stop. And we would set the prices whether or not you liked them, as well as your regular subscriptions and you shalll have to pay, come what may, whether you visited the store or not. We managers would have a great time, only being required to keep the queues of customers in order and occasionally kicking the resentful shelf stackers or protesting till operators. And we would call this wonderful system "Free groceries for everyone, at the point of delivery” Choice? Sure you would have a choice; you could shop at the horrendously expensive local boutique, but you would have to keep paying your weekly subscription to Sainsbury's!

Thucydides wrote 1600 years ago, "Hegemony kills itself. A power that has hegemony always becomes arrogant. A hegemonous system is very self-destructive. It becomes defensive, arrogant and a defender of yesterday. It destroys itself. Therefore no monopoly in history lives for very long."  The NHS monopoly is merely following this inexorable path. Gimmicks disguised as "reform", ranging from fund holding to clinical governance to revalidation to NICE and CHI will not change the decaying structure. And empty words such as "modernisation", even if taken at face value is merely putting some makeup on the face of a moribund entity gasping for Its last few breaths. At least I seem to have come to this immensely sad but inescapable conclusion. Indeed I would welcome some contrary views if only to cheer me up!

Noor Ahmed

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Malvern Hills

The Malvern Hills beckoned for the Medical Society on a cloudy overcast Sunday morning. The walk was divided into 3 categories, the one hour 'easy' walk round British Camp, the 2 hours ok walk from Wyche car park to the hotel and for intrepid walkers the 3 hour walk from North Quarry car park along the ridge to the Malvern Hills hotel where lunch was the reward with good beer on tap (so I was reliably informed).

Well the intrepid's were in some cases dropped off by their spouse, and then led up the very steep start at a cracking pace as if Kilimanjaro was the aim! Some of us slowed down including myself to a more comfortable pace still suitable for Sunday mornings with the children and dog, although the latter ended up way in front. The various headgear on display was intriguing varying from fleecy hats to baseball caps or even a white cricket hat. Trekking poles were in evidence (very useful) and also sticks gathered from the hedgerow. We caught a fleeting glimpse of a swooping sparrow hawk ably identified by DM and the birdsong was quite prolific. At the top of North Hill we came across 2 resting mountain bikers who swopped stories with Chris Gait of trans America fame and were quite overawed. Some keen walkers bagged every hill, others meandered along the contours.

The Ward clan joined up Wyche car park, rendezvous enabled by 'mobile' technology; and the younger members then forged ahead. The aim was to meet the 'short' walkers at the Malvern Hills Hotel. The short walkers were ably led by Paul Williams and included some family members in back carriers who had the easy ride encouraged by Boris the dog, surprisingly his mistress Alysson was the only casualty, she slipped over!

The meal was excellent, just right for all ages, shepherds pie, chips, salad and gooey choc mousse cake –washed down by a very good selection of bitter ales and coke for the younger members, well earned by all concerned. Our president darted around the room taking photos and making everyone at home, including those who joined us just for the meal.

Two of the intrepids, Hilary and husband then turned around and walked all the way back - very impressive. What are they training for? While the rest of us were kindly ferried to pick up our cars. What a lovely event, what special cameraderie we all have and how great that this is continuing.

Jan Meggy

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A Tale of 2 Patients

We are forever hearing about crises affecting the NHS.  Rarely a Winter goes by without tales of bed shortages, patients on trolleys in corridors, all but emergency admissions being stopped with the resulting ever longer waiting lists. The stories go on and on but there never seems to be a viable solution put forward, either by the medical profession or its governmental paymasters.  But are we looking at the problem correctly? Are more beds, more nurses, more tele-medicine, more doctors or even more money the right answer? Perhaps an alternative solution can be learned from looking at how medicine is practised in other countries, indeed, look at how qualified tradesmen work in our own country – it is called ‘job and finish’.

I was recently closely involved with two patients, one of whom was dealt with under  the NHS and the other given the job and finish treatment in Spain . Patient one, a 78 year old man who had been experiencing vague abdominal problems for some months and who suddenly presented with a severe mixed melaena and fresh blood loss PR. He was admitted, underwent an endoscopy which revealed nothing, and was discharged looking and feeling anaemic two days later. He was given appointments for an out patient barium enema (which, depending on the result,  could result in another appointment for a colonoscopy) and a follow up appointment for medical out patients 6 weeks later. Two days later, he collapsed, was readmitted through A&E where, as well as his previous problems, numerous extrasystoles were noted. He was discharged two days later with an appointment to perform a 24 hour ECG when the equipment became available and a cardiology clinic appointment 4 weeks after that. The current state of play is that we are left with a man who  has worsening vague abdominal discomfort, is debilitatingly anaemic and is the possessor of a potential tally of  5 out patient appointments over the next 8 weeks.

Patient number two was another 78 year old man who had decided to spend the colder part of the year in Benidorm , Spain with his wife. He had been there two weeks when he experienced severe central chest pain radiating to his left arm with associated dyspnoea. He was admitted to a local Spanish state hospital where an anterolateral infarct was diagnosed by enzymes, ECG and echocardiogram. The following day, the cardiologist performed an angiogram which revealed severe triple vessel disease. Two days later the patient was flown to Valencia state hospital where triple coronary artery by pass surgery was performed just six days post infarct. Up to this point everything had taken place under the reciprocal health service facilities we have with Spain , and had cost neither the patient nor his insurers a penny. But understandably the patient now wanted to return home and recuperate in familiar surroundings – which is where the insurers came into the picture, and so 12 days post op he is making a very active recovery and enjoying Christmas at home.

Can you imagine scenario number two taking place in the UK ? I can’t but can certainly foresee his case taking up most of the time of an appointments clerk over the next 9 months. Similarly, could scenario number one be handled differently? I’m sure it could under the ‘job and finish’ concept,by keeping the patient in a few more days, and completeing the investigations and any necessary treatment before his discharge – just imagine the number of waiting list slots that would release.

Barrie Davies

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