Here’s the thing about rats. They mess with your head. You lie awake in the silence of the night, listening. A scratch, a scrape, a scurry… Or worse, the sound of wallpaper being stripped from the wall behind the radiator in grandma’s bedroom. It seems rats may be addicted to vintage wallpaper paste.

Suddenly, one fateful day at dawn, no scratch nor scrape nor scurry, but a huge crash. Down the mezzanine spiral stair tumbled two electronic multimeters followed by… one large rat. What this rat wanted with two of my multimeters defied explanation. The more pressing issue was that all three were now on our bedroom floor.

Now, this was not the rotund, easily trappable, lumbering sort of rat from the nearby farm that I occasionally catch on camera raiding peanuts from a bird feeder at the end of the garden.

Oh no… this rat was athletic, savvy, and nimble.

Billy is our geriatric Jack Russell Terrier. He sleeps in our bedroom. He went hyper, tail wagging furiously. “I’ve got this!”, he barked, in hot pursuit of our uninvited intruder.

Our Billy is 15. His diminishing faculties and teeth deficiency would severely hamper his ability to conclude the inevitable confrontation. So I restrained the little fella. The elusive intruder legged it into the hallway.

Care-giving is stressful at the best of times. Every challenge large or small is yours to resolve. I cope with belligerent boilers, dripping taps, frosted freezers, leaky roofs, poorly dogs, resentful residents, even the adversarial medical receptionist. But the war of wits with this resolute rodent tested me right to the edge.

Do we need a van pitching up outside with “Rat Whisperer Rodent Control” or suchlike emblazoned down the sides for everyone to see? Not if I could help it. Thoughts focussed on more discreet solutions - traps, different types of traps… or just maybe… poison:-

1. Humane cage trap… If this wily rat has any notion that “humane” implies a promise of a pleasant release in the delightful Lancashire countryside, he has another thing coming - in the form of an early bath, a deep one.

2. Jumbo sized Nipper trap… Might work if I can get the knack of setting the sprung bar to a delicate hair trigger without dislocating a finger. Otherwise the crafty culprit will abscond with peanut or medium cheddar, leaving the unsprung trap looking ridiculous and no rat to be seen. And crunchy peanut butter has been a major disappointment, turning so watery I could not imagine any self-respecting rodent fancying it.

3. Poison blocks and bait stations… yep! That should do it. Traps deal with one rodent at a time. A bait station can despatch several in one night. The downside is need to ensure no poisoned victims are left exposed for other animals.

Billy may be geriatric, but his sniffer faculties are fully intact. With tail still awag, he showed me exactly where the rat had gone. The rodent fled from the hallway into my mother’s bedroom. She likes to sleep with her bedroom door ajar so I can hear if she calls out in the night.

I felt truly awful. There were 4 inches of rat’s tail exposed from below the radiator edge, but we had no other bedroom to which to evacuate her. I lied. The following morning I explained that the trap shenanigans were to catch a mouse which had come in from the fields.

Hide and seek was not this rat’s forte. Its tell-tale tail remained exposed the following morning. To my shame, I wasn’t brave enough to grab it, even with gloved hand. I tried to trap the tail at arm’s length with a sprung plastic clamp, and failed miserably. The sensitive tail flicked upwards and the rat scurried away behind a chest of drawers.

Later that day, I noticed that the rat had been trying to scratch an escape route in the hall floor, into the subspace below. So I removed a couple of the evidence-bearing parquet blocks to aid the culprit’s task.

I hear you ask:- “Why let the rat into the floor subspace?” Well, four reasons. This destination was far preferable to grandma’s bedroom. I could lay bait stations and poison blocks down there without harming Billy. A deceased (albeit smelly) corpse would remain safely away from other animals. And it took the some of the immediate pressure off me.

Rat terminated. Crisis over.

And now, each morning, I check grandma’s bedroom floor for any new fragments of wallpaper that may have fluttered down from behind the radiator…

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Sad postscript. I was by my mother Yvonne’s side in a hospital cubicle when she died, just two weeks away from her 102nd birthday. A pulsating aorta gave way. After 42 years apart she has rejoined her beloved husband Tom who passed in 1983. I cared for Yvonne for five years. I still care for my wife who has multiple sclerosis.

A village in winter

No grit on the lane

Slip into snow mode

Or skidding’s a pain

-

Wheelchair to transport

A rollator too

Ladies with walking frames,

Cars just won’t do

-

Each week on a Wednesday

My challenge, the same

8 bags and a cool box

Don’t work on a train

-

Power button lit

Like a cheery hello

“Regenerative drive”…

And we’re ready to go

-

Her poise on the driveway,

Her charms beckon me.

Please don’t let her tyres down,

She’s a PHEV !

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I’ll stretch the topic a little for the 3rd item: - Caring and Garden Railways? Of course. My projects are my release, and help support my ability to care. What’s more, Spring is here… (I think).

Home care givers try to sort out *everything*, whatever happens.

The Big Red Bean Bag

When you are 70, lifting another adult isn’t easy. My wife collapsed on the floor. This can happen if she catches a virus on top of her MS. I can lift her a little on my own, but not high enough to get her up on to a bed or chair. And we don’t have a hoist or air lift.

Sometimes, carers have no option but to call an ambulance and paramedics to lift their dependant from the floor. Sadly, aside from diverting a scarce resource, in the UK a non-emergency ambulance call can involve a long wait with the vulnerable dependant stranded for hours on the floor or ground.

Our big red bean bag is a very Helpful Thing. I bought it for grandchildren watching TV. Nowadays it helps me to lift my wife.

I gently sit her up with the bean bag snugly behind her. I stand behind her and the bag, and supporting her shoulders lean her onto the bag and ease her steadily toward me, so the soft bag rolls along between her and the floor, until she is sitting up on the bag. She is now near enough to bed height to allow me to transfer her across to the bed or a chair.

She reassures me this manner of rescue doesn’t hurt her at all.

