Katharine Tylko

Thank you so much for wanting to do the very best for patients. I can't begin to imagine how exhausting it must be to nurse under pandemic conditions when the rules keep changing. Please don't feel bad about taking some time away to recharge your batteries. Your health matters above everything. I do hope that your hospital's management understands that if they want to retain their staff they must support them in every way they can. You are humans not machines. Please - what can we patients do to help?

Please - what can we patients do to ensure that nursing and care staff in future always have effective PPE? It was wrong that your lives and your families' lives were put into serious danger.

Thinking aloud ... Please are there ways of enabling a next-of-kin to say goodbye to a conscious but dying covid-19 patient so that patient doesn't die without family? A voice on a phone? A video on a phone? A written note (in laminated, sanitised plastic pocked)? Some form of talisman that the next-of-kin gives the patient when they're taken to hospital? As a cancer radiotherapy-survivor I know how comforting it was to carry a small note from my husband into the 'lock-down' radiotherapy rooms. Obviously during this pandemic safety is paramount but a safe compromise way of farewell would help everyone involved with the death.

A small update on routine GP-surgery blood tests and injections during COVID-19. Some very good local news from Bath and Swindon. My local GP services are soon to organise 'hot' and 'cold' GP practices. This means that the risk to presumably covid-19-free patients of picking up the virus and spreading it to their household will be much reduced. So for example, I can have my routine B12 jab without a high risk of picking up the virus that's killing people locally and spreading it to a vulnerable asthmatic recovering from cancer. Well done our local NHS!

Thanks very much for your comments. It's hard to balance conflicting serious risks where information is missing. Maybe patients could have the option of learning on-line to do their own routine injections and so protect health-care professionals and the general public? Or maybe army medics could support the district nurses who are needed to care for the seriously ill housebound? Above all we need covid-19 testing for ALL health-care workers to reassure patients that GP practices are safe.

HOW SAFE ARE OUR GP PRACTICES during covid-19? For the health care professionals, their patients, and families of patients? I'm a 65-yr old diabetic needing routine B12 injections. My GP tells me to turn up as normal so I don't develop neurological problems. I don't think anyone in the practice has been tested for covid-19. I'm refusing to turn up since I suspect the GP practice to be a covid-19 hot-spot. I don't want to transmit this virus to my frail, elderly asthmatic husband who's undergone cancer treatment and a lot of surgery. I've persuaded the GP to give me a precription for oral B12. Have I done the right thing? How can I help GPs and patients in far worse dilemmas than mine?

Have signed and shared the petition. Thanks very much for letting us know about it. We patients want to help you front-line staff as much as we possibly can. Please know that we care about you all and are incredibly grateful for your bravery and unselfishness. Please, tell us ordinary patients what we can do to help hospital staff and their families. You are HEROES!

OMG

I love your emphasis on 'be kind'. That immediately puts the patient at the centre of their care. Am writing on behalf of the Campaign Against Painful Hysteroscopy. Please do you know of any NHS initiatives to enable women to choose safely monitored IV sedation with analgesia for endoscopy of the womb? It would end an awful lot of suffering.

Here's the link to the patient info leaflet that the excellent Dr Mary Connor FRCOG (Sheffield Hospital) wrote in conjunction with members of the Campaign Against Painful Hysteroscopy and the RCOG patient info committee: https://www.rcog.org.uk/en/patients/patient-leaflets/outpatient-hysteroscopy The leaflet clearly states the risk of severe pain during outpatient hysteroscopy, and lists cohorts of patients at greatest risk. It says that women may choose to have a GA upfront (so needn't be forced through 'Trial by OP Hysteroscopy'). Unfortunately, responses gained under the Freedom of Info Act and stories told to the campaign show that most NHS hospital Trusts don't use the RCOG leaflet don't warn patients of the risk of severe pain don't offer patients GA or sedation don't stop OP hysteroscopy when the patient is in severe pain Influential hysteroscopists from the British Society for Gynaecological Endoscopy have over the years influenced the outpatient Best Practice Tariff so that hospitals have practically no theatre space or anaesthetists to perform hysteroscopy with GA or sedation. Training for hysteroscopists is often minimal and they learn on red peppers and conscious patients since high-fidelity simulators are too expensive. We're the next scandal following vaginal mesh.

Hysteroscopy patients have a right to ask for general anaesthetic upfront but under-resourced NHS clinics are coercing women into attempting 'Trial by Outpatient Hysteroscopy' first. One patient describes this as 'torture by nice people'.

https://www.sbk-healthcare.co.uk/home/title/2428/nhsconference/updating-and-adapting-outpatient-hysteroscopy-(oph)/?fbclid=IwAR1mgXi4QXIe8OjJOHiYRBouFpWx6QCdcHPniVTMBnx7GRKAQYkHa5-X5XY

The Department of Health and the British Society for Gynaecological Endoscopy (BSGE) are heavily promoting outpatient hysteroscopy. The Dept of Health's long-standing Best Practice Tariff incentivising OP hysteroscopy has meant hospitals have stopped investing in theatre places for hysteroscopy. Women who ask for GA hysteroscopy go onto a long waiting list. Despite the Campaign Against Painful Hysteroscopy's work to give patients their 'Montgomery' legal right to informed choice, and also to improve patient selection and pain-control in outpatients, the Dept of Health continues to hype OPH. The attached file is of a workshop to encourage gynaecologists to 'kickstart' outpatient hysteroscopy services on the basis of 'patient feedback'. Hmmm. The Dept of Health and many of the BSGE's hysteroscopists are ignoring or downplaying the excruciatingly painful OPH experienced by far too many patients throughout the NHS.

The staff at the independent Care Opinion site completely independently of the Campaign Against Painful Hysteroscopy did their own pictorial analysis of the hysteroscopy stories they received. They concluded the main problem was: PAIN.

To read some more horror stories from the Care Opinion website demonstrating the lack of safeguards in NHS outpatient hysteroscopy go to: https://www.hysteroscopyaction.org.uk/wp-content/uploads/2018/10/sept-2018.pdf There's also an essay on 'How the NHS gets away with torturing 1 in 4 women'.