A Fish Food Tub

Drip… drip… drip…

Torrential rain outside. A wet patch on the duvet. My heart sank. How are we going to sleep? The traditional purlins in our bedroom roof are exposed, with a spiral stair up to my mezzanine teccy area in the loft space. I can at least see what’s occurring without a surprise plaster bulge scenario, needing a drill hole to release a cascade of water…

You know those people who don’t throw things away because… just in case? That’s me. I had some empty fish food tubs and cup hooks in the shed. These tubs have a pivoting handle like a bucket, but with more refinement for the required task…

An empty Fish Food Tub is a very Helpful Thing I put a hand towel in the base to muffle the sound of drips.

Now fixed and cleaned, our aged roof had liberal clumps of moss, and a couple of rusted nails had allowed a tile to slip. We’ll need a new roof eventually, but I’m discouraged when see owners nearby scrapping traditional purlins covered by tongue & grove boarding, and replacing them with modern “A” frames as a cheaper option. I couldn’t bear to lose my teccy-area space.

Margarine Tubs

An empty margarine tub is a very Useful Thing. This is I admit a brazen excuse to write a little about garden railways. As weather improves, I’ll write more in articles to follow. These “Flora” tubs are old ones I’ve hoarded. I buy “Olive Spread” from Aldi now.

The tubs were made resplendent in aerosol silver. I scratch-made strip wood frames and sprayed those orange. Then formed aluminium angle axle bearers and wire coil springs. The final stage was to buy in steel wheels, buffers and ladders.

The result, 16mm scale 45mm gauge ore or ballast wagons for a garden railway, or my indoor exhibit. The completed single wagon is on my indoor exhibit.

In the garden. radio controlled loco “Criccieth Castle” hauls a train of “margarine tub” ore wagons round the return loop. Motive power also includes live steamers and some scratch built locos.

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A note.

It didn’t stay long

In a trice, it was gone

Will somebody see

Words crafted by me?

Or perished forever,

My fervent endeavour.

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Enhanced Robies

Each has 3 Arduino Unos for Sensory and Wireless, Command and Control, Vocabulary and Speech. I think the vintage tech “Narrator” chips suit them.

The 37-way emulator and analyser boxes running behind stepped in as extras. They are part of my TD700 plasma project.

Why…?

The Burroughs plasma display power supply (PSU) has become scarily unpredictable.

I could have replaced or rebuilt it, but this work wouldn’t support other projects. Amongst other things, I want to try the 8 line plasma panel as a stand-alone unit. I’ll need the flexibility of an external PSU with DC outputs of +5.1, +12, +30, +250, -12, and -250 volts.

I thought this would be a straightforward project. It wasn’t.

The problem

Full wave rectifiers. I wanted to ground at both G1 and G2, because floating voltages of 100+ DC are not human friendly. But to do this would short out diode D4.

The Answer

Half wave rectification. And some big capacitors. Simpler and more robust than using diodes to try to isolate separate rectifier circuits and their connected equipment.

I had no regulators for -12 and 250 volt outputs. Cue some potentiometer and resistance box experimentation under load.

24 volts AC produces uplifted 35 volts DC output when rectified. Useful here, because a 40 volt DC maximum for input to the step down regulators rules out the 48 volt tap on T3.

Getting started

Well hello, dolly…! Power Cube has wheels.

Components gathered...

Ply offcuts with matt blackboard paint

Aluminium angle and solder tag strips

And some scrap white acrylic for fascia panels.

Angles

On the left, resistance box. I also use this to discharge hot capacitors which may lie in wait for hours with a 200 volt zap for the unwary. Power cube’s lettering is all protected by clear vinyl adhesive film used for book jackets. On the right my original full wave rectifiers, laid out to help a 69 year old do the wiring.

Chewing Gum

When you drop an M3 bolt down the edge of a transformer, chewing gum is your new best friend…

Complete

Components and circuits installed…

AC side power on…

DC side ready…

And a test using +5 +250 -12 volts to power the single line self-scan, and +12 for the Arduino Uno…

And a short video sequence with some blinky light action. This may not play from certain platforms.

Next, let’s see what, if anything, can be done with the 8 line panel. Frustratingly, I failed to find any application notes for my version, so I’ll use an Arduino Mega to help identify the data pinouts on its 37 way connector.

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100!

What better excuse than a 100th birthday to revisit my May 19th article promoting understanding of unpaid care giving.

Everyone says, “Isn't she wonderful for her age?". She is. Of course. I would not be surprised if she outlived both me and my wife. I know… there seems to be something self-fulfilling about that prophesy.

Why…?

My first COPING WITH CARING Substack post outlined that I’m unpaid care giver for two vulnerable ladies, my mother (then aged 99) and my wife aged 67.

Care giving creates a new, unexpected, hectic chapter in the carer’s life. Familiar home routines are scrambled, Sky Sports is cancelled, and “want-to-do” lists are consigned to the waste bin.

My wife’s life was turned upside down by multiple sclerosis more than 30 years ago. She was a State Registered Nurse and Community Midwife. Today, she busies herself with the garden and crafts, and helps as much as she can in the kitchen. I can see her enduring frustration and pain every day.

My relationship with my (adoptive) mother was never great. I was a “strange" child. I have an abiding childhood memory when she told me that our admittedly mischievous dog had:- “Gone to live on a lovely farm…” She remembers little of those times.

So, why am I now her care giver:-

Necessity?

Obligation?

Our utterly dysfunctional system of social care?

None of those. Nor is it about love, or pity, or even duty. I can best describe it as empathy and compassion for two vulnerable ladies close to me, who need my help. This has to be empathy and compassion which wholly respect their own human individuality and dignity.

Help and Support

Do I get practical help and support?

Nope.

Not one iota…

Unless you count my wife’s fortnightly visiting physiotherapy sessions, which she needs to help cope with her MS, and which we pay for. I clear away dining room furniture to make space for the guy’s fold-up physio bench.

And a lovely lady who also comes in fortnightly to clean for us.

I once emailed the local Care Coordinator to ask if I could discuss a contingency plan in case I ceased to be able to care. More than 3 years later, no reply.

On rare visits to the local GP Practice they quiz me:-

“Who is it you care for?”

“How old are they?”

One day, we queued in the street with wheelchair and walking frame for vaccinations. My wife was distraught. The three of us struggled in. I hope they do not treat people like sheep again this year.

There was a large “Age UK” publicity banner displayed in the waiting area. Item 1 on their list was “Carer Health Checks”…

…Not for me, it seems. At a previous encounter the GP gleefully propelled his chair across to his screen and banned me 😅, with a smug smile which said “Gotcha matey, you’re not a carer, you’re a time waster”.

Not that I minded too much. 20 minutes with a dour nurse wondering why I was there, and whose top lip curled at regular intervals, was a waste of everyone’s time.

And so, for whatever reason, they refuse to believe I’m a care giver.

Could it be, a recognition that there are good male care givers out there would be an irksome deviation from somebody’s radical feminist ideology…?

Surely not.

Financial

I’m more fortunate than many UK carers, because care giving has not, so far, stretched our household finances to breaking point.

I obtained a Lasting Power of Attorney (LPA) for mother’s property and financial affairs from the Public Guardian’s Office. The on-line process was straightforward. However, registration of said LPA with HSBC Bank was protracted and frustrating. Registration was impossible to complete online or by telephone, and required at least one personal visit to a “local” branch.

Here are two LPA-related points to bear in mind:-

1. Two (HSBC) banking apps cannot co-exist on the same smartphone, nor can one phone app be used to manage two different accounts. So, managing Mother’s bank account requires an online PC and a physical secure access keypad.

2. An LPA requires the Attorney to represent the Donor. It does not permit the Attorney to countermand a decision which the Donor has the mental capacity to make, no matter how ill-advised you think that decision may be. Without delving into the detail here, my 59 year old youngest brother never left home. A continuing situation to which Mother inadvertently gave her blessing, and one which, sadly, another brother and I will have to unravel when the time comes for us to act as her executor-trustees.

Happiness

Care givers strive to be super-human. We morph on demand into attendants, comforters, dressers, mediators, mentors, nurses, podiatrists, psychologists, waiters, weightlifters and more. I try... But cannot excel in all those roles. My personal bandwidth has limits, and my age is beginning to tell:-

I talk to myself a lot.

I talk to the dog a lot. (He’s very supportive…)

I capture new ideas and thoughts by writing them down before they fade away.

That they are washed, dressed, fed, watered, tea’d, cared for, kept safe, is not enough. My most important measure of success is whether those I care for are Happy. I try to understand what makes them Happy. If you have a mind to, you can explore and apply a multitude of pillars and theories from Aristotle et al. For those I care for, Happiness seems to work at two simple subjective levels - separate episodes of well being, and more enduring feelings of positive life satisfaction.

And there, I find a paradox. My mother’s declining faculties seem to allow her enduring happiness. She’ll say:- “I’ve had a good day today”, when she’s done little more than binge watch Britbox and Sky News. Is that a “legitimate” experience of happiness? I think it is.

I’ve tried to engage her with books, crosswords, jigsaws and painting to no avail. She’s happy when sneaks a mouthful of marmalade straight from the jar at breakfast, has a jam tart with her 3pm cup of tea, has strawberry jelly with her fruit cocktail in the evening, or gets to sit in the summerhouse on a fine afternoon. But what she loves most of all are gnomes, her garden gnomes.

For my wife, with mental faculties fully intact, enduring happiness can be elusive. She regrets ever agreeing to my mother moving in, and that can be a source of friction. She sometimes finds dealing with Mother’s early signs of dementia difficult, when she may be in pain herself. I will never knowingly abandon either of them to our system of social care. My wife loves her greenhouse, her Koi, Orfs and Grass Carp in our pond, Whatsapp videos of the grandchildren, and her crafts. And she chairs the local “Country Markets”. These things make her happy, or at least, contented.

The house environment is such an important catalyst for happiness:- our dog, the nightlights lighting their way in the dark, the fresh flowers I buy every week.

From time to time, I ask both ladies the question. From mother - always an emphatic “Yes”. From my wife - usually a more hesitant “Yes”. No sign of deference or sarcasm. By no means complacent, that’s probably the best I can hope for.

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Introducing Roboscouts

There should have been three.

But tragedy struck when a near mint, boxed, example being shipped over from the US was mercilessly intercepted and crushed by US Customs for being in possession of a battery. Sadly one less Roboscout on the planet. I had a deal of sympathy for the seller. Roboscout’s large SLA is difficult to remove, even after detachment of 15 miniature Molex PCB plugs and extraction of the main board.

My Roboscouts were made in 2000 by Sharper Image Design. I’m sure I’m not the only one to have spent many a happy head-scratching hour trying to reverse engineer Roboscout’s convoluted PIC-based mainboard - without success. One common fail seems to be a chip which switches between charging and onboard power.

Roger needs a new semi-autonomous brain.

This post is about onboard power, speech and movement. I have more work to do on Roger’s voice recognition and sensory function including Roboscout’s hidden surveillance camera and infra-red sensors.

And a final cautionary note - this post contains my own “venerable” solutions, which some start-of-art guys may find upsetting….

Power

The first step was to scrap Roger’s SLA (lead acid) lump, and replace it with 2 x 10 x 2400mA rechargeable NiMH cells and an LED battery monitor screen.

The space vacated by the SLA is now occupied by two Arduino Megas. A rectangular cut-out in Roger’s base gives access to their USB programming ports.

Speech

For Roger, I decided not to go down my usual “SP0256 Narrator” route. I opted instead for a probably equally obsolete WTV020SD16P card, which, rather cleverly, can randomly access Octally indexed .AD4 audio files (speech phrases) stored on an ordinary SD card. Roger currently has a vocabulary of 178 words and phrases on one card. Here, a WTV020SD16P card undergoes a quick test from a Uno, without an amplifier. So sound right up🔊…

Speech generation from .AD4 files had 4 stages. This seems daunting, but was fairly straightforward. Here’s how I created Roger’s natural speech vocabulary:-

1. Format (overwrite) the SD cards using dedicated SDcardformatter from sdcard.org. Note, not Windows format.

2. On the FreeTTS.com website, select the language and voice, and input the required text to create .MP3 files which can then be downloaded.

3. Use onlineconverter.com/mp3-to-wav site to convert each MP3 file to a WAV file.

4. Use AD4convertor to convert .WAV to .AD4. I installed “AD4convertor” a couple of years ago as a zipped app. It still seems to be available on several sites. You execute it at the command prompt, and it looks like this:- AD4convertor -E4 0000.WAV where “0000” will be assigned as the index number for this word or phrase on the SD card.

I can hear the screams from here. There are *much* easier ways to create a natural robot voice…

Probably… What I like about this method is the facility to have large randomly accessible vocabularies on removable, swappable SD cards.

One final pitfall for the unwary. WTV020SD16P expects 3.5 volt data, not 5 volt data. This is easily accommodated by including a 470ohm resistor in each data line.

Movement

Here was lying in wait a further conundrum. Roboscout’s motor function is driven by brushed electric motors, with simple photointerruptor feedback. Body and limb construction don’t easily lend themselves to servo conversion, which would have been the ideal way to convert Roger to Arduino control.

The best option was to interface digital outputs from two Arduino Megas to12 volt relays via 2N3904 transistors, and to introduce potentiometers for analogue feedback where this could improve on the photointerruptors. I was able to reuse ten of the existing Molex-type motor-feedback connections to new PCB plugs on two relay boards. Each Mega controlling 10 relays on its board.

I decided to use separate relays for left/right, up/down, clockwise/anticlockwise functions. I could have used DPDT relays, but these would have needed separate provision for the “off” state. These separate relays also simplify interfacing the Megas’ digital channels (eg: one digital output for up, another for down.)

Roger’s first brain motor function test, sound right up…🔊

The row of 36 1.8mm LEDs grouped in fours has become my signature interface!

Roger says Hello

After a little cosmetic work on his eye mood colours and mouth LEDs….

Sound right up 🔊…

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In 1971 the Burroughs Corporation of Detroit announced Neon-based Self Scan gas plasma panels as an innovative successor to cathode ray tube technologies. The Self Scans required less power, had no deflection coils, had simplified electronic circuitry, and displayed an attractive sharp, stable character set in monochrome orange. However they still required relatively high voltage to energise the tiny gas tubes.

Unlikely Partners

This is a 1976 Burroughs SSD0132-0040 Self Scan panel. It displays one row of 32 characters. I had the greatest success with this panel, after I connected it to a present day Arduino Uno microcontroller…

Everyone loves a set of blinky lights. Well at least, I do. I have a good excuse for the lights in this picture. These LEDs help me to diagnose - to understand the “handshaking” logic sequences between the Uno and the SSD. To help further, I can slow the process right down to single steps by introducing delays to the Uno’s code. It turns out that most of the signals which tell the display how to behave are “ACTIVE LOW”. So for example, when the SSD wants to say to the UNO:- “I’m ready for the next 6 bits of character data”, it sets pin 7 to (near) zero volts, not, as you might have expected, +3.3 or 5v.

I love the idea of the Uno reaching back into 1976 to bring this SSD to life. That said, the Uno still needs a little help from a DC 250 volt power supply, to energise the plasma display. The 250 volts DC input is the wire shrouded in red heat shrink tube on tag 10 of the lower connector. Don't try this at home folks unless you are really confident with high voltages and safety precautions.

Connections

These are the connections I used to make the SSD active.

• 1, A, 2, B. 3, C - 6 bit data, which I had in reverse order on my first attempt.

• 8 - BLANK UNO → SSD

• F - ACK SSD → UNO (active low)

• 5 - RESET UNO → SSD (active low)

• 7 - READY SSD → UNO (active low)

• D - LOAD → UNO → SSD (active low)

• L - GND

• J - +5 volts

• 10 - +250 volts

• 4 -12 volts

TD700

I’ve had less success with the SSD’s big brother. This is a TD700 DL4 Self Scan plasma display from 1973 which displays 8 rows of 32 characters.

The plasma display panel is detached and separate from the terminal case containing the circuit cards, cage and backplane. It rests on its own supporting feet and is connected by means of an unwieldy multicore cable. This arrangement allows the display panel and keyboard to be used 18 inches or so away from the terminal case.

I started by replacing 2 corroded capacitors on cards "A" and "T" in the control unit cage.

After 4 days spent gingerly notching up the power supply using my trusty variac, trying not to pop the aged PSU capacitors, I achieved a display cursor with ghosting on rows 4 and 7. You can just make it out, top left of display area in the next picture. The faint pixels shown up by the cursor occur in the same positions across the row. I hope this will be a resolvable logic or driver issue in the self-scan control card, rather than a write-off self-scan module…

A working display looks like this…

However, after a short while my experiment had to be rapidly abandoned. The line voltage had suddenly jumped to 600 volts DC. I decided at this point not to risk the aged capacitors any further, but to build the TD700 a brand new external supply.

Wire Wrap

The TD700’s wire wrap backplane is a wonder to behold. No printed circuit copper trace address bus or data bus here…

The aged PSU capacitors are tucked behind the mains transformer, together with other metal canisters which I’m fairly sure are rectifiers…

The transformer frame incorporates a useful set of test points for 5.1v, 12v, -12v, 30v and -250v. Oddly, these points were all up to required values when the variac was supplying only 110 volts AC. This TD700’s identity plate is stamped for 240 volts!

I sourced an external panel transformer whose outputs can easily be adapted to correspond with the TD700’s test point requirements, whilst at the same time capable of supplying the relatively high current requirement. It’s on a trolley because it’s heavy…

Having gathered together the capacitors, voltmeters and other required components, sadly for now the PSU build is low down on my “To Do” list. That will have to be a story for another day.

Coming soon, weather permitting, is “The Station” my garden railway picture story.

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“Terrible Culture of Blame"

When did:- “Don't worry, we will absolutely keep you safe" ¹

Change to:- “Don't worry, if we accidentally kill you, we will definitely learn lessons from it".

In March 2016 then UK Health Secretary Jeremy Hunt said “It is a scandal that every week there are potentially 150 avoidable deaths in our hospitals and it is up to us all to make the need for whistleblowing and secrecy a thing of the past as we reform the NHS and its values and move from blaming to learning”.

Then in June 2022 Mr Hunt spoke of the “Terrible NHS Blame Culture”.

Wait a minute. I appreciate that health professionals are human, but professionals have to understand that they are accountable for their life and death mistakes. If not, how can anyone have confidence and trust in the care they provide. Do we really see patients’ lives and wellbeing as potential collateral damage, as staff “learn", and then move on to the next case. If there exists a “Terrible Culture of Blame” in the NHS, this suggests that too many things happen for which people should rightly be blamed.

You may feel “Collateral damage" is too strong, too controversial, too emotive a term to use.

Perhaps. Until we remember the untested Covid-infected patients that were offloaded by NHS hospitals to care homes supposedly sheltered by Health Secretary Matt Hancock's “Protective Ring of Steel”, and the number of elderly care home residents who, as a consequence, contracted the virus and died in isolation from their families and friends.

The plain fact is, the NHS juggernaut is pathologically incapable of learning from previous scandals.²

“Good Deaths”

Not the 150 a week avoidable ones, part of what follows was deliberate.

A respected health care influencer blocked me on Twitter because I described how between 2003 and 2014 certain English hospitals had been drugging elderly patients then starving them to death. It happened. It was called “The Liverpool Care Pathway” (LCP), and notwithstanding the name, the practice was not confined to the City of Liverpool. In less complimentary circles, LCP earned the then Health Secretary the nickname “Midazolam Matt”. A hospital doctor commentating on Twitter claimed there was no abuse of Midazolam. So I asked him whether he found the LCP’s “Good Deaths” ethically and morally acceptable. He dodged the question. As far as I am aware, no one involved has ever been held accountable.

Contrast Liverpool Care Pathway (LCP) with the Gosport War Memorial Hospital scandal. While the allegations forming the Gosport scandal pre-date LCP, there are distinct parallels between the two. It is alleged that between 1989 and 2000, 456 elderly patients had their lives cut short through the unlawful administration of high doses of opioids³. There was a lamentable failure by Hampshire Police to properly investigate, amid allegations of cover-up, corruption and scapegoating.

The Gosport investigation was taken over by Kent and Essex Serious Crime Directorate in April 2019 as Operation Magenta. After assessing over 750 medical records and 1150 witness statements from family members, 19 suspects have been identified and are being interviewed under caution.

These are major scandals we know about.² That they have come to public attention is due in large part to the unflinching tenacity of family and friends of the deceased, in exposing the truth.

Whilst human judgement is fallible, and professionals can make mistakes, on rare occasions decisions are made that are perverse or downright malevolent. What I find absolutely unforgivable are NHS denials and “cover-ups”, depriving family and friends of the true facts. No one really knows how many more scandals may have been buried by aggressive anti-whistleblowing policies.

As if to underscore these concerns, the latest in a string of NHS whistle blower sackings emerged at Brighton’s Royal Sussex County Hospital. Two renowned surgeons lost their jobs after raising concerns about malpractice and patient safety in neurosurgery and general surgery. Sussex Police are investigating 19 deaths and 23 cases of serious patient harm alleged to have occurred between 2015 and 2020. For those families, now alerted to the probability that their loved ones did not receive the care they deserved, this must be a truly awful time.

This continuing “cover up” culture in the NHS undermines any foundation on which to build confidence and trust.

I’m 69 and unpaid carer for 2 vulnerable ladies. I do not want a hospital-acquired infection. And I do not want to be drugged to the eyeballs on God-Forsaken ward, waiting to die a miserable, lonely death, with the true facts withheld from my family.

“Ah… the NHS will say, that’s all in the past.” I’m not convinced.

Without Trust, the canula they put in your arm is scary. You have no clue, no control, no trust, as to what the NHS might put into your body.

“Complications"

We sometimes hear of an unfortunate patient who entered hospital for a supposedly routine procedure, and then died or suffered harm from “complications”. Which makes me wonder about “complications”. What is a “complication”?

• Poor aseptic technique?

• Hospital-acquired infection?

• Ineffective antibiotics?

• An event or underlying condition that the doctors failed to identify or anticipate?

• Cost cutting exercise?

• Or perhaps, just a plain “cock-up”

Or could this be a euphemism for “cover up”? Surely not!

Disgruntled Staff

An already desperate situation has been exacerbated because overworked, underpaid, disgruntled hospital staff consider they have been left with no option but to take industrial action. The implied government line that clinicians’ love of their vocation should trump their need for a decent level of pay, and safe working conditions for them and for their patients, just doesn’t wash anymore.

Primary Care

I see “our” GP once in a blue moon. He doesn’t like me, and I don’t trust him. On one rare encounter, he didn’t notice the nosebleed I was having, sitting right in front of him. This is the same guy who banned me from carers’ health checks.

So, which would you prefer, a newly qualified, fresh faced doctor well versed in the very latest academic research and diagnostic techniques, who understands the exponentially growing relevance of AI and other technologies… Or a disillusioned, albeit experienced, dyed-in-the-wool practitioner marking time to their early retirement and their pension. (Rhetorical)

My first instinct was that numbers of the former would be declining, with those of the latter increasing, as more overworked GPs near retirement. I was wrong. The numbers of both groups are declining relative to the population they serve. It is estimated nearly half of GPs want to retire before they reach 60.

“…the NHS is in the midst of a chronic workforce crisis, driven by years of insufficient investment in training new staff, inadequate workforce planning, and lack of government accountability…”⁴

“The NHS has lost the equivalent of 2,133 full-time fully qualified GPs since 2015.”⁵

“Whilst the GP workforce is declining, the number patients continues to rise. In April 2023, a record-high of over 62.4 million patients were registered in England. As a result, the average number of patients each full-time equivalent GP is responsible for continues to rise, and now stands at 2,292. This is an increase of 355 patients per GP, or 18.3%, since September 2015, demonstrating the ever-mounting workload in general practice.”⁵

Current health secretary Steve Barclay recently announced £240 million funding to improve GP services through improved use of technology and using receptionists as expert “Care Navigators”. Whilst any funding increase is to be welcomed, this relates to availability of appointments rather than provision of more doctors - little more than a sticking plaster.

Primary care needs more GPs. It can take up to 10 years to train a new GP , exposing a woeful lack of forward work force planning:-

• A medical degree - usually takes 5 years

• Doctor foundation training - usually a further 2 years

• GP training under supervision - usually 18 months in a hospital then 18 months in a GP practice.

Then Health Secretary Jeremy Hunt said:- “We’re training more doctors than ever before”. Welcome news, you’d think, until you realise that the log jam is in insufficient post graduate foundation and specialist training places.

Can it be saved

Whilst I intended this post be about trust (or not) in the NHS, it would have been remiss not to summarise the roles of workforce planning and funding. Funding stream details are complex, particularly in relation to GP practices, and therefore beyond the scope of this article.

Nye Bevan’s 1946-8 model has become increasingly difficult to resource and sustain. Reduced availability of key services, delays, longer waiting times, shortage of doctors and nurses, and decaying estate were already evident before the Covid pandemic.

The British Medical Association (BMA), the trade union and professional body for doctors in the UK said:- “Although NHS spending has increased, it has not increased enough to keep up with demand. There has not been enough investment in infrastructure, which means there are not enough beds in hospitals and some estates are unsafe. Staff have also had to put up with sub-inflationary pay rises since 2008, leaving them feeling undervalued and burnt out.”⁵

Several critical strictures have been at play:-

• extortionate PFI contracts with the private sector, used to finance over 100 new buildings from 1992

• more recently, dodgy PPE contracts

• waste

• expensive clinical errors

• an increasingly litigious society

• increasing demand

• increasing costs of treatments including drug prices

• bed blocking - directly attributable to inadequate social care provision

• aging population, often with multiple morbidities and more complex chronic health needs

On one hand there are widely held suspicions that during the 13 years they have been in government, the Conservatives have deliberately run down the NHS in order to open opportunities for privatisation. It is true that some additional funding was allocated, but it was nowhere near enough.

“The increases in NHS spending agreed by the government were insufficient to deal with the costs of rising demand and deficits that had built up after five years of constraints. Winter pressures from 2014/15 onwards made the effects starkly visible as patients encountered overcrowded A&E departments, long waits on trolleys for hospital beds, and cancelled operations.”⁶

On the other hand Labour in opposition are unlikely countenance substantial increases in personal and corporate taxation to adequately fund the NHS, because to do so would be electoral suicide. And proposed one off “windfall taxes” will not open up consistent revenue streams.

With no clear political will on either side to develop an imaginative, radical funding policy, the NHS will continue to run on an financial knife edge. The possibility of eventual implosion cannot be ruled out.

Artificial Intelligence AI

I may be pilloried for this suggestion.

AI, Artificial Intelligence, coupled with state of art computer vision, scanning and monitoring will assist in saving the NHS, especially for primary care. AI can access millions of instances of diagnostics data and anonymised disease histories in seconds. Chatbots such as GPT4 and Bing Chat do not have inherent “intelligent” power to reason, but their ability to process massive stored data and language provides an extremely convincing impression that they are able to do so, holding (for example) their end of high level debates with human philosopher about the Stoics and Stoicism. These abilities can be applied to clinical imaging, monitoring, note taking, and most significantly of all, diagnostic consultation and routine prescribing.

This is just one study, but it echoes anecdotal findings elsewhere. In clinical settings interacting with humans, ChatBots can perform impressively on ratings for empathy, accuracy, and overall user preference.

We know also that AI Chatbots have a tendency to “hallucinate” (tell lies), when they run out of answers. Nonetheless, on balance, I think would trust a healthcare AI Chatbot just that little bit more than I would trust an overworked, stressed out, fallible human GP.

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Conclusion

So, can I trust the NHS?

Right now? No.

Frustratingly, I cannot find the post where where I read this…

We should stop using the term “patient” because "patient” implies a powerless submissive recipient. They are Clients, entitled to a high quality service. What is required is a two way “Client - Provider" relationship.

1. Unnamed front line A&E doctor amid Covid crisis

2. I’ve taken some of the more well known historical scandals as read:- Thalidomide, Primodos, blood products, vaginal mesh, Mid Staffordshire…

3. Gosport Independent Panel Report.

4. BMA bma.org.uk 25/5/2023

5. BMA analysis of NHS General Practice Workforce Data

6. The King’s Fund: Rise and Decline of the NHS in England 2000-20

You might like one or more of my previous posts…

Plug-in Night Light

A plug-shaped light which fits in a mains socket to light automatically when darkness falls. The gentle glow in bedroom and hall provides a safer, comforting environment for night time wanderers.

Moon Lamp

Mother loves her moon lamp. A translucent orb lit by a light emitting diode (LED). I leave it switched on in her bedroom all night. 2AA batteries last about 2 weeks. It glows white, lighting night time visits to the commode, without being so bright as to keep her awake. Any similarity between the moon lamp’s surface and lunar geography is purely coincidental.

Caravan Step

Heaving your mother with your shoulder is not the most dignified way of elevating her into the back seat of your car. (Not that I actually do that…!)

My mother cannot climb my car’s high door sills unaided. This step helps, although she still has difficulty and needs to persevere.

Hand Held Mini Vac

This vac easily removes crumbs from the worktop and hob. It also likes:-

• pottery shards after a mug makes an unscheduled visit to the kitchen floor

• those nightmare polystyrene fragments that scatter when you open a delivery, and stick limpet-like to your hands, and just about everywhere else

• sleepy wasps

Extended reach grabber

My wife uses a grabber to reach cans and other items from kitchen cupboards, or from the floor. I liked it so much I bought myself one, to retrieve derailed stock from hard to reach corners of the layout in my shed.

Wireless Chime

Talking of sheds, my wife uses this wireless bell push to summon me to the kitchen.

Wheelie Shower Chair

I turn on the shower before going to fetch Mother, and wheel her back in this chair. By the time we get back the water has warmed up, so she doesn’t get cold waiting. The chair goes right into the shower so she can sit while being washed. No need to decant her to a fixed shower chair.

Britbox

What a Godsend…

Mother has watched every episode of “Vera”, “Touch of Frost”, “Doc Martin” at least half a dozen times. She says Brenda Blethyn and David Jason wear lovely hats. I’ve tried to wean her across to Midsomer Murders and Miss Marple (with many more series and episodes), but she invariably returns to Blethyn, Clunes and Jason.

2nd Toilet

No explanation (or picture) needed.

It’s essential.

In England and Wales you may be able to apply to the local council for a disabled facilities grant:- https://www.gov.uk/disabled-facilities-grants

Power Lift Wheelchair

Not cheap. We bought this one second hand.

My wife likes to help as much as she can in the kitchen. Two years ago she fell from her perching stool and broke her hip. She insisted her leg was in spasm due to her MS. After three days, she finally conceded the need to go to hospital. This house now enforces an absolute ban on perching stools.

This clever chair moves forward, backward, left or right, lifts you up, and lowers you down. It weighs an absolute ton, but turns on a sixpence. It gives my wife freedom and independence to move around the kitchen, and reach what she needs to help me.

Dishwasher

Yes, I know. Not especially low-tech. But worth a mention.

I overheard two older guys chatting, and one was saying that the first thing he did on moving to his new place was have the dishwasher removed…

Gosh. I wouldn’t have done that. I love my dishwasher. It has mysterious powers. It waits until I’m sitting down, then pushes the door open by itself, and beeps, demanding to be emptied!

It saves me a huge amount of time.

It saves me a huge amount of backache, from stooping over the kitchen sink.

You might like my other posts:-

We were startled by the bang. A toughened pane in a rotting frame just shattered, scattering a thousand glistening diamonds to the ground. “Help me!” it screamed. “Please don’t neglect me into decay and nothingness…”

I’m so glad we didn’t. I made it better. Roof re-membraned. Wood re-coated. Oversized doors from eBay cut to fit. Windows of clear acrylic.

Now, a welcoming dry refuge whenever raindrops patter on the garden and roof.

A destination and a sanctuary, not too far away for wheelchair or walking frame to venture out.

And on a fine summer’s afternoon, a place to sit in gentle shade with tea and jam tart. Blissful solitude, and quiet contemplation of swaying trees, and an audacious blackbird close by, exploring newly dug garden.

Our wonderful place, with comfy chair, for sitting, and lolling, planning and dreaming….

Whilst I don’t have a great deal of time to devote to them nowadays my robot and train projects continue (slowly) as my occasional escape from care giving. Last night, I became so frustrated with my inability include a short video clip in a reply to a note (most likely operator error), that I decided to create this new post.

It started with a discussion of AI. I was overcome by this sudden urge to create a machine that was primitive, but which could nonetheless learn and recognise colours. So that’s what I did. And here it is.

OK, it is not *exactly* a robot. Nor is it especially useful, but I love it all the same. It is a simple functioning sensory system that “sees” and reports colour.

Sound right up…🔊

The HC-SR04 ultra sound detects the target. The command Mega fires a relay to flood the target with light from 2 rows of LED strips, the sort used under kitchen cabinets.

The target cards are a different colour on each side.

The colour sensor consists of a black metal mask with 96 6mm holes arranged in diagonal lines. Each diagonal line is backed by a theatre quality red or blue or green acetate light filter. Behind the RGB filters are 96 light dependent resistors (LDRs) providing analogue output to 6 Arduino Megas. Each Mega supports 16 analogue inputs, so there are two for each colour.

The (7th) command Mega, collates the input from the 6 others, assigns percentage values for each RGB colour component, and compares these to known values. It also controls speech synthesis from stored allophone values.

The voice is created by an SP0256 “Narrator”. An obsolete chip by today’s standards, which assembles recognisable words from allophone sound fragments. I love this “War Games” type voice, and I use in several of my robots.

I included the 3 now-empty DIL sockets on the interface card for latches, but it turned out I didn’t need them.

As I mentioned. Fairly useless, but hopefully engaging nonetheless…

My thanks to for inspiring me to post this!

Why…?

My first COPING WITH CARING Substack post outlined that I’m unpaid care giver for two vulnerable ladies, my mother aged 99 and my wife aged 67.

Care giving creates a new, unexpected, hectic chapter in the carer’s life. Familiar home routines are scrambled, Sky Sports is cancelled, and “want-to-do” lists are consigned to the waste bin.

My wife’s life was turned upside down by MS more than 30 years ago. She was a State Registered Nurse and Community Midwife. Today, she busies herself with the garden and crafts, and helps as much as she can in the kitchen. I can see her enduring frustration and pain every day.

My relationship with my mother was never great. I have an abiding childhood memory when she told me our (admittedly mischievous) dog had:- “Gone to live on a lovely farm…” She remembers little of those times.

So why am I now her care giver:-

Necessity?

Obligation?

Our dysfunctional system of social care?

None of those. Nor is it about love, or pity, or even duty. I can best describe it as empathy and compassion for two vulnerable ladies close to me, who need my help. This has to be empathy and compassion which wholly respect their own human individuality and dignity.

Help and Support

Do I get practical help and support?

Nope.

Not one iota…

Unless you count my wife’s fortnightly visiting physiotherapy sessions, which she needs to help cope with her MS, and which we pay for. I clear away dining room furniture to make space for the guy’s fold-up physio bench.

I once emailed the local Care Coordinator to ask if I could discuss a contingency plan in case I ceased to be able to care. 3 years later, no reply.

On rare visits to the local GP Practice, they quiz me:- “Who is it you care for?”, “How old are they?”.

One day, we queued in the street with wheelchair and walking frame for vaccinations. The three of us struggled in. There was a large “Age UK” publicity banner displayed in the waiting area. Item 1 on their list was “Carer Health Checks”…

…Not for me, it seems. At a previous encounter the GP gleefully propelled his chair across to his screen and banned me 😅, with a smug smile which said “Gotcha matey, you’re not a carer, you’re a time waster”. Not that I minded too much. 20 minutes with a dour nurse wondering why I was there, and whose top lip curled at regular intervals, was a waste of everyone’s time.

And so, for whatever reason, they refuse to believe I’m a care giver.

Maybe, a recognition that there are good male care givers out there would be an irksome deviation from somebody’s radical feminist ideology…?

Surely not!

Happiness

Care givers strive to be super-human. We morph on demand into attendants, comforters, dressers, mediators, mentors, nurses, podiatrists, psychologists, waiters, weightlifters and more. I try. but cannot excel in all those roles. My personal bandwidth has limits, and my age is beginning to tell:-

I talk to myself a lot.

I talk to the dog a lot. (He’s very supportive…)

I capture new ideas and thoughts by writing them down before they fade away.

That they are washed, dressed, fed, watered, tea’d, cared for, kept safe, is not enough. My most important measure of success is whether those I care for are Happy. I try to understand what makes them Happy. If you have a mind to, you can explore and apply a multitude of pillars and theories from Aristotle et al. For those I care for, Happiness seems to work at two simple subjective levels - separate episodes of well being, and more enduring feelings of positive life satisfaction.

And there, I find a paradox. My mother’s declining faculties seem to allow her enduring happiness. She’ll say:- “I’ve had a good day today”, when she’s done little more than binge watch Britbox and Sky News. Is that a “legitimate” experience of happiness? I think it is.

I’ve tried to engage her with books, crosswords, jigsaws and painting to no avail. She’s happy when sneaks a mouthful of marmalade straight from the jar at breakfast, has a jam tart with her 3pm cup of tea, has strawberry jelly with her fruit cocktail in the evening, or gets to sit in the summerhouse on a fine afternoon. But what she loves most of all are gnomes, her garden gnomes.

For my wife, with mental faculties fully intact, enduring happiness can be elusive. She regrets ever agreeing to my mother moving in, and that can be a source of friction. I will never knowingly abandon either of them to our system of social care. She loves her greenhouse, her Koi, Orfes and Grass Carp in our pond, Whatsapp videos of the grandchildren, and her crafts. These things make her happy, or at least, contented.

The house environment is such an important catalyst for happiness:- our dog, the nightlights, the fresh flowers I buy every week.

This evening after tea I asked both ladies the question. From mother - an emphatic “Yes”. From my wife - a more hesitant “Yes”. No sign of deference or sarcasm. By no means complacent, that’s probably the best I could have hoped for.

I've realised that Caring is not just about physical help, there are just as many psychological challenges.

Whilst personal, I'll make these posts supportive rather than excessively self- obsessed. I'll mention subjects ranging from mashed potato to broken hips, even slipping in an odd garden railway item.

My Two Ladies

I have cared for my wife, to varying degrees, for 30 years. She is 67 and has multiple sclerosis. She strives unceasingly to maintain her independence. She walks short distances with a Rollator, and she drives a hybrid Jazz converted for hand control.

I have cared for my mother for the last 3 years. She's 99 and I'm in process of organising her 100th birthday in August. She has a couple of co-morbidities and the NHS effectively wrote her off 3 years ago, sending her home virtually bedridden on high dose Tramadol. I noticed she could not keep down cheese or eggs. So my wife and I hatched a plan to take her off the Tramadol and put her on a dairy-free diet. 3 years later, she walks with a frame, loves garden gnomes, likes to thumb through “Gardeners's World" and watches “Vera”, “Midsomer Murders”, and “A Touch of Frost" on Britbox. She says Brenda Blethyn and David Jason wear lovely hats. She forgets where the bathroom is, yet her WWII experiences remain extremely vivid. And if she disapproves of something I'm doing she'll give me the “Evil Eye”.

The House

Our bungalow is replete with all manner of mobility aids:- grab rails, bed levers, walking frames, commodes, rollators, and a wheelchair. These are a great help.

However the best thing I did was to get a 2nd toilet installed in what used to be a separate shower room, which we've converted into a wet room.

The next best thing was to erect a series of sturdy metal handrails leading from the kitchen door to the greenhouse.

The Perching Stool!

My wife likes to be able to prepare food in the kitchen. She used a perching stool to help her reach worktops and cupboards. Then one day, she fell off the stool, and now, as well as her MS she suffers from the after-effects of breaking her hip. They tell me that repaired broken hips seldom go 100% right. Perching stools are now banned in our house. Instead, we bought a second hand Invacare “TDX SP” electric chair with power lift. It weighs a ton, turns on a sixpence, and provides my wife with more mobility and reach than the perching stool ever did.

Enough for now. If you've got this far thank you very much for reading.

In posts to come:- relationships, rivalry, Lasting Powers of Attorney, gnome evictions, moon lamps, tomatoes and ironing (to mention a few)…

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